Endodontic Treatment of Unusually Long Discolored Maxillary Central Incisor: A Case Report

Background: Success in root canal treatment is achieved after thorough biomechanical preparation followed by complete obturation of the canal system together with prompt and adequate restoration. Therefore, the endodontic therapy requires specific and complete knowledge of the internal and external anatomy, and its variation in presentation. Such treatment may be performed in root canal systems that do not comply with normal anatomic features described in standard textbooks. This article presents a case of endodontic treatment in an unusually long discolored maxillary central incisor.Case Presentation: A 31 year-old male patient was referred to conservation clinic for endodontic treatment of discolored left maxillary central incisor with associated history of recurrent swelling. Root canal therapy was performed and patient was found to have an unusually long working length of 29mm. This was then followed by enucleation of apical cyst without apical resection.Conclusion: Though the patient presents a maxillary central incisor with canal length in the upper limit of some reported cases, it is unusual in our environment.Keywords: Endodontic, Maxillary central, Unusually long, Treatmen

A retrospective study of traumatic injuries to teeth at a Nigerian tertiary hospital

Background: Various aspects of dental trauma have been studied worldwide. Most of these were among children and adolescents. However, studies involving the adult population with traumatized anterior teeth are few.Objectives: The objectives of this study were to report the pattern of trauma to anterior and posterior teeth among the late adolescent and adult patients seen at the Dental Centre, University College Hospital, Ibadan, Nigeria, the time lapse between trauma and patient presentation, reasons for dental consultation, and the type of treatment received.Materials and Methods: Data were extracted from the dental records of 146 patients with dental trauma that presented between May 2001 and June 2006.Results: One hundred and forty six patients were studied (87 males, 59 females) Males sustained injury more than females. The highest occurrence of trauma was in the age group of 25‑34 years and least in the >65 years. Falls accounted for 34.3% of causes followed by RTA (19.2%). Enamel‑dentine fracture was the most common type of injury, seen in 73 (38.6%) of the traumatized teeth, 5 were avulsed and 20 posterior teeth had cuspal fracture. All the cases of avulsion and most (83.3%) of root fracture presented within 1 week of injury while teeth that presented late had pulpal necrosis. 22% of the patients presented within 1 week of injury while 13.7% came after 10 years.Conclusion: There was late patients’ presentation with average duration of trauma before presentation being 4.6 years; however the more severe the outcome of trauma, the earlier the presentation. Poor esthetics followed by pain were the main complaints at presentation

Between and Betwixt Soil Fertility Improvement and Disease Transmission: An Assessment of the Suitability of Anaerobic Digestion Effluent for Direct Application as Fertilizer

Although anaerobic digestate has been identified as a rich source of essential plant nutrients, its safety measured by the concentration of pathogen present is of great concern to end users. This research explored the efficiency of the mesophilic biodigestion process in the stabilization and sanitization of cow dung and chicken droppings. 6kg each of cow dung and chicken droppings were collected fresh and free from impurities, pre-fermented, mixed with water in the ratio 1:1 by volume to form slurry, fed into the respective reactors and digested for 30 days at an average daily ambient temperature of 37oC. The pH of the medium fluctuated between 6.5 and 8.0. The analysis of the feedstock and effluent of the digesters showed that a total solids reduction of 75.3% and 60.1% were recorded for cow dung and chicken droppings respectively while the reductions in total coliforms were 95% and 70% respectively. E.coli and Shigella spp., were removed while Salmonella spp. and Klebsiella spp. where still present in the digestate. Notwithstanding these results, the digestate still requires further treatment for it to be suitable for application on unrestricted crops either as fertilizer; otherwise a health problem would be created as attempt is made to improve soil fertility

Assessment of Mesophilic Co-Digestion of Cow Dung with Lemon Grass for Biogas Production

The scarcity of energy (fossil) and its attendant pollution menace have provided the avenue to consider alternative sources of energy. A study was carried out on the design and construction of an Anaerobic Digester system using 1mm galvanized steel for the production of biogas from co-digestion of Cow dung and Lemon grass sourced from the Zaria abattoir and the University campus respectively. The experiment lasted for 30 days using a 25-liter pilot scale anaerobic digester. A total of 0.146m3(0.100m3after scrubbing) were produced with a deviation and methane content of 0.003 m3 and 68.53% respectively. The cooking test carried out revealed that the scrubbed gas had higher cooking rates for both water and rice (0.10L/min and 0.0048kg/min respectively) than the unscrubbed gas (0.07L/min and 0.0034kg/min respectively while the biogas flow rate was 0.0049m3/min. An improvement of 42.86% and 41.18% was recorded for the cooking rates for water and rice respectively after the gas were scrubbed. The physico-chemistry of the feedstock in the digester revealed the digester temperature fluctuated between 280C and 36.70C while the pH of the medium fluctuated optimally between 5.81 and 7.73.The daily ambient temperatures varied from 31oC to 42oC. The research demonstrated that anaerobic co-digestion of cow dung with lemon grass produced a high quality biogas

An Economic Evaluation of Home Management of Malaria in Uganda: An Interactive Markov Model

BACKGROUND: Home management of malaria (HMM), promoting presumptive treatment of febrile children in the community, is advocated to improve prompt appropriate treatment of malaria in Africa. The cost-effectiveness of HMM is likely to vary widely in different settings and with the antimalarial drugs used. However, no data on the cost-effectiveness of HMM programmes are available. METHODS/PRINCIPAL FINDINGS: A Markov model was constructed to estimate the cost-effectiveness of HMM as compared to conventional care for febrile illnesses in children without HMM. The model was populated with data from Uganda, but is designed to be interactive, allowing the user to adjust certain parameters, including the antimalarials distributed. The model calculates the cost per disability adjusted life year averted and presents the incremental cost-effectiveness ratio compared to a threshold value. Model output is stratified by level of malaria transmission and the probability that a child would receive appropriate care from a health facility, to indicate the circumstances in which HMM is likely to be cost-effective. The model output suggests that the cost-effectiveness of HMM varies with malaria transmission, the probability of appropriate care, and the drug distributed. Where transmission is high and the probability of appropriate care is limited, HMM is likely to be cost-effective from a provider perspective. Even with the most effective antimalarials, HMM remains an attractive intervention only in areas of high malaria transmission and in medium transmission areas with a lower probability of appropriate care. HMM is generally not cost-effective in low transmission areas, regardless of which antimalarial is distributed. Considering the analysis from the societal perspective decreases the attractiveness of HMM. CONCLUSION: Syndromic HMM for children with fever may be a useful strategy for higher transmission settings with limited health care and diagnosis, but is not appropriate for all settings. HMM may need to be tailored to specific settings, accounting for local malaria transmission intensity and availability of health services

Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda

<p>Abstract</p> <p>Background</p> <p>Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid diagnostic tests (RDTs) could address these challenges but only if the communities will accept their use by CHWs. This study assessed community acceptability of the use of RDTs by Ugandan CHWs, locally referred to as community medicine distributors (CMDs).</p> <p>Methods</p> <p>The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. Pre-designed FGD and KII guides were used to collect data. Manifest content analysis was used to explore issues of trust and confidence in CMDs, stigma associated with drawing blood from children, community willingness for CMDs to use RDTs, and challenges anticipated to be faced by the CMDs.</p> <p>Results</p> <p>CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred.</p> <p>Conclusion</p> <p>Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support. A well-designed behaviour change communication strategy is needed to address the anticipated programmatic challenges as well as community fears and stigma about drawing blood. Level of formal education may have to be a criterion for CMD selection into programmes deploying RDTs.</p

Pre-referral rectal artesunate in severe malaria: flawed trial

<p>Abstract</p> <p>Background</p> <p>Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, have led the WHO to endorse rectal artesunate as a pre-referral treatment for severe malaria. In the light of its public health importance and because its scientific quality has not been assessed for a systematic review, our paper provides a detailed evaluation of the design, conduct, analysis, reporting, and practical features of this trial.</p> <p>Results</p> <p>We performed a checklist-based and an in-depth evaluation of the trial. The evaluation criteria were based on the CONSORT statement for reporting clinical trials, the clinical trial methodology literature, and practice in malaria research. Our main findings are: The inclusion and exclusion criteria and the sample size justification are not stated. Many clearly ineligible subjects were enrolled. The training of the recruiters does not appear to have been satisfactory. There was excessive between center heterogeneity in design and conduct. Outcome evaluation schedule was not defined, and in practice, became too wide. Large gaps in the collection of key data were evident. Primary endpoints were inconsistently utilized and reported; an overall analysis of the outcomes was not done; analyses of time to event data had major flaws; the stated intent-to-treat analysis excluded a third of the randomized subjects; the design-indicated stratified or multi-variate analysis was not done; many improper subgroups were analyzed in a post-hoc fashion; the analysis and reporting metric was deficient. There are concerns relating to patient welfare at some centers. Exclusion of many cases from data analysis compromised external validity. A bias-controlled reanalysis of available data does not lend support to the conclusions drawn by the authors.</p> <p>Conclusions</p> <p>This trial has numerous serious deficiencies in design, implementation, and methods of data analysis. Interpretation and manner of reporting are wanting, and the applicability of the findings is unclear. The trial conduct could have been improved to better protect patient welfare. The totality of these problems make it a flawed study whose conclusions remain subject to appreciable doubt.</p

Improving access to health care for malaria in Africa: a review of literature on what attracts patients

BACKGROUND: Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services. METHODS: This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings. RESULTS: A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers. CONCLUSION: This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly

A second generation human haplotype map of over 3.1 million SNPs

We describe the Phase II HapMap, which characterizes over 3.1 million human single nucleotide polymorphisms (SNPs) genotyped in 270 individuals from four geographically diverse populations and includes 25-35% of common SNP variation in the populations surveyed. The map is estimated to capture untyped common variation with an average maximum r(2) of between 0.9 and 0.96 depending on population. We demonstrate that the current generation of commercial genome-wide genotyping products captures common Phase II SNPs with an average maximum r(2) of up to 0.8 in African and up to 0.95 in non-African populations, and that potential gains in power in association studies can be obtained through imputation. These data also reveal novel aspects of the structure of linkage disequilibrium. We show that 10-30% of pairs of individuals within a population share at least one region of extended genetic identity arising from recent ancestry and that up to 1% of all common variants are untaggable, primarily because they lie within recombination hotspots. We show that recombination rates vary systematically around genes and between genes of different function. Finally, we demonstrate increased differentiation at non-synonymous, compared to synonymous, SNPs, resulting from systematic differences in the strength or efficacy of natural selection between populations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62863/1/nature06258.pd