An assessment of orofacial clefts in Tanzania

<p>Abstract</p> <p>Background</p> <p>Clefts of the lip (CL), the palate (CP), or both (CLP) are the most common orofacial congenital malformations found among live births, accounting for 65% of all head and neck anomalies. The frequency and pattern of orofacial clefts in different parts of the world and among different human groups varies widely. Generally, populations of Asian or Native American origin have the highest prevalence, while Caucasian populations show intermediate prevalence and African populations the lowest. To date, little is known regarding the epidemiology and pattern of orofacial clefts in Tanzania.</p> <p>Methods</p> <p>A retrospective descriptive study was conducted at Bugando Medical Centre to identify all children with orofacial clefts that attended or were treated during a period of five years. Cleft lip and/or palate records were obtained from patient files in the Hospital's Departments of Surgery, Paediatrics and medical records. Age at presentation, sex, region of origin, type and laterality of the cleft were recorded. In addition, presence of associated congenital anomalies or syndromes was recorded.</p> <p>Results</p> <p>A total of 240 orofacial cleft cases were seen during this period. Isolated cleft lip was the most common cleft type followed closely by cleft lip and palate (CLP). This is a departure from the pattern of clefting reported for Caucasian and Asian populations, where CLP or isolated cleft palate is the most common type. The distribution of clefts by side showed a statistically significant preponderance of the left side (43.7%) (χ²= 92.4, p < 0.001), followed by the right (28.8%) and bilateral sides (18.3%). Patients with isolated cleft palate presented at very early age (mean age 1.00 years, SE 0.56). Associated congenital anomalies were observed in 2.8% of all patients with orofacial clefts, and included neural tube defects, Talipes and persistent ductus arteriosus.</p> <p>Conclusions</p> <p>Unilateral orofacial clefts were significantly more common than bilateral clefts; with the left side being the most common affected side. Most of the other findings did not show marked differences with orofacial cleft distributions in other African populations.</p

Shoulder surgeon and autologous cellular regeneration - from bench to bed: part one - the link between die human fibroblast, connective tissue disorder and shoulder.

The original publication is available at http://www.internationalshoulderjournal.org/The process of autologous cell regeneration (ACR) is a facet of cell therapy and regenerative medicine. It is initiated when activated autologous platelet rich plasma alone (PRP), containing cytokines or growth factors, is injected into the dermis or other structure in order to initiate a regenerative or antiaging process. The recipients resident cells at the target zone are activated by biologically active growth factors, derived from the activated platelets in the PRP through a paracrine effect. The platelet gel that contains the fibrin and clumped platelets, releases growth factors that influences activation of macrophages and stem cells in the recipient site. Tissue regeneration is facilitated by stem cell proliferation and differentiation. The PRP that has sealant and wound healing properties, may shift the wound healing cascade to the left, thereby speeding up tissue regeneration and remodelling by the use of the recipients own plasma. Both the fibroblast and myofibroblast play key roles in the wound healing cascade. The fibroblast, of mesenchymal origin, plays a pivotal role in the formation of the extracellular matrix and deposition of collagen. A failure of organised fibroblast function results in important and disabling disease processes and conditions such as chronic ischaemic heart disease and remodelling of the heart, lung fibrosis, fibromatosis, solar aged-face, keloids, hypertrophic scar formation, nodular fasciitis, inguinal hernia, Dupuytren's disease and scleroderma. More recent additions include frozen shoulder and the captured shoulder. In aesthetic medicine, one of the prime functions of fractional photothermolysis with lasers, intense pulsed light and radiofrequency devices, is to stimulate dermal fibroblast proliferation, by thermal energy thereby increasing collagen deposition which enhances facial rejuvenation. Platelet -rich plasma (REGENLAB PRP, REGENLAB-ACR) possesses unique growth factors that stimulate, fibroblast, keratinocyte and myoblasts ex vivo in tissue culture, allowing three-dimensional cell proliferation within the fibrin gel. PRP can be used as a cell carrier (i.e., keratinocytes, fibroblasts), may enhance cell retention at the point of treatment. REGENKIT is authorized for human use, ISO and CE marked. In this overview fibroblast morphology, tissue culture and cell biology relevant to the shoulder surgeon is reviewed