MRI scanning and orthodontics

Magnetic Resonance Imaging (MRI) plays an important role in diagnosis for many head and neck lesions. Both clinical and experimental studies have shown that orthodontic appliances may produce image distortion on MRI scans of the head and neck. A case is presented in which the patient complained of unexplained right-sided facial paraesthesia, whilst undergoing fixed appliance orthodontic treatment. This was a serious symptom, which warranted investigation including a MRI scan. The compatibility of fixed appliances with MRI is discussed.

Vaccine-associated varicella and rubella infections in severe combined immunodeficiency with isolated CD4 lymphocytopenia and mutations in IL7R detected by tandem whole exome sequencing and chromosomal microarray

In areas without newborn screening for severe combined immunodeficiency (SCID), disease-defining infections may lead to diagnosis, and in some cases, may not be identified prior to the first year of life. We describe a female infant who presented with disseminated vaccine-acquired varicella (VZV) and vaccine-acquired rubella infections at 13 months of age. Immunological evaluations demonstrated neutropenia, isolated CD4 lymphocytopenia, the presence of CD8(+) T cells, poor lymphocyte proliferation, hypergammaglobulinaemia and poor specific antibody production to VZV infection and routine immunizations. A combination of whole exome sequencing and custom-designed chromosomal microarray with exon coverage of primary immunodeficiency genes detected compound heterozygous mutations (one single nucleotide variant and one intragenic copy number variant involving one exon) within the IL7R gene. Mosaicism for wild-type allele (20-30%) was detected in pretransplant blood and buccal DNA and maternal engraftment (5-10%) demonstrated in pretransplant blood DNA. This may be responsible for the patient's unusual immunological phenotype compared to classical interleukin (IL)-7Rα deficiency. Disseminated VZV was controlled with anti-viral and immune-based therapy, and umbilical cord blood stem cell transplantation was successful. Retrospectively performed T cell receptor excision circle (TREC) analyses completed on neonatal Guthrie cards identified absent TREC. This case emphasizes the danger of live viral vaccination in severe combined immunodeficiency (SCID) patients and the importance of newborn screening to identify patients prior to high-risk exposures. It also illustrates the value of aggressive pathogen identification and treatment, the influence newborn screening can have on morbidity and mortality and the significant impact of newer genomic diagnostic tools in identifying the underlying genetic aetiology for SCID patients.

Effect of Liverubin™ on hepatic biochemical profile in patients of alcoholic liver disease: a retrospective study

Liverubin™ is an available drug in the Indian market that contains silymarin, the major active complex extracted from the medicinal plant milk thistle (Silybum marianum L.). The study retrospectively tracked and analyzed the data of 602 patients, out of which 230 were alcohol induced; 131 with alcohol-induced liver damage (ALD), 13 with liver cirrhosis, and 86 with fatty liver; to assess the effects of water soluble Silymarin (Liverubin™) on important hepatic biochemical parameters. The data was collected from 32 major cities treated by 72 physicians across India who were observed for the specified treatment duration of 11 months. Data was analyzed by using descriptive statistics. At the end of the treatment the hepatic biochemical profile was appreciably improved: the mean % of change in the levels of important hepatic biochemical parameters was observed as follows: total bilirubin 63.48% (direct bilirubin: 64.96%; indirect bilirubin: 61.63%). The serum SGOT and SGPT changed at a mean % of 65.43 and 69.31 respectively while serum alkaline phosphatase was changed at a mean % rate of 39.81. Liverubin™ proved to be safe & well-tolerated among the studied population and no significant treatment related adverse events were reported during the study. Liverubin™ treatment is found to bring about effective lowering of abnormally elevated hepatic biochemical parameters. Liverubin™, water soluble active Silymarin, in the popularly prescribed doses of 140-mg tid is observed to be a promising safe and effective drug in cases of alcoholic liver disease.

What are the significant factors associated with burnout in doctors?

BACKGROUND

Burnout syndrome is well established as a condition that affects a significant proportion of practising doctors. Although much literature exists on the prevalence of burnout, only specific variables associated with this condition have been analysed.

AIMS

To identify and categorize key factors that are associated with burnout across various medical specialities and geographical locations.

METHODS

Three electronic databases were searched for literature on the factors associated with burnout published in the past 5 years. Inclusion and exclusion criteria were applied in three stages. We analysed and critically appraised each paper individually, identifying the common themes.

RESULTS

Forty-seven papers were included from the 395 identified by our primary search. Younger age, female sex, negative marital status, long working hours and low reported job satisfaction were found to be predictive of burnout syndrome across the literature. Participation in 'wellness programmes' was related to lower burnout incidence. Causation could not be established however, due to the limited number of longitudinal studies.

CONCLUSIONS

More prospective studies are required to assess causation. Despite this, our thematic analysis revealed consistent findings across many papers. This information can be used to inform prevention and interventions to tackle burnout. The associated factors should not be addressed individually, as they are inter-related.

Hip resurfacing arthroplasty: A new method to assess and quantify learning phase

Hip resurfacing had initially gained acceptance and popularity as it helps preserve femoral bone stock. In this study we tried to answer the following questions; 1. Whether there is a learning curve for hip resurfacing? 2. Is it present in surgeons from non-developer centres? 3. Is it present in surgeons from developer centres as well? The Oswestry outcome centre was setup to serve an independent international registry for collecting, analysing and reporting outcomes following hip resurfacing. Over a 10 year period, 4535 patients (5000 hips) were recruited from different countries and within the UK from different centres in this study by 139 surgeons from 37 different countries. Our study has shown that function can be used to assess the level of surgical competence. The results from this multilevel analysis have helped to answer the questions posed in the introduction. Hip resurfacing is a surgical procedure with a learning phase and this learning effect is more pronounced in non-developer surgeons as compared to developer surgeons. Hip scores can be used to assess proficiency and competence of surgeons undertaking hip resurfacing arthroplasty.