Swiss paediatric dentists' preferences and experience on the use of articaine and other local/topical anaesthetics.

PURPOSE: This study was conducted to explore the preference and experience of paediatric dentists based in Switzerland regarding the use of articaine and other local and topical anaesthesia. METHODS: An 18-question survey was developed, piloted, and distributed to the members of the Swiss association of paediatric dentistry (n = 460). The following information were collected: most used local anaesthetic in different age groups, time needed to inject a full ampule, frequency of observed local and systemic side effects, application of topical anaesthetic prior to injection, time waited between application and the injection, and perceived effectiveness of topical anaesthetic. The dentists' responses were analysed with logistic regressions reporting odds ratios (OR) and 95% confidence intervals (CI) at 5%. RESULTS: The response rate was 37% (n = 168) out of the 460 questionnaires sent, with the responders being predominantly female (67%) and 47-year-old on average. More than 80% of the dentists used articaine in all age groups. 45% of responders took longer than 60 s to inject a full ampule. Local and systemic side-effects were observed by 82% and 28% of respondents respectively, although the nature and the significance of those were not detailed due to the anonymous nature of the questionnaire. Significantly less local adverse effects were seen for older children (p = 0.04) and among dentists with more years of experience (p = 0.01). Most responders applied topical anaesthetic and half of them waited longer than 60 s before injection. CONCLUSIONS: Articaine is a widely used local anaesthetic by the studied group of Swiss paediatric dentists regardless of patient's age. The use of topical anaesthetic before injection is a common practice with good perceived effectiveness.

In vitro evaluation of fissure sealants' wear under erosive, abrasive and erosive/abrasive conditions.

PURPOSE: To evaluate and compare the wear of selected resin-based fissure sealants with different compositions properties under erosive, abrasive, and erosive/abrasive conditions. METHODS: Forty-five samples of the following resin-based fissure sealants were prepared: Fissurit (fluoride free), Fissurit F (with fluoride), Fissurit FX (55 wt.% filler content), Grandio Seal (70 wt.% nano-filler content) and bovine enamel. Fifteen samples from each material were randomly allocated into three groups according to the wear condition they would be subjected to as follows: erosive condition (citric acid, 1 min, pH 2.3), abrasive condition (120 brushing strokes at 2 N, toothpaste slurry RDA value = 69), and erosive/abrasive condition (combination of both). The wear challenges were repeated six times each day for 10 days. The material wear was measured using a stylus profilometer. Kruskal-Wallis and Conover's test was applied to compare the resulting material wear between the groups. RESULTS: Under erosive conditions, Grandio Seal and Fissurit FX showed statistically significantly the least material wear. Under abrasive and erosive/abrasive conditions, Grandio Seal showed statistically significantly the least material wear. Fissurit F showed statistically significantly the highest material wear under abrasive and erosive/abrasive conditions, after dental enamel (p < 0.05). CONCLUSION: Higher filler content in sealants leads to better wear resistance. Incorporating fluoride into sealants seems to reduce their wear resistance at similar filler contents.

Identifying the Clinical and Histological Risk Factors affecting Post-Biopsy Voiding Efficiency: An Observational Closed Cohort Study.

BACKGROUND: There is a variability in the reported rate of post-prostate biopsy voiding inefficiency. The burden and potential predictors of this morbidity is not well studied in African patients. This study aimed to evaluate the incidence as well as the clinical and histological factors affecting voiding function in patients undergoing trans-rectal prostate biopsy in an African population. SUBJECTS, MATERIALS AND METHODS: An observational cohort study was carried out in 68 adult males, 40 years and above, scheduled for trans-rectal prostate biopsy for suspected prostate cancer. Those who could not void spontaneously, had either neurological conditions or were on drugs that could affect voiding, were excluded from the research. Data on demographic characteristics of the patients were collected. Uroflowmetry was done to obtain the peak urine flow rate of the patients at baseline and seven days after the procedure. The prostate volume was determined and the presence of other potential clinical and histological risk factors were recorded. The presence of other bleeding-related biopsy complications was also recorded. Statistical analysis was done using SPSS with a p-value of less than 0.05 reported as significant. RESULTS: Voiding inefficiency was recorded in 28 (41.2%) of the patients with majority, 21 (75.0%), experiencing a five to nine-point decrease in their seventh day peak flow rate values. Post-biopsy haematuria occurred in 37 (54.4%) of the population. The presence of haematuria with blood clots was associated with a 10.9 times increased risk of voiding inefficiency after the procedure (p = 0.006). CONCLUSION: About two in five patients developed post-prostate biopsy voiding inefficiency. Blood clot presence was independently. associated with the occurrence of this morbidity.

CONTEXTE: Le taux d'inefficacité mictionnelle après une biopsie de la prostate est variable l'inefficacité prostate. Le fardeau et les et les prédicteurs potentiels de cette morbidité ne sont pas bien étudiés chez les patients africains. Cette étude visait à évaluer l'incidence ainsi que les facteurs cliniques et histologiques affectant la fonction mictionnelle chez les patients subissant une biopsie transrectale de la prostate dans une population africaine. SUJETS, MATÉRIEL ET MÉTHODES: Une étude de cohorte observationnelle a été réalisée chez 68 adultes âgés de 40 ans et plus, programmés pour une biopsie transrectale de la prostate. Ceux qui ne pouvaient pas uriner spontanément, souffraient de troubles neurologiques ou etaient drogues qui peut agissaient la miction ont été exclus de la recherche. Les données sur les caractéristiques démographiques des patients ont été recueillies. Une uroflowmétrie a été fait pour obtenir le débit urinaire de pointe des patients au début de l'étude et sept jours après l'intervention. Le volume de la prostate a été déterminé et la présence d'autres facteurs de risque cliniques et facteurs de risque potentiels, cliniques et histologiques, ont été enregistrés. La présence d'autres complications de la biopsie liées au saignement a également été enregistrée. L'analyse statistique a été effectuée à l'aide du logiciel SPSS, une valeur p inférieure à 0,05 étant considérée comme significative. RÉSULTATS: L'insuffisance mictionnelle a été enregistrée chez 28 (41,2 %) des patients. La majorité d'entre eux, 21 (75,0 %), présentant une diminution de cinq à neuf points dans leurs valeurs de débit de pointe au septième jour. Une hématurie post-biopsie est survenue chez 37 (54,4 %) de la population. La présence d'une hématurie avec caillots sanguins était associée à un risque 10,9 fois plus élevé d'inefficacité mictionnelle après la procédure (p = 0,006). CONCLUSION: Environ deux patients sur cinq ont développé une insuffisance mictionnelle après une biopsie de la prostate. La présence de caillots sanguins était indépendamment associée à l'apparition de cette morbidité. Mots-clés: Symptômes du bas appareil urinaire, biopsie de la prostate, facteurs de risque, rétention urinaire.

Detecting asymptomatic carriage of Plasmodium falciparum in southern Ghana: utility of molecular and serological diagnostic tools.

BACKGROUND: Asymptomatic malaria infections can serve as potential reservoirs for malaria transmission. The density of parasites contained in these infections range from microscopic to submicroscopic densities, making the accurate detection of asymptomatic parasite carriage highly dependent on the sensitivity of the tools used for the diagnosis. This study sought to evaluate the sensitivities of a variety of molecular and serological diagnostic tools at determining the prevalence of asymptomatic Plasmodium falciparum parasite infections in two communities with varying malaria parasite prevalence. METHODS: Whole blood was collected from 194 afebrile participants aged between 6 and 70 years old living in a high (Obom) and a low (Asutsuare) malaria transmission setting of Ghana. Thick and thin blood smears, HRP2 based malaria rapid diagnostic test (RDT) and filter paper dried blood spots (DBS) were prepared from each blood sample. Genomic DNA was extracted from the remaining blood and used in Plasmodium specific photo-induced electron transfer polymerase chain reaction (PET-PCR) and Nested PCR, whilst the HRP2 antigen content of the DBS was estimated using a bead immunoassay. A comparison of malaria parasite prevalence as determined by each method was performed. RESULTS: Parasite prevalence in the high transmission site of Obom was estimated at 71.4%, 61.9%, 60%, 37.8% and 19.1% by Nested PCR, the HRP2 bead assay, PET-PCR, HRP2-RDT and microscopy respectively. Parasite prevalence in the low transmission site of Asutsuare was estimated at 50.1%, 11.2%, 5.6%, 0% and 2.2% by Nested PCR, the HRP2 bead assay, PET-PCR, RDT and microscopy, respectively. The diagnostic performance of Nested PCR, PET-PCR and the HRP2 bead assay was similar in Obom but in Asutsuare, Nested PCR had a significantly higher sensitivity than PET-PCR and the HRP2 bead assay, which had similar sensitivity. CONCLUSIONS: Nested PCR exhibited the highest sensitivity by identifying the highest prevalence of asymptomatic P. falciparum in both the high and low parasite prevalence settings. However, parasite prevalence estimated by the HRP2 bead assay and PET-PCR had the highest level of inter-rater agreement relative to all the other tools tested and have the advantage of requiring fewer processing steps relative to Nested PCR and producing quantitative results.

Persistent Plasmodium falciparum infections enhance transmission-reducing immunity development.

Subclinical infections that serve as reservoir populations to drive transmission remain a hurdle to malaria control. Data on infection dynamics in a geographical area is required to strategically design and implement malaria interventions. In a longitudinal cohort, we monitored Plasmodium falciparum infection prevalence and persistence, and anti-parasite immunity to gametocyte and asexual antigens for 10 weeks. Of the 100 participants, only 11 were never infected, whilst 16 had persistent infections detected by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR), and one participant had microscopic parasites at all visits. Over 70% of the participants were infected three or more times, and submicroscopic gametocyte prevalence was high, ≥ 48% of the parasite carriers. Naturally induced responses against recombinant Pfs48/45.6C, Pfs230proC, and EBA175RIII-V antigens were not associated with either infection status or gametocyte carriage, but the antigen-specific IgG titers inversely correlated with parasite and gametocyte densities consistent with partial immunity. Longitudinal analysis of gametocyte diversity indicated at least four distinct clones circulated throughout the study period. The high prevalence of children infected with distinct gametocyte clones coupled with marked variation in infection status at the individual level suggests ongoing transmission and should be targeted in malaria control programs.

Development and application of therapeutic antibodies against COVID-19.

The pandemic of Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) continues to be a global health crisis. Fundamental studies at genome, transcriptome, proteome, and interactome levels have revealed many viral and host targets for therapeutic interventions. Hundreds of antibodies for treating COVID-19 have been developed at preclinical and clinical stages in the format of polyclonal antibodies, monoclonal antibodies, and cocktail antibodies. Four products, i.e., convalescent plasma, bamlanivimab, REGN-Cov2, and the cocktail of bamlanivimab and etesevimab have been authorized by the U.S. Food and Drug Administration (FDA) for emergency use. Hundreds of relevant clinical trials are ongoing worldwide. Therapeutic antibody therapies have been a very active and crucial part of COVID-19 treatment. In this review, we focus on the progress of therapeutic COVID-19 antibody development and application, discuss corresponding problems and challenges, suggesting new strategies and solutions.

Evaluating Postgraduate Surgical Education Experience, Professional Satisfaction and Personal Well-Being: A Cross-Sectional Survey of Trainees in A Low-Middle Income Country in Sub-Saharan Africa.

BACKGROUND: Education at the postgraduate level is important in grooming competent specialists in different fields of surgical care. This study aimed to evaluate the training experience, professional satisfaction, and personal well-being of postgraduate surgical residents in northern Nigeria. SUBJECTS, MATERIALS AND METHODS: It was a cross-sectional survey of 157 medical doctors enrolled for a minimum of 6 months in surgical residency training in tertiary hospitals in the northern zone of the country. All participants filled a pre-tested questionnaire and their responses were analyzed using Statistical Package for the Social Sciences version 20. RESULTS: The respondents had a mean age of 34.4 ± 4.8 years. Thirty-two (20.5%) agreed that there was a balance between their training needs and rotation for clinical services. There was a marked disparity between the median time allocated for non-ward-based training activities (4.0 hours each per week) and the average time allocated for research activities (1.0 hours per week). Although 89 (57.4%) and 82 (53.3%) reported fair satisfaction in their professional role and private life respectively, a larger proportion expressed poor satisfaction with their participation in recreational (107 [68.6%]) and social activities (90 [58.4%]). One hundred and seventeen (74.5%) stated that a high level of stress was associated with their training. CONCLUSIONS: The surgical residents experienced relatively more training on patient management than on research work. Although their educational experience was associated with a high level of stress in majority of them, most of the trainees expressed fair satisfaction with activities in their professional role and private life.

Stage-specific Plasmodium falciparum immune responses in afebrile adults and children living in the Greater Accra Region of Ghana.

BACKGROUND: Asymptomatic carriage of Plasmodium falciparum is widespread in adults and children living in malaria-endemic countries. This study identified the prevalence of malaria parasites and the corresponding levels of naturally acquired anti-parasite antibody levels in afebrile adults living in two communities in the Greater Accra Region of Ghana. METHODS: Two cross-sectional studies conducted in January and February 2016 and repeated in July and August 2016 recruited subjects aged between 6 and 75 years from high parasite prevalence (Obom) and low parasite prevalence (Asutsuare) communities. Whole blood (5 ml) was collected from each volunteer, plasma was aliquoted and frozen until needed. An aliquot (10 µl) of the blood was used to prepare thick and thin blood smears, 100 µl was preserved in Trizol and the rest was separated into plasma and blood cells and each stored at - 20 °C until needed. Anti-MSP3 and Pfs230 antibody levels were measured using ELISA. RESULTS: Asexual parasite and gametocyte prevalence were higher in Obom than Asutsuare. Antibody (IgG, IgG1, IgG3, IgM) responses against the asexual parasite antigen MSP3 and gametocyte antigen Pfs230 were higher in Obom during the course of the study except for IgM responses against Pfs230, which was higher in Asutsuare than in Obom during the rainy season. Antibody responses in Asutsuare were more significantly associated with age than the responses measured in Obom. CONCLUSION: The pattern of antibody responses measured in people living in the high and low malaria transmission setting was similar. All antibody responses measured against the asexual antigen MSP3 increased, however, IgG and IgG1 responses against gametocyte antigen Pfs230 decreased in moving from the dry to the peak season in both sites. Whilst asexual and gametocyte prevalence was similar between the seasons in the low transmission setting, in the high transmission setting asexual parasite prevalence increased but gametocyte prevalence decreased in the rainy season relative to the dry season.

Diversity and immune responses against Plasmodium falciparum gametocytes in non-febrile school children living in Southern Ghana.

BACKGROUND: Natural exposure to gametocytes can result in the development of immunity against the gametocyte by the host as well as genetic diversity in the gametocyte. This study evaluated the quantity and quality of natural immune responses against a gametocyte antigen, Pfs230 as well as the prevalence and diversity of gametocytes circulating in children living in two communities in southern Ghana. METHODS: Whole blood (2.5 ml) was collected from 137 non-febrile school children aged between 6 and 12 years old quarterly for a 6-month period. A drop of blood was used to prepare thick and thin blood films for parasite prevalence and density estimation. Subsequently, stored plasma samples were used in ELISAs assays to measure antibody responses and avidity against Pfs230. RNA was extraction from Trizol preserved packed cells and subsequently converted to complementary DNA (cDNA) which was used for reverse transcriptase PCR (RT-PCR) to determine gametocytes prevalence and diversity. RESULTS: Gametocyte carriage in the peak season (July) determined by Pfg377 RT-PCR was 49.2% in Obom and 22.2% in Abura, and was higher than that determined by microscopy. Gametocyte diversity was low and predominated by the same allele at both sites. The relative avidity index for antibodies measured in Abura was higher than that recorded in Obom at all time points although Pfs230 IgG concentrations were significantly high (P < 0.0001) in Obom than in Abura at all time points. The IgG responses in Obom were significantly higher than that in Abura during the peak season. CONCLUSION: Naturally induced antibody responses against Pfs230 in children living in both high perennial and low seasonal malaria transmission settings reduced significantly in moving from the peak to the off-peak season. The relative avidity of antibodies against Pfs230 in Abura was significantly higher than those measured in Obom, despite having lower IgG levels. Very limited diversity was identified in the gametocytes circulating in both Obom and Abura.

Validation of two parent-reported autism spectrum disorders screening tools M-CHAT-R and SCQ in Bamako, Mali.

BACKGROUND: Early screening is crucial for early autism spectrum disorders (ASD) diagnosis and intervention. ASD screening tools have mostly been constructed based on the Western cultural context. We hypothesized that their use in Mali may require a prior validation. OBJECTIVE: To validate the modified checklist for autism in toddlers-Revised (M-CHAT-R) and the social communication questionnaire (SCQ) in the Malian sociocultural context for ASD screening. STUDY DESIGN: We administered M-CHAT-R and SCQ in 947 toddlers aged 16-30 months old at the district and community health centers in Bamako and 120 patients (60 autistic and 60 age and sex matched controls) aged ≥4 years old at the psychiatry department in Bamako. Toddlers at moderate to high risk of ASD underwent M-CHAT-R/F and clinical evaluation by an ASD multidisciplinary team. M-CHAT-R and SCQ were evaluated for cultural appropriateness by Malian anthropologists. The sensitivity, specificity, PPV, NPV were determined for both M-CHAT-R and SCQ. Health professionals have been trained during ASD seminary on how to use M-CHAT-R and SCQ for ASD screening in Bamako. RESULTS: We found for the M-CHAT-R a sensitivity of 50%, a specificity of 100%, a PPV of 100% and a NPV of 87%. The SCQ had a sensitivity of 71%, a specificity of 72%, a PPV of 73% and a NPV of 70%. We have found four out of 20 items on the M-CHAT-R that were culturally inappropriate in the Malian context. DISCUSSION: M-CHAT-R and SCQ can be used for early autism screening in Mali. In the future, we plan to train a descent number of Malian physicians in chief and pediatricians at the district hospitals across the country to integrate the early ASD screening into the national health system. CONCLUSION: M-CHAT-R has a perfect specificity and SCQ a fair diagnostic accuracy for ASD in Mali.

Assessment of the quality and quantity of naturally induced antibody responses to EBA175RIII-V in Ghanaian children living in two communities with varying malaria transmission patterns.

BACKGROUND: Recent global reports on malaria suggest significant decrease in disease severity and an increase in control interventions in many malaria endemic countries, including Ghana. However, a major driving force sustaining malaria transmission in recent times is the asymptomatic carriage of malaria parasites, which can enhance immune responses against parasite antigens. This study determined the prevalence and relative avidities of naturally induced antibodies to EBA175RIII-VLl in asymptomatic children living in two communities with varying malaria transmission patterns. METHODS: An asexual stage Plasmodium falciparum antigen, EBA175RIII-VLl was expressed in Lactococcus lactis, purified and used in indirect ELISA to measure total and cytophilic IgG concentrations and avidities in children aged between 6 and 12 years. The children were selected from Obom and Abura, communities with perennial and seasonal malaria transmission, respectively. Venous blood samples were collected in July and October 2015 and again in January 2016. The multiplicity of infection and the genetic diversity of EBA175RIII circulating in both sites were also assessed using polymerase chain reaction. RESULTS: Asymptomatic parasite carriage in the children from Obom decreased from July (peak season), through October and January, however parasite carriage in children from Abura was bimodal, with the lowest prevalence estimated in October. Antibody concentrations over the course of the study remained stable within each study site however, children living in Obom had significantly higher EBA175RIII-VLl antibody concentrations than children living in Abura (P < 0.05, Mann-Whitney test). Over the course of the study, the relative antibody avidities of EBA175RIII-VLl IgG antibodies were similar within and between the sites. CONCLUSION: Naturally acquired IgG concentrations but not relative antibody avidities to EBA175RIII-V were significantly higher in Obom where malaria transmission is perennial than in Abura, where malaria transmission is seasonal.

Ultrasound guided percutaneous nephrostomy: Experience at ahmadu bello university teaching hospital, Zaria.

BACKGROUND: Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound-guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not associated with radiation exposure. We present our experience with ultrasound-guided PCN. PATIENTS AND METHODS: We studied all patients who had ultrasound-guided PCN in our center between January 2013 and January 2017. Information obtained included the patients' demographics, clinical details, primary pathology, indications, outcome, and complications within 30 days. Relevant data were extracted and analyzed using descriptive statistics. RESULTS: A total number of 35 PCNs were performed in 26 patients within the period of study. The median age was 44.5 years. There were 17 females and 9 males. About 88.2% of the females had ureteric obstruction from advanced carcinoma of the cervix while the predominant cause of obstruction in the males was advanced carcinoma of the bladder. Kidney access under ultrasound guidance required well dilated collecting systems for success and ease of puncture. The most common complication was hematuria, which resolved within 24-48 h in all patients uneventfully. CONCLUSION: PCN is an important and common procedure for temporary relief of upper urinary tract obstruction. While fluoroscopic guidance provides superior image guidance, ultrasound guidance is comparatively reliable, albeit with a longer learning curve. Adequate training, careful patients selection, and patience are key to success.

[Epidemiologic study of strabismic amblyopia in Tunisia]. / Etude épidémiologique de l'amblyopie strabique en Tunisie.

The authors study 202 strabismus cases and evaluate the strabismic epidemiology of Tunisia: 58% of squint children have amblyopia. The low vision is important, and getting worse with age. The treatment is simple, consisting of occlusion of the good eye, but it become longer and more difficult after six years. The best results are obtained in the first four years. Good cooperation from the parents is required. The authors insist on the necessity of early detection through testing, the prevention of recurrence and, above all, on preventing the advent of amblyopia as soon as strabismus appears.