Recent Articles

Medication related osteonecrosis of the jaw (MRONJ) is a disorder characterized by loss of blood supply to the jaws and death to the bone. In our previous work, we created a rat model of MRONJ by two injections of 60ug/Kg zoledronic acid (a powerful bisphosphonate abbreviated as ZA) via tail vein followed by extraction of a single first molar. We have shown in this model (ZA-treated rats plus molar extraction) a decrease in the vasculature of the jaws and a delay in bone healing beyond 4 weeks. Purpose: The current study identified angiogenic factors from the jaws of our MRONJ model where expression was altered independent of exposure to ZA alone. Methods: Using RT-PCR arrays containing 84 different gene sequences related to angiogenesis, we screened RNA isolated from the jaws of Control, ZA-treated rats, and our MRONJ rat model (ZA-treated plus first molar extraction), 3 and 6 weeks after extraction. Heat maps of gene expression were analyzed to identify genes where expression was either maximal or lost in MRONJ rats relative to ZA-treated rats without extraction. Results: Our study demonstrates the loss or gain of expression for 22 genes in the MRONJ rat model relative to rats treated with ZA alone. In MRONJ rats, the loss of expression was seen for 10 genes after 3 weeks and 3 additional genes (13 total) after 6 weeks where maximal expression was seen in rats treated with ZA-alone. This study also identified 5 genes that were maximally expressed in MRONJ rats after 3 weeks and an additional 4 genes (9 total) after 6 weeks that were not expressed in rats treated with ZA alone. Conclusions: Our study identifies genes that predict the transition from asymptomatic bisphosphonate exposure to MRONJ.

A woman, named Eve, has been possessed by Evil. She is continuously tortured by host of visions and cursed by demonic voices. She has a miscarriage and commits suicide several times. The therapist builds up a Jungian type of hypnotherapy and hypnoanalysis based upon Eve’s fairy tale experiences come from her childhood. The patient’s absolute good and evil self- and object representations develop in a mutual relationship each other in the form of miscellaneous symbols. Finally, a prolonged struggle of good and bad symbols arrives at a neutral point of rest. Since the therapist is not afraid of Eve’s experiences he wants to take part in them, which leads to a mutual experience of tandem hypnosis shared by both the patient and the therapist. Facing together with Evil the therapist becomes as a devil in a symbolic way while the devil is made gentle as an uncle of Eve’s life. Finally, the patient’s psychosis is healed.

A 43 year old female Patient, with recently diagnosed latent Tuberculosis (TB), started On anti – TB drugs (Isoniazid, Rifampicin), came with symptoms of Motor and sensory polyneuropathy only 4 weeks after starting the drugs. Extensive investigations were pursued. Nerve conduction study showed Features of Guillain – Barre syndrome (GBS). After stopping the Anti TB medications, patient symptoms Improved. This gives us an idea that Anti TB medications can itself trigger GBS. The Association of TB and GBS will be reviewed in Literature as well as the differentials and management.

A large proportion of the population of developing countries still uses traditional medicines, either as a result of the high cost of Western pharmaceuticals and health care, or because the traditional medicines are more acceptable from a cultural and spiritual perspective(1). The WHO estimates nearly 80% of the population still depends upon herbal medicines due to their easy availability, low cost and possible less side effects as compared to allopathic system of medicines(2). These also cover healthcare systems that include beliefs and practices relating to diseases and health, which are products of indigenous cultural development and are not explicitly derived from a conceptual framework of modern medicine. Ingredients used in the preparation of those remedies may even provide attractive templates for the development of new pharmaceutical products(3). All the people of Nepal have no access to allopathic medicine and health center because of illiteracy, poverty and unavailability. Thus, about 80% of the population in Nepal relies on traditional medicine(4). One such example is the use of formulation containing Shorea robusta resin, prepared by local practitioners themselves, for treating infected wounds and burns by some locals in Kathmandu valley. The ingredients used in traditional medicine, therefore, must be recognized and studied, not only as therapeutic agents with verifiable pharmacodynamic properties, but as agents of healing with beneficial effects, even when the precise mode of activity has not been properly understood(3).

Rehabilitation of fracture is the act of restoring an injured part to its former state through proper therapy and training,so as to improve the quality of life. After proper union of fracture, it is desirable that the joints regain normal functions and shape, which is why rehabilitation is an inevitable treatment principle in fracture management 1. Acharya Sushruta, the pioneer in surgery, holds novelty in devising rehabilitative techniques for fracture management. These principles when properly implemented can effectively heal the post fracture complications like pain, restricted mobility and joint stiffness 2. An attempt has been made to explore the concept of rehabilitation in Ayurveda in light of conventional modalities.

Introduction: In England 12,000 children are diagnosed with appendicitis each year. The diagnosis of appendicitis is difficult especially in children. There are many other diagnoses which mimic appendicitis including Meckel’s diverticulum, intussusception, gastroenteritis and mesenteric adenitis. Unfortunately there is no gold standard in the diagnosis of appendicitis and often clinicians are hesitant to submit a child to radiological investigations. Presentation of the case: An eleven year old boy, of Bangladeshi origin, presented to the Royal Gwent Hospital, South Wales, with an acute onset of centralised abdominal pain and vomiting. Following a period of observation and re-examination his pain had localised to the right iliac fossa and it was decided on clinical grounds to perform a laparoscopy for suspected appendicitis. Intra-operative findings showed an intussusception of the small bowel secondary to a mucosal lesion. Histology showed high grade non-Hodgkin’s lymphoma with a pattern suggestive of Burkitt’s lymphoma. Conclusion: The case highlights the importance of accurate diagnosis of appendicitis and the difficulties of managing abdominal pain in children. More needs to be done to develop a better criterion and judicial use of imaging to guide surgical intervention.

Broncho-oesophageal fistula refers to an abnormal communication between a bronchus and the oesophagus. Broncho-oesophageal fistula is rare and can be either congenital or acquired. Congenital fistulas are usually diagnosed in the neonatal period as they present with respiratory distress and cyanosis during feeding. Whereas developmental anomaly is the commonest cause in infancy and childhood, the aetiology in adults is most frequently secondary to an oesophageal malignancy1. Non-malignant causes of fistulae are rare. Diagnosis of a broncho-oesophageal fistula may sometimes be difficult because of an insidious and non-specific clinical course2. A rare case of broncho-oesophageal fistula due to carcinoma of the oesophagus, which was discovered incidentally during a barium swallow study is presented. SUMMARY A 68-year-old man with dysphagia who was diagnosed to have carcinoma of the oesophagus, which was complicated by broncho-oesophageal fistula is presented. The role of radiology in the management of this condition is discussed.

Alzheimer’s disease (AD) is characterized by the slow decline of cognition and functional abilities over time. The diagnosis for probable and possible AD relies principally on clinical criteria. The confirmation of the disease is made post-mortem by identifying extracellular senile plaques and intraneuronal fibrillary tangles in the brains of subjects with clinically defined dementia. However, the field critically lacks validated AD specific peripheral biomarkers to support the diagnosis in living patients or for early detection of patients at risk before symptoms appear. BACE1 (Beta site amyloid precursor protein cleaving enzyme 1) cleaves Amyloid Precursor Protein (APP) at two beta sites and represents a key target enzyme in the monitoring and possible treatment of AD. In our preliminary study, we evaluated the usefulness of salivary BACE1 to determine risk to develop AD in clinically normal patients. A preliminary in house laboratory grading system for BACE1 content in saliva was established with high levels of salivary BACE1 present in older patients and putatively at risk to develop AD. BACE1 seems to be a useful biomarker to help diagnose AD and to monitor disease progression, and remarkably regression, when treated with stem cell secretome.

The objective of the GER-e-TEC project is to provide recorded personalized medical monitoring of residents in nursing homes using an intelligent telemedicine platform. It will assist healthcare staff by automatically processing the information from sensors and questionnaires to provide early detection and escalate alerts to enable health professionals, operating in retirement homes, to optimize patient care.

Telemedicine is now in vogue, allowing thanks to the computer and communication tools to be deployed in the field of health, such as Dermatology, areas in which it has shown interest. As the population is aging, Geriatrics is more and more concerned by this innovative practice and nursing homes are more and more concerned. We take a look at telemedicine projects in France deployed in the field of dermatology in the elderly.