Open Access Case Study

Erupting Odontome- A Compilation of Two Rare Case Reports

L. Chandra Shekar, A. Steffina Lydia Jascinth, G. Sathees Chandra Mouli, A. Feroz Khan

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/27815

Odontomas are the most common type of benign odontogenic tumours; they are asymptomatic and are often discovered during routine radiographs of the jaws. Odontomes can be used as stem cell reservoirs and generally eruption of an odontome into the oral cavity and occurrence of a complex odontome in the anterior maxilla is rare. We report two cases of odontomes one a rare case of erupting complex odontome in the anterior maxilla and the other rare case of partially erupted odontome.

Open Access Short Research Article

Lipoprotein (a) Internalization by RAW 264.7 Cells is Associated with Morphological Changes and Accumulation of Lipids Detectable by Two-photon Scanning Microscopy

Maria Valentina Pasquetto, Alice Santonastaso, Alessandra Tomaselli, Patrizia Vaghi, Elton Hasani, Luca Tartara, Claudia Scotti

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/27433

Lipoprotein (a) [Lp(a)] is an independent cardiovascular risk factor and its pathogenic mechanism is not completely clear. Lp(a) has been detected in atherosclerotic plaques and macrophages are one of the major cell types involved in atherogenesis. In order to characterize internalization of Lp(a) by RAW 264.7 cells, an established model of mouse macrophages, cells were treated with Lp(a) samples purified from plasma by affinity chromatography, and evaluated by western blotting. By 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, a tetrazolium salt, assay, Lp(a) was found to be non-cytotoxic for the cells at all the concentrations tested (0.0165-1.65 mg/ml). An ELISA performed on the lysate of Lp(a)-treated cells allowed to identify the highest intracellular accumulation of Lp(a) at 72 h treatment. Already at 24 h, however, important morphological alterations were detected upon Oil red and Nile red staining. A three-dimensional reconstruction obtained by two-photon scanning microscopy of the intracellular distribution of Nile red stained structures in treated cells shows preferential uptake of lipids in extra-nuclear regions. These data are useful to clarify the temporal and spacial aspects of intracellular accumulation of Lp(a) in RAW 264.7 cells and pose new bases for future studies on intracellular Lp(a) accumulation.

Open Access Short Communication

Invest to Progress? A Survey of the Cost of Postgraduate Training Prior to Specialty Applications in the United Kingdom

Nicholas Bullock, Stephanie Wallis, Ronak Ved

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/28382

Aim: Clinical training is expensive. This survey of foundation doctors across four UK foundation deaneries (Severn, Wales, South Thames and Scotland) identifies that highly variable sums of money were spent by foundation doctors applying for specialty training.

Place and Duration of Study: Bristol Royal Infirmary and University Hospital of Wales, between September 2015 and July 2016.

Methodology: A total of 1506 foundation year two (FY2) doctors were invited to participate in the online survey. Participants were canvassed via ten questions pertaining to their involvement in four groups of career enhancing activities: training courses; postgraduate examinations; qualifications, and conference attendances. The survey was closed after a ‘live’ period of 5 months. 100 FY2 doctors had completed the survey at the time of its closure.

Results: Of the 100 participants, 89 (89.0%) had undertaken at least one career enhancing activity, with a mean expenditure of £1460 per respondent. Surgical and academic programme applicants spent on average over double the amount of those for anaesthetics (p = 0.01) and medicine (p = 0.001) and ten times that of applicants to general practice (p = 0.0001).

Conclusions: These results have potential implications for training expectations, allocation of study budgets and specialty application processes as a whole.

Open Access Original Research Article

Effect of Different Flaw Sizes and Surface Treatment on Biaxial Flexural Strength of Feldspathic Porcelain

Hamid Kermanshah, Farin Shamshirgar, Sholeh Ghabraei, Narges Ameri

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/27619

Background and Objectives: Porcelain restorations are often ground for recontouring and occlusal adjustments. This removes the surface glaze layer and causes flaws that can grow in wet environments due to stress corrosion cracking and decrease the strength of porcelain and subsequently the longevity and clinical service of restoration. The aim of this study was to assess the effect of flaw size and surface treatments on biaxial flexural strength of feldspathic porcelain.

Materials and Methods: Eighty feldspathic porcelain discs were fabricated, polished (P2000) and divided into two series (n=40) each with four subgroups (n=10); three subgroups in each series were centrally indented by means of a Vickers hardness tester under a load of either 9.8 N (A series) or 29.4 N (B series) and were then subjected to no surface treatment (subgroups 2 and 6), polishing (subgroups 3 and 7) or polishing plus silane plus resin (subgroups 4 and 8). Ten specimens in each series were not indented as controls (subgroups 1 and 5). Biaxial flexural strength of the discs was tested after water storage for 48 hours and the data were analyzed by two-way ANOVA and Tukey’s HSD test.

Results: Both control subgroups revealed significantly higher strength than other subgroups (P<0.05) but there was no significant difference among other subgroups (P>0.05). The mean flexural strength of indented subgroups in B series was significantly lower than that in the same subgroups in A series (P<0.05).

Conclusion: Presence and size of flaws affect the flexural strength of porcelain. Within the limitations of this study, none of the surface treatments could strengthen the cracked ceramic.

Open Access Original Research Article

Oxidative Stress Pathway Mechanisms Induced by Four Individual Heavy Metals (As, Hg, Cd and Pb) and Their Quaternary on MCF-7 Breast Cancer Cells

Egbe Egiebor, Adam Tulu, Nadia Abou-Zeid, Ozuem F. Oseji, Ali B. Ishaque

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/27687

Cell death induced by the production of reactive oxygen species (ROS) has largely been associated with the activation of oxidative stress pathway; however, the direct mechanism(s) involved are unknown. This study evaluates the oxidative stress pathways by which four heavy metals (As, Hg, Cd and Pb) administered singly and as a quaternary mixture induce cytotoxic effects on MCF-7 breast cancer cells, in the presence and absence of cellular antioxidant, glutathione (GSH). Cells were exposed to 21.7 µg/ml of the individual metals and the mixture and assayed after 5 hr. Cellular levels of nonspecific ROS, superoxide anion (O2•), mitochondria membrane potential (MMP), and GSH were assayed using flow cytometry-FACScalibur equipped with cell quest pro for data collection. Results showed that, in the presence of cellular GSH, As and Pb induced cytotoxicity by reducing the MMP while Cd, and Hg were cytotoxic by the production of mostly superoxide anions and nonspecific ROS. The mixture exhibited cytotoxicity by decreasing the cellular MMP as well as producing ROS and O2•. When the synthesis of cellular glutathione was inhibited, all five treatments damaged the mitochondria membrane and depleted basal GSH. In addition to depleting the basal GSH and causing damage to the mitochondria membrane, Cd, As, and Pb also elicited the production of ROS.

Open Access Original Research Article

Heart Rate vs Stress Indicator for Short Term Mental Stress

Philippe Fauquet-Alekhine, Laetitia Rouillac, Jérôme Berton, Jean-Claude Granry

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2016/27593

Heart rate variation (HR) being identified as depending on subjects’ stress state when submitted to short term mental stress, this study aimed at analyzing whether or not it could be possible to find a mathematical relationship between the average heart rate variation and the intensity S of a stress indicator in case of short term mental stress, whatever the stress indicator is. The method consisted in working the hypothesis by gathering data providing HR and ratio of frequency power of HRV (Heart Rate Variability) for different level of stress, HRV being considered as a stress indicator and presenting the advantage of being widely used in studies, therefore providing numerous data in the literature. From this data, a mathematical model was designed and then assessed by testing its reliability when applied to HR variation versus different types of stress indicators (EMG, GSR, Work Load, questionnaires such as STAI-S, ALES). The correlation obtained between the model and the data provided by the literature (24 points from 8 studies gathering 272 subjects) gave r=.95 (p<.0001) which allowed us to validate the model. Limits of the model were identified and discussed.

Open Access Original Research Article

Impact of Oncologist Initiated Selective Review of Pathology Specimens in Multidisciplinary Onco-pathological Discussions on the Management of Malignancies in a University Hospital in India

Unni S. Pillai, Biswajit Dubashi, Smita Kayal, Sunu. Cyriac, Debdatta Basu, Ranjith Kumar, Sajini Elizabeth Jacob, Bhawna Badhe

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27156

Aim: Reported discrepancy rates after pathology review of surgical pathology specimens vary widely from 1.3% to as high as 80%. The purpose of this study was to assess the frequency of discordant diagnoses after onco – pathological discussions and to determine whether these contributed to a change in the treatment decision.

Methods: All the consecutive cases, whose diagnoses and management were discussed in the onco – pathological discussions from January 2010 to April 2015 at Jawaharlal Institute of Post Graduate Medical Education and Research, (JIPMER) India, were included in the study. Written informed consent was taken from all the participants. The data was collected retrospectively from the onco- pathology register and the hospital records of the patients. The patients were considered to have a change in the diagnoses only when it resulted in a significant change in therapy or prognosis.

Results: A total of 353 cases were discussed and analyzed in the onco-pathological discussions. Among these 353 cases, 147 cases (41.75%) were haematological malignancies and 206 cases (58.25%) were solid tumors. Discussions were held on 614 pathological specimens, 354 biopsies, 64 cytology and 196 bone marrow studies. Clinically significant discordances were noted between the initial reports and the impressions after onco – pathological discussions in 33 cases (9.35%). The rate of discordance was 8.1% for heamato lymphoid malignancies and 10.12% for solid tumors. Among these 33 cases, follow-up details were available for 24 patients (72.7%) and the clinical behavior of the diseases correlated with the review diagnoses made at the onco – pathological discussions rather than the initial reports.

Conclusions: The onco – pathological discussions have a significant impact on the treatment decisions and outcomes. Onco- pathological discussions should be made as a part of all multidisciplinary boards.

Open Access Original Research Article

Caudal Block for Digital-guided Transrectal Prostate Biopsy

P. O. Areo, J. M. Afolayan, P. T. Adegun, S. A. Dada, T. V. Asowo

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2016/26838

Objective: To assess the effectiveness and safety of caudal block on the pain associated with digital guided transrectal Tru-Cut biopsy of the prostate.

Subjects and Methods: Over a two year period, from July 2013 to June 2015, a cross-section of one hundred and forty men undergoing digital guided transrectal prostate biopsy under caudal block were recruited into the study. 15 ml 1% lignocaine was injected for caudal block. Pain scores, anal sphincter tone and patient satisfaction were assessed and complications recorded.

Results: The mean ± SD (min-max) biopsy time was 12.1 (8-16) minutes. The mean ± SD (min-max) pain score on visual analogue scale (VAS) was 1.2±1.6 and 85% of patients reported excellent satisfaction. There was no statistical significance between pain score and age (P= 0.185) or the number of biopsies taken (P= 0.164). Malignancy was found in 37.1% of patients.

Conclusion: Caudal block is an effective and safe method of anesthesia for digital guided transrectal prostate biopsy.

Open Access Original Research Article

Comparison of Pressure-controlled Inverse Ratio Ventilation versus Pressure-controlled Ventilation in Laparoscopic Cholecystectomy with LMA

Jarahzadeh Mohammad Hossein, Neysari Bahador, Vaziribozorg Sedighe, Dehghani Mohammad Hossein

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27166

Aims: In comparison with volume-controlled ventilation (VCV), the pressure controlled ventilation (PCV) improves oxygenation and ventilation. PCV method decreases peak airway pressure in laparoscopic surgery. The aim of this study is comparison of PCIRV with I: E ratio 1.5:1 and PCV with I:E ratio 1:2 in laparoscopic cholecystectomy with LMA.

Study Design: Before-after clinical trial study.

Place and Duration of Study: Departments of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, between Jull 2014 and Dec 2015.

Methodology: Forty patients who were candidate of elective laparoscopic cholecystectomy were selected. Preparation and medication for anesthesia were same for all patients. Anesthesia ventilation was started by VCV mode, co2 insufflation was done and ventilation continued by PCV mode. Pulmonary and cardiac parameters were examined at baseline. After 20 min results were recorded and then I: E ratio was changed to 1.5:1 and PEEP of 5 cm of H2O continued. Results were recorded after 10 min of PCIRV.

Results: The mean age of patients was 41±11.8 years old. About of participants 25% were male and the mean of BMI was 25.6±2.57.

The Peak pressure were higher in PCV (p-value: 0.001). Plateau pressure was higher during PCIRV (p-value: 0.762). Our results revealed Etco2 significantly increased in PCV. (p-value: 0.023). Airway pressure significantly increased in PCIRV (p-value: 0.001). Tidal volume significantly increased during PCIRV (p-value: 0.001) too. Also in PCIRV mode spo2, heart rate, complliance and PAW were significantly increased. According to our findings there was a significant association between BMI and changes in plateau pressure (p-value: 0.01) and Etco2 (p-value: 0.03) in PCVIR method.

Conclusion: Our study suggests PCIRV as an effective mode of ventilation that could be used in laparoscopic surgery especially in moderately obese patients.

Open Access Review Article

Dental Management of Children with Special Health Care Needs (SHCN) – A Review

Vijender Khokhar, Salil Kawatra, Sukanya Pathak

Journal of Advances in Medicine and Medical Research, Page 1-16
DOI: 10.9734/BJMMR/2016/28426

Oral health of children with special health care needs has been one of grey areas in the field of pediatric dentistry. There has been a general agreement that disabled population has higher prevalence of dental caries, poor oral hygiene, and compromised gingival and periodontal health than the otherwise healthy population. In the past the emphasis has been made on providing basic dental care but in the recent years, the dental professionals and parental groups have shown increased concerns in providing complete oral health care to children with special health care needs. This is as a result of realization that individuals with disability, whether developmental or acquired, are entitled to opportunity to achieve appropriate rehabilitation, to enable them realize their maximum level of functioning. Children with special health care needs present unique challenges for both pediatric and general dentists in order to provide them access to the oral health care system by establishing a treatment plan for those with unique medical, behavioral and dental needs and maintaining oral health over the lifetime. The purpose of this article is to describe the characteristics of some common developmental disabilities and medically compromised states and the challenges these issues present to the oral healthcare practitioner.