Diagnosis and Management of Fractured Teeth; Review Article

Traumatic damage to the teeth and oral tissues are the most common causes of tooth fracture. Because of their location in the oral cavity, front teeth in the upper jaw are the most commonly fractured. Sports, car accidents, and physical violence are the most prevalent causes. Cracked teeth are often diagnosed by visually inspecting the tooth (preferably utilizing microscopes). The size and form of the fracture plane are not always determined by looking at the crack line. One factor that contributes to the difficulty of effectively making an endodontic diagnosis is the inability to visualize the depth of the fracture through a clinical exam alone. Transillumination, microscopes and dyes are a useful tool for finding and diagnosis of the crack, treatment of the crack depends on the type, extend of the crack as well as the condition of the patient. In this review we’ll be looking at the diagnosis, etiology and management of fractured teeth.

Vascular Brain Disease in Geriatric Neuropsychiatry

Vascular brain diseases are a significant cause of dementia, and their presence, alone or associated with degenerative conditions, increases the risk of conversion to progressive cognitive decline. Neuropsychiatric manifestations vary according to the affected brain territory and disrupted neuronal circuits. In the current chapter, epidemiological prevalence, the harmonization of the diagnostic criteria of vascular subtypes, and the impact of age and socio-demographic aspects are critically reviewed. Another explored topic refers to the diagnostic and therapeutic approach. Structural imaging, including magnetic resonance (MRI) and computer tomography (CT), and a thorough neuropsychological and clinical exam, may help establish the differential diagnosis and substantially impact clinical evolution. Treatment involves various strategies, including controlling cardiovascular and metabolic risk factors, such as hypertension, atrial fibrillation, cardiopathies, and adopting a healthy lifestyle. Treatment relies on preventive and health promotion strategies related to the timely control of vascular risk factors and symptomatic approaches. The use of acetylcholinesterase inhibitors aims at stabilizing symptoms and is recommended in all stages of dementia.

SARS-CoV-2 Infection in One Cat and Three Dogs Living in COVID-19-Positive Households in Madrid, Spain

In this study, we describe SARS-CoV-2 infection dynamics in one cat and three dogs from households with confirmed human cases of COVID-19 living in the Madrid Community (Spain) at the time of expansion (December 2020 through June 2021) of the alpha variant (lineage B.1.1.7). A thorough physical exam and nasopharyngeal, oropharyngeal, and rectal swabs were collected for real-time reverse-transcription PCR (RT-qPCR) SARS-CoV-2 testing on day 0 and in successive samplings on days 7, 14, 21, and 47 during monitoring. Blood was also drawn to determine complete blood counts, biochemical profiles, and serology of the IgG response against SARS-CoV-2. On day 0, the cat case 1 presented with dyspnea and fever associated with a mild bronchoalveolar pattern. The dog cases 2, 3, and 4 were healthy, but case 2 presented with coughing, dyspnea, and weakness, and case 4 exhibited coughing and bilateral nasal discharge 3 and 6 days before the clinical exam. Case 3 (from the same household as case 2) remained asymptomatic. SARS-CoV-2 detection by RT-qPCR showed that the cat case 1 and the dog case 2 exhibited the lowest cycle threshold (Ct) (Ct < 30) when they presented clinical signs. Viral detection failed in successive samplings. Serological analyses revealed a positive IgG response in cat case 1 and dog cases 3 and 4 shortly after or simultaneously to virus shedding. Dog case 2 was seronegative, but seroconverted 21 days after SARS-CoV-2 detection. SARS-CoV-2 genome sequencing was attempted, and genomes were classified as belonging to the B.1.1.7 lineage.

P093 Algodystrophy in children: a case report

Background Algodystrophy is an entity very often unrecognized by pediatricians. The evolution is readily dragging and disabling in the absence of early and coordinated care. The Objective: Based on a case observed in a 10-year-old boy, the authors recall the main characteristics of the syndrome, guiding the practitioner to make the diagnosis, and implement appropriate and early therapy. Observation A 10-year-old boy with no previous medical history, presenting with neuropathic-like pain in the wrist and the hand that started a month ago without any triggers. Clinical exam noted functional impotence, a whole limb tremor, hyperesthesia as well as allodynia. The patient's hand is swollen and warm with a claw-like appearance. The rest of the body exam is normal. The laboratory markers and x-rays of the whole limb are normal. Bone scintigraphy confirms the diagnosis of wrist algodystrophy. The treatment combining corticosteroids, functional rehabilitation, and psychotherapy allowed a favorable outcome with no sequelae. Conclusion The diagnosis of algodystrophy remains too often unrecognized, and its management is sometimes inadequate. Early diagnosis and treatment improve the prognosis.

Chronic pyrrolizidine alkaloid toxicosis in a heifer

This heifer came from a group of cattle with chronic diarrhea and emaciation. Some of the animals also had neurological signs, predominantly aggressiveness. Two animals had already died spontaneously after worsening of the clinical signs. The farmer had kept these animals on native pasture during the winter, and he reported that the vegetation had been scarce in that period. On clinical exam, the animals were in bad body condition, with some presenting dyspnea, subcutaneous edema mainly affecting the dewlap, and abdominal distention.

P.223 Correlating the pre- and post-operative subjective experience of myelopathic impairments with the objective clinical exam

Background: Degenerative cervical myelopathy is a debilitating condition of the spinal column resulting in a progressive, clinically measurable loss of motor and sensory function secondary to spinal cord compression. We sought to correlate the patient’s subjective experience of specific myelopathic impairments with components of the objective clinical exam, to determine if the latter provides any clinically-relevant information postoperatively. Methods: Thirty-eight myelopathy patients consented to complete the mJOA questionnaire and receive a physical exam preoperatively, and 6-weeks and 6-months postoperatively. mJOA components were correlated with the physical exam using Spearman correlations with an alpha of 0.05. Results: mJOA scores for sensation and lower limb motor function correlated with the sensory and lower limb motor exams respectively, both preoperatively and 6-weeks postoperatively. mJOA scores for upper limb motor function did not correlate with the upper limb motor exam at either timepoint. Conclusions: At baseline and immediately postoperatively, patients self-report sensation and lower limb motor function accurately. However, the patients’ subjective experience of upper limb motor function does not align with clinical exam findings, suggesting either a continued need for this component of the physical exam or a need for tools that better correlate with the patient’s experience of upper limb motor impairment.

Prehospital FAST reduces time to admission and operative treatment: a prospective, randomized, multicenter trial

Background The focused assessment with sonography in trauma (FAST) exam is an established trauma care diagnostic procedure. Ultrasound performed during prehospital care can improve early treatment and management of the patients. In this prospective randomized clinical trial, we wanted to assess whether a pre-hospital FAST (p-FAST) influences pre-hospital strategy and the time to operative treatment. Methods We studied 296 trauma victims in a prehospital setting. Inclusion criteria were potential abdominal injuries identified either by clinical examination or suggested by the mechanism of injury. Physician-staffed helicopters and emergency ambulances were equipped with portable ultrasound devices. According to a scheme related to calendar weeks, a clinical exam only (CEX) or a clinical exam together with a p-FAST (CEX-p-FAST) was conducted. Outcome variables were prehospital diagnosis and strategy, the time to admission to the trauma room and to operation theater. The study was approved by the university ethical committee (REB#: 46/06). Results CEX-p-FAST showed a high sensitivity (94.7%) and specificity (97.6%) in detection of free fluid compared to CEX-only (80.0%, 84.4%). The median time to admission was reduced significantly by 13 min and to operative treatment by 15 min after CEX-p-FAST. We observed a cross-over rate of 30.8% of p-FAST (n = 36) to CEX-p-FAST during the CEX-only weeks. Conclusion According to the experience of the principal investigators, CEX-p-FAST was superior to CEX-only. Despite the time needed for p-FAST, the relevant admission time was significantly shorter. Thus, p-FAST is recommended in addition to CEX if possible for decision-making in prehospital trauma care. Trial registration German Clinical Trials Register #DRKS00022117—Registered 10 July 2020—Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022117.