Smile – or smiling has a great impact on one’s whole well–being. It is accordingly the mirror image of oneself from the inside–out. In a smile one can assess, somehow if not hundred per cent, how you feel and even your reactions to a certain situation, minute, hour and in a day. It is also the outward clues of happiness and a voice to connect to other people. These are all reasons why everybody has been longing to have good teeth to provide the perfect smile every day.
With the advent of technology, advancement in the dental health care has also grown providing us the ease and convenience when it comes to oral care. One example is when we have broken tooth especially one front tooth.
Dentures are no longer “in”. But these have been widely used a decade ago. Now, we have a lot of innovations already including dental implants.
Dental implants are surgical fixtures used to support dentures or any dental prosthesis. It is a surgical procedure that requires only licensed dental professionals to perform. The benefit of this includes lessening the hassles brought by removable dentures especially when eating. Perhaps the reason why many even travel abroad just to have dental implants where they can get one in an affordable cost.
One good example of such is the dental implants in Mexico. They offer more or less 70% from the total cost of dental implants. Quality is not a question even though it’s cheaper than many since well-equipped and highly trained dentists are the one performing the procedure. In fact, these dental implants in Mexico are included in the American Dental Association and in the International Congress of Oral Implantoligsts.
But if you are living nearer in Costa Rica than in Mexico, you can also check on dental implants in Costa Rica. They also offer discounted rates on every dental implant procedure up to 75% off.
Dental implants are undeniably costly procedures. But taking the opportunities of lesser costs offered by dental clinics mentioned above is already a great decision. Aside from that, after each procedure, you can eventually spend some time vacationing in the nearby staycations in the area.
Image above from guidelineshealth.com.
A patient just came in to the ER department complaining of small streaky areas of reddish black patches under the fingernails for months prior to consult. She went to a beauty shop to have her some manicure, assuming the patches will disappear after manicure. But to her dismay, those patches are still there, hence the ER consult.
Splinter Hemorrhages on the fingernails (image from wikimedia.org)
Being a junior intern on duty, what are you going to ask to your patient?
The first thing to ask to your patient is if she had a very recent trauma or injury to her hands prior to her observation of those streaky areas of reddish black patches under her fingernails. If she said yes, then you can consider those as secondary to trauma.
Those small streaky areas of reddish black patches under the fingernails is actually called splinter hemorrhages. The most common cause of splinter hemorrhages is trauma to the fingernails or toenails. Other causes possibly are bacterial endocarditis, scleroderma, trichinosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, psoriatic nails, antiphospholipid syndrome or malignancy.
If you’re a clinical clerk or a junior intern in the radiology department specifically assigned in MRI division and you are on you’re very first day of duty but you wanted to make your residents or consultants have a “first impression to last”. But you do not know what to expect from your patient’s MRI result with a history of one-sided paralysis.
MRI of the head (image from siemens.com)
Well, here’s one thing that may help you to at least think of something to look for from your patient’s plates.
A cerebral peduncle indentation associated with some forms of transtentorial herniation or the so-called uncal herniation. Kernohan’s Notch.
If you find one, and you are suspecting that it is really that feature, try to go back to your patient and do a detailed history taking and some sort of physical examination.
Kernohan’s notch is a result of a primary condition that may be caused by an injury to the opposite hemisphere of the brain. This means that when you examine your patient and you are seeing a left–sided motor weakness, you should be reading your findings from the right side of your patient’s MRI of the head plates or the other way around.
Aside from injury or head trauma, other cause of this Kernohan’s notch is a brain tumor which still need further investigation.
So, being the junior intern on duty, should you impress your consultant with your findings.