Pancreatic Carcinoma Metastatic to the Gingiva

Metastatic tumors to the oral cavity are uncommon, representing approximately 1% of all cases of oral malignant lesions even when a metastatic disease is present. The 53-year-old female is presented complaining of abdominal pain, weight loss, and a loose stool recurring not more than three times per day. A computed tomography (CT) scan of the abdomen showed a retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with a gastric mucosa biopsy showed a normal result. After laparoscopic surgery, the primary site of adenocarcinoma was not confirmed. The patient was referred to the Maxillofacial Surgery Clinic with pain, swelling, and occasional bleeding around the lower right second mollar. Immunohistochemicaly, the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2), which are highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor to the lower right gingiva and highlights the importance of immunohistochemical examination and how it helped identify both the origin and the nature of gingival neoplasm.

Dysphagia in the Older Age Setting

Dysphagia, or difficulty swallowing, is a common condition, especially among the elderly population and can become debilitating. As we age, there are subtle changes in esophageal motility, but by no means is dysphagia ever considered to be a normal result of aging. Dysphagia usually presents with a variety of accompanying symptoms ranging from regurgitation during meals, mild discomfort, to severe chest pain. It can be challenging to localize the dysphagia from the history. The underlying etiology may become evident during subsequent investigations. It is essential to be able diagnose dysphagia as early detection is associated with decreased morbidity and in some cases mortality. In addition, early detection through clinical suspicion, confirmatory imaging or endoscopic evaluation is important as it can lead to early intervention with proper management depending on the underlying etiology, resulting in economic benefit and reduced medical costs. There are various causes of dysphagia, with the majority being benign, but a physician should always be aware of red flags present which may signal more serious causes, such as an underlying malignancy. Our goal in this review article is to focus on detecting the clinical signs of dysphagia and review appropriate further evaluation and update on management of this potentially serious condition in order for elderly patients to achieve an optimal quality of life.

Smell, Taste and Covid-19: Testing is Essential

During the Covid-19 pandemic is became clear that smell and taste (chemosensory) disturbance is very common in the early stages of disease. This article addresses: 1) why Covid-19 specifically targets the modalities of smell and possibly taste and what is the mechanism 2) what is the frequency of smell and taste loss and, 3) what is the overall prognosis. It is suggested that mouth breathers may be at particular risk of Covid-19. Symptom-based questionnaires are likely to under-estimate the prevalence of chemosensory impairment by as much as 50%. The prevalence of smell loss is so high that a person who has normal olfaction on formal testing is unlikely to be infected significantly with Cov-2. Furthermore, someone without symptoms who has an abnormal smell test could still be infected and liable to spread the disease. Brief, low cost, olfactory tests are available that would permit a high throughput in field stations and airports. A normal result might obviate the need for a nasopharyngeal swab for the Cov-2 virus

DMSA-camSPECT/US fusion imaging of children’s kidneys – Proof of feasibility

Aim SPECT using Tc-99m-dimercaptosuccinic acid (DMSA-camSPECT) and ultrasound (US) are useful diagnostic modalities in pediatric nephrology. Former studies proved SPECT/US fusion to be a problem-solving tool for thyroid and sentinel lymph node imaging. The purpose of this study was to demonstrate the feasibility of real-time DMSA-camSPECT/US fusion in children and to evaluate the technical implementation. Methods Subsequent to a clinical indicated DMSA-camSPECT showing a mostly normal result, 10 children received a SPECT/US fusion. The magnetic sensor-navigated equipment allows a real-time superposition of three-dimensional SPECT data to live US images according to the position of the transducer. Results 100 % of still images and 90 % of cine-loops were sufficient to depict the kidney; at least one sufficient camSPECT/US fusion loop could be accomplished for every kidney examined. Limitations are mainly caused by standard difficulties of conventional US. Conclusion Real-time DMSA-camSPECT/US is feasible in depiction of renal parenchyma. This newly implemented application broadens the scope of SPECT/US fusion imaging.

Reassessing the pathogenicity of c.2858G>T(p.(G953V)) in COL4A5 Gene: report of 19 Chinese families

X-linked Alport syndrome (XLAS) is an inherited renal disease caused by mutations in COL4A5 gene. The c.2858G>T(p.(G953V)) in COL4A5 gene (rs78972735) has been considered pathogenic previously. However, there are conflicting interpretations of its pathogenicity recently. Here we presented 19 Chinese families, out of which 36 individuals (18 probands and 18 family members) carried the c.2858G>T(p.(G953V)) in COL4A5 gene. The clinical manifestations and genetic findings of them were analyzed. We found there were no clinical features of Alport syndrome not only in six probands with c.2858G>T(p.(G953V)) in COL4A5 plus pathogenic variants in other genes (e.g., WT1, ADCK4, NPHP1, TRPC6, COL4A4, and PAX2) but also in another six probands with only the c.2858G>T(p.(G953V)) variant. The other six probands with a combination of c.2858G>T(p.(G953V)) and another pathogenic variant in COL4A5 had XLAS. Eleven family members (11/18, nine females and two males) who had only the c.2858G>T(p.(G953V)) variant were asymptomatic. These two males (at age of 42 and 35 years) had normal result of urine analysis and no more clinical traits of Alport syndrome. We conclude c.2858G>T(p.(G953V)) in COL4A5 gene is not a pathogenic variant for XLAS. Individuals should not be diagnosed as XLAS only based on the detection of c.2858G>T(p.(G953V)) in COL4A5 gene.

Controller Based Proxy for Handling NDP in OpenFlow Network

A significant method should be deployed in OpenFlow environment for reducing the complexity during the implementation of IPv6 neighbor discovery protocol (NDP) in multicast manner. This paper was performed for deploying reactive-based application in controller’s northbound layer for handling as well as cutting the Neighbor solicitation packet’s journey. The application had a capability for storing each of the incoming Neighbor Solicitation (NS) and Neighbor Advertisement (NA) packet information. Therefore, the controller could reply the NS packet directly by using OFPT_PACKET_OUT message that contained the NA packet extracted from the reactive application. The experiment’s result showed that the proposed approach could reduce the NS response time up to 71% than the normal result produced by the traditional/learning switch application.

Neuroacanthocytosis diagnózisa új generációs exom-szekvenálással

In a patient with marked symptoms of Huntington disease after the huntingtin testing, which gave normal result, a whole exome sequencing (WES) has been performed based on an international collaboration. A homozygous G>A nucleotid change in the exon 34 of the VPS13A gene has been detected with WES, a mutation resulting in a premature stop codon at the position 1301. This change is a known pathogenic mutation. The aim of this article is to draw attention on the importance of the WES in the diagnosis of rare neurological diseases without any specific symptoms. Orv Hetil. 2017; 158(42): 1681–1684.

Kesehatan telinga pada siswa Sekolah Menengah Pertama Negeri 8 Manado

Ear is one of the important human organs with its major role in daily activities. Abnormalities of ear and exposure to excessive noise can lead to hearing impairment which causes difficulty in socialization and decreased study ability especially in school age children and adolescent. This study was aimed to obtain the profile of ear health status among students at Sekolah Menengah Pertama Negeri 8 (Junior high school) Manado. This was a descriptive study with a cross-sectional design. Respondents were students at grade IX C SMP Negeri 8 aged 13-15 years olds. Data were obtained by using questionnaire as well as physical ear examination and auditory function test. There were 32 students as respondents consisted of 11 males and 21 females. The results showed that all respondents had normal earlobes, while examination of ear canal showed cerumen in 11 respondents’right ears and 7 respondents’ left ears. Examination of tympanic membrane showed 2 respondents with tympanic membrane that could not be evaluated in right ears and 1 respondents in left ear. The Weber test showed that 1 respondent had lateralization meanwhile the Rinne test showed that all respondents had normal auditory function. Conclusion: Most respondents showed normal result in physical ear examination and auditory function test.Keywords: ear health, auditory function Abstrak: Telinga merupakan salah satu alat indra yang penting dan berperan besar dalam aktivitas sehari-hari. Kelainan dan penyakit pada telinga serta paparan bising berlebihan dapat menyebabkan gangguan pendengaran yang berdampak pada kesulitan bersosialisasi serta penurunan kemampuan belajar terutama pada anak dan remaja usia sekolah. Penelitian ini bertujuan untuk mendapatkan gambaran kesehatan telinga siswa di SMP Negeri 8 Manado. Jenis penelitian ialah deskriptif dengan desain potong lintang. Responden penelitian ialah siswa kelas IX C SMP Negeri 8 Manado dengan rentang usia 13-15 tahun. Pengambilan data dilakukan melalui pengisian kuisioner serta pemeriksaan telinga dan tes fungsi pendengaran. Total responden penelitian berjumlah 32 siswa dengan 11 responden berjenis kelamin laki-laki dan 21 responden berjenis kelamin perempuan. Hasil pemeriksaan daun telinga menunjukan keadaan normal, pada pemeriksaan liang telinga didapatkan serumen pada 11 responden di telinga kanan dan 7 responden di telinga kiri, dan dari pemeriksaan membran timpani didapatkan 2 responden dengan membran timpani tidak dapat dievaluasi pada telinga kanan dan 1 responden pada telinga kiri. Berdasarkan tes fungsi pendengaran didapatkan 1 responden mengalami lateralisasi pada tes Weber sedangkan pada tes Rinne didapatkan hasil fungsi pendengaran yang normal pada seluruh responden. Simpulan: Sebagian besar siswa memperlihatkan hasil normal pada pemeriksaan status kesehatan telinga dan tes fungsi pendengaranKata kunci: kesehatan telinga, fungsi pendengaran

Kesehatan telinga siswa di SMP Negeri 4 Pineleng

Around 20% of information were obtained from both ears daily. Hearing problem in children is sometimes hard to be detected and can cause difficulties in learning process. This study was aimed to obtain the ear health status of students at SMP Negeri 4 Pineleng (junior high school). This was a descriptive observational study with a cross-sectional design. Respondents were 25 students of class IX A. Meatus acoustic external was examined by an otorhinolaryngologist and then the data were processed by using Microsoft Excel. Based on the screening of hearing function, all students showed normal result. Ear canal examination showed that 3 students had cerumen in the right and left ear canals, and 1 student had hyperemia in the left ear. Perforated tympanic membrane were obtained in 2 students in the right and left ear canals. All students had normal Rinne test meanwhile Weber test showed 2 students with lateralization to the right and 1 student with lateralization to the left. Conclusion: Students at SMP Negeri 4 Pineleng had good ear health status.. Keywords: ear health, hearing screening Abstrak: Telinga dapat menyerap sebesar 20% informasi dari kehidupan sehari-hari. Gangguan pendengaran pada anak sulit dideteksi yang berakibat anak sulit untuk menerima pelajaran. Penelitian ini bertujuan untuk mengetahui status kesehatan telinga pada siswa SMP Negeri 4 Pineleng. Jenis penelitian ialah deskriptif observasional dengan desain potong lintang. Responden penelitian ialah 25 orang siswa kelas IX A. Pengambilan data dilakukan dengan pemeriksaan meatus akustikus eksterna oleh dokter spesialis bagian THT-KL, kemudian diolah dengan Microsoft Excel. Hasil skrining pendengaran dari seluruh siswa ialah normal. Pemeriksaan liang telinga didapatkan 3 siswa dengan serumen di telinga kanan dan kiri, serta 1 siswa dengan hiperemis di telinga kiri. Pemeriksaan membran timpani didapatkan perforasi pada 2 siswa, 1 ditelinga kanan dan 1 ditelinga kiri. Hasil tes Rinne semuanya normal. Pada tes Weber didapatkan 2 siswa dengan lateralisasi ke kanan dan 1 siswa lateralisasi ke kiri. Simpulan: Kesehatan telinga siswa di SMP 8 Pineleng cukup baik.Kata kunci: kesehatan telinga, skrining pendengaran