A rare presentation of pulmonary sarcoidosis as a solitary lung mass: a case report

Sarcoidosis is a multisystem, chronic granulomatous disease of unknown etiology that predominantly affects the lungs. Pulmonary sarcoidosis classically presents with constitutional symptoms and computed tomogr...

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Making a Difference with Individual Patients-Health Equity, Power, and Dignity

By Nathan Douthit

   At another session of CUGH's Annual Meeting, Richard Horton, Editor in Chief of the Lancet, debated Cheryl Heaton, director of New York University's Global Institute of Public Health, on the subject: Equity is the defining objective of global health in the 21st century. Heaton argued in favour of the motion, saying that our past neglect has created high reservoirs of need around the world. She made the point that equity creates hope and optimism in vulnerable populations, which turn motivate their ability to bring about change.

   While Horton agreed that equity is a valuable and admirable goal, he argued that global health, as it is currently framed, makes this impossible to achieve. He argued that global health "is not about equity; it is about power", with power held by the privileged. He continued "before there can be equity, individuals must have liberty and power over their lives." Further, liberty requires that all humans be recognized for their dignity. Dignity affirms that every individual is an end unto themselves; not a means to our ends. "Without dignity, there can be no equity." Horton concluded that our obligation is to challenge authorities that deny liberty. We must discharge this obligation if we are to see the dignity of individual patients recognized.

   BMJ Case Reports is committed to recognizing the dignity and worth of individual patients. Our case reports focus on patients at the center of clinical medicine and global health. While our clinical case reports highlight the challenges of dealing with disease, our global health case reports shed light on the determinants of health and disease: the environments in which patients live and work; education and financial well-being; access to healthcare; local and national politics; instability and conflict; the practice of corporations and industry; and, ethnic and cultural histories. Our authors argue for better living conditions and improvements in health at the level of the individual – working towards global health one patient at a time. Each patient is an end unto themselves. We encourage our authors to work with their patients in writing each global health case report and want to be not merely a repository of global health problems and solutions but a repository of patient voices from across the world.

   BMJ Case Reports invites authors to submit global health case reports that give voice to individual patients and uphold their dignity. These reports should examine the determinants of health:

• The effects of culture and environment
• Education and literacy
• How occupation may exacerbate or cause disease
• The effects of conflict, disaster, migration and poverty
• Access to healthcare
• The interventions and innovations put into place in global health to treat individual patients.
• The disproportional effect of social determinants of health on vulnerable communities

   Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports via the submission system. For more information, review our guidance on how to write a global health case report and look through our online collection.

Competing Interests

None Declared

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Value of the Combination Ultrasonography With Ti-RADS Score / Dual Tracer Scintigraphy MIBI-Tc99m/Iodine-123 in the Detection of Malignancy of Thyroid Nodules (≥15 mm) Classified Bethesda III or IV on Cytology

Condition:   Malignancy of Thyroid Nodules
Intervention:   Drug: MIBI-Tc99m/Iodine-123
Sponsor:   Nantes University Hospital
Not yet recruiting

https://ift.tt/2HjIoN6

Avelumab, Cetuximab, and Palbociclib in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Condition:   Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Avelumab;   Drug: Palbociclib;   Drug: Cetuximab
Sponsors:   Kathryn Gold;   Pfizer
Not yet recruiting

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Comparative microstructural analysis of bone osteotomies after cutting by computer-assisted robot-guided laser osteotome and piezoelectric osteotome: an in vivo animal study

Abstract

Most industrial laser applications utilize computer and robot assistance, for guidance, safety, repeatability, and precision. In contrast, medical applications using laser systems are mostly conducted manually. The advantages can be effective only when the system is coupled to a robotic guidance, as operating by hand does not reach the required accuracy. We currently developed the first laser osteotome which offers preoperative planning based on CT data, robot guidance, and a precise execution of the laser cuts. In an animal trial, our system was used to create a grid pattern of the same depth on the inner layer of parietal bone in 12 adult sheep. The same bone cuts were done with piezoelectric osteotome on the contralateral side. The micro-CT and histological analysis showed more new mineralized bone in the laser group compared to the piezoelectric group. As well, a cutting pattern with especially a constant osteotomy depth in the laser group was demonstrated. The here presented autonomous osteotomy tool shows not only an advantage in early bone healing stage but additionally sharp bone cuts with a very high accuracy and freely selectable design cuts.

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Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up

Abstract

Gingival melanin hyperpigmentation is an esthetic concern for many individuals. In this study, we compared the standard surgical removal method with two different Er,Cr:YSGG laser settings in order to find the best treatment method. In 33 dental arches, the following three treatment groups were comparatively evaluated: (1) surgical stripping, (2) removal with laser setting 1 (4.5 W, 50 Hz, 100% water, 80% air, 60 μs, 800 μm Tip; MZ8), and (3) laser setting 2 (2.5 W, 50 Hz, 20% water, 40% air, 700 μs, 800 μm Tip; MZ8). We comparatively evaluated pain, patient satisfaction and wound healing, treatment time, and the amount of bleeding. Re-pigmentation was evaluated after 1 and 12 months by Hedin and Dummet pigmentation scores. Laser setting 1 had the best results regarding pain and patient satisfaction, although not statistically significant (P > 0.05). Wound healing results were better using lasers compared to surgical stripping (P < 0.05). Laser setting 1 was a faster procedure with mild amounts of bleeding. The least amount of bleeding was seen with laser setting 2. After 1 month, only two cases of the laser setting 2-treated areas showed an isolated pigmented area in the papilla; at 12 months, the mean Hedin indexes were still less than 2 and mean Dummett index less than 1 in all treatment techniques, with the lowest scores seen in the laser setting 1 sites. Based on our results, Er,Cr:YSGG laser can be more convenient for gingival depigmentation compared to surgical blade. Although not statistically significant, laser setting 1 with shorter pulse duration and higher water spray showed better overall results. However, laser setting 2, with longer pulse duration and less water spray, resulted in better coagulative effects and can be used to control bleeding wherever necessary in clinical practice.

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Physical, chemical, and biological properties of white MTA with additions of AlF 3

Abstract

Objectives

Addition of aluminum fluoride (AlF₃) to MTA was tested to inhibit dental discoloration.

Materials and methods

MTA Angelus with 0, 5, 15, and 45% AlF₃ were tested. The set cements were characterized using scanning electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction. Radiopacity and setting time were analyzed according to ANSI/ADA 57 and ASTM C266-08. Volume change was evaluated using volumetric micro-CT analysis. The pH and calcium ion release were assessed after 3 and 24 h and 28 days. Dental discoloration in contact with the cements was assessed after 24 h and 28 and 90 days of contact with bovine and human dentine. Tissue reaction to subcutaneous implantation in rats was examined after 30 and 60 days.

Results

AlF₃ altered the microstructure of MTA. The addition of 5% AlF₃ did not significantly alter the radiopacity, setting time, and volume change (p > 0.05). pH and calcium ion release significantly increased with addition of AlF₃ (p > 0.05). All the tested proportions of AlF₃ prevented the dental darkening verified for MTA Angelus in bovine and human teeth. AlF₃ did not interfere in inflammatory response of MTA in all periods of analysis; otherwise, lower amounts showed less intense inflammatory infiltrate.

Clinical relevance

AlF₃ prevents destabilization of bismuth oxide and consequent tooth darkening, frequently verified in clinical practice when using white MTA.

Conclusions

The use of 5% of AlF₃ in combination to MTA resulted in a cement that did not result in dental discoloration and did not affect significantly physical, chemical, and biological properties.

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