Severe odontogenic infections: a 5-year review of a major referral hospital in Ghana

Introduction: odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana. Methods: a retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review. Results: a total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD = 16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig's angina was the commonest (52%) form of presentation of spreading odontogenic infection. Conclusion: this study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management

An Experiment to Determine the Prospect of using Cocoa Pod Husk Ash as Stabilizer for Weak Lateritic Soils

A study was conducted to determine the extent to which the engineering and geotechnical properties of a lateritic soil for road construction works can be improved by using cocoa pod husk ash (CPHA) additive.Natural lateritic soil samples were collected from test pits near El wak Sports Stadium, Accra, Ghana and were subjected to Atterberg’s limit and particle size distribution tests as well as compaction and California Bearing Ratio (CBR) tests. The soil was then treated with 0.5%, 1.0%, 2.0%, 4.0%, 6.0%, 8.0%, and 10.0% of CPHA and then tested for variations in the engineering properties.From the various tests carried out on the natural soil sample, and when CPHA was added, it was observed that CPHA has a significant negative effect on the maximum dry density and a positive significant effect (p<0.05) on the liquid limit. The addition of CPHA to the soil however, did not significantly (p>0.05) affect the California Bearing Ratio, optimum moisture content, plastic limit and plasticity index, and therefore the CPHA is regarded as a poor soil stabilizer. Other findings show that CPHA has no pozzolanic properties. Keywords: Cocoa pod husk ash, stabilizer, lateritic soil, pozzolanic properties

A one-year prospective study of the safety, tolerability and pharmacokinetics of the highest available dose of paliperidone palmitate in patients with schizophrenia

<p>Abstract</p> <p>Background</p> <p>There are no previous reports of paliperidone palmitate's (PP) long term tolerability or pharmacokinetics of the highest dose in patients with schizophrenia. This study evaluates safety and tolerability, as well as pharmacokinetics, of the highest marketed dose of PP (150 mg eq. [234 mg]) in stable patients with schizophrenia over a 1-year period.</p> <p>Methods</p> <p>In this 1-year prospective study, eligible patients (aged 18-65 years; Positive and Negative Syndrome Scale's total score ≤ 70) received an initial deltoid injection of PP 150 mg eq. The second injection one week later and subsequent once-monthly injections were deltoid or gluteal. All injections were to be PP 150 mg eq. Patients willing to participate in intensive pharmacokinetic sampling were classified as Treatment A. Patients unwilling to undergo intensive pharmacokinetic sampling or unable to tolerate the 150 mg eq. dose (consequently receiving flexible doses of 50, 100 or 150 mg eq.) were classified as Treatment B.</p> <p>Results</p> <p>Of the 212 patients (safety analysis set), 73% were men; 45% white; 20% black; 34% Asians; mean (SD) age 41 (10.2) years, and mean (SD) baseline Positive and Negative Syndrome Scale total score 54.9 (9.03). A total of 53% (n = 113) patients completed the study and 104 received PP 150 mg eq. throughout. Mean (SD) mode dose of PP was 144.8 (19.58) mg eq. The dosing initiation regimen resulted in rapidly achieved and maintained therapeutic paliperidone levels over the study (average concentrations during the dosing interval were 34.7, 40.0, and 47.8 ng/mL after the 2nd, 8th, and 14th injection respectively). Most frequent (≥ 10%) treatment-emergent adverse events were nasopharyngitis (n = 37), insomnia (n = 32), injection-site pain (n = 32), headache (n = 28), and tachycardia (n = 27). Akathisia (n = 19) and tremor (n = 11) were the most common extrapyramidal adverse events. 33 patients had an SAE and 27 discontinued due to treatment-emergent adverse events. No deaths were reported. Mean (SD) weight change from baseline was 2.5 (5.41) kg at endpoint. Patients' psychoses remained stable.</p> <p>Conclusions</p> <p>Safety results after one-year therapy with the highest available dose of once-monthly paliperidone palmitate were consistent with results from previous studies, with no new concerns noted. Plasma concentrations were within the expected range.</p> <p>Trial registration no</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01150448">NCT01150448</a></p

The non-acidogenic potential of two Ghanaian meals

This study tested whether a meal of Ga Kenkey and fried fish with tomato/pepper sauce (kenkey and fish), or fried ripened plantain with beans (Red-Red) is acidogenic. The pH of baseline saliva given by volunteers prior to eating a meal, and at specific intervals after the meal (effect saliva) was measured using a Kent EIL 7020 pH meter. As control, volunteers were given a “glucose challenge” in which they rinsed their mouths with a 5% glucose solution for exactly 60 seconds. Changes in pH of effect saliva were determined with reference to their respective baseline saliva. The mean pH of saliva changed significantly by negative 0.50 ten minutes after the glucose challenge and negative 0.23 a further five minutes later. Immediately after a meal of “Red-Red” the mean pH of saliva significantly changed by positive 0.45. Ten and 15 minutes after the meal the mean saliva pH changes were positive 0.13 and positive 0.06, respectively. The mean pH of saliva changed by positive 0.39 fifteen minutes after volunteers ate kenkey and fish, and twenty-five minutes after the meal the mean change in pH was positive 0.10. The reduction in pH of saliva below baseline value after the glucose challenge confirmed its acidogenic potential. Since there was no depression of saliva pH below baseline values after volunteers had eaten either of the two meals, it is concluded that “Red-Red”, as well as kenkey and fish have non-acidogenic potential. By extension, this suggests that either meal has non-cariogenic or cariostatic effect. JOURNAL OF THE GHANA SCIENCE ASSOCIATION Volume 2 No. 2 (2000) pp. 1-

Number needed to treat and number needed to harm with paliperidone palmitate relative to long-acting haloperidol, bromperidol, and fluphenazine decanoate for treatment of patients with schizophrenia

Srihari Gopal1, Joris Berwaerts1, Isaac Nuamah1, Kasem Akhras2, Danielle Coppola1, Ella Daly1, David Hough1, Joseph Palumbo11Johnson &amp;amp; Johnson Pharmaceutical Research &amp;amp; Development, LLC, Raritan, NJ, USA; 2Johnson &amp;amp; Johnson Pharmaceutical Services, LLC, Raritan, NJ, USABackground: We analyzed data retrieved through a PubMed search of randomized, placebo-controlled trials of first-generation antipsychotic long-acting injectables (haloperidol decanoate, bromperidol decanoate, and fluphenazine decanoate), and a company database of paliperidone palmitate, to compare the benefit-risk ratio in patients with schizophrenia.Methods: From the eight studies that met our selection criteria, two efficacy and six safety parameters were selected for calculation of number needed to treat (NNT), number needed to harm (NNH), and the likelihood of being helped or harmed (LHH) using comparisons of active drug relative to placebo. NNTs for prevention of relapse ranged from 2 to 5 for paliperidone palmitate, haloperidol decanoate, and fluphenazine decanoate, indicating a moderate to large effect size.Results: Among the selected maintenance studies, NNH varied considerably, but indicated a lower likelihood of encountering extrapyramidal side effects, such as akathisia, tremor, and tardive dyskinesia, with paliperidone palmitate versus placebo than with first-generation antipsychotic depot agents versus placebo. This was further supported by an overall higher NNH for paliperidone palmitate versus placebo with respect to anticholinergic use and Abnormal Involuntary Movement Scale positive score. LHH for preventing relapse versus use of anticholinergics was 15 for paliperidone palmitate and 3 for fluphenazine decanoate, favoring paliperidone palmitate.Conclusion: Overall, paliperidone palmitate had a similar NNT and a more favorable NNH compared with the first-generation long-acting injectables assessed.Keywords: long-acting injectables, first-generation antipsychotics, randomized, number needed to treat, number needed to harm, paliperidone palmitate, second-generation antipsychotic