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Malignant Melanoma of Oral Cavity, A Case-Based Review of the Literature
No full textIntroduction: Primary Mucosal Malignant Melanoma is an aggressive cancer, especially when there is a late diagnosis. The mortality is low in early stages but in advanced stages is less than a 30% on a 5-years following. Only a 0.5% to 3% of Melanomas are Mucosal Melanomas. Among them, the Mucosal Malignant Melanoma of oral cavity is a rare tumor, with an extremely aggressive behavior at diagnosis.Case Report: 51 years old male, consult on April 2015, at Centro de Salud Familiar Flor Pedreros Parra, Trehuaco city, Chile, for dark blue round tumor, 1.5 cm wide, placed near the tooth 1.3, compromising the gum. The patient refers previous consultations with a smaller and flat lesion. He reveals important everyday sun exposure, without proper UV protection. One month later, the tumor grows and becomes indurate, consequently the patient was transferred to Herminda Martin Hospital of Chillán City, where incisional biopsy concludes “Mucosal Malignant Melanoma with infiltration of surroundings tissuesâ€. Chemotherapy is realized with poor results. Last control with Odontology in August 2015, the tumor evolves to a black nodule, 4 cm wide, compromising the upper maxilla, right eye and mouth opening, concomitant to multiple black satellite papula. Computed Tomography showed skull base infiltration, cervical lymphatics and other zones of head and neck. The patient was transferred to palliative care and died before a year from diagnosis.Discussion: The primary Mucosal Malignant Melanoma of oral cavity it’s a very strange condition. It has variable presentations, sometimes like a little maculae with different colors or like a highly pigmented tumor with ulcers or hemorrhage, with a high growing rate. It has an important metastatic potential and a poor prognostic. This is the reason why early clinical suspect and diagnosis is extremely valuable
Purification and Characterization of an Extracellular High Molecular Mass Esterase from Bacillus pumilus
No full textEsterases (EC 3.1.1.x) represent a diverse group of hydrolases catalyzing the cleavage and formation of ester bonds and are widely distributed in animals, plants and microorganisms. The esterase was purified from cell-free culture broth to homogeneity by size exclusion chromatography with 7.7 fold purification and 22.5% yield. The Mr of the purified esterase of B. pumilus was 17 kDa by SDS-PAGE. The esterase appeared to be a novel decameric protein as it possessed a single band of Mr 17 kDa in SDS PAGE and 170 kDa in Native PAGE. A Lineweaver-Burk plot was calibrated to determine Km (3.94 mM), Vmax (49.02 mM/mL/min), Kcat (138.89 sec-1), Kspec (35.28) and Ksi (26.58 mM) values of purified esterase of B. pumilus for its substrate p-nitrophenylacetate. Energy of activation (Ea) of purified esterase of Bacillus pumilus was 2.61 Jmol-1as determined with the help of an Arrhenius plot. The DMSO drastically inhibited the activity of purified esterase while benzene and propan-2-ol were fairly tolerated by the esterase. The potential protease inhibitors such as PMSF, EDTA, SDS and DTT were found to decrease the activity of purified esterase. Thermostability of the purified esterase was checked at 45oC. Purified esterase lost more than 50% of its initial activity at 45oC after 6.5 h of incubation in a water-bath under shaking
Letter to the Editor: Bilateral Spontaneous Adrenal Hematoma: Diagnostic Difficulty of Adrenal Insufficiency
No full textSpontaneous bilateral adrenal hematoma is a rare affection with diverse etiologies and can lead to adrenal insufficiency with life-threatening consequences in the absence of immediate and proper management. The clinical manifestation varies depending on the gravity of the hemorrhage. In most cases, there are no specific signs of adrenal insufficiency; and the diagnosis is made by an incidental finding on an imaging made for another reason. Through this paper, we wish to draw the attention of medical practitioners and endocrinologists on the diagnostic and therapeutic approaches to this seemingly uncommon but potentially life-threatening condition. We illustrate this through a case report of a Moroccan patient - who fully consented to this study - and then propose a decision tree. The diagnosis of adrenal insufficiency complicating a bilateral adrenal hemorrhage was thus retained. Bilateral adrenal hematoma has diverse causes. The prevalence and severity of bilateral adrenal hematomas (BAH) are not be neglected. Be it spontaneous or caused clotting disorder, BAH can lead to adrenal insufficiency, with life-threatening consequences if left unattended to.Computed tomography (CT) scan and magnetic resonance imaging (MRI) are the best imaging techniques for diagnosis. Medical management should be preferred in the absence of acute abdomen or life-threatening condition
A New Endoscopic Resection Method for Rectal Carcinoid Tumor: Underwater Endoscopic Mucosal Resection
No full textAbstrac
Using Medical Students to Create and Sustain Healthy Work Environments for Professional Advancement in Health Care Systems in Abia State, Nigeria
No full textIntroduction: The need for medical students to cordially interact with health care professionals and patients especially those living positively with HIV and AIDS should not be underestimated. Interprofessional education prepares medical students on clinical posting for quality health care services to patients including HIV positive persons who are likely to be discriminated against. Therefore, creating healthy work environments is imperative to ensure patient safety, and enhance staff relationships.Materials and Method: Two days pre-clinical seminar which centered on professionalism, teamwork, interpersonal relationships, and effective communication to guarantee healthy work environments for patients was carried out to prepare 107 medical students for a twelve weeks clinical posting. At the end of the posting, two days post-clinical seminar to harness students’ experiences, views and performances during the clinical posting was conducted. After the seminar, teachers’ observations, remarks as well as students’ experiences, views and performances were grouped together and analyzed qualitatively and quantitatively.Results: A good number of the students 75(70.1%) established good interpersonal relationships with the patients while 63(58.9%) of students had effective interprofessional interaction with other health workers. Also 81(75.7%) of the students indicated that they had good interprofessional interaction with fellow students. Study recorded better health services to clients as evidenced by increase in shared case managements among the students. Students were able to identify pressing challenges in work environments and collaborated with colleagues to find solutions to the challenges.Conclusions: Interprofessional learning can increase students’ understanding of professionalism, teamwork and encourage friendlier environments that will guarantee better health care services to patients
ORIGINAL: How to Improve the Clinical Suspicion of Pulmonary Embolism in Hospitalized Patients
No full textBackground: The high number of missed diagnosis of pulmonary embolism antemortem still has not improved.Objective: To define the causes of misdiagnosis and suggest another way in order to increase the rate of clinical suspicion.Material and Methods: The cases with autopsy-confirmed of PE from 32986 autopsies were studied retrospectively. The data was classified according to the useful points to investigate the causes of undiagnosed antemorten.Results: The number of patients that had the diagnosis suspected of PE antemorten was 692 (24.2 %). The dominant cause of misdiagnosis was deficient clinical suspicion (26.4 %). The underlying conditions that most frequently cause unsuspected PE were heart disease 24.6 % (mainly myocardial infarction), pneumonia (23 %) and cancer (15.1 %). Altogether, the percentage of correct clinical diagnosis of PE was 26.9 % (95 % CI).Conclusions To increase the rate of correct diagnosis of PE, it is necessary to perform the clinical suspicion in the atypical forms that are common, besides the classical markes used
Educational Assistants’ Use of ImPAACT for Increasing Message Selection and Turn-Taking with Children with Complex Communication Needs
No full textContext: Educational assistants (EAs) provide extensive and individualized support for many students who require augmentative and alternative communication (AAC) in school systems. An important factor related to student’s success is EA training and skill development for effective communication with children who use AAC.Case Report: This case series examined ImPAACT: Improving Partner Applications of Augmentative Communication Techniques with three EA and student dyads. The study investigated whether a comparable treatment effect as found in Binger et al. (2010) could be demonstrated. Three phases of intervention (i.e., baseline, instruction, and generalization) were investigated. All phases were completed in the public school setting in which the students were enrolled and the EAs were employed. EA’s correct application of instructional strategies, student’s multi-symbol selections, and student’s turns were calculated. Type and form of student’s turn were calculated as well.Conclusions: All EAs increased correct application of strategies and all students increased use of multi-symbol selections and overall number of turns taken. Students’ type of turn (i.e., response, comment, initiation) and form of turn (i.e., vocalization, gesture, symbol selection) increased and diversified. Variable rates of behavior were noted across EAs and students. Potential explanations for these findings are discussed
Prevalence of Carpal Tunnel Syndrome in Diabetic Patients with and without Metabolic Syndrome
No full textBackground and Objectives: Carpal tunnel syndrome (CTS) is defined as the impaction of the median nerve in the carpal tunnel of the wrist. Metabolic disorders are closely associated with CTS; and metabolic syndrome (MS) is found to be more in patients with CTS. Metabolic syndrome is highly prevalent in patients with type 2 diabetes. This study was conducted to determine the prevalence of CTS in diabetic patients with and without metabolic syndrome.Material and Methods: In this cross-sectional study, 439 diabetic patients that participated in the study of risk factors for coronary artery disease in Kerman (KERCADRS) were enrolled. People with positive clinical symptoms for CTS and a positive Boston questionnaire, were referred to a neurologist for further diagnosis. For the diagnosis of metabolic syndrome, three criteria (ATPIII, IDF and new criteria in Kerman) were used. Also, electro-diagnostic tests were used for the diagnosis of CTS. Data were analyzed by independent t-test and chi square test in SPSS20.Results: The prevalence of CTS in diabetic patients was 24.23%. The prevalence of the disorder in male and female patients was 16.21% and 30.65%, respectively. The results showed that there is no significant difference in the prevalence of CTS in diabetic people with and without metabolic syndrome, in overall as well as sex subgroups.Discussion and Conclusion: The higher prevalence of CTS in diabetic patients in this study compared to other studies shows the lack of prevention and case finding in diabetic patients. Therefore, screening, educating and informing at risk people about the disease is necessary
Effects of Behavioural and Prosthetic Management in a Case with Ankyloglossia and High Arched Palate: Pre and Post Operative Comparison
No full textPurpose: This single subject research design across multiple treatments was aimed towards determining the efficacy of behavioral and prosthetic management in congenital ankyloglossia class IV and high arched palate; pre and post lingual frenectomy.Method: The study was conducted over four phases: two pre operative and two post operative. The first phase was started with behavioral management solely followed by the second phase, where a combination of behavioral and prosthetic management simultaneously, was tried out. The participant then underwent lingual frenectomy. Post operatively, the third phase was initiated with a combinatorial use of behavioral and prosthetic management. However noticing the simultaneous improvement in the range of motion of tongue, a fourth trial phase was conducted, by seizing the prosthetic management and continuing only with the behavioral management.Results: The first two pre operative trial phases resulted in an insignificant shift in percentage of correct consonants (PCC) from 68.59% to 70.93%. However the post operative phases yielded interesting results. Although in the third phase the PCC shifted to 72.7%, but a remarkable improvement was visible in the fourth phase of the study, as the PCC shifted to 84.57%.Conclusion: The results highlighted that in such classical cases, professionals should shed their dilemma of whether to clip the tie or not? This decision will actually help in reducing the unnecessary clinical trials along with better prognosis of client’s speec
Constricting and Validating Hindi Monosyllabic Speech Perception Test Material for Hearing Impaired Children
No full textThe current study aimed to compare speech perception score of children with Hearing impairment using CI and HA. The Hindi speech perception test was designed for children aged between two to six years-old. A total of 226 normal hearing children consisting four groups from 2 years to 6 years participated as normative sample. Test items were selected on the basis of familiarity & frequent consonants occurred in daily uses. Test consists of each set of 40 pictorial stimuli which scored 2 for auditory response, 1 for auditory and visual cues, zero for no response even after auditory and visual stimulation. Similarly in experimental groups, 30 subjects with HI using HA were recruited with mean age 8.083 years consisting of 13 female and 17 male. Other group comprises of 30 subjects with HI using CI with mean age 8.231 years and consisting of 14 female & 16 male. Both the group had exposure to aural –oral therapy for at least 3 years. After‘t’ tail test analysis it was seen that both the group had statistically significant difference in speech perception score. Subjects with CI showed significant higher score in speech perception ability. This research article further discussed the HA technical short coming over C