Electric scooters: convenient transport or ED headache?

Electric scooters (e-scooters) provide a potentially attractive means of private transportation in the pandemic era, during which use of public transport is discouraged. E-scooter use has become widespread recently, and we have noticed a concomitant rise in related craniomaxillofacial injuries, often associated with alcohol consumption and lack of protective equipment. We present here the first-published UK data on electric scooter injuries which, in the post-lockdown period, included facial lacerations, mandibular and midface fractures, avulsed teeth, and cervical spine injury. We urge that forthcoming legislation make e-scooters subject to at least the same requirements in lighting, helmet wear, and sobriety as bicycles and that, in this way, their benefits can be enjoyed while reducing associated morbidity and mortality.

A blacksmith's tale: use of a rare earth magnet to facilitate safe removal of a metallic fragment from the face.

A 48-year-old blacksmith presented to A&E after sustaining facial injuries while operating a metal punch press. Radiographs revealed the presence of a metallic foreign body within the cheek, but this was clinically impalpable. By using a neodymium rare earth magnet extraorally, it was possible to identify the position of the fragment several centimetres lateral to the entry wound. Triangulation of the fragment's position allowed retrieval under local anaesthetic through the original penetration wound, without need for cross sectional imaging or extensive exploration under general anaesthetic. This case highlights an application for magnets in detection and removal of impalpable metallic foreign bodies embedded in superficial soft tissues.

Dental care provision to UK military personnel serving on Operation Herrick in Afghanistan. Part 2: aetiology and management.

Aims: To evaluate the nature of tooth-related morbidity in military personnel deployed on Operation Herrick and to compare the management of dental emergencies to that in non-deployed personnel. Method: Data were collected prospectively for UK Service personnel on Operation Herrick (OpH) during an 18-month period and measured against prospectively collected 'home base' (HB) control data. Results: Molar teeth were responsible for 64.1% (2,089/3,259) of presentations on OpH and 69.5% (323/467) at HB, causing 81.4% (622/764) of cases of pain lasting for >60 minutes and/or waking the patient on OpH and 86.0% (129/150) at HB. Third molars were responsible for 48.3% and 43.3% of such cases, respectively, and first molars 20.7% and 26.7%. The ratio of temporary to definitive restorations was 0.42 at HB compared with 0.18 on OpH (P <0.001). Antibiotics were prescribed in 5.7% of all cases of pulpitis /periapical infection on OpH and 7.9% at HB. A third molar causing pericoronitis was 2.4 times more likely to be extracted on OpH than at HB (27.4% cf 11.6%). Conclusions: A more definitive approach to management is evident on deployment, reflecting the effort to conclusively treat immediately. To maintain this standard of care it is vital that military dental surgeons continue to be skilled in minor oral surgery.

Dental care provision to UK military personnel serving on Operation Herrick in Afghanistan. Part 1: access to dental care.

Aims: To assess factors influencing access to dental care and to determine the true level of dental morbidity experienced by UK military personnel serving on Operation Herrick. Methods: Data on dental emergencies were collected prospectively over an 18-month period. Deployed personnel were divided into those co-located with a dental centre and those not co-located. Personnel were separately surveyed on return from Operation Herrick; individuals who had suffered an oral/dental problem whilst deployed were asked to complete a questionnaire. Results: There were 4,017 dental emergency attendances by 3,355 UK military personnel (282/1,000 man years at risk). A total of 278 non-co-located patients were transported with the sole purpose of seeing a dental officer, 79% by helicopter; a median of 24 hours was lost from their operational role (vs one hour for those co-located). In the cohort surveyed after their return from Afghanistan, 37/118 (31.4%) patients who had wanted to see a dentist whilst deployed did not manage to. Conclusions: Dental morbidity is common and can affect operational effectiveness, but this risk is reduced by co-location with a dental centre. There is a substantial component of 'hidden' dental morbidity in deployed personnel. Evaluating dental morbidity using dental centre attendees likely underestimates the true levels by approximately a third.

Retrospective analysis of the prevalence and incidence of caries in the distal surface of mandibular second molars in British military personnel.

Mandibular third molars are commonly removed because of distal caries in the adjacent tooth. To find out the prevalence of distal caries in mandibular second molars we retrospectively studied the primary care dental records of 720 British military personnel (653 men and 67 women) from various centres. These records are standardised and personnel are required to attend for inspection regularly. Those who had been under 20 years of age at enlistment, who had served for at least five years, and had five recorded dental inspections, were included. The median (IQR) period from the first to last inspection was 15 (9.7 - 19.2) years, and inspections were a median (IQR) of 14.1 (12.8 - 15.8) months apart. A total of 59/1414 (4.2%) mandibular second molars developed caries in their distal surfaces. This was 4% higher when they were associated with a partially-erupted mandibular third molar than when associated with one that was fully erupted or absent (29/414 (7%) compared with 30/1000 (3%); p=0.001). Carious lesions developed in the distal aspect of 22/133 mandibular second molars (16.5%) that were adjacent to a mesioangularly impacted third molar. Of these, 19/22 were successfully restored. Four mesioangularly impacted mandibular third molars would have to be extracted to prevent one case of distal caries in a second molar (number needed to treat=3.25). Second molars that are associated with a partially-erupted mesioangular mandibular third molar have a higher risk of caries, and this can be reduced by removal of the third molar. However, distal caries in second molars seems to be a treatable and slowly-developing phenomenon and we recommend that the merits and risks of the prophylactic removal of third molars should be discussed with the patient, who should have long-term clinical and radiographic checks if the tooth is retained.

Education, regulation, representation and remuneration in dentistry - who does what?

Dentistry in the United Kingdom demands a wide range of supportive and regulative bodies, the roles of which are intertwined, overlapping and changeable. The interaction between these bodies is not always clear, and often the present-day role of the body is far removed from its original purpose. Consequently, the system can appear daunting and opaque. Even so, a thorough understanding of this topic is requisite for those considering applying for higher specialist training, and pertinent for practitioners with an interest in the dental political arena. We hope this paper goes some way towards unravelling the tangle of boards, committees, associations, societies and councils that commonly influence dentistry, and provides a starting point for those interested in increasing their knowledge of the profession at the strategic level.

Getting into medical school - a guide for dental graduates.

Dentists may apply to medical school with a view to ultimately specialising in oral and maxillofacial surgery or oral medicine. While there is much information on applying to medical school, very little is specific to the dental graduate. This paper discusses the contemporary admissions process including the application form, admissions tests, and interview.

Squamous cell carcinoma arising in mucosal plasmacytosis.

The authors present an unusual case of invasive squamous cell carcinoma (SCC) developing in a pre-existing plasmacytosis of the lip. The roles of chronic inflammation, immunosuppression, and smoking in the pathogenesis of this tumour are briefly discussed. The authors highlight a significant side effect of the use of immunosuppressive drugs in benign conditions.

The transverse mega-apophysis--An unusual neck lump.

Although detection of a calcified structure in the neck may indicate an underlying infective or neoplastic process, it may also, as in this case, represent a variation of normal skeletal anatomy. The danger of such skeletal anomalies is that they may be referred for investigations such as fine needle aspiration and, when this is unsuccessful, subsequent open biopsy examination. Ultrasound is recommended as a first line investigation.

Soft tissue giant cell tumour of low malignant potential arising in the masseter--a rare entity in the head and neck.

We report a case of a soft tissue giant cell tumour of low malignant potential that occurred in the masseter muscle. This is exceptionally rare and we know of only four previously published cases in the head and neck. Differentiation of this tumour from its malignant counterpart is important as management differs considerably. Because of the possibility of local recurrence, clinical follow up with or without postoperative radiotherapy is advised after excision.

Normal chest radiography in pulmonary tuberculosis: implications for obtaining respiratory specimen cultures.

SETTING: Urban tuberculosis (TB) clinic, Nashville, Tennessee, USA. OBJECTIVE: Chest radiographs (CXRs) help in the diagnosis of pulmonary TB, but may be normal. Mycobacterium tuberculosis in culture is diagnostic of TB, but cultures are not routinely obtained in resource-poor settings. We examined rates and risk factors for pulmonary TB associated with normal CXR. DESIGN: An observational cohort study was performed among all respiratory culture-positive TB cases referred to the Nashville Health Department from October 1992 to July 2003. Clinical factors, demographics and underlying medical conditions were assessed. RESULTS: Of 601 study patients, 53 (9%) had normal CXRs: 31/138 (22%) were human immunodeficiency virus (HIV) infected and 22/463 (5%) were non-HIV-infected/unknown (P<0.001). Among HIV-infected patients, normal CXR was more likely in persons with renal failure (13% vs. 3%, P=0.048). Among non-HIV-infected/unknown patients, normal CXR was more likely in those who were asymptomatic at presentation (32% vs. 13%, P=0.022). In multivariable logistic regression analysis, HIV infection was associated with an increased risk of normal CXR (odds ratio [OR] 6.61, P<0.0001); factors associated with reduced risk were dyspnea (OR 0.24, P=0.026), positive sputum smear (OR 0.45, P=0.028) and cough (OR 0.48, P=0.038). CONCLUSIONS: The rate of normal CXR among persons with culture-confirmed pulmonary TB was high. Respiratory specimen cultures should be obtained in TB suspects with a normal CXR, particularly HIV-infected persons.

Contamination of headwater streams in the United Kingdom by oestrogenic hormones from livestock farms.

Most studies of hormonal activity in rivers have focused on inputs from sewage treatment works (STW), and their consequences for endocrine disruption in fish. It is possible that livestock is contributing to this hormonal activity in rivers. This study represents a search for evidence of steroid hormone contamination in streams associated with livestock farms. The majority of the 10 sites selected were streams running through dairy farms, although some examples of beef, sheep and pigs were included. Passive water samplers (Polar Organic Chemical Integrative Samplers-POCIS) were deployed up- (control) and down-stream of the farms for 3 to 10 weeks (mean=39 days) during the period November 2004 to January 2005. At one site, water samples were also taken automatically during rainfall events. All samples were solvent-extracted. Total oestrogenic activity in concentrates of the extracts was analysed using the Yeast Estrogen Screen (YES) calibrated against 17beta-oestradiol (E2), while oestrone (E1), E2 and 17alpha-ethinylestradiol (EE2) were analysed by liquid chromatography-mass spectrometry (LC-MS/MS). Stream water from the entirety of only one rainfall event was sampled directly, but this revealed background activity (E2 equivalents) of 0-0.3 ng/l, rising to a transient peak of 9.4 ng/l. Average oestrogenic activity at this site as estimated from the POCIS samplers was 1.8-2.7 ng E2 equiv./l. Estimated average oestrogenic activity across all sites (with one exception) lay in the range 0-26.5 ng E2 equiv./l (mean=2.0 ng/l; S.D.=5.1), based on the POCIS samples. The outlier was 292 ng/l, and this could not be specifically linked with livestock rearing. 92% of monitoring stations (at least one on each farm) contained some oestrogenic activity, and activity was higher at downstream sites in 50% of cases. Although no EE2 was detected analytically in any stream, E1 and E2 were almost ubiquitous, with E2 equivalents ranging from 0.04 to 3.6 ng/l across all sites. Furthermore, steroid concentrations downstream of livestock were higher than upstream in 60% of cases, more markedly so than for the YES data. In several cases, activity upstream was greater than downstream, and this tended to be associated with higher activity than could be accounted for by the hormone analyses. Both the YES and chemical analytical data suggest that fish in headwater streams on or near some livestock farms may be at risk of endocrine disruption.

Reticuloendotheliosis in Hungarian partridge.

A large commercial flock of Hungarian partridge (Perdix perdix) experienced elevated mortality associated with a wasting disease in May 1998. Postmortem examination of females consistently revealed a distended crop and abnormal gray-white tissue infiltrating the wall of the crop and thoracic esophagus. Neoplasia in male partridge was observed in the liver. Microscopic examination of the crop and thoracic esophagus revealed transmural masses of immature lymphocytes with frequent mitotic figures. Similar cells were observed in the liver of affected males. Virus particles consistent in size and morphology with reticuloendotheliosis virions were observed in neoplastic lymphoid cells via electron microscopy. Reticuloendotheliosis virus was isolated from each of four blood samples. This disease has not previously been reported in Hungarian partridges. Hungarian partridge may represent a potential reservoir of infection for other gamebirds, including prairie chickens.

Nutrient losses by surface run-off following the application of organic manures to arable land. 1. Nitrogen.

Research was conducted on nitrogen (N) surface run-off losses following organic manure applications to land, utilising a purpose-built facility on a sloping site in Herefordshire under arable tillage. Different rates and timing of cattle slurry, farmyard manure and inorganic N and phosphorus (P) fertiliser were compared, over a 4-year period (1993-97). P losses from the same studies are reported in a separate paper. The application of cattle slurries to the silty clay loam soil increased the loss of solids and NH4(+)-N in surface water flow compared to control plots receiving inorganic fertiliser only, or no treatment, but had little effect on NO3(-)-N losses by this route. Results were consistent with other observations that rainfall events immediately after manure applications are particularly likely to be associated with nutrient run-off losses. Losses via subsurface flow (30 cm interflow) were consistently much lower than via surface water movement and were generally unaffected by treatment. Increasing slurry application rate and, in particular, slurry solids loading, increased solids and NH4(-)-N losses via surface run-off. The threshold, above which the risk of losses via surface run-off appeared to be greatly increased, was ca. 2.5-3.0 t/ha slurry solids, which approximates to the 50 m3/ha limit suggested for slurry within UK 'good agricultural practice'. Sealing of the soil surface by slurry solids appears to be a possible mechanism by which polluting surface run-off may occur following slurry application on susceptible soils. Total losses of NH4(+)-N and NO3(-)-N during the 4-year monitoring period were insignificant in agronomic terms, but average soluble N concentrations (NH4(+)-N + NO3(-)-N) in run-off, ranging from ca. 2.0 mg/l, up to 14.0 mg/l for the higher rate slurry treatments. Peak concentrations of NH4(+)-N > 30 mg/l, are such as to be of concern in sensitive catchments, in terms of the potential for contribution to accelerated eutrophication and adverse effects on freshwater biota.

Urinary tract cryptosporidiosis in commercial laying hens.

Formalin-fixed kidney tissues from adult egg-laying chickens in two houses of an egg-production complex in the upper Midwest were submitted to Iowa State University for histopathologic examination. An increased incidence of visceral gout, average daily mortality 1%-2% higher than expected, and egg production within normal limits were observed in both houses. Numerous developing stages of Cryptosporidium were observed on the apical surface of epithelial cells lining renal collecting tubules and ureters. Scanning and transmission electron microscopy were used to visualize colonization of cryptosporidia, disruption of microvilli, and exfoliation of parasitized epithelial cells. Lymphoplasmacytic infiltration in the wall of ureters and hyperplasia of parasitized epithelial cells resulted in partial obstruction of ureters, which may have induced visceral gout in affected hens. This is the first report of urinary tract cryptosporidiosis occurring in adult hens in a modern commercial egg-production facility.

Local and systemic immune response to a microencapsulated sub-unit vaccine for plague.

Microencapsulated Fl and V sub-unit antigens of Yersinia pestis were used to immunize mice intraperitoneally with a combination of 25 micrograms of each of the microencapsulated sub-units. The combined microsphere formulation induced both mucosal and systemic immunity. There was an additive effect in combining sub-units and the protection afforded by the combined microencapsulated antigens was superior to that provided by the administration of any single encapsulated antigen and by the existing whole cell vaccine. The protective efficacy of the combined microencapsulated sub-units was further enhanced by co-administering cholera toxin B sub-unit. Microencapsulation of the sub-units offered advantages which included depot release of the vaccine in vivo and the facilitation of oral, intranasal or inhalational delivery. Therefore, immunization with microencapsulated sub-unit antigens was an effective means of generating humoral and cellular responses which endowed protective immunity.