Multidisciplinary Dentistry

Increasing cancer burden: Time to modify lifestyle behaviours S Leena Sankari Indian Journal of Multidisciplinary Dentistry 2018 8(2):55-56

Effect of direct administration of functional foods on oral flora in patients undergoing fixed orthodontic treatment T Jaya Chandra, Anoosha Manda Indian Journal of Multidisciplinary Dentistry 2018 8(2):57-60 Introduction: Orthodontic treatment facilitates the growth of pathogens and leads to white spot lesions and caries formation. This study was carried out to compare the efficacy of probiotics, prebiotics, and symbiotics on the salivary levels of Streptococcus mutans, Lactobacillus, and Bifidobacterium. Materials and Methods: Saliva samples were collected from the patients who were undergoing comprehensive orthodontic treatment at two different time intervals, baseline (T0) and postintervention (T1) that is 1 month after administration of prebiotic, probiotic, and symbiotic bacteria, respectively, for Groups A, B, and C; placebo was included in Group D. Samples were inoculated on selective media, after incubation growth was identified. Colony counts were recorded in colony forming units per milliliter. Paired t-test, analysis of variance, and post hoc Tukey's honest significant difference test were used for analysis, and P < 0.05 was considered to be statistically significant. Results: Among the participants, S.mutans counts were found to be decreased (P < 0.05) and lactobacilli and bifidobacterium counts were found to be increased (P > 0.05). Conclusion: Short-term consumption of probiotics, prebiotics, and symbiotics had effectively reduced the S. mutans levels in the oral cavity with increased levels of Lactobacillus and Bifidobacterium when compared with the placebo group.

Oral cancer awareness and attitude toward its screening: A study among people with different occupations Tathagata Bhattacharjee, Somnath Gangopadhyay Indian Journal of Multidisciplinary Dentistry 2018 8(2):61-70 Background: The number of oral cancer cases is increasing in India. The prevalence of this disease is increasing in various occupational groups. Aims: This study aimed to assess the awareness of oral cancer and attitude toward screening and the prevalence of related habits and habit-related oral lesions among people with different occupations. Settings and Design: Sixteen closed-ended questions were used to assess the awareness of oral cancer. Responses were scored in accordance with the defined rules. Patients' attitude toward oral cancer screening was also assessed using ten additional questions under four headings. Information regarding the oral habits was recorded using the WHO steps questionnaire. Materials and Methods: Distribution of occupation in the study population was categorized as per the International Standard Classification of Occupations-08 structure and all the study samples ware clinically examined to diagnose any habit-related oral changes. Statistical Analysis Used: Student's independent sample's t-test was applied to compare normally distributed numerical variables between groups; unpaired proportions were compared by Chi-square test or Fisher's exact test. One-way analysis of variance was used to compare the means of three or more samples for numerical data. Results and Conclusion: A statistically significant difference (P = 0.0001) in general awareness of oral cancer was seen among various occupational groups. The attitude toward oral cancer screening was assessed and found no statistically significant results, which signifies that significant motivation for oral cancer screening is required in different occupational workplaces.

An online survey about awareness and motivation regarding periodontal health in Maharashtra Priyanka Gangadhar Kapse, Ramreddy K Yeltiwar, Pallavi K Patil, Kaustubh S Thakare Indian Journal of Multidisciplinary Dentistry 2018 8(2):71-75 Context: Chronic periodontitis is multifactorial disease with high prevalence rate in India. Motivation in periodontitis patients is thought to play a major role in influencing periodontal health in this patient. This online study focuses on different areas for motivation such as age, financial, and educational status including different health-care professionals. Aims: The purpose of this study was to evaluate awareness, behavior, and motivation regarding periodontal disease in general population and health professionals (dental and medical) in Maharashtra state with aim and objectives to assess the patient's knowledge and concern about the importance of self-care in controlling periodontal disease. Settings, Design, Subjects, and Methods: The study sample consisted of 1001 participants ranging between 20 and 60 years old. The questionnaire was prepared and circulated by the mobile application (WhatsApp). A questionnaire consisting of multiple choice questions was used as assessment tool and its content evaluated the patients profile, their knowledge about periodontal disease, the dental professional's commitment to instruct the patients toward their behavior concerning oral hygiene along with their perception of the importance of self-care for disease control and knowledge and motivation in dental and medical professionals about periodontal health. Statistical Analysis Used: The completed questionnaires were then analyzed statistically on survey monkey website to obtain the results through tables and graphs of the frequency distribution. Results: The result of this study shows basic awareness about oral hygiene in educated population but an acute lack of oral hygiene awareness and limited knowledge of oral hygiene in general population. Conclusions: Hence, there is an urgent need for comprehensive educational programs to promote good oral health and impart education about the correct oral hygiene practices. There is need for awareness not only in the general population but also in health-care professionals too.

Evaluation of knowledge and attitude about gingival displacement materials and techniques among dental practitioners Vijeta Gajbhiye, Rajlakshmi Banerjee, Usha Radke, Anuj Chandak, Priti Jaiswal Indian Journal of Multidisciplinary Dentistry 2018 8(2):76-81 Statement of Problem: Edentulism is a condition that critically affects the quality of life of patients by compromising function as well as esthetics. Fixed partial dentures have been a treatment of choice to replace missing teeth. Despite its various advantages, failures are not uncommon. Recording accurate impressions is a crucial prerequisite to ensure the success of prosthesis. Gingival displacement, especially in restorations with subgingival margins, is extremely important to record the accurate impressions of the finish line. Aim and Objectives: The purpose of the study was to evaluate the knowledge and attitude about gingival displacement materials and techniques among dental practitioners in Nagpur region. Materials and Methods: A survey consisting of 15 questions regarding gingival deflection method was distributed among 200 dental practitioners. The participants were approached personally with the printed questionnaire and through E-mail. Results: The survey showed that approximately 86% of the dental practitioners practicing in Nagpur region did not perform gingival displacement before making impressions. Out of 16% of the dentists who perform gingival displacement, only 10% of them were prosthodontists. The most common method used for gingival displacement was retraction cord. Better techniques such as cordless gingival displacement were used by only 6% of the dentists because of lack of knowledge and technique sensitivity of these materials. Financial concerns may also be a deterrent for performing gingival displacement in such cases. Conclusion: Hands-on experiences on gingival displacement need to be imparted at the undergraduate level and the importance of gingival displacement for the success of prosthesis needs to be conveyed to dental practitioners, so as to bring about a change which results in a better rehabilitation of patients with partial edentulism.

Effect of various luting agents on retention of cement-retained implant restorations with different modifications - An in-vitro study S Mohammed Imthiyas, Bala Subramanian, Prabhu Karupiah, A Kirubakaran, VC Karthik, Suganya Ganesan Indian Journal of Multidisciplinary Dentistry 2018 8(2):82-86 Introduction: Cement-retained restorations are the most common mode of attaining retention in implant prosthesis. Surface modifications can enhance the retention of the cement-retained implant restorations. Materials and Methods: A total of 45 copings (n = 45) were fabricated and divided into three groups based on the types of cements used: Group A – zinc phosphate cement, Group B – zinc polycarboxylate cement, and Group C – glass-ionomer cement. Each group was subdivided into three subgroups depending on the surface treatment employed: Subgroup 1 – unmodified copings (controlled group), Subgroup 2 – sandblasted copings, and Subgroup 3 – roughened abutment. The blocks with abutments on which the coping was cemented on them were locked on a universal testing machine. Results: The mean load required to debond the copings cemented with zinc phosphate cement under various surface modifications was found to be 154 N for unmodified copings, 184 N for sandblasted copings, and 171 N for roughened abutments. The mean load required to debond the copings cemented with zinc polycarboxylate cement under various surface modifications was found to be 212 N for unmodified copings, 325 N for sandblasted copings, and 390 N for roughened abutments, respectively. The mean load required to debond the copings cemented with Type 1 glass-ionomer cement under various surface modifications was found to be 302 N for unmodified copings, 413 N for sandblasted copings, and 412 N for roughened abutments. Conclusion: The retentive properties of the three types of cements tested in this study were statistically significant. Type 1 glass-ionomer cement shows the highest mean retentive strength, followed by zinc polycarboxylate and zinc phosphate cement. There was no statistically significant difference between the sandblasted and roughened abutment copings cemented with Type 1 glass-ionomer cement.

Use and application of computer and internet in dental education among students of Nagpur city Sanjana Agrawal, Anita Rama Kahar, Usha Radke, Surbhi Pandagale, Priya Agrawal, Jayashree Joshi Indian Journal of Multidisciplinary Dentistry 2018 8(2):87-93 Background: Computer and Internet has currently become most easily accessible vehicle for extracting and viewing the data to everybody. Each folk carry the Internet in our hand and use it in just one finger bit. In dental education, additional use of computer and Internet is not a story of happening once and whereas, it is a routine procedure. The computers and Internet is employed for teaching and learning purpose. For the students, the Internet is currently one in every of the foremost necessary sources of data for looking and resolving the queries in academics beneath the steering of revered colleges. Hence, we decided do conduct such study in three dental institutes of our Nagpur city. Aim: Assessment of computer and Internet use and its application in dental education among the dental students of three dental institutes of Nagpur city. Materials and Methods: A cross-sectional questionnaire survey was undertaken among the first to final BDS students of three dental colleges of Nagpur city. Results: One hundred and twenty (16.12%) of the participants use the Internet for searching information in dentistry. Three hundred and eighty-five (51.74%) of them use Internet for searching textbooks, videos, and literature. Three hundred and two (40.59%) of them prefer to read text from a book than computer. Conclusion: Majority of the dental students use computer and Internet for their studies. At the identical time students were not a lot aware of e-books. They conjointly preferred to read text from a book. The preclinical year student's angle toward the use of computer and Internet was found to be more than clinical year students.

Software in forensic odontology P Anuja, Nagabhushana Doggalli Indian Journal of Multidisciplinary Dentistry 2018 8(2):94-100 Let us now pause for a moment of science!! Technological advances are becoming more and more important in forensic sciences these days. Forensic odontology plays a major role in identifying those individuals who cannot be identified visually or by other means. Various software, such as Windows Identification, Disaster and Victim Identification (DAVID) and automated dental identification system (ADIS), have been developed that greatly help in easier identification. With the development of various software such as Adobe Photoshop and Dentascan, it is possible to scan the dentition of a deceased within minutes. The various post processing software like Adobe Photoshop (Adobe Systems Incorporated, San Jose, California) allows visualization of the data adapted to every possible antemortem X-ray for identification. This review describes the significance of various software used in forensic odontology.

Nanorobotic wonders: A revolutionary era in periodontics Pratiksha Bordoloi, Sheikabba Shahira, Amitha Ramesh, Biju Thomas Indian Journal of Multidisciplinary Dentistry 2018 8(2):101-105 Greatness does not come in size. Surprises come in small packages. Robots have recently been introduced to undertake basic surgical procedures, and with the help of nanobiotechnology, another dimension of robotics has been developed as NANOROBOTS. Oral cavity is the mirror of the overall health of an individual. The various chronic inflammatory oral diseases influence the systemic health of an individual and vice versa. Various treatment modalities have been introduced for the prevention and management of periodontal disease. The introduction of nanorobots may possibly maintain the comprehensiveness of oral health. The dental application of nanorobots is leading to the emergence of nanodentistry. Nanorobots induce oral analgesia, desensitize tooth, and are also used in preventive, restorative, and curative procedures and major tooth repair. Treatment opportunities in periodontics are hypersensitivity cure, dentiforobots, bone replacement materials, nanoimplants, nanolasers, etc. Hence, the aim of this review article is to emphasize the use and the future scope of nanorobotics in periodontics.

Role of acidic additives in noncaloric sweeteners in causation of dental erosion Avijit Avasthi Indian Journal of Multidisciplinary Dentistry 2018 8(2):106-110 Dental erosion is a nondestructive carious process, slowly dissolving tooth structure because of extrinsic, intrinsic, and idiopathic causes, resulting in painless loss of tooth structure without the involvement of microorganisms. Polyols/noncaloric sweeteners are promoted extensively owing to cariostatic action and low-glycemic response, but pose a risk of dental erosion because of acidic additives incorporated into sugar-free products which cause demineralization of enamel. Erythritol, sorbitol, mannitol, and xylitol are some of the polyols publicized in maintaining good oral health by the American Dental Association. A review of the existing literature was done by searching through databases such as PubMed, EBSCO, Hinari, and Sage on noncaloric sweeteners from February to end of May 2016 using keywords noncaloric sweetener, polyols, dental erosion, casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP), nanohydroxyapatite, and prevention of erosion. Novel preventive strategies by infusing CPP ACP, milk protein casein, and fluoride into sugar-free formulations may resolve the cause of dental erosion.

Sahel Medical Journal

Growth patterns of preterm infants: A prospective study in an indigenous African population Rosena Olubanke Oluwafemi, Moses Temidayo Abiodun Sahel Medical Journal 2018 21(4):181-188 Background: Optimal growth of preterm infants reflects their overall health status; however, indigenous growth charts are rarely available to monitor them adequately in infancy. Objectives: The aim of this study was to describe growth patterns of preterm infants and to generate percentile charts as well as relevant predictive equations for expected weight-for-age in their various birth weight categories. Materials and Methods: This was a prospective, analytic study. Anthropometric measurements of eligible consecutive preterm babies were monitored biweekly/monthly in infancy. Temporal changes in body weights and occipitofrontal circumferences (OFCs) were presented graphically. The Pearson's correlation coefficient was done to derive predictive equations. LMS chartmaker light version 2.54 (Medical Research Council, UK) generated percentile charts. P < 0.05 was considered statistically significant. Results: A total of 154 preterm infants were recruited during the study period, with a male-to-female ratio of 1:1.5. Their mean gestational age (GA) was 31.3 ± 2.4 weeks, and mean birth weight was 1510.8 ± 347.5 g. Average daily weight gains were 9.4, 17.4, and 20.0 for extremely low birth weight (ELBW), very LBW (VLBW), and LBW, respectively, in the 1st month (F = 1.733, P = 0.183). The peak weight gain period occurred at the 4th month for ELBW (28.3 g/day), 5th month for VLBW (38.3 g/day), and 7th month for LBW (38.3 g/day). There was a strong positive correlation of their body weight with their postnatal age (y = 505.6x + 1511.5; R2 = 0.92) as well as OFC with age (y = 1.33x + 29.94; R2 = 0.94). Growth charts for weights and OFCs were generated showing 5th, 50th, and 95th percentiles. Conclusion: The preterm infants gained weight with increasing postnatal age following an initial weight loss in the early neonatal period. Their relative growth velocities were similar in all birth weight categories.

The use of hydroxycarbamide in children with sickle cell anemia Hafsat Rufai Ahmad, Jamilu Abdullahi Faruk, Adekunle Matthew Sobowale, Amos Solomon, Adebiyi Niyi Mustapha, Olufemi Gboye Ogunrinde Sahel Medical Journal 2018 21(4):189-193 Background: Although hydroxycarbamide (hydroxyurea [HU]) has been in use for decades in both adults and child populations with sickle cell disease (SCD), its reported use has remained low in Africa and Nigeria where the largest number of SCD patients reside. Availability, cost, and concerns about safety and efficacy are some of the challenges to its use. Objectives: This study highlights the experience of using HU for children with sickle cell anemia in Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: A descriptive, retrospective observational study of children is presented. Demographic, clinical, and laboratory features of children on HU, the indications for therapy and adverse clinical events encountered were analyzed. Results: A total of 165 children were treated with HU over a 4-year period, their ages ranging between 0.9 and 17 years. A total of 85 (47.5%) had HU for >12 months, while 61 (34.1%) were on treatment <11 months, while 19 (10.2%) were lost to follow-up. There was a significant increase in the weight, height, fetal hemoglobin, mean corpuscular volume, and a significant reduction in white cell counts; with no differences in the packed cell volume, hemoglobin concentration, creatinine, alanine transaminase, and bilirubin levels. Adverse events and/or comorbidities were reported in 48 (56.5%) patients, while one patient discontinued treatment because of skin rash. Conclusion: This study highlights the increased utilization of HU among children in an African region, the observed clinical events, and laboratory parameters. The benefits are demonstrable, and the drug-related organ toxicities appear minimal.

Oral manifestations of dengue fever Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran Sahel Medical Journal 2018 21(4):194-198 Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever.

Target organ damage among subjects with high-normal blood pressure in a Nigerian tertiary health institution H Saidu, KM Karaye, BN Okeahialam Sahel Medical Journal 2018 21(4):199-203 Background: There is paucity of data on the relationship between high – normal blood pressure (BP) and target organ damage (TOD) in sub-Saharan Africa including Nigeria. This study therefore, aimed to assess target organ damage (TOD) among subjects with high – normal BP in comparison with hypertensives and subjects with optimal BP. Materials and Methods: The study was cross-sectional and comparative conducted at Aminu Kano Teaching Hospital, Kano on eligible subjects aged 18 years and above. Three groups comprising of randomly selected subjects (high -normal (group 1), hypertension (group 2) and optimal BP (group 3)), with each group having 100 in number were studied. Funduscopy and relevant investigations including transthoracic echocardiography were carried out. High – normal BP was defined as systolic BP of 130 -139mmHg and/or diastolic BP of 80-89mmHg. Results: The mean age of subjects in group 1 was 27.32 ± 8.20 years and 60% were female, 34.04±6.25 years for group 2 and 53% were female, and 52.81 ± 13.3 years for group 3 and 56% were female (P = < 0.001). The most prevalent TOD was left ventricular hypertrophy, present in 62% of hypertensives, 14% of those with high-normal BP and 2% of those with optimal BP(P = <0.001). Micro albuminuria and slight increase in creatinine were found in 12.9% and 6% of subjects with high-normal BP; 25.7% and 25% of hypertensives and 4.1% and 3% of subjects with optimal BP. The study found a significant progressive increase in both cardiovascular disease risk factors and target organ damage (TOD) as BP increased across the blood pressure categories from optimal BP to high – normal BP and to hypertension (P = <0.05). Conclusion: Subjects with high-normal BP had significantly higher prevalence of both TOD and cardiovascular disease risk factors than those with optimal BP but lower than hypertensives, suggesting that efforts to control BP should start early to reduce the complications of high BP.

Snakebites in a Nigerian children Population: A 5-year review Ikenna Kingsley Ndu, Benedict Onyeka Edelu, Uchenna Ekwochi Sahel Medical Journal 2018 21(4):204-207 Background: Snakebite envenomation is a worldwide problem, which is an important cause of death in the developing countries and still remains a neglected public health problem. Children sustain more severe toxicity from envenomation compared to adults and thus have different outcomes. Objectives: This study was carried out to review the demographics, risk factors, interventions, and outcomes of snakebite victims in the pediatric age group in Enugu, Southeast Nigeria, to improve the existing database. Materials and Methods: This was a descriptive, retrospective study conducted at the children emergency room (CHER) of Enugu State University Teaching Hospital (ESUTH), Enugu. The admission records of all the children that were admitted into CHER of ESUTH over a 5-year period (January 2012 to December 2016) were reviewed. Analysis was mainly descriptive. Frequency distributions of all relevant variables were reported as tables and prose. Test of significance for discrete variables was done using the Chi-square test. P <0.05 was regarded as statistically significant. Results: There were 5182 admissions with 13 cases of snakebite, giving a prevalence rate of 0.25%. Late presentation was significantly associated with longer duration of hospitalization (P = 0.026, χ2 = 4.952). Five (30.8%) patients had complications distributed as follows: one gangrenous limb (7.7%), one necrotic ulcer (7.7%), and three compartment syndromes (23.1%). Prehospital visit interventions included visit to the native doctor, local incision, application of herbs, tourniquet, and black stone application. One of the patients died, giving a case fatality rate of 7.7%. Conclusions: The prehospital emergency interventions given to snakebite victims still reflect practices that are harmful. It is possible that the majority of snakebite cases in our environment do not present to the health facilities. More efforts are required to improve the health-seeking behavior and emergency interventions for snakebite victims.

Pattern of hearing loss in a tertiary hospital in the North Western Nigeria Iliyasu Yunusa Shuaibu, Dotiro Chitumu, Ibrahim Babatunde Mohammed, Nurudeen Adebola Shofoluwe, Mohammed Aminu Usman, Aminu Bakari, Lateef Kunle Lawal Sahel Medical Journal 2018 21(4):208-212 Background: Hearing impairment is a major public health problem in developing countries. According to the World Health Organization, approximately 15% of the world's adult population has some degree of hearing loss. About one-third of those who are affected have disabling hearing loss and two-third of them live in developing countries. Aim: This study aims to determine the causes and pattern of hearing loss in Zaria, North Western Nigeria. Materials and Methods: This was a retrospective study conducted at ear, nose, and throat unit of Ahmadu Bello University Teaching Hospital Zaria, Kaduna Nigeria. The hospital is a tertiary health-care facility in North Western Nigeria and is a referral center to many primary, secondary, tertiary and private health facilities in Nigeria. The records of all patients who were managed for hearing loss in our unit over a period of 5 years between January 2011 and December 2015 were reviewed. Information obtained from the case files included demographic characteristics, main presenting symptoms, and causes of hearing loss. Findings of pure tone audiograms, tympanograms, and otoacoustic emission were also recorded. The data obtained were analyzed using statistical package for Social Science Version 21. Results: Of the 277 patients who presented with hearing loss, only 144 met the inclusion criteria. There were 86 (59.7%) males and 58 (40.3%) females with sex ratio (M:F) of 1.4:1. The mean age was 29.9 years with standard deviation of ±2.18. The most common cause of hearing loss was presbyacusis 24 (16.7%) followed by ototoxicity 14 (9.7%), most of the patients 91 (63.2%) had bilateral hearing loss while 53 (36.8%) had unilateral hearing loss. Majority 112 (77.8%) had sensorineural hearing loss, followed by 24 (16.7%) conductive and mixed 8 (5.5%). Majority of the patients 94 (64.3%) had mild to moderately severe with the remaining 50 (34.7%) having severe to profound hearing losses, respectively. Tympanometric findings showed that 118 (90.8%) and 11 (8.5%) had Types A and B tympanograms, respectively. Conclusion: Majority of the patients were adult with bilateral mild to moderately severe sensorineural hearing loss. Age-related hearing loss was the most common cause of hearing loss followed by ototoxicity.

Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit Bello Yusuf Jamoh, Sani Atta Abubakar, Sani Muhammad Isa Sahel Medical Journal 2018 21(4):213-217 Background: Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is strategically located to serve as referral center for most stable and emergency cases in the northwestern part of Nigeria. Patients also come on self-referral. Objective: This study aimed to describe the pattern of medical presentation and outcomes at the emergency unit of ABUTH over a 4-year period. Materials and Methods: A review of medical admissions into the Emergency unit of ABUTH, Zaria, between January 2013 and December 2016 was carried out using the case records of patients as well as register of admissions and discharges, information obtained were entered into a predetermined questionnaire. Results: The patients admitted during the period numbered 5193, with age range of 15–92 years. There were 2895 (56.0%) males and 2298 (44.0%), with a male-to-female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred with the highest frequency (20.6%), followed by gastrointestinal (20.5%), renal (14.5%), endocrine (13.8%), respiratory (12.4%), cardiac (9%), neurological (2.8%), and hematological (1.1%). There was a significantly (P < 0.001) higher occurrence of noncommunicable diseases (71.5%) than communicable diseases (28.5%), as well as higher male cases in renal, respiratory, hematological emergencies (P < 0.05). There were more admissions in the wet season, (April to September) while the October to January period consistently recorded the low admission rates. An increasing trend in emergency medical admissions was observed, being highest in the year 2016. The median duration of stay was 4.5 days (range of 0–12 days). The outcomes of admission revealed 470 (9%) deaths, 2012 (37%) direct discharges, and 2801 (54%) transfers to male or female medical wards. Cases of tetanus had the highest case fatality rate (45%) while hypertensive emergencies had the lowest (4%). Conclusion: There is a rising trend of communicable as opposed to non-communicable diseases' emergencies in Zaria. Of the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria.

Turnaround time for electrolytes, urea, and creatinine in a clinical laboratory Ekiye Ayinbuomwan, Tomi Mathew Adaja Sahel Medical Journal 2018 21(4):218-221 Background: Timeliness is expressed as the turnaround time and is often used by the clinician as a benchmark for laboratory performance. Clinicians depend on fast turnaround time to achieve early diagnosis and treatment of their patients and early patient discharge from emergency departments or hospital in-patient services. Determination of the turnaround time would enable a critical self- appraisal of our laboratory services and improve our turnaround time. Objective: This study assessed the turnaround time for electrolytes, urea and creatinine tests from the emergency departments of the hospital. Materials and Methods: An observational study was conducted between September and October 2016 amongst patients from the Intensive Care Unit, Accident and Emergency Department and Children Emergency Room, whose blood specimens were received at the Chemical Pathology Department for emergency electrolytes, urea and creatinine tests. A total of 122 specimens were randomly selected and the average time taken to complete each phase was measured and the overall turnaround time calculated. Data was analysed using statistics software SPSS (version 13.5). Results: Audited cases consisted of 20 (16.4%) specimens from the Intensive Care Unit, 40 (32.8%) from the Children Emergency Room and 62 (50.8%) from the Accident and Emergency Department. The average turnaround time for the Accident and Emergency Department, Intensive Care Unit, and Children Emergency room were 6.5hours, 4.2hours and 5.2hours respectively. Conclusion: This study revealed that the turnaround time for electrolytes, urea and creatinine for patients in the emergency units is quite long and requires some improvement which could be done with the use of Laboratory Information System to track specimens from the various emergency units of the hospital.

Multi-organ dysfunction syndrome as the first presentation of acute brucellosis, a case report and literature review Ibrahim Masoodi Sahel Medical Journal 2018 21(4):222-226 Multiple organ dysfunction syndrome (MODS) is a continuous process with incremental degrees of physiologic derangements in individual organs. The alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. MODS, as defined, is a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in two or more organs or organ systems that are induced by a variety of acute insults, including sepsis. The cornerstone in the management remains correction of the triggering agent. The clinical scenario of a young male who presented with progressive shortness of breath, renal failure, and epistaxis (MODS) at presentation is discussed in this report. The diagnosis of this patient was clinically quite challenging. On evaluation, he proved to have multi-organ failure due to Brucella melitensis. The patient improved with conventional B. melitensis treatment. The Brucella infection is a male predominant disease and frequently presents with typical symptoms of fever, fatigue, etc., and the diagnosis often is straightforward, but the reports of atypical presentation have been described in the literature. The heaviest disease burden of B. melitensis lies in countries of the Mediterranean basin and Arabian Peninsula. However, the disease is not uncommon in India, Mexico, and Central America. Hence, clinicians need to be aware of this clinical entity all over the globe. The report of the case and brief review of literature are presented in this report.

Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria Idris Abdullahi Nasir, Maryam Muhammad Zakari, Adamu Idris, Abdurrahman Elfulaty Ahmad Sahel Medical Journal 2018 21(4):227-228

Oral manifestations of dengue fever

Oral manifestations of dengue fever
Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran

Sahel Medical Journal 2018 21(4):194-198

Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever. 

Severe traumatic brain injury is associated with a unique coagulopathy phenotype

Background Traumatic brain injury (TBI) patients present on a spectrum from hypo- to hypercoagulability, depending on the injury complexity, severity, and time since injury. Prior studies have found a unique coagulopathy associated with TBI utilizing conventional coagulation assays such as INR; however, few studies have assessed the association of TBI and coagulopathy employing viscoelastic assays that comprehensively evaluate the coagulation in whole blood. This study aims to reevaluate the TBI-specific trauma-induced coagulopathy utilizing arrival thrombelastography (TEG). Because brain tissue is high in key pro-coagulant molecules, we hypothesize that isolated TBI is associated with pro-coagulant and hypofibrinolytic profiles compared to injuries of the torso, extremities and polytrauma including TBI. Methods Data are from the prospective Trauma Activation Protocol (TAP) study. Activated clotting time (ACT), angle, maximum amplitude (MA), 30-minute percent lysis after MA (LY30), and functional fibrinogen levels (FFLEV) were recorded. Patients were categorized into isolated severe TBI (I-TBI), severe TBI with torso and extremity injuries (TBI+TORSO/EXTREMITIES), and isolated torso and extremity injuries (I-TORSO/EXTREMITIES). Poisson regression was used to adjust for multiple confounders. Results Overall, 572 patients (48 I-TBI, 45 TBI+TORSO/EXTREMITIES, 479 I-TORSO/EXTREMITIES) were included in this analysis. The groups differed in INR, ACT, angle, MA, and FFLEV but not in LY30. When compared to I-Torso/Extremities, after adjustment for confounders, severe I-TBI was independently associated with ACT30. Conclusion Severe I-TBI was independently associated with a distinct coagulopathy with delayed clot formation but did not appear to be associated with fibrinolysis abnormalities. Low fibrinogen and longer ACT values associated with I-TBI suggest that early coagulation factor replacement may be indicated in I-TBI patients over empiric antifibrinolytic therapy. Mechanisms triggering coagulopathy in TBI are unique and warrant further investigation. Level of Evidence Level III, retrospective cohort study, prognostic University of Colorado Denver, Department of General Surgery, Trauma Research Center Financial Disclosures: The authors appreciate research support from Haemonetics with shared intellectual property. Presentation history: portions of this manuscript was presented in the form of an oral presentation at the 13th Annual Academic Surgical Congress, January 30-February 1, 2018 in Jacksonville, Florida ** Member of Western Trauma Association Acknowledgments: "Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health (T32 GM008315 and P50 GM049222), The National Heart, Lung, and Blood Institute (UM 1HL 120877) and the Department of Defense (USAMRAA, W81XWH-12-2-0028). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (or other sponsors of the project)." *Corresponding Author – Address: 13001 E. 17th Place, B119 Bldg 500, E3309 Aurora, CO 80045 Phone: (303) 724-2498, Email: angela.sauaia@ucdenver.edu © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://bit.ly/2VrC5vs

Temperature measurement in severely traumatized patients

No abstract available

from Emergency Medicine via xlomafota13 on Inoreader http://bit.ly/2Qa44fa

The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study

Introduction Over the last five years, the American Association for the Surgery of Trauma (AAST) has developed grading scales for Emergency General Surgery (EGS) diseases. In a prior validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay and mortality in skin and soft tissue infections (STI). Methods This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics and outcomes such as mortality, overall complications, hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. Results 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher LRINEC scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status and hospital-level volume. Grade V disease was significantly associated with mortality as well. Conclusion This validation effort demonstrates that Grade IV and V STI are significantly predictive of complications, hospital length of stay and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process, in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes. Study Type Prognostic/Epidemiologic retrospective multicenter trial Level of Evidence III Presented at the 78th Annual Meeting of the American Association for the Surgery of Trauma, San Diego, CA, 21 September, 2018. Address for Correspondence and Reprints: Stephanie A. Savage, MD, MS, Indiana University School of Medicine, 1604 N. Capitol Ave, Suite B253, Indianapolis, IN 46202, (317) 962-2093, stasava@iupui.edu There are no conflicts of interest related to this manuscript. Dr. Cox was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant #UL1 TR001860, and by the Agency for Healthcare Research and Quality through grant #T32HS022236. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ. There are no other financial disclosures related to this manuscript. © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://bit.ly/2VjUme3

Pediatric Emergency Department Readiness Among US Trauma Hospitals

Background Pediatric readiness among US emergency departments is not universal. Trauma hospitals adhere to standards that may support day-to-day readiness for children. Methods In 2013 4,146 emergency departments participated in the National Pediatric Readiness Project to assess compliance with the 2009 Guidelines to Care for Children in the Emergency Department. Probabilistic linkage (90%) to the 2009 American Hospital Association (AHA) survey found 1,247 self-identified trauma hospitals (levels 1, 2, 3, 4). Relationship between trauma hospital level and weighted pediatric readiness score (WPRS) on a 100-point scale was performed; significance was assessed using a Kruskal-Wallis test and pediatric readiness elements using chi-square. Adjusted relative risks (ARR) were calculated using modified Poisson regression, controlling for pediatric volume, hospital configuration, and geography. Results The overall WPRS among all trauma hospitals (1,247) was 71.8. Among those not self-identified as a children’s hospital or emergency department approved for pediatrics (EDAP) (1088), Level 1 and 2 trauma centers had higher WPRS than level 3 and 4 trauma centers, 83.5 and 71.8 respectively versus 64.9 and 62.6. Yet, compared to EDAP trauma hospitals (median 90.5), level 1 general trauma hospitals were less likely to have critical pediatric-specific elements. Common gaps among general trauma hospitals included presence of inter-facility transfer agreements for children, measurement of pediatric weights solely in kilograms, quality improvement processes with pediatric-specific metrics, and disaster plans that include pediatric-specific needs. Conclusion Self-identified trauma hospital level may not translate to pediatric readiness in emergency departments. Across all levels of general non-EDAP, non-Children’s trauma hospitals, gaps in pediatric readiness exist. Non-children’s hospital EDs (i.e. EDAPs) can be prepared to meet the emergency needs of all children and trauma hospital designation should incorporate these core elements of pediatric readiness. Level of Evidence Prognostic and epidemiological study, level III. Corresponding Author: Katherine Remick, MD, Department of Emergency Medicine, Dell Children’s Medical Center, 4900 Mueller Blvd., Austin, TX 78723, Phone: (512)393-1496, Email: kate.remick@austintexas.gov Conflicts of Interest: The authors report no conflicts of interest. Meeting Presentations: 3rd Annual Meeting of the Pediatric Trauma Society, November 11-12, 2016 in Nashville, TN Funding: This project was also partially supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U03MC00008 - Emergency Medical Service for Children Network Development. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://bit.ly/2QcWdgI