Journal of Advances in Medicine and Medical Research

Aims: To present the case of a patient diagnosed by neurology with neurosarcoidsosis with cognitive impairment after long-term treatment with corticosteroids who showed marked improvement in his cognition upon initiation of donepezil. To provide a brief overview of the treatment of neurosarcoidosis and corticosteroid-induced cognitive disorders with acetylcho-linesterase inhibitors and clarify any literature regarding the use of acetylcholinesterase inhibitors in neurosarcoidosis.

Presentation of Case:  G.A. was a 46-year-old African American veteran who spent 14 years in the Army as a Patriot Missile Crewmember. He was exposed to active combat and ionizing radiation in the gulf and suffered from Posttraumatic Stress Disorder (PTSD) and Recurrent Major Depressive Disorder Moderate (MDD). Eight years after retirement he presented with transient visual symptoms and left-sided focal facial and lower extremity weakness. Neurosarcoidosis was diagnosed by his neurologist who identified a lesion in his right basal ganglia and thalamus on MRI. He was treated with corticosteroids for 8-9 years and referred for psychiatric evaluation 1 year after cessation of corticosteroids. He reported persisting slowed thinking, impaired memory and slow reaction times. Neuropsychological testing done 1 year after diagnosis was repeated 3 years later and showed little change. He had been treated with sertraline 200 mg daily for PTSD and MDD. Donepezil 5 mg at bedtime was added and after 2 months he reported marked improvement. Donepezil was increased to 10 mg and after 1 week his thinking returned to normal and he had no complaints. His wife confirmed his history. He was thinking more clearly; his recall and reaction time were improved and he felt more confident in himself. Follow-up neuropsychological testing is planned in 12 months.

Discussion: There are no reports of the use of acetylcholinesterase inhibitors in the treatment of neurosarcoidosis.

Conclusion: The use of donepezil for the treatment of corticosteroid-induced cognitive impairment in neurosarcoidsosis deserves further investigation.

Background: An Aberrant frenum encroaches the gingival health when it is attached too closely to the gingival margin, either due to interference in the plaque control or due to a muscle pull. Such condition has to be treated by frenectomy which can be performed by scalpel, electrocautery, or with soft tissue lasers. Hence, the aim of the study is to compare the degree of healing of patients after frenectomy procedure with surgical scalpel, electrocautery and diode laser technique.

Study Design:  Original research article.

Place and Duration of Study: Department of Periodontics at Narsinhbhai Patel Dental College & hospital at Visnagar, between July 2015 and august 2016.

Materials and Methods: A total of 15 subjects ranging from 16 to 40 years of age group with papillary or papillary penetrating frenal attachment in the maxillary anterior region were selected. Enrolled subjects were randomly divided into three groups as follows Group A (n = 5): Comprised of 5 subjects selected for conventional scalpel technique. Group B (n = 5):  comprised of 5 subjects selected for electrocautery technique.  Group C (n = 5):  comprised of 5 subjects selected for diode laser technique. Various parameters such as bleeding, pain, and swelling, presence of infection, wound healing and patient comfort were evaluated.

Results: The results indicated patients treated with the diode laser had less postoperative pain (P < 0.0001) and required fewer analgesics (P < 0.001) as compared to patients treated with the conventional scalpel & electrocautery technique. Wound healing at 7^th day and after 1 month for all the groups showed statistical significant difference with better outcome in Group C. However, wound healing at the end of 3 months did not show any significant difference between the groups.

Conclusion: Based on current findings and clinical outcome, diode lasers provide better patient perception and an efficient and satisfactory option for procedures such as frenectomy.

Background: Extended Spectrum Beta Lactamase (ESBL) producing bacterial strains are the major causes of nosocomial and community-acquired infections worldwide. The aim of the study was to evaluate the effectiveness of Brilliance ESBL Agar (BEA) (a chromogenic culture medium) for the detection of ESBL in comparison with Double Disc Synergy Test (DDST) and confirm results from both methods by Single-plex Polymerase Chain Reaction (PCR) as gold standard.

Materials and Methods: A total of 75 clinical isolates of Escherichia coli were screened for ESBL production using BEA & DDST from various clinical specimens. The antibiotic susceptibility testing was done by the Kirby-Bauer disc diffusion method using Cefotaxime (30 µg) and Ceftazidime (30 µg) discs on Mueller Hinton agar. ESBL producing strains were detected phenotypically by DDST and BEA at 24 h and 48 h, respectively. Isolates screened by both methods were confirmed using PCR for the detection of bla_SHV, bla_TEM, bla_CTX-M genes.

Results: The prevalence of ESBL was 61%. The sensitivity and specificity of DDST at 24 h and 48hours incubation time was 91.3% and 89.5%, respectively. BEA showed an increase in sensitivity and specificity at 48 h with 97.8% and 98.0%, respectively. All ESBL producing strains detected by phenotypic tests were also found harboring ESBL genes (bla_SHV, bla_TEM, bla_CTX-M) by PCR.

Conclusion: The use of BEA in the screening of ESBL production was found to give much better results than DDST and can be used where PCR cannot be performed.

Background: Haemorrhoidal disease, one of the most common anorectal disorders, when complicated, is a painful concern to the patient. Miligan Morgan haemorrhoidectomy is a commonly performed gold standard procedure for haemorrhoids with good results but is a very painful procedure. Stapled haemorrhoidopexy has emerged as a possible alternative promising lesser immediate post operative complications.

Methods: Sixty patients between age group of 20-70 years with symptomatic haemorrhoidal disease planned for surgical technique were randomized into two groups: A stapled haemorrhoidopexy(SH) group operated on using PPH 03 kit and a Miligan Morgan (MM) group operated on using a standard open haemorrhoidectomy technique.

Results: The mean operative time, average pain scores and consequent parenteral and oral analgesics requirement was significantly lower in stapled group. There was no significant difference in immediate complications between the two groups. Duration of hospital stay was significantly lower in SH group and they returned to work significantly earlier and were more satisfied than the open group.

Conclusion: Stapled haemorrhoidopexy is an effective procedure for haemorrhoids with minimal immediate complications but the cost is exorbitant.

Aims: To evaluate the prevalence of the Ponticulus posticus in a Brazilian sample and discuss about the importance of this anatomical variation in forensic dentistry area.

Study Design: Observational and transversal study.

Place and Duration of Study: Department of Morphology, Anatomy division, Piracicaba Dental School, University of Campinas-UNICAMP, between June 2014 and December 2015.

Methodology: We used 242 lateral cephalometric radiographs of adult individual skulls from both sexes (from 18-60 years old). The sample was divided into the following groups: 92 lateral radiographs of males, and 150 lateral radiographs of females. The visual assessment method was performed by the same examiner. Classification form was carried out in three categories in both sexes: Presence of Ponticulus posticus with complete ossification; presence of Ponticulus posticus with incomplete ossification and absence. Data were performed a descriptive analysis by a decision tree. The sample data were segmented by sex, posteriorly by the presence of Ponticulus posticus, and then as complete or incomplete. Also were applied chi square test to analyze the correlation between the presence or absent of the Ponticulus posticus in relation about sex and the correlation about the Ponticulus posticus is complete or incomplete. The significant level was adjusted to 5%.

Results: From the total sample of 242 individuals, 92 (38.02%) were male sex and 150 (61.98%) were female sex. Among the male ones, 19 (7.85%) had shown Ponticulus posticus with 10 (4.13%) of them presenting incomplete foramen ossification and the other 9 (3.72%) presenting complete foramen ossification. Concerning the females ones, 34 (14.05%) exhibited this anatomical variation, being 21(8.68%) incomplete and 13 (5.37%). In general, there was no sex influence (chi-square, p = 0.8354399) in the presence of Ponticulus posticus, indicating that sex is not an influence factor.

Conclusion: The presence of this anatomical variation cannot be related to sexual dimorphism.

Dimethylamine (DMA) is a toxicant commonly present in foods, air and water. Diospyros species is a group of plants being reported to contain several bioactive agents. The study was aimed at investigating the biological activities of Diospyros chloroxylon leaf extract (DCLE) on DMA-induced toxicity in liver of Wistar rats. The DMA significantly (p < 0.05) reduced serum Superoxide dismutase (SOD) and catalase activities by 43.9% and 60.6%, while malondialdehyde (MDA) was found to be significantly (p < 0.05) elevated by 150% compared with controls. Hepatic SOD and catalase activities, and reduced glutathione (GSH) level were significantly (p < 0.05) reduced by 49.9%, 32% and 26.3%, respectively, while MDA level was increased by 94.5% in DMA group against controls. The DCLE significantly (p < 0.05) increased SOD and catalase activities, and lowered MDA level in serum and liver against DMA treatment. DNA fragmentation was observed to be significantly elevated by 42.5% in DMA-treated rats compared with controls.  Pretreatment with DCLE significantly (p < 0.05) lowered DNA fragmentation in the [DCLE + DMA] group. Histological data reveal that DMA caused periportal cell infiltration in hepatocytes, whereas the control, DCLE and [DCLE + DMA] groups showed no visible lesion. Immunohistochemical (IHC) staining of CD34 showed a strong expression in DMA group, while DCLE + DMA] showed a moderate expression. This study thus suggests that methanolic leaf extract of Diospyros chloroxylon ameliorates oxidative stress, DNA damage and cell proliferation in liver of rats treated with Dimethylamine.

Background: Treatment of musculoskeletal disorders by Traditional Bone Setters (TBS) is as old as man’s effort at caring for his bone. In spite of the numerous limb-deforming and limb-threatening complications caused by this unorthodox method of care, the TBS still enjoy high patronage in the developing world.

Aim: To evaluate the patronage and practice as well as the perception of patients receiving orthopaedic care at the University of Port Harcourt Teaching Hospital (UPTH) concerning traditional bone setters.

Methods: A prospective non-randomized cross sectional study of 192 patients presenting to the University of Port Harcourt Teaching Hospital from Jan 2013 to July 2014 with complications following TBS care of musculo-skeletal problems was undertaken. Relevant data was obtained from each patient and analyzed. Descriptive statistics are presented in the results.

Results: A total of 192 patients were seen; One hundred and fifteen (115; 64.6%) were males while seventy-eight (78; 35.4%) were female patients giving a male to female ratio of 1.5:1. Age of the patients ranged from 10months to 76years with mean age (35.1 ± 19.3) years. Patients aged (21-30) years and (31-40) years age groups cumulatively constituted 42.6% of the study population.

Students (65; 33.8%) and traders (41; 21.3%) were more common than other professions, with 73.4% of the population having at least secondary level of education.

Following injury, more patients (78.6%, n=151/192) visited the TBS first than hospitals (10.2%, n= 41/192) with 46.4% (n=89) of patients visiting at least 2 TBS before hospital visit. The most common reason (n=82/192) for TBS visit was the strong faith patients had in the TBS.

Conclusion: Strong faith in the competence of the TBS and perceived lower cost of care are key factors influencing perception and patronage of the TBS in Port Harcourt. Intervention programs need to address these key factors.