The treatment of talar body fractures with compression screws: a case series

Fractures of talar body are rare and serious injuries and frequently seen in multiply injured and polytraumatised patients. The high variability of talar fractures, their relatively low incidence together with the high percentage of concomitant injuries makes treatment of these injuries a challenge to the surgeon

The effect of orthodontic extraoral appliances on depression and the anxiety levels of patients and parents

Background: Psychosocial consequences and post‑operative anxiety in patients after fixed orthodontic treatment are important parameters that must be evaluated by clinicians not to effect patient and their parent’s psychosocial mood negatively.Objective: The aim of this study was to evaluate the changes in depression and anxiety levels of orthodontic patients and their parents before the extraoral appliance therapy, and at a 1‑year follow‑up.Materials and Methods: Patients and one of their parents responded to a series of questionnaires and evaluation scales in order to assess depression and anxiety levels. Two groups of patients and their parents were surveyed; one group that had not yet embarked on the treatment and another that had commenced extra‑oral appliance therapy 1 year prior to the study.Results: The 1‑year‑treatment group scored significantly higher than the pre‑treatment group on the depression scale and the trait‑anxiety scale. State‑trait anxiety inventory scores did not differ significantly between the  groups. The parents of the 1‑year‑treatment group also scored significantly higher on the Beck depression inventory than those of the pre‑treatment group.Conclusion: The results of this study emphasize the need for due consideration of psychological parameters before and during treatment with extra‑oral appliances, particularly with regard to depression and anxiety.Key words: Anxiety, depression, exoral appliance

Intramedullary skeletal kinetic distractor in lower extremity lengthening

[No Abstract Available

Dudak damak yarıklı bireylerin kendini-kabul düzeylerinin değerlendirilmesi

Purpose: To survey the self acceptance of cleft lip and palate (CLP) individuals. Material and Methods: This study consisted of 34 patients with age range of 11-16 from the Department of Orthodontics of Faculty of Dentistry at Cumhuriyet University. Study sample was divided into 2 groups. The first group consisted from 14 individuals with CLP and the second group includes 20 individuals without CLP. The data of the study obtained with “Self-Acceptance Inventory”. We used Mann- Whitney U Test to compare the Self Acceptance of both groups. Results: There were significant differences between the Self Acceptance of study and control groups (p< 0, 05). Conclusion: Beside aesthetic operations performed on CLP patients we should not neglect psychologic status of these patients. Also we should support and psychologically rehabilitate the parents of these patients. ÖZET Amaç: Dudak damak yarıklı (DDY) çocukların kendini kabul düzeyleri yönünden incelenmesi. Gereç ve Yöntem: Çalışmamız Cumhuriyet Üniversitesi, Diş Hekimliği Fakültesi, Ortodonti anabilim dalında tedavi gören ve yaşları 11 ile 16 arasında değişen toplam 34 hasta üzerinde yürütülmüştür. Hastalar iki guruba ayrılmış, birinci gurup 14 DDY’li bireyden, ikinci grup ise 20 adet sağlıklı bireyden oluşturulmuştur. Çalışmamızda veriler “Kendini Kabul Envanteri” ile toplanmıştır. Grupların kendini kabul düzeyi açısından karşılaştırılmasında Mann- Whitney U Testi kullanılmıştır. Bulgular: Deney ve kontrol gurubu kendini kabul düzeyi açısından karşılaştırıldığında, gruplar arasında fark anlamlı bulunmuştur (p<0,05). Sonuç: DDY’li bireylerin dış görünüşlerini düzeltmek için yapılan operasyonların yanı sıra psikolojik yapıları da ihmal edilmemelidir. Ayrıca DDY’li çocuğa sahip ebeveynler de çeşitli şekilde moral ve destek rehabilitasyonlarına tabi tutulmalıdır. Anahtar Kelimeler: dudak damak yarığı, kendini kabul, psikolojik duru

Can Initial Torque Value Predict the Success of Orthodontic Mini-Screws?

Objective:To investigate the correlation between initial torque and removal torque of orthodontic mini-screws.Materials and Method:Sixty-four orthodontic mini-screws (measuring 1.5 × 4.4 mm, 1.6 × 4.7 mm, 1.7 × 5.5 mm, and 1.8 × 5.6 mm) were used. All mini-screws were inserted into the fibulas of 8 male rabbits. The initial torque values were immediately recorded using a digital torque gauge. For 2 months, 115 g force was applied to mini-screws inserted into the right fibula of the rabbits. The same procedure was followed for inserting the mini-screws into the left fibula of the rabbits but without applying any force. After 2 months, the removal torque values were recorded for all mini-screws. All statistical analyses were performed using SPSS version 14.0 for Windows. Spearman's correlation coefficient was used to analyze the relationships between initial and removal torque values.Results:Intragroup comparison of all brands of mini-screws showed similar features. There were no statistically significant differences between the initial torque values of all mini-screws (p > 0.05). The Spearman correlation coefficient showed that correlations between the initial and removal torque values were insignificant (p>0.05).Conclusion:The results of this study suggest that the initial torque value is not a reliable method for predicting the success of a mini-screw

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

BACKGROUND: Liver biopsy is the reference standard for diagnosing the extent of fibrosis in chronic liver disease; however, it is invasive, with the potential for serious complications. Alternatives to biopsy include non-invasive liver tests (NILTs); however, the cost-effectiveness of these needs to be established. OBJECTIVE: To assess the diagnostic accuracy and cost-effectiveness of NILTs in patients with chronic liver disease. DATA SOURCES: We searched various databases from 1998 to April 2012, recent conference proceedings and reference lists. METHODS: We included studies that assessed the diagnostic accuracy of NILTs using liver biopsy as the reference standard. Diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was conducted using the bivariate random-effects model with correlation between sensitivity and specificity (whenever possible). Decision models were used to evaluate the cost-effectiveness of the NILTs. Expected costs were estimated using a NHS perspective and health outcomes were measured as quality-adjusted life-years (QALYs). Markov models were developed to estimate long-term costs and QALYs following testing, and antiviral treatment where indicated, for chronic hepatitis B (HBV) and chronic hepatitis C (HCV). NILTs were compared with each other, sequential testing strategies, biopsy and strategies including no testing. For alcoholic liver disease (ALD), we assessed the cost-effectiveness of NILTs in the context of potentially increasing abstinence from alcohol. Owing to a lack of data and treatments specifically for fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), the analysis was limited to an incremental cost per correct diagnosis. An analysis of NILTs to identify patients with cirrhosis for increased monitoring was also conducted. RESULTS: Given a cost-effectiveness threshold of £20,000 per QALY, treating everyone with HCV without prior testing was cost-effective with an incremental cost-effectiveness ratio (ICER) of £9204. This was robust in most sensitivity analyses but sensitive to the extent of treatment benefit for patients with mild fibrosis. For HBV [hepatitis B e antigen (HBeAg)-negative)] this strategy had an ICER of £28,137, which was cost-effective only if the upper bound of the standard UK cost-effectiveness threshold range (£30,000) is acceptable. For HBeAg-positive disease, two NILTs applied sequentially (hyaluronic acid and magnetic resonance elastography) were cost-effective at a £20,000 threshold (ICER: £19,612); however, the results were highly uncertain, with several test strategies having similar expected outcomes and costs. For patients with ALD, liver biopsy was the cost-effective strategy, with an ICER of £822. LIMITATIONS: A substantial number of tests had only one study from which diagnostic accuracy was derived; therefore, there is a high risk of bias. Most NILTs did not have validated cut-offs for diagnosis of specific fibrosis stages. The findings of the ALD model were dependent on assuptions about abstinence rates assumptions and the modelling approach for NAFLD was hindered by the lack of evidence on clinically effective treatments. CONCLUSIONS: Treating everyone without NILTs is cost-effective for patients with HCV, but only for HBeAg-negative if the higher cost-effectiveness threshold is appropriate. For HBeAg-positive, two NILTs applied sequentially were cost-effective but highly uncertain. Further evidence for treatment effectiveness is required for ALD and NAFLD. STUDY REGISTRATION: This study is registered as PROSPERO CRD42011001561. FUNDING: The National Institute for Health Research Health Technology Assessment programme

The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality

Background Most diarrhoeal deaths can be prevented through the prevention and treatment of dehydration. Oral rehydration solution (ORS) and recommended home fluids (RHFs) have been recommended since 1970s and 1980s to prevent and treat diarrhoeal dehydration. We sought to estimate the effects of these interventions on diarrhoea mortality in children aged <5 years

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions