Wuchereria Bancrofti Infection in Children Living in a Rubber Plantation Estate in South-South Nigeria.

BACKGROUND: Chronic manifestations of bancrofti filariasis can be debilitating. There is paucity of description of this disease in the childhood population, yet early detection can prevent disability such as elephantiasis. OBJECTIVE: The objective of the study was to determine the prevalence and clinical features of this infection among children in a plantation estate in Cross River State, Nigeria. METHODS: It was a cross-sectional study in subjects aged 1 to 18 years, recruited from the nine camps of the settlement, using multistage sampling technique. The presence of Circulating Filarial Antigen (CFA) was tested for using Immunochromatographic Card Technique (ICT). Simple proportions, percentages, Chi square and Fisher's exact tests were used to analyse the data. RESULTS: A total of 342 subjects were recruited into the study. One hundred and sixty three (47.7%) were males. The mean age was 8.52± 4.41years. Majority of the subjects, 316(92.4%), were from families of low socioeconomic status. Twenty of the 342 children (5.8%) were positive for microfilaria antigenaemia. Increasing age (p=0.006) and duration of stay in the estate (p=0.005) were positively associated with antigenaemia. None (0%) of the 55 subjects who used insecticide treated nets was positive for CFA, while 20 (6.97%) of the 287 who did not, were positive (p=0.03). Only ten (3.95%) of the 253 subjects who used insecticide spray vs 10 (11.0%) of the 89 who did not use spray were positive for CFA (p=0.016). Itching was the only significant symptom identified. CONCLUSION: The prevalence of Wuchereria bancrofti in the subjects was 5.8%, with increasing prevalence with age. Itching was the only significant clinical feature. The use of insecticide treated nets and insecticide sprays significantly reduced the chances of being infected. There is a need for elimination programme to be extended to the childhood population and to sub-urban areas.

CONTEXTE: Les manifestations chroniques de la filariose de bancrofti peuvent être débilitantes. Il existe peu de descriptions de cette maladie dans la population infantile, mais une détection précoce peut prévenir des handicaps tels que l'éléphantiasis. OBJECTIF: L'objectif de l'étude était de déterminer la prévalence et caractéristiques cliniques de cette infection chez les enfants d'une plantation dans l'État de Cross River, au Nigéria. METHODES: Il s'agissait d'une étude transversale chez des sujets âgés de 1 à 18 ans, recrutés dans les neuf camps de la colonie, en utilisant la technique d'échantillonnage à plusieurs degrés. La présence d'antigène filarien circulant (CFA) a été testée à l'aide de la technique de carte immunochromatographique (ICT). Des proportions simples, des pourcentages, le Chi carré et des tests exacts de Fisher ont été utilisés pour analyser les données. RESULTATS: Un total de 342 sujets ont été recrutés dans l'étude. Cent soixante trois (47,7 %) étaient des hommes. L'âge moyen était de 8,52 ± 4,41 ans. La majorité des sujets, 316 (92,4 %), provenaient de familles de faible statut socio-économique. Vingt des 342 enfants (5,8 %) étaient positifs pour l'antigénémie des microfilaires. L'augmentation de l'âge (p = 0,006) et de la durée de séjour dans le domaine (p = 0,005) était positivement associée à l'antigénémie. Aucun (0%) des 55 sujets qui ont utilisé des moustiquaires imprégnées d'insecticide n'était positif pour le CFA, tandis que 20 (6,97%) des 287 qui n'en avaient pas étaient positifs (p=0,03). Seuls dix (3,95 %) des 253 sujets qui ont utilisé un insecticide contre 10 (11,0 %) des 89 qui n'ont pas utilisé de spray étaient positifs pour le CFA (p = 0,016). Les démangeaisons étaient le seul symptôme significatif identifié. CONCLUSION: La prévalence de Wuchereria bancrofti chez les sujets était de 5,8 %, avec une prévalence croissante avec l'âge. Les démangeaisons étaient la seule caractéristique clinique significative. L'utilisation de moustiquaires imprégnées d'insecticide et de pulvérisations d'insecticide a considérablement réduit les risques d'infection. Il est nécessaire d'étendre le programme d'élimination à la population infantile et aux zones suburbaines. Mots clés: Filariose de Bancrofti, Enfants, Zone d'Endémie.

Disulfiram's journey from rubber vulcanization to T-cell activation.

Disulfiram, a drug prescribed for the treatment of alcohol use disorders for more than 60 years, has recently been repurposed for cancer treatment. New work in The EMBO Journal now describes a disulfiram role in immunotherapy of cancer, involving direct binding to Lck to mediate activation of tumor-infiltrating T cells.

Multivalent rubber-like RNA nanoparticles for targeted co-delivery of paclitaxel and MiRNA to silence the drug efflux transporter and liver cancer drug resistance.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Analogous to the border customs, liver mainly functions as a filter to detoxify chemicals and metabolite administered orally or intravenously. Besides, the liver cancer cells overexpress the drug exporters which cause high drug effluxion from liver cancer cells, leading to chemoresistance and a diminished chemotherapeutic effect on liver cancer. Recently, we found that RNA nanoparticles display rubber-like property that can rapidly deliver therapeutics to tumor site efficiently and the rest of the RNA nanoparticle were cleared by renal excretion within half hour after systemic injection. Therefore, we designed a new multivalent RNA nanoparticle harboring three copies of hepatocyte targeting-ligands, one copy of miR122, and 24 copies of Paclitaxel to overcome the drug effluxion and chemoresistance thus, synergistically treating HCC. The hepatocyte targeting ligands introduce tumor specificity to the RNA nanoparticles as they selectively bind and internalize into liver cancer cells. The rubber-like RNA nanoparticles allow for enhanced targeting ability to the HCC tumors. The RNA nanoparticles carrying miR122 and PTX were delivered to the liver cancer cells efficiently due to their rubber-like property to enhance their EPR as well as the receptor-mediated endocytosis by hepatocyte targeting-ligands. The miR122 efficiently silenced the drug exporters and the oncogenic proteins. The synergistic effect between miR122 and PTX was confirmed by HSA (Highest Single Agent) synergy model. IC50 was determined to be 460 nM. In vivo studies on mice xenografts revealed that the RNA nanoparticle predominantly accumulated in HCC tumor sites and efficiently inhibited the tumor growth after multiple IV injection. This demonstrates the potential of the rubber-like multivalent RNA nanoparticles to conquest the liver cancer, a currently incurable lethal disease.

Fractal analysis of concurrently prepared latex rubber casts of the bronchial and vascular systems of the human lung.

Fractal geometry (FG) is a branch of mathematics that instructively characterizes structural complexity. Branched structures are ubiquitous in both the physical and the biological realms. Fractility has therefore been termed nature's design. The fractal properties of the bronchial (airway) system, the pulmonary artery and the pulmonary vein of the human lung generates large respiratory surface area that is crammed in the lung. Also, it permits the inhaled air to intimately approximate the pulmonary capillary blood across a very thin blood-gas barrier through which gas exchange to occur by diffusion. Here, the bronchial (airway) and vascular systems were simultaneously cast with latex rubber. After corrosion, the bronchial and vascular system casts were physically separated and cleared to expose the branches. The morphogenetic (Weibel's) ordering method was used to categorize the branches on which the diameters and the lengths, as well as the angles of bifurcation, were measured. The fractal dimensions (DF) were determined by plotting the total branch measurements against the mean branch diameters on double logarithmic coordinates (axes). The diameter-determined DF values were 2.714 for the bronchial system, 2.882 for the pulmonary artery and 2.334 for the pulmonary vein while the respective values from lengths were 3.098, 3.916 and 4.041. The diameters yielded DF values that were consistent with the properties of fractal structures (i.e. self-similarity and space-filling). The data obtained here compellingly suggest that the design of the bronchial system, the pulmonary artery and the pulmonary vein of the human lung functionally comply with the Hess-Murray law or 'the principle of minimum work'.

Rubber tourniquet technique: A simple, safe, and cost-effective method of hepatic resection in neonates and infants.

BACKGROUND: Despite the improvements in patient care, understanding of surgical anatomy of liver and surgical techniques, liver resection is a high-risk procedure specifically in infants and neonates; whose blood volume is limited (80 ml/kg). This report shares the experience of hepatic resection with "Rubber tourniquet technique" in patients less than 6-months of age. METHODS: Hepatic resection in a 4-month-old pair of Conjoined twins with shared liver and a 3-day old baby with large Congenital Hepatoblastoma was performed using Penrose rubber drain as a tourniquet around the liver parenchyma to reduce blood loss. RESULTS: Blood loss was minimal (<20CC) and all the three babies survived the procedure without complications. CONCLUSION: Rubber tourniquet technique is simple, safe and cost-effective for liver resections in neonates and infants with hepatic lesions and separation of conjoined twins with shared liver and it can easily be employed in resource constraint settings.

Vacuum sealing drainage therapy in the presence of an external fixation device: A case report.

RATIONALE: Vacuum sealing drainage (VSD) is widely utilized for treating traumatic wounds. PATIENT CONCERNS: It is particularly difficult and time consuming to use in combination with an external fixator. DIAGNOSES: This is because the hardware or pins used for fixation interfere with maintaining a seal, resulting in poor adhesion and subsequent air leakage. INTERVENTIONS: To resolve this problem, we have devised a new method for sealing the wound dressing, while maintaining the required vacuum.When using this technique, a rubber strip is wrapped around each pin in 3 circles outside the plastic drape, and then tightly tied. OUTCOMES: After completing this procedure, a vacuum is obtained, and any air leakage stops. We employed this technique to treat a cohort of patients in our department over a period of two years, and obtained good healing of soft tissue without air leakage, as well as good clinical outcomes. LESSONS: We have observed that patients treated with this method experienced good clinical outcomes without air leakage, and we recommend its use in treating cases where an external fixation device is present.

Elastic rubber strips to heal large wounds of the body wall.

BACKGROUND/PURPOSE: Closure of large wounds is a difficult surgical challenge. This article reports on the effective closure of large surgical wounds using elastic rubber strips. METHODS: One to 3 circular elastic rubber strips were sutured by applying moderate tension to the opposite edges of 30 large wounds in 28 patients. The strips were sutured in a successive "X" fashion by crossing one over the other. These rubber strips were replaced when they ruptured or after their tension had reduced because of the closure of the wounds. RESULTS: Complete closure of the wounds was achieved with no further need for any surgical procedure or device. One patient with laparostomy and colostomy presented with difficulty on adapting the colostomic bag, and the rubber strips were removed. The rubber strip had little effect on a large wound of the skull. In the late postoperative follow-up, 3 of the 15 closed laparostomies developed incisional hernias, and all these patients were subjected to hernioplasties with good results. CONCLUSION: The use of circular elastic rubber strips maintained at moderate tension is a simple, effective, and inexpensive surgical option for healing large wounds. It is readily available at any hospital and requires no extensive surgical experience.

The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids.

BACKGROUND: Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option.There are substantial data in the literature concerning efficacy and safety of 'rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. METHODS/DESIGN: The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids. DESIGN: A multi-centre, parallel group randomised controlled trial. OUTCOMES: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention. PARTICIPANTS: 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals. RANDOMISATION: A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. DISCUSSION: The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids. TRIAL REGISTRATION: ISRCTN41394716.

Sutura elástica para tratamento de grandes feridas / Elastic sutures for the treatment of extensive wounds

O fechamento de grandes feridas continua sendo um importante desafio para o cirurgião plástico. O objetivo deste artigo é a divulgação da sutura elástica como uma técnica eficaz para o fechamento de grandes feridas. Foram incluídos no estudo 14 pacientes portadores de grandes lesões decorrentes de traumas diversos em membros inferiores. O fechamento completo das feridas foi obtido por procedimento dividido em duas etapas, sendo a primeira representada por aproximação das bordas opostas da ferida por meio de tiras circulares elásticas de borracha e a segunda, realizada alguns dias após, com a retirada das tiras elásticas, seguida de sutura simples com fio mononáilon. A sutura elástica demonstrou ser uma técnica segura, funcionalmente eficaz, de fácil execução e de baixo custo para fechamento de grandes feridas, evitando áreas doadoras, como nos enxertos de pele.

The suture of extensive wounds remains a major challenge for plastic surgeons. The objective of this article is to promote use of elastic sutures as an effective procedure for the closure of extensive wounds. Fourteen patients presenting with extensive wounds caused by trauma in the lower limbs were included in the study. The entire wound was sutured in each patient with a two-step procedure. In the first step, the opposite edges of the wound were approximated using rubber circular elastic bands. In the second step, carried out a few days later, the elastic bands were removed, followed by a simple suture with monofilament nylon thread. Placement of elastic sutures proved to be a safe, functionally effective, easy-to-perform, and low-cost procedure for the closure of extensive wounds without using donor areas as skin grafts.

Management of flat or inverted nipples with simple rubber bands.

BACKGROUND: Occurrences of flat or inverted nipples are not uncommon problems, and although they should not preclude breastfeeding, they often seriously hamper initiation and continuation of breastfeeding. Various therapies including nipple exercise, breast shells, inverted syringes, or surgical corrections have been reported with varying success rates. SUBJECTS AND METHODS: A new method has been devised by the authors that consisted of tying a rubber band around the base of the nipple, with the help of a syringe applicator, to make it prominent. Latex rubber bands cut from condom rims were used in this study. The band had to be worn only during feeding. This method was tested on 19 mothers with flat, inverted, or otherwise deformed nipples. The babies were born in hospitals and were between 9 and 38 days old, mostly fed by bottle feeding, at the time of presentation. The mothers had been counseled about the importance of good attachment during breastfeeding and shown the new method. They were instructed to use the method at home and attend follow-up on day 3, day 7, and day 28. RESULTS: Sixty-three percent of mothers could achieve latching at the breast with good attachment within 3 days, and all did by the end of the month, as nipples no longer remained a problem. The insufficiency of milk was gradually taken care of by frequent suckling with time. No complications like pain or slipping of the band were reported. CONCLUSIONS: This simple method may be a good bedside solution for flat/retracted nipples. The authors strongly believe that if the new method is applied immediately after birth under supervision, no mother with nipple problem will be required to feed nonhuman milk to her baby.

Rubber-toughening of dimethacrylate dental composite resin.

UNLABELLED: Dimethacrylate dental composite resins exhibit inherently low toughness. Toughening of these materials may reduce the incidence of marginal and bulk fracture of composite restorations. OBJECTIVE: To determine if dimethacrylate dental restorative materials can be rubber-toughened, and if so, to identify a possible mechanism. METHODS: A filler composed of aggregates of polybutadiene/silica as well as irregularly-shaped silica slabs was produced by mixing silica with polybutadiene in dichloromethane. The dried filler was subsequently ground and sieved to < 25 microm. Polybutadiene/silica ratios were varied from 0:1 (control) to 0.5:1. EDAX analysis verified the composition of the complex filler. Filler was added to a bis-GMA/bis-EMA/TEGDMA resin system and fractured in three-point bend test mode at a crosshead speed of 1 mm/min. In addition, 1 bar was fractured at a crosshead speed of 0.001 mm/min to identify a possible mechanism for toughening. RESULTS: In specimens fractured at 1 mm/min, flexural modulus is increased or maintained and flexural strength and energy to break increase as the amount of polybutadiene in the aggregates increases. Cavitation of high-rubber-containing aggregates is demonstrated. In the one specimen fractured at 0.001 mm/min, a marked increase in size of high-rubber-containing aggregates along with severe shear damage in the surrounding matrix is shown, suggesting that cavitation with subsequent absorption of energy during shear yielding is the likely mechanism behind the increase in energy to break in bars fractured at 1 mm/min. SIGNIFICANCE: These results indicate that dimethacrylate dental composite materials can be rubber toughened, which may potentially reduce marginal and bulk fractures of composite restorations, and consequently extend their service lifetime.

Natural rubber latex allergy in children: clinical and immunological effects of 3-years sublingual immunotherapy.

BACKGROUND: We previously demonstrated that one year of sublingual immunotherapy (SLIT) with natural rubber latex (NRL) was safe and efficacious in paediatric patients with NRL allergy. RESEARCH DESIGN AND METHODS: We studied 12 NRL-allergic children (age 4-15), previously assigned to the treated arm of a double-blind placebo controlled study, who received a commercial latex SLIT for three years. Adverse reactions were monitored. The primary end-point was the NRL glove-use test. As secondary end-points, skin prick test with NRL and NRL serum specific IgE were used. MAIN OUTCOMES MEASURES: No SLIT-related side effects were observed. A significant reduction of the glove-use score was observed after one-year treatment (5.1 +/- 4.2 vs. 14.8 +/- 5.7, p=0.0031). This parameter was further reduced in the second year since SLIT start (2.0 +/- 2.7, p=000007). After 3 years of SLIT all patients had a negative glove-use test (p<0.0001). Baseline wheal areas of skin prick test (6.8 +/- 2.5 mm2) were significantly reduced after 2 (5.3 +/- 1.8 mm2) and 3 years (4.0 +/- 1.8 mm2) of SLIT (p=0.039 and 0.027, respectively). Baseline values of serum specific IgE (23 +/- 34 KU/l) were significantly reduced after 3 years since SLIT start (6.4 +/- 5.0, p=0.0371). CONCLUSIONS: Three years of latex SLIT is safe and consolidates the efficacy previously observed after one year of treatment in paediatric patients.

Considerações clínicas e biomecânicas de elásticos em Ortodontia / Clinical and biomechanical aspects of elastics in Orthodontics

A evolução e a melhoria dos materiais elásticos aumentaram e muito sua aplicabilidade nos tratamentos ortodônticos em diversas situações, como: na simplificação da fixação dos arcos aos braquetes em substituição às ligaduras metálicas, na retração de dentes, no fechamento de espaços auxiliares em aparelhos extrabucais e em alguns tipos de mecânicas ortodônticas. Desta forma, o objetivo deste artigo é apresentar uma revisão sobre os tipos e propriedades dos elásticos usados em Ortodontia: os de borracha e os sintéticos. Serão abordadas as vantagens, desvantagens, indicações e limitações quanto ao seu uso, de forma a orientar os profissionais da área e estudantes de pós-graduação em Ortodontia, facilitando sua seleção e utilização. Além disso, serão sugeridas algumas aplicações clínicas mais frequentes dos elásticos em Ortodontia, bem como os aspectos biomecânicos mais relevantes

Plaque removal with a novel rubber chewing wheel device: results of a randomized clinical trial.

OBJECTIVE: The objective of this study was to evaluate the ability of a disposable rubber chewing wheel (Rolly Brush device) to remove plaque after meals. METHODOLOGY: This was a randomized, four-armed, investigator-blinded study where subjects were assigned into tooth brushing, mouthrinse, chewing gum, and Rolly Brush groups. Plaque index was measured before and after one of the four plaque removal techniques. Questionnaires were administered to ascertain the subject's opinion of the Rolly Brush device compared with the other plaque removal methods. RESULTS: Rolly Brush removed plaque better than mouth rinsing (p < 0.03). Subjects reported that Rolly Brush removed plaque better than mouthrinse (p < 0.001) or chewing gum (p < 0.001), but not better than tooth brushing (p = 0.365). Subjective reports indicated that the Rolly Brush device was less likely to disrupt taste compared to mouthrinse (12% versus 30% of the subjects, respectively). Subjects randomized to the Rolly Brush group also rated the device highest in terms of ease of use, although there were no statistical differences among the methods. CONCLUSION: These results suggest that a disposable rubber chewing wheel, the Rolly Brush device, is an acceptable means of removing plaque after meals, and should be well tolerated by the public.

Development of a long-acting therapeutic system: Part I: A method to produce silicon rubbers with well-defined microstructures.

Based on the free-volume theory of diffusion in rubbers it is shown that the diffusion coefficient D of a permeating drug can be written as the product of two probabilities D approximately w(1)w(2). The polymer chains in a rubber are subject to thermal vibrations. Hence collisions between vibrating polymer segments and permeating drug molecules can occur. w(1) describes the probability that by such a collision a drug molecule experiences an energy exchange which is large enough to overcome its interactions with its neighborhood. w(2) describes the probability that a permeating drug molecule will find in its immediate neighborhood a free volume being equal or larger than its own volume. Diffusion takes place if the drug molecule experiences a sufficiently large exchange of momentum and finds at the same time a sufficiently large free volume. As both events are independent their overall probability is given by the product of the two probabilities. For a given rubber and a given species of drug molecules in a first approximation w(1) can be considered as constant. This means the diffusion coefficient is mainly determined by w(2). This probability, however, is strongly determined by the microstructure of the rubber. In this study a procedure is developed allowing for a straightforward synthesis of silicone rubbers with defined network density.

Infusores elastoméricos en la administración de fármacos / Elastomeric infusers in drug administration

El desarrollo de los sistemas de infusión elastoméricos, o infusores, ha supuesto un importante avance en la administración, tanto ambulatoria como hospitalaria, de fármacos en determinadas situaciones clínicas. El mantenimiento de valores plasmáticos de fármacos estables permite un mayor control de la enfermedad y de sus síntomas acompañantes, y supone una mejora en la calidad de vida de los pacientes, por lo que los infusores elastoméricos son una alternativa eficaz para la administración de tratamientos en pacientes oncológicos, con procesos terminales o con dolor agudo y/o crónico. En este artículo se lleva a cabo una revisión de las ventajas, el manejo y los cuidados de dichos infusores (AU)

Chronology of histological changes after band ligation of esophageal varices in humans.

BACKGROUND AND STUDY AIMS: While the histological effects of endoscopic sclerotherapy in humans have been extensively described, the effects of endoscopic ligation have been reported in only two cases. The purpose of this study was to reconstruct the chronological sequence of histological changes after ligation of esophageal varices. PATIENTS AND METHODS: Autopsy specimens from six patients who received ligation of varices from nine hours to 22 months ante-mortem were evaluated for gross and microscopic changes. RESULTS: Early after ligation, the appearance was that of a polyp with its base compressed by the band. Variceal thrombosis was seen on day 2. Varying degrees of ischemic necrosis of the polyp were present on days 0-5. If the bands did not remain in situ for two days (premature loss), necrosis of the polyp and dilated variceal vessels were seen. On day 22, superficial ulcers were observed. After complete healing, fibrosis was seen in the submucosa. CONCLUSIONS: The changes seen in the present study are similar to those described in animals. The delay in ulcer healing, compared with the gross changes reported during follow-up endoscopic examinations, may be related to the severity of the underlying illness and the compromised immune status of patients in the present series.