Antiphospholipid syndrome and neurofibromatosis type I: a coincidence or new association? / Síndrome antifosfolípide e neurofibromatose tipo I: uma coincidência ou nova associação?

ABSTRACT - Numerous studies have reported on structural vascular anomalies and ischemia associated with neurofibromatosis type 1 that are thought to stem from dysfunction of neurofibromin, the neurofibromatosis type 1 protein. Documented cases of associated antiphospholipid syndrome fulfilling the accepted diagnostic criteria are exceptionally rare, with only three cases reported in the literature. Here, we report on a patient with neurofibromatosis type 1 and a history of spontaneous abortions presenting with sudden vision loss in the right eye and swelling of the optic nerve head. Fluorescein angiography indicated anterior ischemic optic neuropathy. Brain magnetic resonance imaging revealed findings consistent with left cavernous sinus meningioma. Serologic testing demonstrated persistently elevated anti-b2-glycoprotein antibodies. Her findings suggested antiphospholipid syndrome with concomitant clinical and laboratory evidence of antiphospholipid syndrome: frequent abortions, a vaso-occlusive episode, and persistently elevated antiphospholipid syndrome antibodies. To our knowledge, this case represents the first neuro-ophthalmic manifestation of antiphospholipid syndrome associated with neurofibromatosis type 1.

RESUMO - Inúmeros estudos têm relatado anomalias vasculares estruturais e isquemia associada com à neurofibromatose tipo 1 que, acredita-se, resultam da disfunção da neurofibromina, a proteína tipo 1 da neurofibromatose. Casos documentados de síndrome antifosfolípide associada que atendem aos critérios diagnósticos aceitos são excepcionalmente raros, com apenas três casos relatados na literatura. Aqui, relatamos um paciente com neurofibromatose tipo 1 e histórico de abortos espontâneos apresentando perda repentina de visão no olho direito e edema de cabeça do nervo óptico. A angiofluoresceínografia indicou neuropatia óptica isquêmica anterior. Ressonância magnética cerebral revelou achados compatíveis com meningioma do seio cavernoso esquerdo. O teste sorológico demonstrou anticorpos anti-b2 glicoproteína persistentemente elevados. Seus achados sugerem síndrome antifosfolípide com evidências clínicas e laboratoriais concomitantes de síndrome antifosfolipídica: abortos frequentes, episódio vaso-oclusivo e anticorpos antifosfolípides persistentemente elevados. Pelo nosso conhecimento, este caso pode representar a primeira manifestação neuro-oftálmica da síndrome antifosfolípide associada à neurofibromatose tipo 1.

Index Admission Laparoscopic Cholecystectomy for Gall Stone Pancreatitis.

Background: Timing of Laparoscopic Cholecystectomy (LC) after gallstone pancreatitis varies considerably between surgeons.We examined outcomes at JN Medical College and hospital where most patients underwent LC following initial management of gallstone pancreatitis. Methods: This prospective study is carried out between June2009 to June 2013 in J.N.M.C.H. Patients with signs and symptoms of acute pancreatitis were admitted and evaluated. All patients admitted were provided the standard care. After exclusion of some patients, remaining underwent laparoscopic cholecystectomy irrespective of severity of disease in index admission, although patients with severe biliary pancreatitis were operated after stabilization of general condition. Results: A total of 134 patients with gallstone pancreatitis were identified of whom 90 underwent laparoscopic cholecystectomy (LC) in the index admission.77 patients were of mild pancreatitis while 13 were of severe pancreatitis. Out of 77 patients with mild pancreatitis 8 patients and 6 out of 13 patients with severe pancreatitis had a difficult dissection (p value<0.05).In terms of hospital stay mean duration of stay was 8.7 days in mild pancreatitis group, whereas it is 19.8 days in severe pancreatitis group (p value <0.05). Of these 90 patients79 (88%) underwent LC successfully while 11 (12%) required conversion to open cholecystectomy where 8 were of mild and 3 were of severe pancreatitis. 14 (15%) had a difficult dissection, where 8 were of mild and 6 were of severe pancreatitis There were 6 (6.7%) postoperative complications in form of wound infection and bile leak overall. The difference in terms of variables like conversion rate to open surgery, need of drain placement, bile leak and wound infection was statistically not significant.Conclusion: LC should be used for GSP during the same hospital admission with favorable outcome with complications and conversion rate compared to elective LC. All patients of mild pancreatitis and patients of severe pancreatitis with no local and systemic complications could undergo laparoscopic cholecystectomy in index admission.

Prevalence of needle stick injuries among doctors and nurses working in Sheikh Zayed hospital Rahim Yar Khan

Background: Needle stick injuries remains potential source of transmission of infections

Objective: To determine the prevalence of needle stick injuries among doctors and nurses working in Sheikh Zayed Hospital Rahim Yar Khan

Methodology: This cross sectional study was conducted from 1[st] June to 31[st] December 2014. All the nurses and medical officers who were listed in the medical superintendent office of the Sheikh Zayed Hospital Rahim Yar Khan were included in the study. A structured, self administered questionnaire was designed to describe the occurrence of needle-stick injuries among respondents. The questionnaire sought information about socio-demographic characteristics such as age, sex, marital status and years of experience. The questionnaire also included information about the frequency of being stuck by a needle or a sharp instrument while at work during the last six months. A yes/no response were used to assess whether the doctor/nurse reported the injury. The participants were asked about the reasons of needle stick injuries and how they managed the incident. Data analysis was performed using SPSS, version 17. The chi-square test was used to assess the association between duration of service and needle stick injuries

Results: Total of 308 health care workers [HCWs] participated in this study which included 173 medical officers and 135 nurses. About half of the medical officers were in the age category of 30 to 39 years while half of the nurses in 20 to 29 years of age. Among these HCWs 27.8% medical officers and 25.2% nurses had above 10 years of work experience. Needle stick injury was reported by 22.54% doctors and 37.78% nurses in the past six months and it was found significantly higher among nurses as compared to doctors [p=0.001]. Among perceived reasons of needle stick injuries the most frequently reported reason was workload [48.7% doctors, 56.9% nurses] followed by Recapping of needle [30,8% doctors, 21.6% nurses], hurriedness [12.8% doctors, 13.7% nurses] and non-cooperation of patient [7.7% doctors, 7.8% nurses]. After needle stick injury only 38.5% doctors and 25.5% nurses washed it with disinfectant. Duration of service was significantly associated with needle stick injury among doctors [p=0.000] and nurses [p=0.000]

Conclusion: In summary, we conclude that the frequency of Needle stick injury among Health Care Workers is high and duration of service was significantly associated with needle stilck injuries

Frequency of enterococcus faecalis in saliva and root canals with treatment failure

To compare the frequency of E. faecalis in the saliva and root canals of teeth associated with apical periodontitis due to endodontic treatment failure in the same patient. Cross-sectional comparative study. Samples were collected from Operative Dentistry Department, AFID, while Iaboratory processing was done at AFIP, Rawalpindi. Study duration was one year. Fifty patients, both males and females with failed endodontic treatment were selected. Saliva and root canal samples were collected from each patient, inoculated on MacKonkey agar plate and incubated at 35-37[degree]C for 48 hrs. E. faecalis colonies were identified by colony morphology, gramstain, catalase, bile asculin test, arabinose fermentation and growth in 6% NaCl nutrient broth. The frequency of E. faecalis in saliva was 34% and in root canal it was 58%. Frequency between the presence of E. faecalis in root canals and saliva was found to be statistically different [p = 0.001]. The presence of E. faecalis in root canal was not associated with their presence in saliva

Frequency of enterococcus faecalis in saliva and root canals with treatment failure

To compare the frequency of E.faecalis in the saliva and root canals of teeth associated with apical periodontitis due to endodontic treatment failure. Cross-sectional comparative. Samples were collected from Operative Dentistry department, AFID, while laboratory processing was done at AFIP, Rawalpindi. Duration of this study was one year. Fifty patients, both males and females with failed endodontic treatment were selected. Saliva and root canal samples were collected from each patient, inoculated on MacKonkey agar plate and incubated at 35-37°C for 48 hours. E.faecalis colonies were identified by colony morphology, Gram stain, catalase, bile asculin test, arabinose fermentation and growth in 6% NaCl nutrient broth. The frequency of E. faecalis in saliva was 34% and 58% in root canal samples. Frequency of the presence of E.faecalis in root canals and saliva was found to be statistically different [p=0.000]. The presence of E.faecalis in root canal was not associated with their presence in saliva

Comparative study of efficacy of formocresol and calcium hydroxide pulpotomy in primary molars

Comparative study of formocresol and calcium hydroxide pulpotomy procedure has a particular importance in this part of the subcontinent where low socioeconomic status is debilitating and does not allow many persons to undergo an expensive therapy like Mineral Trioxide Aggregate therapy, laser therapy and electro cauterization modality of pulpotomy. The purpose of this study was to compare the efficacy of two different vital pulp therapy techniques both clinically and radiographically in cariously exposed primary molars, utilizing calcium hydroxide and formocresol as the material for pulpotomy. It was a Quasi-experimental study. The sampling technique was a non-randomized convenience sampling. The study was conducted and completed in one year 28, Military Dental Centre, La-hore. The study was carried out using clinical and radiological criteria of follow up for evaluating the success of the two techniques by selecting 60 subjects, all Pakistanis. The sample comprised of subjects within 4 to 6 years age bracket selected alternatively according to gender. Formocresol and Calcium hydroxide pulpotomy was performed after amputation and proper hemostasis of the coronal pulp chamber and the selected patients were divided into two groups. The patients selected for formocresol pulpotomy were placed in Group F and the patients for calcium hydroxide pulpotomy were placed in Group C. Follow up of the cases were performed at 03 months, 06 months and 01 year period and the results in terms of success and failure were recorded in the stipulated data form and analyzed by SPSS version 17 for Windows. Sixty cariously exposed primary molars required vital pulp therapy. Thirty primary molars [50%] in Group F and thirty primary molars [50%] in Group C. 27 teeth [90%] treated with formocresol and 17 teeth [56.7%] with calcium hydroxide were classed as clinically and radiographically successful at the end of one year. The results showed a significant difference in the efficacy of the two groups [p= 0.004]. It was concluded that there was a significant difference in the efficacy of the two medicaments projecting higher rate of success with formocresol as compared to calcium hydroxide both clinically and radiographically

Causes of root canal failure noted in AFID

The aim of the study was to determine the most common causes of root canal failure in patients who reported to the operative department of AFID [Armed forces institute of dentistry] for retreatment. This was a cross sectional study carried out at the operative department of ARID Rawalpindi from January 2011 to December 2012. Among 200 patients included in the study, 112 [56%] were male and 88[44%] were female with mean age of 31.24 years [SD +/- 10.1]. In the present study the most common cause of root canal failure was found to be underfilled [42%] followed by poor lateral condensation [22%] and unfilled / untreated [20%], overfilled [6%], fractured instruments [4%] and inadequate coronal restorations [3%]. The patients presented with different symptoms The most common symptom being the tenderness [74%] followed by pain [20%], swelling [15%], loss of restoration [13%], sinus formation [6%], mobility [4%], fractured crown [4%] and split tooth [1%]

Frequency determination of aetiological factors in teeth treated endodontically

To study the effect of morphine on in vitro production of testicular T from un-stimulated or LH stimulated Leydig cells. Experimental study. Biological and Biomedical Sciences Department, Aga Khan University Karachi. De-capsulated testes from two rats were subjected to enzymatic dispersion for each experiment. Cells were pre-incubated in the incubation medium to remove endogenous Testosterone Thereafter, 80K cells were used for each treatment in 2001 of suspension. Incubation medium contained either no treatment [control] or different concentrations of morphine [5x10-5 -10-9 M]. Leydig cells were also incubated with different doses of LH [16-500 ?IU] and morphine. Naloxone, an opioid receptor antagonist [10-6 M], was used to determine if morphine induced effects on the Leydig cells could be reversed. Incubations were carried out for three hours in a shaking water bath at 340C. Reaction was stopped by placing the tubes in a water bath at 600C, and thereafter the tubes were transferred to a tray containing ice before freezing. Testosterone was measured directly in the incubation medium by radioimmunoassay. Morphine reduced Testosterone production from Leydig cells at all concentrations tested [p<0.01]. There was a dose dependent response to LH stimulation by the Leydig cells and testosterone levels were significantly different from control [p<0.01] and incubation with morphine in the presence of LH significantly reduced T levels [p<0.01]. Inhibition of opioid receptors with naloxone significantly attenuated morphine induced inhibition of T [p<0.01]. These in vitro results show that the morphine inhibits T secretion directly at the testis level

Reasons for extractions in patients seen in Pak field hospital level Darfur, Sudan

This cross sectional study was conducted at Pak Field Hospital Level 3 Darfur Sudan from Jan 2011 till May 2012 to find out the reasons for extractions of teeth in UNAMID troops. 1500 patients, from various countries were interviewed and examined. Percentage of six common reasons [caries and its sequel, periodontal problems, impactions, prosthetic, orthodontic and other causes] were calculated by SPSS version 16, as whole, separate for male, female and for individual countries. Results showed that Overall 41.2% of the teeth were extracted due to advanced dental caries whereas 34.8% due to periodontal disease, 12.04% due to impactions, 4.4% for prosthetic purposes, 4.3% for orthodontic and 3.2% for other reasons. Advanced caries was the primary cause for extractions in male while impactions and orthodontic causes were the main reasons. Highest numbers of teeth were extracted due to advanced caries in patients from Nigeria [43.5%] and due to periodontal reason from patientsof Bangladesh [37.1%] and Nepal [37%]

Self medication practice among dental patients of afid: a cross sectional study

To determine the prevalence and cause of self-medication among dental patients, a cross sectional study was conducted on 335 patients of AFID Rawalpindi. Patients were interviewed on basis of questionnaire highlighting age, gender, income and educational qualification, history of past practice of self-medication, substances used and causes of it. Frequency tables were generated and statistical relationship between the variables was analyzed by SPSS version 16. 31.34% of the respondents claimed to be involved in self medication. 48% respondents used self-prescribed antibiotic and analgesics, 22% used clove oil, tobacco or tablet aspirin in tooth cavity, 17% had got their treatment by roadside unqualified dentists and 13% consulted faith healer to relieve tooth pain. 33% felt that their complaints were minor enough to consult dentist, 53% were short of time to visit hospital [ and were prompted by family members to self medicate, 10% were afraid of dental treatments while only 4% claimed that these were cheaper options for them. Self-medication practices were common in participants of this study. Government should enforce relevant legislation which limits the practice of road side local tooth healers and restricts the sales of drugs without prescription

Comparison of powered and manual toothbrushes in removal of plaque

The present study was undertaken to compare the efficacy of manual and powered toothbrushes in 70 patients between 19 and 44 years of age who reported with mild gingivitis to AFID. Patients were randomly divided into two groups of 35 each. Group A patients were selected for electronic powered tooth brushes, while group B patients were selected for manual brushes. At baseline, after one and 3 months, plaque was rated using Silness-Loe plaque index. Data were statistically analyzed using SPSS version 12. Both brushes significantly reduced the plaque accumulation, though to different degrees. A lower plaque score [score 0 and 1] was obtained at three months in 88.5% patients using powered brushing and in 77.1% patients using manual brushing. Powered brushing showed lower plaque score in 11.4% more patients than the manual brushing after three months of follow up

Diabetic patients; level of awareness about oral health knowledge, attitude and practices

Diabetes Mellitus [DM], the commonest endocrine disorder is associated with 2-4 times increased risk of coronary artery disease and other macro and microvascular complications in the body. Oral diseases are also more common in diabetics as compared to normoglycemic individuals. The aim of this study was to gather baseline information on knowledge, attitude, and practices of diabetic patients regarding their oral health with the view of enhancing dental health education for them, which will help in updating their knowledge about the diasese and its associated systemic and various oral complications. This study was a cross sectional descriptive survey of 300 diabetic patients visiting the Operative Department of Armed Foreces Institute Of Dentistry Rawalpindi, Pakistan from January 2010 to January 2011. Out of total 300 patients 195 [65%] were males and 105 [35%] were females. 36 [12%] were suffering from Type 1 Diabetes Mellitus and 264 [88%] were suffering from Type 2 Diabetes Mellitus. 64% of the patients had knowledge about the oral complications of diabetes. 35% of this group knew about this issue from their treating physicians and 65% from dentists. 13% did not know that diabetes predisposed them to oral disease, and 23% denied any existence of a link between diabetes and oral health. The level of awareness end dental health knowledge in diabetic patients are good in our army set up which is comparable to previous studies carried out locally and abroad but it still needs to be improved by health education

Efficacy of gluma desensitizer[TM] and duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions

The objective of this study was to compare the efficacy of Gluma Desensitizer[TM] and Duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions by a randomized control trial. 196 patients having hypersensitive non-carious cervical lesions were divided into two groups. Gluma Desensitizer[TM] was applied to patients in Group A and Duraphat[TM] to patients ingroup B. Patient's pain response to compressed air was recorded on the visual analogue scale at baseline, 5 minutes, 7 days and 30 days after treatment. Data were analyzed using SPSS version 12. Comparison of sensitivity between the two treatment groups on application of compressed air showed a statistically significant difference. The results of this study showed that Gluma Desensitizer[TM] showed better results in relieving dentinal hypersensitivity than Duraphat[TM] in non-carious cervical lesions

Evaluation of hepatoprotective activity of Clerodendrum serratum L.

The ethanol extract of C. serratum roots and ursolic acid isolated from it were evaluated for hepatoprotective activity against carbon tetrachloride induced toxicity in male Wistar strain rats. The parameters studied were estimation of liver function serum markers such as serum total bilirubin, total protein, alanine transaminase, aspartate transaminase and alkaline phosphatase activities. The ursolic acid showed more significant hepatoprotective activity than crude extract. The histological profile of the liver tissue of the root extract and ursolic acid treated animal showed the presence of normal hepatic cords, absence of necrosis and fatty infiltration as similar to the controls. The results when compared with the standard drug silymarin, revealed that the hepatoprotective activity of the constituent ursolic acid is significant as similar to the standard drug.

Biphasic resection of a mandibular molar

Teeth once designated obsolete for rehabilitation and deemed for extraction should be re-evaluated for salvaging two thirds or even one-third component of the individual teeth. In our part of the continent, financial restraints can affect the orthodox procedures of root amputation if the final restoration is not provided at an earlier date. This case report enlightens on a biphasic approach combining radisection and coronal resection of a tooth with an endodontic perforation, which is a procedure not normally executed for mandibular molars but was adopted after taking the socioeconomic status of the patient into consideration

Nonsurgical endodontic management of cutaneously draining odontogenic sinus

Odontogenic cutaneous sinus tract is a rare but well documented condition. It is usually misdiagnosed as a local skin lesion and maltreated by systemic antibiotics and/ or surgical excision with eventual recurrence. This is because the primary etiology is incorrectly determined. We came across a 38 year old patient who presented with a cutaneous lesion on her left cheek with frequent purulent discharge and was not responding to systemic antibiotics. The case history, diagnosis and management of this condition is presented here

Efficacy of camphorated paramonochlorophenol to a mixture of honey and mustard oil as a root canal medicament

Objective:To compare the efficacy of camphorated paramonochlorophenol to a mixture of honey and mustard oil as a root canal medicament. Design: An in vitro comparative study. Place and Duration of Study: This study was carried out in collaboration with microbiology department of Armed Forces Institute of Pathology, Rawalpindi and was conducted from Aug-2001 to Nov-2001. Materials and A sample of 90 infected root canal contents of decayed teeth was collected from Operative Dentistry Department of Armed Forces Institute of Dentistry, Rawalpindi. Each sample was inoculated aerobically as well as an-aerobically. Organisms were identified and isolates were preserved and refrigerated for experiments. Medicaments were procured and prepared in comparable dilutions. Minimum inhibitory concentration of both medicaments was compared by susceptibility testing against already preserved isolates. The tested mixture [honey and mustard oil equal v/v] demonstrated antibacterial activity against all isolates at concentration of 12.5%[mean of effective conc.17.11%] while that of camphorated paramonochlorophenol was comparably at higher concentration 3.1%[mean of effective conc. 3.35%]. However the mixture revealed better results than that of individual agents, which was 12.5% to 25% respectively. Mixture [honey and mustard oil] was effective, viable alternate endodontic medicament