A prospective clinical evaluation of the longevity of resorbable sutures in oral surgical procedures

Introduction: The objectives of this prospective randomized study were to clinically evaluate the longevity of resorbable sutures (chromic catgut and vicryl) and determine the effect of chlorhexidine mouth wash on their absorption time in oral surgical procedures. Both sutures were of size 3/0 with round body needle and were placed using the standard technique.Methods and Materials: One hundred patients selected for the study were divided into two groups of 50 patients each (vicryl and chromic catgut groups). Each group was subsequently subdivided into chlorhexidine (17 cases); warm saline mouth wash (17 cases) and warm water mouth wash (16 cases (control).Results: The sutures were placed during various minor surgical procedures e.g. third molar surgery (65 cases), incisional biopsy (7 cases), excisional biopsy (8 cases), sutured lacerations (10 cases) and malar elevations through intraoral upper buccal sulci approach (8 cases) and 2 cases of cystic enucleations. The mean longevity of chromic catgut for chlorhexidine was 11.4 days with a range of 5-16 days. The patients, who used warm saline mouth wash, had a mean longevity of 11.7 days with a range of 7-24 days. The mean longevity of vicryl in patients that used chlorhexidine was 22.7 days, with a range of 14-36 days and that of warm saline mouth wash was 24.5 days with a range of 14-47 days.Conclusion: The resorbable sutures investigated have a mean longevity, which was slightly shorter than the figure stated by the manufacturer. Chlorhexidine was found to have no appreciable effect on absorption time of the sutures.Key words: Evaluation, longevity, oral, resorbable sutures, surgical procedur

Palatal Impalement Injury With Retained Foreign Body in a Child: Case Report and Literature Review

Impalement injuries are uncommon in the head and neck region, and when associated with the retained foreign body present a challenge to the clinician with regards to management. This type of injury may occasionally be associated with life-threatening complications or permanent disability. Therefore, clinicians involved in the management of head and neck trauma need to be constantly reminded of this uncommon type of injury and the different treatment options.This is a case report of impalement injury to the palate of a child by a hair weaving instrument. Clinical and plain radiographic examination was sufficient for foreign body localization. The foreign body was successfully extricated under local anaesthesia and conscious sedation using a simple conservative technique with no complications

A retrospective review of 61 cases of adenomatoid odontogenic tumour seen in five tertiary health facilities in Nigeria

Introduction: Adenomatoid odontogenic tumor (AOT) is a benign lesion originating from the dental lamina or its remnants. It is a relatively uncommon neoplasm representing about 3% of all odontogenic tumors. The aim of this study was to examine the clinical and radiological characteristics of AOTs in five major tertiary centres in Nigeria. Methods: Archival hospital-based data stores of five tertiary health facilities in Nigeria were accessed. Case files and biopsy records were retrieved to obtain relevant information. Data was collected according to a proforma for standardization and entered into and analysed using SPSS for Windows (version 20.0; SPSS Inc. Chicago, IL). Results: 61 (4.5%) cases of AOT were documented. The age range was 8-46 years with a mean age of 20.4±9.9 years. Male: Female ratio was 1:1.3. The anterior maxilla had 34 (55.8%) cases and the anterior mandible had 20 (32.8%) cases. 40 (65.6%) follicular cases, 20 (32.8%) extra-follicular cases and 1(1.6%) extraosseous case were found. 31 cases (61.1%) were associated with impacted teeth and the upper canine was involved in 19 (57.6%) cases. Conclusion: This study showed AOT to be more common in the maxilla, more in females, most often associated with impacted canines, however, the suggestion of AOT being a “Two third tumour” was not observed in this study

Giant tongue lipoma

Lipomas are the most common soft tissue mesenchymal neoplasms are uncommon in the oral and maxillofacial region. Oral lipomas usually exhibit slow asymptomatic growth and are less than 20 mm at their largest diameter. A 71-year-old man was referred to our regional oral and maxillofacial department by a dentist after noticing an asymptomatic tongue swelling. Examination and further radiographic and histological investigations revealed a large tongue lipoma which had been present for over three years. Initially it was decided to keep this benign lesion under review. However its relatively rapid growth over the next six months started to affect his speech, eating and airway and was subsequently removed surgically under general anaesthetic. This unusual case report documents the presentation, diagnostic considerations and treatment of this lipoma. It also highlights the important role clinicians have in detecting and investigating or referring any abnormal pathology. Keywords: Lipoma, Tongue, Diagnosis, Histopathology, Treatmen

Ion–Molecule Rate Constants for Reactions of Sulfuric Acid with Acetate and Nitrate Ions

Atmospheric nucleation from precursor gases is a significant source of cloud condensation nuclei in the troposphere and thus can affect the Earth's radiative balance. Sulfuric acid, ammonia, and amines have been identified as key nucleation precursors in the atmosphere. Studies have also shown that atmospheric ions can react with sulfuric acid to form stable clusters in a process referred to as ion-induced nucleation (IIN). IIN follows similar reaction pathways as chemical ionization, which is used to detect and measure nucleation precursors via atmospheric pressure chemical ionization mass spectrometers. The rate at which ions form clusters depends on the ion-molecule rate constant. However, the rate constant varies based on the ion composition, which is often not known in the atmosphere. Previous studies have examined ion-molecule rate constants for sulfuric acid and nitrate ions but not for other atmospherically relevant ions like acetate. We report the relative rate constants of ion- molecule reactions between nitrate and acetate ions reacting with sulfuric acid. The ion- molecule rate constant for acetate and sulfuric acid is estimated to be a factor of 1.9-2.4 times higher than that of the known rate constant for nitrate and sulfuric acid. Using quantum chemistry, we find that acetate has a higher dipole moment and polarizability than nitrate. This may contribute to an increase in the collision cross-sectional area between acetate and sulfuric acid and lead to a greater reaction rate constant than nitrate. The ion- molecule rate constant for acetate with sulfuric acid will help quantify the contribution of acetate ions to atmospheric ion-induced new particle formation.Peer reviewe

Calcifying epithelial odontogenic tumour-case series from five Nigerian Teaching Hospital

Background: Calcifying epithelial odontogenic tumour (CEOT) also known as Pindborg’s tumour is a relatively rare odontogenic neoplasm of epithelial derivationthat constitutes about 0.4-3% of all intraosseous odontogenic tumours.Objectives: To document all cases of CEOT encountered in five tertiary centres in Nigeria and their clinical, radiologic and histologic characteristics.Design: A retrospective study.Setting: Tertiary Dental Facilities in Lagos, Ibadan, Ife, Port Harcourt and Zaria (all in Nigeria) were involved in the study.Subjects: All odontogenic tumours (OTs) in the period from 1970 -2014. Case file records and biopsy reports were retrieved from the records of the five Teaching Hospitals, to obtain age, gender, location, size, clinical symptoms, pathological reports and radiographic description.Results: Out of a total of 1369 OTs, 20 (1.5%) cases of CEOT were reported. CEOT had a male to female ratio of 1.9:1, with mandible: maxilla ratio of 1.5:1 and the most common location being the premolar /molar region in the mandible. Nine (45%) cases appeared radiolucent while 11(55%) cases had mixed radio density. The mean diameter for mixed radio-dense lesions (4.83±2.99) was higher than that for radiolucent lesions (2.75±1.17) and the difference was statistically significant (p=0.049).Conclusion: CEOT is a rare tumour representing 1.5% of OTs. CEOT presents with some subtle geographic differences in its demography, however, further studies are required to investigate if these differences are coincidental or genetically  determined

THE "WHERE?" IN PARTICIPATORY LOCAL LAND USE PLANNING - A WEB MAPPING APPROACH IN SOUTH-WEST CAMEROON

International audienc

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians

Introduction: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria.Methods: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran’s I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance.Results: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblas- toma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within.Conclusion: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following:  the country’s tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes.Keywords: Ameloblastoma, ethnicity, spatial analysis, Nigeria

Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study

BACKGROUND: Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS: DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS: From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference –23%, 95% CI –33 to –13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (–13%, –24 to –3; p=0·01). INTERPRETATION: DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING: European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section

Descriptive epidemiology of salivary gland neoplasms in Nigeria: An AOPRC multicenter tertiary hospital study

Objectives: Accurate diagnosis of salivary gland neoplasms (SGN) in many centers in Africa is limited by poor diagnostic resources and ancillary services. Hence, we have carried out a multicenter epidemiological study to understand the true burden of SGN in Nigeria. Method: In this descriptive cross‐sectional study, we have deployed resources available to members of the African Oral Pathology Consortium (AOPRC) to examine the burden of salivary gland lesions in Nigeria, using a multicenter approach. Data from seven major tertiary health institutions in northern, western, and southern Nigeria were generated using a standardized data extraction format and analyzed using the Epi‐info software (Version 7.0, Atlanta, USA). Result: Of the 497 cases examined across the seven centers, we observed that SGN occurred more in females than males. Overall, pleomorphic salivary adenoma (PA) was found to be the most common. PA was found to be the commonest benign SGN while adenocystic carcinoma (ADCC) was the commonest malignant SGN. Regional variations were observed for age group, diagnosis, and gender distribution. Significant statistical differences were found between males and females for malignant SGNs (p‐value=0.037). Conclusion: We found regional variation in the pattern of distribution of SGN in Nigeria. This is the largest multicenter study of SGN in Nigeria, and our findings are robust and representative of the epidemiology of this neoplasm in Nigeria