Hypochlorite accident in endodontic treatment: complication prevention and assistance

The outcome of endodontic treatment directly depends on the high-quality instrumental and medical treatment of root canals. The most effective, widespread and well-known antiseptic used for rinsing root canals is sodium hypochlorite. Unfortunately, in the process of irrigation complications arise in the form of sodium hypochlorite of various concentrations extrusion into the periapical region. We must not forget about the anatomical and topographic features of the structure of nearby structures, such as the mandibular canal and the maxillary sinus. The aim of the clinical case is to assess the depth of irrigant penetration into the periodontal area using radiography and to develop an algorithm for actions in the event of a hypochlorite accident.

Modulation of Gut Microbiota to Enhance Effect of Checkpoint Inhibitor Immunotherapy

Accumulating evidence demonstrated the crucial role of gut microbiota in many human diseases, including cancer. Checkpoint inhibitor therapy has emerged as a novel treatment and has been clinically accepted as a major therapeutic strategy for cancer. Gut microbiota is related to cancer and the effect of immune checkpoint inhibitors (ICIs), and supplement with specific bacterial species can restore or enhance the responses to the ICIs. Namely, specified bacteria can serve as the biomarkers for distinguishing the patient who will respond to ICIs and determine the effectiveness of ICIs, as well as predicting the efficacy of checkpoint inhibitor immunotherapy. Regardless of the significant findings, the relationship between gut microbiota and the effect of ICIs treatment needs a more thorough understanding to provide more effective therapeutic plans and reduce treatment complication. In this review, we summarized the role of gut microbiota played in immune system and cancer. We mainly focus on the relationship between gut microbiota and the checkpoint inhibitor immunotherapy.

Somatic GATA2 mutations define a subgroup of myeloid malignancy patients at high risk for invasive fungal disease

Invasive fungal disease (IFD) can be a severe treatment complication in patients with myeloid malignancies, but current risk models do not incorporate disease-specific factors, such as somatic gene mutations. Germline GATA2 deficiency is associated with a susceptibility to IFD. To determine whether myeloid gene mutations were associated with IFD risk, we identified 2 complementary cohorts of patients with myeloid malignancy, based on (1) the diagnosis of invasive aspergillosis (IA), or (2) the presence of GATA2 mutations identified during standard clinical sequencing. We found somatic GATA2 mutations in 5 of 27 consecutive patients who had myeloid malignancy and developed IA. Among 51 consecutive patients with GATA2 mutations identified in the evaluation of myeloid malignancy, we found that IFD was diagnosed and treated in 21 (41%), all of whom had received chemotherapy or had undergone an allogeneic stem cell transplant. Pulmonary infections and disseminated candidiasis were most common. The 90-day mortality was 52% among patients with IFD. Our results indicate that patients with somatic GATA2 mutations are a vulnerable subgroup of patients with myeloid malignancy who have high risk for treatment-associated IFD and suggest that a focused approach to antifungal prophylaxis be considered.

Assessment of Chromolena odorata potential ability of hemostasis in patients with and without Haemophilia A Inhibitors

Haemophilia is a chronic bleeding illness that causes several difficulties in the patient's daily life in various aspects. Inhibitor development is presently the most important treatment complication observed in patients with hemophilia. Treatment modalities of Haemophilia A with either plasma or recombinant FVIII regimes results in the development of inhibitors and the risk of complications in patients. Hence, newer treatment strategies involving innovative hemostatic therapy are warranted for better management of hemophilia patients. The aim and objective of this study was to assess the efficacy of Chromolena odorata mediated hemostasis in patients with hemophilia A inhibitors. It was a cohort study constituting 147 clinically diagnosed hemophilic A patients. All the patients underwent treatment with FVIII A regimes (specific or multiple). The severity of hemophilia and clotting time was assessed by standard FVIII and aPTT assays, respectively. Modified Bethesda assay method was used to detect FVIII inhibitors. The hemostatic capacity of Chromolena odorata was evaluated by pooling the patient’s plasma with Chromolena extract concentrate. Younger age group (15-30) were more prevalent (56.4%) among hemophilia pathogenesis. Hemarthrosis was the significant co-morbidity observed in 58.5% of patients. Majority of the patients (72.7%) were diagnosed with severe hemophilia A. We identified 10 clinically evident patients to possess inhibitors for FVIII. Evaluation of Chromolena odorata hemostatic potential showed the improvement of clotting capacity with optimal concentrations of extract in patients with inhibitors. The findings of the study revealed the hemostatic properties of Chromolena odorata that can be recommended in the treatment strategies of Haemophilia patients.

Radiation-induced sarcoma presenting as a gluteal abscess: a diagnostic and therapeutic challenge

Sarcomas are a rare and fatal treatment complication following radiotherapy. Radiation-induced sarcomas (RISs) presenting as a gluteal abscess is a rarity, accounting for its varied presentation. We present a case of a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess. Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma. Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions. She is currently planned for chemotherapy. Cancer survivors have an increased risk of developing a second malignancy following radiation treatment. RISs are highly aggressive, exhibit a varied clinical presentation and pose a challenge in early diagnosis; thus, have a poor outcome. RISs pose a diagnostic challenge; any dubious lesion in the previously irradiated field should raise suspicion and prompt aggressive management.

PRACTICAL REALIZATION OF METHODOLOGY OF PROCESS CONTROL OF TOOLING

The problem of providing of necessary quality and exploitation of properties of details of machines acquires an all more important value in an engineer. However to present tense the not worked out is generalized theoretical dependences between the parameters of quality of surface, exactness of treatment, operating properties of details and parameters of processes of tooling, that allow to decide the task of the technological providing of the set operating properties of details. Process control of forming of surface with necessary properties comes true mainly by the use of partial experimental dependences and tables of the modes of treatment. Complication of problem consists in that at treatment of details it is necessary to set such terms of treatment, that would provide the complex of requirements in relation to the wear of instrument, exactness of treatment, to descriptions of quality of surface, productivity and others like that. The areas of the most effective use of the productive systems are foremost determined by a technological equipment that is component part by the nomenclature of workparts and CAS of management. Experience of development and exploitation of mechanisms of parallel kinematics confirms them high efficiency and perspective of this direction of engineer. As a result of structural features of arrangement, the mechanisms of parallel kinematics have the reserved kinematics chains that form spatial structures. As a rule these structures are founded on the base of the three-cornered cored systems. They have high rigid descriptions, provide high-rate and accelerations of working organs. Accordingly given an opportunities it is allowed by substantial character to promote static and dynamic exactness of positioning of mechanisms. Wide introduction of mechanisms of parallel kinematics absence of theoretical bases of development of mechanisms interferes with, in particular mechanisms of an increase exactness. The increase of exactness needs complex research of kinematics and working processes that take place in their basic knots. Therefore researches are sent to the increase of parameters of static and dynamic exactness of spatial mechanisms of parallel kinematics is actual.

Retrospective analysis of gastrointestinal pathology associated with Takayasu arteritis

Background: Takayasu arteritis (TA) is a systemic vasculitis, affecting mainly large aortal branches. AT is considered to be a rare disease [1]. TA actual frequency in the general population is not estimated due to a number of objective and subjective factors [2]. Gastrointestinal (GI) diseases in TA patients are not sufficiently studied. GI involvement can be a consequence of the main pathological process as well as drug treatment complication. The need to analyze the frequency and structure associated with at lesions of the digestive system determines the relevance of this work.Objective: in a retrospective cohort study to assess the frequency and structure of TA-associated GI pathology.Materials and methods: a retrospective cohort study included 183 patients with verifi ed TA. All had been hospitalized and observed in the Sverdlovsk regional Clinical Hospital 1 from 1979 to 2018, and were examined according to the clinical guidelines valid by the period of hospitalization. The results of 22 fatal cases autopsies were also analyzed. The study was approved by the local Ethical Committee, the Sverdlovsk Regional Clinical Hospital 1.Results: GI diseases were registered in 70 (38%) of the cohort 183 participants. The most frequently registered GI disease was chronic gastritis (28 cases; 40%), nonalcoholic fatty liver disease (22 cases; 31%), chronic pancreatitis (33 cases; 47%). Meanwhile, GI lesion was confi rmed in 20 cases of autopsy (87%). Moreover, 2 tumors of the stomach and hepar were revealed only postmortem.Conclusion: the data obtained emphasize the importance of more thorough clinical and instrumental monitoring of the GI tract in TA patients.

Complicated appendicitis in Children in Aba, Nigeria

Introduction: Acute appendicitis is one of the most common abdominal emergencies globally. Etiologyremains poorly understood with few advances over the past decades. Obtaining a confident pre-operativediagnosis remains a challenge, as appendicitis must be entertained in any patient presenting with an acuteabdomen. A clinical classification is used to stratify management based on simple (non-perforated) andcomplex (gangrenous or perforated) inflammation, although many patients remain with an equivocaldiagnosis, which remains one of the most challenging dilemmas. The aim of the study is to evaluate themanagement and outcome of complicated appendicitis at the Abia State University Teaching HospitalAba Nigeria. Methodology: A prospective analysis of all children treated for appendicitis at the AbiaState University Teaching Hospital Aba between 2016 and December 2018. Proforma was opened fordemographic data, clinical presentation, diagnosis, treatment, complication and outcome. Results: A totalof 100 children aged between 2 and 15 (mean 8.7 ± 2.8) years, comprising 60males and 40 females withmale/female ratio 3:2 had appendectomy which accounted for 8% of total pediatric operations and 40% ofpediatric abdominal operations. Only 40 (40%) children presented during the first episode of symptomsand in clinically stable state while 60 (60%) were referred after wrong diagnosis and treatment by generalpractitioners which resulted in different complications ranging from appendix abscess 10 (10%), appendixmass 15 (15%), perforated appendix 30 (30%), gangrenous appendix 5 (5%) . These influenced postoperative outcome with wound infection recorded in 20 (20%), wound break down 10 (10%), septicemia15 (15%), pelvic abscess 5 (5%) and death 1 (1%). These were not recorded among those who presentedearly who also had significantly lower duration of hospitalization and cost of treatment. Conclusion: Latereferral due to paucity of knowledge, long referral chain and low index of suspicion was rampant whichsignificantly increased associated morbidities and mortality among children managed with appendicitisKeywords: Appendicitis, children, complicated