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Critically Ill Patients with Variable Heart Failure in Severe COVID-19 Disease: A Case Series
No full textCOVID-19 disease, while primarily a respiratory disease, has proven itself a multi-system disorder with profound cardiovascular sequelae. In patients with SARS-CoV-2 infection, effective early diagnosis and management of concomitant cardiovascular manifestations of the disease are key to favorable outcomes. Here we present a case series of three patients with varied cardiovascular presentations of severe COVID-19 illness: cardiogenic shock from Takotsubo cardiomyopathy, arrhythmia in a patient with suspected hydroxychloroquine-associated cardiomyopathy, and right-sided heart failure with obstructive shock in the setting of massive pulmonary embolism. Through our experience, we aim to provide a better understanding of the unique spectrum of the cardiovascular effects of severe COVID-19 disease to guide management of the critically ill
Orthodontic Treatment by Compensation of a Skeletal Class III Associated with Mandibular Laterognathy: Aesthetic Challenge and Therapeutic Occlusion
Get PDFIntroduction: This case report describes compensatory orthodontic treatment in a young patient aged 13 years. She presented with a class III skeletal malocclusion associated with mandibular laterognathy. The patient's main reason for consultation was the anterior cross bite and the aesthetics of her smile.Materials and Methods: The chosen treatment was therefore an orthodontic camouflage with the extraction of the first mandibular premolars and the second maxillary premolars, in order to catch a correct anterior articular and restore a good occlusal relationship, however, the mandibular laterognathy was camouflaged by means of dental compensations and also by correcting the deviation of the incisors medians through a class III mechanics with good anchorage management.Results: After 24 months of treatment, an ideal overjet and overbite associated with a Class I canine and molar relationship, was obtained, associated with a perfect coincidence of the interincisor medians.Conclusion: Class III skeletal cases can often be treated either by orthodontic camouflage or surgery. In our case study, the treatment adopted was orthodontic camouflage with extractions. The results of the treatment were satisfactory and the occlusal objectives were achieved. The final harmonious smile pleased the patient and improved her self-esteem and quality of life
Interleukin 6 as a Predictive Biomarker for Atrial Fibrillation after Coronary Bypass Grafting: A Systematic Review
Get PDFAtrial fibrillation (AF) progresses after coronary bypass grafting in 11–40% of patients. Plasma biomarkers such as interleukin 6 (IL-6) can assess the risk of AF development. We performed a systematic review using as sources: PubMed, LILACS, and Cochrane Library databases were investigated using Boolean operators and MeSH terms (Medical Subject Headings Terms) “Atrial Fibrillation AND Interleukin AND Biomarkers”. As the following eligibility criteria: observational studies, studies with coronary artery bypass grafting with plasma levels of IL-6 recorded after the screening, 11 articles were selected. Three studies met the inclusion and exclusion criteria. Results: IL-6 levels in AF group - Ishida et al. reported the plasma levels of IL-6 during the post-operative period as 360 ± 143 pg/mL, while Pretorius et al. reported it to be 380.6 ± 151.1 pg/mL. Lastly, Ziabakhsh-Tabari et al. reported a post-operative plasma IL-6 level of 38.2 ± 32 pg/mL. It is considered that new studies about the object are necessary, and these studies should be more standardized. Preferably, it would be important for the daily measurement of IL-6 and its correlation with AF development for statistical analysis to set the best time for sample collection and cut-off value
Over-The-Counter Sales of Antibiotics at Community Pharmacies in Belize: A Cross-Sectional Simulated Client Visit study
Get PDFAim: In Belize, antibiotics are categorized as prescription-only drugs, and their sales over the counter without a prescription is prohibited. This study assessed the sales and dispensing of antibiotics in community pharmacies without a prescription. Methods: 36 community pharmacies in 4 districts of Belize were assessed for non-prescription sales of antibiotics using a simulated client method (SCM) approach from September to November 2019. Results: The majority (19; 52.8%) of the community pharmacies assessed refused to sell antibiotics without a prescription from a physician. Approximately 17 (47.2%) sold and dispensed antibiotics to simulated clients (SCs) without a prescription. Adequate patient counseling was provided by the pharmacists to the SCs. Conclusion: Some level of lack of compliance with the sales of antibiotics without prescription was observed among community pharmacists in this study. There is a need to reinforce stricter control on the sales and dispensing of antibiotics without prescription in the country of Belize
The Role of Sugars in the Caries Process
Get PDFThe carious disease is a post-eruptive infectious pathology of the hard tissues of the tooth. It is the most common dental disease, with a prevalence of 60 to 90% in school children worldwide. It is a significant public health issue. The caries process involves cariogenic bacteria (mutans streptococci - lactobacilli), which, by metabolizing carbohydrates, produce acids that lower the pH of the oral cavity below a critical threshold and thus cause demineralization of the enamel.Indeed, the consumption of sugars and sweetened products is a known risk factor for caries induction. The most cariogenic sugars are the fast sugars, mainly sucrose, widely used in the food industry. In addition to the nature of the sugar, several other factors condition the appearance of caries disease, namely the quantity of sugar consumed, its consistency, the duration of its contact with the teeth, the time and frequency of its consumption.Among the pillars of caries prevention, the control of the frequency and timing of consumption is essential. If the eradication of free sugars remains challenging to apply, their consumption must be reduced. This article aims first to discuss the link between the different types of sugars and the caries process and then present the current recommendations for the consumption of sugars to prevent caries disease
Mediastinal Mature Teratomas Penetrating the Chest Wall
No full textMediastinal mature teratomas (MMT) are benign and slow-growing tumors in the anterior mediastinum, which can reach a huge size. Surgical resection is often challenging, however, with proper surgical planning, complete resection is feasible with good outcomes. we report a rare case of MMT penetrating the chest wall as a result of chronic inflammation successfully treated with en bloc surgical resection
Fascia Focused Manual Therapy Interventions-Proposed Treatment for Post-COVID Syndrome
No full textThe novel virus identified as severe acute respiratory syndrome coronavirus [SARS-CoV-2] has resulted in the Coronavirus disease [COVID-19] worldwide pandemic. Confirmed cases of COVID-19 has surpassed 57 million people globally and numbers are exponentially increasing weekly. Significant numbers of recovering patients are reporting long-term, on-going painful soft tissue and respiratory complications. While the total number of deaths directly associated with COVID-19 has exceeded 1million people worldwide, a more accurate figure is estimated to be significantly higher due to limited testing and issues around accurately attributing cause of death. Since its earliest emergence experts have identified the primary source of entry to the body being the nasal and oral cavities via aerosol droplets proliferating across the respiratory tract. Similar Coronaviruses have typically caused mild enteric symptoms including nausea, vomiting, diarrhoea, and respiratory diseases including the common cold. In contrast, COVID-19 has been shown to cause acute fatal pneumonia, systemic out-of-control inflammatory responses, over-production of hyaluronan, cytokines, chemokines and C-reactive protein [CRP], leaky blood vessels, clot-causing antibodies leading to coagulation of blood, and resulting blood clots. Recorded high levels of serum Interleukin 6 [IL-6], Interleukin 8 [IL-8] as well as Tumour necrosis factor alpha [TNF-α] and IL-1β have been observed in COVID-19 patients all contributing to connective tissue damage. The connective tissue fascia has been described as “the universal singularity” due to its ubiquitous nature and has been identified in virtually every organ and structure within the body. Based on available evidence this paper suggests that the Corona virus travels upon the highway that is the fascial singularity whence it permeates cells on a local and global level. A significant number of post-COVID-19 [SARS-CoV-2] patients will experience on-going fascia related pain and a wide range of functional issues. Based on current research this short report proposes that appropriate fascia focused manual and movement therapy interventions will assist patients in recovering from the COVID-19 [SARS-CoV-2]. Fascia focused therapeutic interventions are shown to reduce pain and support a re-establishment of function while providing safe, effective and appropriate non-invasive therapy. A comprehensive search was conducted to systematically review research/reports and professional opinions related to post-COVID-19 syndrome. Surveying appropriate research and reports provided unique detail concerning fascial tissue involvement and underlying disease mechanisms including long-term after-effects of the novel Coronavirus disease [COVID-19]
Duckbill Calcaneum Fracture
Get PDFIntroduction: The avulsion fractures of the calcaneal tuberosity represent a rare model of injury that is caused by a powerful tension force of the Achilles tendon associated with or not a direct shock to the calcaneusCase report: We report a case of direct trauma to the heel on the edge of the swimming pool at the sport stroke of swimming.Percutaneous reduction by bone reduction forceps under fluoroscopy with osteosynthesis by two percutaneous cannula screws on Kirchner wires. Equine cast immobilization after removal of the threads. Good clinical and functional radiological evolution.Conclusion: The percutaneous screw under fluoroscopy is the best technique with good results anatomical and functional and aesthetic
Male Infertility - An Analysis in a Low Resource Setting
Get PDFPurpose The prevalence of male subfertility is increasing among couples seeking fecundity in recent years. A prospective study was carried out in a gynecological outpatient, to determine the benefit of a low-cost algorithm for the diagnosis of adult males with suboptimal semen parameters. Materials and Methods Twenty-nine males, who had a sperm concentration of less than 15 million/ml were considered in the study. The cost of diagnosis was kept low; not exceeding 150 US dollars. A similar algorithm of the investigation was followed for all patients and medical treatment was provided as per treatment guidelines. Results A confirmed etiology could be determined in 9 patients, while a probable diagnosis was suggested in 17 males. Endocrino-metabolic causes were the most important etiological factors in our Indian population. Lifestyle diseases like obesity, and insulin resistance were prominently found in the suspected acquired hypogonadotropic hypogonadism group..Medical treatment was provided to 24 males, and 64% showed good improvement in the seminal count, after 3 months of therapy. Only selected patients were referred to higher tertiary centers, for specific interventions like sperm retrieval techniques, and intracytoplasmic sperm injection of the female partner. Conclusion This study proves that male subfertility can be managed in a low-resource semiurban center, with the help of a simple algorithm with ease and proficiency, hence reducing the economic burden on these couples. Also, this analysis has helped us to ascertain the relative propensity of etiological factors among adult males with infertility, in North India at the present time