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Journal Cover El Mednifico Journal  
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2307-7301
   Published by Mednifico Publishers Homepage  [1 journal]
  • Patterns of herbal use among patients attending family practice centers

    • Authors: S I Shalaby, Mosleh A Ismail, Nadia M Mansour, Heba M Abbas, Neelima Gupta
      Abstract: Background: Complementary and Alternative Medicine (CAM) is common in both developing and developed countries. This cross-sectional descriptive study was conducted to identify the prevalence of herbal use among patients, factors associated with herb use, the most common herbs used, medical conditions for herb use and factors that might affect herbal use among patients.Methods: The study was carried out on 300 patients attending two primary health care centers at Fanara village, Ismailia, Egypt. Study population was allocated randomly using a systematic random sample. A structured questionnaire consisting of three sections was designed to fulfill the study objectives: personal and socio-demographic characteristics, background knowledge of herbal use and exploring the belief towards herbal therapy.Results: The prevalence of herbal medicine (HM) use was 76.7%. The most frequent herb used by participants was peppermint (32.6%), the most common indications of herbs were respiratory problems (47.3%) and the most common method of use was boiling. About 71% were of the opinion that herbs were beneficial for health and knowledge of herb usefulness was significantly related with all sociodemographic characteristics except for family size, income and smoking status. A statistically significant relationship existed between previous herbal use and old age particularly at the age of ≥50 (p<0.001), and ex-smokers were significantly related to herbal remedies (p=0.02). Employment status was significantly related to previous herbal use (88.1%) (p=0.004).Conclusion: Beliefs of safety of HM were significantly associated with education (high; p=0.03), job (employee; p=0.01), smoking (current smokers; p=0.01) and health insurance coverage (uncovered; p=0.02).
      PubDate: 2015-01-08
      Issue No: Vol. 2 (2015)
  • Types and frequency of pre-analytical errors at University of Gondar
           hospital laboratory

    • Authors: Zelalem Addis, Tadelo Wondimagegn, Belaynesh Tachebele
      Abstract: Background: As many as 93% of errors encountered in the diagnostic process are largely due to lack of standardized procedures in the pre-analytical phase of quality assurance. Hence, the aim of this study was to assess the types and frequency of pre-analytical errors in University of Gondar hospital.Methods: This was a cross sectional study that involved prospective evaluation of request papers and samples sent to the hospital laboratory for hematological and clinical chemistry analysis. Data was collected by laboratory professionals and summarized into different categories of pre-analytical quality indicators.Results: A total of 1533 (750 for hematology and 783 for clinical chemistry) samples with their respective request papers were evaluated in this study. In general, none of the request papers contained all the information that they were supposed to contain. One or more of patient identification parameters were missing in 8.7% of the request papers. Name of the requesting physician and address of the sender were missing from 44.5% and 6.5% of the request papers. Clinical information of the patients was missing in about 98% of the requests. Examination of the samples showed that 1.02%, 2.8% and 0.98% of the samples were hemolyzed, insufficient for analysis and clotted respectively.Conclusion: This study showed the existence of different pre-analytical errors in the laboratory studied. The laboratory can evaluate itself based on some of the pre-analytical quality indicators and should strive for improving its quality for maximum patient benefit.
      PubDate: 2015-01-07
      Issue No: Vol. 2 (2015)
  • Treacher Collins syndrome - a report of two cases with review of

    • Authors: Priyadharshini Alva, Shishir Ram Shetty, Subhas Babu G, Anaya Madiyal
      Abstract: Background: Treacher Collins syndrome is congenital disorder characterized by developmental anomalies of the maxillofacial region. The zygomatic complex and mandible are usually involved.Case Presentation: We are hereby reporting the clinical and radiological features of two cases of Treacher Collins syndrome occurring in different age groups. The extraoral and intraoral features of this syndrome are described in detail.Conclusion: Multiple major reconstructive surgical procedures in severe form of TCS shown only marginal improvement. Therefore future research should be directed towards preventive aspects and early prenatal detection of this condition.
      PubDate: 2015-01-06
      Issue No: Vol. 2 (2015)
  • A conservative approach to reattach fractured anterior tooth fragment

    • Authors: Amit Chaudhari, Priya Chaudhari
      Abstract: Dental trauma to the anterior maxillary teeth is common in children, which may result in fracture or tooth dislocation. One of the options for managing coronal tooth fractures when the tooth fragment is available is reattachment, which can provide good and long-lasting aesthetics. This article reports on coronal tooth fracture case that was successfully treated using tooth fragment reattachment. Reattachment of a tooth fragment is a viable technique that restores function and aesthetics with a very conservative approach.
      PubDate: 2015-01-06
      Issue No: Vol. 2 (2015)
  • Massive upper and lower gastrointestinal bleeding due to intra-abdominal

    • Authors: Muharrem Karaoglan, Fuat Ipekci, Ismail Sert, Safak Ozturk, Azad Gazi Sahin
      Abstract: Background: Gossybipoma is defined as surgical material such as compresses or sponges forgotten at the operation site following surgical procedures. The incidence of gossypiboma is generally underreported due to medico-legal causes and being asymptomatic in many patients for months or years.Case Presentation: This case report presents the massive upper and lower gastrointestinal bleeding due to intra-abdominal gossypiboma in a patient with Hartmann colostomy.Conclusion: The possible surgical materials should be kept in mind for all patients with history of surgical operations. In patients with gastrointestinal bleeding and history of previous operation, the diagnosis of the gossypiboma should not be overlooked.
      PubDate: 2015-01-06
      Issue No: Vol. 2 (2015)
  • Occult medullary carcinoma of thyroid - an unusual clinical and pathologic

    • Authors: Khalid S Aljabri, Samia A Bokhari, M Haq, A Durani, A Altayeb, S J Alzahrani, M Alshareef
      Abstract: Background: Medullary thyroid cancer is a neuroendocrine tumor originating from the parafollicular C cells of the thyroid which secrete calcitonin. MTC accounts for approximately 4% of all clinically detected thyroid malignancies. The prevalence of occult MTC in the general population is not well established.Case Presentation: We describe a rare patient with occult sporadic MTC who presented with cervical lymphadenopathy and an asymptomatic mediastinal mass and elevation of calcitonin and carcinoembryonic antigen levels.Conclusion: Our practice is to recommend basal calcitonin testing for thyroid nodule patients with increased risk of MTC, including those with a family history of MTC, with a diagnosis of hyperparathyroidism or pheochromocytoma, or symptoms of flushing or diarrhea.
      PubDate: 2015-01-05
      Issue No: Vol. 2 (2015)
  • Florid squamous and focal mucinous metaplasia in Warthin’s tumor
           mimicking low grade mucoepidermoid carcinoma: A diagnostic dilemma on fine
           needle aspiration cytology

    • Authors: Debjani Mallick, Sonia Gon, Riti Tushar Kanti Sinha, Gayatri Ghosh
      Abstract: Background: Lack of typical cytological features of Warthin’s tumor (WT) on fine needle aspiration cytology (FNAC) added by presence of atypical features in the form of metaplastic or atypical squamous cells on a necrotic background may mimic carcinoma leading to pre-operative diagnostic dilemma.Case Presentation: An interesting case of WT in a 53 year old female is being reported with a history of sudden increase in the size, along with evidence of level I and II lymph nodes on CT scan. FNAC prompted a diagnosis of WT with florid squamous metaplasia with low grade mucoepidermoid carcinoma as a differential diagnosis. Histopathology confirmed the diagnoses of WT with vast areas of florid squamous metaplasia and focal areas showing mucinous metaplasia.Conclusion: Awareness of potential source of erroneous diagnoses, especially the squamous component of the lesion coupled with awareness of typical features of the lesion may result in higher accuracy rate thereby helping in proper management.
      PubDate: 2015-01-05
      Issue No: Vol. 2 (2015)
  • Literature evaluation of a case with endometrial cancer and primary
           cutaneous anaplastic large cell lymphoma

    • Authors: Feryal Karaca, Fatma Sert, Elif Calıs, Emine Bagır, Erkut Erkut
      Abstract: Background: Radiotherapy (RT) is used as an indispensable treatment approach for cancer therapy as an adjuvant or alone for definitive option. For early stage endometrial cancer, RT is applied after operation as an adjuvant. Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a type of lymphoma which is seen rarely and has excellent prognosis with accurate treatment. It is another indication for RT. Developments in the diagnosis and the treatment of PCALCL have improved the disease prognosis and outcomes.Case Presentation: We present a case of a 55-years-old patient who had endometrial cancer and PCALCL, whose 9 years follow-up period was excellent with no recurrences and no metastasis. The outcome was achieved with the combination of surgery and RT.Conclusion: The presented case is important for long follow-up duration with no metastasis and/or no recurrences with single RT usage in both primary cancers. Single RT applications may be considered as an initial treatment option for surgically excised PCALCL with excellent outcome.
      PubDate: 2015-01-05
      Issue No: Vol. 2 (2015)
  • Treatment option for deficient maxilla by bone expansion using D-shaped
           bone expander for implant restorations

    • Authors: Satheesh B Haralur, Farhan K Shah, Nausheen Khan
      Abstract: Background: Researchers are continuously developing various implant site development techniques to improve the predictability of implant restoration. The bone expansion from osteotome is a simple technique to improve the bone width, and is mainly applied to maxillary bone. It enables the dentist to select the optimum implant location and orientation for better functional and aesthetic rehabilitation.Case Presentation: A male patient of 30 years of age with history of tooth extraction nine weeks before due to non-restorable carious tooth destruction, reported to our department of Prosthodontics wanting to replace missing 11 and 16. Clinical examination of the extracted site with digital palpation, bone mapping showed the deficient bone width in both the region for the adequate implant size and buccal soft tissue concavity in the lateral incisor region. Bone mapping revealed the underlying bone was deficient in width by 1-1.5 mm for 3.4-3.8 mm diameter implant placement. Following conventional Panoramic, peri-apical radiographs, initial clinical examinations dental implants were advised with bone expansion by osteotomes.Conclusion: The osteotome techniques are a predictable, simple alternative to complex augmentation techniques to place an implant in case of bone atrophy. The bone expansion technique is limited to maxillary the bone, with bone width deficient less than 3 mm. Since it is a single stage surgical procedure, it is advantageous for the patient for early prosthetic replacement.
      PubDate: 2015-01-03
      Issue No: Vol. 2 (2015)
  • Half annular pancreas - a cadaveric case report

    • Authors: B Satheesha Nayak, Naveen Kumar, Srinivasa Rao Sirasanagandla, Ravindra S Swamy, S Sudarshan
      Abstract: Background: Annular pancreas is an unusual and not often reported congenital anomaly of the pancreas. Thus, it is rarely suspected when the patient is asymptomatic. However, the condition may be occasionally associated with other clinical complications of the abdomen.Case Presentation: We report here a case of partial or incomplete annular pancreas detected during cadaveric dissection. A triangular projection from the head of the pancreas extended over the anterior surface of the second part of the duodenum and covered its major portion. As a possible compression effect, the first part of the duodenum was dilated.Conclusion: Prior knowledge of existence of incomplete annular pancreas helps in the diagnostic approach of radiological procedures. As annular pancreas may predispose to other congenital or morphological abnormalities, its timely diagnosis is warranted.
      PubDate: 2015-01-03
      Issue No: Vol. 2 (2015)
  • Coexistence of a normal thyroid with a non-functional ectopic thyroid
           tissue: a case report with review

    • Authors: Sunder Goyal, Snigdha Goyal, Shveta Narang, Isha Saini
      Abstract: Background: Ectopic thyroid is not uncommon but presence of non-functional ectopic thyroid tissue in the neck with a coexisting normal thyroid is quiet rare.Case Presentation: A 10-year-old female presented with a mass in the anterior upper neck. The thyroid function tests of the patient were within normal limits. Ultrasonography revealed a normal thyroid gland and a solid mass in the midline of upper half of neck. Fine needle aspiration cytology (FNAC) of swelling revealed thyroid tissue. Scintigraphy showed a normal thyroid and the mass didn’t show any uptake of 99mTcO4−. The mass was excised. Histopathology proved it as ectopic thyroid tissue. The patient had an uneventful recovery.Conclusion: Diagnosis of ectopic thyroid tissue poses dilemma to treating physician. In order to prevent misdiagnosis and mismanagement, it is mandatory to prove presence of normal thyroid tissue in lower neck with the help of 99mTcO4− scintigraphy.
      PubDate: 2015-01-03
      Issue No: Vol. 2 (2015)
  • Intraosseous ganglion cyst of scaphoid: A case report

    • Authors: Nasir Muzaffar, Nissar Shah, Sulaiman Seth, Sheikh Ajaz
      Abstract: Background: Intraosseous ganglion cysts are rare causes of hand and wrist pain. Differential diagnosis of painful cystic radiolucent carpal lesions includes osteoid osteoma and osteoblastoma. Isolated cases of ganglion cysts occurring in the lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx have been reported.Case Presentation: A case of intra-articular intraosseous ganglion cyst of the scaphoid is presented. A 32-year-old right-handed man presented with a 2 year history of progressive left-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. This case was treated with curettage and bone grafting having excellent results with visual and analog pain scores reduced from 68 to 11 and range of motion was 90° extension to 80°flexion and full grip strength.Conclusion: Cases of intraosseous ganglions are reported in literature mostly in lower limbs and lunate among carpals, with scaphoid being a rare site of the involvement. In this report, we described a symptomatic case which was successfully treated by intralesional curettage, and autogenous bone grafting.
      PubDate: 2015-01-02
      Issue No: Vol. 2 (2015)
  • Percutaneous drainage of abdominal fluids using available materials:
           University of Benin teaching hospital experience

    • Authors: Blessing Ose-Emenim Igbinedion, Micheal Ibadin, Tobechukwu Tagbo Marchie, Micheal Nkwor Okobia
      Abstract: Background: The role, function and practice of radiologists have expanded over the last three decades with attendant overlap and conflict with other clinical disciplines. Interventional radiology has reduced the cost, hospital stay, complication rate, morbidity and mortality of patients in most instances in comparison with traditional management. Unfortunately the necessary materials and trained manpower is unavailable in most hospitals in our environment.Methods: This study was a descriptive retrospective study of interventions performed at the nascent interventional section of the Radiology department of University of Benin Teaching Hospital (UBTH), Benin, Nigeria. The data of all the percutaneous drainages of abdominal fluid performed between January 2013 and February 2014 were retrieved. The materials used for the interventions were also recorded.Results: There were 13 females and 4 males who had percutaneous drainage (PD) of abdominal fluids performed during this period. The mean age was 36.7 years. Three patients had ascitic fluid drainage, 4 had hepatic abscesses PD, 2 had subcutaneous abscesses PD, 2 had hepatic cysts PD, 2 had endometriotic fluids PD, 1 had iliopsoas abscess PD and 3 had percutaneous nephrostomies. Materials utilized ranged from intravenous cannulae, needle/stylet assemblage, Foley’s catheter and pigtail catheters.Conclusion: Radiological interventions can be successfully performed in Nigeria (and possibly Africa) using available materials despite frustrating constraints in the acquisition of interventional materials and equipment which arise from poverty, inaccessible or expensive materials, discouraging hospital management policies, and inter/intra-discipline conflicts.
      PubDate: 2014-12-29
      Issue No: Vol. 2 (2014)
  • Reproductive health complications among women: A study in a tertiary
           hospital of Mumbai

    • Authors: Mousumi Gogoi, Sayeed Unisa
      Abstract: Background: In spite of the drastic reduction in maternal morbidity over the last few decades due to improvements in obstetric care, maternal mortality remains to be a challenge in the developing world. Maternal mortality is the most extreme consequence of poor maternal health and millions of women in developing countries experience life threatening and other serious health problems related to childbirth. Concerning the issue of maternal morbidity and mortality, the study tries to find out the health complications during pregnancy, delivery and post-delivery among women belonging to lower socio-economic strata in Mumbai city.Methods: The study was based on primary data by interviewing 300 inpatients in a tertiary hospital of Mumbai during January to June 2013.Results: Out of total, 97% women reported of any complications during pregnancy while 85% of women reported complications during delivery. Of all respondents, excessive vomiting, weakness, anemia during pregnancy and prolonged labor, excessive bleeding during delivery were highly reported. Complications were mostly reported by young, less educated and primiparous women. Most of the pregnancies ended with live birth while a few reported of delivered stillbirth having any labor related complications. Higher proportion of women received more than three antenatal care visits as the majority of women from lower strata had undergone check-up only when they suffered from complications.Conclusion: Usually women visit medical officer at the government hospital or local medical practitioner for check-ups. So, it is necessary to improve services available and availed during complications related to childbirth.
      PubDate: 2014-12-29
      Issue No: Vol. 2 (2014)
  • A comparison of survival with chemoradiation therapy alone versus surgery
           and post-esophagectomy chemoradiation in patients with esophageal

    • Authors: Manoochehr Aghajanzadeh, Abbas Rahimi, Dina Emami, Gilda Aghajanzadeh, Sina Khajeh Jahromi, Hannan Ebrahimi
      Abstract: Background: Esophageal cancer is usually incurable. Aggressive treatments involving multimodality therapies have been offered to improve overall survival rates. It seems that various therapeutic approaches can have a different outcome and survival. The aim of our study was to compare survival with chemoradiation therapy (CRT) alone versus surgery and post-esophagectomy chemoradiation therapy (CRT-S) in patients with esophageal carcinoma.Methods: This historical cohort study assigned 226 patients with stage I to III esophageal cancer who referred to Radio-oncology clinic of Razi hospital from 2005-2011 for oncology treatment. Patients were categorized into two groups. One group treated by chemoradiation therapy (CRT) alone and other group treated with surgery and post-esophagectomy chemoradiation. Overall survival of two groups was compared. For statistical analysis SPSS was used and the comparison of groups was performed with Kaplan-Meier analysis and Log-rank test.Results: Of 266 patients with stage I to III esophageal cancer, 222 patients were in the CRT group and 44 patients were in the CRT-S group. 22 patients had stage I, 82 had stage II and 118 had stage III. Median survival was 17 month for the CRT group and 18 month for the CRT-S group. There was no significant difference in survival rate between chemoradiation therapy alone (CRT) and post-esophagectomy chemoradiation therapy (CRT-S) (P>0.005).Conclusion: Based on these data, we concluded that patients with tumors, especially of squamous cell carcinoma, that respond to initial chemoradiotherapy did not derive any survival benefit from subsequent surgery and three-month mortality was significantly higher in the surgery group. Surgery imposes a major emotional trauma and an excessive and unnecessary cost on the patient and the community health system. We conclude that it is better to use CRT for patients with non-advanced esophageal cancer.
      PubDate: 2014-12-27
      Issue No: Vol. 2 (2014)
  • The effects of n-3 fatty acids intake on PON1 activity and fatty acid
           status in type 2 diabetic patients – A pilot study

    • Authors: Zorica Rasic-Milutinovic, Tamara Popovic, Jasmina Debeljak-Martacic, Gordana Perunicic-Pekovic, Suncica Borozan, Danijela Ristic-Medic, Milena Lackovic, Maria Glibetic
      Abstract: Background: Paraoxonase–1 (PON1) enzymatic activity appears to play a role in maintaining the endothelial-atheroprotective effects of high density lipoprotein (HDL)-cholesterol and has been linked to vascular disease and diabetes. The objective of this study was to determine the effect of fish oil consumption on antioxidative capacity of HDL-cholesterol by measuring erythrocyte activity of antioxidant enzymes [catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and PON1], malonil dialdehide (MDA) parameter of oxidative stress, metabolic parameters and phospholipids fatty acid status in type 2 diabetic patients.Methods: Twenty patients (12 females, 8 males, mean age 53±6) received daily 4 g natural fish oil (1.2g n-3 fatty acids; 20:5n-3 [EPA] and 22:6 n-3 [DHA]) during 12 weeks.Results: PON-1 activity increased by 105.2 % (p<0.05) and SOD increased by 23.5% (p<0.05). Improvement of PON-1 activity was associated with serum n-3 fatty acid increment by 52% (p=0.01). Increased PON-1/HDL-C ratio (by 95%) was independently associated with changing of MDA and 20:4n-6 (AA)/EPA ratio (p=0.01). HbA1c was improved significantly by 21% (p<0.01), and HDL-C by 19% (p=0.05).Conclusion: Results of this study confirm that n-3 fatty acid status presented biomarker of intake and indicated that low dose of fish oil (1.2 g EPA+DHA) added to a habitual diet improved antioxidant property of HDL-C, by increasing PON1 activity, as well as SOD and MDA in type 2 diabetic patients.
      PubDate: 2014-12-27
      Issue No: Vol. 2 (2014)
  • A retrospective comparison of docetaxel and paclitaxel as single-agent
           second-line chemotherapy for advanced stage non-small cell lung cancer

    • Authors: Julide Celdir Emre, Aysegul Baysak, Gursel Cok, Ozer Ozdemir, Tuncay Goksel
      Abstract: Background: A few chemotherapy agents are used for second line treatment of advanced stage lung cancer, and their benefits are limited. The aim of our study was to compare response rates, survival and toxicity of single agent docetaxel versus paclitaxel in the second line chemotherapy of advanced stage lung cancer.Findings: Sixty two advanced stage lung cancer patients treated with a single agent taxane as second line chemotherapy between January 1997 and January 2006 were retrospectively analyzed. Chi-squared and Kaplan Meier methods were used for statistical analyses using SPSS software program. Study population was composed of 51 males and 11 females with median age of 54.35 (± 8.18) years. 21 patients were treated with single-agent paclitaxel whereas 41 patients were treated with single-agent docetaxel. Overall response rate was 14.3% in paclitaxel group and 12.2% in docetaxel group (p>0.05). Median survival time was 32 weeks in paclitaxel group and 24 weeks in docetaxel group (p>0.05). There was no difference regarding grade 3 or 4 toxicity between groups.Conclusion: There was no statistically significant difference between docetaxel and paclitaxel groups in the second line chemotherapy of advanced stage non-small lung cancer regarding response or toxicity.
      PubDate: 2014-12-27
      Issue No: Vol. 2 (2014)
  • Assessment of childhood cancer at National Oncology Center in Sana'a
           city, Yemen

    • Authors: Abdulhameed Ali Al-Thaifani, Ashwaq A Al-Ariki
      Abstract: Background: No published studies assess childhood cancer and obstacles to receive cancer treatment in Yemen. The aim of this study was to assess childhood cancer and obstacles to receive cancer treatment at National Oncology Center (NOC) in Sana'a city, Yemen.Methods: A descriptive cross-sectional study of 119 children with cancer was conducted at the NOC in Sana'a city, Yemen from March to May, 2012. Data was collected through face-to-face interview and retrospectively from patients' files. The data regarding socio-demographic characteristics, medical history of childhood cancer and obstacles to receive cancer treatment were collected by structured questionnaire. The collected data was analyzed using the SPSS. A p-value <0.05 (2-sided) was considered statistically significant.Results: One hundred and nineteen children with cancer and their parents were included in our study. The mean age and SD was 8.7 ± 4.5 years. 63.9% of the participants were boys. Lymphomas were the most common cancer diagnosed, representing 35.3% of all childhood cancers followed by leukemias (22.7%) and malignant bone tumors (12.6%). A high proportion of childhood cancer was diagnosed at advanced stages and constituted for 58%. Tumor grading was mentioned in 25.2% of cases. Histology diagnosis was achieved in 89.1% of cases. 80.7% did not receive cancer treatment on regular basis.Conclusion: The study concluded that at the National Oncology Center, lymphomas were the most common childhood cancer diagnosed, followed by leukemias and malignant bone tumors. The distribution of cancer was more in boys than girls. Poor service was the main obstacle to received cancer treatment regularly. The study recommends that a national cancer registry should be introduced.
      PubDate: 2014-12-16
      Issue No: Vol. 2 (2014)
  • Effectiveness of hand versus rotary instrumentation on retreatment of
           curved canals

    • Authors: Ebru Özsezer Demiryürek, Emre Bodrumlu
      Abstract: Background: Various nickel–titanium (NiTi) rotary endodontic instruments have been developed to facilitate cleaning and shaping of root canals. This study aimed to evaluate the efficiency, cleaning ability and safety of two different rotary NiTi instruments with a solvent versus hand files in the removal of canal fillings.Methods: Forty five simulated canals with 35° curves made of clear polyester resin were used in this study. All canals were prepared with K-files and filled using cold lateral compaction of gutta-percha and AH Plus sealer. The teeth were randomly divided into three groups of 15 specimens each. Removal of gutta-percha was performed with the following techniques: Hedström files, ProTaper Universal rotary retreatment system and Mtwo-R. All techniques were used with the solvent chloroform. The followings factors were evaluated: time taken to reach working length, time for gutta-percha removal, total time, apically extruded material during filling removal and number of fractured instruments. Pre- and post-reinstrumentation weights of all the blocks were recorded and efficacy capacity of each retreatment technique was assessed.Results: The canal wall clearance efficiency of ProTaper retreatment files were more successful than Mtwo-R and hand instruments. With respect to the difference between pre- and post-reinstrumentation weights, Mtwo-R was the most effective instrumentation technique. Regarding the mean time of retreatment and time required for reaching the working length, Mtwo-R instruments were significantly faster than the others. In addition, the hand instrumentation was more successful comparing to others in terms of the amount of apically extruded material.Conclusion: Under experimental conditions, Mtwo-R/Mtwo and ProTaper retreatment instruments proved to be efficient and time-saving devices for the removal of gutta-percha.
      PubDate: 2014-12-11
      Issue No: Vol. 2 (2014)
  • Mucopolysaccharidosis type III, Sanfilippo syndrome: What does coarse
           facies mean'

    • Authors: Avina Fierro, Hernandez Aviña
      Abstract: Background: The purpose of this study was to describe the peculiar facial dysmorphism of Sanfilippo syndrome, the most frequent type of mucopolysaccharidosis with a progressive clinical course of nervous system degeneration.Findings: We performed a retrospective study of the literature and reviewed clinical photographs of fifty published patients with Sanfilippo syndrome, in order to review the principal features of craniofacial anomalies, while attempting to delineate the syndrome phenotype with the specific dysmorphism previously described as “coarse facies”. The present study demonstrates the classical phenotype of the Sanfilippo syndrome in the majority of patients with mild course. We observed that the most common dysmorphic facial features were: head with mild macrocephaly, low anterior hairline, frontal bossing, periocular region with broad and thick eyebrows, eyes widely spaced, midface with wide and depressed nasal bridge, wide nose with anteverted nares, broad, smooth philtrum, wide mouth with thick vermillion of upper lip, and broad jaw.Conclusion: Sanfilippo syndrome is characterized by normal phenotype at birth and at early infancy, when the patient has progressive regression in capabilities by deterioration of gait, speech and behavior and shows a special facial dysmorphism associated with a specific facial pattern. The dysmorphic scoring system may be used to classify patients and get an early, correct clinical diagnosis.
      PubDate: 2014-11-28
      Issue No: Vol. 2 (2014)
  • Ehlers Danlos syndrome in an edentulous patient with temporomandibular
           joint dislocation

    • Authors: Renu Tanwar, Asha R Iyengar, K S Nagesh, Rishabh Kapila, Gurvinder Kaur
      Abstract: Background: Ehlers Danlos syndrome (EDS) is heterogeneous genetic syndrome involving connective tissue. It is characterized by clinical signs of skin hyper-extensibility, delayed wound healing with atrophic scarring, joint hypermobility, easy bruising and generalized connective tissue fragility. Oral cavity is not immune to these systemic effects.Case Presentation: A 40 year old Indian male patient reported to the Department of Oral Medicine and Radiology with chief complaint of clicking in front of ear and difficulty in closing the mouth properly as his jaw seems to get stuck sometimes. The problem started about two years back when patient underwent full mouth extraction due to mobility in all teeth. On general examination certain anomalous features were observed which included hyper-extensibility of fingers of the hands and cigarette paper scars on legs and foot. The patient was completely edentulous and could touch tip of tongue to the tip of nose. Panoramic and temporomandibular joint (TMJ) limitation views were taken and MRI of TMJ was advised. Based on history and clinical features; we came to diagnosis of TMJ dislocation and Ehlers Danlos syndrome. Patient was advised to avoid wide opening of the mouth. Since the medical condition of the patient was capricious for implants prosthesis, the patient was advised to use relined complete denture.Conclusion: Ehlers Danlos syndrome is a rare genetic disorder of connective tissue. Oral manifestation and dental consideration for such cases should be well evaluated and managed appropriately.
      PubDate: 2014-11-27
      Issue No: Vol. 2 (2014)
  • Child sexual abuse leads to psychological disorders: Literature review

    • Authors: Savera Aziz Ali, Sumera Aziz Ali
      Abstract: This scholarly paper explains the relationship between child sexual abuse and psychological disorders. Childhood sexual abuse (CSA) is a forceful sexual contact with a child who is incapable of consenting. The impact of sexual abuse can range from physical to very severe psychological effects. Psychological disorders caused by child sexual abuse include panic disorder, anxiety, depression, substance abuse, low self-esteem and post-traumatic stress disorder. The phenomenon of child sexual abuse is shaped by some important theories like behavioral, psychodynamic, attachment, cognitive and integrated theory. These theories may help to develop a sound empirical base through which cost effective strategies can be made to prevent child sexual abuse. Although child sexual abuse is considered as an offensive act in Pakistan, but it is usually hidden in our society. Approximately 3,861 and 1,204 child sexual abuse cases were reported in 2012 and 2013 respectively from Pakistan. A series of current cases of child sexual abuse has brought the issue to the limelight. Child sexual abuse affects not only the individual but also the families and societies on large scale. Therefore, an integrated approach focusing on the parents, teachers and medical professionals can be proposed to prevent this issue. Prevention programs such as parenting education, home-visiting programs, public education, and training sessions can be developed. Therefore, it is highly important for the families and communities to work together with the support of stakeholders, so that a voice can be raised against CSA and this will ultimately reduce psychological problems in the society.
      PubDate: 2014-11-25
      Issue No: Vol. 2 (2014)
  • Sleep and its disorders

    • Authors: Ahmed M Kabel, Ibrahim A Maghrabi
      Abstract: Sleep is a natural state characterized by reduced or absent consciousness, relatively suspended sensory activity and inactivity of voluntary muscles. Sleep is divided into rapid eye movement and non-rapid eye movement sleep. Human sleep needs vary by age and among individuals and sleep is considered to be adequate when there is no daytime sleepiness or dysfunction. Disruption of sleep can be caused by a variety of causes. Sleep disorders may be serious enough to interfere with normal physical, mental and emotional functioning. Management of sleep disorders includes behavioral and psychotherapeutic treatment, rehabilitation and management, medications and other somatic treatment.
      PubDate: 2014-11-24
      Issue No: Vol. 2 (2014)
  • Development of nitroimidazopyrans and nitroimidaoxazoles for tuberculosis

    • Authors: Mohammad Asif
      Abstract: The conventional approach to antitubercular drug development requires introduction of novel molecules for the treatment of resistant mycobacterium strains. The nitroimidazopyrans, nitroimidaoxazoles and other analogs are being studied as antitubercular agents and their characteristics form the basis of this review. These new tuberculosis treatments shorten the duration of treatment and/or reduce the number of doses, improve the coverage of MDR-TB/XDR-TB and are more effective in treatment of latent TB infection.
      PubDate: 2014-11-19
      Issue No: Vol. 2 (2014)
  • Patient specific instrumentation: A minimally invasive technique for knee

    • Authors: Mahmoud A Hafez, Ashsish Jaiman, Hosamuddin Hamza
      Abstract: Patient specific instrumentation (PSI) is considered a minimally invasive technique regardless of whether the skin incision is small or traditionally long. PSI provides two pieces of instruments to replace the complex conventional instruments that may reach up to 100 pieces. PSI eliminates the need for using the invasive intramedullary rods that perforate the medullary canal leading to higher risk of bleeding, fat embolism, infection and fractures. PSI also reduces operative time and speeds the recovery of patients. In this review, the authors collect the data given on total knee arthroplasty (TKA) using PSI. The criteria for TKA as well as the development of different surgical techniques and how PSI would benefit the surgeons and patients to conduct a successful surgery have been discussed.
      PubDate: 2014-11-17
      Issue No: Vol. 2 (2014)
  • The role of microRNAs in HIV infection

    • Authors: Marta Calado, Harapan Harapan
      Abstract: MicroRNAs (miRNAs) are a class of approximately 22-nt long non-coding RNAs found in eukaryotes. miRNAs are involved in the specific regulation of both protein-coding and putatively non-coding genes by post-transcriptional silencing. Evidences support the idea that mammals continue to employ non-coding RNA to silence viruses. Although HIV-1 infection modulation by miRNAs is unclear, there are several hypotheses that may possibly explain the confounded nature of miRNAs effects in virus-infected host systems. Studies of the interactions of HIV-1 and miRNAs might generate new insights into the mechanism of HIV-1 infection, for instance, whether HIV-1 infection affects the miRNA pathways and whether miRNA pathways target the HIV-1 genome to modulate infection. Research into how HIV-1 infection affects the host miRNA pathway also could improve our understanding of the mechanisms underlying HIV-1 mediated pathologies and T lymphocytes depletion. In this paper, we discuss several possible mechanisms of interaction between miRNAs and HIV-1 including silencing of cellular mRNAs sequences that relevant to HIV-1 replication.
      PubDate: 2014-11-15
      Issue No: Vol. 2 (2014)
  • Embolization of uterine and ovarian artery anastomosis in the treatment of
           menorrhagia secondary to adenomyosis and leiomyoma

    • Authors: Dustin Hofstede, Peter Munk, Roshni Patel, Nivmand Khorrami
      Abstract: Background: Adenomyosis is a benign uterine condition that causes menorrhagia and dysmenorrhea. Although hysterectomy is considered a definitive treatment, it is not an ideal option for women who wish to preserve their fertility. Minimally invasive procedures such as uterine artery embolization (UAE) have the potential to eliminate surgery for women who have failed conservative and medical treatment for adenomyosis and leiomyoma.Case Presentation: This case report discusses a 54-year-old female who presented with menometrorrhagia refractory to medical treatment. Pelvic T2 MRI revealed findings consistent with adenomyosis and leiomyoma. Elective UAE was performed and follow up was scheduled at 3, 6 and 12 months.Conclusion: This case provides a review of UAE, the efficacy of UAE for the treatment of leiomyoma and adenomyosis, the primary causes of treatment failure, and what has been done to address these shortcomings. UAE has significant promise for the treatment of these disorders. However, establishing UAE as a first line treatment requires further research.
      PubDate: 2014-11-10
      Issue No: Vol. 2 (2014)
  • Intestinal occlusion due to cryptogenic, multifocal, ulcerous, stenosing
           enteritis treated by laparoscopy

    • Authors: Alejandro Weber Sánchez, Pablo Weber, Rafael Carbó, Jorge Fishleter
      Abstract: Background: Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is characterized by stenotic zones and multiple mucosal ulcerations in the small bowel. The diagnosis is clinical and histopathological based on the history of periodic attacks of intestinal obstruction, vomiting and abdominal pain. According to our knowledge, this is the only report of treatment of CMUSE via laparoscopy.Case Presentation: A 47-year-old man arrived to the emergency room with intense colicky pain initiated 24 hours before arrival, accompanied by nausea, gastrobiliary vomiting, constipation and inability to pass flatus. Physical examination revealed abdominal distension, generalized abdominal tenderness to palpation, peristalsis with metallic tone, no signs of peritoneal irritation, and extremities with mild edema. Laboratory exams showed hyperglycemia, hyponatremia and hypoalbuminemia. Plain abdominal X rays reveled dilated loops of small bowel and fluid levels mainly on the left hemiabdomen, suggesting mechanical ileus. No evidence of free air in the abdomen was found. Intravenous fluids and electrolyte replacement was initiated and a nasogastric tube was inserted for decompression. Medical management failed to improve the symptoms after 24 hours, so an exploratory laparotomy was performed. The affected segment was resected laparoscopically. Pathology reported multiple sites of ulceration concerning the mucosae and submucosae, myenteric plexus hypertrophy and pseudo pyloric gland metaplasia. Multiple eosinophils and neutrophils were detected. Patient was discharged from the hospital on the fifth postoperative day and started with prednisolone 30mg/day for 3 months. Three years after he has not had any other episode of intestinal obstruction.Conclusion: Diagnosis of CMUSE must be considered in cases of repeated attacks of small bowel obstruction and when stenotic areas and superficial ulcers are found. Laparoscopic surgery should be considered in patients with repeated attacks of intestinal obstruction and in whom CMUSE is suspected because it permits a diagnosis and resection of the affected segments with the advantages on the minimal invasive surgery.
      PubDate: 2014-11-10
      Issue No: Vol. 2 (2014)
  • Right-sided diaphragmatic eventration with gastric volvulus and abnormal
           rotation of liver

    • Authors: Rakesh Mehra, Uma Debi, Anupam Lal, Saroj Kant Sinha, Nadeem Parvez, Kaushal Kishor Prasad
      Abstract: Background: Diaphragmatic eventration is permanent elevation of an immobile hemidiaphragm. It is commonly described on the left side and very rarely on the right side. It usually is associated with acute gastric volvulus with strangulation. Sometimes it is complicated with malrotation of abdominal contents. Mesenteroaxial volvulus is usually primary, without an underlying diaphragmatic defect.Case Presentation: A 50-year-old male presented with occasional shortness of breath and intermittent abdominal pain for past four months. Chest examination revealed decreased movements on right side. Chest X-ray showed elevated right hemidiaphragm and minimal left sided mediastinal shift. Fluoroscopy revealed decreased movement of the right hemidiaphragm. Contrast enhanced CT scan of the chest and abdomen revealed that right hemidiaphragm was raised and reaching up to the level of horizontal fissure. Mild basal atelectasis was present in underlying lung parenchyma. There was herniation of liver with mild rotation, right kidney, hepatic flexure of colon, few jejunal loops, abdominal fat and few mesenteric vessels into the right thoracic cavity. Upper gastrointestinal contrast study revealed displacement of antrum above the gastroesophageal junction. A diagnosis of eventration of right diaphragm with abnormal rotation of liver and mesenteroaxial gastric volvulus was made.Conclusion: The prompt diagnosis of right diaphragmatic eventration with mesenteroaxial gastric volvulus and abnormal rotation of liver is critical to avoid catastrophic complications of ischemia, perforation and strangulation as early management in such cases without gastric necrosis is associated with less postoperative morbidity and mortality.
      PubDate: 2014-11-04
      Issue No: Vol. 2 (2014)
  • Married women’s access to resources and decision making power in
           Nekemte Town, West Ethiopia

    • Authors: Elias Teferi, Sileshi Garoma
      Abstract: Background: Gender equality and non-discrimination on the basis of sex are fundamental human rights. Studies in this respect are scarce in Ethiopia in general and study area in particular. Hence, this study was aimed at assessing married women’s access to resources and decision making power and associated factors.Methods: A cross-sectional community based household survey supplemented by qualitative study was conducted from April 1-30, 2012. A sample of 845 married women was randomly selected from six sub cities of the town by using a multistage sampling technique. Three focus group discussions were conducted to complement the quantitative data. Data was entered and analyzed using IBM SPSS statistical software 20. Thematic analysis was used for qualitative data.Results: Sixty three percent of the respondents reported that they had net access to resources. Access to resources was significantly associated with the predictor variables such as age (AOR, 2.14; 95% CI: 1.33 to 4.12), access to media (AOR, 0.70; 95% CI: 0.007 to 0.714), educational status, (AOR, 0.36; 95% CI: 0.19 to 0.67), income (AOR, 2.14; 95% CI: 1.24 to 3.72), and duration in marriage (AOR, 2.87; 95% CI: 1.22 to 6.75). Also, 64.3% had net decision making power. Decision making power was significantly associated with access to media (AOR, 0.32; 95% CI: 0.17 to 0.60), occupational status (AOR, 0.20; 95% CI: 0.10 to 0.42), duration of marriage (AOR, 0.39; 95% CI: 0.19 to 0.84) and number of children (AOR, 3.10; 95% CI: 1.65 to 5.80).Conclusion: A significant proportion of the respondents had no access to resources and decision making power that needs an urgent attention at all levels of societal hierarchy including policymakers, stakeholders and professionals to enhance women’s access to resources and decision making power.
      PubDate: 2014-09-07
      Issue No: Vol. 2 (2014)
  • Ultrasound and MRI findings of syntelencephaly and correlation with
           perinatal pathology

    • Authors: Nurtac Akgul, Cem Y Sanhal, Serap Toru, Inanc Mendilcioglu, Kamil Karaali
      Abstract: Background: Holoprosencephaly (HPE) is a complex brain malformation characterized by impaired midline cleavage of the embryonic forebrain. Syntelencephaly (SE) is an uncommon and distinct subset of holoprosencephaly. In cases with syntelencephaly, hemispheric fusion does not occur at rostral forebrain but rather across posterior frontal region. Here we report ultrasound and magnetic resonance findings of a fetal case with syntelencephaly, which is an extremely rare prenatal diagnosis, and its correlation with fetal autopsy.Case Presentation: A 20-year-old woman gravida 2, para 1 at 26th week of gestation was referred to our perinatology unit for second opinion ultrasound (US). The couple was third degree consanguine and their first child suffered from hearing loss with no detectable etiology. On axial and sagittal planes of grayscale US, bilateral ventriculomegaly, absence of cavum septum pellucidum and interventricular septum with the presence of interhemispheric fissure and suspected agenesis of corpus callosum were detected. Additionally, coronal examination revealed suspected cerebral hemispheric fusion and absence of interhemispheric fissure near the fetal vertex. Fetal cranial magnetic resonance imaging (MRI) revealed dilatation at all anatomic regions of lateral ventricles and no interventricular septum. Interhemispheric fissure was present at anterior frontal and occipital regions. However, the middle part of the interhemispheric fissure was absent and the fusion of both hemispheres was evident between posterior frontal and parietal regions. Additionally, the midbody of corpus callosum was absent. These findings were considered as the characteristics of SE. Amniocentesis revealed normal karyotype and the couple chose pregnancy termination after our disclosure about the possible poor postnatal prognosis of the entity. Conclusion: The diagnosis of fetal HPE and its subtypes is important to determine prognosis and proper parental counselling. As in our case, multidisciplinary approach should be performed for the accuracy of the diagnose and fetal brain MRI may play an important role in more subtle cases.
      PubDate: 2014-08-31
      Issue No: Vol. 2 (2014)
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