Acromioclavicular joint dislocation and concomitant labral lesions: a systematic review

Acromioclavicular (AC) joint dislocations frequently co-occur with intra-articular glenohumeral pathologies. Few comprehensive studies have focused on labral tears specifically associated with AC joint trauma. This systematic review will address this gap. A comprehensive electronic search was conducted across PubMed, Cochrane Library, and Google Scholar (pages 1–20) spanning from 1976 to May 19, 2023. Seven studies met the inclusion criteria for this systematic review, consisting of three retrospective studies and four case series. These studies collectively involved 1,044 patients, of whom 282 had concomitant labral lesions. The pooled prevalence of intra-articular labral injuries associated with acute AC joint dislocation was 27%. The prevalence of these labral lesions varied significantly between studies, ranging from 13.9% to 84.0% of patients, depending on the study and the grade of AC joint dislocation. Various types of labral tears were reported, with superior labrum anterior to posterior (SLAP) lesions being the most common. The prevalence of SLAP lesions ranged from 7.2% to 77.4%, with higher grades of AC joint dislocations often associated with a higher prevalence of SLAP tears. Moreover, grade V dislocations exhibited a complete correlation with SLAP tears. The studies yielded contradictory findings regarding older age and higher grades of AC joint dislocation as risk factors for concurrent labral lesions. This review underscores the frequent association between labral lesions and AC joint dislocations, particularly in cases of lower-grade injuries. Notably, SLAP lesions emerged as the predominant type of labral tear.

Amazonian forest termites: a species checklist from the State of Acre, Brazil / Térmitas da Floresta Amazônica: uma lista de espécies do Estado do Acre, Brasil

Abstract The Brazilian state of Acre is located in the southwestern Amazon and it is characterized by a humid tropical forest vegetation that covers plains and mountains. Up to this point, the composition of termite species in the state is not known. The aim of this study was to provide a checklist of termite species or recognizable taxonomic units for the state of Acre. Sampling was conducted through field expeditions at the Serra do Divisor National Park, Chandless State Park, Humaitá Forest Reserve, and Chico Mendes Environmental Park using a standardized rapid termite inventory protocol in the first two areas and active searching collections in the others, without a specific protocol. This study also included occurrence records published in the scientific literature. A total of 128 species and morphospecies of termites were found in Acre, distributed across 59 genera and four families. The most frequently occurring species in Acre was Heterotermes tenuis (Hagen, 1858). The study also identified six new species records for Brazil. The predominant feeding groups were soil-feeders and wood-feeders, as expected from data obtained from surveys in humid tropical forests. Despite the significant number of new records for Acre (112), it is concluded that a larger sampling effort is still required, as many areas of the state have not yet been studied for termites.

Resumen O estado brasileiro do Acre está localizado no sudoeste da Amazônia e é caracterizado por uma vegetação de floresta tropical úmida que cobre planícies e montanhas. Até então, a composição de espécies de térmitas no estado não é conhecida. O objetivo desse estudo foi construir um checklist de espécies ou unidades taxonômicas reconhecíveis de térmitas para o estado do Acre. A amostragem foi conduzida através de expedições de campo no Parque Nacional da Serra do Divisor, no Parque Estadual Chandless, na Reserva Florestal Humaitá, e no Parque Ambiental Chico Mendes utilizando o protocolo rápido de diversidade de térmitas nas duas primeiras áreas e coletas avulsas nas demais, sem um protocolo específico. Este estudo também incluiu registros de ocorrência publicados na literature científica. Um total de 128 espécies e morfoespécies de térmitas foram encontradas no Acre, distribuídas em 59 gêneros e quatro famílias. A espécie de ocorrência mais frequente no Acre foi Heterotermes tenuis (Hagen, 1858). O estudo também identificou seis novos registros de espécies para o Brasil. Os grupos alimentares predominantes foram os humívoros e xilófagos, como esperado a partir de dados obtidos de pesquisas em florestas tropicais úmidas. Apesar do número significativo de novos registros para o Acre (112), conclui-se que ainda é necessário um esforço amostral maior, uma vez que muitas áreas do estado ainda não foram estudadas para térmitas.

Primary ovarian mucinous carcinoid arising in a mature cystic teratoma-A rare entity

Mature cystic teratomas are benign unilateral tumors often diagnosed in young females. Carcinoid tumors are slow-growing tumors originating from neuroendocrine cells. A thorough histopathological study of the tumor is mandatory and the surgical treatment is adapted according to the characteristics of the patient. The present case was considered as a primary mucinous carcinoid tumor of the ovary because it was confined to the ovary, had an intact capsule, no vascular invasion, or other suspicious lesions were noted in the abdominal cavity. This case is notable due to the rarity of its occurrence and the age of presentation.

YouTube as a source of patient education information for elbow ulnar collateral ligament injuries: a quality control content analysis

Background@#While online orthopedic resources are becoming an increasingly popular avenue for patient education, videos on YouTube are not subject to peer review. The purpose of this cross-sectional study was to evaluate the quality of YouTube videos for patient education in ulnar collateral ligament (UCL) injuries of the elbow. @*Methods@#A search of keywords for UCL injury was conducted through the YouTube search engine. Each video was categorized by source and content. Video quality, reliability, and accuracy were assessed by two independent raters using five metrics: (1) Journal of American Medical Association (JAMA) benchmark criteria (range 0–4) for video reliability; (2) modified DISCERN score (range 1–5) for video reliability; (3) Global Quality Score (GQS; range 1–5) for video quality; (4) ulnar collateral ligament-specific score (UCL-SS; range 0–16), a novel score for comprehensiveness of health information presented; and (5) accuracy score (AS; range 1–3) for accuracy. @*Results@#Video content was comprised predominantly of disease-specific information (52%) and surgical technique (33%). The most common video sources were physician (42%) and commercial (23%). The mean JAMA score, modified DISCERN score, GQS, UCL-SS, and AS were 1.8, 2.4, 1.9, 5.3, and 2.7 respectively. @*Conclusions@#Overall, YouTube is not a reliable or high-quality source for patients seeking information regarding UCL injuries, especially with videos uploaded by non-physician sources. The multiplicity of low quality, low reliability, and irrelevant videos can create a cumbersome and even inaccurate learning experience for patients.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed

Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana

Objectives: Cervical precancer screening programs are difficult to establish in low resource settings partly because of a lack of human resource. Our aiming was to overcome this challenge. We hypothesized that this could be done through task shifting to trained nurses. Design: Descriptive retrospective cross-sectional review. Setting: Training was at the Cervical Cancer Prevention and Training Center (CCPTC) and screening was carried out at the clinic and at outreaches / peripheral facilities.Participants: All women who reported to the clinic for screening or were recruited during outreaches Interventions: All 4 nurses were trained for at least 2weeks (module 1). A total of 904 women were screened by the trained nurses using the EVA system. Quality assurance was ensured. Main outcome measures: Primary screening and follow-up were carried out by the trained nurses with quality assured through image sharing and meetings with peers and experienced gynaecologists. Results: 828 women had primary screening and 76 had follow-up screening. 739 (89.3%) were screened at the clinic and 89 (10.7%) at outreaches/peripheral facilities. Of all screened, 130 (14.5%) had cervical lesions, and 25 (2.8%) were treated, 12 (48.0%) by Loop Electrosurgical Excision Procedure (LEEP) performed by a gynaecologist, 11 (44.0%) with thermal coagulation by trained nurses except one, and 2 (8.0%) with cryotherapy by trained nurses. Conclusion: We demonstrate the utility of a model where nurses trained in basic colposcopy can be used to successfully implement a cervical precancer screening and treatment program in low-resource settings

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture:case report, literature review, and differential diagnosis

Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture:case report, literature review, and differential diagnosis

Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.

Effectiveness of levodropropizine on post-operative sore throat after endotracheal intubation for head and neck surgery: A double-blind randomized controlled trial

@#Objective: To determine the effectiveness of levodropropizine in reducing the incidence of post-operative sore throat (POST) among ear, nose, throat, head and neck (ENT-HNS) patients undergoing general endotracheal anesthesia. Methods: Design: Double-Blind, Randomized, Placebo Controlled Trial Setting: Tertiary Government Training Hospital Participants: Sixty (60) ENT-HNS patients aged between 19 to 60 years old admitted to the Southern Philippines Medical Center from January to March 2019 for surgeries on benign thyroid tumors, benign submandibular gland tumors and tonsils requiring orotracheal intubation were randomized into control and treatment groups of 30 patients each. Results: There was a statistically significant difference (p=.0016) in the incidence of POST 6 hours after surgery between control (25/30; 83%) and treatment (16/30; 53.33%) groups. However, confounders such as length and type of surgery (more females and tonsillectomy cases in the control group) were not fully eliminated by randomization. Conclusion: Perioperative levodropropizine significantly decreases the incidence of moderate (as well as mild) postoperative sore throat. It was not shown to decrease the incidence of severe sore throat. A larger cohort (adjusted for other confounders) may better describe the benefit of this treatment.

Intra-Atrial Dyssynchrony Using Cardiac Magnetic Resonance to Quantify Tissue Remodeling in Patients with Atrial Fibrillation / Dessincronia Intra-atrial à Ressonância Magnética Cardíaca para Quantificação da Remodelação Tecidual em Pacientes com Fibrilação Atrial

Abstract Background: Recent studies suggest that left atrial (LA) late gadolinium enhancement (LGE) can quantify the underlying tissue remodeling that harbors atrial fibrillation (AF). However, quantification of LA-LGE requires labor-intensive magnetic resonance imaging acquisition and postprocessing at experienced centers. LA intra-atrial dyssynchrony assessment is an emerging imaging technique that predicts AF recurrence after catheter ablation. We hypothesized that 1) LA intra-atrial dyssynchrony is associated with LA-LGE in patients with AF and 2) LA intra-atrial dyssynchrony is greater in patients with persistent AF than in those with paroxysmal AF. Method: We conducted a cross-sectional study comparing LA intra-atrial dyssynchrony and LA-LGE in 146 patients with a history of AF (60.0 ± 10.0 years, 30.1% nonparoxysmal AF) who underwent pre-AF ablation cardiac magnetic resonance (CMR) in sinus rhythm. Using tissue-tracking CMR, we measured the LA longitudinal strain in two- and four-chamber views. We defined intra-atrial dyssynchrony as the standard deviation (SD) of the time to peak longitudinal strain (SD-TPS, in %) and the SD of the time to the peak pre-atrial contraction strain corrected by the cycle length (SD-TPSpreA, in %). We used the image intensity ratio (IIR) to quantify LA-LGE. Results: Intra-atrial dyssynchrony analysis took 5 ± 9 minutes per case. Multivariable analysis showed that LA intra-atrial dyssynchrony was independently associated with LA-LGE. In addition, LA intra-atrial dyssynchrony was significantly greater in patients with persistent AF than those with paroxysmal AF. In contrast, there was no significant difference in LA-LGE between patients with persistent and paroxysmal AF. LA intra-atrial dyssynchrony showed excellent reproducibility and its analysis was less time-consuming (5 ± 9 minutes) than the LA-LGE (60 ± 20 minutes). Conclusion: LA Intra-atrial dyssynchrony is a quick and reproducible index that is independently associated with LA-LGE to reflect the underlying tissue remodeling.

Resumo Fundamento: Estudos recentes sugerem que o realce tardio com gadolínio (RTG) no átrio esquerdo (AE) pode quantificar a remodelação tecidual subjacente que abriga a fibrilação atrial (FA). No entanto, a quantificação do RTG-AE requer um trabalho intenso de aquisição por ressonância magnética e pós-processamento em centros experientes. A avaliação da dessincronia intra-atrial no AE é uma técnica de imagem emergente que prediz a recorrência da FA após ablação por cateter. Nós levantamos as hipóteses de que 1) a dessincronia intra-atrial está associada ao RTG-AE em pacientes com FA e 2) a dessincronia intra-atrial é maior em pacientes com FA persistente do que naqueles com FA paroxística. Método: Realizamos um estudo transversal comparando a dessincronia intra-atrial no AE e o RTG-AE em 146 pacientes com história de FA (60,0 ± 10,0 anos, 30,1% com FA não paroxística) submetidos à ressonância magnética cardíaca (RMC) durante ritmo sinusal antes da ablação da FA. Com utilização de RMC com tissue tracking, medimos o strain longitudinal do AE em cortes de duas e quatro câmaras. Definimos a dessincronia intra-atrial como o desvio padrão (DP) do tempo até o pico do strain longitudinal (DP-TPS, em %) e o DP do tempo até o pico do strain antes da contração atrial corrigido pela duração do ciclo (DP-TPSpreA, em %). Utilizamos a razão da intensidade da imagem (RIM) para quantificar o RTG-AE. Resultados: A análise da dessincronia intra-atrial levou 9 ± 5 minutos por caso. A análise multivariada mostrou que a dessincronia intra-atrial no AE esteve independentemente associada ao RTG-AE. Além disso, a dessincronia intra-atrial no AE foi significativamente maior em pacientes com FA persistente do que naqueles com FA paroxística. Por outro lado, não houve diferença significativa no RTG-AE entre pacientes com FA persistente e paroxística. A dessincronia intra-atrial no AE mostrou excelente reprodutibilidade e sua análise foi menos demorada (5 ± 9 minutos) do que o RTG-AE (60 ± 20 minutos). Conclusão: A dessincronia intra-atrial no AE é um índice rápido, reprodutível e independentemente associado ao RTG-AE para indicar remodelação tecidual subjacente. (Arq Bras Cardiol. 2019; 112(4):441-450)

Levothyroxine versus levothyroxine with iodine in reduction of thyroid nodule volume: a double-blind randomized controlled trial

@#<p><strong>Objective: </strong>To compare levothyroxine alone and in combination with iodine on thyroid nodule volume reduction.</p><p><strong>Methods: </strong></p><p><strong>Design:           </strong>Double-Blind Randomized Controlled Trial</p><p><strong>Setting:           </strong>Tertiary Government Hospital</p><p><strong>Participants: </strong>Nineteen (19) euthyroid patients age 19-54 with at least 1 cytologically benign thyroid nodule were randomized to receive either levothyroxine + iodine or levothyroxine + placebo, taken once a day for 6 months with ultrasound and thyroid stimulating hormone monitoring on the 3rd and 6th month of intervention.</p><p><strong>Results: </strong>Main outcome measures included thyroid nodule volume reduction after six months of intervention. The mean change in volume from baseline to six months of levothyroxine + iodine group showed no statistically significant difference in nodule volume across time between  levothyroxine + placebo group, -0.010 ± 1.250 (CI -0.521 - 0.501) versus 0.507 ± 1.128 (CI 0.025 - 0.990), p=.158.  There were also new nodules (4 nodules) in the placebo group and none in the iodine group. No major adverse events were noted during the study.</p><p><strong>Conclusion: </strong>The two groups did not significantly differ in terms of nodule volume reduction.</p><p><strong>Keywords:</strong> thyroid nodule, prevention and control; drug therapy; iodine compounds, therapeutic use; levothyroxine, therapeutic use</p>

Lesión quística en un premolar superior relacionada con un molar primario pulpotomizado / Lesão cística num pré-molar superior relacionada com um molar decíduo pulpotomizado / Cystic lesion on an upper premolar related to pulpotomized primary molar

La pulpotomía es un tratamiento endodóncico frecuentemente realizado en niños. A pesar de que se trata de un procedimiento seguro, se han reportado efectos secundarios. Caso clínico: Un niño de 10 años de edad llegó para revisión dental. Los resultados de los rayos X mostraron una lesión radiolúcida por encima del segundo molar primario superior izquierdo, relacionada con el diente permanente. La extracción de los primeros y segundos molares primarios se realizó bajo anestesia local. La lesión quística se eliminó quirúrgicamente, y el análisis histopatológico mostró un quiste dentígero inflamatorio. Una cavidad casomarsupialización fue creada para permitir la erupción de los premolares. Después de un año de seguimiento, el hueso se había regenerado totalmente y los premolares habían erupcionado completamente. Conclusión: Este caso resalta la necesidad de una supervisión regular de los dientes pulpotomizados, incluso si están asintomáticos, además de la fase de erupción de los dientes permanentes y primarios. La marsupialización del quiste dentígero permitió el tratamiento eficaz y la preservación del premolar involucrado.

A pulpotomia é um tratamento endodôntico frequentemente realizado em crianças. Ainda que seja um procedimento seguro, efeitos colaterais foram reportados. Relato de caso: Um menino de 10 anos veio para um check-up dentário. Os resultados da radiografia mostraram uma lesão radiolúcida acima do segundo molar superior esquerdo, relacionada com o dente permanente. A extração dos primeiros e segundos molares decíduos foi realizada sob anestesia local. A lesão cística foi removida cirurgicamente e a análise histopatológica revelou um cisto dentígero inflamado. Uma cavidade marsupialização foi criada para permitir a erupção dos pré-molares. Depois de um ano de acompanhamento, o osso encontrava-se completamente regenerado e os pré-molares tinham erupcionado completamente. Conclusão: Este relato de caso destaca a necessidade de uma supervisão regular dos dentes pulpotomizados, mesmo se estes são assintomáticos, tal como acontece na fase de erupção dos dentes permanentes e decíduos. A marsupialização do cisto dentígero proporcionou um tratamento eficaz e permitiu a preservação do pré-molar envolvido.

Pulpotomy is a frequent endodontic treatment performed in children. Even though it is a safe procedure, side effects have been reported. Case Report: A 10-year-old boy came for a dental checkup. X-ray findings showed a radiolucent lesion above the maxillary second deciduous left molar, related to the permanent tooth. Extraction of the first and second deciduous molars was realized under local anesthesia. The cystic lesion was removed surgically, and histo-pathological analysis showed an inflammatory dentigerous cyst. A marsupialization cavity was created to allow eruption of the premolars. After a one-year follow-up, the bone had completely regenerated, and premolars had completely erupted. Conclusion: This case report highlights the need for regular supervision of pulp treated teeth, even if they are asymptomatic, as well as eruption phase of permanent and deciduous teeth. Marsupialization of the dentigerous cyst provided effective treatment and allowed preservation of the involved premolar.

Acquired hemophilia presenting as gross hematuria following kidney stone - a case report and review of the literature

ABSTRACT A rare condition in itself, acquired hemophilia A, seldom presents as isolated gross hematuria. It is a serious condition with a high mortality rate and thus clinical suspicion followed by prompt diagnosis is imperative (1). In fact, only 8 cases of such presentation of this condition have been reported thus far in the literature. Of these, none describe the initial presentation of hematuria with the inciting event of a kidney stone. We present a case of a 67-year-old man with signs and symptoms of nephrolithiasis accompanied by profuse hematuria, who was subsequently found to have developed expression of factor VIII inhibitor leading to acquired hemophilia A.

Bleeding time using Moringa oleifera (Malunggay) leaf extract versus saline control in a rabbit epistaxis model: A randomized controlled trial

OBJECTIVE: To determine bleeding time using Moringa oleifera leaf extract versus saline control in an experimental epistaxis model.METHODS:Design: Randomized controlled trialSetting: Tertiary Government Training HospitalParticipants: Ten adult male New Zealand White rabbits were acclimatized for 1 week in a standard environment. One-centimeter long, full-thickness mucosal wounds in the junction of the nasal floor and anterior part of the septum were treated randomly with topical Moringa oleifera extract or colored isotonic saline control in either right or left nasal cavity, one site at a time. The duration of bleeding - time bleeding started to time bleeding stopped -- was recorded in seconds. Data was subjected to a t-test for paired samples.RESULTS: The mean bleeding time for wounds treated with Moringa extract was 53 seconds (range 38-70 secs), versus 159 seconds (range 100-218 secs) for controls. The bleeding time in the former was significantly shorter than in the latter (p = .000019, t-stat = 8.139), with a mean difference of 106 seconds between the two groups.CONCLUSION: Moringa oleifera leaf extract was associated with significantly shorter bleeding time than saline control in this experimental epistaxis model and may be worth investigating further as a hemostatic agent for epistaxis.

Bleeding time using Moringa oleifera (Malunggay) leaf extract versus saline control in a rabbit epistaxis model: A randomized controlled trial

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine bleeding time using Moringa oleifera leaf extract versus saline control in an experimental epistaxis model.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Randomized controlled trial<br /><strong>Setting:</strong> Tertiary Government Training Hospital<br /><strong>Participants:</strong> Ten adult male New Zealand White rabbits were acclimatized for 1 week in a standard environment. One-centimeter long, full-thickness mucosal wounds in the junction of the nasal floor and anterior part of the septum were treated randomly with topical Moringa oleifera extract or colored isotonic saline control in either right or left nasal cavity, one site at a time. The duration of bleeding - time bleeding started to time bleeding stopped -- was recorded in seconds. Data was subjected to a t-test for paired samples.<br /><strong>RESULTS:</strong> The mean bleeding time for wounds treated with Moringa extract was 53 seconds (range 38-70 secs), versus 159 seconds (range 100-218 secs) for controls. The bleeding time in the former was significantly shorter than in the latter (p = .000019, t-stat = 8.139), with a mean difference of 106 seconds between the two groups.<br /><strong>CONCLUSION:</strong> Moringa oleifera leaf extract was associated with significantly shorter bleeding time than saline control in this experimental epistaxis model and may be worth investigating further as a hemostatic agent for epistaxis.</p>

Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.

Objective: Metabolic acidosis after deep hypothermic circulatory arrest (DHCA) for thoracic aortic operations is commonly managed with sodium bicarbonate (NaHCO3). The purpose of this study was to determine the relationships between total NaHCO3 dose and the severity of metabolic acidosis, duration of mechanical ventilation, duration of vasoactive infusions, and Intensive Care Unit (ICU) or hospital length of stay (LOS). Methods: In a single center, retrospective study, 87 consecutive elective thoracic aortic operations utilizing DHCA, were studied. Linear regression analysis was used to test for the relationships between the total NaHCO3 dose administered through postoperative day 2, clinical variables, arterial blood gas values, and short‑term clinical outcomes. Results: Seventy‑five patients (86%) received NaHCO3. Total NaHCO3 dose averaged 136 ± 112 mEq (range: 0.0–535 mEq) per patient. Total NaHCO3 dose correlated with minimum pH (r = 0.41, P < 0.0001), minimum serum bicarbonate (r = −0.40, P < 0.001), maximum serum lactate (r = 0.46, P = 0.007), duration of metabolic acidosis (r = 0.33, P = 0.002), and maximum serum sodium concentrations (r = 0.29, P = 0.007). Postoperative hypernatremia was present in 67% of patients and peaked at 12 h following DHCA. Eight percent of patients had a serum sodium ≥ 150 mEq/L. Total NaHCO3 dose did not correlate with anion gap, serum chloride, not the duration of mechanical ventilator support, vasoactive infusions, ICU or hospital LOS. Conclusion: Routine administration of NaHCO3 was common for the management of metabolic acidosis after DHCA. Total dose of NaHCO3 was a function of the severity and duration of metabolic acidosis. NaHCO3 administration contributed to postoperative hypernatremia that was often severe. The total NaHCO3 dose administered was unrelated to short‑term clinical outcomes.

Evaluation of Thyroid Hormones Changes and CD4+ T-cell Count during Menstrual Cycle in Pulmonary TB Infected Women in Nnewi, Nigeria.

Background: Tuberculosis remains a disease of major public health importance worldwide including Nigeria. Endocrine abnormalities have been reported among Tuberculosis patients with the thyroid inclusive. Aims of Study: The present study was designed to evaluate the thyroid hormones changes and CD4+ T-cell count during menstrual cycle in women infected with Pulmonary Tuberculosis in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south east Nigeria. Materials and Methods: The study comprised 90 premenopausal females aged 15-45 years randomly recruited at Direct Observed Therapy (DOT) Clinic at NAUTH, Nnewi from 2013-2014. 30 participants were Symptomatic TB infected females who were not yet on drugs at the time of sample collection while 30 were Symptomatic TB infected females on Anti tuberculosis therapy. The remaining 30 were apparently healthy hospital staff with regular menstrual cycle. After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples were collected at follicular and luteal phases of their menstrual cycle for analysis of Thyroid hormones (T3, T4 and TSH) using Enzyme Linked Immunosorbent Assay (ELISA) method. CD4 T-cell counts was determined using cyflow SL Green Cytometer. Results: Result showed significantly lower T3 and CD4 T-cells with normal TSH values in Symptomatic TB compared with control females at both phases of menstrual cycle (P=.05 respectively). TSH value was significantly lowered in Symptomatic TB than Symptomatic TB on ATT while T3 and CD4 T-cell count were significantly higher in Symptomatic TB on ATT compared to Symptomatic TB at both phases of menstrual cycle (P=.05). Conclusion: Euthyroid sick syndrome was observed among Symptomatic TB females which showed some level of improvements with administration of ATT. A new national strategic plan for TB control is advocated to include routine thyroid function check with special attention paid to the reproductive function.

Rhinofacial conidiobolomycosis in a 16-year-old girl

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present the case of a 16-year-old girl with progressive facial disfigurement spanning 11 months due to conidiobolomycosis<br /><strong>METHODS:</strong><br /><strong>Design</strong>: Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results-- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma- resulting in delayed provision of appropriate treatment. On the fourth biopsy using the Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed. <br /><strong>CONCLUSION:</strong> Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.</p>

A 15-year occult foreign body in the subglottic area of a 50-year-old woman

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of subglottic foreign body (FB) impaction in a 50-year-old woman diagnosed with bronchial asthma for 15 years.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Public Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 50-year-old woman with recurrent cough and dyspnea for 15 years that had been managed as a bronchial asthma developed stridor and halitosis in the last 5 years. Flexible laryngoscopy revealed a subglottic mass and CT scan confirmed a suspicious foreign body in the lumen of the subglottis. Signs and symptoms resolved after peroral endoscopic removal of the foreign body from the larynx. Histopathology of the extracted material from the airway confirmed it to be "bone tissue".<br /><strong>CONCLUSION:</strong> Foreign body aspiration can occur in adults without predisposing factors. Its diagnosis can be challenging as it can mimic respiratory disorders such as bronchial asthma. Endoscopy and computed tomography are valuable for correct diagnosis and management. An incorrect initial diagnosis should be considered in the light of unresolved symptoms and prompt referral to an appropriate specialist may prevent undue suffering and dangerous complications. </p>

The impact of cleft lip and palate repair on maxillofacial growth / 国际口腔科学杂志·英文版

Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects: early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate; Veau's pushback palatoplasty and Langenbeck's palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth; timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Still, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not.