Australasian Medical Journal
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Plasma rich in growth factors in dentistry
No full textBackgroundPlasma rich in growth factors (PRGF) has wider use in many fields of dentistry due to its endogenous biocompatible regenerative potential i.e., their potential to stimulate and accelerate tissue healing and bone regeneration.AimsThis review shows the increasing use of PRGF technology in various fields of dentistry.Methods In the last nine years PubMed has been searched in order to find out published articles upon PRGF in dentistry and 36 papers have been included.Results PRGF technology has many advantages with positive clinical and biological outcomes in tissue healing and bone regeneration.ConclusionIn order to determine the most effective therapeutic value for patients, further research is required
Huge retrorectal cystic teratoma mimicking menengitis
No full textRetrorectal primary mature cystic teratomas are extremely rare and can be challenging to diagnose and treat in adults. These lesions are frequently clinically unrecognized and misdiagnosed. We present a case of a 39-year-old male patient with mature cystic teratoma presenting with repeated episodes of meningitis. He presented to our emergency department with complaints of fever, headache and vomiting since 15 days. He was treated for initial diagnosis as tuberculosis meningitis by a specialist of infection disease with antibiotics after a CSF study which was culture negative. Since he had recurrent meningitis, radiological investigations revealed by suggested it to be a retrorectal mature cyst 20cm in diameter which may be related with the cerebrospinal fluid. He underwent a total cyst excision of the lesion and histopathology confirmed a mature cystic teratoma. We identified about 25 cases of recurrent meningitis associated with dermoid and epidermoid cysts in the Medline literature search. A high index of suspicion is an important factor in making an early diagnosis; rectal examination and radiologic evaluation are also valuable
Intra-luminal intestinal metastasis from malignant pleural mesothelioma
Get PDFMalignant pleural mesothelioma (MPM) is a locally invasive tumour that rarely metastasises. Gastro-intestinal (GI) metastases from MPM are extremely uncommon. We present a case of a 73-year-old patient hospitalized for abdominal pain. Since a faecal occult blood test was positive, he underwent a colonoscopy identifying an intestinal adenocarcinoma. CT-scan showed a clinically asymptomatic right pleural tumour lesion histologically consistent with a MPM. A revision of the intestinal histology confirmed a metastasis from the MPM. The diagnosis of GI-MPM metastasis is challenging as it can be clinically and radiologically misdiagnosed. It should be considered in any patient with MPM history
A rare case of invasive aspergillosis complicating rapid progressive glomerulonephritis
Get PDFInvasive aspergillosis (IA) is a known sequel of severe immunosuppression and usually characterized by diagnostic difficulties because of low yield, sensitivity and specificity of positive respiratory culture results. IA is also associated with a mortality rate exceeding 80 per cent even with early detection and aggressive therapy. Patients on immunosuppressive therapy for microscopic polyangiitis complicated by non-neutropenic sepsis are susceptible to IA. It is a huge challenge differentiating between a vasculitis flare and an invasive fungal infection. Early bronchoscopy for tracheal aspiration is the diagnostic test of choice. It may however be difficult to perform this invasive procedure in an unstable patient. Prophylactic fungal therapy is recommended in patients at high risk.A high index of suspicion is pertinent as early therapy may still give a slim chance of survival in some patients. Only a few cases of IA complicating microscopic polyangiitis is reported in the literature. However, to the best of our knowledge there is no reported case of a rapid course with multi-organ failure as seen in this patient
Clinical profile and outcome of critically ill pregnant females with H1N1 influenza
No full textBackgroundRecord based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza.AimsTo study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU) with real-time recombinant polymerase chain reaction (rRT-PCR) proven positive H1N1 cases.Methods A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH) and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired) were analysed.Results There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent) patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness.ConclusionPregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived
The dimensions of the corpus callosum of the cerebrum
No full textAimsTo determine the dimensions of the human corpus callosum and its parts. The objective was also to know its location in the cerebral hemisphere of South Indians. Methods Twenty mid-sagittal sections from formalin fixed human cadaveric brain specimens were used for this study and the parameters recorded were: distances from frontal pole to occipital pole (AB), inferior surface to the superior surface of the brain (CD), frontal pole of brain to genu (AG), occipital pole of cerebrum to corpus callosum splenium (BS), from splenium of corpus callosum to superior colliculus (Ls-SC) and inferior colliculus (Ls-IC), genu to fornix (GF), outer curvature O (G-S) and inner curvature I (G-S) from genu to splenium, the entire outer curvature (OUTCR) and inner curvature (INCUR) from beginning of corpus callosum rostrum to the splenium end. We did also measure the thicknesses of its splenium (S), isthmus (I), body (T), genu (G) and rostrum (R). ResultsStatistical analysis using correlation study showed significance between A-B and B-S, O (G-S) and INCUR, O (G-S) and OUTCR, A-G and R, T and I. Highly significant correlations were found between C-D and Ls-IC, O (G-S) and I (G-S), I (G-S) and G-F, G-F, and G. Very highly significant correlations were seen between I (G-S) and INCUR, Ls-SC, and Ls-IC, T and S. ConclusionThis morphometric study on the corpus callosum provides data that could be valuable in the diagnosis of lesions of the corpus callosum. The data are of particular relevance to neurologists and radiologists
Methadone Maintenance Therapy (MMT) in Malaysia: An observational clinical study
No full textBackgroundMethadone is widely used to treat opiate addiction, in particular heroin. Proper administration via drug optimisation is the only way to achieve net clinical outcomes. AimsThis is an observational cross-sectional study, sought to observe the clinical response to a methadone maintenance therapy (MMT) program. Methods Setting: Four treatment clinics in Kuala Lumpur, Malaysia. Patients and methods: One-hundred and twenty-two methadone patients. Their demographic characteristics, medical history, methadone doses, duration in the program, and compliance rates were recorded. Main outcome measures: The opiate withdrawal scale was used to assess the severity of withdrawal symptoms. Results The mean methadone dose was 50mg (range, 20–160mg). The minimum recorded duration in the MMT program was three months, the maximum was 40 months, and the mean was seven months. 90 per cent of the patients were addicted to multiple substances; of those, 70 per cent were addicted to three or more substances. Many patients reported cravings and seeking behaviours while on methadone.ConclusionGradual increments in methadone doses are relatively safe, but patients should be monitored daily. Doses should be increased to control withdrawal symptoms. Despite optimal dosing, cravings and drug-seeking behaviours may not be controlled in some patients, and an alternative to methadone may be an option