Herbal formulations are advantageous in many ways. They are safe, easily available, better shelf life, economical, and absence of microbial resistance so far. They are most effective when used with proper knowledge. Considering the low toxicity and antibacterial effectiveness, these herbs could be used as an adjunct to NaOCl thereby lowering its toxicity and also providing the added antioxidant advantage. Due to their high safety profile, these irrigants have the potential to replace chemical irrigants in patients with a history of allergic reactions to NaOCl and also in pediatric patients where open apices limit the use of chemical irrigants. Many studies have concluded that herbal extracts produce promising results when used as endodontic irrigants. Further studies like quantitative real-time-polymerase chain reaction and confocal microscopic examination of the biofilms could provide better insight into the herbal irrigants. Combination of these herbal irrigants can also be tested for their synergistic action and also the possible interactions between the ingredients. This review has revealed that there is a paucity of comparative clinical trials utilizing these herbal endodontic irrigants despite having good baseline data showing promising results from in-vitro and ex-vivo studies.
Physicians may encounter patients with a collection of psychologic disorders that present with neurologic symptoms or signs, yet have no identifiable structural or functional etiology within the nervous system. These disorders comprise the so-called pseudoneurologic syndromes, which can mimic almost any organic disease. A careful history and physical examination often can identify the psychologic origin of the symptoms. Presenting syndromes can include pseudoparalysis, pseudosensory syndromes, pseudoseizures, pseudocoma, psychogenic movement disorders and pseudoneuro-ophthalmologic syndromes. These presentations may be distinguished from organic disease by observing signs and symptoms or eliciting test responses that are nonphysiologic and incompatible with organic disease. Once a pseudoneurologic syndrome is identified, patients require compassionate and understanding care to resolve underlying emotional problems.
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The major pseudoneurologic syndromes are summarized in Table 1. The pseudoneurologic syndromes can mimic almost any organically based disease. A thorough history and neurologic examination are the most important aids to the clinician in distinguishing organically from psychologically based disease. Clues to the diagnosis of pseudoneurologic syndrome are outlined in Table 2. Although these clues do not rule out organically based disease, they should raise the clinician's suspicion for pseudoneurologic syndrome. In particular, objective findings such as normal reflexes, muscle tone and pupils are rarely altered by psychogenic causes, and pseudoneurologic syndrome often does not follow neuro-anatomic (e.g., dermatomal) patterns.
No single clinical finding reliably differentiates epileptic seizures from pseudoseizures. Pseudoseizures are involuntary and refractory to anticonvulsant medication, and can mimic generalized convulsive seizures, absence seizures or complex partial seizures.17 Non-convulsive pseudoseizures are more common than convulsive ones. Patients with pseudo-seizures often have a history of abuse or trauma, a familiarity with epilepsy (e.g., in a family member or as an allied health professional), are female and have onset of seizures in the late teens.
The history of the seizure is often helpful. Pseudoseizures may be suspected if the patient is able to act out or recall precisely what occurred during the seizure.18 Clinical features that suggest pseudoseizures include seizures that follow stress or occur in the presence of an audience. Clinical features of pseudoseizures vary from one seizure to the next, while epileptic seizures are stereotypical. Pseudoseizures have a gradual onset, whereas epileptic seizures tend to start abruptly. Symptoms at the onset of pseudoseizures that can be confused with seizure auras include palpitations, choking, numbness, pain and visual hallucinations.
Pseudoneurologic syndromes occasionally occur, and primary care physicians should be familiar with them. A careful history and physical examination give the best clues to an accurate diagnosis, which can save time and money by avoiding exhaustive and expensive investigations and prevent suffering caused by invasive procedures.
Clinical expressions of Oral Submucous Fibrosis. Oral Submucous Fibrosis in a 27-year-old male with a history of gutkha chewing. Panel A shows sunken cheeks and prominent malar bone. Panel B shows significant blanching or marble-like appearance of the soft palate and faucial pillars. Note the altered, inverted shape of the uvula. Panels C & D show blanched bands of upper and lower labial mucosae and vestibule, which are stiff and palpable. Panels E, F & G: A 24-year-old female with a history of chewing baked areca nut. Panel E: significant blanching of soft palate and faucial pillars, and shrunken uvula. Panels F & G: thick fibrous bands and brown/black pigmentation on left & right buccal mucosae 2ff7e9595c
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