C-reactive protein a better indicator of inflammation after third molar extraction

Purpose: The purpose of this study was to evaluate the relation between pre-operative pain and pre-operative levels of C-reactive and post-operative pain and swelling in impacted third molar surgery.Materials and Methods: In this prospective study subjects were patients indicated for mandibular third molar extraction. Patients were assessed for certain inclusion and exclusion criteria’s. A standard surgical extraction procedure was followed to reduce the bias. Hematological investigation of C-reactive protein levels were recorded pre-operatively and post-operatively. Pain, swelling and trismus in patients were assessed pre-operatively and post-operatively in an interval of 24 hours, 48 hours and 7 days. Pain and swelling were measured using verbal analogue scale and thread length measurement respectively. The mouth opening was recorded, too.Results: Post-operative C-reactive protein levels were seen consistency raised in those cases which showed high pre-operative levels. Peak levels of C-reactive protein were seen at 48 hours post operatively. It was observed that preoperative pain swelling and mouth opening were seen to be variable in all the cases having high C-reactive protein levels.Conclusion: C-reactive protein was found to be a better indicator of inflammation than pre-operative pain, swelling and mouth opening for post-operative discomfort.Key words: C-reactive protein, inflammation, third molar extraction

HbA1c as a marker to reduce lower limb amputation in patients with type 2 diabetes mellitus

Background: Diabetes mellitus is one of the most serious and prevalent chronic diseases worldwide. One of the most common complications of diabetes in the lower extremity is the diabetic foot ulcer which is the precursor to ~85% of lower extremity amputations in persons with diabetes. Materials and Subjects: This is a case- control study which was carried out at Jabir Abu-Aliz Specialized Center, Khartoum State, Sudan between October 2006 and April 2007. Forty type 2 diabetes cases with septic foot (group 1 cases), 40 type 2 diabetes cases without septic foot (group 2 cases), and 40 healthy controls participated in this study. Their demographic data were collected. Serum HbA1c levels were estimated by affinity chromatography method. Results: The level of HbA1c was 9.947±1.40%, 7.908±0.45% and 6.462±0.07%. in group 1, group 2, and the healthy control respectively. There was significant increase in percentage level of HbA1c in group 1 cases compared to group 2 cases and healthy control (p = 0.002, 0.001 respectively). We found very low correlation between fasting blood sugar and HbA1c in group 1 cases (r = + 0.331; p=0.042). Conclusion: This study indicates that the progression to the complication of foot ulcer in type 2 diabetic patients was correlated to the level of HbAlc. These data may suggest a beneficial effect of considering measurement of HbA1c as a routine test especially for elderly diabetic patients with diabetes for long period. This may help to maintain blood glucose levels in the normal or near normal range and to provide an opportunity for patients to live out their normal life expectancies with minimal complications. Keywords: glycohemoglobin, neuropathy, septic foot, glycemic control.Sudan Journal of Medical Sciences Vol. 3 (3) 2008: pp. 227-23

Correlating the Dermatology Life Quality Index with psychiatric measures: A systematic review.

© 2018 Published by Elsevier Inc. All rights reserved.Skin conditions may have a major impact on the psychologic well-being of patients, ranging from depression to anxiety. The Dermatology Life Quality Index (DLQI) is the most commonly used quality of life tool in dermatology, though it has yet to be correlated with psychiatric measures used in clinical therapeutic trials. We conducted a systematic review to determine whether there is any correlation between the DLQI and psychiatric measure scores, potentially allowing the DLQI to be used as a surrogate measure for depression or psychiatric screening. Six databases were searched using the following keywords: "DLQI," "Dermatology Life Quality Index," "Psych*," "depression," "anxiety," "stress," and "trial*." All randomized trials where full DLQI and psychiatric scores were provided were included. PRISMA guidelines were followed. In all, 462 records were screened, but only seven met inclusion criteria. Hospital Anxiety and Depression Scale (HADS) was the most commonly used psychiatric measure; the "depression" component score changes correlated strongly with the DLQI (r = 0.715). There needs to be guidance on psychiatric measurement and reporting in clinical trials. Although the DLQI correlated well with the "depression" domain of the HADS scale, interviews and screening for depression are still vital for full assessment of patient psychologic well-being.Peer reviewe

Modelling Returns and Volatilities During Financial Crises: a Time Varying Coefficient Approach

We examine how the most prevalent stochastic properties of key financial time series have been affected during the recent financial crises. In particular we focus on changes associated with the remarkable economic events of the last two decades in the mean and volatility dynamics, including the underlying volatility persistence and volatility spillovers structure. Using daily data from several key stock market indices we find that stock market returns exhibit time varying persistence in their corresponding conditional variances. Furthermore, the results of our bivariate GARCH models show the existence of time varying correlations as well as time varying shock and volatility spillovers between the returns of FTSE and DAX, and those of NIKKEI and Hang Seng, which became more prominent during the recent financial crisis. Our theoretical considerations on the time varying model which provides the platform upon which we integrate our multifaceted empirical approaches are also of independent interest. In particular, we provide the general solution for low order time varying specifications, which is a long standing research topic. This enables us to characterize these models by deriving, first, their multistep ahead predictors, second, the first two time varying unconditional moments, and third, their covariance structure

Localizing introgression on the chromosome of rice by genomic in situ hybridization (GISH)

Genomic in situ hybridization was used to detect introgressed segment from Oryza australinesis onto the chromosomes of introgression line derived from the hybrid O. sativa x O. australinesis. Genomic DNA from Oryza australinesis was labeled with biotin and hybridized to the homologous sequences on the O. sativa chromosomes. The probe hybridization fluoresced green and non labeled O. sativa chromosomes appeared red or blue due to counterstaining with propidium iodide (PI) or 4,6-diamidino-2-phenylindole (DAPI). This differential painting of chromosomes unequivocally detected the introgressedsegment. Among the 200 cells analyzed, 6.5% of the cells showed  hybridization signal. Signal appeared on one chromosome in 5%, on two homologous chromosomes in 1% and on sister chromatids in 0.5%of the cells. Hybridization was seen on the short arm of the chromosome 12 of the introgression line

A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination

Background Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of ‘massive open online courses’ (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills. Aims/objectives To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students. Methods Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention. Results There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543). Conclusion Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format. Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research

"Pseudosarcoma" in a pregnant woman

BACKGROUND: Intravascular fasciitis (IVF) is a rare benign condition characterised by reactive myofibroblastic proliferation arising from the superficial or deep fascia and involving arteries and/or veins. It is a distinct variant of the more common condition of nodular fasciitis, which possesses similar clinical and histological features to IVF, but lacks vascular invasion. A thorough review of the literature revealed 26 reported cases of IVF. CASE PRESENTATION: We report a case of IVF in a 16-week pregnant lady affecting the hypothenar eminence of the hand associated with the ulnar artery. CONCLUSION: The characteristic involvement of muscular arteries and veins by reactive myofibroblastic proliferation in IVF suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. We propose that hormone-related changes associated with pregnancy may play an important role in the aetiopathogenesis of this myofibroblastic lesion

Hyperhomocysteinemia and Low Folate and Vitamin B12 Are Associated with Vascular Dysfunction and Impaired Nitric Oxide Sensitivity in Morbidly Obese Patients.

There is a high prevalence of hyperhomocysteinemia that has been linked to high cardiovascular risk in obese individuals and could be attributed to poor nutritional status of folate and vitamin B12. We sought to examine the association between blood homocysteine (Hcy) folate, and vitamin B12 levels and vascular dysfunction in morbidly obese adults using novel ex vivo flow-induced dilation (FID) measurements of isolated adipose tissue arterioles. Brachial artery flow-mediated dilation (FMD) was also measured. Subcutaneous and visceral adipose tissue biopsies were obtained from morbidly obese individuals and non-obese controls. Resistance arterioles were isolated in which FID, acetylcholine-induced dilation (AChID), and nitric oxide (NO) production were measured in the absence or presence of the NO synthase inhibitor, L-NAME, Hcy, or the superoxide dismutase mimetic, TEMPOL. Our results demonstrated that plasma Hcy concentrations were significantly higher, while folate, vitamin B12, and NO were significantly lower in obese subjects compared to controls. Hcy concentrations correlated positively with BMI, fat %, and insulin levels but not with folate or vitamin B12. Brachial and arteriolar vasodilation were lower in obese subjects, positively correlated with folate and vitamin B12, and inversely correlated with Hcy. Arteriolar NO measurements and sensitivity to L-NAME were lower in obese subjects compared to controls. Finally, Hcy incubation reduced arteriolar FID and NO sensitivity, an effect that was abolished by TEMPOL. In conclusion, these data suggest that high concentrations of plasma Hcy and low concentrations of folate and vitamin B12 could be independent predictors of vascular dysfunction in morbidly obese individuals

A rare benign disorder mimicking metastasis on radiographic examination: a case report of osteopoikilosis

Osteopoikilosis (OPK) is a rare, autosomal dominant bone disorder, characterized by multiple, discrete round or ovoid radio densities scattered throughout the axial and appendicular skeleton. OPK is usually asymptomatic but rarely there may be slight articular pain and joint effusions. OPK is generally diagnosed incidentally on radiographic examinations and may mimic different bone pathologies, including bone metastases. Radionuclide bone scan has a critical role in distinguishing OPK from osteoblastic bone metastases. In this case report, we present a young man with right hip pain due to OPK, whose plain radiogram and computerized tomography findings thought cancer metastasis