Tuberculous meningitis is globally highly prevalent and is commoner in resource-limited countries and in patients with immunosuppression. Central nervous system tuberculosis is one of the severest forms of ext...
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Τετάρτη 28 Ιουνίου 2017
Tuberculous meningoencephalitis associated with brain tuberculomas during pregnancy: a case report
Associative Learning Should Go Deep
Publication date: Available online 28 June 2017
Source:Trends in Cognitive Sciences
Author(s): Esther Mondragón, Eduardo Alonso, Niklas Kokkola
Conditioning, how animals learn to associate two or more events, is one of the most influential paradigms in learning theory. It is nevertheless unclear how current models of associative learning can accommodate complex phenomena without ad hoc representational assumptions. We propose to embrace deep neural networks to negotiate this problem.
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Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance
Complete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor ti...
http://ift.tt/2tnbUKU
Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance
Complete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor ti...
http://ift.tt/2tnbUKU
Tuberculous meningoencephalitis associated with brain tuberculomas during pregnancy: a case report
Tuberculous meningitis is globally highly prevalent and is commoner in resource-limited countries and in patients with immunosuppression. Central nervous system tuberculosis is one of the severest forms of ext...
http://ift.tt/2t3gZW8
Febrile headache and leg weakness as the initial symptoms of tickborne encephalitis
Description
A 61-year-old woman presented to the emergency department (ED) with a 1-week fever associated with progressive headache. She also reported weakness and paraesthesias in both legs. In the ED, the patient had normal vital parameters and reported no other medical history. Clinical examination showed a slight neck stiffness; the rest of the examination was normal. Laboratory findings showed a mild inflammatory syndrome. The patient had a lumbar punction; the cerebrospinal fluid (CSF) showed moderate pleocytosis (140 leucocytes/μL with a mononuclear cell dominance). After a normal CT scan, an MRI examination was performed (figures 1and 2). Several days later, intrathecal IgM and IgG antibodies came back positive.
Figure 1
T2-weighted transverse MRI. Localised hyperintense band involving the tegmentum pontis (arrow heads) and the cerebellar vermis (arrow).
Figure 2
Coronal MRI, fluid attenuation inversion recovery...
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Letter to the editor regarding “Blood count values and ratios for predicting sleep apnea in obese children”
We are writing in reference to a study published in your journal titled 'Blood count values and ratios for predicting sleep apnea in obese children' by Erdim I, et al. [1] They concluded that NLR, PLR and RDW were found to be significantly higher in children whose AHI was ≥5 than in children from the other groups. We are very impressed about the study, and enjoyed reading it. It is noteworthy that their article is the first paper to investigate whether various CBC test parameters could provide a method for diagnosing and determining the severity of OSAS in obese children.
http://ift.tt/2u0yhUa
From Japan to Europe: the importance to assess excessive daytime sleepiness in adults with ADHD symptoms
We read with great interest the article [1] by Ito, which presents the findings of a web-based study on the prevalence of excessive daytime sleepiness (EDS) and ADHD symptoms in adults with possible ADHD. Their findings show that the prevalence and severity of EDS in Japanese adults with ADHD symptoms are higher compared to those individuals classified as non-ADHD (9822 subjects). This study suggests that EDS and inattentive symptoms share a common underlying mechanism. We thank the authors for highlighting the importance of EDS in ADHD patients.
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The Influence of Intraoperative Testing on Surgical Decision-making During Cochlear Implantation.
Objective: To review our use of intraoperative testing during cochlear implantation (CI) and determine its impact on surgical decision-making. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: A total of 197 children and adults who underwent a total of 266 primary and/or revision CI by a single surgeon from 2010 to 2015. Intervention: Intraoperative electrophysiologic monitoring including evoked compound action potentials and electrical impedances. Main Outcome Measures: Whether surgical management was changed based on intraoperative testing. Results: In only 2 of 266 patients (0.8%), the back-up device was used due to findings on intraoperative testing. In three patients (1.1%), X-ray was performed intraoperatively to confirm intracochlear electrode placement, which was found to be normal in all patients. Conclusion: Our data suggest that with respect to CI in children and adults in straightforward cases (e.g., normal anatomy, nondifficult insertion, etc.), routine intraoperative evoked compound action potentials, impedances, and imaging rarely influence surgical decision-making in our clinic and may have limited usefulness in these patients. The implications of this are discussed and a review of the literature is presented. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
http://ift.tt/2soZePn
http://ift.tt/2soZePn
Outcomes and Time to Emergence of Auditory Skills After Cochlear Implantation of Children With Charge Syndrome.
Objective: Review perioperative complications, benefits, and the timeframe over which auditory skills develop in children with CHARGE syndrome who receive a cochlear implant (CI). Study Design: IRB-approved retrospective chart review of children with CHARGE syndrome who had at least 12 months of cochlear implant use. Setting: Tertiary care children's hospital. Patients: Twelve children, seven males and five females. Mean age implant = 3.5 years (1.7-8.2 yr); mean duration follow-up = 4.7 years (1.5-10.1 yr). Intervention: Cochlear implantation. Main Outcome Measures: Auditory skills categorized into four levels, temporal bone imaging findings, perioperative complications, time to emergence of speech perception, expressive communication mode. Results: All children imaged with magnetic resonance imaging had cochlear nerve deficiency in at least one ear. Speech awareness threshold improved with the CI compared with aided preoperative in 83% of children, with means of 51.7 dB SAT preoperative and 27.1 dB with the CI (p
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http://ift.tt/2sTnsob
The Hannover Coupler: Controlled Static Prestress in Round Window Stimulation With the Floating Mass Transducer.
Introduction: Stimulation of the cochlear round window (RW) with the floating mass transducer (FMT) still suffers from large variation in clinical outcomes. Beside the geometric mismatch between RW and FMT diameter that is a known limiting factor in achieving optimal coupling between actuator and RW membrane, the applied static force between FMT and RW is usually undefined. In this study, the feasibility and efficacy of a specially designed FMT coupler permitting application of static preloads to the RW membrane to optimize FMT-RW coupling was investigated. Methods: Experiments were performed in fresh human cadaveric temporal bones. The "Hannover Coupler" FMT-prosthesis has a spherical tip (d=0.5 mm) at the front end and a spring at the prosthesis back that enables the application of static preloads and mobility of the FMT at the same time. Stapes footplate (SFP) displacements in response to acoustic stimulation of the tympanic membrane and to RW stimulation by the FMT were measured by a Laser-Doppler vibrometer. Results: Average SFP displacement responses of ASTM standard F2504-05 compliant temporal bones to RW stimulation by the "Hannover Coupler" were dependent on the applied force (~0-100 mN) and increased by up to 25 dB at frequencies >= 1 kHz. When averaged at speech relevant frequencies (0.5, 1, 2, 4 kHz) SFP displacements showed a global maximum at RW preloads of ~4 mN. Conclusion: The coupling between FMT and RW membrane was improved by the application of static RW preloads as indicated by increased SFP amplitudes to RW stimulation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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http://ift.tt/2soSCjW
Critical Ischemia Times and The Effect of Novel Preservation Solutions HTK-N and TiPROTEC on Tissues of a Vascularized Tissue Isograft.
Background: We herein investigate critical ischemia times and the effect of novel preservation solutions HTK-N and TiProtec on the individual tissues of a rat limb isograft. Methods: Orthotopic hind-limb transplantations were performed in male Lewis rats following 2h, 6h or 10h of cold ischemia. Limbs were flushed and stored in either HTK-N, TiProtec, HTK or saline solution. Muscle, nerve, vessel, skin and bone samples were procured on day 10 for histology, immunohistochemistry, confocal and electron microscopy and RTqPCR analysis. Results: Histomorphology of the muscle showed a mainly perivascular inflammatory infiltrate, fibrotic degeneration and neovascularization after 6h and 10h of cold ischemia. However, centrally aligned nuclei observed in muscle fibers suggest for muscle regeneration in these samples. In addition to Wallerian degeneration, nerve injury was significantly (p=0.032) aggravated after prolonged cold ischemia. Proinflammatory and regulatory cytokines were most significantly upregulated after 2h cold ischemia. Our data suggest no superiority of novel perfusates HTK-N and TiProtec in terms of tissue preservation, compared to HTK and saline. Conclusions: Limiting cold ischemia time below 6h is the most significant factor to reduce tissue damage in vascularized tissue transplantation. Signs of muscle regeneration give rise that ischemic muscle damage in limb transplantation might be reversible to a certain extent. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2sTkCQ1
http://ift.tt/2sTkCQ1
Targeted Next-generation Sequencing in Brazilian Children With Nephrotic Syndrome Submitted to Renal Transplant.
Background: The aims of this study were to identify the genetic mutations profile in Brazilian children with nephrotic syndrome and to determine a genotype-phenotype correlation in this disease. Methods: Next generation sequencing (NGS) and mutation analysis were performed on 24 genes related to nephrotic syndrome in a cross-sectional study involving 95 children who underwent kidney transplantation due to nephrotic syndrome, excluding congenital cases. Results: A total of 149 variants were identified in 22 out of 24 sequenced genes. The mutations were classified as pathogenic, likely pathogenic, likely benign and benign per the chance of causing the disease. NPHS2 was the most common mutated gene. We identified 8 patients (8.4%) with hereditary NS and 5 patients (5%) with probably genetically caused NS. COL4A3-5 variants were found as well, but it is not clear whether they should be considered isolated FSGS or simply a misdiagnosed type of the Alport spectrum. Considering the clinical results, hereditary NS patients presented a tendency to early disease onset when compared to the other groups (p=0.06) and time to end stage renal disease (ESRD) was longer in this group (p=0.03). No patients from hereditary NS group had NS recurrence after transplantation. Conclusions: This is the first study in children with steroid resistant nephrotic syndrome who underwent kidney transplantation using NGS. Considering our results, we believe this study has shed some light to the uncertainties of genotype-phenotype correlation in NS, where several genes cooperate to produce or even to modify the course of the disease. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Pharmacokinetics and Clinical Outcomes of Generic Tacrolimus (Hexal) Versus Branded Tacrolimus in De Novo Kidney Transplant Patients: A Multicenter, Randomized Trial.
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Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation.
Background: Low tacrolimus concentrations have been associated with higher risk of acute rejection, particularly within African-American (AA) kidney transplant recipients; little is known about intrapatient tacrolimus variabilities impact on racial disparities. Methods: Ten year, single-center, longitudinal cohort study of kidney recipients. Intrapatient tacrolimus variability was assessed using the coefficient of variation (CV) measured between 1 month posttransplant and the clinical event, with a comparable period assessed in those without events. Pediatrics, nontacrolimus/mycophenolate regimens and nonrenal transplants were excluded. Multivariable Cox regression models were used to analyze data. Results: 1411 recipients were included (54.4% AA) with 39 521 concentrations utilized to assess intrapatient tacrolimus CV. Overall, intrapatient tacrolimus CV was higher in AAs vs non-AAs (39.9+/-19.8 % vs. 34.8+/-15.8% p40%) was a significant explanatory variable for disparities in AAs; the crude relative risk of acute rejection in AAs was reduced by 46% when including tacrolimus variability in modeling and reduced by 40% for graft loss. Conclusions: These data demonstrate that intrapatient tacrolimus variability is strongly associated with acute rejection in AAs and graft loss in all patients. Tacrolimus variability is a significant explanatory variable for disparities in AA recipients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2sToh0l
http://ift.tt/2sToh0l
Necrotising coronaritis with fatal outcome
A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction. Although significant obstructive coronary artery disease was ruled out by coronary angiography, cardiac MRI showed transmural necrosis of the lateral free wall with extensive microvascular obstruction consistent with ischaemic heart disease. Within 48 hours after initial presentation, the patient suddenly arrested due to pulseless electrical activity with futile resuscitation efforts. Autopsy revealed myocardial perforation with extensive haematothorax due to pericardial laceration, caused by the mechanical chest compressions. Eventually, histology identified diffuse necrotising coronary vasculitis as a rare cause of ischaemic heart disease.
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Cost analysis of microtia treatment in the Netherlands
Ear reconstruction for microtia is a challenging procedure. Although analyzing aesthetic outcome is crucial, there is a paucity of information with regard to financial aspects of microtia reconstruction. This study was conducted to analyze the costs associated with ear reconstruction with costal cartilage in patients with microtia.
http://ift.tt/2triS2d
Bilateral Buccinator Myomucosal Flap Outcomes in Nonsyndromic Patients with Repaired Cleft Palate and Velopharyngeal Insufficiency
The purpose of this study was to assess speech outcomes and complication rate in nonsyndromic repaired cleft palate patients undergoing bilateral buccinator myomucosal flaps for velopharyngeal insufficiency management.
http://ift.tt/2u0gCvE
“The Anatomy of the Medial Antebrachial Cutaneous Nerve and its Significance in Ulnar Nerve Surgery – an Anatomical Study”
During cubital tunnel surgery, the medial antebrachial cutaneous nerve (MACN) may be injured, causing painful scars, neuromas, hypaesthesia or hyperalgesia. As the literature on the anatomy of crossing branches in this area is contradictory, this study aimed to re-examine the anatomy of the MACN in this region.
http://ift.tt/2trxqPb
Clinical, histological and ultrasound follow-up of the breast reconstruction with one-stage muscle sparing “wrap” technique: a single-center experience
Prepectoral implant placement and complete coverage with porcine acellular matrix after mastectomy is a new concept in breast surgery presented in few cases in literature. The aim of this paper is to present our single center experience in one-stage breast reconstruction muscle sparing "wrap" technique by evaluating clinical and aesthetic outcomes, ultrasound and histological examination and patient quality of life.
http://ift.tt/2u0xh2l
The long-term impact of oncoplastic breast conserving surgery using Latissimus Dorsi miniflaps on mammographic surveillance and the detection of local recurrence
Latissimus Dorsi Miniflap is a breast-conserving volume replacement technique for reconstruction of large breast defects. While mammographic features of Mini Flap reconstruction have been described, little is known about the incidence, mode of presentation and size of local recurrence after this procedure. The aim of this study was to investigate the impact of Latissimus Dorsi Miniflap reconstruction on frequency, presentation and detection of local recurrence.
http://ift.tt/2trs1YD
Ratiometric co-delivery of multiple chemodrugs in a single nanocarrier
Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Chao Chen, Ran Tao, Dan Ding, Deling Kong, Aiping Fan, Zheng Wang, Yanjun Zhao
Co-delivery of multiple anti-cancer drugs in a single nanoplatform has shown great promise in enhancing therapeutic efficacy and reducing adverse effects. However, the ratiometric dose control is pivotal, but often challenging in combinational nanomedicine. Here, we report the employment of cyclodextrin-bearing amphiphilic polymer conjugate micelles for ratiometric, non-covalent loading of three hydrophobic model drugs, curcumin (CUR), camptothecin (CPT), and doxorubicin (DOX) in one single nanocarrier. Each drug was physically encapsulated in the cyclodextrin-bearing polymer conjugate via guest-host complexation. All three drugs displayed a 1:1 complexation behavior with the cyclodextrin, which corresponded to a drug loading of 6.0±0.1% (CUR), 7.5±0.1% (CPT), and 9.0±0.1% (DOX) (w/w). The apparent association constant between the conjugate and drug was 2803.7±87.0 (CUR), 3699.4±123.3 (CPT), and 6760.9±176.3 (DOX), respectively. Ratiometric co-assembly of three types of drug-loaded conjugates produced mixed micelles in a dose- and ratio-controlled manner. The hydrodynamic diameter of co-assembled spherical micelles was ca. 150nm that was similar to the single-drug loaded micelles. The ratiometric co-delivery of three drugs via mixed micelles was demonstrated both in HepG2 cells in vitro and in a mice model in vivo compared to a mixture of free drugs, as evidenced by co-localization analysis. This work provides a facile way to realize ratiometric co-administration of multiple drugs.
Graphical abstract
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Characterizing the time-course of antihypertensive activity and optimal dose range of fimasartan via mechanism-based population modeling
Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Jürgen B. Bulitta, Soo Heui Paik, Yong Ha Chi, Tae Hwan Kim, Soyoung Shin, Cornelia B. Landersdorfer, Yuanyuan Jiao, Rajbharan Yadav, Beom Soo Shin
Fimasartan is a novel angiotensin II receptor blocker. Our aims were to characterize the time-course of the antihypertensive activity of fimasartan via a new population pharmacokinetic/pharmacodynamic model and to define its optimal dose range. We simultaneously modelled all fimasartan plasma concentrations and 24-h ambulatory blood pressure monitoring (ABPM) data from 39 patients with essential hypertension and 56 healthy volunteers. Patients received placebo, 20, 60, or 180mg fimasartan every 24h for 28days and healthy volunteers received placebo or 20 to 480mg as a single oral dose or as seven doses every 24h. External validation was performed using data on 560 patients from four phase II or III studies. One turnover model each was used to describe diastolic and systolic blood pressure. The input rates into these compartments followed a circadian rhythm and were inhibited by fimasartan. The average predicted (observed) diastolic blood pressure over 24-h in patients decreased by 10.1±7.5 (12.6±9.2; mean±SD)mmHg for 20mg, 14.2±7.0 (15.1±9.3) mmHg for 60mg, and 15.9±6.8 (11.5±9.9)mmHg for 180mg daily relative to placebo. The model explained the saturation of antihypertensive activity by counter-regulation at high fimasartan concentrations. Drug effect was maximal at approximately 23ng/mL fimasartan for diastolic and 12ng/mL for systolic blood pressure. The proposed mechanism-based population model characterized the circadian rhythm of ABPM data and the antihypertensive effect of fimasartan. After internal and external model validation, 30 to 60mg oral fimasartan given once daily was predicted as optimal dose range.
Graphical abstract
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Sprayable Carbopol hydrogel with soluble beta-1,3/1,6-glucan as an active ingredient for wound healing – Development and in-vivo evaluation
Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Jostein Grip, Rolf Einar Engstad, Ingrid Skjæveland, Nataša Škalko-Basnet, Ann Mari Holsæter
Chronic wounds represent a significant health problem worldwide. There is a need for advanced- and cost-efficient wound healing products able to increase patient comfort and reduce the healing time. The aim of this study was to develop a sprayable hydrogel dressing with beta-glucan (βG) as the active ingredient, targeting future application in the treatment of both chronic and burn wounds. The βG was chosen as an active ingredient because of its promising wound healing capabilities, whereas Carbopol 971P NF (Carbopol) was chosen as the thickening agent in the formulation due to several attractive characteristics such as its low viscosity, low toxicity, high transparency and good ion tolerance. Four different hydrogel formulations were prepared with varying Carbopol concentrations. The higher Carbopol concentration, 0.5% (w/w), was used to prepare three formulations comprising the HighCP:NoβG, HighCP:LowβG and the HighCP:MediumβG formulation, respectively. Lower Carbopol concentration, 0.25% (w/w), was used to prepare the LowCP:HighβG formulation. The content of βG varied from 0.25% in the HighCP:LowβG, 0.5% in the HighCP:MediumβG and 1.0% (w/w) in the LowCP:HighβG formulation, respectively. The first part of the study focused on the rheological characterization of the hydrogels and the fluid affinity testing. All formulations were confirmed to be stable gels; the βG was shown to augment the gel strength by increasing the yield strength of the gel in a dose dependent manner. The stability of the formulations containing either Carbopol alone or in a combination with βG did not deteriorate over 26weeks, and the fluid donation and absorption study indicated a fluid donation profile, which favors healing of dry wounds. The in vivo efficacy of the formulations, evaluated in the modified diabetic male mice (db/db mice), showed that Carbopol alone was unable to induce improved healing and caused adverse reactions in some wounds. The inclusion of βG increased the epithelialization and wound contraction in the db/db mice when given at high βG:Carbopol ratio. The positive effect of βG was, however, not sufficient to counteract the adverse effect of Carbopol, thus a more suitable thickening agent should be investigated for further development of a sprayable wound care product.
Graphical abstract
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A novel chalcone derivative, LQFM064, induces breast cancer cells death via p53, p21, KIT and PDGFRA
Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Bruna Lannuce Silva Cabral, Artur Christian Garcia da Silva, Renato Ivan de Ávila, Alane Pereira Cortez, Rangel Magalhães Luzin, Luciano Morais Lião, Eric de Souza Gil, Gérman Sanz, Boniek G. Vaz, José R. Sabino, Ricardo Menegatti, Marize Campos Valadares
This study shows the design, synthesis and antitumoral potential evaluation of a novel chalcone-like compound, (E)-3- (3, 5-di-ter-butyl-4-hydroxyphenyl)-1- (4-hydroxy-3-methoxyphenyl) prop-2-en-1-one [LQFM064) (4)], against human breast adenocarcinoma MCF7 cells. Some toxicological parameters were also investigated. LQFM064) (4) exhibited cytotoxic activity against MCF7 cells (IC50=21μM), in a concentration dependent-manner, and triggered significant changes in cell morphology and biochemical/molecular parameters, which are suggestive of an apoptosis inductor. LQFM064) (4) (21μM) induced cell cycle arrest at G0/G1 phase with increased p53 and p21 expressions. It was also shown that the compound (4) did not interfere directly in p53/MDM2 complexation of MCF7 cells. In these cells, externalization of phosphatidylserine, cytochrome c release, increased expression of caspases-7, −8 and −9, reduced mitochondrial membrane potential and ROS overgeneration were also detected following LQFM064 (4) treatment. Further analysis revealed the activation of both apoptotic pathways via modulation of the proteins involved in the extrinsic and intrinsic pathways with an increase in TNF-R1, Fas-L and Bax levels and a reduction in Bcl-2 expression. Furthermore, KIT proto-oncogene receptor tyrosine kinase, insulin-like growth factor (IGF1) and platelet-derived growth factor receptor A (PDGFRA) were downregulated, while glutathione S-transferase P1 (GSTP1) and interferon regulatory factor 5 (IRF5) expressions were increased by LQFM064 (4)-triggered cytotoxic effects in MCF7 cells. Moreover, it can be inferred that compound (4) has a moderate acute oral systemic toxicity hazard, since its estimated LD50 was 452.50mg/kg, which classifies it as UN GHS Category 4 (300mg/kg>LD50<2000mg/kg). Furthermore, LQFM064 (4) showed a reduced potential myelotoxicity (IC50=150μM for mouse bone marrow hematopoietic progenitors). In conclusion, LQFM064 (4) was capable of inducing breast cancer cells death via different cytotoxic pathways. Thus, it is a promising alternative for the treatment of neoplasias, especially in terms of the drug resistance development.
Graphical abstract
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Effect of humic acid on uranium(VI) retention and transport through quartz columns with varying pH and anion type
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): Liang Du, Shicheng Li, Xiaolong Li, Ping Wang, Zhaoya Huang, Zhaoyi Tan, Chunli Liu, Jiali Liao, Ning Liu
Humic acid (HA)1 is ubiquitous in the environment and is an important factor in the migration behavior of U(VI) in the geological medium. The present work investigated the effect of HA on the migration behavior of U(VI) using quartz column experiments at different pH values and in the presence of various anions. The U(VI) adsorption characteristics and speciation were also studied to illuminate further the migration behavior of U(VI). Our results indicated that, at pH 6.0, HA slightly increased the migration velocity of U(VI) during the initial phase and reduced the quantity of eluted U(VI) because of the formation of HA-U(VI). The relative concentration (c/c0) of U(VI)was higher in the HA-U system at pH 8.0 than that at pH 5.0 because of the higher solubility of HA in basic solutions and the difference in charge of HA-U(VI). In the U-HA-anion system at pH 6.0, the breakthrough pore volumes (PVs2) of U(VI) in electrolytes containing Cl− and SO42− anions (PV = 8) are much higher than for solutions containing phosphate (PV = 3), while the HA migration behavior was not significantly affected by the type of anion. Thus, the fast migration of U(VI) under HA and phosphate was attributed to phosphate rather than HA. This result suggests that phosphate should be given more attention in predictions of U(VI) migration, especially in regions with high groundwater phosphate content.
http://ift.tt/2tnhMnj
Accuracy and Reliability of Intraoral Scanners: Are They the Better Option?
Abstract
Purpose of Review
The aim was to compare the accuracy of digital intraoral impressions with conventional impressions on the fabrication of different types of restorations. This study also compared the accuracy, reliability, and ease of use of different types of intraoral scanners available and correlated the results with the different scanning technologies.
Recent Findings
Digital impressions offer the same level of accuracy as conventional impressions regarding fabrication of crowns, fixed dental prostheses (FDPs), implant-supported crowns, and short-span FDPs with marginal gap values within the clinically acceptable range (<120 μm). However, for full-arch restorations, conventional impressions result in better accuracy.
Summary
Further enhancements needs to be undertaken regarding intraoral scanners to improve its accuracy regarding fabrication of full-arch restorations. Further in vivo studies evaluating the accuracy of intraoral digital impressions on the fabrication of a wider range of restorations such as inlays, veneers, and full-arch restoration need to be conducted.
http://ift.tt/2tqUBt7
An ultrasensitive photoelectrochemical immunosensor for insulin detection based on BiOBr/Ag2S composite by in-situ growth method with high visible-light activity
Source:Biosensors and Bioelectronics, Volume 97
Author(s): Dawei Fan, Haoyuan Wang, Malik Saddam Khan, Chunzhu Bao, Huan Wang, Dan Wu, Qin Wei, Bin Du
A novel ultrasensitive label-free immunosensor based on BiOBr/Ag2S composite with high visible-light photoelectrochemical activity was prepared for the detection of insulin. After BiOBr was modified by thioglycolic acid, Ag2S nanoparticles were grown in-situ on the surface of BiOBr hierarchical microspheres to first form novel BiOBr/Ag2S composite. When ascorbic acid (AA) was used as an efficient electron donor for scavenging photo-generated holes, BiOBr/Ag2S composite material showed excellent photoelectrochemical activity. In order to immobilize insulin antibody, adhesive polydopamine (PDA) film formed by self-polymerization of dopamine was fabricated onto BiOBr/Ag2S modified electrode. Moreover, PDA film could further enhance the visible light absorption of BiOBr/Ag2S. When the solutions of 0.08molL−1AgNO3 and 0.1molL−1 AA were selected respectively during fabrication and detection process of this sensor, the best photocurrent singles were obtained. Under the optimum experimental condition, the specific binding between insulin and antibody resulted in a decrease in photocurrent intensity and the intensity decreased linearly with the logarithm of insulin concentration in the range of 0.001–20ngmL−1 with a detection limit of 0.2pgmL−1. The photoelectrochemical sensor ITO/BiOBr/Ag2S/PDA/anti-Insulin/BSA/Insulin revealed facile preparation, high sensitivity, and acceptable reproducibility, which may have practical applications in the biosensor, clinical diagnosis of cancers, photocatalysis, and other related fields.
http://ift.tt/2s3Bvop
A high sensitive visible light-driven photoelectrochemical aptasensor for shrimp allergen tropomyosin detection using graphitic carbon nitride-TiO2 nanocomposite
Publication date: 15 December 2017
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Mahmoud Amouzadeh Tabrizi, Mojtaba Shamsipur, Reza Saber, Saeed Sarkar, Vahid Ebrahimi
Herein, for the first time a visible-light-driven photoelectrochemical (PEC) aptasensor for shrimp tropomyosin determination was fabricated by using graphitic carbon nitride (g-C3N4) and titanium dioxide (TiO2) as photoactive nanomaterials, ascorbic acid (AA) as electron donor and ruthenium (III) hexaammine (Ru(NH3)63+) as signal enhancer. The surface of an ITO electrode was first modified with g-C3N4, TiO2, and polyethyleneimine (PEI) and then the amine terminal aptamerTROP probe was attached to PEI by the use of glutaraldehyde (GA) as cross-linker. After that, Ru(NH3)63+ was adsorbed on aptamer to enhance the photocurrent signal. The principle of proposed PEC aptasensor is based on the formation of a selective complex between tropomyosin and immobilized aptamerTROP probe on the surface of ITO/g-C3N4-TiO2/PEI/aptamerTROP-Ru(NH3)6+3. After the incubation of tropomyosin with TROP aptamer probe, the photocurrent signal decreased due to releasing adsorbed Ru(NH3)63+ on aptamer and preventing AA from scavenging photogenerated holes to the photoactive modified electrode. Under the optimized conditions, the fabricated PEC aptasensor was used for the determination of shrimp tropomyosin in the concentration range of 1–400ngmL−1 with a limit of detection of 0.23ngmL−1. The proposed PEC aptasensor exhibited high selectivity, sensitivity, and good stability.
Graphical abstract
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Quantitative ratiometric phosphorescence hypoxia–sensing nanoprobes based on quantum dots/Ir(III) glycerol monoolein cubic-phase nanoparticles
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Jiajun Liu, Youshen Wu, Yao Yu, Ke Li, Yuanyuan Ji, Daocheng Wu
A novel protocol is developed to prepare quantum dot (QD)/Ir(III) complex glycerol monoolein (GMO) cubic-phase nanoparticles (Qd/Ir GMCPNPs) as hypoxia nanoprobes, in which hypoxia probe Tris [1-phenylisoquinoline-C2, N] Iridium(III) [Ir(piq)3] and the reference QDs are separately loaded at hydrophilic and hydrophobic channels to avoid interference. Qd/Ir GMCPNPs were nearly spherical in shape, with an average size of 20–30nm. Their phosphorescence spectra showed that nanoprobes have a wide excited wave length range of 360–500nm, which is suitable for different types of measurement instruments. When the oxygen content decreased from 21% to 1%, the luminescent intensity ratio of Qd/Ir GMCPNPs in the solution and cells increased 4-fold and 2.8-fold, respectively, with an acceptable linear relationship. Particularly, extensive preliminary quantitative ratiometric oxygen sensing and long tumor imaging monitoring can be achieved with these nanoprobes.
http://ift.tt/2tmM5e9
Multiple amplified enzyme-free electrochemical immunosensor based on G-quadruplex/hemin functionalized mesoporous silica with redox-active intercalators for microcystin-LR detection
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Cuifen Gan, Bingfeng Wang, Junying Huang, Aori Qileng, Zuyu He, Hongtao Lei, Weipeng Liu, Yingju Liu
A novel multiple amplified enzyme-free immunosensor was developed for competitive immunoassay of microcystin-LR (MC-LR). Classical electrochemical immunosensors usually employ enzymes as biocatalysts to afford amplified signals, but the proteolytic degradation and poor stability are still crucial problem. Herein, monodisperse core-shell mesoporous silica (SiO2@MSN)-functionalized DNAzyme concatamers were synthesized to load hemin and methylene blue (MB) as the mimic enzyme. Firstly, the surface of SiO2@MSN was conjugated with secondary antibody as the recognition of MC-LR antibody and with a DNA strand as the initiator. Two auxiliary DNA strands were then selected for the in-situ propagation to form a double-helix DNA through hybridization chain reaction (HCR), forming numerous DNAzymes (G-quadruplex/hemin) after the addition of hemin. Secondly, MB was inserted into the formed double-helix DNA, and also loaded in the brush-like structure of mesoporous SiO2@MSN. The molecular docking study showed that electrons can transfer more effectively with π-π stack of hemin/G-quadruplex and intercalation of MB/DNA, thus the catalytic ability of DNAzymes can be greatly improved. With the aid of MB, DNAzymes can catalyze the reduction of H2O2 to produce the electrochemical signal. This enzyme-free electrochemical immunosensor can successfully detect MC-LR in a range of 0.5ng/L and 25μg/L with a detection limit of 0.3ng/L. This stable, sensitive and selective nonenzymatic electrochemical immunoassay shows promise for applications in food and environmental monitoring.
http://ift.tt/2s4ey4q
Editorial Board
Source:Biosensors and Bioelectronics, Volume 97
http://ift.tt/2s3OhDx
Carbon nanostructures as immobilization platform for DNA: A review on current progress in electrochemical DNA sensors
Source:Biosensors and Bioelectronics, Volume 97
Author(s): P. Abdul Rasheed, N. Sandhyarani
Development of a sensitive, specific and cost-effective DNA detection method is motivated by increasing demand for the early stage diagnosis of genetic diseases. Recent developments in the design and fabrication of efficient sensor platforms based on nanostructures make the highly sensitive sensors which could indicate very low detection limit to the level of few molecules, a realistic possibility. Electrochemical detection methods are widely used in DNA diagnostics as it provide simple, accurate and inexpensive platform for DNA detection. In addition, the electrochemical DNA sensors provide direct electronic signal without the use of expensive signal transduction equipment and facilitates the immobilization of single stranded DNA (ssDNA) probe sequences on a wide variety of electrode substrates. It has been found that a range of nanomaterials such as metal nanoparticles (MNPs), carbon based nanomaterials, quantum dots (QDs), magnetic nanoparticles and polymeric NPs have been introduced in the sensor design to enhance the sensing performance of electrochemical DNA sensor. In this review, we discuss recent progress in the design and fabrication of efficient electrochemical genosensors based on carbon nanostructures such as carbon nanotubes, graphene, graphene oxide and nanodiamonds.
http://ift.tt/2tmVGle
Recent advances in transition-metal dichalcogenides based electrochemical biosensors: A review
Source:Biosensors and Bioelectronics, Volume 97
Author(s): Yi-Han Wang, Ke-Jing Huang, Xu Wu
Layered transition metal dichalcogenides (TMDCs) comprise a category of two-dimensional (2D) materials that offer exciting properties, including large surface area, metallic and semi-conducting electrical capabilities, and intercalatable morphologies. Biosensors employ biological molecules to recognize the target and utilize output elements which can translate the biorecognition event into electrical, optical or mass-sensitive signals to determine the quantities of the target. TMDCs nanomaterials have been widely applied in various electrochemical biosensors with high sensitivity and selectivity. The marriage of TMDCs and electrochemical biosensors has created many productive sensing strategies for applications in the areas of clinical diagnosis, environmental monitoring and food safety. In recent years, an increasing number of TMDCs-based electrochemical biosensors are reported, suggesting TMDCs offers new possibilities of improving the performance of electrochemical biosensors. This review summarizes recent advances in electrochemical biosensors based on TMDCs for detection of various inorganic and organic analytes in the last five years, including glucose, proteins, DNA, heavy metal, etc. In addition, we also point out the challenges and future perspectives related to the material design and development of TMDCs-based electrochemical biosensors.
http://ift.tt/2s3L86y
Dual signal amplification strategy of Au nanopaticles/ZnO nanorods hybridized reduced graphene nanosheet and multienzyme functionalized Au@ZnO composites for ultrasensitive electrochemical detection of tumor biomarker
Source:Biosensors and Bioelectronics, Volume 97
Author(s): Xian Fang, Junfeng Liu, Jing Wang, Hong Zhao, Hongxuan Ren, Zengxi Li
Herein, a dual signal amplification strategy was employed in fabricating ultrasensitive electrochemical immunosensor for alpha fetoprotein (AFP) detection, which was realized by utilizing of ZnO nanorods/Au nanopaticles hybridized reduced graphene nanosheet (Au/ZnO/RGO) and horseradish-peroxidase (HRP) bioconjugated detection antibody (Ab2) functionalized Au@ZnO (Ab2/HRP-Au@ZnO). During the fabrication of the immunosensor, a new kind of multiple-head surfactants CxN3 with different alkyl chain length played important roles such as acting as the surfactants of Au/ZnO/RGO and the reductant agents of Au@ZnO composite. Due to the good adsorption property and large surface area of Au/ZnO/RGO, plenty of the capture antibodies (Ab1) were immobilized on the electrode surface, and trace AFP was sensitively monitored. Furthermore, Ab2/HRP-Au@ZnO exhibited high affinity interaction with AFP through "sandwich" immunoreactions, along with the peroxidase-like catalytic activity of Au@ZnO, leading to a further enhancement in the sensitivity of the proposed immunosensor. The successful synthesis of the nanomaterials was characterized through a serious of techniques including Raman, XRD, FT-IR, SEM and UV–vis. Under the optimal conditions, two linear ranges of 0.02–10,000 and 10,000–100,000pgmL-1 AFP with a lower detection limit of 0.01pg mL-1 (S/N=3) was obtained. Especially, the proposed AFP immunosensor can be applied to detect human serum samples with satisfactory results, indicating a potential application in clinical monitoring of tumor biomarkers.
http://ift.tt/2tndJaO
Enzyme-less electrochemical displacement heterogeneous immunosensor for diclofenac detection
Publication date: 15 November 2017
Source:Biosensors and Bioelectronics, Volume 97
Author(s): T.T.K. Nguyen, T.T. Vu, G. Anquetin, H.V. Tran, S. Reisberg, V. Noël, G. Mattana, Q.V. Nguyen, Tran Dai Lam, M.C. Pham, B. Piro
We describe an electrochemical immunosensor based on functionalization of a working electrode by electrografting two functional diazonium salts. The first one is a molecular probe, diclofenac, coupled with an arylamine onto which a specific antibody is immobilized by affinity interactions; the second is a redox probe (a quinone) also coupled with an arylamine, able to transduce the hapten-antibody association into a change in electroactivity. The steric hindrance induced by the antibody leads to a current decrease upon binding of the antibody on the grafted molecular probe; conversely, when diclofenac is present in solution, a displacement equilibrium occurs between the target diffusing into the solution and the grafted probe. This leads to dissociation of the antibody from the electrode surface, event which is transduced into a current increase ("signal-on" detection). The detection limit is ca. 20 fM, corresponding to 6pgL−1 diclofenac, which is competitive compared to other label-free immunosensors. We demonstrate that the sensor is selective and is able to quantify diclofenac in tap water.
Graphical abstract
http://ift.tt/2s3Oh6v
A real-time-range potentiostat coupled to nano-Au-modified microband electrode array for high-speed stripping determination of human blood lead
Source:Biosensors and Bioelectronics, Volume 97
Author(s): Wen Zhang, Yiwei Xu, Xiaobo Zou, Ping Wang
A novel method of real-time-range measurement, characterized by pre-sampling forecast and balanced-range switching, is introduced in this study. According to this method, raw current signals in biosensing procedures may be measured and recorded with real-time-optimized instrumental settings. A low-cost and high-performance potentiostat is developed to validate the proposed method. The transient process of real-time-range measurement is investigated to optimize sampling interval and circuit parameters. Typical time consumption of a sampling cycle is less than 100μs, which makes high-speed and real-time-range measurement possible. The proposed method also brings excellent current resolution that is better than 0.8pA. It improves weak signals in stripping determinations, and is particularly suitable for biological samples. As-fabricated potentiostat, coupled to a nano-Au-modified microband electrode array, is adopted in high-speed stripping determinations towards human blood lead levels (HBLLs). Accuracy and precision of this method are validated with certified reference material (CRM). Obtained values (4.31 ± 0.18μgL−1) meet with certified levels of CRM (4.24 ± 0.11μgL−1). Coefficient of variation percent (CV %) is no more than 5.0% for intra- or inter-assay analyses. Finally, this method is utilized for human population based study. Two groups of data, from this method and inductively coupled plasma mass spectrometry (ICP-MS), are analyzed using a statistic tool of t-test, and no statistically significant difference is found.
http://ift.tt/2s46JvI
Aging and Confidence Judgments in Item Recognition.
Author: Voskuilen, Chelsea; Ratcliff, Roger; McKoon, Gail
DOI: 10.1037/xlm0000425
Publication Date: POST AUTHOR CORRECTIONS, 22 June 2017
http://ift.tt/2tmXR7N
Working Memory Capacity and the Antisaccade Task: A Microanalytic-Macroanalytic Investigation of Individual Differences in Goal Activation and Maintenance.
Author: Meier, Matt E.; Smeekens, Bridget A.; Silvia, Paul J.; Kwapil, Thomas R.; Kane, Michael J.
DOI: 10.1037/xlm0000431
Publication Date: POST AUTHOR CORRECTIONS, 22 June 2017
http://ift.tt/2uko9oz
Effect of orthognathic surgery on profile esthetics in Class II:1 malocclusions
Abstract
Objectives
To measure the effect of orthognathic surgery on Class II:1 profile silhouette esthetics and to identify pretreatment parameters and thresholds for consistent esthetic improvement.
Methods
Pre- and posttreatment black profile silhouettes of 20 patients with Class II:1 malocclusion who had received combined orthodontic/orthognathic treatment were evaluated retrospectively by 20 European orthodontists and laypeople each using a visual analogue scale (VAS). A variety of pretreatment skeletal and facial angles were measured cephalometrically and on the silhouette profiles. Descriptive statistics and Pearson's correlation coefficients were calculated.
Results
The population showed a mean VAS improvement of 12.6%. VAS changes were significantly and directly related to pretreatment ANB in all evaluator groups (r = 0.48–0.59), whereas the interrelation with the degree of pretreatment profile convexity angle was less clear and statistically significant for the orthodontic evaluators only (r = −0.34 to −0.51). The highest correlation coefficients in all evaluator groups were seen for the relationship with pretreatment VAS scores (r = −0.64 to −0.73).
Conclusion
The lower the pretreatment VAS score and the profile convexity angles or the larger the pretreatment ANB angles were, the more the VAS improved. Pretreatment thresholds for consistent improvements were as follows: VAS score < 20 mm, ANB > 8°, and profile angle ≤ 155°.
http://ift.tt/2tmNukG
Incidence and severity of gingival invaginations associated with early versus late initiation of orthodontic space closure after tooth extraction
Abstract
Objective
Gingival invaginations are a common side effect of orthodontic extraction–space closure. The timing of initiating the closure of an extraction space varies greatly in clinical practice. In this multicenter pilot and randomized controlled trial, we prospectively investigated whether initiating space closure in the early stage of wound healing would benefit the incidence and severity of invaginations developing in the extraction sites.
Methods
A total of 368 patients were screened for indications to extract at least one mandibular premolar. Those recruited were randomly assigned to one of two treatment arms: initiation of space closure either 2–4 weeks (arm A) or ≥12 weeks (arm B) after tooth extraction. Clinical data regarding treatment process and periodontal tissue response were recorded during and after space closure and analyzed by a specialized biometrics unit. The study was performed under continuous surveillance by an independent study control center.
Results
A total of 74 extraction sites were analyzed. Regarding the incidence of gingival invaginations, there were no significant intergroup differences [p = 0.13; group A comprising 37/44 (84.1%) and group B 29/30 (96.7%) invaginated sites]. The same was true based on either maxillary (p = 0.52) or mandibular (p = 0.21) sites only, and the severity of the invaginations did not differ between the treatment arms.
Conclusions
As to the incidence and severity of gingival invaginations, we did not notice any statistically significant differences between the two timeframes. Our data do, however, provide a basis to identify additional confounders and to improve the accuracy of case-load estimations for future trials.
http://ift.tt/2ukfFxC
Effects of combined orthodontic-orthognathic treatment for class II and III correction on posterior airway space
Abstract
Objectives
Comparison of treatment effects on the posterior airway space (PAS) in patients treated with combined orthodontic–orthognathic surgical treatment.
Methods
Pre- and postsurgical lateral cephalograms of 53 (34 females, 19 males) Caucasian patients were analyzed using a customized set of measurements. According to malocclusion (Class II or III) and surgical approach (either monognathic or bignathic), patients were allocated into four groups. PAS was assessed from cranial to caudal at six levels (P1–P6). Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at p < 0.05.
Results
In patients treated for Class II malocclusion, PAS retropalatally (P1 level) almost remained unchanged, whereas measurements at levels P2–P6 showed a mean increase ranging from approximately 2–5.5 mm. Significant changes were most pronounced in monognathic Class II patients (group 1) at levels P2–P4 with mean values ranging from approximately 3.7–5.5 mm. In patients treated for Class III malocclusion (groups 3 and 4), measurements at the P1 level almost remained unchanged in patients who underwent mandibular setback surgery (group 3), whereas the same measurements exhibited significant increase (>6 mm) in patients treated with bignathic surgery (group 4).
Conclusions
Bignathic surgery led to smaller changes of pharyngeal depth in Class II and III patients than monognathic surgery. Alterations of the PAS due to orthognathic surgery should be considered during orthodontic and presurgical treatment planning.
http://ift.tt/2tmL2dF
Electrochemical Carbon Based Nanosensors: A Promising Tool in Pharmaceutical and Biomedical Analysis
Publication date: Available online 28 June 2017
Source:Journal of Pharmaceutical and Biomedical Analysis
Author(s): Sevinc Kurbanoglu, Sibel A. Ozkan
Nanotechnology has become very popular in the sensor fields in recent times. It is thought that the utilization of such technologies, as well as the use of nanosized materials, could well have beneficial effects for the performance of sensors. Nano-sized materials have been shown to have a number of novel and interesting physical and chemical properties. Low-dimensional nanometer-sized materials and systems have defined a new research area in condensed-matter physics within past decades. Apart from the aforesaid categories of materials, there exist various materials of different types for fabricating nanosensors. Carbon is called as a unique element, due to its magnificent applications in many areas. Carbon is an astonishing element that can be found many forms including graphite, diamond, fullerenes, and graphene. This review provides an overview of some of the important and recent developments brought about by the application of carbon based nanostructures to nanotechnology for both chemical and biological sensor development and their application in pharmaceutical and biomedical area.
http://ift.tt/2sopMQB
Bilateral inner ear damage after electrical injury: A case report
Source:Auris Nasus Larynx
Author(s): George Psillas, Marios Stavrakas, Ioanna Petrou, Dimitrios Rachovitsas, Konstantinos Markou
Electrical injury occurs as a result of direct contact with an electrical source. We present the case of a 62-year-old male patient, an electrician by profession, who was hit by a high-voltage electrical current while working with cables in proximity to a wet floor. The patient suffered from immediate loss of consciousness and five days later he started complaining of slight hearing loss, persistent vertigo, instability and bilateral tinnitus. A thorough audiological and vestibular examination revealed an extensive bilateral vestibulocochlear dysfunction. The exact pathogenetic mechanisms of inner ear dysfunction after electrical injury have not been fully elucidated, although it is believed that there is significant improvement with time. Long-term follow-up, medical assistance and psychological support are crucial factors for the patient management.
http://ift.tt/2sSR0m8
Effect of orthognathic surgery on profile esthetics in Class II:1 malocclusions
Abstract
Objectives
To measure the effect of orthognathic surgery on Class II:1 profile silhouette esthetics and to identify pretreatment parameters and thresholds for consistent esthetic improvement.
Methods
Pre- and posttreatment black profile silhouettes of 20 patients with Class II:1 malocclusion who had received combined orthodontic/orthognathic treatment were evaluated retrospectively by 20 European orthodontists and laypeople each using a visual analogue scale (VAS). A variety of pretreatment skeletal and facial angles were measured cephalometrically and on the silhouette profiles. Descriptive statistics and Pearson's correlation coefficients were calculated.
Results
The population showed a mean VAS improvement of 12.6%. VAS changes were significantly and directly related to pretreatment ANB in all evaluator groups (r = 0.48–0.59), whereas the interrelation with the degree of pretreatment profile convexity angle was less clear and statistically significant for the orthodontic evaluators only (r = −0.34 to −0.51). The highest correlation coefficients in all evaluator groups were seen for the relationship with pretreatment VAS scores (r = −0.64 to −0.73).
Conclusion
The lower the pretreatment VAS score and the profile convexity angles or the larger the pretreatment ANB angles were, the more the VAS improved. Pretreatment thresholds for consistent improvements were as follows: VAS score < 20 mm, ANB > 8°, and profile angle ≤ 155°.
http://ift.tt/2tmNukG
Incidence and severity of gingival invaginations associated with early versus late initiation of orthodontic space closure after tooth extraction
Abstract
Objective
Gingival invaginations are a common side effect of orthodontic extraction–space closure. The timing of initiating the closure of an extraction space varies greatly in clinical practice. In this multicenter pilot and randomized controlled trial, we prospectively investigated whether initiating space closure in the early stage of wound healing would benefit the incidence and severity of invaginations developing in the extraction sites.
Methods
A total of 368 patients were screened for indications to extract at least one mandibular premolar. Those recruited were randomly assigned to one of two treatment arms: initiation of space closure either 2–4 weeks (arm A) or ≥12 weeks (arm B) after tooth extraction. Clinical data regarding treatment process and periodontal tissue response were recorded during and after space closure and analyzed by a specialized biometrics unit. The study was performed under continuous surveillance by an independent study control center.
Results
A total of 74 extraction sites were analyzed. Regarding the incidence of gingival invaginations, there were no significant intergroup differences [p = 0.13; group A comprising 37/44 (84.1%) and group B 29/30 (96.7%) invaginated sites]. The same was true based on either maxillary (p = 0.52) or mandibular (p = 0.21) sites only, and the severity of the invaginations did not differ between the treatment arms.
Conclusions
As to the incidence and severity of gingival invaginations, we did not notice any statistically significant differences between the two timeframes. Our data do, however, provide a basis to identify additional confounders and to improve the accuracy of case-load estimations for future trials.
http://ift.tt/2ukfFxC
Effects of combined orthodontic-orthognathic treatment for class II and III correction on posterior airway space
Abstract
Objectives
Comparison of treatment effects on the posterior airway space (PAS) in patients treated with combined orthodontic–orthognathic surgical treatment.
Methods
Pre- and postsurgical lateral cephalograms of 53 (34 females, 19 males) Caucasian patients were analyzed using a customized set of measurements. According to malocclusion (Class II or III) and surgical approach (either monognathic or bignathic), patients were allocated into four groups. PAS was assessed from cranial to caudal at six levels (P1–P6). Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at p < 0.05.
Results
In patients treated for Class II malocclusion, PAS retropalatally (P1 level) almost remained unchanged, whereas measurements at levels P2–P6 showed a mean increase ranging from approximately 2–5.5 mm. Significant changes were most pronounced in monognathic Class II patients (group 1) at levels P2–P4 with mean values ranging from approximately 3.7–5.5 mm. In patients treated for Class III malocclusion (groups 3 and 4), measurements at the P1 level almost remained unchanged in patients who underwent mandibular setback surgery (group 3), whereas the same measurements exhibited significant increase (>6 mm) in patients treated with bignathic surgery (group 4).
Conclusions
Bignathic surgery led to smaller changes of pharyngeal depth in Class II and III patients than monognathic surgery. Alterations of the PAS due to orthognathic surgery should be considered during orthodontic and presurgical treatment planning.
http://ift.tt/2tmL2dF
Ultrasound Risk Categories for Thyroid Nodules and Cytology Results: A Single Institution’s Experience after the Adoption of the 2016 Update of Medical Guidelines by the American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi
Objectives. In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results. Methods. From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk). Results. We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology). Conclusions. A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules
http://ift.tt/2tkmEtq
Ultrasound Risk Categories for Thyroid Nodules and Cytology Results: A Single Institution’s Experience after the Adoption of the 2016 Update of Medical Guidelines by the American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi
Objectives. In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results. Methods. From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk). Results. We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology). Conclusions. A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules
http://ift.tt/2tkmEtq
Retrospective study of intranasal dexmedetomidine as a prophylactic against emergence delirium in pediatric patients undergoing ear tube surgery
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Lisgelia Santana, Katherine Mills
ObjectivesThis study evaluated the effect of intranasal dexmedetomidine on emergence delirium (ED) in pediatric patients who underwent ear tube surgeries. Due to the brief nature of the surgery and low levels of pain experienced, an IV is rarely needed, limiting the medications available to anesthesiologists to manage postoperative delirium that may arise during recovery from inhalational anesthesia. Intravenous dexmedetomidine is an alpha-2 agonist anesthetic that is used in pediatric patients for the management of ED in various surgical procedures. However, intranasal medication has not been evaluated specifically in ear tube surgeries for ED prevention.MethodsWe conducted a retrospective chart review of pediatric patients at Nemours Children's Hospital who had undergone ear tube insertion or removal surgery between 2013 and 2015, controlling for confounding variables such as age, surgery duration, and anesthesiologist. We used the post anesthesia emergence delirium (PAED) tool, an instrument created to assess ED in the clinical setting. We analyzed the data for significant differences in PAED score and time in the post anesthesia care unit (PACU) between patients treated with intranasal dexmedetomidine and the control group that did not receive the medication.ResultsWe found no significant difference between the PAED scores of those patients treated with intranasal dexmedetomidine prior to ear tube surgeries and those who did not receive the medication, and no difference in the duration of PACU stay.ConclusionThese results conflict with other research on intranasal dexmedetomidine and its potential to prevent ED in pediatric patients. This information should prompt further prospective investigation into the most efficacious use of dexmedetomidine for ED prevention, both in terms of timing and dosage required.
http://ift.tt/2t2bC9V
Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Nicholas Scalzitti, Shana Hansen, Stephen Maturo, Joshua Lospinoso, Peter O'Connor
IntroductionObstructive sleep apnea (OSA) affects 1–5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA.MethodsA prospective study was conducted in children, ages 2–17. Subjects completed in-lab polysomnography simultaneously with ambulatory monitoring. Caregivers attempted home studies on two subsequent nights to compare the home monitor and the laboratory polysomnogram (PSG).ResultsThirty-three subjects completed simultaneous laboratory polysomnogram with portable monitoring. Twenty patients completed home studies, with 16 completing 2 nights of monitoring. The measurement of AHI by the portable monitor was different than that obtained by the PSG with statistical significance for the comparisons of PSG vs. In-Lab (p = 0.0026), PSG vs. Home 1 (p = 0.033), and PSG vs. Home 2 (p = 0.033). The sensitivity of the portable monitor for diagnosing OSA was best for the In-lab use at 81%, but only 69% and 70% for the uses at home on the 2 nights respectively. Interestingly, the comparison of AHI and lowest oxygen saturation measurements from the home sleep test in children age 6 and older did not differ significantly from the PSG.ConclusionsThis pilot study demonstrated differences between home sleep testing and in-lab polysomnography for the diagnosis of pediatric sleep apnea. These differences were predominantly found to exist in younger children. Larger prospective studies are needed prior to widespread use, but home studies may alleviate issues of access to care and higher costs of laboratory polysomnography.
http://ift.tt/2sjnHKB
Evaluation of locked plate in the osteosynthesis of fractures in osteoporotic bones
Annals of African Medicine 2017 16(3):127-130
Background: The use of conventional dynamic compression plates (DCPs) in osteoporotic bones is associated with higher chances of implant failure. The advent and use of locking combi-plates have ensured a stable construct during osteosynthesis of fractures in osteoporotic bones. Objectives: The study aims to assess the outcome of use of locking combi-plates in the management of fractures in osteoporotic bones in our environment. Materials and Methods: Cases of patients with nonunion and localized osteoporosis from January 2014 to December 2014 that were managed with locked combi-plates were reviewed. Outcome was assessed by time to healing, stability of implant construct after 6 and 12 months. Results: There were 10 patients with mean age of 47.4 ± 12.63 years. There were 9 males and 1 female, and road traffic crashes were the mechanism of injury in 90% (n = 9) and gunshot injuries in 10% (n = 1). Atrophic nonunion was the most common indication for osteosynthesis with 80%, followed by fibrous nonunion with 10.0%. The humerus was the most common long bone involved with 50%. Locked broad DCP was used in 62.5%, and the duration between initial injury and surgery was 6 and 48 months, with an average of 17.5 months. The outcome was such that 90% healed after 12 months on follow-up while one case had the implant backing out and delay union at 6 months. Conclusion: The use of locked plate in the management of nonunion in the presence of osteoporosis ensures stable fixation construct and healing. Contexte: L'utilisation de plaques de compression dynamiques conventionnelles dans les os ostéoporotiques est associée à des chances plus élevées de défaillance de l'implant. L'avènement et l'utilisation de combi-plaques de verrouillage ont assuré une construction stable lors de l'ostéosyntheis de fractures dans les os ostéoporotiques. Objectifs: L'étude vise à évaluer le résultat de l'utilisation de combi-plaques de verrouillage dans la gestion des fractures dans les os ostéoporotiques dans notre environnement. Méthodologie: Les cas de patients atteints d'ostéoporose non syndiquée et localisée de janvier 2014 à décembre 2014 qui ont été gérés avec des combi-plaques verrouillées ont été examinés. Le résultat a été évalué par le temps de guérison, la stabilité de la construction d'implant après 6 et 12 mois. Résultats: il y avait 10 patients avec un âge moyen de 47,4 12,63. Il y avait 9 hommes et 1 accident de la route et de la route était le mécanisme de la blessure dans 90% (n = 9) et les blessures par balle dans 10% (n = 1). La non-union atrophique était l'indication la plus courante pour l'ostéosynthèse avec 80%, suivie d'une non-union fibreuse avec 10,0%. L'humérus était l'os le plus fréquent impliqué avec 50%. La plaque de compression dynamique bloquée (DCP) a été utilisée à 62,5% et la durée entre la blessure initiale et la chirurgie était de 6 et 48 mois avec une moyenne de 17,5 mois. Le résultat était tel que 90% ont été guéris après 12 mois de suivi, tandis que 1 cas avait l'implantation de l'implant et retardé l'union à 6 mois. Conclusion: L'utilisation de la plaque verrouillée dans la gestion de la non-union en présence d'ostéoporose assure une construction stable de fixation et une guérison.
http://ift.tt/2siBP7b
Primary hyperparathyroidism in pregnancy
Annals of African Medicine 2017 16(3):145-147
Primary hyperparathyroidism (PHT) is a frequent and asymptomatic pathology in 80% of patients, and a parathyroidal adenoma is found in the most case. However, rare cases might occur during pregnancy; and the literature reported up to 200 cases. We report three cases of PHT that occurred during the second and last third trimesters of pregnancy stage in patients aged 26, 42 and 32-year-old. Despite diagnosis limitations, since scintigraphy is prohibited in pregnancy, the patients were managed conservatively with good prognosis for both mothers and babies. L'hyperparathyroïdie primaire (HTP) est une maladie fréquente et asymptomatique chez 80% des patients. Un adénome parathyroïdien est retrouvé chez une grande majorité des cas. Cependant, l'apparition au cours de la grossesse est particulièrement rare et la littérature ne rapporte que 200 cas. Nous en rapportons 3 cas d'hyperparathyroïdie âgés de 26, 42 et 32 ans, survenue au cours du deuxième et troisième trimestre de la grossesse. Malgré les limites diagnostiques dues à l'interdiction de la scintigraphie au cours de la grossesse, la gestion avait été faite de façon très conservative de sorte à avoir le meilleur pronostic pour les patientes leurs fétus.
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Randomized controlled trials: Ethical and scientific issues in the choice of placebo or active control
Annals of African Medicine 2017 16(3):97-100
The use of control group in clinical trials has been universally acclaimed by researchers to effectively help discriminate between the actual effects of an intervention and those arising from other factors. However, the choice of the control that provided both scientific and ethical acceptability among researchers has been a source of intense debate. We conducted a literature search on the use of placebo and active controls in clinical trials and X-ray the arguments for and against both choices in randomized control trials and concluded by highlighting the scenarios where the use of placebo is justified.
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Low back pain in pregnant women attending antenatal clinic: The Aminu Kano teaching hospital experience
Annals of African Medicine 2017 16(3):136-140
Background: The profound physiologic effects of pregnancy affect the musculoskeletal system. Pregnant women are at increased risks of low back/pelvic girdle pains. Objective: To determine the incidence of low back/pelvic girdle pains among pregnant women. Materials and Methods: This was a cross-sectional study conducted from May 1 to June 30, 2016, among consenting pregnant women at Aminu Kano Teaching Hospital. Ethical approval was obtained from the Hospital Ethics Committee. Information was obtained in a questionnaire on consecutive pregnant women. Data obtained were analyzed using SPSS version 18 (SPSS Inc., Chicago, Illinois, USA, 2012). Fisher's exact test was used for categorical data, and P ≤ 0.05 was considered statistically significant. Results: A total of 309 pregnant women were recruited from May 1 to June 30, 2016. The mean age ± standard deviation was 28.4 ± 5.86 years. The incidence of low back pains (LBPs) and pelvic girdle pains among the pregnant women was 106 (34.3%) and 178 (57.6%), respectively. The pain was severe among 26 (9.2%) pregnant women, which warranted analgesic usage. Pain radiation was reported in >50% of cases. There was an incidental finding of urinary incontinence in 36 (12.6%) cases. Low back/pelvic girdle pain was not associated with body mass index (BMI) (P = 0.390). Conclusion: The incidence of LBPs and pelvic girdle pains was high and found to be 34.3% and 57.6%, respectively. Analgesics were used especially among those with severe pains. There was an incidental finding of urinary incontinence among pregnant women with complaints of low back/pelvic girdle pains. There was no statistically significant association between LBPs and maternal BMI.
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Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy
Annals of African Medicine 2017 16(3):101-106
Introduction: Diabetes mellitus (DM) is a major cause of concern because of its increasing prevalence rate and related microvascular as well as macrovascular complications, including kidney disease. Microalbuminuria has been accepted as the earliest marker for diabetic nephropathy; however, a large proportion of renal impairment occurs in nonalbuminuric state. We planned to investigate the serum and urinary levels of the tubular damage markers (neutrophil gelatinase-associated lipocalin [NGAL] and cystatin C [Cys C]) in patients of type 2 diabetes to detect early kidney injury. Materials and Methods: This cross-sectional hospital-based study included 180 patients with type 2 DM according to the American Diabetes Association criteria. Serum NGAL (S.NGAL) and urine NGAL (U.NGAL) and Cys C were measured in all study participants and investigated for correlation with microalbuminuria. Results: Our results showed that U.NGAL and S.NGAL levels were significantly high in patients with microalbuminuria as compared to normoalbuminuric controls. Serum Cys C was also higher in microalbuminuric patients than who had normoalbuminuria. A positive correlation of urinary albumin excretion with S.NGAL and U.NGAL was noted. U.NGAL also showed positive correlation with duration of diabetes, glycated hemoglobin, and dyslipidemia. Receiver operating characteristic curve analysis showed that the area under the curve for U.NGAL and S.NGAL were 1 and 0.8, respectively, which indicates that they are sensitive markers for early renal damage. Conclusion: Urinary biomarkers were significantly elevated in normoalbuminuric type 2 diabetic patients compared with nondiabetic controls and could be used as markers of nephropathy at a very early stage even before the development of microalbuminuria, the current gold standard for early diagnosis. Despite the promise of these new biomarkers, further large, multicenter prospective studies are still needed.
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Sonographic assessment of urolithiasis in university of Abuja teaching hospital, Nigeria
Annals of African Medicine 2017 16(3):95-96
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Emerging trends of nosocomial pneumonia in intensive care unit of a tertiary care public teaching hospital in Western India
Annals of African Medicine 2017 16(3):107-113
Background: Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. Materials and Methods: It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients. Results: Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P < 0.00001). Most common organism causing HAP was Staphylococcus aureus (43.4%) and VAP was Klebsiella pneumoniae (49%). Maximum antibiotic sensitivity was found to piperacillin + tazobactam (58.8%), followed by imipenem (49.5%) and meropenem (41.8%), whereas maximum antibiotic resistance was found to cefepime (95.1%), followed by ceftazidime and amoxicillin (91.2%). Conclusion: Nosocomial pneumonia showed high incidence (17.44%) and mortality (60%). Common organisms identified were S. aureus and K. pneumoniae. Resistance was high for commonly used antibiotics and high antibiotic sensitivity for piperacillin + tazobactam and carbapenem. Contexte: La pneumonie nosocomiale pose un grand défi à un intensiviste. Des informations détaillées sur la pneumonie acquise dans les hôpitaux (HAP) et la pneumonie acquise par le ventilateur (VAP) sont essentielles pour la prévention et la gestion optimale, améliorant ainsi les soins de soins intensifs de qualité (UTI). Par conséquent, nous avons cherché à étudier la tendance actuelle de la pneumonie nosocomiale en UTI. Matériaux et méthodes: il s'agissait d'une étude de cohorte observationnelle prospective menée dans l'UCI d'un hôpital public d'enseignement tertiaire sur une période de 18 mois. Nous avons étudié le profil clinique et le résultat de 120 patients adultes qui ont développé le VAP / HAP pendant la période d'étude. Nous avons également analysé les organismes responsables, la sensibilité aux antibiotiques et le modèle de résistance chez ces patients. Résultats: Sur 120 patients, 29 patients étaient HAP et 91 patients étaient VAP. La mortalité était de 60% (72), et le développement du VAP et l'exigence de ventilation mécanique ont montré une association significative avec la mortalité (P < 0,00001). L'organisme le plus fréquent causant HAP était Staphylococcus aureus (43,4%) et VAP était Klebsiella pneumoniae (49%). Une sensibilité antibiotique maximale a été observée chez la pipéracilline + tazobactam (58,8%), suivie de l'imipénème (49,5%) et du méropénem (41,8%), alors que la résistance antibiotique maximale a été observée à cefépime (95,1%), suivie de ceftazidime et de l'amoxicilline (91,2%) . Conclusion: la pneumonie nosocomiale a montré une incidence élevée (17,44%) et la mortalité (60%). Les organismes communs identifiés étaient S. aureus et K. pneumoniae. La résistance était élevée pour les antibiotiques couramment utilisés et une forte sensibilité aux antibiotiques pour la pipéracilline + le tazobactam et le carbapénème.
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Cross-sectional, observational study of anterior segment parameters using anterior segment optical coherence tomography in North Indian Population
Annals of African Medicine 2017 16(3):131-135
Purpose: To study the anterior segment (AS) parameters using AS optical coherence tomography (AS-OCT) in the North Indian population. Methods: A hospital-based, observational, cross-sectional study was conducted over a period of 1 year. It included 251 normal individuals aged 20–70 years. Participants underwent imaging with AS-OCT.Ocular parameters included anterior chamber angle (ACA), iris cross-sectional area (ICSA), iris thickness (IT), and iris curvature (IC). The parameters were measured nasally and temporally for both sexes and different age groups. Results: The mean age of participants was 48.3 ± 13.9 years and 50.6% were men. The ACA decreased with age whereas ICSA, IT, and IC increased with age. The ACA (P = 0.0001nasally and temporally), ICSA (P = 0.011 nasally, P = 0.027 temporally), IT750 (P = 0.001 nasally, P = 0.011 temporally), IT1500 (P = 0.002 nasally, P = 0.002 temporally), and IC (P = 0.059 nasally, P = 0.128 temporally) underwent statistically significant changes with increasing age. No significant difference was seen in parameters of different sex. Conclusion: In this subset of the Indian population, the change in the AC parameters with age influences the AC dimensions predisposing the eye to glaucomatous conditions. These data are applicable clinically for the assessment and surgical management of patients requiring AS surgery. Objectif: Étudier les paramètres du segment antérieur (AS) en utilisant la tomodensitométrie optique AS (AS-OCT) dans la population du nord de l'Inde. Méthodes: Une étude axée sur l'hôpital, observationnelle et transversale a été menée sur une période de 1 an. Il comprenait 251 individus normaux âgés de 20 à 70 ans. Les participants ont subi une imagerie avec AS-OCT. Les paramètres oculaires comprenaient l'angle de la chambre antérieure (ACA), la surface transversale de l'iris (ICSA), l'épaisseur de l'iris (IT) et la courbure de l'iris (IC). Les paramètres ont été mesurés par voie nasale et temporelle pour les deux sexes et différents groupes d'âge. Résultats: l'âge moyen des participants était de 48,3 ± 13,9 ans et 50,6% des hommes. L'ACA a diminué avec l'âge alors que ICSA, IT et IC ont augmenté avec l'âge. L'ACA (P = 0,0001 par voie nasale et temporelle), ICSA (P = 0,011 nasale, P = 0,027 temporellement), IT750 (P = 0,001 par voie nasale, P = 0,011 temporellement), IT1500 (P = 0,002 par voie nasale, P = 0,002 temporellement) Et IC (P = 0,059 nasal, P = 0,128 temporellement) ont subi des changements statistiquement significatifs avec l'âge. Aucune différence significative n'a été observée dans les paramètres du sexe différent. Conclusion: Dans ce sous-ensemble de la population indienne, la variation des paramètres CA avec l'âge influence les dimensions AC prédisposant l'oeil aux conditions glaucomateuses. Ces données sont applicables cliniquement pour l'évaluation et la gestion chirurgicale des patients nécessitant une chirurgie AS.
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A profile of adverse effects of antihypertensive medicines in a tertiary care clinic in Nigeria
Annals of African Medicine 2017 16(3):114-119
Background: There has been a dearth of comprehensive data on the profile of adverse reactions to antihypertensive medicines in the Nigerian setting despite increased use. Objective: This study was aimed to characterize the adverse reactions experienced in the homogenously black African population. Methods: The study was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria, in consenting eligible hypertensive patients ≥18 years. Adverse reactions were sought using patient's self-report and a medicine-induced symptom checklist. Results: A total of 514 patients (340 females) aged 22–97 years were studied. Thirteen percent, 27.6%, 26.7%, 22.0%, and 10.7% were on 1, 2, 3, 4, and ≥5 medicines, respectively, for control of their blood pressure with the frequency of adverse effects increasing proportionately up to four medicines. Adverse reactions to antihypertensive medicines were reported by a total of 93 (18.1%) patients. Diuretics – 27.9%, calcium channel blockers (CCBs) – 26.8%, and angiotensin-converting enzyme inhibitors (ACEIs) – 26.8% accounted for most of the adverse reactions seen, notably frequent micturition and headaches (CCB); excessive micturition and dizziness (diuretics); dry irritating cough (ACEI). Notable complaints for all patients using the checklist were increased frequency of micturition, reduction in libido, and headaches. The reactions resulted in the discontinuation and substitution of therapy in 49.5% of the patients. Conclusions: The characterization of these reactions in Nigerians requires further studies as frequent micturition reported is still a neglected complaint in antihypertensive therapy.
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Overview of extremity musculoskeletal neoplasms at the Ahmadu Bello University Teaching Hospital Zaria, Nigeria
Annals of African Medicine 2017 16(3):141-144
Background: The burden of managing patients with musculoskeletal neoplasms in the West African sub-region is quite significant. This is largely due to late presentation, delay in making diagnosis, and failure of obtaining consent to certain surgical procedures. Improvements in diagnosis and treatment over the years have however increased life and limb survival for many patients. This study was aimed at evaluating the clinicopathologic pattern of neoplasm as it affects the upper and lower limbs with a view to determining the most common types, the most involved sites of the body and the age at presentation of these tumors. Materials and Methods: A total of 65 patients with histologically confirmed neoplasm of the upper and lower limbs arising from bone, cartilage, skeletal muscle, synovium, and tendon sheath were retrospectively selected 7 years from January 2008 to 2015. Results: Forty-one (63.1%) patients were males, whereas 24 (36.9%) were females. Age range is between 5 and 75 years, average of 30.8 years. Lower limb involvement was recorded in 40 (61.5%) patients, with remaining 25 (38.5%) patients in upper limbs. 28 (43.1%) patients had benign lesion, whereas 37 (56.9%) were malignant. Giant cell tumor (GCT) was the most frequent benign tumor (50%) while osteogenic sarcomas top the list on the malignant variety (32.4%). The most commonly affected bones were tibia, carpal-metacarpal, and femur in that order. Conclusion: In our center, GCT and osteogenic sarcoma are the most frequently encountered benign and malignant musculoskeletal extremity neoplasms, respectively, with the tibial bone being most commonly affected.
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Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures
Annals of African Medicine 2017 16(3):120-126
Background: Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged Intensive Care Unit and hospital stay, with its concomitant mortality. These may be prevented or reduced by good analgesic therapy which is the subject of this study. Methods: This was a prospective study of effects of analgesia on changes in pulmonary functions of patients with traumatic multiple rib fractures resulting from blunt chest injury. Results: There were 64 adult patients who were studied with multiple rib fractures caused by blunt chest trauma. Of these patients, 54 (84.4%) were male and 10 (15.6%) were female. Motorcycle (popularly known as "okada") and tricycle (popularly known as keke napep) accidents significantly accounted for the majority of the multiple rib fractures, that is, in 50 (78.1%) of the patients. Before analgesic administration, no patient had a normal respiratory rate, but at 1 h following the administration of analgesic, 21 (32.8%) of patients recorded normal respiratory rates and there was a significant reduction in the number (10.9% vs. 39.1%) of patients with respiratory rates >30 breaths/min. Before commencement of analgesic, no patient recorded up to 99% of oxygen saturation (SpO2) as measured by pulse oximeter, while 43.8% recorded SpO2of 96%. This improved after 1 h of administration of analgesics to SpO2of 100% in 18.8% of patients and 99% in 31.3% of patients and none recording SpO2of < 97% (P = 0.006). Before analgesia, no patient was able to achieve peak expiratory flow rate (PEFR) value >100% of predicted while only 9 (14.1%) patients were able to achieve a PEFR value in the range of 91%–100% of predicted value. One hour after analgesia, a total of 6 (9.4%) patients were able to achieve PEFR values >100% predicted, while 35 (54.7%) patients achieved PEFR values in the range of 91%–100% predicted. Conclusion: Adequate analgesia is capable of reversing the negative effects of chest pain of traumatic multiple rib fractures on pulmonary function parameters through improvement in respiratory mechanics.
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Atherogenic index of plasma for the assessment of cardiovascular risk factors
Annals of African Medicine 2017 16(3):148-148
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Animal-derived natural products of Sowa Rigpa medicine: Their pharmacopoeial description, current utilization and zoological identification
Publication date: 31 July 2017
Source:Journal of Ethnopharmacology, Volume 207
Author(s): Karma Yeshi, Paolo Morisco, Phurpa Wangchuk
Ethnopharmacological relevanceThe Bhutanese Sowa Rigpa medicine (BSM) uses animal parts in the preparation of numerous polyingredient traditional remedies. Our study reports the taxonomical identification of medicinal animals and the description of traditional uses in English medical terminologies.Aim of the studyTo taxonomically identify the medicinal animals and their derived natural products used as a zootherapeutic agents in BSM.Materials and methodsFirst, the traditional textbooks were reviewed to generate a list of animal products described as ingredients. Second, animal parts that are currently used in Bhutan were identified. Third, the ethnopharmacological uses of each animal ingredients were translated into English medical terminologies by consulting Traditional Physicians, clinical assistants, pharmacognosists, and pharmacists in Bhutan. Fourth, the animal parts were taxonomically identified and their Latin names were confirmed by crosschecking them with online animal databases and relevant scientific literature.ResultsThe study found 73 natural products belonging to 29 categories derived from 45 medicinal animals (36 vertebrates and 9 invertebrates), comprising of 9 taxonomic categories and 30 zoological families. Out of 116 formulations currently produced, 87 of them contain one or more extracts and products obtained from 13 medicinal animals to treat more than 124 traditionally classified illnesses. Only five animal ingredients were found available in Bhutan and rest of the animal parts are being imported from India.ConclusionsOut of 73 natural products described in the traditional textbooks, only 13 of them (some omitted and few substituted by plants) are currently included in 87 formulations of BSM.
Graphical abstract
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Alterations in liver marker enzymes and recovery ability of cyprinids as indicators of aquatic pollution
Abstract
Information on the detection of pesticides in fresh water Lakes of Kashmir (Dal and Mansbal) through GC–MS technique is scarce, and also the recovery in biochemical parameters (AST, ALT and ALP) of fish after transferring them to clean media has not been reported yet. The water samples were collected from three sites and analyzed for their pesticide profile by dispersive liquid–liquid micro extraction (DLLME) followed by GC–MS. Influence of pesticides on liver marker enzymes of Cyprinus carpio and Carassius carassius was also investigated. The results obtained showed the presence of three main pesticides viz. chlorpyrifros, dimethoate and dichlorvos in waters of Dal Lake whereas no pesticide was detected in waters of Mansbal. The higher values for AST, ALT and ALP activities and decrease in protein content were obtained in the samples from the Dal Lake compared with those from Mansbal Lake (p < 0.05). These data when compared with the values found in C. carpio and C. carassius from both the Dal Lake and Mansbal Lake kept under laboratory conditions after 15, 30, 45 and 60 days of maintenance in clean media found that during depuration, all the enzyme activities came down significantly (p < 0.05) indicating the compensatory response by the fish against the pesticide stress. Therefore, these parameters could be used as indicators of pesticide pollution in aquatic organisms and were recommended for environmental monitoring for investigating the mechanism involved in the recovery pattern.
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Parasites and pollution: the effectiveness of tiny organisms in assessing the quality of aquatic ecosystems, with a focus on Africa
Abstract
The aquatic environment represents the final repository for many human-generated pollutants associated with anthropogenic activities. The quality of natural freshwater systems is easily disrupted by the introduction of pollutants from urban, industrial and agricultural processes. To assess the extent of chemical perturbation and associated environmental degradation, physico-chemical parameters have been monitored in conjunction with biota in numerous biological monitoring protocols. Most studies incorporating organisms into such approaches have focussed on fish and macroinvertebrates. More recently, interest in the ecology of parasites in relation to environmental monitoring has indicated that these organisms are sensitive towards the quality of the macroenvironment. Variable responses towards exposure to pollution have been identified at the population and component community level of a number of parasites. Furthermore, such responses have been found to differ with the type of pollutant and the lifestyle of the parasite. Generally, endoparasite infection levels have been shown to become elevated in relation to poorer water quality conditions, while ectoparasites are more sensitive, and exposure to contaminated environments resulted in a decline in ectoparasite infections. Furthermore, endoparasites have been found to be suitable accumulation indicators for monitoring levels of several trace elements and metals in the environment. The ability of these organisms to accumulate metals has further been observed to be of benefit to the host, resulting in decreased somatic metal levels in infected hosts. These trends have similarly been found for host–parasite models in African freshwater environments, but such analyses are comparatively sparse compared to other countries. Recently, studies on diplozoids from two freshwater systems have indicated that exposure to poorer water quality resulted in decreased infections. In the Vaal River, the poor water quality resulted in the extinction of the parasite from a site below the Vaal River Barrage. Laboratory exposures have further indicated that oncomiracidia of Paradiplozoon ichthyoxanthon are sensitive to exposure to dissolved aluminium. Overall, parasites from African freshwater and marine ecosystems have merit as effect and accumulation indicators; however, more research is required to detail the effects of exposure on sensitive biological processes within these organisms.
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Imaging Profile of the Ear in Hearing Loss Patients in Hospital Universiti Sains Malaysia: 5 year Cross Sectional Analysis at a Tertiary Otologic Centre
Authors: Rohaizam bin Japar [1], Dinsuhaimi bin Sidek [1], Suzina Sheikh Ab. Hamid [1], Rohaizan binti Yunus [2] Affiliations: [1] Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia [2] Department of Radiology, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia Conflict of Interest: None declared This article has been peer reviewed Article […]
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Morphometric Analysis of the Orbital Process of the Palatine Bone and its Relationship to Endoscopic Orbital Apex Surgery.
Background: Endoscopic approaches to the orbit improve the ability to directly access apical lesions while minimizing manipulation of normal structures. Inferomedial orbital access is limited by the orbital process of the palatine bone (OPPB) which prevents dissection and retraction in the inferolateral vector. Objective: The objective of this study was to examine the morphometric characteristics of the OPPB and quantify the benefit of complete resection to surgical access. Methods: Morphometric osteologic measurements of the OPPB were performed in 59 human skulls. A radius subtended by the OPPB was calculated to generate a hemispheric dissection corridor achievable by complete resection of the OPPB. Cadaveric and live surgical dissections were then performed on 15 orbits to develop discreet endoscopic surgical landmarks which could be used to both identify the OPPB and verify complete resection. Results: The mean(+/- SD) radius of the OPPB was 0.47 +/- 0.28 cm. Complete OPPB resection provided an additional 0.36 +/- 0.42 cm3 of surgical exposure within the inferomedial apex. Relative to the Caucasian (n = 27) skulls, the radii in the Asian (n = 27) and African (n = 5) skulls were significantly smaller (p
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A Prospective, Randomized Comparison of Lower Eyelid Retraction Repair With Autologous Auricular Cartilage, Bovine Acellular Dermal Matrix (Surgimend), and Porcine Acellular Dermal Matrix (Enduragen) Spacer Grafts.
Purpose: To compare outcomes of lower eyelid retraction repair with 3 types of spacer grafts: autologous auricular cartilage, bovine acellular dermal matrix (Surgimend, Integra, Plainsboro, NJ), porcine acellular dermal matrix (Enduragen, Stryker, Kalamazoo, MI). Methods: A prospective, randomized clinical trial was conducted in patients undergoing lower eyelid retraction repair with spacer graft. Subjects received autologous auricular cartilage, bovine acellular dermal matrix, or porcine acellular dermal matrix between June 2015 and July 2016. Patient demographics, margin to reflex distance 2, conjunctival injection, eyelid swelling, tearing, discomfort, itching, and complications were recorded preoperatively and at postoperative week 1, month 1, month 3, and month 6. Results: Of the 49 randomized lower eyelids (39 patients), 42 eyelids (32 patients) completed the study. The preoperative margin to reflex distance 2, conjunctival injection, eyelid swelling, tearing, discomfort, and itching showed no statistical difference. Postoperative week 1 swelling was statistically significantly higher in auricular cartilage, followed by bovine acellular dermal matrix, then porcine acellular dermal matrix (p = 0.04). The mean postoperative month 6 margin to reflex distance 2 trended toward a better outcome from auricular cartilage over bovine acellular dermal matrix (p = 0.029), but after p was adjusted for multiple pairwise comparisons, this was no longer statistically significant (p = 0.088). All other postoperative 6-month measurements showed no statistical difference. Conclusions: Among patients randomized to 3 types of spacer grafts for lower eyelid retraction repair, outcomes were not statistically significant different when the 3 groups were compared. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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