Interception of a Reverse Incisor Occlusion in Mixed Dentition

Introduction: This case report describes an orthodontic interception of a mixed dentition reverse incisor bite in a 12-year-old boy at the time of consultation. Case Report: After a careful clinical examination supported by routine radiological examinations, a skeletal class III diagnosis was made and an orthodontic interception was decided to restore the inverted incisor joint and the various orofacial functions disrupted by the malocclusion. After twenty months of interceptive treatment consisting of a joint jump and class III intermaxillary traction, we found satisfactory overhang and coverage allowing us to monitor the placement of the definitive canines with an improvement in the skin profile and smile. Conclusion: This simple gesture which made it possible to put the mandible back in a position restoring normal incisal coverage contributes to good orofacial muscle maturation closely linked to the various occlusal functions restored.

Some skin conditions in pigs: types, control and prevention

Skin conditions in pigs are common problems presented to the veterinary surgeon. A careful clinical examination, especially considering the age of the pig and the distribution of the lesions, all aids making an accurate diagnosis and treatment plan. Pain management is essential in clinical management. Sarcoptic mange is a condition that can be eliminated from pigs and should be considered a welfare problem. Ear necrosis and trauma injuries can be particularly problematic and must be treated aggressively. African swine fever (ASF) presents with a range of clinical signs including skin lesions, and all veterinary surgeons must be able to put ASF as a differential where appropriate.

P074 Prolonged fever in children: Epidemiological and etiological profile in the eastern region of Morocco—about 119 cases

Background Prolonged fevers (PF) are defined as a thermal shift >38 ° C without any immediately obvious cause (fever of unknown origin). The fever is considered as prolonged when it lasts at least 7 days in children and 5 days in infants. PF constitute a frequent reason for consultation. Our Objective is to highlight the epidemiological and etiological profile of prolonged fevers in children in the eastern region of Morocco. Material and methods Our work is a retrospective study of 119 cases, conducted from January 1, 2015 to July 31, 2018 in the pediatric department of the C.H.U Mohammed VI Mother-Child Hospital in Oujda, Morocco. Results The hospital incidence of PF in this study was 2.8%. The patients average age was 49 months. A male predominance was noted (63 boys). The patients were living in urban zone in 76% of cases. The symptom duration before first consultation was 18 days. Children with a history of suspected but not confirmed infection with notion of taking antibiotics and antipyretics were noted in 30% of cases. The functional signs were dominated by digestive symptoms in 34 patients, followed by mucocutaneous signs in 26% of cases, and cardiorespiratory manifestations in 12% of cases. The main physical signs were represented by a tumor syndrome in 34 patients, and 31 cases of cutaneous involvement. The etiologic diagnosis was confirmed by an abdominal ultrasound in 48% of cases, a myelogram in 19% of cases, a chest X-ray in 17% of cases, and a cardiac ultrasound in 14.5% of cases. At the end of the etiological investigation, the infectious causes were in 52 cases, inflammatory diseases in 32 cases, neoplasia in 27 cases, and undetermined causes 8 cases. Discussion The hospital incidence of prolonged fevers is difficult to estimate because of the nosological problem they pose. However, FP constitutes 0.4% to3% of the reasons for pediatric hospitalization. In our study, it was 2.8%. Regarding age, almost half of the children hospitalized for FP exploration are under the age of six. This can be explained by the high frequency of febrile diseases, in particular infectious diseases, at this age the male predominance was marked in most studies with a sex ratio ranging from 1.1–1.8. The clinical signs on admission did not allow a clear etiological orientation, and it was the repeated questioning and physical examination during hospitalization that guided the etiological investigation. The most common feature is infectious causes. There is a high percentage of neoplastic causes compared with the literature. Indeterminate causes constitute only 6.7% compared with higher figures in the literature which can be explained by the progress of examinations in the field of etiological research. Conclusion Prolonged fevers in children therefore remains a complex condition to handle despite advances in diagnostic means. Careful clinical examination is necessary for the management of children with PF. In fact, the patient should be regularly reassessed in search of new symptoms and other investigation leads. The reasoned prescription of additional workups and critical analysis of clinical signs are also essential steps in the etiological investigation.

Evaluation of tendoAchilles Lesions by (MRI)

Background: The AT is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity; despite its strength, the AT is also vulnerable to injury, due to its limited blood supply from musculotendinousa, also it withstands great forces, especially during sporting exercises and it's located superficially. Aim of the Work: To evaluate the role of (MRI) in the diagnosis of AT disorders. Patients and Methods: Type of Study: retrospective and prospective studies. Study Setting The study was conducted in Radiology Department at Ain Shams University Hospitals. Study Period from march 2018 to march 2020. Study Population This study included 40 patients. The patients were referred from either the orthopedic, rheumatology outpatient clinics of Ain Shams hospitals or private clinics to radiology department in Ain Shams University. Results Full thickness tear (30.0%) and Tendenosis (30.0%) were the most frequently detected pathologies followed by partial thickness tear (27.5%) and bursitis ( 22.5%) with significant more risk in male gender and middle age ( >46 years). More than one pathology were found in the same MRI study and this led to development of degenerative theory, that consider almost ruptured AT develop on top of pathological one. Conclusion MRI is a gold standard and important diagnostic tool in the evaluation of AT lesions especially in chronic and complex cases, and who do not respond to conservative measures and provides precious information for surgical intervention in parallel with careful clinical examination. Full thickness tear and partial thickness tear may develop on top of pathological tendon.

Galectin 3 as a new therapeutic target for fibrosis and metabolic disorders in type 2 diabetes

Background: The objective of our research work was to identify the predictive factors of metabolic disorder and the pro-fibrotic factors which would be correlated with high levels of Galectin-3(Gal-3) in a population of patients with type 2 diabetes. Methods: We carried out an analytical cross-sectional study.We included 260 type 2 diabetics followed in our endocrinology department.For the purpose of determining a threshold value of Gal-3,we asked for a non-diabetic control group. The medical history interview included history of diabetes, use of antihypertensive medications, lipid-lowering medication, smoking habits and physical activity.A careful clinical examination was performed for all patients and all of them underwent a biological analysis with an assay of the plasma concentrations of Galectin-3. Results: Our study included 260 type 2 diabetics with an average age of 59.4±8.9years.The sex ratio was 0.78.We established a threshold for galectin-3 with the best sensitivity and specificity at 11.25ng/ml using the ROC curve.We found a significant positive correlation of Gal-3 with age (p<0.001),duration of diabetes (p=0.024),systolic blood pressure (p =0.032), diabetic retinopathy (p<0.001), body mass index (p=0.01), waist circumference(p<0.001), hypertension (p<0.001), dyslipidemia (p=0.023),triglyceridemia (p=0.029).An inverse association between Gal-3 level and physical activity(p=0.014),hypoplipemic treatment (p=0.040),metformin (p=0.028) and glomerular filtration rate (p<0.001) were observed. Conclusion: We established a threshold value of Gal-3 and we discovered the clinical and biological parameters correlated with the elevation of Gal-3 which would be pro-fibrosating factors.We have also demonstrated that this lectin is a key player as a new marker and therapeutic target for the control of metabolic disorders.

An Update on Dentinal Hypersensitivity - Aetiology to Management – A Review

BACKGROUND Dentinal hypersensitivity is a common clinical disease that occurs as a result of dentin exposure. Though the term dentin hypersensitivity and dentin sensitivity is used interchangeably, dentin hypersensitivity is an exaggerated form of dentinal sensitivity which arises due to localized pulpal inflammation, pulpal nerve sprouting, and development of inflammatory sodium channels. It is characterised by short sharp pain emerging from exposed dentinal tubules in reaction to various stimuli. Such dentin exposure could be due to either enamel loss or cemental loss. This is followed by removal of smear layer by mechanical or chemical means. At present, the hydrodynamic theory, which describes fluid movement in response to stimuli within exposed dentinal tubules, is a commonly recognized explanation for dentin hypersensitivity. It is more common in premolars and canines, and it affects the facial surfaces of the teeth towards the cervical aspect. Studies suggested microscopic changes in the structure of sensitive dentin compared with normal dentin. The diagnosis of dentinal hypersensitivity requires careful clinical examination and eliciting the response using various stimuli. Dentinal hypersensitivity is usually managed by the use of physical or chemical agents. They work either by disturbing the neural response to pain stimulus or block fluid flow by occluding the tubule. The desirable features of a desensitising agent include the ability to give instant and longlasting pain relief, being simple to use, well accepted, not harmful to the pulp. It is recommended that the desensitizing agent is used for at least two weeks. Some of the newer agents used for management includes CPP-ACP, proarginine, nanomaterials, herbal products, propolis etc. In cases where there is tooth structure loss, appropriate restorative material is used to cover the exposed dentin. Root canal therapy is considered the last resort for pain relief after all other options have failed to provide relief. The present article outlines the etiopathogenesis, risk factors, diagnosis, prevention and treatment of dentinal hypersensitivity. KEY WORDS Dentinal Hypersensitivity; Dentin Sensitivity; Desensitizing Agents; Iontophoresis

128 Rapidly Proliferative Pilomatrixoma On the Eyebrow of A 7-Year-Old Boy – A Case Report

Pilomatrixoma or calcifying epithelioma of Malherbe is a benign tumour originating from pluripotent precursors of hair matrix cells. We present a paediatric patient with a rapidly enlarging eyebrow mass with a differential diagnosis of sebaceous cyst, pyogenic granuloma, or malignancy. A 7-year-old boy presented in primary care with a 0.5cm non-inflammatory nodule on his medial brow present for 2-3 months. History of previous trauma was not elicited and there were no features of bleeding or ulceration. It was then lanced, following diagnosis of an infected sebaceous cyst. Within weeks, the nodule underwent rapid proliferation, enlarging to 2cm in diameter. He was urgently referred to secondary care pending further investigation for possible trauma-induced pyogenic granuloma or malignancy. Upon presentation in secondary care, we observed a protruding erythematous and ulcerated mass, indurated in texture and adherent to overlying skin. The patient was submitted to excisional biopsy with a vertical elliptical approach to minimise distortion of the brow. Small, calcified deposits were observed in the tumour substance. Histologically, basaloid basophilic cells were predominant and mixed with ghost cells and foci of giant multinucleate cells, verifying diagnosis of a pilomatrixoma. Pilomatrixoma exhibits tendency towards mimicry of lesions such as epidermoid, sebaceous, dermoid cyst, pyogenic granuloma or even keratoacanthoma with a pre-operative detection rate as low as 11%. With a bimodal age distribution, arising in the first and sixth decades of life, this case highlights a need for a high degree of suspicion in young patients with careful clinical examination in order to aid diagnosis and prompt appropriate treatment.

Compression neuropathies

Nerve compression disorders affect nerve trunks, particularly in the upper extremity where carpal tunnel syndrome (median nerve compression at the wrist) is the most common and ulnar nerve compression the second most common disorder. Compression affects the various components of the nerve trunk, including the intraneural blood vessels, the Schwann cells, the axons, and the connective tissue components. It results in sensory and motor dysfunction, and sometimes pain. Risk factors for nerve compression disorders are known and may predict surgical outcome. A careful clinical examination should always be done, sometimes complemented with appropriate electrophysiology and magnetic resonance imaging for diagnosis. If conservative treatment is not appropriate, or fails, simple decompression is generally the primary treatment, but problems may persist. The presence of other neuropathies should be considered.

A Modified Reconstruction Technique of Chest Wall after Radical Resection of Chondrosarcoma Underlying the Breast

Chest wall tumors are uncommon and include a variety of Cartilaginous, bony, and soft tissue lesions. The clinical presentation varies from asymptomatic to chest pain or ulcerating chest mass. Retro mammary chondrosarcoma of the chest wall can present as a painless breast mass and may be mistaken for a breast tumor. A careful clinical examination and relevant investigations are a cornerstone to plan an appropriate surgical procedure.

Metastatic Adenocarcinoma of Lungs, Mimicking Primary Scapular Tumor: A Case Report and Review of Literature

Introduction: Cancer metastasis to the scapula and tibia is an infrequent clinical presentation. Lung cancer is one of the leading causes of death in the world. Around 80–85% of lung cancer are non-small cell lung cancer and around 30–35% of them are adenocarcinoma which metastasize to bone. Scapular metastasis is a rare event and presents with bone pain. Case Report: In this case report of 56-year-old male, presented with swelling to the scapula as a first symptom followed by swelling in the tibia. On further investigation, it was found to be multiple metastasis primaries as an adenocarcinoma of the lung. He was managed with palliative chemotherapy, which enhanced the patient’s quality of life, slowing down the disease process and clinical improvement. Conclusion: Lung cancer is the most common cancer which is progressing rapidly and spreading commonly to bones. When patients present with a mass or any suspicion of tumor, careful clinical examination and diagnostic tools often catch malignancy. Key words: Scapular metastasis, adenocarcinoma lung, bone metastasis, palliative chemotherapy, non-small cell lung carcinoma.