Do Implant Retained Prostheses Improve the Quality of Life of Patients with Extraoral Maxillofacial Defects - A Systematic Review.

BACKGROUND: There is limited evidence available regarding patient satisfaction and quality of life assessment in patients with extraoral maxillofacial prostheses. OBJECTIVES: This systematic review aims to understand the impact of extraoral implant retained prosthesis in improving the quality of life in patients with extraoral maxillofacial defects/abnormalities. METHODS: A comprehensive search was performed of nine electronic databases up to August 2022, which yielded three articles that satisfied the inclusion criteria. The study characteristics and findings were extracted, and the included studies were assessed for quality. RESULTS: Three cohort studies were selected. Despite the lack of uniformity in the quality of life instruments, there was a general trend in improvement in the quality of life for patients with implant retained extraoral prostheses. The studies were also deemed to be of high quality on assessment. CONCLUSION: Given the limitations of this systematic review, there exists limited evidence indicating that implant prostheses may enhance the quality of life for individuals with extraoral maxillofacial defects or abnormalities.

Burnout in trauma and orthopaedics: a cross-sectional study of surgeons from across the United Kingdom.

INTRODUCTION: Improving psychological wellbeing in healthcare professionals has demonstrable links with improvements in system-performance and patient outcomes. The aims of this study were to determine the prevalence of burnout among orthopaedic surgeons within the United Kingdom (UK) and to identify any influencing factors. METHODS: This prospective, cross-sectional nationwide study used the Oldenburg Burnout Inventory to assess burnout among orthopaedic registrars, middle grades and consultants from across the UK. In total, 369 participants completed an anonymised online survey. Reasons for burnout were assessed using a list of 20 stressors followed by a white-space box for elaboration. RESULTS: Respondents included 204 (55.3%) consultants, 100 (27.1%) registrars and 65 (17.6%) who were an associate specialist, trust grade or fellow. Some 252 (68.3%) participants experienced moderate-level burnout and 81 (22.0%) high-level burnout. There was no significant association between burnout and grade (p = 0.283), gender (p = 0.433), marital status (p = 0.932), years since graduation (p = 0.397), overseas training (p = 0.642), hours worked (p = 0.601), region (p = 0.699) or hospital type (p = 0.813). A high level of disengagement and exhaustion were identified, with the latter being a greater contributory factor. The most common reasons for burnout were insufficient staff numbers, an overload of administrative work and limited time to see patients. CONCLUSION: There was a moderate to high level of burnout among orthopaedic surgeons within the UK. Clinical and management teams should focus on improving staff numbers, reducing administrative work and increasing clinic consultation times to limit any further disengagement and exhaustion from surgeons. Reducing burnout may help to improve mental wellbeing, work satisfaction and workforce productivity.

EPA Consensus Project Paper: Do Implant- Supported/Retained Prostheses Improve the Quality of Life of Patients with Intraoral Maxillofacial Defects? - A Systematic Review.

BACKGROUND: There is limited evidence available regarding patient satisfaction and quality of life assessment in patients with intraoral maxillofacial defects managed with maxillofacial prostheses. OBJECTIVES: This systematic review aims to understand the impact of intraoral implant prostheses in improving the quality of life in patients with intraoral maxillofacial defects/abnormalities. METHODS: A comprehensive search was performed of nine electronic databases from January 1970 to August 2022. Hand searching of the reference lists of the included papers and of relevant journal publications between 2012 and 2022 was also undertaken. Key information was extracted from included studies alongside quality and risk of bias assessments. RESULTS: The systematic review encompassed a total of seven studies, comprising five retrospective and two prospective investigations, with one of the prospective studies being a randomised clinical trial. The evaluation of the risk of bias and quality assessment revealed heterogeneity in the results, preventing meaningful comparisons among the included studies. CONCLUSION: Within the limitation of the systematic review, there is limited evidence to suggest that implant prostheses improve the quality of life in patients with intraoral maxillofacial defects or abnormalities.

Reversal of direct oral anticoagulants in adult hip fracture patients. A systematic review and meta-analysis.

BACKGROUND: Increasing numbers of patients are taking Direct Oral Anticoagulants at the time of hip fracture. Evidence is limited on how and if the effects of DOAC's should be reversed before surgical fixation. Wide variations in practice exist. We conducted a systematic review to investigate outcomes for three reversal strategies. These were: "watch and wait" (also referred to as "time-reversal"), plasma product reversal and reversal with specific antidotes. METHODS: A systematic search was conducted using multiple databases. Results were obtained for studies directly comparing different DOAC reversal strategies in hip fracture patients and for studies comparing DOAC-taking hip fracture patients (including patients "reversed" using any method and "non-reversed" patients) against matched controls taking either a vitamin-K antagonist or not receiving anticoagulation therapy. This allowed construction of a network meta-analysis to indirectly compare outcomes between "reversed" and "non-reversed" DOAC patients. With respect to "watch and wait"/"time-reversal", a cut-off time to surgery of 36 hours was used to distinguish between "time-reversed" and "non time-reversed" DOAC patients. The primary outcome was early/inpatient mortality, reported as Odds Ratios (OR). RESULTS: No studies investigating plasma products or reversal agents specifically in hip fracture patients were obtained. Fourteen studies were suitable for analysis of "watch and wait"/"time- reversal". Two studies directly compared "time-reversed" and "non time-reversed" DOAC-taking hip fracture patients (58 "time-reversed", 62 "non time-reversed"). From 12 other studies we used indirect comparisons between "time-reversed" and "non time-reversed" DOAC patients (total, 357 "time-reversed", 282 "non time-reversed"). We found no statistically significant differences in mortality outcomes between "time-reversal" and "non time-reversal" (OR 1.48 [95%CI: 0.29-7.53]). We also did not find a statistically significant difference between "time reversal" and "non time-reversal" in terms of blood transfusion requirements (OR 1.16 [95% CI 0.42-3.23]). However, several authors described that surgical delay is associated with worse outcomes related to prolonged hospitalisation, and that operating within 36 hours is safe. CONCLUSIONS: We suggested against "watch and wait" to reverse the DOAC effect in hip fractures. Further work is required to assess the optimal timing for surgery as well as the use of plasma products or specific antidotes in DOAC-taking hip fracture patients.

Waterlow score for risk assessment in surgical patients: a systematic review.

INTRODUCTION: The Waterlow score (WS) is used routinely in clinical practice to assess risk of pressure sore development. Recent studies have also suggested its use in preoperative risk stratification. The primary aim of this systematic review was to evaluate the current evidence on the WS in predicting morbidity and mortality in surgical patients. METHODS: A systematic review was carried out in accordance with PRISMA and SWiM guidelines. A search strategy was conducted on the MEDLINE and EMBASE databases. Quality was assessed using the Newcastle-Ottawa scale. FINDINGS: Overall, 72 papers were identified, of which 7 met inclusion criteria for full text review, and 4 were included for analysis. All studies were cohort in nature and published between 2013 and 2016, encompassing a total of 505 surgical patients. The studies included general, vascular, transplant and orthopaedic surgery. A high WS was demonstrated to have statistically significant association with increased morbidity and mortality as well as need for intensive care unit admission and length of stay. Furthermore, this was a more accurate predictor compared with the P-POSSUM and ASA scoring systems used currently in routine practice. CONCLUSIONS: The WS is a promising tool for risk stratification of surgical patients. It is already collected routinely by nursing staff throughout hospitals in the UK and would therefore be easy to implement. However, further large prospective studies are required in order to validate these findings prior to its establishment for this role in everyday surgical practice.

The global burden of trauma during the COVID-19 pandemic: A scoping review.

Purpose; The COVID-19 pandemic has necessitated profound adaptations in the delivery of healthcare to manage a rise in critically unwell patients. In an attempt to slow the spread of the virus nationwide lockdown restrictions were introduced. This review aims to scope the literature on the impact of the pandemic and subsequent lockdown on the presentation and management of trauma globally. Methods; A scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search was carried out on the Medline, EMBASE and Cochrane databases to identify papers investigating presentation and management of trauma during the COVID-19 pandemic. All studies based on patients admitted with orthopaedic trauma during the COVID-19 pandemic were included. Exclusion criteria were opinion-based reports, reviews, studies that did not provide quantitative data and papers not in English. Results; 665 studies were screened, with 57 meeting the eligibility criteria. Studies reported on the footfall of trauma in the UK, Europe, Asia, USA, Australia and New Zealand. A total of 29,591 patients during the pandemic were considered. Mean age was 43.7 years (range <1-103); 54.8% were male. Reported reductions in trauma footfall ranged from 20.3% to 84.6%, with a higher proportion of trauma occurring secondary to interpersonal violence, deliberate self-harm and falls from a height. A decrease was seen in road traffic collisions, sports injuries and trauma occurring outdoors. There was no significant change in the proportion of patients managed operatively, and the number of trauma patients reported to be COVID-19 positive was low. Conclusion; Whilst the worldwide COVID-19 pandemic has caused a reduction in the number of trauma patients; the services managing trauma have continued to function despite infrastructural, personnel and pathway changes in health systems. The substantial effect of the COVID-19 pandemic on elective orthopaedics is well described, however the contents of this review evidence minimal change in the delivery of effective trauma care despite resource constraints during this global COVID-19 pandemic.

Isolated Neurogenic Bladder Associated With Human T-Lymphotropic Virus Type 1 Infection in a Renal Transplant Patient From Central Australia: A Case Report.

BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1-infected individuals without HAM/TSP has been reported, and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide, but not an isolated neurogenic bladder. CASE: A 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid HTLV-1 proviral load. The magnetic resonance imaging myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures, and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonization of the urinary tract. CONCLUSION: Isolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes.

An Unusual Case of Pulmonary Mucormycosis.

Invasive fungal infections in solid organ transplant recipients are associated with significant morbidity and mortality. Of these fungal infections, mucormycosis presents as an aggressive, frequently fatal angioinvasive infection. Immunocompromised hosts and diabetes are important risk factors. These infections are frequently difficult to diagnose. A high index of suspicion in the appropriate setting and early, aggressive treatment with the newer antifungal agents have altered the previously grave prognosis. We present the first reported case of cavitating pulmonary mucormycosis in a renal transplant recipient caused by an unusual species of Mucorales. The patient was treated with a combination of lobectomy and antifungal treatment comprising of amphotericin B and posaconazole. He remains free of disease recurrence on monotherapy with posaconazole.

Nitrogen acquisition and resource allocation strategies in temperate seagrass Zostera nigricaulis: Uptake, assimilation and translocation processes.

The dominant seagrass in Port Phillip Bay (PPB), Australia, Zostera nigricaulis, declined between 2000 and 2011, coinciding with the 'Millennium drought' that ended in 2009. These seagrasses are nitrogen-limited, underpinning the need to develop nitrogen budgets for better ecosystem management. Environmentally realistic measurements of specific uptake rates and resource allocation were undertaken to develop nitrogen budgets and test the hypothesis that the above-ground and below-ground compartments are able to re-mobilise ammonium and nitrate through uptake, translocation and assimilation to adapt to varying levels of nitrogen in the ecosystem. Uptake of 15N labelled ammonium and nitrate by above- and below-ground seagrass biomass, epiphytes and phytoplankton was quantified in chambers in situ. Preferential uptake of ammonium over nitrate was observed, where the uptake rate for nitrate was about one sixth of that for ammonium. Epiphytes and phytoplankton also registered an increased affinity for ammonium over nitrate. Translocation experiments demonstrated the uptake by both the above-ground and below-ground biomass, respectively from the water column and pore water, and subsequent translocation to the opposite compartment. Acropetal translocation (below- to above-ground biomass) was more prevalent than basipetal translocation. This is a unique outcome given basipetal translocation has been widely reported for Zostera by other researchers.

Molecular and Cellular Requirements for the Assembly of Tertiary Lymphoid Structures.

At sites of chronic inflammation, recruited immune cells form structures that resemble secondary lymphoid organs (SLOs). Those are characterized by segregated areas of prevalent T- or B-cell aggregation, differentiation of high endothelial venules (HEVs) and local activation of resident stromal cells. B-cell proliferation and affinity maturation towards locally displayed autoantigens have been demonstrated at those sites, known as tertiary lymphoid structures (TLSs). TLS formation has been associated with local disease persistence and progression as well as increased systemic manifestations. While bearing a similar histological structure to SLO, the signals that regulate TLS and SLO formation can diverge, and a series of pro-inflammatory cytokines has been ascribed as responsible for TLS formation at different anatomical sites. Here we review the structural elements as well as the signals responsible for TLS aggregation, aiming to provide an overview to this complex immunological phenomenon.

Uptake of inorganic phosphorus by temperate seagrass beds of Posidonia and Amphibolis in Southern Australia.

Seagrasses occupy a narrow band of sandy seabed close to the coast and are therefore vulnerable to anthropogenic influences, particularly meadows near large population centres. Over 5000 ha of seagrasses have been lost from Adelaide coastal waters (South Australia) over the past 70 years and much of this loss has been attributed to nutrient inputs from wastewater, industrial and stormwater discharges. This led to the Adelaide Coastal Waters Study to understand processes along the Adelaide metropolitan coast that led to seagrass loss. This study, a subset of the larger ACWS study, used in situ nutrient spike approach to obtain ecologically relevant estimates of seasonal variability in phosphorus uptake in two species of temperate seagrass common to this coast (Amphibolis antarctica and Posidonia angustifolia). Total uptake of phosphorus by biological components in the seagrass beds, viz., seagrass, epiphytes and phytoplankton, was negligible, never exceeding 0.5% of the total resource. Phosphorus uptake rate varied seasonally with higher rates in winter (1.49 µmol P.g(-1) DW.h(-1)) and lower rates in spring (0.70 µmol P.g(-1) DW.h(-1)) for Amphibolis and highest in winter (2.09 µmol P.g(-1) DW.h(-1)) and least in spring (0.14 µmol P.g(-1) DW.h(-1)) for Posidonia. Low biological uptake rates of inorganic phosphorus could be attributed to carbonate sediments and particulates in the water column binding inorganic phosphorus, limiting its availability for biological uptake. From an environmental perspective, seagrass beds in the Adelaide coastal waters account for the assimilation of only 5.4% (19.53 t yr(-1)) of the total anthropogenic inputs of phosphorus.

Protein-polymer functionalized aqueous ferrofluids showing high T2 relaxivity.

Controlled size, shape and dispersibility of superparamagnetic iron oxide nanoparticles (SPIONs), has been achieved in a protein-polymer colloidal dispersion. Stable ferrofluid (FF) is synthesized in an aqueous medium of collagen, bovine serum albumin and poly(vinyl) alcohol that equilibrates with time, at ambient conditions, into an organized matrix with iron oxide particles sterically caged at defined sites. It mimics a biomineralization system; hence the process is termed biomimetics. Though the exact mechanism is not understood at this stage, we have established, with serial dilution of the protein-polymer solution that the SPIONs are formed inside the self-contained clusters of the two proteins and the polymer, which show a tendency to self assemble. More than the interparticle dipolar attractions of magnetic particles, electrostatic interactions play a role in cluster formation and collagen is responsible for the overall stability, supported by systematic dynamic light scattering data. The basic aim of this study was to increase magnetization of a previously synthesized ferrofluid without hampering stability, by reducing the total macromolecular concentration. Thrice the magnetization was achieved and in addition, the synthesized FFs exhibited very high transverse relaxivity and showed good contrast in mice liver, in the in vivo studies.

Managing nitrogen inputs into seagrass meadows near a coastal city: flow-on from research to environmental improvement plans.

Increased human habitation has led to a 30 to 50-fold increase in nutrient loads to the coastal waters of Adelaide, resulting in the loss of over 5000 ha of seagrass meadows. The rate of loss since the 1940s has been irregular, averaging 85 ha yr(-1), marked by a substantial peak between 1971 and 1977. A modelling approach allowed comparison of the annual input with the annual uptake rates for the different biotic components in the seagrass bed. In 2005, the estimated uptake of ammonium (465 t yr(-1)) and nitrate (3.04 t yr(-1)) by the seagrass and associated epiphytes in the Adelaide region accounted for 31% of the ammonium and <1% of the nitrate that is currently discharged into the coastal waters. Environment Improvement Programs, such as the one implemented in 1996, may reduce the total nitrogen loads to 700 t yr(-1), possibly stemming further losses and facilitating recolonisation of new seagrass.

Molecular characterization of Chikungunya virus during an outbreak in South India.

INTRODUCTION: Re-emergence of Chikungunya is a major public health problem in the southern states of India. OBJECTIVES: This study was undertaken to investigate an outbreak of Chikungunya, in June-August 2008 using PCR and determine the prevalent genotypes of Chikungunya virus (CHIKV) associated with the outbreak. MATERIALS AND METHODS: Samples of blood were collected (in heparinized vacutainer tubes) from suspected patients of CHIKV infection from both Government Taluk Hospital in Kerala and a tertiary care hospital in Chennai, Tamil Nadu. A one-step RT-PCR was carried out on a block thermo-cycler targeting the E2 gene that codes for the viral envelope protein. The amplicons were verified for 305 bp size by standard agarose gel electrophoresis. The PCR products were purified, sequenced, and compared with other CHIKV strains reported from different geographical regions. A phylogenetic tree was constructed using MEGA 4. RESULTS: Altogether 118 samples were collected from patients who presented with sudden onset of fever and/or joint pain, myalgia, and headache. CHIKV infection was confirmed by RT-PCR in 14 patients and all these cases were from Kerala. The positivity correlated with the early stage of the disease as all these patients had fever of less than seven days duration. The study isolates have been allotted the GenBank accession nos. GQ272368-GQ272381. Phylogenetic analysis of recent CHIKV isolates by partial sequencing of E2 region shows that isolates are closely related to strains from neighboring states and the African type. CONCLUSION: RT-PCR is a useful technique for the early detection of CHIKV infection during outbreaks. Molecular characterization of the strains indicates that majority of the strains have originated from the Central/East African strains of CHIKV.

Uptake and resource allocation of ammonium and nitrate in temperate seagrasses Posidonia and Amphibolis.

Ecologically relevant estimates of seasonal variability in nitrogen uptake and allocation in two species of temperate seagrasses were obtained using in situ isotope-labelling approach. Significantly higher uptake rates of ammonium by leaves, roots and epiphytes of Amphibolis than Posidonia were observed. Overall, root uptake rates were lower than other components. Effect of season was not significant for leaves, roots or epiphytes of the two species. However, plankton uptake varied seasonally with higher rates in winter (0.98 mg N g(-1)D Wh(-1)). In contrast, nitrate uptake rates for various components were significantly affected by seasons. Uptake rates by plankton were highest ranging from 0.003 mg N g(-1)D Wh(-1) (summer, Amphibolis) to 0.69 mg N g(-1)DWh(-1) (winter, Posidonia). Uptake of nitrate by roots was negligible. Biotic uptake rates for nitrate were an order of magnitude slower than ammonium, demonstrating an affinity for ammonium over nitrate as a preferred inorganic nitrogen source. Adelaide coastal waters have lost over 5000 ha of seagrasses, much of this attributed to nutrient inputs from wastewater, industrial and stormwater. Managing these inputs into future requires better understanding of the fate of nutrients, particularly biological uptake. This study attempts to quantify uptake rates of nitrogen by seagrasses.

Extramedullary paraspinal hematopoiesis in hereditary spherocytosis.

Hereditary spherocytosis (HS) is a common inherited hemolytic anemia due to red cell membrane defects. Extramedullary hematopoiesis is a compensatory response to insufficient bone marrow blood cell production. The preferred sites of extramedullary hematopoietic involvement are the spleen, liver and lymph nodes; but in HS, the posterior paravertebral mediastinum is also commonly involved. We report a case of a 50-year-old male who presented to us in respiratory distress and with bilateral paravertebral posterior mediastinal masses, which on trucut biopsy were found to be extra-hematopoietic masses; and the patient was found to have hereditary spherocytosis.

Environmental effects of dredging on sediment nutrients, carbon and granulometry in a tropical estuary.

This monitoring study encompassed a period prior to dredging, during dredging and post dredging between July 1999 to June 2000 in Ponggol estuary located along the northeastern coast of Singapore. Mean concentrations of sediment nutrients in mg x Kg(-1) (+/- standard error of means) prior to dredging, during dredging and post dredging were 9.75 +/- 4.24, 8.18 +/- 4.29 and 11.46 +/- 4.74 for ammonium, 0.08 +/- 0.05, 0.06 +/- 0.02 and 0.09 +/- 0.01 for nitrite, 0.04 +/- 0.04, 0.11 +/- 0.17 and 0.25 +/- 0.30 for nitrate, 4.83 +/- 3.48, 0.77 +/- 0.48 and 8.33 +/- 9.73 for phosphate respectively. Pre dredge, dredge and post dredge levels of total carbon (TC) were 18.5 +/- 3.7, 20.2 +/- 3.5 and 34.6 +/- 12.0, of total organic carbon (TOC) were 10.5 +/- 2.9, 19.5 +/- 3.6 and 34.6 +/- 12.0 and of total inorganic carbon (TIC) were 7.9 +/- 1.0, 0.7 +/- 0.4 and non detectable in the sediments, respectively. Both, sediment nutrients and carbon registered lower concentrations with onset of dredging, with the exception of nitrate and TOC. A shift in sedimentary carbon from inorganic carbon to organic carbon was also observed with the onset of the dredging activities when the organically enriched historically contaminated layer was exposed. Sediment granulometry showed that the sediments in the estuary were predominantly silt and clay prior to dredging, which changed to sand with onset of dredging. Silt load in the sediments was highest post-dredge. Sediment nutrients and sediment organic carbon were observed to associate with the finer fractions (silt and clay) of sediments. Finer fractions of sediments get resuspended during a dredging event and are dispersed spatially as the result of tides and water movements. Prior to this study, the potential for nutrient release and sediment granulometry due to dredging have been suggested, but there have been few studies of it, especially in the tropics. The baseline information gathered from this study could be used to work out effective management strategies to protect similar tropical ecosystems elsewhere, should there be no other alternative to dredging.

Outbreak of chikungunya due to virus of Central/East African genotype in Malaysia.

Chikungunya is an acute febrile illness caused by an alphavirus which is transmitted by infective Aedes mosquitoes. Two previous outbreaks of chikungunya in Malaysia were due to chikungunya virus of Asian genotype. The present outbreak involved two adjoining areas in the suburb of Ipoh city within the Kinta district of Perak, a state in the northern part of Peninsular Malaysia. Thirty seven residents in the main outbreak area and two patients in the secondary area were laboratory confirmed to be infected with the virus. The index case was a 44-year Indian man who visited Paramakudi, Tamil Naidu, India on 21st November 2006 and returned home on 30th of November 2006, and subsequently developed high fever and joint pain on the 3rd of December 2006. A number of chikungunya virus isolates were isolated from both patients and Aedes albopictus mosquitoes in the affected areas. Molecular study showed that the chikungunya virus causing the Kinta outbreak was of the Central/East African genotype which occurred for the first time in Malaysia.

Co-infection of dengue virus and chikungunya virus in two patients with acute febrile illness.

During an outbreak of chikungunya in a dengue hyperendemic area within the Kinta district of Perak, two patients with acute febrile illness were laboratory confirmed to have co-infection of both dengue and chikungunya viruses in their blood. The concomitant presence of two types of viruses transmitted by the same vector in a susceptible population contributed to the resultant event. A good understanding of virus vector ecology in association with population dynamics and wider application of improved laboratory techniques by using different cell-lines suited for optimal replication of each type of virus and the correct utilization of powerful molecular techniques will enhance accurate diagnosis of these infectious diseases.