Open Access Pub publishes peer-reviewed, free-to-read open-access articles. Showing
articles matching Bilateral — open any to read the full text,
or download the PDF or XML.
Oct 2021 DOI 10.14302/issn.2470-0436.jos-21-3978
J. Agustin KimCorresponding author
second year Resident, Rizal Medical Center, Ophthalmology Department
Objective To present a case of Bilateral Internuclear Ophthalmoplegia in a 75yo patient Case Description A 75 year old, Filipino, male, known hypertensive for 10 years, but not compliant to medications, presented with a sudden onset binocular horizontal, diplopia and bilateral exotropia associated with dizziness. No other symptoms like slurring of speech, body weakness, numbness were noted. Primary gaze exotropia, abduction nystagmus, gaze evoked vertical nystagmus were also noted. Imaging was done which revealed hypodense focus in the subcortical region of the right centrum semiovale extending to the right corona radiata, with unremarkable orbits, midbrain and pons findings. WEBINO was still considered even without the presence of a pontine lesion in the imaging. The patient was advised patching and was asked to follow up after a month.
Oct 2021 DOI 10.14302/issn.2473-1005.jdoi-21-3976
Kasuga TaichiCorresponding author
Faculty Shinmyouzu Dental Clinic and Oral and Maxillofacial Surgery, Nerima, Tokyo 178-0061, Japan
Auto transplantation is a fast and economical option when a suitable donor tooth is available for replacement of a tooth considered impossible to treat. The purpose of this case report is to describe methods used for autotransplantation and its advantages for cases with a missing bilateral mandibular firstmolar, as compared with a dental implant, removable partial denture, and other methods of prosthesis. In the present patient who underwent auto transplantation, clinical and radiographic outcomes were considered satisfactory at one and two years postoperatively. Bone healing was observed around the roots of transplanted teeth, which showed good function. In autotransplantation cases, even when the donor tooth has complete root formation, a high success rate can be achieved when the patient is properly selected and treated. Although the chance of root resorption remains because of necrotic pulp and periodontal irritation during manipulation, auto transplantation should be considered as a good treatment modality in feasible cases. Based on the present findings, even though autotransplantation is not common in general dental practice, we consider that it offers a clinically and economically viable alternative as compared to other more complicated prosthetic and dental implant treatments. The purpose of this report is to show that auto transplantation is a superior treatment method for single molar defects as compared to other prosthetic methods, as the periodontal ligament of the patient can be used and cutting adjacent teeth is avoided. In addition, it is a treatment method that can effectively utilize a wisdom tooth.
Sep 2019 DOI 10.14302/issn.2474-3585.jpmc-19-3018
Konadu-Yeboah DominicCorresponding author
Orthopaedic and Trauma Surgeon, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Part-Time Lecturer, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Radial Club Hand (RCH) is a rare and complex congenital disorder of the pre-axial border of the upper extremity. It is a congenital longitudinal radial ray deficiency which presents as radial deviation of the hand and distal forearm in the shape of a golf club 12. Radial ray deficiency (the most common type of longitudinal failure of formation) is a spectrum of malformations affecting the structures of the radial side of the forearm, including hypoplasia of the bones, joints, muscles, tendons, ligaments, nerves and blood vessels. The thumb dysfunction, wrist instability and short upper extremity that accompany this condition can cause significant functional impairment particularly in patients with bilateral involvement. Thus, the performance of activities of daily living such as accomplishing personal hygiene, fastening buttons and zippers becomes challenging 3.
Jun 2019 DOI 10.14302/issn.2576-6694.jbbs-19-2784
Cesar Pinto Leal-Junior ErnestoCorresponding author
Laboratory of Phototherapy and Innovative Technologies in Health, Nove de Julho University – UNINOVE, Sao Paulo, Brazil.
The aim of this clinical study was to determine the efficacy of bilateral alternating somatosensory stimulation for the management of stress and anxiety during and after the Trier Social Stress Test (TSST), a laboratory procedure for reliably inducing stress in human subjects. For this, a randomized, placebo-controlled, triple-blinded clinical trial of 80 qualified subjects was conducted. Subjects were randomized into two groups, a treatment group (n=40) and a control (placebo) group (n=40). Metrics of emotional stress assessed were a subjective rating of the level of emotional stress and salivary cortisol levels, both obtained at 3 timepoints: before treatment (baseline), immediately following completion of the TSST, and after 20 minutes of rest following completion of the TSST. Results showed that the treatment group had a statistically greater decrease in the subjective rating of stress relative to the control group both immediately following the TSST and 20 minutes after the TSST. Salivary cortisol levels in the treatment group were also lower than the control group at those same time points. These results suggest that bilateral alternating somatosensory stimulation may be effective in reducing subjective levels of stress and anxiety. It also may actively attenuate stress-related cortisol levels, which may reflect a mechanism for reducing cortisol-induced inflammation back to baseline after exposure to stressful situations.
Feb 2018 DOI 10.14302/issn.2576-6694.jbbs-18-1887
S. Hageman NathanCorresponding author
David Geffen School of Medicine at UCLA, Los Angeles, CA Corresponding Author
The application of bilateral alternating stimulation in tactile (BLAST) form technology, a non-invasive, somatosensory-based method, has been shown to modulate the electrical activity of brain networks that mediate the stress response, resulting in a stress-reducing effect in individuals with high reported levels of anxiety, such as post-traumatic stress disorder (PTSD). In this study, we examined archival data from a heterogeneous group of users (n = 1109) of BLAST technology via Touchpoints, a novel BLAST-based treatment modality, all of whom had high self-reported levels of stress and anxiety. Ratings of levels of emotional stress and bodily distress on a scale of 0 (no stress/distress) to 10 (worst stress/distress of one's life) before and after the application of Touchpoints for 30 seconds were entered into an app. Results showed a statistically significant reduction in the levels of both emotional stress and bodily distress, 62.26% and 50.502%, respectively, after 30 seconds of BLAST technology was applied. This demonstrates a clear benefit of BLAST on the stress response, reducing both emotional stress and disturbing body sensations. Recent work examining EEG changes after BLAST technology is applied suggests that BLAST may reduce sympathetic activation by reducing the electrical activity of key areas of the salience network. Further work will more precisely characterize the effects of BLAST, its potential clinical uses, and the mechanisms of actions behind it’s apparent stress-reducing effects.
Feb 2016 DOI 10.14302/issn.2574-4488.jna-15-712
Bernieh BassamCorresponding author
Nephrology, Department of Internal Medicine, Tawam Hospital, Al-Ain, United Arab Emirates.
Background Dapagliflozin; the new oral hypoglycemic agent; is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that acts by inhibiting glucose reabsorption in the proximal tubule of the nephron. Main reported side effects are osmotic diuresis, dehydration, urinary tract and genital infections. Here, we report a case of acute bilateral hydronephrosis after the introduction of dapagliflozin. Case Presentation A 52 year old nurse lady, with 15 year history of type2 diabetes mellitus (T2 DM) complicated by type4-renal tubular acidosis, hypertension, proteinuria, and hyperlipidemia. Patient had two episodes of UTI’s in 2011 required full urologic work up, were successfully treated with simple courses of oral antibiotics. CT pyelography done in 2011 was normal. Dapagliflozin was added to her therapeutic regimen in March 2015. Results Within 48 hours after starting dapagliflozin, she reported increased urine output. Ten days later; she developed severe bilateral loin and lower back pain, followed by suprapubic pain, dysuria and fever. Urine analysis and cultures confirmed E. coli urosepsis. Renal US revealed echogenic kidneys with 12 mm bilateral hydronephrosis, normal ureters and urinary bladder. Discontinuation of dapagliflozin in April 2015 resulted in resolution of symptoms. Repeat CT of the abdomen in July 2015 revealed no hydro nephrosis. Conclusions This is the first case report of reversible bilateral hydronephrosis after the use of dapagliflozin. The cause of hydronephrosis, could be explained by over-diuresis and/or by the unmasking of underlying subclinical obstruction in both uretero-pelvic junctions (UPJ).
Jan 2026 DOI 10.14302/issn.2470-0436.jos-25-5905
Al-Yarabi MohammedCorresponding author
Purpose To report a rare case of Mooren’s ulcer in a healthy young male without systemic autoimmune disease, and to highlight the effectiveness of conjunctival resection as therapy for cases unresponsive to medical management. Case report A 34-year-old immunocompetent male presented with progressive peripheral corneal ulceration in the left eye. Extensive systemic and infectious evaluations, including rheumatologic, immunologic, and microbiological testing, were unremarkable. Human leukocyte antigen genotyping was DR17(03)-negative and DQ2-positive. Rheumatological evaluation yielded no definitive systemic diagnosis. Despite immunosuppressive therapy with adjuvant medications, the epithelial defect and stromal inflammation persisted. The patient underwent conjunctival resection, resulting in marked reduction in inflammation, rapid re-epithelialization, and structural stabilization of the cornea. Histopathology of excised conjunctiva showed nonspecific inflammation without granulomatous changes, vasculitis, or neoplastic features. During follow-up, patient remained in remission with visual acuity preserved at 6/6 bilaterally and no recurrence. Conclusion Mooren’s ulcer is rare but vision-threatening. Early recognition, comprehensive evaluation, and timely surgical intervention can be vision-saving. This case highlights the role of a multidisciplinary approach and supports conjunctival resection as a useful adjunct in refractory disease. Long-term follow-up is essential.
Aug 2024 DOI 10.14302/issn.2470-0436.jos-24-5162
Alves Ambrósio JoãoCorresponding author
Introduction Cystoid macular edema (CME) is a sight-threatening condition caused by fluid accumulation in the macula due to blood-retinal barrier disruption. Various factors, including drug reactions, can lead to retinal fluid leakage. Leflunomide, a disease-modifying anti-rheumatic drug, marked significant progress in managing rheumatoid arthritis. Although effective, Leflunomide has rarely been linked to CME. This report presents a unique case of Leflunomide-induced CME, adding to the limited literature on this subject. Methods We report the case of a 75-year-old female with rheumatoid arthritis treated with Leflunomide, presenting with bilateral CME and reduced visual acuity (VA). Comprehensive ophthalmic evaluations, including VA tests, fundus examination, and optical coherence tomography, were conducted. Results The patient presented with CME and decreased VA in both eyes for several months. She had undergone cataract surgery 20 years prior and was using topical nepafenac, dorzolamide, and dexamethasone. Initial VA was OD 20/50 and OS 20/40. VA improved with treatment, but CME recurred upon discontinuation. The patient had been on Leflunomide for one year. After consulting with the Rheumatology department and considering a previous case of bilateral Leflunomide-induced CME, the drug was discontinued. CME resolved without recurrence or the need for topical treatment. At her final visit, VA was OU 20/25. Conclusion This case highlights Leflunomide as a potential, though rare, cause of CME. It emphasizes considering systemic medications in CME diagnosis. Timely discontinuation of Leflunomide may resolve CME and prevent further visual impairment. Further studies are needed to understand this rare side effect comprehensively.
Mar 2024 DOI 10.14302/issn.2694-1201.jsn-22-4184
Ekladious AdelCorresponding author
Sarcoidosis is granulomatous autoinflammatory autoimmune remitting relapsing disease affecting every organ in the body, it is the most difficult disease to diagnose in the absence of serum or imaging biomarker. Differential diagnosis is broad which included inflammatory, infective, neurodegenerative and neoplastic, histological biopsy is the only confirmative marker, and even histological confirmation is not robust as infection, malignancy and some drugs can induce granuloma, the most common organs affected are lung, lymph nodes, skin, eyes, liver, and less commonly pituitary gland, bones, brain, peripheral nerves, and heart, causing bilateral hilar lymphadenopathy, granulomatous lymphadenitis.
Feb 2021 DOI 10.14302/issn.2372-6601.jhor-21-3733
Qing XinCorresponding author
Department of Pathology, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90502, USA.
Breast implant-associated anaplastic large cell lymphoma (ALCL) is a recently recognized type of T-cell lymphoma that can develop following breast implants, with morphologic and immunophenotypic features indistinguishable from those of ALK-negative ALCL. Here we report a case of a 58-year-old woman with a history of subglandular silicone implants placed for bilateral breast augmentation 25 years ago, who presented with bilateral breast pain and was found to have bilateral Baker Grade III capsular contracture, and heterogenous fluid collection centered near the left third costochondral articulation, a suspicious left chest wall lesion, and left axillary lymphadenopathy on imaging. A left axillary lymph node core biopsy and an aspiration of the fluid were performed, and no malignant cells were identified. The patient underwent bilateral removal of breast implants and total capsulectomies. Microscopic examination of the capsule surrounding the left breast implant revealed large pleomorphic tumor cells in a fibrinous exudate. By immunohistochemistry, the tumor cells were found to be positive for CD3 (subset), CD4, CD7, CD30 (strong and uniform), and CD43, and negative for CD2, CD5, CD8, and ALK1, supporting the diagnosis of breast implant-associated ALCL. No lymphoma cells were identified in the right breast capsule, confirmed by CD30 stain. Breast implant-associated ALCL is a very rare disease that can develop many years after breast implant placement. Proper evaluation with breast imaging and pathologic workup is essential to confirm the diagnosis in suspected cases. Our case highlights that adequate sampling is important in the investigation of patients with suspected breast implant-associated ALCL.
Dec 2020 DOI 10.14302/issn.2639-3166.jar-20-3318
K. Ceesay EbrimaCorresponding author
University of Gambia, Banjul, Gambia
For economic growth and development in any WE African country the GDP progress is depending on the key push-pull factors as migration, personal remittances received, bilateral aids and, absolutely, employment in agriculture which is about 1/3 of the population and not a predominant and protected minority as happens in the industrialized EU and North America. In order to represent the framework of the reciprocal dependencies the present study used the statistics of Gambia from WDI covering the periods from 1960 to 2017 by applying linear regression models. The results confirmed that migration and remittances have significant positive impact on employment in agriculture because new investment in agriculture created new skilled and unskilled employment. The results also found out that employment in agriculture has negative and significant impacts on foreign aids: 10% increase in migration, increases foreign aid by 50.3%. Increasing 10% of remittance, increase economic growth by 0.14% but 10% increases in employment in agriculture, decrease economic growth by 0.04%. To face globalization the economy of the Gambia should use the foreign aid to improve agriculture production and productivity thereby increase economic growth through human capital theory of migration, skilled migration, export and food security, the study recommends.
Feb 2020 DOI 10.14302/issn.2768-0207.jbr-20-3194
Mohammed AL-Namnam NisreenCorresponding author
Departmet of Oral Biology and Biomedical sciences, Faculty of Dentistry, MAHSA University, 42610 Bandar Saujana Putra, Malaysia
Rhinosinusitis is one of widely spread diseases in the region and the role of the anatomical variations in its pathogenesis remains unresolved. A retrospective study using CBCT scan was employed to locate and measure the diameter of 320 primary maxillary ostium (PMO) (n = 160 subjects) among the Malay and Chinese populations (Mongoloid race) in Malaysia. Image analysis was performed using the i-CAT Vision Software, employing the multiplanar reconstruction window in which axial, coronal and sagittal planes were visualized in 0.3 mm intervals. The mean diameter of the PMO was significantly larger in the Chinese than the Malay. Females had larger size than the male and bilateral asymmetry was noticed, where the right side PMO was larger than the left side (p < 0.05). In addition, PMO opened more in the posterior third position of the hiatus semilunaris (61.9%) than anterior and middle third. The PMO showed a statistically significant posteriorly placed position in the Chinese than the Malays and this was more evident in the right side PMO (p < 0.01). In conclusion, the PMO commonly opens in the posterior third of the hiatus semilunaris and its diameter is significantly greater in the Chinese female with evidence of bilateral asymmetry. Awareness the anatomical variation of the Ostium diameter and location among the Malay and Chinese populations potentially has important clinical effects during surgical procedures.
Nov 2019 DOI 10.14302/issn.2641-5518.jcci-19-3098
Caner EdizCorresponding author
Department of Urology, University of Health Sciences (Istanbul), Sultan Abdulhamid Han Education and Research Hospital, Istanbul, Turkey
Idiopathic retroperitoneal fibrosis also known as Ormonds disease is a rare disorder characterized by the development of fibrotic tissue in the retroperitoneum. The fibrotic tissue may compress ureters, leading to obstructive nephrouropathy and renal failure. A 58-year-old man with fatigue, loss of appetite and unable to urinate was admitted to our clinic. Because of the serum creatinine value of 5.3 mg/dl, urinary ultrasonography was performed and bilateral grade 3 hydronephrosis with moderate level urine in bladder was detected. Hydronephrosis did not regress by transurethral foley catheter and suspicious appearance in the retroperitoneal area was found in abdominal magnetic resonance imaging. Tru-cut biopsy result of the current lesion was finally reported as a connective tissue. Bilateral double j catheter insertion was performed and started to immunosuppression therapy with corticosteroid. Two months later, double j catheters were removed and hydronephrosis was not detected in follow-up. In this case report, we tried to explain that, retroperitoneal fibrosis should be considered in the differential diagnosis of postrenal acute renal failure, even in patients without a classic symptom such as pain. In addition, early surgical intervention should be avoided in such patients.
Sep 2019 DOI 10.14302/issn.2474-3585.jpmc-19-3009
Konadu-Yeboah DominicCorresponding author
Orthopaedic and Trauma Surgeon, Komfo Anokye Teaching Hospital, Kumasi, Ghana, Part-Time Lecturer, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Blount’s disease, also known as tibia vara, is a developmental disorder involving the posteromedial proximal tibial physis resulting in progressive varus, procurvatum and internal torsion of the affected tibia 1. The condition was first published by Blount in 1973 2. The aetiology of this disease is unkown. However, associations exist between blount’s disease and the Afro-Caribbean race, early age of walking and obesity 34. Furthermore, genetic predisposition has been postulated as well as mechanical loading of the physis 456. Affected children are usually overweight and start walking early. It is bilateral in 80% of cases 7.
Mar 2019 DOI 10.14302/issn.2642-9241.jrd-19-2689
A. S. Sardenberg RodrigoCorresponding author
Chief of Thoracic Surgery, Hospital Paulistano, Americas Serviços Médicos São Paulo, Brazil
Background The aim of this study is to evaluate the outcomes of patients submitted to diaphragmatic pacing, and the impact on quality of life of patients who chronically depend on mechanical ventilation, as well as the effectiveness of phrenic stimulation to eliminate the need for mechanical ventilation. Methods From 2010- 2014, 10 patients completely dependent on mechanical ventilation were operated upon, with the implantation of phrenic pacing device. The diagnoses were quadriplegia and congenital central hypoventilation syndrome (CCHS). All patients underwent bilateral approach to the phrenic nerves, by video-assisted thoracic surgery or mini-thoracotomy. Results All patientsstarted pacing 30-40 days post-operatively. The mean age of patients was 12.1 years (2-27 years range) with a median of ten years. Six patients (54.5%) were as old as ten years, and three (27.2%) were older than 20 years. Younger patients had CCHS and older ones were quadriplegic. All patients with CCHS (n = 4) were nine years old or younger while only two quadriplegic patients were in this age group. Conclusions Diaphragmatic pacing can provide improvement in the quality of life of patients who depend on mechanical ventilation, allowing freedom to conduct daily activities, lower respiratory infections, and tracheostomy decannulation.
Mar 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2630
P. Schwarm FrankCorresponding author
Department of Neurosurgery, Justus-Liebig University Giessen, Giessen, Germany
Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger sample sizes are needed to establish the optional DBS electrode.
Feb 2019
P Dargan DallanCorresponding author
Mersey Regional Burns and Plastic Surgery Centre, Whiston Hospital, Warrington Road, Prescot, Merseyside, L35 5DR, United Kingdom
Background: Chest wall deformities may be managed with skeletal manipulation, which risks life-threatening complications. Custom-made prostheses are a less invasive surgical option, manufactured from silicone elastomer using 3D computed tomographic reconstruction and 3D-printed thoracic models. Methods: All patients undergoing custom-made implants between January 2010 and March 2017 were identified from the prosthetic department records. A retrospective review of the clinical records was performed. Mean follow up period was 1.8 years. A comparison was made with our earlier results from 1995 to 2009. Results: Twenty-six patients underwent insertion of custom-made implants for chest wall deformity. Pectus excavatum was present in 50% (n=13), and Poland syndrome 42% (n=11). All 11 female patients underwent 3D reconstruction and 3D printed models, and 3 of 15 males. Four underwent simultaneous bilateral breast augmentation, and three had staged breast augmentation. Seroma occurred in 27% (n=7), and hypertrophic scar in 12% (n=3). The reoperation rate was 23% (n=6), including autologous fat graft in two patients. Surgical suction drains were used in 42% (n=11) patients, of whom 36% (n=4) developed seroma, compared with 17% (n=2) of those without drains (p=0.08). Conclusions: Custom-made prostheses are an effective and safe option for patients with chest wall deformities. The majority have a short postoperative inpatient stay (81%) and are satisfied with the outcome (77%). Seroma was the commonest complication (27%), and drains did not reduce seroma risk. Single dose intravenous antibiotic prophylaxis is adequate. A minority of patients opt for further aesthetic procedures.
Jan 2019 DOI 10.14302/issn.2470-5020.jnrt-18-2555
Ya. Abdullaiev RizvanCorresponding author
Kharkiv Medical Academy of Postgraduate Education, Department of Ultrasound Diagnostics, Ukraine
Introduction: Tension-type headache (TTH) is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. TTH, divided into episodic and chronic types, introduced in the manual "International Classification of Headache Disorders"(ICHD-I), is of practical importance. Infrequent episodic headaches (no more than once a month) may not require drug therapy, but, on the contrary, frequent forms may require expensive treatment. Objective: To study the state of cerebral hemodynamics and cerebrovascular reactivity in patients with Tension-type headache and evaluate the efficacy of treatment with Phenibite using Doppler ultrasound. Materials and Methods: A retrospective analysis of the results of ultrasound dopplerography of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA), Vertebral and Basal (VA, BA) arteries was performed in 188 patients with TTH. Among them are infrequent episodic TTH - 68 (36,2%) patients, frequent episodic TTH - 64 (34,0%) patients, chronic TTH - 56 (29,8%) patients. The age of the subjects was 18-45 years, among them 85 (45.2%) men and 103 (54.8%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance and pulsativity indexes (RI, PI) in all vessels were determined. Patients were given consent to participate in the study. Results: Infrequent episodic (IFE) TTH were recorded in 86.4% of cases, frequent episodic (FE) — in 88.9%, and chronic (Ch) TTH — in 81.6% of cases. Bilateral TTH was noted in 39.2%, frontal localization - in 35.6%, in the occipital region - in 25–7% of cases. The asymmetry of the maximum systolic blood flow velocity (Vs) in the paired arteries within 20-30% was considered a violation of cerebral hemodynamics, which was detected in 38.7% of patients. An increase in Vs was noted in all cerebral vessels, especially in patients with FE TTH and chronic Ch TTH compared with the control group. In patients with IFE TTH the average value of RcFMt was 1.24±0.03, in patients with FE TTH - 1.25±0.02, in patients with Ch TTH - 1.27±0.03. In patients with TTH, hyper-responsiveness to hypercapnic test was detected: RcCO2 was 1.43±0.05 in the group with FE TTH; 1.39±0.07 in the group of Ch TTH and 1.37±0.04 in the group of IFE TTH, which indicates a tendency for the tension of the vasodilator regulation mechanism even in clinically insignificant forms of TTH. In the study of reactivity to the O2-test, a hyporeactive response was observed in the groups with FE TTH and Ch TTH (0.38±0.04 and 0.35±0.05, respectively. The treatment with Phenibut carried out in a step-by-step manner - during the first week the drug was applied at a dose of 250 mg 2 times a day, over the next 6 weeks the dose increased to 500 mg 2 times a day, then the dose was reduced back to 250 mg 2 times a day. Among patients with FE TTH, the frequency of headache decreased from 5.7±2.3 to 3.6±2.1 days/month, and in patients with Ch TTH - from 22.8±1.7 to 17.7±1,3 days/month (P<0,05). Influence of the drug was manifested at the initially increased RcFMt and RcCO2. A decrease in initially elevated RcCO2 was noted in all (FE TTH, ChTTH, IFETTH) clinical groups. However, this decrease was not statistically significant. Conclusion: In patients with TTH, an increase in the Vs is more often recorded, their asymmetry in the middle cerebral artery. Hyperreactivity on CO2-load is typical for patients with chronic TTH, and reflects the mobilization of metabolic regulation of cerebral blood flow. Conducting FMt was the most informative method for detecting autoregulatory disorders mainly in patients with IFE TTH. FE TTH in patients is characterized by the presence of a hyperactive reaction to hypercapnic and orthostatic tests, probably due to mobilization of humoral-metabolic and neurogenic links of regulation. In the group of patients with chronic TTH prevails hyporeactivity for hyperventilation test, reflecting the depletion of vasoconstriction reserve. The use of Phenibut(Noophen® (JSC Olainfarm Latvia in the treatment of TTH is accompanied by a decrease in the frequency of pain, and of pericranial muscle tone, most pronounced in patients with FE TTH. It's effectiveness is evident in the normalization of the coefficients of cerebrovascular reactivity in a patients with chronic TTH. The minimal statistical significance was observed on the dynamics of blood flow only in the VA.
Aug 2017 DOI 10.14302/issn.2470-0436.jos-17-1721
C. Rodger DamienCorresponding author
USC Roski Eye Institute, Los Angeles, California
A 57-year-old Hispanic female presented with 3 days of blurry vision in the left eye. Eight years prior, she had a branch retinal artery occlusion in the right eye and a hematologic work-up revealed a 4G/4G polymorphism in plasminogen activator inhibitor-1. With the current episode, she was found to have bilateral branch retinal artery occlusions and mild vitritis in the left eye, simulating a toxoplasma infection. An infectious and inflammatory work up, however, was negative and the vitritis resolved after a short course of steroids. Plasminogen activator inhibitor-1 mutations may be associated with an increased risk of retinal vascular occlusions.
Aug 2016 DOI 10.14302/issn.2470-5020.jnrt-15-750
Adam Thrasher TimothyCorresponding author
Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
Background To quantify the underlying rhythmic patterns observed in surface electromyography (SEMG) in patients with Parkinson’s Disease (PD), to compare rhythmicity of PD gait with normal gait, and to compare overground walking to treadmill gait. Methods Eight individuals with idiopathic PD, and ten individuals with no history of neurological disorders participated. SEMG was recorded from the vastus lateralis, tibialis anterior, lateral gastrocnemius and biceps femoris muscles bilaterally. Each participant performed two trials of overground walking and two trials of treadmill walking at a self-selected comfortable walking speed. SEMG was analyzed using a non-linear statistical model that identified underlying recurrent locomotor patterns, which estimated the relative contribution of central pattern generators to the observed muscle activation signals. An index of rhythmicity was determined from the statistic, R2. Results The rhythmicity of PD gait was significantly higher than that of normal gait (p = .0458). There was also a significant difference between the rhythmicity of overground walking and treadmill walking (p = .0097). Conclusions Individuals with PD appear to walk with muscle activation patterns that are more rhythmic than normal. This suggests that there is more stride-to-stride consistency, and there are fewer postural adjustments and responses to perturbations. We also found that treadmill gait was more rhythmic than overground walking. These findings, although preliminary, challenge the paradigm and current approach to gait retraining of patients with PD.
Jul 2016 DOI 10.14302/issn.2473-1005.jdoi-16-1159
Yezdani ArifCorresponding author
Sree Balaji Dental College and Hospital.
This case report reiterates the fact that a bilateral posterior crossbite with severe skeletal class II malocclusion in the growth period could be effectively treated by a comprehensive approach with a rapid palatal expansion appliance followed by fixed appliance therapy. A 14-year-old boy presented with a severe skeletal Class II malocclusion with an orthognathic maxilla, retrognathic mandible and a high mandibular plane angle with an Angles’ Class II division 1 subdivision malocclusion with maxillary constriction, increased overjet, deep bite and severe crowding of maxillary and mandibular incisors. A banded rapid palatal expansion appliance was initially given to correct the bilateral posterior cross bite and subsequently maxillary and mandibular first premolars were extracted and Roths’ Pre adjusted edgewise appliance therapy (0.022 x 0.28-inch slot) was strapped up to correct the severe tooth size-arch length discrepancy. The patient’s soft tissue profile and dentofacial esthetics improved dramatically with increased self-confidence and enthused self-esteem.
Apr 2016 DOI 10.14302/issn.2470-0436.jos-15-763
El-Assal KarimCorresponding author
Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, UK.
Background: Optic nerve head drusen are acellular hyaline deposits located anterior to the lamina cribrosa, frequently associated with visual field defects. Sometimes rapid worsening of vision may occur due to complications such as acute vascular events, choroidal neovascularization, or serous maculopathy. Case Presentation: Although there are no proven treatments for Optic nerve head drusen associated field loss, we present the case of a patient with Optic nerve head drusen and bilateral rapid progression of visual field loss that has stabilized on intraocular pressure lowering medication. This suggests a role for IOP-mediated retinal ganglion cell loss in this individual. The mechanism of progressive Optic nerve head drusen associated field loss is poorly understood, however experimental glaucoma models and human in vivo imaging studies have shown that structural differences within the optic nerve head are likely to contribute to individual susceptibility to IOP-mediated damage. Conclusion: We propose that eyes with Optic nerve head drusen may be less able to dampen IOP mediated stress, contributing to loss of retinal ganglion cells in some patients.
Apr 2016 DOI 10.14302/issn.2470-0436.jos-15-710
Campa ClaudioCorresponding author
Sant’Anna University Hospital, Ferrara, Italy
Idiopathic macular telangiectasia type 2 is a rare retinal condition usually characterized by parafoveal telangiectatic vessels, hyperplastic pigment plaques and seldom a full thickness macular hole or a retinal neovascularisation. Herein we describe an atypical presentation of this disease. Methods Review of the patient’s clinical and angiographic records. Results A 87-year-old white man was diagnosed with idiopathic macular telangectasia type 2. Ophthalmological and angiographic examination disclosed telangiectasia of the parafoveal capillaries together with extensive bilateral granular soft drusen and unilateral retinal angiomatous proliferation (RAP). Initially photodynamic therapy with verteporfin (PDT) and subsequently intravitreal injections of bevacizumab were used to treat RAP lesion. This approach provided visual acuity stabilization up to 24 months. Conclusion This case of ours shows that drusen may be a feature of macular teleangiectasia type 2. It also emphasizes that PDT and anti-VEGF therapy are both safe and effective for treating neovascular complications of this disease.