Restorative and orthodontic interdisciplinary management of an adult patient using modified Hawley appliance: a case report

This report presents a case of an adult female patient who had undergone orthodontic treatment to correct her malocclusion was referred to the Restorative Dentistry Clinic at the time when her brackets were due for debonding. The patient had presented with spacing of the anterior segments of both upper and lower arches with the upper canines in crossbite. At the end of the orthodontic correction of the occlusion the patient was referred to the restorative dentist for replacement of missing molars in the upper and lower arches. Fixed bridge prosthesis, implant-retained crowns or removable dentures were the treatment options for tooth replacement. Due to financial challenges the first two options were unavailable to the patient. The need to wear retainers made it impractical for the patient to be provided the third option of removable dentures. A modified design of Hawley retainers was then made for the patient that had pink acrylic bases and acrylic stock teeth to replace missing teeth. Thus, the functions of retainer and removable denture were combined in one appliance. The modified Hawley appliance designed for the patient in this study is a typical example of interdisciplinary management by the restorative dentist and the orthodontist to give appropriate care to the adult orthodontic patient

Mini-STRs screening of 12 relatives of Hausa Origin in northern Nigeria

The forensic identification of closely related individuals  genetically has often been difficult probably due to strong phenotypic concordances. Short tandem repeats (STRs) have been used in kinship tracing, identifying missing person and skeletal remains, paternity testing and mass disasters victim identification. This research was performed to determine the efficiency of the miniSTRsD14S1434 and D9S1122 in differentiating between closely related persons in Nigeria. The sample consisted of twelve individuals who self-identify as relatives. DNA extracted from blood was amplified using primers for the two miniSTR loci and resolved subsequently on 4% Agarose gel. An initial denaturation for 3 min at 95°C with annealing temperature at 57.4°C and 30 cycles of PCR produced best results. Different alleles of the markers D9S1122 (9, 10, 12, 13, 14,15,16) and D14S1434 (13,15,17,19,20) were identified in the samples studied with a high degree of heterozygosity as seen in the computed estimates of 0.8000 and 0.6364 for the D9S1122 and D14S1434 loci respectively. The gel resolutions show a combined probability of exclusion of 0.94 for the population and 0.97 for siblings. These loci can therefore efficiently differentiate individuals and establish family relationship in the Hausa population and will be important for forensic identification of individuals in the population.Keywords: STRs; identification; Hausa; Nigeria; Allele

Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Sickle cell anemia (SCA) is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculo-skeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study. This work aims to prospectively document the musculo-skeletal disease burden among SCA patients.</p> <p>Methods</p> <p>In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH), the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (%) and mean values (SD) as appropriate.</p> <p>Results</p> <p>The HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%) of sites affected. Lesions involving the spine were rare 11 (0.9%). Multiple presentations occurred in 89 (28.0%) of patients; 62 (69.7%) of which were children below 10 years.</p> <p>Conclusions</p> <p>Musculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential morbidity and mortality of these conditions to ensure early diagnosis and adequate management.</p

BIODEGRADATION OF POLYNUCLEAR AROMATIC HYDROCARBONS USING INDIGENOUS STRAINS OF BACTERIA FOR SUSTAINABLE SOIL DEVELOPMENT

16S rRNA gene sequence analyses of the four isolates from a former industrial site (OC1, OC2, OC3, and OC4) were assigned to the genus, Enterobacter (OC1) and Pseudomonas (OC2, OC3, and OC4). The degradation and growth behaviour of the four isolates were investigated on naphthalene, fluoranthene, pyrene and chrysene. All the strains utilized naphthalene, fluoranthene, chrysene but pyrene partially, as sole sources of carbon and energy. The time course studies using relative concentration> 100, >115, > 89 and> 12 ppm for naphthalene, fluoranthene, pyrene and chrysene respectively, resulted in rapid exponential increases in cell numbers and concomitant disappearance of the test substrates. Naphthalene was degraded between the range of 25 and 99%, while chrysene degradation ranged between 35 and 69%, pyrene 4 -21% and fluoranthene 7 -19 %. Our results suggest that contaminated, former industrial sites contain a capable microbial community that may be used for bioremediation of the site for sustainable soil developmen

Traditional eye medicine use in microbial keratitis in Uganda : a mixed methods study [version 2; peer review: 2 approved]

Background: Traditional eye medicine (TEM) is frequently used to treat microbial keratitis (MK) in many parts of Africa. Few reports have suggested that this is associated with a worse outcome. We undertook this large prospective study to determine how TEM use impacts presentation and outcome of MK and to explore reasons why people use TEM for treatment in Uganda. Methods: In a mixed method prospective cohort study, we enrolled patients presenting with MK at the two main eye units in Southern Uganda between December 2016 and March 2018 and collected information on history, TEM use, microbiology and 3-month outcomes. We conducted qualitative interviews with patients, carers traditional healers on reasons why people use TEM. Outcome measures included presenting vision and at 3-months, comparing TEM Users versus Non-Users. A thematic coding framework was deployed to explore reasons for use of TEM. Results: Out of 313 participants enrolled, 188 reported TEM use. TEM Users had a delayed presentation; median presenting time 18 days versus 14 days, p= 0.005; had larger ulcers 5.6 mm versus 4.3 mm p=0.0005; a worse presenting visual acuity median logarithm of the minimum angle of resolution (Log MAR) 1.5 versus 0.6, p=0.005; and, a worse visual acuity at 3 months median Log MAR 0.6 versus 0.2, p=0.010. In a multivariable logistic regression model, distance from the eye hospital and delayed presentation were associated with TEM use. Reasons for TEM use included lack of confidence in conventional medicine, health system breakdown, poverty, fear of the eye hospital, cultural belief in TEM, influence from traditional healers, personal circumstances and ignorance. Conclusion: TEM users had poorer clinical presentation and outcomes. Capacity building of the primary health centres to improve access to eye care and community behavioural change initiatives against TEM use should be encouraged

Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients

<p>Abstract</p> <p>Background</p> <p>Epidemiological studies show that about 11.6% to 33.0% of all boys and about 3.6% to 19.3% of all girls suffer dental trauma of varying severity before the age of 12 years. Moderate injuries to the periodontium such as concussion and subluxation are usually associated with relatively minor symptoms and hence may go unnoticed by the patient or the dentist, if consulted. Patients with these kinds of injuries present years after a traumatic accident most of the time with a single discoloured tooth. This study sets out to document the incidence of various posttraumatic sequelae of discoloured anterior teeth among adult Nigerian dental patients.</p> <p>Methods</p> <p>One hundred and sixty eight (168) traumatized discoloured anterior teeth in 165 patients were studied. Teeth with root canal treatment were excluded from the study. Partial obliteration was recorded when the pulp chamber or root canal was not discernible or reduced in size on radiographs, total obliteration was recorded when pulp chamber and root canal were not discernible. A retrospective diagnosis of concussion was made from patient's history of trauma to the tooth without abnormal loosening, while subluxation was made from patient's history of trauma to the tooth with abnormal loosening.</p> <p>Results</p> <p>Of the 168 traumatized discoloured anterior teeth, 47.6% and 31.6% had partial and total obliteration of the pulp canal spaces respectively, 20.8% had pulpal necrosis. Concussion and subluxation injuries resulted more in obliteration of the pulp canal space, while fracture of the teeth resulted in more pulpal necrosis (p < 0.001). Injuries sustained during the 1^stand 2^nddecade of life resulted more in obliteration of the pulp canal space, while injuries sustained in the 3^rddecade resulted in more pulpal necrosis.</p> <p>Conclusion</p> <p>Calcific metamorphosis developed more in teeth with concussion and subluxation injuries. Pulpal necrosis occurred more often in traumatized teeth including fractures.</p

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic