Homonymous hemimacular thinning: a unique presentation of optic tract injury in neuromyelitis optica.

A 42-year-old African American woman with a 5-year history of neuromyelitis optica was found to have an incongruous homonymous hemianopia. Optical coherence tomography (OCT) showed corresponding left homonymous hemimacular thinning. Magnetic resonance imaging of the brain demonstrated a demyelinating lesion in the left optic tract (OT) just anterior to the lateral geniculate nucleus and diffusion tensor magnetic resonance tractography confirmed axonal fiber loss in the left OT. This case illustrates the complementary and confirmatory roles of visual field testing, macular OCT, and neuroimaging in an OT lesion, which caused selective hemimacular thinning through retrograde degeneration.

Intraarticular injections of platelet rich plasma and plasma rich in growth factors with arthrocenthesis or arthroscopy in the treatment of temporomandibular joint disorders: A systematic review.

Intra-articular platelet rich plasma injections [PRP] or platelet rich growth factors [PRGF] injections have been used as therapeutic treatment options for patients with temporomandibular joint disorder [TMD] in recent years. The purpose of this paper is to evaluate the level of the available scientific evidence in the current literature on the benefits of applying PRP or PRGF injections to patients with TMD simultaneously or after arthrocentesis or arthroscopy to reduce post-operative pain and improve temporomandibular joint function. This systematic review was conducted according to PRISMA criteria and an electronic database search was carried out in the PubMed, Scopus and Cochrane databases during May 2021. The patients in the study group were injected with intra-articular PRP or PRGF simultaneously or after arthrocentesis or arthroscopy while the patients in the control group had arthrocentesis or arthroscopy without an intra-articular injection or received an injection of hyaluronic acid or Ringer's lactate solution. Eight randomised controlled clinical trials were selected. The PRP and PRGF intra-articular injections demonstrated significant differences in terms of pain reduction in three studies and improved mandibular function in two. The treatment with PRP or PRGF intra-articular injections demonstrated slightly better clinical results but of little significance in comparison with the control group. Evidence of their effectiveness is crucial to establish them as non-invasive treatments and as an affordable option for treating some types of TMDs. In accordance with Evidence-based dentistry principles, this review has been assigned a C recommendation.

A Novel Technique for Bulk-Fill Resin-Based Restorations: Achieving Function and Esthetics in Posterior Teeth.

Advances in the mechanical properties of composite resins have allowed for their use in posterior teeth. Conventional resins have several problems associated with polymerization shrinkage stress. The development of "bulk-fill" resins has allowed for their use in single increments up to depths of 4 mm, with very low polymerization shrinkage stress. Nevertheless, differences in anatomy and the desire for optimal esthetics present unique difficulties. This article describes a step-by-step technique using flowable bulk-fill resin as a substitute for dentin in a single increment, together with a high-reflective-index resin to restore enamel and decrease clinical time, obtaining anatomically and esthetically acceptable results without detriment to the mechanical properties required to restore the functionality of the posterior teeth.

A Step-by-Step Conservative Approach for CAD-CAM Laminate Veneers.

The use of CAD/CAM technology has allowed the fabrication of ceramic restorations efficiently and with predictable results. Lithium disilicate is a type of glass ceramic material that can be used for the elaboration of laminate veneers, being monolithic restorations which require characterization through a covering ceramic in order to achieve acceptable esthetic results. The next case report shows a predictable clinical protocol for the rehabilitation of the anterior teeth through the preparation of CAD/CAM veneers (e.max CAD, Ivoclar Vivadent, Liechtenstein) which have been characterized by a nanofluorapatite ceramic (e.max Ceram, Ivoclar Vivadent, Liechtenstein) through the layering technique.

Severe early bilateral macular edema following fingolimod therapy.

We report a case of bilateral macular edema (ME) within 10 days of starting fingolimod 0.5mg therapy in a patient with Multiple Sclerosis (MS). The complication resolved without treatment as demonstrated by sequential Optical Coherence Tomography (OCT). Fingolimod is a sphingosine-1-phosphate receptor modulator that reduces lymphocyte presence in the CNS. In pivotal trials, ME, a known complication of fingolimod, typically occurred unilaterally with onset at approximately 3 months. A 60y/o AA female, diagnosed with MS in 1977, started oral fingolimod treatment on 05/31/2011. Baseline screening with OCT and ophthalmology evaluation showed no ME. On 06/10, she developed bilateral blurry vision and discontinued fingolimod. On 06/27, OCT revealed severe bilateral ME. Later OCT exams showed a progressive decrease in Central Foveal Thickness (CFT) and Macular Volume (MV), without specific treatment other than discontinuation of fingolimod. On 7/27, CFT, MV, and Visual Acuity (VA) were similar to baseline. This is the first reported case of bilateral, early onset ME following fingolimod treatment at the current FDA-approved dose of 0.5mg. Diabetes, a known risk factor for ME, may have contributed to her early, bilateral involvement. Our case provides further support for earlier OCT, in conjunction with ophthalmic examinations, for at-risk patients on fingolimod, and suggests that cessation of fingolimod may be associated with resolution of ME.

The learning environment at a public university in northern Chile: how is dental education perceived by students? / El ambiente de aprendizaje en una universidad pública del norte de Chile: ¿cómo perciben los estudiantes la formación en odontología?

ABSTRACT. Introduction: the learning environment is considered essential in health sciences careers due to its significant influence on students overall learning achievements. The DREEM questionnaire was developed as a tool to obtain this environment's profile. In Chile, the learning environment has been studied in medical schools but no information is available on the field of public dentistry schools. The goal was to determine the students' perception of the learning environment in the dental career at Arturo Prat University in Iquique (Chile), based on the DREEM questionnaire. Methods: the Spanish version of DREEM was applied to 103 volunteers. Students were grouped in three levels: basic (first year), pre-clinical (second and third years) and clinical (fourth and fifth years). Data were processed and scores were determined for each level and for each DREEM domain (learning, teacher, academic perception, atmosphere, and social perception) which constitutes the learning environment. The Tukey test was used to determine statistical differences between groups. Results: no significant differences were found between the basic and the pre-clinical levels, but statistical differences were found at the clinical level. The overall score was 117.81/200, meaning a "more positive than negative" environment, despite a decrease in perception from the basic to the clinical level. Conclusion: the learning environment is perceived positively by students, despite a decreasing perception from the basic to the clinical level, mostly due to psychosocial factors.

RESUMEN. Introducción: el ambiente de aprendizaje se considera esencial en las carreras de ciencias de la salud debido a su significativa influencia en los logros académicos de los estudiantes. El cuestionario DREEM fue desarrollado como una herramienta para obtener el perfil de dicho ambiente. En Chile, se ha estudiado el ambiente de aprendizaje en las escuelas de medicina, pero no existe información en el campo de las escuelas públicas de odontología. El objetivo del presente estudio consistió en determinar la percepción de los estudiantes sobre el ambiente de aprendizaje en la carrera de Odontología de la Universidad Arturo Prat de Iquique (Chile), con base en el cuestionario DREEM. Métodos: se aplicó la versión española de DREEM a 103 voluntarios. Los estudiantes se agruparon en tres niveles: básico (primer año), preclínico (segundo y tercer años) y clínico (cuarto y quinto años). Se procesaron los datos y se determinaron los puntajes para cada nivel y para cada dominio del cuestionario DREEM (aprendizaje, profesor, percepción académica, ambiente y percepción social) que hace parte del ambiente de aprendizaje. Se utilizó la prueba de Tukey para determinar diferencias estadísticas entre los grupos. Resultados: no se encontraron diferencias significativas entre los niveles básico y preclínico, pero se hallaron diferencias estadísticas en el nivel clínico. La puntuación total fue de 117.81/200, lo que significa que hay un entorno "más positivo que negativo", a pesar de una disminución en la percepción del nivel básico al clínico. Conclusión: el ambiente de aprendizaje es percibido positivamente por los estudiantes, a pesar de una percepción decreciente desde el nivel básico hasta el clínico, sobre todo debido a factores psicosociales.

Síndrome de Kartagener: presentación de un caso / Kartagener's syndrome: report of a case

Se reporta un caso de síndrome de Kartagener (situs inversus), sinusitis y bronquiectasia), en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo", en Ciudad de la Habana, en un paciente de 33 años de edad, que presenta los 3 elementos de la tríada de Kartagener. Se investigó en el Servicio de Medicina y el el Deparatamento de Radiología. Se revisó la literatura de este síndrome poco frecuente y se encontró franco predominio en los niños menores de 15 años, así como complicaciones respiratorias graves en los afectados. Se hace énfasis en la importancia del diagnóstico precoz y el tratamiento adecuado de las afecciones de las vìas respiratorias altas, lo que permite una orietación para evitar futuras bronquiectasias y sinusopatías. Se hace mención a los aspectos genéticos, así como la incidencia de variantes del padecimiento. Se hace énfasis en los procederes de enfermería específicos del síndrome