The real penalty: number of OMFS patients presenting to the emergency department at Sunderland Royal Hospital after England fixtures before and during the 2018 FIFA Football World Cup.

The aim of this study was to establish a link between a large televised sporting event and the incidence of patients presenting to the emergency department with oral and maxillofacial injuries. When compared with daily attendances throughout the year, the mean (SD) number rose from 2.53 (1.69) to 4.00 (1.53) (p=0.005) between 1 November 2017 and 31 July 2018 on the day after an England fixture, an increase of 58%. These data show the need for workforce planning during large-scale national sporting events because of the rise in the number of patients presenting. They show that the increase in workload is caused by a higher number of both traumatic and non-traumatic injuries.

Condylar hyperplasia: current thinking.

Unilateral condylar hyperplasia is a rare disease that causes facial asymmetry as a result of excessive vertical or horizontal growth, or both, of the mandibular condyle. Investigation should address the patient's concerns, and establish whether the disease is active with the use of single positron emission tomography (PET). Proportional reduction of the condyle arrests active disease and restores mandibular height, and any residual asymmetry can be corrected according to conventional orthognathic principles. We recommend the use of 3-dimensional virtual planning for such complex movements. The rarity of the disease means that, to our knowledge, high-quality evidence is lacking and further research is needed.

The prevalence and clinical correlates of elevated ALT levels in an urban Chinatown community.

Alanine aminotransferase (ALT) levels are a primary consideration in treatment decisions regarding hepatitis B virus (HBV) infection. Levels can be elevated as a result of HBV-related liver injury or to other causes. The aim of this study was to assess the background prevalence and clinical correlates of elevated ALT levels in Chinese immigrants who were HBsAg negative. Subjects consisted of adults seen in an urban Chinatown Internal Medicine practice between 1, 2006 and 12, 2007. Clinical information was collected retrospectively. An elevated ALT level was defined as >19 U/L for women and >30 U/L for men. The primary analysis focused on 2457 persons who were HBsAg negative. Their mean age was 55 +/- 18 years, 64% were female and 36% were obese. All subjects were ethnically Chinese and 96% were born in Asia. Thirty percent had an elevated ALT level. In univariate analysis, factors associated with elevated ALT included older age (P < 0.001), female gender (P = 0.001), obesity (P < 0.001), diabetes (P < 0.001), hypercholesterolemia (P < 0.001) and hypertension (P < 0.001). In multivariate analysis BMI, diabetes, female gender and hypercholesterolemia were significantly associated with elevated ALT level. An additional analysis focused on a group of patients who were HBsAg positive, HBeAg negative and had HBV-DNA levels <1000 copies/mL. Fifty percent had elevated ALT levels. In conclusion, elevated ALT levels are common among Chinese immigrants without HBV (30%) and are associated with features of the metabolic syndrome. Liver biopsy should be performed in selected patients with HBV to distinguish the cause of ALT elevation before initiating antiviral therapy.

Infants in a neonatal intensive care unit: parental response.

OBJECTIVE: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU. DESIGN: Random sample of NICU parents and term non-NICU parents were assessed across a variety of psychiatric and psychosocial measures shortly after the birth of their infant. SETTING: Christchurch Women's Hospital, New Zealand. Labour ward and level III NICU. PARTICIPANTS: A total of 447 parents (242 mothers; 205 fathers) with an infant admitted to a regional NICU during a 12 month period; 189 parents (100 mothers; 89 fathers) with infants born at term and not requiring NICU admission. MAIN OUTCOME MEASURES: Depression and anxiety symptoms, psychosocial functioning. RESULTS: Overall, levels of anxiety and depression were low in both parent groups. Compared with control parents, a higher percentage of NICU parents had clinically relevant anxiety and were more likely to have had a previous NICU admission and be in a lower family income bracket. Infant prematurity was associated with higher levels of symptomatology in both NICU mothers and fathers. CONCLUSIONS: Specific interventions are not needed for most parents who have an infant admitted to the NICU as they appear to adapt relatively successfully. Infant prematurity impacts negatively on the father as well as the mother. Consequently these parents may benefit from increased clinical attention.