Antibiotics: their use and misuse in paediatric dentistry. A systematic review.

AIM: The use of antibiotics by health care professionals has benefitted humankind to a great extent. Recent reports show an increasing trend of antibiotic prescription by paediatric dentists. This systematic review aims to address the current pattern of antibiotics prescription among the paediatric dental population according to the evidence-based literature. The question of research addressed here deals with the assessment of the correlation of the injudicious prescription of antibacterial agents and antibiotic resistance among the population of interest. METHODS: Electronic search databases: PubMed, Ovid and Cochrane Library, were used to review studies as per their relevance and findings. Keywords for search were associated with population: 'paediatric patients', intervention: 'antibiotics treatment', 'prescribing behaviour', and outcomes: 'antibiotic resistance' RESULTS: A total of 542 abstracts were identified, 45 of which met the inclusion criteria and were reviewed. A multifactorial relationship leading to increased prescription of antibiotics in paediatric dentistry was observed. Very few studies actually correlated this prescribing behaviour with resistance to these drugs. No consensus regarding the duration of antibiotic therapy or prophylaxis was found. CONCLUSION: Insufficient literature support necessitates the requirement of increased evidence to draw a definitive association between the prescribing trends of antibiotics in paediatric dentistry and drug resistance. The development of intervention programmes like antibiotic stewardship ensuring collaboration between patients and paediatric dentists can ensure effective antibiotic prescription.

Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol.

Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within the alpha granules of platelets act on stem cells in the bulge area of the hair follicles and stimulate the development of new follicles along with neovascularization. PRP has become a promising treatment modality for AGA. Although there have been several studies previously reported, a standard practice for PRP preparation and administration as well as a method to evaluate results have not been established. This literature review was conducted to evaluate the effectiveness of PRP for AGA and discuss the various treatment protocols that have been proposed.

3p deletion syndrome.

3p deletion is a rare cytogenetic finding. Here we describe a 3 months old male with congenital malformations. His karyotype revealed 3p deletion 46,XY,del(3)(p25-pter). The child had flexion deformity of wrist and elbow which has never been reported before.

A synchronous presentation of two different ovarian tumors: a rare occurrence.

Approximately 60% of all ovarian tumors are epithelial in origin, and these neoplasms are thought to arise from the ovarian surface epithelium or small epithelial inclusion cysts. Surface epithelium is capable of differentiating into serous (tubal), mucinous, endometrioid or transitional epithelium. Serous and mucinous cystadenomas are the most common epithelial tumors and, together, account for about 30% of ovarian tumors We report a case of a 29-year-old lady P1L1 presenting with the chief complaints of pain abdomen off and on since the last 1 year. Ultrasonography revealed normal uterus with enlarged right ovary, with a cyst measuring 46 mm × 36 mm × 55 mm showing internal echoes with volume of 50 cc., left ovary also enlarged with multiple well-defined cysts measuring 34 mm × 44 mm × 69 mm with volume of 55 cc and the largest cyst measuring 37 mm. Bilateral ovarian cystectomy was done and sent for histopathology. To our surprise, both the ovaries revealed different histopathological pictures, with the right ovary revealing serous cystadenoma and the left ovary showing mucinous cystadenoma. This rare occurrence has never been reported so far in the literature to the best of our knowledge.

Histopathologic changes following neoadjuvant chemotherapy in locally advanced breast cancer.

AIMS: To compare the clinical and pathologic assessment of response to neoadjuvant chemotherapy and describe the various histopathologic changes observed. MATERIALS AND METHODS: We studied a group of 40 patients with locally advanced breast cancer who had their initial workup in the form of clinico-imaging assessment of the size and pretreatment biopsy from the lesion. All the patients received two to six cycles of neoadjuvant chemotherapy, either cyclophosphamide 50 to 60 mg/m 2 IV, doxorubicin 40 to 50 mg/m 2 IV and 5-fluorouracil 500 to 800 mg/m 2 IV (CAF) or cyclophosphamide, epirubicin, and 5-fluorouracil (CEF). Clinical and pathologic assessment of response to chemotherapy was done based on the UICC guidelines. RESULT: Complete clinical response (cCR) was seen in 10% cases (4/40), thirty percent patients had (12/40) partial response and 60% (24/40) had stable disease after neoadjuvant chemotherapy. Pathologic complete response (pCR) with no evidence of viable tumor was observed in 20% patients (8/40). Fifteen patients (37.5%) showed partial response and 42.5% patients (17/40) had a stable disease. No patient progressed during the course of chemotherapy. Changes in the tumor type were observed following chemotherapy, most common being the mucinous change. Histologic changes like dyscohesion, shrinkage of tumor cells, elastosis, collagenization, necrosis, lymphocytic reaction, giant cell response are some of the common observations seen following treatment with neoadjuvant chemotherapy. CONCLUSION: Pathologic assessment of response to neoadjuvant chemotherapy is a better predictor than the clinical response. The chemotherapy drugs can be modified based on the response observed after 1-2 cycles of neoadjuvant, the response being based on both tumor and patient's responsiveness.

To close or not to close, that is one of the questions? Perceptions of Trauma Association of Canada surgical members on the management of the open abdomen.

BACKGROUND: The optimal abdominal closure in critically ill surgical/trauma patients remains controversial with a wide variety of commonly employed techniques. We sought to evaluate clinical equipoise by surveying Canadian surgeons regarding the use of temporary abdominal closure strategies in damage control and emergency situations. METHODS: A structured mixed-mode (Website and paper), scenario-based questionnaire was developed by members of the Canadian Trauma Trials Collaborative and directed to surgical members of the Trauma Association of Canada (TAC). RESULTS: The overall response rate was 84% (86 out of 102). In resuscitated hemodynamically stable trauma patients, 42% (29 out of 69) of respondents elected to primarily close an "extremely tight" abdominal cavity while only 23% (16 out of 70) would primarily close the same patient when physiologic exhaustion (Damage control (DC) conditions-hypothermia, acidosis, and coagulopathy) supervened. Although the majority reported preference for temporizing abdominal closures [73% (51 out of 70) non-DC, 75% (52 out of 69) DC] when the fascia was physically impossible to close; the reported primary use of mesh in these situations was quite high [24.6% (17 out of 69) non-DC, 24% (16 out of 69) DC], including a reported 7% (5 out of 69) nonabsorbable mesh usage in a contaminated octogenarian abdomen. CONCLUSION: Reported opinions suggest an overall appreciation for markers of "Damage Control," although clinical equipoise exists regarding the preferred technique and a frequent early use of mesh. These results highlight the necessity for further research but suggest challenges in defining a common standard for multicenter trials.

Ciprofloxacin-induced QTc prolongation.

Ciprofloxacin has been widely used for treating infections and has been found to have very low cardiovascular side effects. QTc prolongation with the use of ciprofloxacin is yet to be reported in literature. A case report highlighting QTc prolongation by use of ciprofloxacin is being presented.

Myoclonus during prolonged treatment with sertraline in an adolescent patient.

A 15-year-old female adolescent with depression developed myoclonus after uninterrupted treatment with sertraline over 6 years. She was also receiving methylphenidate. Withdrawal of sertraline and continuation of methylphenidate did not result in any improvement. Treatment with valproic acid resulted in improvement of the movement disorder. This report suggests that myoclonus may be a side effect of sertraline in some adolescents. Further, we hypothesized that extended treatment over several years, young age, and a compromised central nervous system due to underlying disorders may be risk factors for the development of this side effect.

Trauma faculty and trauma team activation: impact on trauma system function and patient outcome.

OBJECTIVE: To determine the impact of the presence of an attending trauma surgeon during trauma team activation on system function and patient outcome. METHODS: After a retrospective review of medical records and trauma registry, a comparative study between two American College of Surgeons Committee on Trauma Level I trauma centers was performed. One center (Hennepin County Medical Center) required a chief surgical resident, two junior residents, and a board-certified emergency medicine faculty to be present in the emergency department for all trauma team activations. The attending trauma surgeon was notified at the time of trauma team activation and was neither required to be present in the emergency department at time of patient arrival nor in the hospital 24 h/day. The other center (St. Paul Ramsey Medical Center) required a chief surgical resident, two junior residents, a board-certified emergency medicine faculty member, and an attending trauma surgeon to be present in the emergency department for all trauma activations and in hospital 24 hours/day. Over a 21-month period, all major trauma patients (Injury Severity Score > 15 or emergent operation within 4 hours of admission and any Injury Severity Score) that triggered trauma team activation were examined. Resuscitation time, time to incision, probability of survival, and mortality were analyzed. RESULTS: Resuscitation time was shorter at St. Paul Ramsey Medical Center when compared with Hennepin County Medical Center. Analysis by mechanism of injury demonstrates that this was true for blunt trauma (39+/-13 vs. 27+/-12 minutes, p = 0.001) and for penetrating trauma (28+/-14 vs. 24+/-17 minutes, p = 0.01). Subgroup analysis of penetrating trauma victims demonstrated that there was a significant difference in resuscitation times for gunshot wounds but not for stabs. There was no difference in how quickly operations could be initiated for blunt trauma patients. However, in penetrating cases, time to incision was significantly shorter at St. Paul Ramsey Medical Center (50+/-29 vs. 66+/-43 minutes, p = 0.01). There was no significant difference in mortality for any category of Trauma and Injury Severity Score probability of survival in blunt or penetrating trauma. Analysis of "in-house" and "out-house" time intervals demonstrated no difference in survival in any mechanism of injury, nor was there a difference in overall mortality. CONCLUSION: The presence of a trauma surgeon on the trauma team reduced resuscitation time and reduced time to incision for emergent operations, particularly in penetrating trauma. However, it had no measurable impact on mortality based on Trauma and Injury Severity Score probability of survival. Attending trauma surgeon presence on the trauma team improves in-hospital trauma system function without affecting patient outcome.

The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics.

OBJECTIVE: To develop a reliable and valid child and parent self-report instrument to screen children with anxiety disorders. METHOD: An 85-item questionnaire was administered to 341 outpatient children and adolescents and 300 parents. Utilizing item analyses and factor analyses, the original scale was reduced to 38 items. A subsample of children (n = 88) and parents (n = 86) was retested an average of 5 weeks (4 days to 15 weeks after the initial screening. RESULTS: The child and parent Screen for Child Anxiety Related Emotional Disorders (SCARED) both yielded five factors: somatic/panic, general anxiety, separation anxiety, social phobia For the total score and each of the five factors, both the child and parent SCARED demonstrated good internal consistency (alpha = .74 to .93), test-retest reliability (intraclass correlation coefficients = .70 to .90), discriminative validity (both between anxiety and other disorders and within anxiety disorders), and moderate parent-child agreement (r = .20 to .47, p < .001, all correlations). CONCLUSIONS: The SCARED shows promise as a screening instrument for anxiety disorders. Future studies using the SCARED in community samples are indicated.

Activation of P388D1 macrophage cell line by chemotherapeutic drugs.

It has been found that certain antineoplastic drugs impart their function with a distinct duality. Besides being tumoricidal, they are capable of acting as immunopotentiator. This led us to investigate the effect of cytosine arabinoside (CA), vincristine sulphate (VS), cyclophosphamide (CS), mitomycin C (MMC), hydroxy urea (HU) and lipopolysaccharide (LPS) on a macrophage cell line P388D1. Supernatants collected from P388D1 cells treated with CA, VS, CS, MMC, HU or LPS demonstrated enhanced production of tumor necrosis factor (TNF) confirmed by bioassay on L929 tumor target cells and increased interleukin-1 (IL-1) production by standard thymocyte proliferation bioassay. Also, supernatants showed increased amounts of nitric oxide and lysozyme using Griess reaction and reduction in turbidity of Micrococcus lysodeikticus, respectively. The above findings demonstrate that these drugs may be used not only as chemotherapeutic agents but also as macrophage-activating agents.

Multiple shoot induction by benzyladenine and complete plant regeneration from seed explants of chickpea (Cicer arietinum L.).

The efficacy of benzyladenine (BA) to induce multiple shoots from seed explants of chickpea (Cicer arietinum L.) was assessed. Shoot differentiation was influenced by the type of seed explant, genotype and concentration of BA. Orientation of the explant also strongly influenced the shoot regeneration response. The optimum BA concentration for shoot/shoot bud regeneration was genotype dependent. Two types of BA-induced response were observed: (1) at less than 7.5 gm BA, direct shoot differentiation (2 to 4-cm-long shoots) was observed within 30 days; (2) at higher BA concentrations (75-100 µM), shoot/shoot bud differentiation was achieved in 45-90 days. A high BA concentration inhibited subsequent rooting of shoots. Roots, however, could be easily induced on shoots derived from <12.5 µM BA. Following transfer to soil, 80% of the regenerants developed into morphologically normal and fertile plants.

Rooting and establishment of in vitro grown shoot tip explants of chickpea (Cicer arietinum L.).

Shoot tip explants of 5.chickpea varieties were evaluated for efficiency of rooting using MS basal medium (1/4, 1/2 and full strength). Maximum rooting was observed in 3 varieties when cultured in MS medium with 1/4 strength. Plantlets thus developed, were further cultured in Hoagland solution (1/4 strength) for 15-20 days which enhanced root number and root length. Such plantlets established well in vermiculite/soil.

Fine needle aspiration cytology of lymph nodes - abstract

Lymphadenopathy is a common clinical problem with an often diverse differential diagnosis. To determine if fine needle aspiration cytology (FNAC) can provide an accurate and reliable diagnosis of malignancy related lymphadenopathy, the records of 328 patients examined by a single cytopathologist were retrieved for analysis. One hundred and seventy-seven (54 percent) were deemed "reactive," 14 (4.3 percent) were unsatisfactory and 91 (27.7 percent) were positive for malignancy. Of the positives, 35 (38.5 percent) were malignant lymphomas. The diagnosis of malignancy was confirmed in 88 (95.7 percent) ofaspirates; 3 (4.5 percent) were deemed false positive using strict criteria. Typing accuracy of malignant lymphomas was 71 percent and for other forms of malignancy the accuracy was 98 percent. The positive predictive value was 97 percent. The results demonstrate that FNAC can provide a reliable diagnosis of malignancy and malignant lymphomas can be fairly reliably typed by this technique (AU)

Granulomas in murine schistosomiasis mansoni contain vasoactive intestinal peptide-responsive lymphocytes.

Granulomas develop around schistosome ova in murine Schistosoma mansoni. These granulomas have eosinophils that produce VIP. It is possible that VIP participates in immunoregulation. VIP-mediated effects usually operate through a cAMP-dependent mechanism. To identify VIP-responsive inflammatory cells in murine schistosomiasis, inflammatory cells were exposed to VIP and assessed for adenylate cyclase activation and VIP binding. VIP increased adenylate cyclase activity in splenic lymphocytes from both normal and infected mice. In each case, the half-maximal stimulation was at about 5 x 10(-8) M. [125I]VIP bound to splenic lymphocytes specifically, with a Kd of 10(-8) M. This suggested that maximal adenylate cyclase activation requires full receptor occupancy. The receptor was highly specific for VIP. Hormone analogs, that are VIP receptor antagonists in some tissues, were only weak agonists of the lymphocyte VIP receptor. Granuloma cells also bound VIP and responded with adenylate cyclase activation in a manner similar to that of spleen cells. Both splenic T and B lymphocytes responded to VIP. Deletion experiments, using anti-Thy 1.2, suggested that most of the responsive granuloma cells were T lymphocytes. Thus, VIP alters cAMP metabolism in granuloma T cells through a receptor-coupled mechanism similar to that observed for spleen cells. Binding studies on mouse intestinal epithelial cells suggested that their VIP receptor is functionally and possibly structurally different from the VIP receptor on mouse lymphocytes. Additional experiments suggested that VIP and other neuropeptides are unlikely to alter the granulomatous response through a primary interaction with the granuloma macrophages.

Chain shortening of palmitic acid in human subjects.

Chain shortening of palmitic acid was examined in vivo by comparing oxidation rates of [1-13C]palmitate vs [16-13C]palmitate fed to four male subjects consuming a high-fat diet. For 9 d subjects were fed a diet of normal foods providing an energy intake equal to their estimated requirements. The diet provided (as energy) approximately 14% protein, 46% carbohydrate, and 40% fat at a P:S ratio of 0.25. Analysis of breath 13CO2 enrichment on day 3 permitted analysis of background 13C contribution from the test diet alone. On days 4 and 7 either [1-13C]palmitic acid or [16-13C]palmitic acid (9-13.5 mg/kg body wt) was fed with the breakfast meal. The whole-body rate of oxidation of [1-13C]palmitic acid was significantly greater than that observed for [16-13C]palmitic acid. These results suggest that up to 34% of dietary palmitic acid consumed may be subjected to extramitochondrial chain shortening.