Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England

Objectives: This study aimed to analyse the characteristics of comprehensive dental care provided under general anaesthesia (CDGA) and to review the additional treatment required by children over the 6 years subsequent to CDGA. Method: Information collected from hospital records for the 6-year period following the first CDGA included the types of dental treatment performed at CDGA, the return rates for follow-up appointments, further treatment required subsequent to CDGA and the types of dental treatment performed at repeat DGA. Results: The study population consisted of 263 children, of whom 129 had a significant medical history, with mean age of 6.7 years. The results revealed that the waiting time for CDGA was significantly shorter in children who had a significant medical history, with 49 % being admitted for CDGA within 3 months of pre-GA assessment, as compared to 29 % of healthy children. 67 % of children had follow-up care recorded, with a slightly higher proportion of children with significant medical history returning for follow-up [70 % (90/129)] compared with 65 % (87/134) of healthy children. Re-treatment rates were 34 % (88/263), the majority of cases being treated under local analgesia (42/88). 34 of 263 children had repeat DGA (12.9 %). Of these 71 % (24/34) were children with significant medical history. The mean age at repeat DGA was 9 years. In 25 of 34 children (74 %), repeat DGA was due to trauma, oral pathology, supernumerary removal, hypomineralized teeth or new caries of previously sound or un-erupted teeth at CDGA. The ratio of extraction over restoration (excluding fissure sealants) performed at repeat DGA was 2.8, compared with the ratio of 1.3 in the initial CDGA. Conclusions: There was a higher ratio of extraction over restorations at the repeat DGA. This suggests that the prescribed treatments at repeat DGA were more aggressive as compared to the initial CDGA in 1997. The majority of the treatment required at repeat DGA was to treat new disease

The effect of premature extraction of primary teeth on the subsequent need for orthodontic treatment.

AIM: To investigate if premature extraction of primary teeth was associated with orthodontic need in the permanent dentition. STUDY DESIGN: This was a case-control study based on retrospective dental records. METHODS: As part of NHS (UK) Dental Epidemiology Programme a sample of 366, 12-year-old children from Bradford and Airedale were examined. The survey collected data on patient demographics, dental health status including orthodontic need. Data linkage was undertaken for those children participating in the NHS Dental Epidemiology Programme who had previously accessed the local Salaried Dental Service (SDS). For these children, retrospective dental information was collected about premature extraction of primary teeth. RESULTS: From the 366 children who were surveyed, 116 children had received treatment at the local SDS in the past. Significantly more children from ethnic minorities, low socioeconomic backgrounds and high caries rate (p < 0.001) were seen in the SDS. For the 107 children who attended SDS, an increased total number of primary teeth extractions was positively associated with orthodontic need (odds ratio:1.18, CI -1.01 to 1.37). STATISCTICS: Multilevel modelling was undertaken to identify variables associated with orthodontic need. CONCLUSIONS: In the study group, orthodontic need was significantly associated with the number of primary teeth extracted

A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies

Background The aim of this study is to describe the major evolutionary historical events among Leishmania, sandflies, and the associated animal reservoirs in detail, in accordance with the geographical evolution of the Earth, which has not been previously discussed on a large scale. Methodology and Principal Findings Leishmania and sandfly classification has always been a controversial matter, and the increasing number of species currently described further complicates this issue. Despite several hypotheses on the origin, evolution, and distribution of Leishmania and sandflies in the Old and New World, no consistent agreement exists regarding dissemination of the actors that play roles in leishmaniasis. For this purpose, we present here three centuries of research on sandflies and Leishmania descriptions, as well as a complete description of Leishmania and sandfly fossils and the emergence date of each Leishmania and sandfly group during different geographical periods, from 550 million years ago until now. We discuss critically the different approaches that were used for Leishmana and sandfly classification and their synonymies, proposing an updated classification for each species of Leishmania and sandfly. We update information on the current distribution and dispersion of different species of Leishmania (53), sandflies (more than 800 at genus or subgenus level), and animal reservoirs in each of the following geographical ecozones: Palearctic, Nearctic, Neotropic, Afrotropical, Oriental, Malagasy, and Australian. We propose an updated list of the potential and proven sandfly vectors for each Leishmania species in the Old and New World. Finally, we address a classical question about digenetic Leishmania evolution: which was the first host, a vertebrate or an invertebrate? Conclusions and Significance We propose an updated view of events that have played important roles in the geographical dispersion of sandflies, in relation to both the Leishmania species they transmit and the animal reservoirs of the parasites

Prophylaxis Against Venous Thromboembolism (VTE) in Patients with Traumatic Brain Injury (TBI)

Several recent national guidelines and reviews conclude that pharmacologic, in addition to mechanical thromboprophylaxis, appears to be safe among TBI patients with stabilized hemorrhagic patterns. Despite this, there are many issues concerning efficiency and safety in severe TBI, especially in patients with coagulopathies

Infecções do trato respiratório inferior pelo vírus sincicial respiratório em crianças hospitalizadas menores de um ano de idade Respiratory syncytial vírus - associated lower respiratory tract infections in hospitalized infants

Analisou-se características clínicas e evolutivas em crianças menores de um ano internadas com infecção do trato respiratório inferior por vírus sincicial respiratório (VSR). Feito estudo transversal com 89 lactentes hospitalizados durante as épocas de maior incidência do VSR, em 1997 e 1998, na cidade do Rio de Janeiro. Foram pesquisados antígenos virais, nas secreções de nasofaringe, com anticorpos monoclonais anti-VSR, antiinfluenza A e B e antiparainfluenza tipo 3, por ensaio de imunofluorescência indireta. Formaram-se três grupos: bronquiolite ou bronquite sibilante (n=44), pneumonia (n=26) e bronquiolite e pneumonia (n=19). Houve positividade para o VSR em 42 (47,1%) pacientes. Em 1997 a média de dias de oxigenoterapia foi de 5,2 e em 1998, de 2,5 dias (p> 0,05). Não houve diferença de apresentação clínica entre os lactentes que apresentaram positividade para o VSR e aqueles cujo resultado foi negativo. A sensibilidade e especificidade da sibilância em relação ao isolamento de VSR foram 85% e 65%, respectivamente. O VSR foi o principal causador de infeções do trato respiratório inferior em lactentes que necessitaram de hospitalização.<br>For analysis of clinical features and outcome of hospitalized infants with respiratory syncytial virus lower respiratory tract infection, was carried out. Cross-sectional study with 89 infants, hospitalized in two public hospitals during the 1997 and 1998 RSV seasons, in Rio de Janeiro city. Nasopharyngeal secretions were obtained and specimens processed for viral antigens detection by indirect immunofluorescence assay with the use of anti RSV, antiinfluenza A and B and anti parainfluenza type 3 monoclonal antibodies. Patients were allocated into three diagnostic groups: bronchiolitis or wheeze bronchitis (n = 44); Pneumonia (n = 26) and bronchiolitis or wheeze bronchitis and pneumonia (n = 19). Positivity for RSV was found in 42 (47.1%) patients. More days of hospitalization were seen in 1997 in comparison with the follow year (p >0.05). No clinical differences were found between RSV positive and negative children. The sensitivity and specificity for wheezing concerning the isolation of RSV were, respectively, 85% and 65%. RSV was the major cause of LRTI in hospitalized infants