Francisella philomiragia Bacteremia in a Patient with Acute Respiratory Insufficiency and Acute-on-Chronic Kidney Disease.

Francisella philomiragia is a very uncommon pathogen of humans. Diseases caused by it are protean and have been reported largely in near-drowning victims and those with chronic granulomatous disease. We present a case of F. philomiragia pneumonia with peripheral edema and bacteremia in a renal transplant patient and review the diverse reports of F. philomiragia infections.

Prevalence of medical emergency events in primary dental care within the UK.

Introduction Dental professionals have an ethical and legal obligation to diagnose and manage medical emergencies which may occur in primary dental care.Aims and objectives To investigate the prevalence of medical emergencies in UK primary dental care and explore the medical emergency training needs of UK primary dental care professionals.Design and setting Cross-sectional survey, targeting dentists, dental hygienists and dental therapists across the UK working within primary dental care.Materials and methods An online survey was distributed via dental society mailing lists, social media groups and a dental conference. The questionnaire consisted of participants demographics and training in, prevalence of and confidence surrounding medical emergencies.Results Respondents (n = 400) were dentists (55.8%), dental hygienists/therapists (38.8%) and specialists (5.5%). Most participants received basic life support training (62%) in 2019, before COVID-19. The most common medical emergencies were syncope, non-specific collapse and hypoglycaemia, being encountered every 1.59, 1.64 and 8.26 years, respectively. The preferred method for medical emergency training was practical based, with more training in administering emergency drugs and equipment identified as a training need.Conclusion Dental professionals will encounter medical emergencies in primary dental care every 1-2 years and are therefore not uncommon.

Bond Strength and Adhesion Mechanisms of Novel Bone Adhesives.

Bone adhesives offer distinct advantages over the use of screws to attached internal fixation plates (IFPs). As the chemical composition of bone is similar to dentine, it is possible that the types of monomers used to make dentine adhesives could be utilised to affix IFPs to bone. The ability to attach a bio-resorbable IFP to porcine bone was assessed for the monomer 10-methacryloyloxydecyl dihydrogen phosphate (MDP), used either as a homopolymer or a copolymer with urethane dimethacrylate (MDP + U). Additionally, the addition of a priming step (MDP + U + P) was evaluated. The chemical interactions of the monomers with bone were assessed using XRD and imaged using TEM, revealing the formation of nano-layered structures with the MDP primer, something we believe has not been reported on bone. In a 6-week artificial aging study both MDP + U and MDP + U + P demonstrated adequate shear bond strength to affix bio-resorbable IFPs. The cytotoxicity profiles of the adhesive formulations were determined using indirect and direct contact with MC3T3 cells, with indirect conditions suggesting the MDP + U + P is as cytocompatible as the resorbable IFP. The findings of this study suggest our newly developed adhesive has the potential to be used as a bone adhesive to affix bioresorbable IFPs.

Influence of injection speed on the effectiveness of incisive/mental nerve block: a randomized, controlled, double-blind study in adult volunteers.

This randomized, double-blind trial tested the null hypothesis that speed of deposition has no influence on the injection discomfort, efficacy, distribution, and duration of pulp anesthesia after incisive/mental nerve block in adult volunteers. Thirty-eight subjects received incisive/mental nerve blocks of 2.0 mL lidocaine with 1:80,000 epinephrine slowly over 60 seconds or rapidly over 15 seconds at least 1 week apart. Pulp anesthesia was assessed electronically to 45 minutes after injection. Injection discomfort was self-recorded on visual analogue scales. Overall, 48.7% of volunteers developed pulp anesthesia in first molars, 81.8% in bicuspids, and 38.5% in lateral incisors. The mean duration of pulp anesthesia was 19.1 minutes for first molars, 28.5 minutes for bicuspids, and 19.0 minutes for lateral incisors. Speed of injection had no significant influence on anesthetic success or duration of anesthesia for individual teeth. Slow injection was significantly more comfortable than rapid injection (P < .001). The null hypothesis was supported, although slow injection was more comfortable.

Speed of injection influences efficacy of inferior alveolar nerve blocks: a double-blind randomized controlled trial in volunteers.

This randomized double-blind crossover trial investigated the efficacy and discomfort associated with slow (60 seconds) and rapid (15 seconds) inferior alveolar nerve blocks (IANB) using 2.0 ml of 2% lidocaine with 1:80,000 epinephrine in securing mandibular first molar, premolar and lateral incisor pulp anesthesia in 38 healthy adult volunteers. Episodes of maximal stimulation (80 microA) without sensation on electronic pulp testing were recorded. Injection discomfort was self-recorded by volunteers on 100 mm visual analogue scales. Data were analyzed by McNemar, Friedman, Wilcoxon Signed Ranks, and paired t tests. Slow IANB produced more episodes of no response to maximal pulp stimulation than rapid IANB in molars (220 episodes versus 159, p < 0.001), premolars (253 episodes versus 216, p = 0.003) and lateral incisors (119 episodes versus 99, p = 0.049). Slow IANB was more comfortable than rapid IANB (p = 0.021).

Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study.

This randomized crossover double-blind trial compared the efficacy of buccal infiltration with 4% articaine and 2% lidocaine (both with 1:100,000 epinephrine) in securing mandibular first molar pulp anesthesia. Injections were given at least 1 week apart in 31 healthy adult volunteers. Electronic pulp testing was undertaken at baseline and at 2 minute intervals until 30 minutes postinjection. A successful outcome was recorded in the absence of pulp sensation on two consecutive maximal pulp tester stimulations (80 muA). 64.5% of articaine and 38.7% of lidocaine infiltrations were successful (p = 0.008). Articaine infiltration produced significantly more episodes of no response to maximum stimulation in first molars than lidocaine (236 and 129, respectively, p < 0.001). Mandibular buccal infiltration is more effective with 4% articaine with epinephrine compared to 2% lidocaine with epinephrine. Both injections were associated with mild discomfort.

Determination of the mental foramen position in dental radiographs in 18-30 year olds.

OBJECTIVES: To determine the radiographic position and reliability of assessing mental foramen (MF) position in relation to premolar crowns in an 18- to 30-year-old UK-based population. METHODS: Following ethical approval and a power calculation, the position of the MF was recorded in relation to premolar crowns and apices in 100 dental panoramic tomographs. Positions were assessed by three senior clinicians independently, then by consensus. Data were analysed using descriptive statistics, χ(2) and Fleiss' and Cohen's kappa. RESULTS: Reliability data showed only fair to moderate agreement on independent scoring. Substantial to almost perfect agreement was achieved by consensus, demonstrating the most common position for the MF to be between the first and second premolar teeth when using both premolar crowns (51%) and apices (76%) as reference points. There was a significant difference in the position of the foramen between the left and right sides (p < 0.05), with only 62% of cases showing symmetry. CONCLUSIONS: The most common position for the MF is between the first and second premolar teeth; however, anatomical variation is seen. Use of pre-operative radiographs to relate the position of the MF to premolar crowns may not be reliable.

Differential Evolutionary Selection and Natural Evolvability Observed in ALT Proteins of Human Filarial Parasites.

The abundant larval transcript (ALT-2) protein is present in all members of the Filarioidea, and has been reported as a potential candidate antigen for a subunit vaccine against lymphatic filariasis. To assess the potential for vaccine escape or heterologous protection, we examined the evolutionary selection acting on ALT-2. The ratios of nonsynonymous (K(a)) to synonymous (K(s)) mutation frequencies (ω) were calculated for the alt-2 genes of the lymphatic filariasis agents Brugia malayi and Wuchereria bancrofti and the agents of river blindness and African eyeworm disease Onchocerca volvulus and Loa loa. Two distinct Bayesian models of sequence evolution showed that ALT-2 of W. bancrofti and L. loa were under significant (P<0.05; P < 0.001) diversifying selection, while ALT-2 of B. malayi and O. volvulus were under neutral to stabilizing selection. Diversifying selection as measured by ω values was notably strongest on the region of ALT-2 encoding the signal peptide of L. loa and was elevated in the variable acidic domain of L. loa and W. bancrofti. Phylogenetic analysis indicated that the ALT-2 consensus sequences formed three clades: the first consisting of B. malayi, the second consisting of W. bancrofti, and the third containing both O. volvulus and L. loa. ALT-2 selection was therefore not predictable by phylogeny or pathology, as the two species parasitizing the eye were selected differently, as were the two species parasitizing the lymphatic system. The most immunogenic regions of L. loa and W. bancrofti ALT-2 sequence as modeled by antigenicity prediction analysis did not correspond with elevated levels of diversifying selection, and were not selected differently than predicted antigenic epitopes in B. malayi and O. volvulus. Measurements of ALT-2 evolvability made by χ2 analysis between alleles that were stable (O. volvulus and B. malayi) and those that were under diversifying selection (W. bancrofti and L. loa) indicated significant (P<0.01) deviations from a normal distribution for both W. bancrofti and L. loa. The relationship between evolvability and selection in L. loa followed a second order polynomial distribution (R2 = 0.89), indicating that the two factors relate to one another in accordance with an additional unknown factor. Taken together, these findings indicate discrete evolutionary drivers acting on ALT-2 of the four organisms examined, and the described variation has implications for design of novel vaccines and diagnostic reagents. Additionally, this represents the first mathematical description of evolvability in a naturally occurring setting.

Development of a methacrylate-terminated PLGA copolymer for potential use in craniomaxillofacial fracture plates.

We synthesised methacrylate-terminated PLGA (HT-PLGA, 85:15 LA:GA, 169kDa), for potential use as an adhesively attached craniomaxillofacial fracture fixation plate. The in vitro degradation of molecular weight, pH and flexural modulus were measured over 6weeks storage in PBS at 37°C, with commercially available high (225kDa, H-PLGA) and low (116kDa, L-PLGA) molecular weight 85:15 PLGAs used as comparators. Molecular weights of the materials reduced over 6weeks, HT-PLGA by 48%, H-PLGA by 23% and L-PLGA by 81%. HT-PLGA and H-PLGA exhibited a near constant pH (7.35) and had average flexural moduli in excess of 6GPa when produced, similar to that of the mandible. After 1week storage both exhibited a significant reduction in average modulus, however, from weeks 1-6 no further significant changes were observed, the average modulus never dropped significantly below 5.5GPa. In contrast, the L-PLGA caused a pH drop to below 7.3 by week 6 and an average modulus drop to 0.6 from an initial 4.6GPa. Cell culture using rat bone marrow stromal cells, revealed all materials were cytocompatible and exhibited no osteogenic potential. We conclude that our functionalised PLGA retains mechanical properties which are suitable for use in craniofacial fixation plates.

Diplopia and ocular motility in orbital blow-out fractures: 10-year retrospective study.

OBJECTIVE: To investigate diplopia (binocular single vision [BSV] test) and ocular motility (uniocular field of fixation [UFOF] test) characteristics in blow-out fractures of the orbit and their value in fracture management. MATERIAL AND METHODS: Patients with isolated blow-out fractures treated from 2000 to 2010 were included. BSV scores were stratified into three categories: low BSV category (0-60); moderate BSV category (61-80), and high BSV category (81-100). UFOF scores were also divided into three categories: low score (60-240), moderate score (241-270), and high score (271-365) categories. RESULTS: A total of 183 patients (106 surgically and 77 conservatively managed) met the inclusion criteria. There was no significant improvement in BSV postoperatively in surgically managed patients with preoperatively high BSV, whereas there was significant improvement (p < 0.05) for the high BSV category in the conservative group. Preoperative BSV was found to be significantly related (p < 0.05) to postoperative BSV, subjective diplopia outcome, follow-up time, and number of follow-up visits. However, improvement of BSV score in the surgical group was not found to be significantly correlated with subjective outcome in relation to diplopia. Preoperative UFOF score has no influence on subjective outcome in relation to diplopia. Surgical timing, approach, and choice of implant material were not found to be statistically related to final diplopia outcome, follow-up time, or number of follow-up visits. CONCLUSIONS: BSV is better correlated with diplopia outcome, follow-up time, and number of follow-up visits than is UFOF. On the basis of this study, surgical intervention would not be recommended for blow-out fracture cases with BSV score >80% for correction of diplopia alone.

Is mandibular molar buccal infiltration a mental and incisive nerve block? A randomized controlled trial.

INTRODUCTION: The aim of this study was to compare the efficacies of buccal local anesthetic infiltrations at various sites of the mandible in order to elucidate the mechanism of action of articaine mandibular infiltrations. METHODS: After a power calculation and ethical approval, 22 volunteers received 1.8 mL 4% articaine hydrochloride with 1:100,000 adrenaline as a buccal infiltration at the canine, first, or second molar in a randomized, double-blind, crossover design. The injections at the canine and first molar were considered equidistant from the mental foramen. Responses of the first and second molars, first premolar, and lateral and central incisors were assessed using an electronic pulp tester over a 47-minute period. Volunteers were asked to rate the discomfort of each injection using a visual analog scale. Data were analyzed using repeated measures analysis, McNemar, and Mann-Whitney U testing. RESULTS: Injections at the canine and first molar teeth produced anesthesia in all teeth tested in some volunteers. There was no significant difference between anesthetic success of the first premolar after infiltration at the canine or the first molar. Injection at the second molar failed to produce anesthesia of the incisor teeth. Anesthesia was significantly more likely after injections at an adjacent site. There was no difference in discomfort associated with injections at different sites of the mandible. CONCLUSIONS: Articaine first mandibular molar infiltrations achieve an effect via a combination of modified mental and incisive nerve block and local infiltration. Infiltration at the second molar produces anesthesia of both molar and premolar teeth, primarily via infiltration.

A comparison of the anterior middle superior alveolar nerve block and infraorbital nerve block for anesthesia of maxillary anterior teeth.

BACKGROUND: The authors conducted a study to compare the efficacy of the anterior middle superior alveolar (AMSA) nerve block with that of the infra-orbital nerve block (IONB) in achieving pulpal anesthesia in the anterior maxilla. METHODS: Twenty-eight healthy adult volunteers received 1.0 milliliter of 2 percent lidocaine with 1:80,000 epinephrine as an AMSA nerve block or IONB via computer-controlled local anesthetic delivery (CCLAD) across two visits. The authors used electronic pulp testing to measure pulpal anesthesia. Participants provided subjective reports of lip numbness and injection discomfort. The authors analyzed the data by using the McNemar, Mann-Whitney and t tests. RESULTS: Anesthetic success, defined as two or more consecutive episodes of no sensation in response to maximal stimulation, was significantly greater with the AMSA nerve block than with the IONB in central (P = .012) and lateral (P < .001) incisors; however, anesthesia was achieved in only 42.9 percent of central incisors with the AMSA nerve block. The authors observed a significantly greater number of episodes of no response in the premolar and canine teeth after IONB. Onset of anesthesia was shorter after IONB in canines (P = .002) and central incisors (P = .022). The incidence of subjective lip numbness was 100 percent after IONB and 14.3 percent after AMSA nerve block (P < .001), with numbness lasting twice as long after IONB (P = .019). The authors noted no significant difference in injection discomfort between the two techniques (P = .768). CONCLUSIONS: The IONB produced anesthetic success in canine and premolar teeth, with a more rapid onset than that for the AMSA nerve block. Although the AMSA technique was significantly more successful than IONB in attaining incisor anesthesia, it was ineffective for central incisors, as assessed according to rigorous electronic pulp testing. The IONB and AMSA nerve block produced similar levels of injection discomfort.

Articaine infiltration for anesthesia of mandibular first molars.

A randomized, controlled trial of 31 healthy volunteers compared 4% articaine with 1:100,000 epinephrine buccal infiltration to buccal plus lingual infiltration of the same dose of drug in achieving pulpal anesthesia of mandibular first molar teeth. Data were compared with efficacy of an inferior alveolar nerve block using 2% lidocaine 1:80,000 epinephrine in a cohort of 27 of the volunteers. Anesthesia was determined using electronic pulp testing. Buccal and buccal plus lingual infiltrations of articaine with epinephrine did not differ in efficacy in obtaining pulpal anesthesia for mandibular permanent first molars (p = 0.17). Efficacy of 4% articaine with epinephrine infiltrations for first molar pulp anesthesia was similar to that of an IANB using lidocaine with epinephrine over a 30-minute study period (96 and 80 episodes of no response to maximal stimulation respectively, p = 0.097). Subjective tooth numbness was more common after IANB than buccal infiltration (p = 0.005). The discomfort of buccal infiltration with articaine was volume dependent (p = 0.017) and similar to that of an IANB.