Rehabilitation of an Extremely Atrophied Mandibule with Cortical Plates

A 74-year-old woman presented in our dental practice with severe loss of alveolar bone and soft tissue without any apparent systemic pathology contributing to her dental conditions. She had a complete removable prosthesis supported with a four locaters system. Unfortunately, two of the four supporting implants were failed. The patient wanted a fixed prosthesis. The treatment plan was to use the remaining implant with an additional axial implant and two cortical plates (Victory ®) followed by implant placement. The implants and plates were immediately loaded with a screw-retained prosthesis made with Znatex frame (Victory Implants ®) and resine.

“I Can’t breathe”: Two Case Reports of Inadequate Reversal of Residual Muscle Paralysis

Reversal of residual muscle paralysis is usually done at the end of a General Anaesthesia with Relaxant Technique (GART) before extubation. However, some patients may have inadequate reversal of their residual muscle paralysis. This may lead to persistent muscle paralysis despite the patient being awake from anaesthesia. A scenario of “I can’t breathe” therefore comes to play which is scary and discomforting to the affected patients. We hereby present two cases of inadequate reversal of residual muscle paralysis in our patients who underwent different procedures under general anaesthesia. The aim of this presentation is to highlight the need for adequate reversal of residual muscle paralysis, the need to routinely monitor neuromuscular function during general anaesthesia and to review the existing literature.

Subchondroplasty Bone Substitute Material (BSM) Histological Analysis after Total Knee Arthroplasty: A Case Series

In our series of 227 patients who underwent prior Subchondroplasty of the knee wiht bone substitute material (BSM) we had the opportunity to review 4 cases which returned for conversion to Total Knee Arthroplasty (TKA). The average time to convert to a TKA was 23.5 months (18-35 months).

Coronally Repositioned Semilunar Flap for Root Coverage: A Case Report

Gingival recession is one of the most commonly encountered periodontal problem. It is one of the most difficult to treat periodontal issue since it requires great amount of clinical skills and patient co-operation. There are plethora of techniques and their modifications available with different levels of predictability for root coverage. One of the highlighted technique amongst many is the coronally repositioned semilunar flap. It has various advantages like tension free flap during healing (without sutures), better predictability and minimal clinical skills required. This case report describes in detail a case treated with semilunar flap and discusses further about it.

Comparative Analysis and Forecasting on the Death Rate of COVID-19 Patients in Nigeria Using Random Forest and Multinomial Bayesian Epidemiological Models

The novel COVID-19 (SARS-COV-2) is a disease currently ravaging the world, bringing unprecedented health and economic challenges to several nations. There are presently close to 175,000 reported cases in Nigeria with fatalities numbering over 2,163 persons. The main objective of this paper is to compare the analysis and predictive accuracy between the Random Forest and the Multinomial Bayesian Epidemiological model for a cumulative number of deaths for COVID-19 cases in Nigeria by identifying the underlying factors which may propagate future occurrences. It is worthy to note that the Random Forest algorithm is an ensemble learning approach for classification, regression, and other tasks that works by training a large number of decision trees G(t) while the Multinomial Bayesian algorithm provides an excellent theoretical framework for analyzing experimental data and the highlight of its success relies on its ability to integrate prior knowledge about the parameters of interest as a distribution function p(Ck|d).

An Incidental Finding of Situs Ambiguus with Polysplenia in an Asymptomatic 70-Year-Old Male

The term “Situs ambiguus” describes the configuration when some, but not all thoracic and abdominal organs are abnormally positioned. It is commonly associated with polysplenia, or multiple spleens. 50-100% of situs ambiguus with polysplenia have associated cardiac malformations [1]. We present a 70 year old male who came to our hospital for complete, acute, urinary retention, and was found to have invasive prostate cancer. Incidentally, the liver was positioned on the left side, and the spleen was located on the right side. There were multiple perisplenic nodular formations with peripheral calcifications that had enhancement kinetics similar to those of the spleen, suggesting polysplenia. In low thoracic cuts, the tip of the heart was clearly on the left side. The presence of situs ambiguus with polysplenia in the absence of cardiac abnormalities makes this case a unique presentation of an already rare condition. Clinicians should regularly consider the possibilities of anatomical variation in their medical and surgical practices.

Successful Surgical Repair of Left-Sided Diaphragmatic Hernia after Adult Orthotopic Liver Transplantation: Case Report

Postoperative delayed diaphragmatic hernia (DH) is a rare and uncommon event after adult orthotopic liver transplantation (OLT), which however could be potentially life-threatening complication, especially in the absence of early and correct diagnosis and appropriate surgical treatment. We present a case of 48 year-old male with left diaphragmatic herniation of left part of transverse colon, who thirty nine months before underwent OLT with right-sided allograft implantation and which was recently successfully managed by open abdominal approach in our institution. The postoperative course was uneventful and he was discharged at the 8th day after surgery. Our case illustrates, that delayed DH after the OLT in adults could be a new problem, which affect transplant recipients with long-term follow-up period. Hence, we consider, that once the diagnosis of DH is confirmed, the patient should be operated immediately, in order to avoid the possible life-threatening complications.

Hypercalcemia: An Ominous sign of Malignancy

Hypercalcemia is a disorder commonly encountered by primary care physicians. The diagnosis often is made incidentally in asymptomatic patients Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. 90% of cases of hypercalcemia are due to primary hyperparathyroidism and malignancy. This article highlights the importance of proper work-up of elevated serum calcium levels and complications that can arise from failure to do so. This is a case report of a 63-year-old female who was found to have asymptomatic hypercalcemia of 10.5 mg/dl but was lost to follow up and presented four years later to her primary care physician with complaints of pain in the neck and weakness in bilateral shoulders, arms, wrists, and numbness of 4th and 5th digits. MRI revealed lytic lesions on the cervical and thoracic spine with compression deformity likely due to metastatic breast cancer. Lab reports revealed a serum calcium level of 12.1mg/dl and the patient’s chart (mammogram/ breast US) confirmed malignant breast cancer.