Conventional Endodontic Retreatment of Persistent Pain on Previously Treated Tooth in an Elderly Patient: A Case Report

Clinical evaluation for a successful root canal treatment is assessed by various criteria, which are clinical, histopathological, and radiographical criteria. Therefore, failure of endodontic treatment can be described as a recurrence of clinical symptoms, with the presence of a periapical radiolucency or both. Failure factors in the treatment are frequently related to persistent infection. Conventional endodontic retreatment is indicated for symptomatic previously treated teeth or asymptomatic teeth with inadequately done initial endodontic treatment to avoid potential recurrence. Endodontic retreatment in elderly patients is a great challenge because the clinician has to reassure both the physical and psychological factors of the patient to determine whether to save a tooth or perform an extraction. Some difficulties may also be found in root canal retreatment, including finding the root canal hole or root canal blockage found in parts of the root canal that have not been repaired in the previous treatment. A 60-year-old female patient came with the chief complaint of recurrent pain, and subjective discomfort in the maxillary left central incisor. The patient had anxiety about the dental treatment. The tooth had a history of root canal treatment four months ago. The clinical examination showed a positive response to the percussion test. The radiographical analysis showed a root canal underfilling, 2-3 mm short of length from the apex. The tooth was diagnosed as a previously treated tooth with symptomatic apical periodontitis. Endodontic retreatment was performed based on the patient’s clinical condition and consent, followed by composite restoration. The clinical and radiographic re-evaluation after four weeks of follow-up revealed an excellent condition. This favorable result showed that a conventional retreatment plan of persistent pain on the previously treated tooth in an elderly patient led to progressive healing, and a longer follow-up was advised.

Detecting immunotherapy-sensitive subtype in gastric cancer using histologic image-based deep learning

Immune checkpoint inhibitor (ICI) therapy is widely used but effective only in a subset of gastric cancers. Epstein–Barr virus (EBV)-positive and microsatellite instability (MSI) / mismatch repair deficient (dMMR) tumors have been reported to be highly responsive to ICIs. However, detecting these subtypes requires costly techniques, such as immunohistochemistry and molecular testing. In the present study, we constructed a histology-based deep learning model that aimed to screen this immunotherapy-sensitive subgroup efficiently. We processed whole slide images of 408 cases of gastric adenocarcinoma, including 108 EBV, 58 MSI/dMMR, and 242 other subtypes. Many images generated by data augmentation of the learning set were used for training convolutional neural networks to establish an automatic detection platform for EBV and MSI/dMMR subtypes, and the test sets of images were used to verify the learning outcome. Our model detected the subgroup (EBV + MSI/dMMR tumors) with high accuracy in test cases with an area under the curve of 0.947 (0.901–0.992). This result was slightly better than when EBV and MSI/dMMR tumors were detected separately. In an external validation cohort including 244 gastric cancers from The Cancer Genome Atlas database, our model showed a favorable result for detecting the “EBV + MSI/dMMR” subgroup with an AUC of 0.870 (0.809–0.931). In addition, a visualization of the trained neural network highlighted intraepithelial lymphocytosis as the ground for prediction, suggesting that this feature is a discriminative characteristic shared by EBV and MSI/dMMR tumors. Histology-based deep learning models are expected to be used for detecting EBV and MSI/dMMR gastric cancers as economical and less time-consuming alternatives, which may help to effectively stratify patients who respond to ICIs.

Experimental substantiation of novocaine therapy for threatened abortion

Published in 1955 by R.A.Vortapetov and P.G.Zhuchenko data on the favorable result of treatment with novocaine in 80 women with threatening termination of pregnancy prompted us to experimentally study the nature of the effect of novocaine introduced into the vascular bed on the intensity of uterine contractions

Nutritional Status of Patients Co-Infected with TB/HIV During Tuberculosis Treatment at Conakry-Guinea UHC

Introduction: The aim was to assess weight gain during tuberculosis treatment in patients co-infected with tuberculosis and HIV. Methods: Tuberculosis patients co-infected with HIV and undergoing tuberculosis treatment in the pneumophtisiology and infectious and tropical diseases departments of the CHU in Conakry were included. Results: 562 patients were included, with a mean age of 35.6±11.3 years, and 52.5% were women. The average Body Mass Index [BMI] at baseline was 17.8 3.3 kg/m2. 71.5% of patients had a favorable result and 28.5% had an unfavorable result [death, abandonment]. Healed and lost patients gained an average of 2.6 kg and 0.1 kg respectively. Deceased patients lost an average of 3.6 kg. The weight variations of the cured patients were different from those of the deceased [p < 0.001]. A weight gain of 5% after 6 months of treatment was associated with the treatment site [OR=3.81; 95% CI 1.08 to 13.45], alcohol consumption [OR=10.33; 95% CI 1.20 to 89.16], malnutrition before treatment [OR=2.72; 95% CI 1.43 to 5.17] and the form of tuberculosis [OR=3.27; 95% CI 1.15 to 9.33]. Conclusion: Newly diagnosed patients co-infected with TB-HIV at Conakry's CHU are often malnourished. Weight gain during treatment seems to be a reliable indicator of the overall response to treatment.

Intravitreal Ranibizumab for Treatment of Posttraumatic Choroidal Neovascularization: a Case Report

An analysis of the case of applying a course of fibrinolytic therapy and one intravitreal injection of an angiogenesis inhibitor in a patient with traumatic rupture of the choroid complicated by choroidal neovascularization (CNV) is presented. Patient B., 20 years old, complained of a lack of objective vision after a blunt injury to his right eye in March 2018. Visual acuity decreased to 0.01 (ETDRS 0 characters). During the examination revealed: partial hemophthalmus, rupture of the choroid, Berlin retinal opacification. Local fibrinolytic conservative therapy with positive dynamics was carried out in the form of increasing visual acuity to 0.3 (ETDRS 21 characters) and partial resolution of hemophthalmus. According to optical coherence tomography angiography (OCTA), minimally active CNV was detected. Due to the weak activity of the pathological process, a decision was made on dynamic observation. A follow-up examination in August 2018 revealed an increase in CNV activity according to OCTA and fluorescence angiography (FAG), in connection with which intravitreal administration of ranibizumab (lucentis) was performed. Subsequently, the patient was under dynamic observation for one year. Positive dynamics was revealed in the form of an increase in visual acuity, first to 0.7 (ETDRS 48 characters) 3 months after intravitreal injection, and after a year — to 0.9 (ETDRS 55 characters). After treatment according to OCTA and FAG, the activity of CNV was not determined. Despite the favorable result of treatment, further monitoring of the patient is necessary, since the long-term prospects for maintaining the achieved high visual functions remain unclear due to the insufficient experience in treating patients with this pathology according to the literature.

Full digital workflow in fixed adhesive dental prosthesis: Description of a clinical technique

Digital dentistry has gained space in several dental specialties. It is possible to achieve excellent results with the digital workflow, which combines the efficiency of the restorative material with a greater marginal adaptation. This study aimed to report a clinical case through the digital workflow, with a faster and clinically acceptable prosthetic resolution. In this clinical case report, digital workflow allowed a faster and clinically acceptable prosthetic resolution. A 45-year-old female patient reported cementation failure of the prosthetic crown on tooth 14. As it was a vital tooth, the tooth received a total crown preparation. In the same clinical session, the patient's mouth was scanned then a capture software obtained a virtual model. After, the design software planned a digital "diagnostic wax-up", so a leucitic ceramic was chosen for the rehabilitation. The ceramic block was milled and receive stain and glaze, dispensing the prosthesis laboratory. Then, the adhesive cementation was performed with a dual-polymerized resin cement. The final crown had ideal adaptation, with no need for interproximal and occlusal adjustments, with an excellent marginal fit. Within the limitations of this study, this case report showed that the digital workflow allowed a favorable result in a shorter working time, which brought back function and aesthetics, without the need for interproximal and occlusal adjustments. Keywords Prosthodontics; Cosmetic dentistry; CAD-CAM.

Palpebral Non-Hodgkin Lymphoma with Non-specific Reactive Hepatitis

ABSTRACT Extranodal Non-Hodgkin Lymphoma (NHL) remains an odd issue and something to discuss. Clinical evidence and guidelines on the treatment have not yet been broadly published and accessible. Here, we present a case of a thirty-eight years old woman complaining of mass on both lower lids of the eyes. The CT Scan examination showed enhancing solid masses on right-sided and left-sided palpebra inferior that press bulb oculi, suspected as bilateral malignant masses of bilateral palpebra inferior. Laboratory data revealed the surge of liver function marker. The patient was eventually diagnosed with Non-Hodgkin Lymphoma (NHL) of palpebra inferior B cell type high-grade stadium II E. Although there are still ongoing research and development of definitive treatments, R-CHOP a regiment given to this patient has shown complete favorable result with dosage adjustment due to the surge of basal liver function. The regiment was considered safe since no adverse effects reportedKeywords: extranodal, lymphoma non-hodgkin, palpebra, liver function

Comparative Analysis of Small Moleclues and Natural Plants Compounds as Therapeutic Inhibitors Targeting RdRp and Nucleocapsid Proteins of SARS CoV 2: An in Silico Approach

Nucleocapsid protein and RNA-dependent RNA polymerase (RdRp) activity in viral structural membrane, transcription and replication has been recognized as an attractive target to design novel antiviral strategies. The essential feature of the N protein of SARS COV 2 is to bind to the viral genome to promote the exact folding of the hammerhead ribozyme averting unproductive RNA confirmations and lead them to right into a helical capsid shape or RNP complex, whose packaging is crucial to viability. RdRp is an essential enzyme that helps in RNA synthesis by catalyzing the RNA template-dependent development of phosphodiester bonds. RdRp makes a complex with two cofactors nsp7 and nsp8 to play a key role in RNA synthesis, transcription and replication of the SARS-CoV-2. In our study we used small molecules and natural plants compounds as therapeutic inhibitors targeting RdRp and N proteins of SARS COV 2. Their structures were geometrically optimized and energetically minimized using Hyperchem software. Molecular docking was performed using Molegro virtual docker and top ligands were selected based on MolDock score,Rerank score and H-bonding energy. Our results showed that 9 compounds against N protein and 7 compounds against RdRp protein forming better inhibitory effect with most lowest MolDock score − 285.68kcal/mol and − 201.5kcal/mol respectively. we hope that these small molecules and natural plants compounds can inhibit the viral enzymes and helps the patients in reducing specific symptoms of SARS-CoV-2 infection. However in vivo experimental studies and clinical trials need to get that more favorable result.

The Impact of Obstacle’s Risk in Pedestrian Agent’s Local Path-Planning

While the risk from the obstacle could significantly alter the navigation path of a pedestrian, this problem is often disregarded by many studies in pedestrian simulation, or is hindered by a simplistic simulation approach. To address this problem, we proposed a novel simulation model for the local path-planning process of the pedestrian agent, adopting reinforcement learning to replicate the navigation path. We also addressed the problem of assessing the obstacle’s risk by determining its probability of collision with the obstacle, combining with the danger from the obstacle. This process is subsequently incorporated with our prediction model to provide an accurate navigation path similar to the human thinking process. Our proposed model’s implementation demonstrates a more favorable result than other simulation models, especially in the case of the obstacle’s appearance. The pedestrian agent is capable of assessing the risk from the obstacle in different situations and adapting the navigation path correspondingly.

Comparison of Fissurectomy and Lateral Internal Sphincterotomy in the Surgical Management of Chronic Anal Fissure

Background: The anal fissure is a small spilt in the distal anoderm, and it most commonly occurs in the posterior midline of anal canal. Anal fissure causes severe sharp pain on defecation, occasionally accompanied by streak of blood on outside of stool or blood on toilet tissue. Fissures are classified as acute or chronic, acute fissure usually heal spontaneously within six weeks. Fissurectomy had been used as separate technique in the treatment of chronic anal fissure with favorable result. Parallel inside sphincterotomy produces an enduring fall of anal resting pressure, that reestablish mucosal perfusion bringing about recuperating, yet genuine drive component is obscure, and the instrument that travel from intense to constant gap stay dark. This study is design to assess the outcome between two groups, than better modality of the two could be chosen. Objective: To compare fissurectomy and lateral internal sphincterotomy in the management of chronic anal fissure. Patient and Methods: The Randomized controlled trial was conducted during 18-02-2015 to 17-08-2015 at Department of surgery,Liaquat University of Medical & Health Sciences, Hyderabad. A total of 218 patients with chronic anal fissure were included in this study. Patients were randomly divided into two groups. Patients in Group A were underwent fissurectomy and patients group B was underwent lateral internal sphincterotomy. Surgery was performed and patients were followed for 8 weeks on regular basis and satisfactory out comes was noted. Information along with demographics was entered in the proforma. Results: Rate of satisfactory outcome was significantly high in group B as compare to group A [92.66% vs. 76.15%; p=0.001]. Conclusion: Subcutaneous sidelong internal sphincterotomy is a significant surgery for patients with persistent anal fissure. It is compelling and safe, offers fast help of torment, and advances early gap mending without being gone to by any significant complexities.