Double teeth in the primary dentition: Case reports from a Nigerian Tertiary Hospital

The term double tooth is used to describe the developmental dental abnormalities called gemination and fusion. Gemination is an attempted, incomplete division of a single tooth germ during the proliferation stage of odontogenesis, while fusion is the union of two or more independently developing teeth. Although the prevalence of primary double teeth is low, double teeth are of clinical interests because of the associated clinical problems. The clinical problems associated with the condition in the primary dentition are often downplayed for various reasons in spite of their importance. Primary double teeth ought to be carefully investigated so that these clinical problems which may affect the permanent dentition can be effectively managed. Perhaps primary double teeth have not received adequate documentation in our environment because of the low prevalence. This paper presents four primary double teeth in three patients. One of the cases presented occurred bilaterally, a relatively uncommon phenomena. The associated clinical problems are illustrated in the cases and the management discussed. Although primary double teeth are asymptomatic and in some cases may not interfere with function, they do have associated clinical problems. Early diagnosis and regular clinical and radiographic observations are necessary for effective management and appropriate treatment of the anomaly

Multiple maxillofacial fractures in a patient undergoing orthodontic treatment: a case report

Severe maxillofacial injuries among patients receiving orthodontic treatment are very rare. When they occur, they can be life threatening with several complications which include neurologic deficits, malunion of fracture segments secondary to delay in reduction and immobilization of fracture segments and massive blood loss. Delay in treatment of such maxillofacial injuries in the presence of other life threatening injuries predisposes the patient to residual and minor malocclusion. The interdisciplinary management of injuries sustained by an orthodontic patient and the challenges associated with its management are highlighted in this report.Reduction and immobilization was carried out under general anaesthesia using an arch bar in the mandibular arch. Direct bonded brackets in the maxillary arch with additional eyelet wires were used in the management of the fractures. An acceptable reduction of bilateral parasympseal fractures was obtained with available intermaxillary fixation. There was some residual and minor malocclusion attributed to the delay in treatment and possibly the method used.A multi-disciplinary team approach for the management of maxillofacial fractures in patients undergoing orthodontic treatment with fixed appliances is suggested. Orthodontic treatment with surgical involvement has been found to improve both facial aesthetics and occlusal function

Assessment of Air Quality Model Predictions of Ozone Concentrations Characterized by Large Hourly Changes in Houston, Texas

The Houston-Galveston-Brazoria (HGB) area has been shown to be affected by two types of ozone formation. The 'typical' ozone formation, common in most parts of Houston and other urban areas, depicted by a gradual rise in hourly ozone concentration. The other type of ozone formation is depicted by a rapid rise in ozone formation defined as either [greater than or equal to] 40 ppb/hr or [greater than or equal to] 60 ppb/2hr change in hourly ozone concentration. These rapid ozone formation or 'non- typical ozone formation' (NTOC) have been shown to affect attainment metric by as much as 10 ppb. We have evaluated the regulatory Air Quality Model's (AQM) ability to accurately simulate the observed rapid ozone formation peculiar to this region using the two major emission inventories and have compared it with observations from days that corresponded with the modeling period. Results show that the model lacks the ability to predict observed maximum one hour and two hour changes

Antiemetic prophylaxis with promethazine or ondansetron in major gynaecological surgery

Background: Postoperative nausea and vomiting remain a significant cause of morbidity among patients undergoing general anaesthesia. The optimal strategy for prevention, however, remains controversial. This study evaluated the efficacy of ondansetron 8 mg compared with promethazine 25 mg or placebo for the prevention of nausea and vomiting in patients undergoing elective major gynaecological surgery.Methods: Seventy-five patients received intravenous injection of the study medication (ondansetron-25, promethazine-25 or placebo-25) immediately before the induction of anaesthesia. Nausea and vomiting were assessed over a 24-hour postoperative period.Results: Nausea occurred in 20%, 40% and 72% of the promethazine, ondansetron and placebo groups respectively (p = 0.001). The overall incidence of vomiting was 12%, 16%, and 60% (p = 0.000) for promethazine, ondansetron and the placebo respectively. Postoperative drowsiness was prominent in the promethazine group. There was no significant difference in effectiveness between promethazine and ondansetron.Conclusions: Promethazine 25 mg was significantly more effective than ondansetron 8 mg in the prevention of postoperative nausea and vomiting. Promethazine is inexpensive and the cost of drugs is of importance in developing African countries. Drowsiness was a significant side-effect with promethazine, and this will be a disadvantage in ambulatory surgery

Natal and neonatal teeth: Literature review and report of seven cases in a Nigerian Tertiary Hospital

Teeth that are present in newborn infants are called "natal teeth" while teeth that erupt within the first 4 weeks after birth are called "neonatal teeth". The incidence of the appearance of natal and neonatal teeth has been reported to be between one in every 1000 and one in every 6000 births. Natal teeth may be uncomfortable for a nursing mother and present a risk of aspiration and swallowing by the infant if they are loose. Also, they may cause irritation and trauma to the infant\u27s soft tissues. Under these circumstances, these teeth need to be extracted. This paper presents 7 cases of natal and neonatal teeth. Three of the cases presented with natal molar teeth which are rare. The clinical features, complications and management are discussed

Non-random distribution of deleterious mutations in the DNA and protein-binding domains of IRF6 are associated with Van Der Woude syndrome

Background: The development of the face occurs during the early days of intrauterine life by the formation of facial processes from the first Pharyngeal arch. Derangement in these well-organized fusion events results in Orofacial clefts (OFC). Van der Woude syndrome (VWS) is one of the most common causes of syndromic cleft lip and/or palate accounting for 2% of all cases. Mutations in the IRF6 gene account for 70% of cases with the majority of these mutations located in the DNA-binding (exon 3, 4) or protein-binding domains (exon 7-9). The current study was designed to update the list of IRF6 variants reported for VWS by compiling all the published mutations from 2013 to date as well as including the previously unreported VWS cases from Africa and Puerto Rico.Methods: We used PubMed with the search terms; "Van der Woude syndrome," "Popliteal pterygium syndrome," "IRF6," and "Orofacial cleft" to identify eligible studies. We compiled the CADD score for all the mutations to determine the percentage of deleterious variants.Results: Twenty-one new mutations were identified from nine papers. The majority of these mutations were in exon 4. Mutations in exon 3 and 4 had CADD scores between 20 and 30 and mutations in exon 7-9 had CADD scores between 30 and 40. The presence of higher CADD scores in the protein-binding domain (exon 7-9) further confirms the crucial role played by this domain in the function of IRF6. In the new cases, we identified five IRF6 mutations, three novel missense mutations (p.Phe36Tyr, p.Lys109Thr, and p.Gln438Leu), and two previously reported nonsense mutations (p.Ser424*and p.Arg250*).Conclusion: Mutations in the protein and DNA-binding domains of IRF6 ranked among the top 0.1% and 1% most deleterious genetic mutations, respectively. Overall, these findings expand the range of VWS mutations and are important for diagnostic and counseling purposes.</p

Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country

Training in resuscitation is done worldwide by a dedicated council who is responsible for training and frequent recertification. Nigeria has no Resuscitation council and training is the responsibility of individual health institutions. There is no mandatory law on resuscitation training or recertification. This study sought to investigate how much training in CPR occurs, how effective this training is and how confident our anaesthetic trainees are in implementing present guidelines. A detailed questionnaire was anonymously filled by trainee anaesthetists who attended a revision course prior to postgraduate examinations. They answered questions on their length of training in anaesthesia, CPR training re-ceived, confidence in implementing existing guidelines and suggestions for improvement. Thirty -six trainees responded. Mean length of anaesthetic training was 3.55 ±2.39 years. 55.6% of trainees had received some CPR training. 75% of this was conducted by their anaesthetic department. Eleven trainees (30.6%) were confident in their ability to perform CPR according to 2005 guidelines, twelve (33.3%) had ever defibrillated a patient and only ten (27.8%) were confident in their ability to interpret ECG There is low confidence among junior anaesthetists in Nigeria in performance of CPR, poor knowledge of ECG interpretation of cardiac arrest rhythm and little practice in defibrillation. The establishment of a Resuscitation council would ensure adequate and frequent training which would improve knowledge, boost confidence and result in better patient care

A comparison of the effect of two doses of propofol with sodium thiopentone in the prevention of suxamethonium induced fasciculation and myalgia

Background: The use of suxamethonium commonly results in fasciculation and myalgia. This could be distressing to the patient. We compared the efficacy of high dose propofol, 3.5mg/kg with standard dose propofol, 2mg/kg and thiopentone sodium, 5mg/kg in reducing the suxamethonium induced fasciculation and myalgia.Methods: A prospective double blind randomized study in 105 unpremedicated, ASA l or II patients, scheduled for elective general anaesthesia. They were randomized, and induced with propofol, 2mg/kg (Group P), thiopentone, 5mg/kg (Group STP) or high dose propofol, 3.5mg/kg (Group HP). Tracheal intubation was facilitated with IV suxamethonium (1mg/kg). The incidence and severity of fasciculation, 24 hours postoperative myalgia and creatine phosphokinase (CPK) levels were recorded.Results: The incidence (p &lt; 0.001) and severity (p =0.034) of fasciculation was significantly lower in Group HP than Groups P and STP. The incidence (p &lt;0.001), and severity (p =0.010)of myalgia followed a similar trend. The mean 24hours postoperative CPK level was significantly lower in Group HP than Groups P and STP, p &lt;0.001.Conclusion: It is concluded that high dose propofol is more efficient than standard dose propofol and thiopentone in minimizing suxamethonium-induced fasciculation and myalgia. Key Words: suxamethonium, myalgia, fasciculation, creatinine kinase, propofol, sodium thiopenton

The dynamics of clinical students speciality preference: A study of the College of Medicine, University of Lagos

Background: Undergraduate medical education is only an initial step in training the highly differentiated doctor. The medical specialties chosen by doctors for their career play an important part in workforce planning of healthcare services and as a predictive index in the composition of medical graduates and potential physicians. However, there is little theoretical understanding of how different medical specialties are perceived or how choices are made. Objective: The aim of this study is to shed more light on how medical students view specialisation as well as to discover the factors that strongly influence their choice of medical specialty. Methodology: This study was a descriptive cross-sectional study carried out using anonymous self-administered questionnaire. Simple random sampling technique was used. Data management and analysis was done using SPSS software version 15.0. Results: The response rate was 93.7%. The respondents had a good overall knowledge about specialisation in Medicine as 175 (98.3%) of the respondents knew about specialisation in Medicine as well as the different specialties in Medicine. Majority 126 (70.8%) of the respondents would want to specialise and about two-thirds, 112 (62.9%) indicated preferred specialties as Obstetrics & Gynecology 31 (17.5%), Pediatrics 30 (16.7%), Surgery 25 (14.3%), Internal medicine 17 (9.5%) and Public Health 14 (7.9%). Conclusion: The study revealed the patterns of preference of medical students to medical specialty and factors that strongly influence their choice during clinical postings