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Long-Term Outcomes in 831 Kidney Transplant Recipients with 20 Years of Graft Function
Get PDFAn understanding of long-term outcomes for kidney transplant(KTx) recipients who survive with graft function beyond a specific time posttransplant is the first step in creating protocols to optimize care for current and improve outcomes for future recipients. We studied 831KTx recipients-580 living donor(LD); 251 deceased donor(DD)—with graft survival(GS) >20 years. For primary LD recipients, 25-year patient survival(PS) was 83%; 35-year, 59%. Their 25-year death-censored graft survival(DCGS) was 89%; 35-year, 72%. DD recipients had lower PS(P<0.01), DCGS(P<0.01). After 20 years, two major causes of graft loss(GL) were death with function(DwF)(58%, LD; 58%, DD) and interstitial fibrosis and tubular atrophy(IFTA)(22%, LD; 23%, DD). Two major causes of DwF were cancer(31%, LD; 31%, DD) and cardiovascular disease(CVD)(19%, LD;17%, DD). Per multivariate analysis(MVA), risk factors for GL after 20 years in pre–calcineurin inhibitor(CNI) era were human leukocyte antigen(HLA) mismatches >3 antigens, pretransplant type 1 diabetes mellitus(DM1); in CNI era, a history of rejection, female gender. New comorbidities after 20 years were common: CVD(13%, non-DM1;18%, DM1), infections(27%, non-DM1;37%, DM1), 20-29 years posttransplant. Cancer after 20 years included: nonmelanotic skin cancer,22%; solid organ,7%; post-transplant lymphoproliferative disease(PTLD),2%. To improve long-term outcomes, clinical trials on prevention, recognition, and treatment of new comorbidities are needed
Control of Metastatic Tumor Growth in a Patient with Sporadic Metastatic Malignant Peripheral Nerve Sheath Tumor (sMPNST) Using the Hope Protocol, an Alternative Treatment Regimen for Cancer
No full textMetastatic sporadic malignant peripheral nerve sheath tumor (sMPNST) is associated with only 17% five-year survival rate using standard chemotherapy and there are no 10-year survival reports with the exception of a case report wherein a patient with metastatic sMPNST is still alive with no active disease and on no further cancer therapy, >12 years from DeltaRex-G treatment initiation. In this case report, we describe an interim alternative treatment regimen designed and used by a patient with metastatic sMPNST, while awaiting the return, GMP bioproduction, and QC certification of DeltaRex-G as a potential treatment option. We report on the successful control of metastatic tumor growth over a one-year treatment period using the Hope Protocol consisting of artemisinin, curcumin, cannabis oil, disulfiram, fenbendazole, mebendazole, albendazole, atorvastatin, doxycycline, vitamin C, vitamin E, a plant-based diet, sans refined sugar, yoga, acupuncture, meditation, exercise and hot sauna, and we discuss their biochemical mechanisms of action
Severe Neuroleptic Induced Ischemic Colitis: A Case Report
No full textIschemic colitis (IC) is a rare adverse effect of antipsychotic medications and is most commonly associated with the phenothiazine class of neuroleptics. Different cases reported in patients without other obvious risk factors led to the link between taking neuroleptics and acute ischemic colitis. The severe form is acute necrotizing colitis. This entity is characterized by sudden onset of abdominal pain and bloody diarrhea, progressing rapidly to produce severe illness with general peritonitis and shock.We report a case of a 26 years old Moroccan man, treated for four years for chronic psychosis, admitted to the emergency for abdominal pain and diarrhea. Clinical examination showed a conscious patient, tachycardia at 120 beats/min, febrile to 38.5 ° C, with generalized abdominal defense. Laboratory tests revealed: GB 33400, CRP 290 mg/l, abdominal tomography revealed colonic distension. The patient was prepared and admitted to the operating room. During the intervention, a colonoscopy was performed and shown ulcerated lesions with a purplish background without interval healthy mucosa. A subtotal colectomy with ileostomy and sigmoidostomy were performed. The histological examination of the surgical specimen showed superficial and extended ulcerations without interval healthy mucosa. Thus, no factors for IC were detected by appropriate workup other than the long-time use of neuroleptics. The restoration of continuity by ileorectal anastomosis was achieved two months later with a good clinical outcome, and the patient was recommended for psychiatry to reevaluate his antipsychotic regimen given the association with IC.Our case supports that neuroleptics can promote IC in patients under antipsychotic medications. It should alert physicians who prescribe neuroleptics and colorectal surgeons to the possibility of intestinal ischemia. Although the clinical presentation is non-specific, abdominal pain and distension should be headed, and endoscopy carried out. A better knowledge of this condition should promote earlier diagnosis and improve management
The Place of Dentofacial Orthopaedics in the Treatment Planning of Facial Clefts: About Two Clinical Cases
Get PDFFacial clefts are considered as predominant malformations of the oro-facial sphere due to their frequency, aesthetic and functional repercussions. The overall prevalence of cleft palates is estimated at 1 per 700 births in the general population, with 77% of isolated cases, 16% associated with another malformative pathology, and 7% associated with a known syndrome. They can disrupt soft tissues (upper lip, nasal threshold, nasal wing, palate veil), hard tissues (alveolar arch, dental germs, palate), or both.They constitute a congenital dysmorphosis for which the therapeutic management extends from birth to the end of adolescence. Orthodontic care has evolved considerably in recent years, mainly due to the synergy of the different specialities involved in the care of these children by the multidisciplinary team.These cleft lips and palates have a multifactorial and complex etiology requiring a multidisciplinary approach. Orthodontic treatment has a strategic place in this treatment and involves temporary, mixed, and permanent dentition.The aim of this article is to review the place of dentofacial orthopaedics in the therapeutic calendar of facial cleft management
Determination of the Occlusal Plane in Complete Denture: About the Paterson Technic
Get PDFThe rehabilitation by complete removable denture is commonly used for edentulous patients. The respect of operating procedures represents the main condition for therapeutic success.Among these procedures, the determination and the orientation of occlusal plane remain an important step to respect minutelyIndeed, it is one of the most stages for obtaining an optimal smile esthetic, a facial harmony and improve the oral functions.Various technics were reported by many authors: anatomical, radiographic, and physiologic methods such as piezography and Paterson technic.This later consists on the determination of the individualized occlusal plane according to the registration of physiological movements.In this context, we will describe Paterson method via a case report and discuss its feasibility, clinical effectiveness as well as its advantages compared to others technics
COVID-19 related Psychotic Disorder: Symptomatology in Infected and Uninfected Patients
Get PDFIntroduction: Psychotic disorder has been rarely reported in patients with COVID-19 infection and also in patients affected by the pandemic but who do not have COVID-19 infection. It is unclear if the disorder occurs due to the stress of the pandemic or is due to a cerebral infection of the virus.Methods: on PubMed we searched for all reports of patients who developed a new psychosis during the COVID-19 pandemic to review their symptomatology.Results: Psychotic symptoms were similar in onset, description, duration and severity in patients who had been infected and those who were affected by the pandemic but did not have the infection. In both groups, most patients were young, without previous psychiatric history, had experienced severe external stress due to the pandemic, had an abrupt onset of symptoms, had severe hallucinations and delusions and needed psychiatric hospitalization. The disorder commonly lasted about a week, after which anti-psychotic medications could be stopped.Conclusion: External psychological stress and not cerebral COVID-19 infection is the likely cause of psychotic disorder in both infected and uninfected patients.
Solitary fibrous tumor of the pleura with Doege-Potter syndrome.
No full textA solitary fibrous tumor of pleura (SFTP) is a rare tumor. Complete tumor resection is the curative treatment and the key to preventing recurrence. We present here the case of a 65-year-old female diagnosed with Doege-Potter syndrome who underwent resection of a pleural solitary fibrous tumor
Radiotherapy and Management in Maxillofacial Prosthodontic: Part 1- Before Radiotherapy
Get PDFAnti-cancer treatments (surgery, radiotherapy and chemotherapy) lead to numerous sequelae and side effects, unpleasant or even disabling in the oral cavity. In the absence of appropriate dental care, the consequences can be highly detrimental.The side effects of radiotherapy, the loss of substances following often associated surgical interventions and the unfavorable context of these patients require rational planning and consultation approved by the various practionners.The management of patients before, during and after these anticancer treatments by the specialist in maxillofacial prosthesis is important, in fact the objectives outlined to be achieved in terms of the management of PMF are: restoration of orofacial functions, participation in the proper conduct of anticancer treatment, palliation of its complications and psychological support for these patients.The aim of this article is to review the various complications of radiotherapy, as well as the protocols and recommendations for the management of patients before radiotherapy and to highlight the role of the specialist in maxillofacial prosthodontics in this management
The biological and Mechanical Behavior of the Standard Implant under Removable Partial Dentures: Systematic Review:
Get PDFBackground: The implant-supported removable partial denture appears to be an interesting alternative for cases where the implant-supported fixed prosthesis is contraindicated whether it is for medical, local, or financial reasons. The objective of this systematic review is to evaluate the biological and mechanical behavior of the implant under a removable partial denture.Methods: A literature search was conducted on the following databases: Pubmed [Medline], Science Direct, and Cochrane Library. The research was limited to publications in English and French during the period from 01/1/2007 to 27/03/2020.Results: Of the 334 citations initially identified, 22 articles met our inclusion criteria, assessing the implant survival rate, patient satisfaction, and the occurrence of implant and prosthetic complications. As well as the evaluation of the stress distribution on the three support surfaces of this prosthesis. Finally, the evaluation of implant localization. The results showed a high rate of implant survival and the occurrence of some prosthetic complications. Stable and acceptable bone resorption over the long term. Better stress distribution at the implant and the bone.Conclusion: The biological and mechanical behavior of the implant under this type of prosthesis appears to be viable in the short, medium, and long term. Although this association between implantology and partial prosthesis seems promising, additional studies are needed to spread this practice still reserved for some specific cases
Assessement of the Nasal Shape after Orthognathic Maxillary Surgery
Get PDFBackground: Orthodontic and surgical modifications have been shown to have aesthetic effects on the shape or position of the nose. Aim: To evaluate nasal changes using cephalometric assessment after orthognathic surgery. The PIDAQ was cross-culturally adapted into Malay version by forward- and backward-translation processes, followed by psychometric validation.Methods: A cross-sectional study was carried out involving 20 Moroccan orthognathic patients from January to March 2019. Their mean age was 22.40 (+/-6.98 years). The amplitude of the surgical movements of all patients was measured using measurements on profile teleradiographs and photos of faces taken before and after surgery. The statistical analysis of cephalometric data before and after surgery was performed using the Wilcoxon test. The significance level was p≤0.05.Results: The results revealed a significant reduction in the angular values of SNA (°) (p<0.001), GoGn/SN (°) (p=0.038), Occ/Sn (°) (p=0.007) and AoBo (mm) (p=0.025). No statistically significant differences were noted for specific cephalometric variables before and after surgery as for facial photographs. All the values of the specific measurements before and after were significant except Prn - SN. Conclusion: The width of the base of the nasal wing and the displacement and the amount of rotation of the nasal tip increased considerably in most patients while the X-axis to Prn distance decreased