Assessment of the effect of unfractionated heparin administered either by intravenous infusion vs. subcutaneous injection on heparin-binding protein, and plasminogen activator inhibitor-1 in critically ill septic patients: a randomized controlled trial.

OBJECTIVE: The study compared the impact of unfractionated heparin (UFH) administered via two routes (infusion and subcutaneous injection) on heparin-binding protein (HBP) and plasminogen activator inhibitor-1 (PAI-1) levels in critically ill sepsis patients. PATIENTS AND METHODS: Forty critically ill sepsis patients were randomly assigned to receive either a low-dose intravenous infusion of UFH (500 units/hour) or subcutaneous UFH (5,000 units/8 hours) for seven days. HBP and PAI-1 were measured at baseline and on days one, two, and seven. RESULTS: Intravenous administration of UFH showed a significant reduction in percentage change of HBP compared to subcutaneous administration on days one [(-35% vs. -13%, p = 0.03*) (*indicates a significant result *p < 0.05, relative to the subcutaneous group)] and seven (-62% vs. -39%, p = 0.02*). Also, the percentage change of PAI-1 was significantly reduced in the infusion group compared to the subcutaneous group on days one (-28% vs. -3%, p = 0.008*), two (-42% vs. -3%, p = 0.001*), and seven (-62% vs. 27%, p = 0.001*), respectively. Furthermore, a significant improvement in the 14-day survival was observed in the infusion group compared to the subcutaneous group (p = 0.008*). CONCLUSIONS: Intravenous infusion was the route of choice for UFH administration in critically ill septic patients, with a promising effect on HBP, PAI-1, and survival.

Genotyping of avian infectious bronchitis virus in Afghanistan (2016-2017): the first report.

BACKGROUND: Avian infectious bronchitis (IB) is a highly contagious viral disease which affects the poultry industry. The virus exists in a wide variety of genotypes, and phylogenetic analysis has been used to classify infectious bronchitis virus (IBV) strains. AIMS: The object of the study is a molecular characterization of circulating IBV in Afghanistan as a first study. METHODS: The tracheal tissue specimens from 100 different commercial broiler flocks with respiratory distress in Afghanistan were collected during 2016-2017. After real-time reverse transcriptase-polymerase chain reaction (RRT-PCR), IBV-positive samples were further characterized. A 390 bp hypervariable spike glycoprotein gene segment was amplified using Nested PCR, sequenced, and analyzed. RESULTS: The results of real-time RT-PCR showed that 45/100 of the mentioned flocks were IBV positive. Phylogenetic analysis of all positive samples revealed that IBV strains were clustered into two distinct genotypes: LX4 (GI-19) (9/45) and IS-1494 like (GI-23) (34/45). Also, 2 of the 45 samples remained uncharacterized. CONCLUSION: It is the first study focusing on the molecular epidemiology of IBV in Afghanistan, extending our understanding of IB in the region. These results showed the high rate of IB infection in Afghanistan broiler farms and confirm the continuing monitoring of IBVs to modify the vaccination program.

Effects of a novel marine probiotic, Lactobacillus plantarum AH 78, on growth performance and immune response of Nile tilapia (Oreochromis niloticus).

AIMS: Evaluation of the efficacy of marine lactic acid bacteria, Lactobacillus plantarum AH 78, on growth performance and immune response of Nile tilapia (Oreochromis niloticus) challenged with Aeromonas hydrophila. METHODS AND RESULTS: Marine probiotic, Lact. plantarum AH 78, was incorporated in Nile tilapia diets at 0·0, 0·5, 1·0 or 2·0% (w/w). The diets were fed to juvenile Nile tilapia for 40 days, after which they were challenged with pathogenic bacterium, Aer. hydrophila. The best growth rates and feed efficiency were obtained at 0·5% probiotic, while fish survival was not affected by dietary probiotic. After challenge with Aer. hydrophila immunological responses and survival were recorded at 1·0% probiont. Likewise, significant up-regulation of the expression of cytokine genes, IL-4, IL-12 and IFN-γ, in fish livers was found at 1·0% probiont, compared to the control diet. Concomitantly, AH 78 colonized the intestinal mucosa of treated fish, even after reverting to the control diet, and remained viable in the feed stored at 4°C up to 12 months. CONCLUSIONS: Marine Lact. plantarum AH 78 at 0·5-1·0% inclusion level conferred the best performance and immune response of Nile tilapia challenged with Aer. hydrophila. SIGNIFICANCE AND IMPACT OF THE STUDY: Marine Lact. plantarum AH 78 could be considered as a potential probiotic to control disease outbreaks in farmed Nile tilapia.

Assessment of the relationship between perceptions of dental aesthetics and demand for orthodontic treatment in 10-11 year old school children in Birmingham, UK.

OBJECTIVE: To examine the relationship between perceptions of dental aesthetics and demand for orthodontic treatment, and to determine whether the former can be used to predict the latter. METHOD: A prospective cross sectional epidemiological survey of a random and representative sample of comprehensive primary schools in South Birmingham, UK. Participants were 389 randomly selected school children aged 10-11 years from 7 primary schools in South Birmingham. Their perceptions of dental aesthetics were determined using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Demand for treatment was assessed by asking subjects if they wanted treatment with braces to correct their teeth. RESULTS: Only 2% of subjects assessed their dentition in the "definite need" for orthodontic treatment category. Demand for treatment was significantly greater in girls than boys (49% and 37% respectively, p < 0.05). Total demand (41%) was considerably greater than self assessed aesthetics in the "definite need" and "borderline need" categories combined (14%). Demand was accurately reflected in patients who perceived their dentition as having moderate to severe (AC 6-9) and very mild aesthetic impairment (AC 1). CONCLUSIONS: Perceptions of dental aesthetics using the AC of IOTN were able to predict demand for orthodontic treatment in patients with malocclusions of moderate to severe (AC 6-9) aesthetic impairment.

Students' attitudes towards an on-line orthodontic learning resource.

AIM: The purpose of this study was to develop an online undergraduate orthodontic e-course and assess its success as a learning resource from the students' perspective. METHODOLOGY: The orthodontic e-course was composed of six main components; modules, photo gallery, clinical consultations, glossary, reading lists and resources. Four undergraduate orthodontic lectures were converted into a web-based format using text, photographs, PowerPoint presentations and animations. The sample was comprised of sixty-four third year undergraduate dental students at Birmingham Dental School, UK. Their average age was 20.7 years (age range: from 20-25 years). A questionnaire was developed to assess; course design, course delivery, course outcome and the potential use of the e-course as a teaching method. RESULTS: There were no significant difference between genders (P < 0.05). Overall, student responded very positive to positive for course design, course delivery and course outcome. The orthodontic e-course was still seen by most subjects (86%) as an adjunct and not a replacement of the traditional teaching methods. 34.4% of subjects felt that it should be as an optional supplement and 51.6% felt that it should be integrated with the undergraduate orthodontic curriculum. The significance of the program as a learning resource was reported to be the best aspect of the program. CONCLUSION: Delivery of web-based material in the undergraduate orthodontic curriculum was seen by students as a significant learning resource which supplements traditional learning methods.

Cephalometric norms in an Arabic population.

AIM: To identify cephalometric norms for a Jordanian population. DESIGN: A cross sectional study using a sample selected on the basis of a balanced face and a Class I occlusion. MATERIALS AND METHODS: 65 subjects aged 14-17 years were selected from a larger sample on the basis of Class I incisors, a balanced profile and no previous orthodontic treatment. Lateral skull radiographs were digitised directly to produce values for SNA, SNB, ANB, UI/MX, LI/MN, UI/LI, MMPA and LI/A-Pog. RESULTS: SNA and SNB were very close to the Eastman Standards. MMPA was significantly lower in Jordanians whilst UI/MX and LI/MN were significantly higher. Lower incisors were 4.6 mm further forward in relation to A-Pog in Jordanians.

Orthodontic treatment need in Jordanian school children.

OBJECTIVE: To assess the need for orthodontic treatment among Jordanian school children. RESEARCH DESIGN: The vehicle of this study was the dental health component (DHC) of the index of orthodontic treatment need (IOTN). The examinations were carried out using mouth mirrors and stainless steel rulers. No more than 30 school children were examined at one time to prevent examiner fatigue. SETTING: Clinical examinations were carried out on the school premises under natural lighting. PARTICIPANTS: 320 10th grade school children aged 14 to 17 years were selected at random to represent the four main areas of Amman as divided by the Ministry of Education in Jordan. MAIN OUTCOME MEASURES: A 'definite need' for orthodontic treatment was recorded if the patient fell into grades four and five of the IOTN, while grade 3 represented 'borderline need' and grades 2 and 1 'no need' for treatment. RESULTS: A 'definite need' for treatment was recorded in 28% of children and 22% had 'border line' need on dental health grounds. Three main occlusal features were responsible for allocating children into the former category; severe displacements of more than 4 mm (45%), increased overjet of greater than 6 mm but less than or equal to 9 mm (22%) and impeded eruption of teeth (24%). CONCLUSIONS: This study has shown that 28% of Amman school children were in need of orthodontic treatment for dental health reasons.

Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery.

Vascular thrombosis remains a dreaded complication of any microvascular procedure, be it composite tissue transfer or replantation of amputated limbs or parts. Despite the tremendous advances in microvascular-related technologies and the accumulated surgical skills, failures caused by occlusion of anastomosed vessels remain a continuous source of frustration to all microsurgeons alike. Several anticoagulation and antiplatelet protocols have been proposed to be used in conjunction with microvascular surgery. More recently, thrombolytic drugs such as urokinase, streptokinase, and thrombolysin have been introduced, yet their systemic effect on hemostasis remains an undesirable side effect. We present our experience with local intra-arterial, intravenous, and soft-tissue injection of recombinant tissue plasminogen activator rt-PA in replantation surgery in three consecutive patients. Arterial thrombi are managed by intra-arterial rt-PA infusion with the catheter placed proximal to the arterial anastomosis. Venous thrombi are best lysed by infusing rt-PA in an engorged vein of the replanted limb. In replanted digits, direct intravenous infusion is not possible. In such situations, injection of rt-PA in the pulp soft tissues may result in successful salvage. We believe this agent also has a role in microvascular composite tissue transfer in preventing free flap failures as well as in salvaging failing flaps.

An appraisal of the Peer Assessment Rating (PAR) Index and a suggested new weighting system.

The PAR Index was developed to measure treatment outcome in orthodontics. Validity was improved by weighting the scores of some components to reflect their relative importance. However, the index still has limitations, principally due to the high weight assigned to overjet. Difficulties also arise from the application of one weighting system to all malocclusions, since occlusal features vary in importance in different classes of malocclusion. The present study examined PAR Index validity using orthodontic consultant assessments as the 'Gold standard' and clinical ranking of occlusal features and statistical modelling to derive a new weighting system, separate for each malocclusion class. Discriminant and regression analyses were used to derive new criteria for measuring treatment outcome. As a result a new and more sensitive method of assessment is suggested which utilizes a combination of point and percentage reductions in PAR scores. This was found to have better correlations with the 'Gold standard' than the PAR nomogram.

Necrotising infection of the orofacial tissues in neonates (noma neonatorum). Case report.

Noma neonatorum should be differentiated from noma, in that it is typically a disease of seriously ill premature infants whose birth weight was low, and is caused by Pseudomonas aerugenosa septicaemia. We know of only two case reports of noma neonatorum involving newborn infants born at full term, so we report here another case of noma neonatorum in a neonate born at full term. In addition we describe the differences between noma neonatorum and noma (cancrum oris), a clinically related entity.

Local intravenous thrombolysis with recombinant tissue plasminogen activator for salvage of forearm replantation.

Microvascular anastomoses are at risk of thrombosis, especially when repairing avulsed or crushed tissues, or when ischemia time is prolonged. When all surgical techniques to avoid thrombosis of the microanastomoses fail, thrombolytic agents may play a role in dissolving the thrombus and preventing rethrombosis. The authors present a case in which recombinant tissue plasminogen activator (rt-PA) was locally infused to salvage thrombosed venous microanastomoses after replantation of an amputated forearm. They also review the effects of different thrombolytic agents, and emphasize the benefits of rt-PA and its promising role in microsurgery.

Vascularized fascial patch for repair of suboccipital dural defect.

Advanced knowledge about cutaneous vascularity has enabled the development of axial flaps such as fasciocutaneous, septocutaneous, and musculocutaneous flaps. It has also laid the foundation for microsurgical free flaps. The newly emerging concept of angiosomes sheds yet more light on the complexity and multiplicity of peripheral blood supply. We describe the use of an extended vertical trapezius flap carrying a segment of latissimus dorsi muscle with the underlying paraspinal fascia to close an infected and irradiated posterior fossa craniectomy and dural defect. This flap illustrates the elevation of an angiosomal block of tissues as an axial flap vascularized by the alternative major blood supply of one of its constituents. The potentials of this "angiosomal flap" are explored. A brief review of dural defect repair is also presented.

Giant cell tumor (osteoclastoma) of the mandible: a diagnostic dilemma and a therapeutic challenge.

A recurrent giant cell lesion of bone 4.5 years after initial curettage from the mandibular body is described in a 40-year-old premenopausal female patient. Giant cell tumor is exceedingly rare in this location and histologically may be indistinguishable from giant cell reparative granuloma. The treatment rationale for this particular patient was extrapolated from the treatment of giant cell tumor in other more commonly involved bones. En bloc resection is indicated irrespective of the grade or stage of the tumor, provided satisfactory reconstruction can be achieved. The morbidity from tumor treatment should never, in any case, exceed the morbidity from the tumor itself.

Bacille Calmette-Guérin (BCG)-itis of the hand: a potential hazard for health workers.

The bacille Calmette-Guérin vaccine has been used widely for several decades in tuberculosis prophylaxis. More recently, it has been used therapeutically in the management of neoplastic diseases such as malignant melanoma and urinary bladder tumors. Complications of the b. Calmette-Guérin vaccine and therapy are widely reported in the literature. However, its potential hazard to health workers is not well described. We present a case of b. Calmette-Guérinitis on the extensor surface of the left ring finger of a surgical resident following an accidental prick with a contaminated syringe while installing intravesical b. Calmette-Guérin to a patient being treated for a bladder tumor. A brief review of tuberculous hand infection is presented together with its recommended treatment. A review of the various usages of b. Calmette-Guérin is also presented, stressing the various reported complications.

Microvascular soft-tissue coverage and distraction osteosynthesis for lower-extremity salvage.

In our attempts to salvage massive lower-extremity injuries, even in the presence of severe peripheral vascular pathology, adequate soft-tissue coverage is no longer a limiting factor due to recent advances in microvascular composite tissue transfer. Restoration of tibial continuity without shortening has emerged as the last obstacle in the formidable task of salvaging lower extremities with grade III B and III C defects. Proposed solutions to this problem include conventional free cancellous bone-grafting applicable to small defects only, vascularized bone grafts, or shortening of the leg with subsequent elongation using the Ilizarov technique. We present our experience with 3 consecutive cases of lower-limb salvage, utilizing a new approach in which microsurgical soft-tissue reconstruction has been combined with bony reconstruction by distraction osteosynthesis. Bone transport by distraction osteosynthesis under a free flap performed while preserving the initial limb length throughout the treatment period proved to be superior to other methods in selected cases and is presented as a new technique for the management of problematic lower-limb injuries.

The effects of archwire forces on incisor intrusion.

The forces exerted by archwires were measured in association with both Begg and Straight-Wire attachments. Seven stainless steel and three nickel-titanium wires were tested at vertical deflections equivalent to 20, 30, and 40 degrees, these being incorporated via anchor bends or reverse curve of Spee as appropriate to each system. All seven brands of stainless steel arches demonstrated similar performance. An increase in archwire diameter from 0.016 to 0.018 inch increased intrusive forces by 64 per cent for stainless steel and 58 per cent for nickel-titanium. Increasing anchor bend or reverse curve of Spee produced considerable force increases across the range of specimens. Begg archforms produced more force than Straight-Wire archforms of similar deflection when attached to molars only. Attachment of archwires to second premolars in addition to molars reduced the intrusive forces produced by Begg arches, but increased the forces of Straight-Wire arches.