Immunotherapy retreatment: case report, review of the literature and proposal for the definition of different scenarios

Immune checkpoint inhibitors have improved the treatment landscape of different tumors and one of the emerging issues is the reintroduction of immunotherapy after discontinuation. Scarce evidence is currently available and different definitions have been used. The case of a patient with pretreated advanced urothelial cancer, who responded to immunotherapy retreatment after long-term benefit from the previous course, is reported. Based on a review of the different clinical scenarios, a definition of immunotherapy retreatment was proposed, as rechallenge or reintroduction, based on the reasons of discontinuation of the previous course. Clinical factors potentially associated with clinical benefit from immunotherapy retreatment are discussed, even though ad hoc studies are needed to assess the efficacy and safety of the different immunotherapy retreatment strategies.

Type IIIb dens in dente endodontic retreatment: a case report

Dens in dente is a developmental anomaly characterized by dental tissues invagination that varies from a slight increase of the cingulum´s fossa to a deep groove that can extend up to the dental apex. Objectives The aim of this study was to report a dens in dente endodontic retreatment case with the presence of fistula and periapical lesion. Case report: Non-surgical retreatment was performed from the removal of the filling endodontic material, use of Calcium Hydroxide as intracanal medication changed every two months for a one year and a half period, and later, apical closure with MTA and endodontic filling of the remaining thirds with thermoplastic gutta-percha. Results: Postoperative follow-ups were performed for a 4 years period where a reduction of the periapical lesion diameter and disappearance of the fistula were observed. Conclusion: These results demonstrate that the present non-surgical dens in dente endodontic retreatment protocol could be considered a viable option for success.

Treatment Outcomes of Tuberculosis Retreatment Case and Its Determinants in West Ethiopia

Background: Tuberculosis (TB) is a major public health concern in the developing world. World Health Organization’s (WHO’s) list of 30 high TB burden countries accounted for 87% of the world’s cases. The annual infection rate in developing countries reached 2% or more; where as in developed countries this figure is 0.5%. Objective: The objective of this study is to assess treatment outcomes of tuberculosis retreatment case and its determinants at Nekemte Referral Hospital (NRH), West Ethiopia. Methods: A retrospective cross-sectional study was conducted. All registered adult TB patients under retreatment regimen who were treated at NRH TB clinics from January 2014 to December 2017 were included in this study. A multiple logistic regression was used to assess the significance and strength of association. A P-value <0.05 was used as statistically significant. Results: The prevalence of retreatment case was 12.12%. Of 219 study participants 159(72.6%) were patients with relapse, 43(19.6%) were with retreatment after failure and 17(7.8%) were patients who return after loss to follow-up. On multivariable logistic analysis poor treatment outcome was more likely to occur among patients with positive Acid Fast Bacilli (AFB) result at 5th month (Adjusted odds ratio (AOR =4.3, 95%, (1.8-10.0) p=0.001) and patients taking category 1 (2ERHZ/4RH) drugs (AOR=2.1, 95% CI= (1.1-4.5) p=0.048). Conclusion: This study showed that treatment outcomes of TB retreatment case were below standard set by the WHO. Factors that were significantly associated with poor treatment outcome were positive AFB resulting at 5th month and patients on category 1(2ERHZ/4RH).

Endodontic Retreatment of an Upper First Molar with Bifurcated Palatal Canal Using Preoperative Cone-beam Computed Tomography: A Case Report

BACKGROUND: Anatomic variations in palatal canal morphology in maxillary first molars (MFMs) are relatively rare occurrences. Therefore, omission is common unless clinicians recognize their presence. CASE REPORT: The aim of this report is to point out new signs that can be viewed as indicators of the existence of additional canals in the palatal root (PR) in this upper first molar endodontic retreatment case. Moreover, the role of preoperative cone-beam computed tomography (CBCT) in both discovering and determining the location of those additional canals will also be discussed. CONCLUSION: Besides formerly discussed signs that indicate the existence of this canal, clinicians should also pay attention to other signals on periapical radiograph, including the aberrant divergence of a palatal canal at apical third and an unusual lesion occurring laterally in the periapical area of palatal root.

Treatment outcome of tuberculosis patients and factors determining treatment outcome at peripheral health settings of Northern Ethiopia: a five year retrospective study

Objective Evidences of treatment outcome and identifying factors associated with treatment failure through a register based retrospective study have significant contribution in in the improvement of a National Tuberculosis Program. However there is a scarcity of data from peripheral health settings in Ethiopia. Therefore this study is aimed at determining treatment outcome of tuberculosis patients and associated factors. Results A total of 3471 patient records were included. More than half, (58%) were males and the mean age was 34 ± 17 years. Majority (43%) had extra-pulmonary TB. From the total TB patients, 18.8% were HIV co infected. The overall treatment success was 89.5%. Being HIV coinfected, pulmonary negative, extra-pulmonary and retreatment case were significantly associated with treatment failure.

Acute odontogenic maxillary sinusitis treated endodontically – two case reports and 15-day CBCT outcome

Patients presented acute recurrences from Otorhinolaryngology treatments with unilateral symptoms compatible with maxillary sinusitis with a dental origin (MSDO). Cone beam computed tomography (CBCT) showed sinus extensive membrane thickening that was not visible at periapical exam associated to the maxillary molar infection in both cases. Respiratory structures assessment was possible using a 6-inches field of view CBCT. Non-surgical endodontic treatment (case 1) performed and retreatment (case 2) showed a fast symptoms relief. Recall examination after 15 days revealed healthy soft tissues with normal periodontal probing and no dental mobility. In addition, 15-day CBCTs revealed initial maxillary sinus membrane recovery after the endodontic approaches in the reported cases. No additional medical intervention nor antibiotics administration were necessary in these MSDO cases management. Long-term follow-up in such cases is advisable to exclude other potential dental or respiratory issues. Diagnose and follow-up using CBCT presented significant sinus membrane thick reduction with no symptom’s recurrence after the endodontic treatment.

An Unusual Mishap during Root Canal Access in Retreatment Case

Varieties of objects have been introduced into the root canal system accidentally or intentionally; removal of these objects necessitates the success of the treatment. This paper explains an unusual bur fracture during nonsurgical endodontic treatment and its removal by ultrasonic energy with ease and without the removal of extra large amount of root dentin.