Case Series of Applications of Resting State Functional MRI in Brain Tumor Surgery: A Novel Technique

Background The extent of resection for brain tumors is a critical factor in determining the oncologic outcome for a patient. However, a balance between preservation of neurological function and maximal resection is essential for true benefit.Functional magnetic resonance imaging (fMRI) is one of the approaches that augments the neurosurgeon's ability to attain maximal safe resection by providing preoperative mapping. It may not be possible to perform awake craniotomy with intraoperative localization by direct cortical stimulation in all patients, such as children and those with neurocognitive impairment. Task-based fMRI may have limited value in these cases due to low patient cooperability. Methods In this article we present in a case-based format, the various clinical scenarios where resting state fMRI (rs-fMRI) can be helpful in guiding neurosurgical resection. rs-fMRI of the patients has been acquired on Philips 1.5 T system. Seed voxel method has been used for processing and analysis. Conclusion rs-fMRI does not require active patient cooperation to generate useful information and thus can be a promising tool in patients unable to cooperate for task-based studies.

Orthodontic Treatment of Bilateral Transposition of Maxillary Canines and Lateral Incisors

Dental transposition is a severe disturbance of tooth position and its eruptive sequence. It may affect any tooth, and it may occur at any location within the dental arch, although some teeth may be more frequently affected than others. There are several types of dental transposition, and their classification depends on the type of teeth involved. The aetiology of transposition is not very clear and has always been the subject of controversies, and it is still not completely understood. The prevalence of dental transposition and the factors related to this dental anomaly have been well documented in the literature. When treating dental transposition, many factors which may affect the treatment results must be considered, such as aesthetics, occlusion, treatment duration, patient comfort, patient cooperation, and periodontal support. Various treatment options are currently available for the treatment of dental transposition. Successful treatment outcomes depend on the patient’s age, concern about facial and dental aesthetics, motivation of the patient, functional requirements, type of malocclusion, and the position of the root apices. The present case report is aimed at outlining the orthodontic treatment of a young adult patient diagnosed with bilateral maxillary canine-lateral incisor transposition.

Anaesthetic Management of Left Temporal Glioma Undergoing Awake Craniotomy

For an awake craniotomy, a 49 year old (ASA 2), 78 kg woman with type II DM was given regional anaesthesia (scalp block) with monitored anaesthesia care (MAC). She had a headache, which was primarily caused by a left temporal glioma. She was very apprehensive about having this procedure done while she was awake. Fentanyl and Dexmedetomidine infusions in combination with scalp block initially provided adequate operating conditions. Because the patient needed to be fully awake, alert and cooperative during the language and motor mapping, all sedation was turned off. Patient was cooperative and obeyed commands during motor and language mapping as well as during tumour excision. Patient underwent complete excision of tumour without any postoperative neurological deficit. The success of the awake craniotomy is dependent on the patient cooperation, anaesthesiologist's experience, adequate intraoperative analgesia coverage, careful sedation titration, and meticulous planning.

Case Report: Severe Side Effects Following Treatment With First Generation Antipsychotics While Cariprazine Leads to Full Recovery

Schizophrenia is a psychiatric disorder characterized by positive, negative, cognitive and affective symptoms. Patient cooperation with health care professionals, compliance with the treatment regime, and regular use of medications are some of the preconditions that need to be met for a favorable disease course. A negative experience following the use of a first-generation antipsychotic to treat first-episode psychosis can negatively affect a patient's motivation for further medication use. In the clinical case reported here, cariprazine was able to restore one such patient's confidence in therapy and facilitated their cooperation with the physician, thereby ensuring effective control of negative and positive symptoms and good functioning for a period of 1 year. Cariprazine may be a good option for maintenance therapy following first-episode psychosis, especially in situations in which a patient has had a negative first experience associated with antipsychotic medication use.

Applications of Silver Diamine Fluoride in Dentistry

Various studies published in the literature around the world indicate a significant prevalence of early childhood caries (ECC). Treatment of early childhood caries (ECC) using silver diamine fluoride (SDF) has become a viable alternative, particularly for young and anxious children, because traditional restorative treatments is unlikely to combat this prevalent condition. Arrested caries is identified by the hardening of teeth and it changes its color from dark brown to black. More restorative treatments can be performed if necessary. Traditional ECC restorative treatments are not always inexpensive or feasible, as they involve patient cooperation to achieve a satisfactory result. Japan was the first country to promote silver diamine fluoride in 1960. SDF has been used to prevent the spread of caries in various Asian nations, including Japan and China. It was enacted as a fluoride to treat sensitive teeth in the United States by Food and Drug Administration ( FDA). For young children or individuals with specific needs, it is painless and simple to use .The fluoride in SDF stimulates remineralization while the silver ions act as an antimicrobial agent when applied to carious lesions and stop cariogenic biofilms from growing. SDF also prevents future degradation of the dentin's collagen. With a 38 percent use rate, SDF has been utilized in a number of nations. According to a review, SDF is a harmless, economical caries control agent with a wide utilisation in dentistry, and it may meet the WHO Millennium Development Goal (MDG) as well as the United States Institute of Medicine's criteria. The applications of SDF in dental treatment are discussed in this article.

Complete Dental Management of an Autism and Intellectual Disability Patient under General Anaesthesia: A Case Report

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and the presence of restricted interests and repetitive behaviours. Comorbidities following ASD, such as seizure, intellectual disability, and sensory impairment worsen patients’ ability to care for themselves. We present the case of a 22-year-old man with autism, intellectual disability and visual impairment who had recurrent pain in his upper and lower left posterior teeth that had cavities. On the first visit, the patient was observed and had panoramic x-ray. Clinical examination could not be done properly due to lack of patient cooperation. Restoration, pulp capping, tooth extraction, and odontectomy were planned under general anaesthesia.

Assessment of bronchodilator response by forced oscillation technique in preterm infants with evolving bronchopulmonary dysplasia

Inhaled bronchodilators are often given in preterm infants with evolving or established bronchopulmonary dysplasia. However, it is unclear which patients may benefit from it and when it is the best time to start treatment. The forced oscillation technique (FOT) is a noninvasive method for assessing lung mechanics that proved sensitive to airway obstruction reversibility in children and adults. FOT does not need patient cooperation, which is ideal for infants. Bedside tools for applying FOT in infants during spontaneous breathing and different respiratory support modes are becoming available. This case report illustrates for the first time that FOT has potential value in assessing airway obstruction reversibility in preterm infants, informing which infants may manifest a clinical benefit from the treatment with bronchodilators.

Hemodynamic evaluation of patients with Moyamoya Angiopathy: comparison of resting-state fMRI to breath-hold fMRI and [15O]water PET

Purpose Patients with Moyamoya Angiopathy (MMA) require hemodynamic evaluation to assess the risk of stroke. Assessment of cerebral blood flow with [15O]water PET and acetazolamide challenge is the diagnostic standard for the evaluation of the cerebral perfusion reserve (CPR). Estimation of the cerebrovascular reactivity (CVR) by use of breath-hold-triggered fMRI (bh-fMRI) as an index of CPR has been proposed as a reliable and more readily available approach. Recent findings suggest the use of resting-state fMRI (rs-fMRI) which requires minimum patient compliance. The aim of this study was to compare rs-fMRI to bh-fMRI and [15O]water PET in patients with MMA. Methods Patients with MMA underwent rs-fMRI and bh-fMRI in the same MRI session. Maps of the CVR gained by both modalities were compared retrospectively by calculating the correlation between the mean CVR of 12 volumes of interest. Additionally, the rs-maps of a subgroup of patients were compared to CPR-maps gained by [15O]water PET. Results The comparison of the rs-maps and the bh-maps of 24 patients revealed a good correlation (Pearson’s r = 0.71 ± 0.13; preoperative patients: Pearson’s r = 0.71 ± 0.17; postoperative patients: Pearson’s r = 0.71 ± 0.11). The comparison of 7 rs-fMRI data sets to the corresponding [15O]water PET data sets also revealed a high level of agreement (Pearson’s r = 0.80 ± 0.19). Conclusion The present analysis indicates that rs-fMRI might be a promising non-invasive method with almost no patient cooperation needed to evaluate the CVR. Further prospective studies are required.

The treatment of Covid tongue in an isolation unit

Background: In 2019, a viral disease spread from Wuhan, Hubei Province in China. The disease was caused by severe acute respiratory syndrome related to coronavirus 2 (SARS-CoV-2 virus), which was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses. Purpose: This article reports the multi-discipline treatment of Covid tongue and exfoliative cheilitis with a main diagnosis of bilateral pneumonia caused by SARS-CoV-2 infection. Case: A female patient, 70 years old was referred with a diagnosis of bilateral pneumonia by a pulmonologist. She complained of painful wounds all over her mouth. An intraoral clinical examination revealed white-thick lesion and multiple ulcerations, whilst an extraoral exam for exfoliative dermatitis has not been described. The working diagnosis was Covid tongue mixed with exfoliative cheilitis. Case management: The procedure was performed by teledentistry and direct visits to implement oral health care by asepsis, debridement and the application of Oxygene gel. Conclusion: The lesion was treated successfully due to the multidisciplinary approaches by an internist and pulmonologist by implementing integrated knowledge and was supported hugely by patient cooperation.

The Application of Pendulum as a Space Regainer in Orthodontic Treatment

Background: The process of distalization in orthodontic treatment is often very difficult. The most common method is the use of cervical headgear. However, due to poor patient compliance, it leads to poor treatment outcomes. Treatment alternatives that require minimal compliance include Jones jig, magnets, and pendulum. Objective: This study aimed to perform distalization of a maxillary molars on a bilateral Class II molar relationship patient with a crowded maxillary arch. Case Report: A 10-year-old female with a Class II molar relationship, bilateral posterior crossbite, and nonerupted upper canines was treated with a rapid palatal expander (RPE), pendulum appliance, and fixed appliance. The crowding in the maxillary arch and spacing in the mandibular arch were eliminated, and transverse discrepancies were corrected. Conclusion: Pendulum appliance is very effective in creating spaces for the eruption of canines and ectopic premolars. Pendulum appliances have been introduced for a long time and have proven successful for molar distalization and space regainer and require minimal patient cooperation. Like other distalization appliances, distal tipping of the molars and mesial movement of the premolars could be observed.