| Abstract: |
Hyperfunctional facial wrinkles are caused by overactivity of the facial expression muscles.Botulinum toxin is an exotoxin produced by clostridium botulinum bacterium. It is a muscle relaxing agent. When botulinum toxin is injected directly into the selected overactive muscles which are involved in the hyperfunctional wrinkles, these muscles will be relaxed.Botox vial containing approximately 100 u of botulinum toxin-A, Twenty patients with different types of hyperfunctional facialwrinkles were included in the present study . They included ten patients(50%) with transverse forehead lines, four patients (20%) with glabellar frown lines, and six patients (30%) with crow’s feet.Pregnant , lactating women and neuromuscular diseases patients, pre-existing brow ptosis or facial asymmetry were excluded and all aged between 20 and 45 .In this thesis, all of the studied patients had cosmetic improvement. Good to moderate improvement was found in 90%, 75%, and 66.7% ofPatients with transverse forehead lines, glabellar frown lines, and crow’sfeet respectively. While, mild improvement was attained in 10%,25% and 33.3 of patients with transverse forehead lines glabellar frown lines and crow’s feet respectively.All patients of wrinkles were satisfied of the cosmetics resultsRicin also have been tried in treatment of many immunological disorders as diabetes mellitus type I, rheumatoid arthritis, systemic lupus erythematosus, graft versus host disease with encouraging results.Clinical manifestations of toxicity:The clinical signs, symptoms, and pathological manifestations of ricin toxicity vary with the dose and the route of exposure. Experimental animal studies indicate that clinical signs and pathological changes are largely route specific; for example, inhalation results in respiratory distress and airway and pulmonary lesions; ingestion causes gastrointestinal signs and gastrointestinal hemorrhage with necrosis of liver, spleen, and kidneys; and intramuscular intoxication causes severe localized pain, muscle and regional lymph node necrosis, and moderate involvement of visceral organs.Diagnosis of ricin intoxication:Like other potential intoxications on the unconventional battlefield, epidemiological findings will likely play a central role in diagnosis. The observation of multiple cases of very severe pulmonary distress in a population of previously healthy young soldiers, linked with a history of their having been at the same place and time during climatic conditions suitable for biological warfare attack, would be suggestive. The differential diagnoses of aerosol exposure to ricin would include staphylococcal enterotoxin B, exposure to pyrolysis by-products of organofluorine polymers. Confirmation of ricin inhalational intoxication would most likely be through enzyme-linked immunosorbent assay analysis of a swab sample from the nasal mucosa. Enzyme-linked immunosorbent assays (for blood or other body fluids) or immunohistochemical techniques (for direct analysis of tissues) may be useful in confirming ricin intoxication. However, because ricin is bound very quickly regardless of route of challenge, and metabolized before excretion, identification in body fluids or tissues is difficult.Treatment of ricin intoxication:Because ricin acts rapidly and irreversibly (directly on lung parenchyma after inhalation, or is distributed quickly to vital organs after parenteral exposure), post exposure therapy is more difficult and it depends mainly on symptomatic therapies. Therefore, immunization of personnel at risk for ricin exposure is even more important than it is for some of the other potential biological warfare agents.
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