Open Access Case Report

Correction of Skeletal Openbite Using Zygomatic Miniplates

Sepideh Dadgar, Farhad Sobouti, Mehran Armin, Nasim Esnaashari

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/30193

Aims: Anterior open bite is often caused by excessive vertical development of the  posterior maxilla. In such cases, it is hardly possible to establish absolute anchorage for molar intrusion by traditional orthodontic mechanics. The use of skeletal anchorage for orthodontic tooth movement is offering a minimally invasive treatment option for correction of skeletal anterior open bite and enhancement of facial esthetics as an alternative to major surgery.

Presentation of Case: This article reports a case of 23 year old female patient, who had a moderately severe skeletal anterior open bite, that was successfully corrected by using titanium miniplates and miniscrews. The miniplate were inserted in zygomaticomaxillary buttress area and fixed with two miniscrews on each side. Titanium miniscrews were inserted bilaterally in palatal region to preserve molar axial inclination during intrusion. An intrusion force was provided with niti coilsprings for 9 months.

Discussion: After active treatment of 24 months, The mean amount of accomplished molar intrusion was 2.8 mm ± 0.64 mm, with a rate of 0.311 mm ± 0.071 mm per month and a bite closure of 5.61 mm ± 1.23 mm. No significant buccal tip was observed in the right and left molars upon intrusion. Her retrognathic chin and convex profiles were improved by counterclockwise rotation of the mandible.

Conclusion: Our results suggest that titanium miniplates are useful for intrusion of posterior teeth. Intrusion of the posterior teeth induced counterclockwise rotation of the mandible and, as a consequence, corrected the anteroposterior intermaxillary relationship with a significant improvement in the facial soft tissue convexity.

Open Access Case Report

Envelope Technique with Vestibular Releasing Incision - A Single Step Procedure for Root Coverage

Krishnajaneya Reddy Pathakota, Naveen Anumala, Dilip Gopinath Nayak, Pradeep Koppolu, Vani Chappidi

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/30585

Treatment of gingival recession in cases with a shallow vestibule and frenal pull are always challenging. Root coverage techniques have been continuously revised and simplified over the past few decades to obtain more predictable, esthetic, and stable results. 

Case Presentation: Two healthy patients with isolated Miller’s class I gingival recession, shallow vestibules, and frenal pull, were treated with an envelope technique using connective tissue grafts with vestibular releasing incisions in a single step procedure.

Conclusion: The single step technique resulted predictable root coverage and increased width of keratinized gingiva. This technique promises to be a viable option for the treatment of isolated gingival recession associated with shallow vestibule and high frenal pull.

Open Access Case Study

The Use of Computed Tomography to Locate and Remove a Third Molar Accidentally Displaced into the Maxillary Sinus

José Ricardo Vancetto, Marcelo Gonçalves, Andrea Gonçalves, Guilherme Monteiro Tosoni

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/31109

ims: The aim of this article is to illustrate a case of oroantral communication caused by an accidental introduction of the third upper molar into the maxillary sinus and the importance of computed tomography to its location and removal.

Presentation the Case: This study reports a case in which a tooth accidentally displaced into the maxillary sinus was properly located by imaging exams and surgically removed while preserving most of the adjacent oral structures.

Discussion: Although dental accidental intrusion into the maxillary sinus has been reported in the literature with greater frequency in relation to other facial areas, such as pterigo - palatal fossa, the fat of the cheek or the lower submandibular space, we should not rule out any hypothesis until the tooth is properly located.

Conclusions: 1) In cases of accidental dental displacements, computed tomography should be adopted as a standard supplementary examination in order to locate the tooth and plan appropriate surgical procedures. 2) Caldwell-Luc surgery was efficient, ensuring the access and removal of third molars which have been accidentally moved; it is also relatively simple, low cost and allows the preservation of tissue. 3) Removal of the tooth or fragment should be performed as soon as possible to avoid further complications, but initial alveolar drilling should be avoided.

Open Access Original Research Article

Dental Implants Therapy: A Cross-Sectional Study of Patients’ Knowledge and Awareness

Rana AL Amri, Samah Saker

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/30449

Aim: This cross sectional study aimed to assess knowledge and attitude among partially dentate patients visiting dental clinic regarding to dental implant as a modality of treatment.

Methodology: A total of 114 adult dental patients (52 men, 62 women; age range 18-80 years) were recruited for this study. Printed standardized self explanatory questionnaire were handed to the patients during their dental visits and informed consent was taken from all participants. Data collected using validated and reliable self- explanatory questionnaire were analyzed using simple descriptive and analytical analysis.

Results: Patients' awareness about dental implant among 114 participants showed that 36.6% of the study sample were aware about complete denture as alternatives treatment when compared to fixed partial denture, while 28.1% (54.5%) of the participants were well informed about the dental implant, most of them were in the age group (21-40) years. Dentists followed by the media and friends were the main sources of dental information. High cost was the main factor prevented 32.5% of the participant from selecting the dental implant when needed.

Conclusion: Knowledge about dental implant therapy should be improved through different educational channels.

Open Access Original Research Article

Retracted: Photoplethysmogram Technique to Characterize the Carotid-to-toe Pulse Duration during Different Human-postures

S. Abdalla, N. Al-Aama

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2017/30470

Photoplethysmogram, including Pulse Transit Time (PTT), technique were used to detect blood volume changes in human carotid-to-toe. The main problem is how to evaluate the PTT values continuously from the subject with accurate readings. Monitoring PTT values of a person is useful in non-invasive, cuff-less estimation of blood pressure measurement. In this study, PTT values of 12 healthy subjects (8 males and 4 females) age 23.8 ± 1.5 years have been estimated using an auto-regressive with exogenous input (ARX) model. We presented autoregressive model for single variant and multi-variant model, using time series model, taken into account exogenous variables, a locally constant autoregressive model, and a radial basis function autoregressive model. We implemented the time domain system identification using an autoregressive with exogenous input (ARX) model. PTT values were estimated for all subjects in three different positions; sit, stand and supine. Results show that the PTT in sit and stand positions are statistically no different (84.5±19.6 ms versus 78±15.9 ms, p = 0.44). However, the PTT in the supine position is significantly higher than the two other positions (145.7±18.4 ms versus 84.5±19.6 ms and 145.7±18.4 ms versus 78±15.9 ms respectively, p < 0.01 for both situations). These results concur with values reported by other researchers (120 ms < PTT < 180 ms) on the effect of posture in estimating PTT.


Retraction Notice: This paper has been retracted from the journal after receipt of written complains. This journal is determined to promote integrity in research publication. This retraction is in spirit of the same. After formal procedures editor(s) and publisher have retracted this paper on 16th  August-2017. Related policy is available here:

Open Access Original Research Article

The Effects of Hamstrings’ Cooling and Cryostretching on Sit and Reach Flexibility Test Performance in Healthy Young Adults

Panagiotis D. Gkrilias, Elias M. Tsepis, Konstantinos A. Fousekis

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/31034

Aims: To investigate the effect of hamstrings’ cooling and short-duration Cryostretching on sit and reach flexibility test (SR) performance.
Study Design: Crossover Randomized Clinical Trial.
Place and Duration of the Study: Department of Physical Therapy, Technological Educational Institute (TEI) of Western Greece, Aigio Achaias, Greece, 3 months.
Methodology: Eighteen (18) healthy male (age: 21,3±4,5 yr, weight: 79,0±12,7 Kg, body fat: 14,6±4,0%) participated in the present study. Subjects were randomly divided into 3 groups which received in a random and counterbalanced order: a) hamstrings’ cooling with cold packs for 15 minutes, b) hamstrings’ cooling and static stretching for 14 minutes and 1 minute (30’’ for each extremity), respectively and c) passive rest (control status) for 15 minutes, on three visits made. Sit and Reach (SR) test, was applied before and after each intervention to assess the hamstrings’ flexibility.

Results: Baseline Sit-and Reach results (SR 1) did not differ significantly between all 3 conditions (Cooling vsControl: 13,6±5,8 cm vs 13,8±7,1 cm P = 0,817; Cryostretching vs Control: 13,4±6,3 cm vs 13,8±7,1 cm P=0,620; Cooling vs Cryostretching: 13,6±5,8 vs 13,4±6,3 cm P=0,817). A significant improvement of hamstrings’ flexibility in SR2, was observed after hamstrings’ cooling intervention compared to corresponding values of Control (14,5±6,1 cm vs 13,2±7,0 cm P=0,026) and after cryostretching intervention compared to corresponding values of Control (14,9 ± 6,6 cm vs 13,2±7,0 cm, P=0,011). Flexibility values of hamstrings’ cooling alone compared with those after hamstrings’ cooling associated with a short bout of cryostretching (in SR 2), did not differ significantly (14,5±6,1 cm vs 14,9±6,6 cm, P= 0,502).

Conclusion: Hamstrings’ cooling and cryostretching can improve performance in SR test and thus can be used as alternative methods for increasing the hamstrings’ flexibility in short term.

Open Access Original Research Article

The Role of Diffusion Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Hepatocellular Carcinomas and Regenerative-Dysplastic Nodules in Cirrhotic Liver

Rustu Turkay, Baris Bakir, Mehmet Burak Ilhan, Berna Turkay, Hadi Sasani, Yilmaz Onal

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2017/30379

Objective: The differential diagnosis of hepatocellular carcinomas (HCC) and regenerative-dysplastic nodules (RDN) in cirrhotic patients is critical for patient management and can be a challenging imaging procedure. The goal of our study is to evaluate the contribution of diffusion-weighted imaging in the differential diagnosis of these lesions.

Materials and Methods: 50 patients, diagnosed as hepatocellular carcinoma and/or RDN in cirrhotic liver, were included in our study. All HCC and some of RDN lesions (5 lesions out of 25) were confirmed histopathologically. Rest RDN was called with imaging characteristics and follow-up images (18-27 months, mean 19.2 months follow up time). Magnetic resonance images along with Diffusion weighted images with b = 800 s/mmwere evaluated by 2 radiologists. All imaging examinations were performed with 1.5 Tesla MR machine. Diffusion weighted images and ADC (apparent diffusion coefficient) mapping of lesions were evaluated and ADC values were calculated. The results were compared with conventional dynamic magnetic resonance images.

Results: In our study 95% of 40 Hepatocellular carcinomas demonstrated diffusion restriction. 52% of 25 RDN were isointense on diffusion-weighted images. The difference of the signal intensity distribution was statistically significant between two lesions (p<0.001). On quantitative analysis, we calculated ADC values of lesions and ADC ratio of lesion-to-liver values. The mean ADC values and ADC ratio of the RDN was higher than that of the hepatocellular carcinomas, and there was a significant difference between 2 groups (p<0.001). When a cutoff value of 0.95 is considered for ADC ratio, on diffusion imaging with ADC mapping 97.5% sensitivity and 64% specificity can be calculated to differentiate hepatocellular carcinoma from RDN.

Conclusion: Diffusion weighted imaging can improve differential diagnosis of these two lesions in cirrhotic liver combined with contrast enhanced magnetic resonance imaging.

Open Access Original Research Article

Demographics and Outcome of Referrals of Critically Ill Patients from a University Teaching Hospital, Uyo, South – South, Nigeria

E. Etta Otu, U. Isobara Imoh

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/31038

Background: Referral of critically ill patients from one centre to another is an integral part of healthcare system.

Aims: To evaluate the outcome of referral practices from the Intensive Care Unit of the University of Uyo Teaching Hospital.

Patients and Methods: This was a retrospective study of all consecutive critically ill patients referred from the intensive care unit (ICU) of the University of Uyo Teaching Hospital, Uyo, to other hospitals between January 2009 – December 2014. All patients studied were transferred by medical personnel in either land or air ambulances. The primary and secondary outcomes measured were whether the patients received the proposed treatment and mortality respectively. Data from the referring centre were obtained from the ICU admission and discharge register and patient’s folder, while data during transfer and outcome were obtained from the accompanying medical personnel and patient’s family members. Data analysis was done using SPSS version 16.

Results: Thirteen patients referred were analysed. Majority of the patients (77%) were referred for neurosurgical review, mechanical ventilation and CT-Scan and/or MRI. Two patients were referred for specialized burns care, and one patient for radiotherapy. Seven patients (54%) were transferred with land ambulance, while six (46%) were transferred with air ambulance. Regarding outcome, eight (62%) patients were successfully transferred to their destination hospitals, and all received proposed treatment. A total of three patients survived while ten died, thus giving an overall mortality rate of 77%.

Conclusion: The outcome of critically ill patients referred from our centre to other hospitals is poor. Therefore, appropriate personnel should be employed and equipment provided in our centre to manage the patients.

Open Access Original Research Article

The Importance of Chronic Musculoskeletal Pain as a Factor Associated with Locomotive Syndrome in the Elderly

Daniela Regina Brandão Tavares, Ana Laura de Figueiredo Bersani, Fania Cristina dos Santos, Maria Carolyna Fonseca Baptista, Virginia Fernandes Moça Trevisani

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/31090

Background: Locomotive Syndrome (LS) refers to a high risk of disability and dependency care due to a disorder in locomotive organs. It is increasing particularly because of populational aging. Chronic musculoskeletal pain in the elderly is also an important risk factor for disability and may be related to LS. The analysis of this relationship was the object of this research.

Methods: It was an observational, descriptive and analytical study, comprising 100 elderly people in São Paulo. Socio-demographic aspects and data about pain, falls, physical activity, self-perception of health and functionality were assessed. Additionally, the Brazilian version of "25-Question Geriatric Locomotive Function Scale," the GLFS 25-P, was applied for the screening of LS as well as the verbal description scale of pain. In the statistical analysis, the 2-sample Test for Equality of Proportions, the Chi-square test and multivariate analysis were performed.

Results: LS was present in 63% of the elderly, and musculoskeletal pain in 61% of them, this being predominantly severe in intensity. A significant association of LS with chronic pain (p=0.001) was found, as well as osteoarthritis of knee, hip and spine, falls, physical inactivity, worsening self-perception of health and functional dependence for instrumental activities. In a multivariate analysis, chronic musculoskeletal pain was the variable most strongly related to LS (OR 15.92, IC 95% 3.08-82.27).

Conclusion: Chronic musculoskeletal pain emerged as an important factor associated with LS in the elderly, which could highlight the role of analgesic strategies also aimed at the prevention or therapeutics of this syndrome in aging.

Open Access Original Research Article

Greek Military Nurses Readiness to Provide Transcultural Care to Immigrants

M. Malliarou, A. Oikonomou, S. Nika, P. Sarafis

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/BJMMR/2017/30615

Aim: The aim of this study is to explore the cultural competence of military nurses in Greece by measuring levels of cultural knowledge, empathy and cultural skills.

Methodology: It is a quantitative, non-experimental, correlational design in which the researchers determined cultural competence of Greek military nurses. The Transcultural Self-Efficacy Tool (TSET) was used to measure cognitive, practical, and affective level, using self-rated, scale-weighted questions from 1–not confident to 10–totally confident. The distribution and collection of questionnaires was conducted from February to March 2015. The study sample consisted of 127 Military Nurses of the Armed Forces throughout Greece. The response rate was 98% (RR).

Results: Mean value of cognitive subscale was found to be 7.2 (SD=1.7) of affective subscale was 6.9 (SD=1.8) while mean value of practical subscale were found to be 7.8 (SD=1.5). Using multiple linear regression analysis it was found that Military nurses with a master degree or a PhD rated 0.77 greater score in cognitive subscale, 1.09 greater score in affective subscale, those who had problem dealing with managing patients with different cultural backgrounds had scored 0.88 lower in cognitive subscale, 0.90 lower score in affective subscale, 0.90 lower score in practical subscale and those who thought that the resolution of problems arising with patients from different cultural environments is of medium or of much importance rated 0.80 higher in cognitive subscale, 1.18 higher in affective subscale, 1.01 higher in practical subscale. Military nurses who had been trained in transcultural care after graduation scored 1.09 higher in practical subscale.

Conclusion: The ever growing population coming from different cultural backgrounds like immigrants in Greece is a challenge for nurses to provide care based on cultural needs of patients. This study highlights the need for transcultural education for military nurses.