Perception, Knowledge, and Professional Behavior of Dentists about Silver Diamine Flouride: A Nationwide Survey

Objectives The aim of this study was to survey the educational experiences, knowledge, and attitude of dentists in Pakistan about the professional use of silver diamine fluoride (SDF). This study also aimed to determine if SDF educational experience at the undergraduate level can result in a more positive attitude and increased clinical usage of SDF. Materials and Methods This was a cross-sectional survey, conducted at multiple dental institutes across Pakistan using a pre-validated questionnaire to assess the knowledge, experience, and professional expertise of dentists regarding the use of SDF. The data were entered and analyzed using the SPSS (version 23.0) data management software by IBM. Results The results of this study were deemed significant in terms of achievement of the study aims. The majority of the responders, 178 (79.8%), reported online resources to be the main source of information about SDF treatment, whereas 103 (46.1%) responders gained information from a dental journal. A higher number of consultants were reported to be well educated regarding SDF treatment during their residency training as compared with demonstrators, house officers, and postgraduate trainees (p < 0.001). About 64 (28.7%) responders agreed that SDF is a better alternative treatment for children with behavioral issues, 74 (33.2%) agreed that it is a better treatment option for medically fragile patients, and 79 (35.4%) agreed that it can be used as an alternative for patients with dental anxiety. It was agreed by 82 (36.8%) responders that SDF is a good treatment option for patients who recently have received chemotherapy radiation therapy. Conclusion It is the need of time to put all educational efforts together to enhance knowledge regarding the use, advantages, and potential problems of SDF.

Dorsal root ganglion stimulation combined with spinal cord stimulation for effective treatment of postherpetic neuralgia - A case report -

Background: Although spinal cord stimulation (SCS) can be a treatment option for intractable postherpetic neuralgia (PHN), obtaining proper stimulation at the thoracic dermatome is difficult. Dorsal root ganglion (DRG) stimulation may be an effective treatment for patients with insufficient efficacy in SCS only.Case: A 54-year-old man with intractable PHN was referred to our clinic. Pain was localized to the distribution of the T1–3 dermatomes. SCS trial was conducted, and lead was placed within the epidural space over the C6–T1 level; however, the stimulation was inadequate for his pain site. Therefore, another lead was placed within the left T1 and T2 DRG for trial, and T1 DRG stimulation provided adequate stimulation. T1 DRG stimulation and SCS could cover the entire pain site with paresthesia, and his pain was decreased by over 50%.Conclusions: DRG stimulation combined with SCS may be a good treatment option for intractable thoracic PHN.

Gasserian ganglion radiofrequency thermoablation in a patient with aneurysm of the anterior communicating artery

BackgroundGasserian ganglion radiofreqeucy thermoablation is a good treatment option for the management of pain in trigeminal neuralgia. We report a case in which the patient of trigeminal neuralgia combined with anterior cerebral artery aneurysm was treated successfully by gasserian ganglion thermoablation without any complication.CaseAn 85-year-old female presenting with electric shock like sensation in the gum and molar teeth was diagnosed as trigeminal neuralgia. Carbamazepine medication and trigeminal nerve blockade relieved her pain partially, but severe side effects of carbamazepine occurred. Magnetic resonance angiography of the brain showed saccular aneurysm in inferior aspect of the anterior communicating artery. Gasserian ganglion thermoablation under sedation anesthesia using nicardipine was performed carefully without any rupture of the cerebral aneurysm.ConclusionsGasserian ganglion thermoablation could be performed safely in a patient with cerebral aneurysm without any inadvertent event.

Efficacy of Osimertinib in NSCLC Harboring Uncommon EGFR L861Q and Concurrent Mutations: Case Report and Literature Review

The efficacy of first-and second-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in NSCLC patients with the EGFR L861Q mutation has been studied previously. However, there is little evidence on the efficacy of osimertinib in NSCLC patients with uncommon mutations. Here, we report the case of a 68-year-old man with advanced NSCLC with concurrent EGFR L861Q mutation as well as TP53 and RB1 mutations. The patient was treated with osimertinib as first-line therapy and achieved a remarkable progression-free survival of 15 months. His symptoms were significantly alleviated and the dose was well tolerated. The findings of the present study indicate that osimertinib might be a good treatment option for NSCLC patients with the L861Q mutation.

Unusual case of disappearing hepatic hydatid cyst: COVID-19 times

The larvae of the tapeworm Echinococcus granulosus cause echinococcosis or hydatid disease. Liver is the most commonly involved organ accounting for 60%–80%. Rupture into the biliary radicle through a cystobiliary communication is the most anticipated complication seen in 5%–17%, presenting with obstructive jaundice and cholangitis. We present a young patient who had presented with cholangitis and a tender hepatomegaly. Contrast-enhanced CT (CECT) had revealed a large hepatic hydatid cyst with multiple daughter cysts and significant dilatation of intrahepatic/extrahepatic biliary system. He had undergone an emergency Endoscopic Retrograde Cholangiopancreatography (ERCP) with extraction of the membranes and stenting of the common bile duct. A few cycles of albendazole were given to sterilise before elective laparoscopic surgery. However, a follow-up CECT showed complete resolution of the hepatic hydatid with calcification. In conclusion, medical treatment with a few cycles of albendazole and ERCP with stenting could be a good treatment option.

Repeated capsaicin patch applications in patients with localized peripheral neuropathic pain

Neuropathic pain is still a challenging problem. It is experienced by millions of people worldwide, with an approximate prevalence of 7‒10% in the general population. Despite the availability of a variety of treatment methods, a significant proportion of patients suffer from poorly controlled neuropathic pain. Capsaicin is a highly selective TRPV1 (Transient Receptor Potential Vanilloid Type 1) agonist. When applied topically, it leads to the defunctionalisation of hyperactive nociceptive receptors, temporary destruction of peripheral nerve endings, and a significant reduction or cessation of pain. Therefore 8% capsaicin patches are used to treat several peripheral, localized neuropathic pain syndromes. The study aimed to present a case series of patients suffering from peripheral, localized neuropathic pain in case the use of repeated applications of 8% capsaicin patches significantly reduced the intensity of pain. In 5 out of 6 patients we observed a gradual extension of the pain relief period until the pain disappeared, which led to the reduction or discontinuation of systemic pharmacotherapy. In summary, a therapy limited to a certain area of the body, without potential systemic adverse effects, which requires repetition at fairly long intervals, appears to be a good treatment option.

Laparoscopic Cholecystectomy for Acute Cholecystitis: Indication, Risk, and Outcome

Background: A laparoscopic cholecystectomy is a fundamental approach to treating acute cholecystitis, and the timing of performing this given treatment is associated with clinical outcomes. It is unknown whether surgical indication, risk, and consequences of laparoscopic cholecystectomy for acute cholecystitis differ from those for the chronic form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases. Objective: This study aimed to evaluate surgical indication, risk, and outcomes of laparoscopic cholecystectomy for acute cholecystitis. Methods: This prospective observational study was carried out at Bangladesh Medical College Hospital (Uttara Campus) from July 2006 to November 2008. A total of 103 acute cholecystitis patients were observed to evaluate the safety, risk, and outcomes (includes hospital stay, joining to routine daily works) of laparoscopic cholecystectomy. Result: Male and female ratio is 1:4, and the mean age in our series is 47 years. Acute calculas cholecystitis ultra-sonogram feature shows the highest percentage (85.4%) compare to the other four parts. The study also confirmations around 69% did not get any complications, and bleeding was the most frequently observed (16%) complication. The overall outcomes in this research were observed around 75% of total operated patients did not experience any difficulty and said they fit entirely. The other 19% who had some complications include Pain, RTI, Seroma, Jaundice, Cholangitis, Wound infection). Conclusion: Regarding bile duct injury and prolonged complications, laparoscopic surgery is not a very good treatment option for acute cholecystitis.

External Urethral Orifice Metastasis of Cervical Cancer Treated With Intraluminal Urethral Brachytherapy Using a Lumencath Applicator: the First Case Report

Background: This is the first case report of external urethral orifice metastasis in primary cervical cancer.Case presentation: The patient was histologically diagnosed with cervical squamous cell carcinoma, which involved not only the lower third of the vagina but also isolated metastasis of the external urethral orifice. We performed definitive chemoradiotherapy with weekly cisplatin and external beam radiation therapy followed by brachytherapy (BT). Considering tumor involvement, we used the Tandem, Cylinder, and Lumencath applicators to treat not only the cervix and vagina but also the entire urethra in BT sessions. The prescribed BT dose was 24 Gy in four fractions. The average clinical target volume (CTV) D90 of the cervix, vagina, and urethra in BT sessions were 7.3, 6.0, and 5.6 Gy, respectively. The average CTVs of the urethra in D0.1 cc and D1 cc were 18.1 Gy and 9.0 Gy, respectively. No grade ≥3 acute and late toxicities were observed during the 9-month follow-up. We achieved excellent local control for both primary tumor and external urethral orifice metastasis of cervical cancer.Conclusion: This rare case report suggested that gynecologists and radiation oncologists should keep in mind to examine not only the cervix and vagina but also the external urethral orifice for patients with primary cervical cancer. Intraluminal urethral BT using the Lumencath applicator is a good treatment option for cervical cancer with urethral involvement.

Real-World Experience of Telbivudine and Lamivudine as Antiviral Prophylaxis for Chemotherapy-Related Hepatitis B Reactivation

Background: There is currently no data regarding the efficacy of prophylactic telbivudine in hepatitis B patients undergoing chemotherapy. This study aims to describe the results of preemptive telbivudine and lamivudine to prevent chemotherapy-related HBV reactivation.Methods: The medical records of all patients with HBsAg positive or HBs-Ag negative, anti-HBc positive, who were referred to the hepatology clinic between May 2014 and December 2016, were retrospectively reviewed. As this is a descriptive study, no statistical analysis was done.Results: A total of 52 patients with prophylactic telbivudine or lamivudine therapy were included, with 26 patients in each group. Rituximab-based treatment was given in nine and five patients in the telbivudine and lamivudine group, respectively. The number of patients who completed antiviral treatment up to six months after chemotherapy was 17 patients in each group. There was less incidence of HBV reactivation in the telbivudine group (2 of 17 patients, 11.8%) than in the lamivudine group (7 of 17 patients, 41.2%). Delayed reactivation was noticed in 1 of 2 patients in the telbivudine group and 3 of 7 patients in the lamivudine group. The median log10[HBV DNA] at reactivation was 4.52 (1.70 – 8.35) IU/mL. Severe hepatitis was observed in two patients in the lamivudine group and one patient in the telbivudine group. Of 34 patients who completed antiviral treatment, two patients died due to primary cancer. No interruption of chemotherapy or mortality due to hepatitis was noticed in both groups.Conclusions: Preemptive telbivudine or lamivudine in HBsAg positive or HBsAg negative, anti-HBc positive patients seems to be a good treatment option.

A retrospective evaluation after insertion of the MicroGYNious single incision sling in cases of stress urinary incontinence

In the literature the rate of stress incontinence is reported between 29-75%. Compared to the established tension free vaginal tapes, the question arises, whether stabilization of the urethra can also be achieved by minimally invasive single incision slings. The aim of this retrospective analysis is to evaluate the cure rate after insertion of MicroGYNious sling. The study was carried out on 115 patients, who received a MicroGYNious sling. It was used both as a single operation for stress urinary incontinence and as a combined procedure. The degree of incontinence preoperatively and continence rate postoperatively with follow-ups (6 weeks, 6 months, one year, two years and three years) were recorded. Due to a high number of lost to follow-up after one year, only the data up to one year postoperative were included in the analysis. Preoperatively, grade I incontinence was found in 6.1%, grade II 35.7%, grade III 58.3% of the operated women. The continence rate was 96.7% postoperatively, 90 % after 6 weeks, 87.2 % after 6 months, 86.7% after one year. In terms of continence rates, the MicroGYNious sling shows similar results compared to the established procedures. Therefore, this sling provides a good treatment option for the stress urinary incontinence. These good results must be confirmed in prospective randomized trials.