38 research outputs found

    Oral Pemphigus Vulgaris: Case Report

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    BACKGROUND: Pemphigus is a potentially life threatening autoimmune disease that causes blisters and erosions of the skin and the mucous membrane. The epithelial lesions are a result of auto-antibodies that react with desmosomal glycoproteins that are present on the cell surface of the keratinocyte. The autoimmune  reaction against these glycoproteins causes a loss of cell to cell adhesion, resulting in the formation of  intraepithelial bullae. Eighty to ninety percent of patients with pemphigus vulgaris develop oral lesions and in 60% of cases oral lesions are the first sign. Timely recognition and therapy of oral lesion is critical as it may prevent skin involvement. If treatment is instituted during this time, the disease is easier to control and the chance for an early remission of the disorder is enhanced.CASE DETAILS: This case report describes the case of a patient who complained of ulcers of the mouth and difficulty in swallowing since 20 days, who was diagnosed as having Pemphigus vulgaris. Due to early  diagnosis, lower doses of medication for a shorter period of time could control the disease.CONCLUSION: Dental professionals must be sufficiently familiar with the clinical manifestations of  pemphigus vulgaris to ensure early diagnosis and treatment which in turn determines the prognosis and course of the disease.KEYWORDS: Pemphigus, oral lesions, mucous membrane, chronic oral ulcers, pemphigus vulgari

    Scleroderma and dentistry: Two case reports

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    © 2016 The Author(s).Background: Scleroderma is a chronic connective tissue disorder with unknown etiology. It is characterized by excessive deposition of extracellular matrix in the connective tissues causing vascular disturbances which can result in tissue hypoxia. These changes are manifested as atrophy of the skin and/or mucosa, subcutaneous tissue, muscles, and internal organs. Such changes can be classified into two types, namely, morphea (localized) and diffuse (systemic). Morphea can manifest itself as hemifacial atrophy (Parry-Romberg syndrome) although this remains debatable. Hence, we present a case of morphea, associated with Parry-Romberg syndrome, and a second case with the classical signs of progressive systemic sclerosis. Case presentation: Case one: A 20-year-old man of Dravidian origin presented to our out-patient department with a complaint of facial asymmetry, difficulty in speech, and loss of taste sensation over the last 2 years. There was no history of facial trauma. After physical and radiological investigations, we found gross asymmetry of the left side of his face, a scar on his chin, tongue atrophy, relative microdontia, thinning of the ramus/body of his mandible, and sclerotic lesions on his trunk. Serological investigations were positive for antinuclear antibody for double-stranded deoxyribonucleic acid and mitochondria. A biopsy was suggestive of morphea. Hence, our final diagnosis was mixed morphea with Parry-Romberg syndrome. Case two: A 53-year-old woman ï»żof Dravidian origin presented to our out-patient department with a complaint of gradually decreasing mouth opening over the past 7 years. Her medical history was noncontributory. On clinical examination, we found her perioral, neck, and hand skin to be sclerotic. Also, her fingers exhibited bilateral telangiectasia. An oral examination revealed completely edentulous arches as well as xerostomia and candidiasis. Her serological reports were positive for antinuclear antibodies against centromere B, Scl-70, and Ro-52. A hand and wrist radiograph revealed acro-osteolysis of the middle finger on her right hand. Hence, our final diagnosis was progressive systemic sclerosis. Conclusion: Through this article, we have tried to emphasize the importance of a general examination when diagnosing rare systemic diseases such as scleroderma and the role of the general dentist when caring for such patients, even though they can be quite rare in general practice.published_or_final_versio

    A Randomised Controlled Trial Comparing Ketamine versus Fentanyl for Procedural Sedation in the Emergency Department for Adults with Isolated Extremity Injury

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    Introduction: Alleviating pain and anxiety of patients during procedures is an essential skill for an Emergency Physician (EP). Several sedatives and dissociative agents are used for PSA (Procedural Sedation and Analgesia). In this study, we aimed to compare two drugs that is, ketamine and fentanyl for procedural sedation in adults with isolated limb injuries in the Emergency Department (ED). Materials and methods: In this prospective, randomised controlled interventional trial, patients aged between 18 to 65 years with isolated extremity injury requiring PSA in the ED were recruited. A total of 200 subjects were included in the study and randomly allocated to either the fentanyl (n=100) or the ketamine (n=100) group. Patients were blinded to the intervention and subsequently premedicated with Midazolam. Following this, they received either ketamine or fentanyl based on the group they were allocated to. Vital signs, including but not limited to the level of sedation, were measured at predetermined time intervals. A Modified Aldrete Score of >8 was used as a criterion for disposition from the ED. Data were collected in a pre-designed proforma. We aimed to compare the effectiveness as well as ascertain the safety profile of the two drugs for PSA in the ED. Results: There was no significant difference between the two groups when age, gender, mechanism of injury and comorbidities were compared. We found that there was no statistically significant difference between the two groups when blood pressure, respiratory rate and depth of sedation were compared. In both groups, there was a significant decrease in pain on the Numerical Rating Scale (NRS) following drug administration from 8 to 3 (p<0.001). Patients in the fentanyl group had an increased incidence of transient oxygen desaturation (p<0.001). Vomiting was more common in the ketamine group (p<0.001). Conclusion: PSA is a safe and efficacious procedure for patients undergoing painful procedures in ED. Patients in both the groups maintained hemodynamic stability throughout the procedure. From our study, we were able to conclude that both ketamine and fentanyl are similar in efficacy for PSA in the ED for adults with isolated limb injuries. In addition, no significant cardiovascular adverse events were noted in either group in our study

    Modeling growth, lipid accumulation and lipid turnover in submerged batch cultures of Umbelopsis isabellina

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    The production of lipids by oleaginous yeast and fungi becomes more important because these lipids can be used for biodiesel production. To understand the process of lipid production better, we developed a model for growth, lipid production and lipid turnover in submerged batch fermentation. This model describes three subsequent phases: exponential growth when both a C-source and an N-source are available, carbohydrate and lipid production when the N-source is exhausted and turnover of accumulated lipids when the C-source is exhausted. The model was validated with submerged batch cultures of the fungus Umbelopsis isabellina (formerly known as Mortierella isabellina) with two different initial C/N-ratios. Comparison with chemostat cultures with the same strain showed a significant difference in lipid production: in batch cultures, the initial specific lipid production rate was almost four times higher than in chemostat cultures but it decreased exponentially in time, while the maximum specific lipid production rate in chemostat cultures was independent of residence time. This indicates that different mechanisms for lipid production are active in batch and chemostat cultures. The model could also describe data for submerged batch cultures from literature well

    Evaluation of efficacy of tacrolimus 0.1% in orabase and triamcinolone acetonide 0.1% in orabase in the management of symptomatic oral lichen planus randomized single blind control study

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    Objectives: Studies done on the management of oral lichen planus using tacrolimus are limited. The aim of the study is to compare the efficacy of tacrolimus with tramcinolone acetonide topically in the management of symptomatic oral lichen planus and also to evaluate adverse effects and opportunistic yeast infections. Materials and methods: A randomized controlled study was conducted on 60 patients with symptomatic lesions of oral lichen planus with biopsy proven who fulfilled the inclusion criteria. Study group comprised of 30 patients who received topical 0.1 tacrolimus in orabase therapy for 4 weeks. Control group comprised of 30 patients who received topical 0.1% triamcinolone acetonide in orabase for 4 weeks. Results: Significant improvement of symptoms (7.80 ΁ 1.90 to 1.2 ΁ 2.6) and clinical scores (3.1 ΁ 1.27 to 2.3 ΁ 1.1) in study group as compared to control group (7.60 ΁ 2.01 to 2.7 ΁ 2.5) and (2.73 ΁ 1.46 to 1.2 ΁ 1.4). No significant adverse effects were observed and no recurrence was noted during treatment and follow-up. Conclusion: Study group has shown significant clinical response (p = 0.002) when compared to control group. However, double-blind, controlled studies are needed to evaluate the efficacy of tacrolimus in the treatment of symptomatic oral lichen planus and to address the safety for long-term therapy

    Familial hypophosphatemic rickets

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    Rickets is the failure of mineralization of osteoid and newly formed bones in a child skeleton. It is commonly associated with vitamin D deficiency; however, it can be because of a decrease in the serum phosphate levels leading to inadequate mineralization of cartilage and bone, consequent skeletal deformities, and growth retardation. The hypophosphatemic conditions that interfere in bone mineralization comprise many hereditary or acquired diseases. One of the hereditary types of hypophosphatemic rickets is the familial hypophosphatemic rickets. This rare variety was diagnosed in a 9-year-old patient who had come with a chief complaint of a missing tooth. In the present case, radiographic aspects of oral and systemic manifestations of familial hypophosphatemic rickets are highlighted

    Can Sagittal Sinus Flow Augmentation Aid in Controlling Intracranial Hypertension? Physiological Rationale and Pilot Feasibility Assessment in a Porcine Model

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    In a porcine model of intracranial hypertension generated by production of intracranial hemorrhage, the sagittal sinus was catheterized and periodic withdrawal of blood was performed. ICP reliably reduced with sinus blood aspiration in both pilot subjects. Our preliminary results suggest a potential role of targeted sagittal sinus aspiration in aiding control of increased ICP conditions, especially when refractory

    Contemporary Results of Bare Platinum Coil Embolization for Wide‐Necked Ruptured Aneurysms: A Subset Analysis of the SMART Registry

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    Background Rupture status and presence of a wide neck are important factors that adversely impact angiographic occlusion after endovascular coiling. A potential strategy to improve occlusion rates in wide‐necked, ruptured aneurysms (WNRA) is modification of coil technology. Methods WNRA were chosen from the SMART registry that comprises 905 intracranial aneurysms treated with SMART bare platinum coils (Penumbra Inc., Alameda, USA) in the US and Canada. WNRA were defined as neck ≄4 mm, dome‐to‐neck ratio <2, or both. Clinical and angiographic data at presentation and follow‐up were assessed. Outcomes included adequate occlusion rate (Raymond–Roy occlusion class I or II), occlusion at 1 year, and good functional outcome (modified Rankin score 0–2) at 1 year. Angiographic outcome was compared for neck ≄4 mm versus <4 mm. Results A total of 143 patients (mean age 59.3, 74.1% female) with 143 WNRA were included. Median aneurysm size was 5.8 mm. 46.2% had a neck ≄4 mm. Balloon remodeling was used in 35.7% (51/143) and stents in 10.5% (15/143). Intraoperative thromboembolic complication rate was 7.0% (10/143). Overall immediate adequate occlusion rate was 78.3% (112/143); postprocedure occlusion rates were lower (62.1%, 41/66 versus 92.2%, 71/77) for aneurysms with necks ≄4 mm than those with necks <4 mm. At 1 year follow‐up, adequate occlusion was achieved in 82.4% (75/91) patients. Aneurysm occlusion improved in 31.9% (29/91) but worsened in 20.9% (19/91) of all patients at 1 year. Retreatment rate among patients who completed the study was 20.2% (20/99). One instance of intraoperative rupture (0.7%) was noted. Good functional outcome was achieved in 57.7% (41/71). Conclusion These results suggest that successful embolization of WNRA with new generation SMART coils can be achieved safely. WNRA continue to require assistive techniques at presentation and also retreatment over time. In addition, neck width may have an adverse impact on angiographic outcome
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