Long-Term Follow-Up of Dental Rehabilitation of a Patient with Clouston Syndrome and Congenital Edentulism (Issues of Theory and Clinical Practice)

The article presents results of a concise analysis of domestic and foreign literature addressing the problem of determining of distinctive diagnostic features in patients with Clouston syndrome as an orphan disease rarely encountered in clinical practice of dentistry. A clinical case of effective orthopaedic rehabilitation of a 10-years-old patient with Clouston syndrome and congenital edentulism using minimally invasive orthopaedic dentistry measures: removable dentures application using shape memory materials is presented. Technological peculiarities and advantages of the chosen approach to treatment are described. Photographic documents of orthopaedic dental treatment results including long-term results within the follow-up period of 10 years are presented providing strong evidence of effective aesthetic, functional and social rehabilitation of the patient. Detailed analytical conclusion is drawn according to the study results.

Panton-Valentine Leukocidin-Positive Methicillin-Resistant Staphylococcus Aureus with Reduced Vancomycin Susceptibility: An Emerging Trend?

Methicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant nosocomial pathogen. This class of MRSA, first reported in the early 1960s and now termed healthcare-associated MRSA (HA-MRSA), was followed by a newer class of MRSA, community-associated MRSA (CA-MRSA). The unique feature of the initial CAMRSA included Panton-Valentine leukocidin (PVL), an abscess-associated toxin and also S. aureus spread factor. CA-MRSA usually causes skin and soft-tissue infections, but occasionally causes invasive infections, including (necrotizing) pneumonia, sometimes preceded by respiratory virus infections. The most successful CA-MRSA USA300 (ST8/SCCmecIVa) caused an epidemic in the United States. In Russia, we first detected PVL-positive CAMRSA (ST30/SCCmecIVc) in Vladivostok in 2006, but with no more PVL-positive MRSA isolation. However, we recently isolated four lineages of PVL-positive MRSA in Krasnoyarsk. Regarding chemotherapy against invasive MRSA infections, vancomycin still remains a gold standard, in addition to some other anti-MRSA agents such as teicoplanin, linezolid, and daptomycin. For resistance, vancomycin-resistant MRSA (VRSA) with MICs of ≥16 μg/mL appeared in patients, but cases are still limited. However, clinically, infections from strains with MICs of ≥1.5 μg/mL, even albeit with susceptible MICs (≤2 μg/mL), respond poorly to vancomycin. Some of those bacteria have been bacteriologically characterized as vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA), generally with HA-MRSA genetic backgrounds. The features of the above PVL-positive Krasnoyarsk MRSA include reduced susceptibility to vancomycin, which meets the criteria of hVISA. In this review, we discuss a possible new trend of PVL-positive hVISA, which may spread and threaten human health in community settings.

The Role of Oxidative Stress and Antioxidants in Occurrence of Myocardial Infarction and Chronic Heart Failure

Oxidative stress is one of the most important mechanisms of cardiovascular diseases, especially in heart failure. Mitochondrial dysfunction and inflammation play a major role in formation of free radicals and antioxidants. The association between oxidative stress, telomere biology and cell senescence plays the key role in cardiovascular pathology development. The paper considers role of pro-oxidant and antioxidant enzymes in heart pathology development. Specifically, the role of such antioxidant enzymes as glutathione peroxidase 3, catalase, and superoxide dismutase is described. The role of gamma-glutamyl transferase is emphasized as its activity increases significantly in cases of heart failure, coronary heart disease, stroke, arterial hypertensions, and arrhythmias. This article is a literature review of the effect of such antioxidants as alpha-tocopherol, ubiquinone, uric acid, and triiodothyronine on development of heart failure and myocardial infarction. A decrease in triiodothyronine concentration is a risk factor for coronary heart disease. High uric acid values in patients with myocardial infarction upon admission to the hospital are associated with a high risk of sudden death. The influence of such minerals such as zinc, copper, magnesium, selenium, potassium, sodium, calcium, and iron on heart failure development has been analyzed. The role of ceruloplasmin as an independent predictor of acute and chronic cardiac disorders cardiac events, mortality, and bad prognosis in patients with heart failure and myocardial infarction is examined. The authors demonstrate the influence of inflammation on heart failure development as well as association of inflammation with oxidative stress.

Analysis of the Educational Process with Application of Distance Learning Technology in Speciality 33.05.01 Pharmacy

In the context of new coronavirus COVID-2019 infection spread, many students in numerous higher education institutions have undergone the transition to education applying distance learning technology while medical students undergo partially remote education. It is worth noting that in the setting of the COVID-19 pandemic, remote education is the best prevention measure for decrease in incidence of the new coronavirus infection among students.

An Objective Method for Assessment of Facial Expression in Patients with Parkinson’s Disease and Healthy Population

Hypomimia is a common symptom of Parkinson’s disease. At the present time, issues related to existence of interrelations between hypomimia and manifestations of common hypokinesia remain under-investigated in aspects of both clinical manifestations and rehabilitation efficacy. An objective method for facial muscle movement diagnostics is necessary to achieve this goal. The article presents novel experience in application of a proprietary method using objective facial expression assessment video analysis on the example of a healthy female subject and a female patient with Parkinson’s disease. The Parkinson’s female patient had objective symptoms of hypomimia: a decrease in velocity and amplitude of eyebrow and mouth movement, slow winking. Therefore, application of this method creates prerequisites for more in-depth study of theoretical and clinical aspects in facial expression of Parkinson’s disease patients.

Practice, Perception, and Associations of Peer Learning Among Resident Doctors in Nigeria: Charting Study

Introduction: Peer learning is an important component of the postgraduate medical curriculum, and it is considered as an integral part of learning in some countries. The practice of peer learning among postgraduate trainees, especially the resident doctors, is an area that has not been explored in Nigeria and other third world countries. This study aims to examine the practice, perception, and drivers of peer-to-peer training in Nigeria. Methodology: This study was a national multi-centre and multi-disciplinary cross-sectional survey, conducted among resident doctors in Nigeria. Semi-structured questionnaires were used to obtain respondents’ biodata, perception and practice on peer learning. Data were analysed using SPSS version 23 software. Results were presented as frequency table and proportion, means, and standard deviation. Inferential statistics such as bivariate analysis was performed. Results: Majority, 287 (73.2%), considered the peer education programme as an appropriate learning practice, 173 (45.9%) considered peer education programme integrated part of the training, while 350/383 (88.2%) engaged in a peer education programme. Statistically, a significant association was found between those who considered peer training as appropriate (p = 0.038) and those who considered peer education as an integral part of postgraduate medical training curriculum (p =0.009). Conclusion: Peer learning is popular among resident doctors in Nigeria. Concerted efforts are needed to re-structure the residency training curriculum in order to maximize the benefits of this learning approach for an effective training programme.

Paget’s Disease of Bone Diagnosed on SPECT/CT: A Case Report

I reported a case of a seventy-five-year-old woman with a backache and pain in left femur. Magnetic resonance imaging (MRI) of back, pelvis and hips showed bone marrow lesion suggesting bone metastasis. The patient was admitted to nuclear medicine department of Krasnoyarsk Regional Clinical Oncology Center. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) of the skeletal system together with several laboratory tests (alkaline phosphatase, calcium, phosphorus), provided grounds for the diagnosis of Paget’s disease. The patient was qualified for treatment to the Rheumatologist.

Pulmonary Hypertension in Patients After Permanent Pacemaker Implantation

Permanent pacemaker (PPM) implantation can lead to thromboembolic events at different times after the procedure. According to literature, 1.7% of patients with pulmonary embolism have an implantable cardiac device. This frequency is higher than reported so far, from 0.16 to 0.47% of the total population. The pathophysiologic mechanism of pulmonary embolism in chronic thromboembolic pulmonary hypertension (CTEPH) is multifactorial. Recently, there is evidence that not only the organisation of thrombotic deposits in the proximal pulmonary arterial vessels is important, but also the development of small vessel disease, which plays an important role in the evolution and progression of the disease. The role of thrombosis in medical devices in contact with blood flow, such as stents, vascular grafts, heart valves, has been well studied and documented in scientific literature on biomaterials. It is clear that implantable cardiac devices such as pacemakers, similarly to other foreign surfaces exposed to blood flow, promote blood clotting and complement activation. Numerous studies to date have addressed the potential risk of distal vascular involvement of pulmonary circulation in the presence of a pacemaker, but none has conclusively proven this hypothesis. Over the last decade, there has been significant progress in the therapeutic potential of CTEPH. Pulmonary endarterectomy remains the only therapeutic method that can lead to lasting clinical improvement in these patients while achieving a good quality of life. This method is operational, with high financial value and is associated with the presence of a highly specialised team of specialists. This justifies the search for ways to prevent the onset of the disease rather than treat the consequences.

Medical Professionalism Perception of Medical Students in Spain

Introduction: Currently, the Doctor-Patient relationship of all cultures and societies is in crisis due to the distrust that has arisen in this social contract. This distrust origins from various changes that have occurred worldwide. We, as doctors, can contribute to solving this crisis, reaffirming the values that integrate medical professionalism. In the absence of specific studies and programmes on medical professionalism in Spanish universities, we consider knowing the perception of medical professionalism by medical students at the University of Murcia essential to see if there is a need to introduce educational improvements in our faculty. Methods: A professionalism questionnaire from the Penn State University School of Medicine (PSCOM) was provided online, voluntarily and anonymously to all students of the Medicine degree of the University of Murcia. Results: The perception of professionalism in students was high, since all categories have more than 75% positive responses on average. The categories of Respect and Altruism were the best rated. On the other hand, there is a slight increase in negative responses as students progress through the degree. Between sexes, however, there were no differences in the criteria. Conclusions: Although the perception of professionalism is good, it is still a perception, so it should reach values closer to 100%. Therefore, the faculty is encouraged to carry out specific programmes to promote medical professionalism in the degree courses.

Poisoning-Induced Non-Cardiogenic Pulmonary Edema: Mechanism and Outcome

Background: pulmonary edema results from the shift of excessive fluid into the alveoli space and can be clinically classified into cardiogenic or non-cardiogenic by pathophysiology. This study aimed to elucidate the mechanism, outcomes, and prevention of poisoning induced non-cardiogenic pulmonary edema (PINCPE). Materials and methods: we conducted a study on etiology, epidemiology, mechanism, risk, and length of hospital stay in PINCPE. A PubMed search using terms: poisoning and non-cardiogenic pulmonary edema. From 1986 to 2017, a total of 15 articles with 16 cases (2 cases in one article) were included. Cut-off value of mean age was used for classification of subjects into younger group and older group, and length of stay (LOS) was compared between the two groups. Results: the age range of the patients was 7 to 72 years, and the average age (mean ± SD [standard deviation]) was 35.7±19.5 years. Among the reported substances in PINCPE, calcium channel blockers (CCBs) were most frequently used (n=8; 50%). In electrocardiogram (ECG), sinus tachycardia (n=8; 50%) was the most common finding. The overall rate of intubation with mechanical ventilator support was 81.3%. The mortality rate was 12.5%. Among patients with PINCPE, LOS was significantly shorter in the younger group aged <35.7 years than in the older group (5.7 vs. 8.9; p=.022). Conclusion: CCB was the most common etiologic agent in PINCPE. Up to 81.3% of PINCPE cases required intubation with ventilator support due to respiratory failure. LOS may increase 3.2 days if the case is complicated with extra-pulmonary organ failure.