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

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

Emergency Caesarean section in a patient with known sickle-cell disease and myasthenia gravis

A 33-year-old patient with known sickle-cell disease (SS) booked for antenatal care at the Lagos University Teaching Hospital at six weeks gestational age. She had been diagnosed with myasthenia gravis three years prior to presentation and placed on oral anticholinesterase and steroid therapy, but her compliance was poor. She had had an operative delivery six years previously, under a general anaesthesia relaxant technique. It had been complicated by delayed emergence and residual muscle weakness, necessitating postoperative ICU admission for mechanical ventilation. In the index pregnancy, she had an emergency Caesarean section with bilateral tubal ligation under a combined spinal-epidural technique. A level of sensory block of T6 was achieved with 2.8 mL of 0.5% hyperbaric bupivacaine administered intrathecally. Towards the end of surgery, analgesia was supplemented through the epidural catheter with injection of 25 μg fentanyl in 6 mL of 0.25% plain bupivacaine. Supplemental oxygen was administered via a Hudson mask at 4 L/min. A live male baby with Apgar scores of 9 and 10 at one and five minutes, respectively, was delivered. The intraoperative period was uneventful. Postoperatively, she was managed in the high care unit. Postoperative analgesia was achieved via the epidural catheter with 6 mL of 0.125% bupivacaine and 2 μg/mL fentanyl four hourly for 48 hours. Subsequent recovery was uneventful. She was discharged to the postnatal ward on the fourth day postsurgery, and home with her baby 10 days later.Keywords: Caesarean section, myasthenia gravis, epidural, sickle-cell diseas

Towards Ending the HIV Epidemic in the US: State of Human Immunodeficiency Virus Screening during Physician and Emergency Department Visits, 2009 -2014

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations. We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4. HIV testing rates in physician offices increased by 105% (5.6–11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3–6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37–11.85]), males (OR 1.34, [CI: 0.91–0.93]), African-Americans (OR 2.97, [CI: 2.05–4.31]), Hispanics (OR 1.80, [CI: 1.17–2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23–3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50–4.73), Hispanics (OR 2.23, 99% CI 1.65–3.01), and Northeast (OR 2.24, 99% CI 1.10–4.54). While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended

A community survey on maternal perception about the initiation of dental home for infants in Lagos, Nigeria

Introduction: because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation after disease development, early preventive dental visits are widely encouraged by dental professional and academic stakeholders. Aim: this study aimed to determine the perceptions and practices of mothers with regards to the establishment of dental home at four local government areas (LGAs) in Lagos, Nigeria. Methods: was a community-based descriptive household survey conducted amongst mothers in Alimosho, Ikorodu, Surulere and Epe LGAs of Lagos State. Socio-demographic data, information about the importance of primary teeth, knowledge about dental home as well as their child´s age at first dental visit and reasons for attending was obtained with a validated, structured interviewer administered questionnaire. Descriptive statistics, Chi-square and multivariable regression analysis were conducted, and the level of significance was set at P<0.05. Results: the highest proportion of the mothers were aged between 26-30 years (27.4%; mean age: 34.58±7.8 years) and had a tertiary level of education (n=206, 59.9%); most respondents (n=80, 51.4%) did not know the age a child should be taken to the dental clinic for the first time and had not taken their child for any dental visit (n=229, 65.4%). Out of those who had previously taken their child for dental visits, the greater proportion (n=115, 95.0%) took the child when he/she was older than one year of age. Overall, only 126 (36.0%) respondents had a good perception about oral health and the need for a dental home while 224 (64.0%) respondents had poor knowledge. Logistic regression analysis of predictor variables that showed mothers with a tertiary level of education (OR=0.108; CI=0.0023-0.495) and those with 2-3 children (OR=0.482; CI=0.253-0.920) had significant lower odds of poor perception about the importance of a dental home. Conclusion: maternal knowledge and practices with regards to dental home were poor and inadequate. It is necessary to create more awareness among parents/caregivers, especially through antenatal and immunization clinics to establish the concept of dental home

The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution

Objective: The aim was to determine the prevalence of early childhood caries (ECC) and its association with infant feeding and oral health‑related behavior among preschool children aged 6–71 months in Lagos.Materials and Methods: This was a descriptive cross‑sectional study in which 302 children aged 6–71 months were selected from four pediatric outpatient clinics in Lagos, Nigeria. A structured questionnaire was used to obtain information regarding oral hygiene practices, dietary habits, breast and bottle feeding, birth weight of child and socioeconomic status of the family, from mothers of the children. The status of dental caries was recorded according to the World Health Organization criteria.Results: The prevalence of ECC among 302 children aged 6–71 months was 21.2% while the mean deft was 0.735. Multivariate logistic regression analysis showed the correlation of ECC with the associated risk factors. ECC was significantly higher in children who were bottle‑fed at night. Method of tooth cleaning other than using fluoridated toothpaste significantly increased the prevalence of ECC. Breastfeeding for duration of 3–6 months showed significantly lesser caries prevalence. Caries significantly increased with age.Conclusion: Early childhood caries is a multifactorial disease in which prolonged duration of breastfeeding, nocturnal bottle feeding, and use of cleaning methods other than fluoridated toothpaste are risk factors for ECC. Oral health promotion programs should be targeted at mothers, pediatricians, nurses, caretakers at day care centers and primary care health workers.Keywords: Early childhood caries, Lagos, prevalence, risk factor

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

Aetiology and treatment outcome of severe traumatic brain injuries in neurosurgical center with inadequate facilities

Background: Severe traumatic brain injury (TBI) is a major challenge to the patient, the relatives, the care givers, and the society in general. The primary and secondary injuries, and the high metabolism are formidable stages of the injury, each capable of taking the life of the patient. The objectives were to determine the etiology and outcome in severe traumatic brain injuries patients.Methods: This was a prospective study on patients with severe traumatic brain injury patients managed in our center from August 2010 to December 2014. Patients were resuscitated in accident and emergency unit using Advanced Trauma Life Support protocols. Those with Glasgow Coma scale scores ≤8 were included in the study.Data were collected with structured proforma which was component of our prospective data bank that was approved by our ethics committee, and were analyzed with Environmental Performance Index info 7 softwareResults: One hundred and ten patients were studied. Males were 86. The mean age Was 31.43 years. Ninety six were involved in road traffic accident. Seventy seven patients had favorable outcome.Conclusion: The commonest etiology was road traffic accident.Seventy seven patients had favorable outcome.Keywords: etiology, outcome, severe traumatic brain injur

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

COVID-19 challenges, responses, and resilience among rural Black women: a study protocol

Despite the aggregated burdens and challenges experienced by rural Black women during the COVID-19 pandemic, many likely also demonstrated strength and resilience to overcome challenges. A mixed methodology and a community-based participatory approach will be used to collect multilevel data on challenges, responses, resilience, and lessons during the pandemic from Black women, community health workers, and community leaders in rural areas in South Carolina (SC). Specifically, the unique circumstances and lived experiences of rural Black women during the COVID-19 pandemic will be documented to understand their needs regarding effective management of social, physical, and mental health challenges through focus group discussions and in-depth interviews with Black women, community health workers, and local community leaders recruited from rural SC communities. Barriers, facilitators, and potential impacts of multilevel resilience development will be identified through a survey administered among rural Black women recruited from 11 rural counties (with one as site for a pilot testing of the questionnaire). A report for public health practice will be developed, including recommended strategies to optimize health systems' emergency preparedness and responses through triangulation of qualitative and quantitative data from multiple sources. Findings in the proposed study will provide valuable references in terms of addressing social determinants of health factor challenges during the pandemic, fostering resilience, and informing evidence-based decision-making for policymakers. The study will contribute to the development of public health emergency preparedness plans, which can promote the resilience of women, their families, and local communities as well as optimize effective preparedness and response of health systems for rural Black women and their families during infectious disease outbreaks and other public health emergencies