Fatal pulmonary embolism following shoulder arthroplasty: a case report

<p>Abstract</p> <p>Introduction</p> <p>Fatal pulmonary embolism following a shoulder joint replacement is a rare event. The exact prevalence of shoulder arthroplasties is not clear. Unlike hip and knee joint replacements where some form of thromboprophylaxis is routinely prescribed, no such guidelines and practice exist for shoulder replacements. Other case reports have confirmed fatal and non-fatal pulmonary embolisms following shoulder replacements, but particular risk factors were identifiable in those patients.</p> <p>Case presentation</p> <p>We report the case of a 73-year-old Caucasian woman with fatal pulmonary embolism secondary to a calf deep vein thrombosis following a shoulder joint replacement procedure. The patient was otherwise healthy; there were no other risk factors directly contributing to deep vein thrombosis and pulmonary embolism except for a body mass index of 34. Post-mortem examination confirmed that the patient had a thrombus in the calf and a pulmonary embolus.</p> <p>Conclusions</p> <p>Fatal deep vein thrombosis and pulmonary embolism can occur following shoulder joint replacements in otherwise normal patients. A high degree of suspicion should therefore be maintained in susceptible individuals. Thromboprophylaxis needs careful consideration in shoulder replacements in susceptible individuals.</p

The Relationship of Cardiovascular Disease to 30-Day Hospital Readmission Among Older Adults with Type 2 Diabetes Mellitus

Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization. The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM.Factors to be investigated are: patient demographics and whether the patient was hospitalized for cardiovascular disease. Participants were older adults\u3e65 years old with T2DM, admitted to a community hospital from January 2012-January 2017.Of 843 patients, 200 were randomly selected to have their electronic medical records reviewed for this study.Patients readmitted within 30 days of discharge were similar to patients who were not readmitted on most demographic characteristics, except for hospitalization in the 12 months before admission. Readmitted patients were more likely to have been hospitalized for cardiovascular disease than not readmitted patients. Older adults with T2DM who were readmitted within 30 days post-discharge were more likely to have had a previous hospitalization and more likely to have been hospitalized for cardiovascular disease.Future analyses will incorporate additional potential predictors of unplanned hospital readmissions

The Relationship of Risk of Falls and Activities of Daily Living to 30-Day Hospital Readmission Among Older Adults with Type 2 Diabetes

Introduction: Reducing thirty-day hospital readmissions is a top healthcare priority. However, there is little research describing the risk factors of readmission among patients with diabetes, especially for older adults. Understanding what the risk factors are for 30-day hospital readmission for older adults with type 2 diabetes (T2DM) would help identify patients at risk of rehospitalization.Objective: The aim of this study was to identify factors associated with 30-day unplanned hospital readmissions among older adults with T2DM. Factors to be investigated are: patient demographics, whether patients were at risk for falling, and patients’ activities of daily living (ADL) at discharge.Methods: Participants were older adults \u3e 65 years old with T2DM, admitted to a community hospital from January 2012-January 2017. Of 843 patients, 200 were randomly selected to have their electronic medical records reviewed for this study.Results: Patients readmitted within 30 days of discharge were similar to patients who were not readmitted on most demographic characteristics, except for hospitalization in the 12 months before admission. No statistically significant differences were found between readmitted and not readmitted patients on whether they were at risk for falls or their ADLS at discharge.Conclusion: Older adults with T2DM who were readmitted within 30 days post-discharge were more likely to have had a previous hospitalization. Readmitted patients did not differ from not readmitted patients on risk for falls or ADLs at discharge. Future analyses will incorporate additional potential predictors of unplanned hospital readmissions

Prosthetic rehabilitation of an orbital defect for a patient with hemifacial atrophy

Removal of an eye may be indicated in cases of congenital abnormality, severe trauma, or disease such as an infection, tumor, or malignancy. The disfigurement associated with a loss of an eye is often accompanied with physical problems, psychological trauma, and a poor quality of life. A prosthetic replacement is the treatment of choice to return the individual to his normal vocation by producing an acceptable and life-like appearance. This article describes prosthetic rehabilitation of a 19-year-old male suffering from facial hemiatrophy with the loss of his left eye due to retinoblastoma when he was 2-year-old using medically graded silicone material. The technique used is simple, cost effective, and easy way for fabrication and rehabilitation of an orbital defect using silicone prosthesis where retention is achieved by a combination of silicone adhesives and tapes, and to a very small extent by bony and soft tissue undercut, hence providing better esthetic and psychological outcome. The acrylic part of the prosthesis was adhered to the socket with the help of a two-way silicon adhesive tape. Since the patient had lost his eye when he was 2-year-old, the development of eye and periorbital tissue on the defect side lead to hemiatrophy; in our approach, we have attempted to build the prosthesis in par with the normal side so that the fullness on the defect side was restored to that of the contralateral side. The fabricated facial prosthesis was durable, esthetic, and had good retention

Aesthetic Rehabilitation with Veneers Using Digital Precision: A Case Report

Smiling is an essential aspect of daily life, and a confident smile can greatly impact an individual's self-esteem. Aesthetic correction of the anterior teeth poses a challenge in dentistry, particularly in cases where there is spacing between the teeth. This can lead to a lack of confidence and negatively affect a person's self-image. Laminate veneers, a cosmetic dental procedure, involve attaching a thin layer of porcelain or resin composite material to the surface of a tooth. Compared to conventional methods, digital technology offers greater precision and efficiency in placing laminate veneers. Computerised templates guide the teeth preparation process, ensuring minimal tooth structure removal and accurate fitting of the veneers. The present report presents a case (43-year-old female patient) of spacing in the maxillary anterior that was corrected using a minimally invasive technique with laminate veneers and a fully digital workflow using lithium disilicate. The use of this material enhances the aesthetics of the patient's smile, requiring minimal tooth reduction and providing a natural appearance. The paper also includes a nine-month follow-up. Incorporating digital technology in the creation and placement of laminate veneers offers numerous benefits, including improved accuracy, reduced turnaround time, and the ability for patients to preview their enhanced smile

Flexural strength and hardness of resins for interim fixed partial dentures

Context: Materials used for the fabrication of interim restorations must satisfy biological, esthetic, and functional needs. Strength and wear resistance are two important physical properties contributing to clinical efficiency. Aim: The objective of this in vitro study was to evaluate and compare the flexural strength and hardness of five resins used for the fabrication of interim fixed partial dentures. Materials and Methods: Five groups containing ten specimens of each material were fabricated in customized brass split molds with dimensions 65×10×2.5 mm. The materials subjected to this study were Revotek LC™ (group RLC), Protemp II™ (group PSC), Acry-lux V™ with regular monomer (group AHC), Acry-lux V™ with self-cure monomer (group ASC), DPI™ self-cure tooth molding powder (group DSC). The specimens were polymerized according to the manufacturers′ instructions and were evaluated for flexural strength using a universal testing machine and for hardness using a microhardness tester. Statistical Analysis: The mean of the five groups was compared using one way analysis of variance (ANOVA) and pair-wise comparison was done using Tukeys honesty significance difference (HSD) test. P≤.05 was considered to be statistically significant. Results: Flexural test results showed that group AHC (79.8950 MPa) had the highest flexural strength followed, in descending order, by group PSC (77.9700 MPa), group ASC (63.7150 MPa), group RLC (58.8110 MPa), and group DSC (51.9840 MPa). Statistically, the difference was found to be highly significant among all the groups. The hardness tests showed that group AHC (17.6900 KHN) had the highest hardness value followed, in descending order, by group PSC (15.9400 KHN), group RLC (12.6000 KHN), group ASC (11.2500 KHN), and group DSC (8.7700 KHN). Statistically, the difference was found to be highly significant among all the groups. Conclusion: Group AHC, representing a heat-polymerizing resin, showed the highest flexural strength and hardness values as compared to auto-polymerizing resins and light-polymerizing resin

A clinico-radiographic study to compare and co-relate sagittal condylar guidance determined by intraoral gothic arch tracing method and panoramic radiograph in completely edentulous patients

Purpose: The purpose of this study was to compare and correlate sagittal condylar guidance determined by intraoral gothic arch tracing method and panoramic radiograph in edentulous patients. Materials and Methods: Twelve completely edentulous patients were selected by the inclusion and exclusion criteria. Conventional steps in the fabrication of complete denture till jaw relation were carried out. Intraoral gothic arch tracing and protrusive interocclusal records were obtained for each patient. Protrusive interocclusal record was used to program the Hanau Wide-Vue semi-adjustable articulator, thus obtaining the sagittal condylar guidance angle. Using RadiAnt DICOM software, on the orthopantomogram obtained for each patient in the study, two reference lines were drawn. The Frankfort's horizontal plane and the mean curvature line (joining the most superior and the inferior points on the glenoid fossa curvature) were drawn. The mean curvature line was extended to intersect the Frankfort's horizontal plane, thus obtaining the radiographic sagittal condylar guidance angle. The condylar guidance angles obtained by these two methods were compared and subjected to paired t-test. Results: There was no statistically significant difference between the sagittal condylar guidance angles obtained between right and left sides with intraoral gothic arch tracing and radiographic methods (P = 0.107 and 0.07, respectively). Conclusion: Within the limitations of this study, it was concluded that the protrusive condylar guidance angles obtained by panoramic radiograph may be used for programming semi-adjustable articulators

Evaluation of accuracy of transfer of the maxillary occlusal cant of two articulators using two facebow/semi-adjustable articulator systems: An in vivo study

Aim: The aim of this study was to compare the accuracy of the angle made by Frankfort horizontal plane-occlusal plane on maxillary casts, mounted using the respective facebows on Artex Amann Girrbach and Hanau Wide-vue semi-adjustable articulators with cephalometrically derived Frankfort horizontal plane-occlusal plane angle as a control. Subjects and Methods: Maxillary casts of 30 subjects were mounted on Hanau Wide-vue and Artex Amann Girrbach semi-adjustable articulators following facebow transfer using respective facebows. The Frankfort horizontal plane-occlusal plane angles of these casts were measured using Wixey's digital angle gauge. They were also subjected to a lateral cephalogram, and the occlusal cant was measured using RadiAnt DICOM software. Statistical Analysis: Using Pearson correlation, the accuracy of the angle made by upper member of the articulator and occlusal plane of mounted maxillary casts in each of the articulator was compared to the Frankfort horizontal plane-occlusal plane angle in lateral cephalogram. Results: A mean difference of 1.9° was found between Hanau Wide-vue articulator and lateral cephalogram and a mean difference of 3.6° was found between Artex Amann Girrbach articulator and lateral cephalogram. Statistically, Pearson correlation value (r) obtained between Hanau Wide-vue and lateral cephalogram was 0.46 and between Artex Amann Girrbach and lateral cephalogram was 0.25. Conclusion: From the statistical value (r) derived, it can be inferred that the Frankfort horizontal plane-occlusal plane angle of the casts articulated on Hanau Wide-vue articulator was more accurate in comparison to that on Artex Amann Girrbach articulator

Prevalence and Characterization of Methicillin-Resistant <i>Staphylococcus aureus</i> from Community- and Hospital-Associated Infections: A Tertiary Care Center Study

The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become increasingly prevalent in both community and hospital settings. The aim of this study was to determine the prevalence, molecular characteristics and antibiotic resistance profiles of CA-MRSA from community- and hospital-associated infections in a tertiary care hospital in Mangalore, India. Of 520 S. aureus isolates, 362 were from inpatients (IP) and 158 were from outpatients (OP). One-hundred and thirty-two MRSA isolates obtained from 94 inpatients and 38 outpatients with complete clinical details were further analyzed. Of these, 81 (61.4%) were CA-MRSA (IP-47.9%, OP-94.7%) and 51 (38.6%) were HA-MRSA (IP-52.1%, OP-5.3%). All (100%) MRSA isolates were mecA gene positive. SCCmec typing identified SCCmec type IV (50.6%) and SCCmec type V (66.7%) in CA-MRSA, while SCCmec type I (41.2%), SCCmec type III (19.6%), SCCmec type IV (31.4%) and SCCmec type V (25.5%) were detected in HA-MRSA isolates. The Panton–Valentine Leukocidin (PVL) gene was found in 70.4% of CA-MRSA, 43.1% of HA-MRSA with SCCmec type IV and SCCmec type V, and in 7.8% of true HA-MRSA. The antibiotic resistance profiles were determined by the disc diffusion method. Resistance to cefoxitin was used to identify MRSA. A significant difference (p < 0.05) was observed between CA-MRSA and HA-MRSA with respect to resistance against cephalexin, cefotaxime, levofloxacin, linezolid and teicoplanin. CA-MRSA was predominantly resistant to ciprofloxacin (86.4%), erythromycin (66.7%), ofloxacin (49.4%), cefotaxime (44.4%), gentamicin (40.7%) and clindamycin (40.7%), while HA-MRSA showed resistance against ciprofloxacin (80.4%), erythromycin (80.1%), cefotaxime (70.6%),ofloxacin (58.8%), clindamycin (47.1%) and levofloxacin (41.2%).This study reports the prevalence of CA-MRSA in community and hospital settings and the possibility of multidrug-resistant CA-MRSA replacing HA-MRSA in hospitals. The observations from our study emphasize the need for urgent measures to manage this emerging crisis in healthcare settings

Nasal reconstruction with silicone using customised impression technique

Facial defects can result from a variety of reasons including trauma, burns, infections, congenital disorders, and neoplasms which require surgical correction or prosthetic rehabilitation or both. Prosthetic replacement using various materials is the treatment of choice when other surgical options are not possible. This report presents a case of acquired nasal defect secondary to a surgically operated adenoid cystic carcinoma using silicone as the material of choice