Insulin Abuse: A Case Report of Munchausen Syndrome.

Hypoglycaemia in individuals with diabetes is defined as the presence of signs or symptoms in addition to potentially occurring abnormal plasma glucose levels in the patient. Munchausen Syndrome (MS) is characterized by the deliberate induction of physical or psychological symptoms or the act of pretending to have symptoms. Patient reports of this factitious disease pattern are limited in the literature. The diagnosis and treatment of this syndrome, which is among factitious disorders, is very difficult. Endocrinological complaints are very common among those admitted to the hospitals. BACKGROUND: Unnecessary and numerous examinations cause financial losses and loss of time for both the individual and the healthcare system. In this case report, we aimed to discuss the management of a patient who tried to gain secondary gain by creating artificial hypoglycemia attacks. CASE REPORT: In this case report, the diagnosis of Munchausen syndrome given to a 28-year-old female patient who was diagnosed with type I diabetes and repeatedly admitted to the hospital due to hypoglycemia attacks is discussed. CONCLUSION: Munchausen syndrome is an important and often overlooked diagnosis that should be kept in mind due to the possibility of individuals harming themselves unpredictably, as well as causing disruptions in the healthcare system and wasting time due to numerous and unnecessary examinations and evaluations. For this reason, it is a diagnosis that should be kept in mind in cases of unexplained hypoglycemia attacks.

Fracture strength of endocrowns after thermomechanical aging.

This in-vitro study aimed to evaluate the fracture strength (FS; N) of composite, feldspathic, and glass-ceramic computer-aided design/computer-aided manufacturing (CAD/CAM) endocrowns after thermomechanical aging. Seventy non-carious human molars were randomly divided into seven groups, according to the CAD/CAM material used for endocrown fabrication. Intact molars without cavity preparations were used as control (n = 10). Following endodontic treatment, standardized endocrown cavities were prepared and endocrowns were fabricated using composite (Cerasmart270, CS and Grandio Blocs, GB), fired and milled zirconia-reinforced lithium silicate (Celtra Duo, CD), leucite-reinforced feldspar ceramic (LRF Initial, LRF), and feldspathic (Cerec Blocks, CE) materials which were luted with universal adhesive (Futurabond U; Voco) and dual-cure resin cement (Bifix QM). Following thermocycling for 20,000 cycles and 480,000 load cycles in a chewing simulator (CS-4.2, SD Mechatronik), FS was evaluated (Instron). Data were analyzed with one-way ANOVA and post hoc Tukey's tests (p < 0.05). FS was significantly influenced by the tested material (p = 0.00). CS had the highest FS, which was not significantly different from intact molars and fired CD (p > 0.05). There were no significant differences in FS between LRF, GB, and CD, which were significantly higher than CE. Most of the failure modes of CS, CD, and GB were repairable, whereas those of CE were irreparable. All the tested materials withstood clinically relevant axial forces. Composite endocrowns exhibited more favorable fracture pattern, whereas feldspathic and leucite-reinforced feldspar ceramic endocrowns exhibited mostly irreparable fractures.

Evaluating the effects of different beverages with daily consumption habits on the wear of restorative materials.

The aim of this study was to investigate the cumulative effects of fruit juices and/or alcoholic beverages on wear track area of the restorative materials by simulating the oral environment in vitro. A microhybrid, a sub-microhybrid, a nanofill resin composite, and a giomer material were used. A daily exposure habits model was created to simulate consumption frequency of acidic and/or alcoholic beverages. Two-body wear tests were carried out using a reciprocating wear tester. ANOVA and Tukey's HSD tests were used for statistical analyses (p < 0.05). When considering experimental groups related to daily exposure habits, statistical difference was found between restorative materials in terms of wear track area (p < 0.01). Joint effect of rmaterial and exposure on wear track area was statistically significant (p < 0.01). Giomer was found to be more affected by acidic and alcoholic beverages. Microhybrid resin composites showed less wear than the other restorative materials. Cumulative effects of alcoholic beverages and fruit juice on wear track area of materials could be related to material's composition and frequency of consumption of acid or ethanol-containing beverages. Daily cumulative effect of acidic and alcoholic beverages was found to be stronger than only acidic fruit juice consumption in terms of wear track area. The plasticizing effect and the concentration of ethanol in the alcoholic beverages provided the basis for the increased wear track area on the restorative materials.

Multiple dural tuberculomas presenting as leptomeningeal carcinomatosis.

Objective and Importance. We present the rare occurrence of multiple dural-based tuberculomas mimicking leptomeningeal carcinomatosis in a young immunocompetent patient. Clinical Presentation. A 36-year-old man presented with a 2-month history of generalized epileptic activity and altered perception. Neurological examination was remarkable for bilateral Babinski's sign. Cranial magnetic resonance imaging (MRI) revealed multiple dural-based enhancing lesions with cerebral edema. Intervention. A right frontal craniotomy was performed for diagnosis. Histological examination revealed multiple confluent necrotizing and nonnecrotizing granulomas with giant cells which was consistent with tuberculosis (TB), and the patient was placed on anti-TB therapy for 24 months. Conclusion. To the best of our knowledge isolated diffuse involvement of the dura mater by TB, mimicking leptomeningeal carcinomatosis, as the sole manifestation of disease has not been reported before. Since pachymeningeal TB is rarely suspected when atypical radiological appearance is combined with the absence of systemic disease, biopsy is inevitably required for diagnosis.