Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme

The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.

Diseases Pattern and Outcome among the Neonates in A Newly Established Special Care Newborn Unit (SCANU) At Secondary Level District Hospital in Bangladesh

Although huge improvement in neonatal mortality reduction in last two decades in Bangladesh but it is still very high compare with many other countries. High neonatal mortality also significantly contribute deaths among the under five children. Neonatal mortality reflects a nation's socio-economic status, efficiency and effectiveness of health care services. This was cross sectional study. The objective of this study was to analyse the diseases pattern and outcome of the neonates admitted in the newly established SCANU (Special care neonatal unit) of 250 bedded General Hospital of Tangail district, Bangladesh. Study period was one year from January 2017 to December 2017. Information from medical records of the SCANU was analysed. During the study period 1,379 neonates were admitted in the SCANU. The ratio between male and female was 1.5:1, 61% of the neonates admitted at first day of life. The reasons for admissions in SCANU were 31% of preterm and low birth weight, 23%birth asphyxia, 13% neonatal sepsis, 9% transient tachypnea of newborn, 5% congenital anomalies and 4% neonatal jaundice. Out of all neonates survival rate was 56% (779), while 25% (349) ended with fatality, 9% (122) were referred to tertiary level hospital and 10% (129) were left the hospital against medical advice. Among the fatal cases 63% died in first 24 hours and 88% in first week of life. Data shows that 47% deaths were due to preterm and low birth weight with its complication, other significant causes were birth asphyxia (30%), septicemia (16%) and congenital anomalies were (6%). Preterm and low birth weight, neonatal sepsis, birth asphyxia, transient tachypnea of newborn; congenital anomalies were the main reasons for admission in SCANU. Prematurity and its complication, birth asphyxia and neonatal sepsis as the major contributors to the neonatal mortality. The study findings will help researchers and policy makers to initiate further research and interventions to reduce fatality among the neonates in the SCANU.

InVO4/TiO2 composite for visible-light photocatalytic degradation of 2-chlorophenol in wastewater

InVO4/TiO2 composite was synthesized via amalgamation of InVO4 with TiO2 (Degussa P-25) powders. Application of the produced composite was evaluated as a catalyst for visible-light photocatalytic degradation of 2-chlorophenol (2-CP) in synthetic wastewater solutions. The catalyst was characterized by X-ray diffraction (XRD), scanning electron microscopy energy dispersive X-ray microanalyses and nitrogen physisorption. The degradation of 2-CP was affected by solution pH, light intensity, photocatalyst dosage and 2-CP initial concentration. InVO4/TiO2 showed higher photocatalytic degradation of 2-CP as compared with Degussa P-25 TiO2. Complete degradation of 2-CP was achieved with the InVO4/TiO2 catalyst under optimized conditions (1 g/L catalyst with a pollutant concentration of 50 mg/L at solution pH 5 and irradiation time of 180 min). Comparatively, 2-CP degradation efficiency of 50.5% was achieved with the TiO2 (Degussa P-25) at the same experimental conditions. The study confirmed that InVO4/TiO2 has high potential for degradation of 2-CP from wastewater under visible-light irradiation.

Pt nanoparticles/TiO2 for photocatalytic degradation of phenols in wastewater

Pt nanoparticles/TiO2 catalysts were prepared and evaluated for UV-photocatalytic degradation ofphenol and 2-chlorophenol (2-CP) in synthetic wastewater solutions. The catalysts were synthesized by immobilizing colloidal Pt nanoparticles onto titanium dioxide (rutile TiO2). Analytical techniques, such as standard Brunauer-Emmett-Teller isotherms, X-ray diffraction, transmission electron microscope, were utillized for investigating the specific surface area, structure, and particle size distribution of the catalysts and its components. The photocatalytic activities of both phenol and 2-CP solutions were studied in a 1L batch photoreactor independently, under 450 W UV irradiation. Samples were drawn at regular intervals and residual concentration of phenol and 2-CP in the samples was analysed using an UV-visible spectrophotometer. Parameters controlling the photocatalytic process, including catalyst concentration, solution pH, and initial phenol (2-CP) concentration, were investigated. The obtained results revealed that Pt/TiO2 showed higher photocatalytic degradation for both phenol and 2-CP pollutants in solution (as compared to the rutile TiO2). The degradation efficiencies of 87.7% and 100% were obtained for phenol and 2-CP, respectively, under optimized conditions (0.5 g/L catalyst with a pollutant concentration of 50 mg/L after irradiation time of 180 min).

Frequency and type of toenail tumors in the dromedary camel

A total of 275 dromedary camels (16 males and 259 females) of local "Arabiyat" breed suffering from different types and degrees of severity of toenail tumors were surgically treated. Histopathological examination of the tissue samples removed from 50 tumor-like growths (2 males and 48 females) revealed three types of tumors; squamous cell carcinoma (70%), spiny keratoderma (22%) and fibroma (8%). An increased incidence of tumors was recorded in the medial when compared to the lateral toenails in both sexes. In females, the incidence in the medial toenails was 90/259 (34.75%) and 71/259 (27.41%) in the right and left forelimbs respectively when compared to the lateral toenails which was 25/259 (9.65%) and 5/259 (1.93%) for the respective right and left forelimbs. In the hind limbs, this ratio was 29/259 (11.20%) and 20/259 (7.72%) for right and left medial toenails respectively, whereas it was 17/259 (6.56%) and 2/259 (0.77%) for the right and left lateral toenails respectively. Similar to the observations in female camels, male camels also showed a higher incidence of these tumors in the medial when compared to the lateral toenails in both fore and hind limbs. Based on these findings, we conclude that in the dromedary camels, the medial toenails of the fore limbs are most commonly affected with tumors; with the most common tumor being the squamous cell carcinoma.

Atypical Antipsychotics and Seborrheic Dermatitis: Three Case Reports

Seborrheic dermatitis (SD) has no diagnostic criteria and its etiology remains unknown. SD is distributed in the areas rich in sebaceous glands. Initially, MALASSEZIA FURFUR was thought to be the causing agent. Currently, SD is thought as not being proportional to the mean yeast count, but rather as an abnormal host immune response to the yeasts on the skin. There are a variety of topical and systemic antifungal agents available as a remedy. Corticosteroids and ultraviolet B are also used as treatment.

Hypothermic machine perfusion of liver grafts for transplantation: technical development in human discard and miniature swine models

INTRODUCTION

Cold storage (CS) is the standard preservation technique for liver transplantation (LTx). Hypothermic machine perfusion (HMP) is an alternative preservation technique that provides a continuous supply of substrates and removes waste products. HMP improves early graft function in kidney transplantation, especially for marginal organs: To our knowledge there have been no reports HMP in human LTx. The aim of this study was to develop a reproducible technique for liver HMP prior to initiating a clinical trial.

METHODS

For the discard protocol, between May 2001 and March 2002, 10 nontransplantable human livers were obtained. We designed a model of atraumatic, centrifugal HMP of the portal vein (PV) and hepatic artery (HA) via donor vascular conduit. Livers were perfused at 3 degrees C to 5 degrees C with Vasosol solution for 5 to 10 hours using a modified Medtronic Portable Bypass System. Perfusion variables (temp, flow, pressure) where recorded every 30 minutes. During the study, we also validated our techniques in an animal model. For the animal protocol; six swine were used as liver donors and randomized to 12 hours of CS in UW (n = 3) or 12 hours of HMP using Vasosol solution (n = 3). LTx was performed in six swine. Animals survived until postoperative day 5.

RESULTS

For the discard protocol, mean HMP time was 6.7 +/- 1.8 hours. Target flow was 0.7 mL/g liver/min. PV and HA pressure ranged from 3 to 5 and 12 to 18 mm Hg, respectively. All grafts were maintained at 3 degrees C to 5 degrees C during HMP. For the animal protocol, all recipients had good liver function and survived to postoperative day 5. AST and TBili were similar between CS and HMP.

CONCLUSIONS

Our method of liver HMP appears to be a safe and reliable method to preserve livers. A clinical trial is now underway to evaluate this technique in human LTx.

Serum protein electrophoretic pattern in young and adult camels

OBJECTIVE

To compare the electrophoretic pattern of serum proteins in clinically healthy adult camels (between 3 and 8 years of age) and camel calves (less than 3 months of age).

DESIGN

Laboratory analysis of serum from healthy camels.

PROCEDURE

Blood was collected from 30 healthy adult camels and 30 camel calves and the serum separated. Total protein of each serum sample was estimated by automated chemistry analyser. The proteins were fractionated by automated electrophoresis on agarose gel.

RESULTS

Serum proteins migrated on the agarose gel as one albumin, two alpha (alpha1 and alpha2-globulins), two beta (beta1 and beta2-globulins) and one gamma-globulin fractions. In adult camels the mean concentration of total protein, albumin alpha1, alpha2, beta1, beta2 and gamma-globulins was 56.8 +/- 1.5, 30.7 +/- 0.8, 2.4 +/- 0.1, 3.2 +/- 0.1, 9.7 +/- 0.3, 3.4 +/- 0.2 and 8.6 +/- 0.3 g/L, respectively. These values in calves were 49.7 +/- 1.8, 23.7 +/- 0.8, 3.2 +/- 0.2, 3.1 +/- 0.2, 14.2 +/- 0.2, 4.0 +/- 0.2 and 4.1 +/- 0.2 g/L, respectively.

CONCLUSION

The concentration of total proteins, albumin and gamma-globulins was higher (P < 0.05) in the adult camels than in camel calves. The concentrations of beta1 globulins was higher (P < 0.05) in calves as compared to adult camels.

The sepsis-coagulant axis: a review

Activation of coagulation is a normal component of the acute inflammatory response. Inflammatory cytokines initiate coagulation events locally at sites of inflammation by converting endothelium from an antithrombotic surface to a prothrombotic surface; by stimulating tissue factor production, which activates both the extrinsic and intrinsic coagulation systems; and by stimulating production of platelet-activating factors. The fibrinolytic system is initially activated but is subsequently inhibited. This results in a marked imbalance in coagulation and fibrinolysis resulting in a net procoagulant state. When thrombin generation and platelet activation exceed the body's capacity to inactivate or remove these factors, disseminated intravascular coagulation (DIC) results. DIC directly contributes to multiple organ failure and death associated with sepsis. Presently available treatments (i.e., heparin and aspirin) are relatively ineffective in treating DIC; however, newer, more potent drugs may soon be available for clinical use.

Role of tissue factor in intra-alveolar fibrin deposition and coagulopathy associated with pneumonic pasteurellosis in cattle

OBJECTIVE

To determine the role of tissue factor (TF) in the coagulation events leading to intra-alveolar fibrin deposition and intravascular thrombosis associated with pneumonic pasteurellosis in cattle.

ANIMALS

Healthy 2- to 4-week-old male Holstein calves.

PROCEDURES

Blood and bronchoalveolar lavage samples were collected before and at 1, 2, 4, and 6 hours after inoculation of saline solution or Pasteurella haemolytica. Total leukocyte count, platelet count, plasma total protein concentration, prothrombin time, and partial thromboplastin time were measured in blood samples. Total nucleated cell count, total protein concentration, and procoagulant activity were measured in bronchoalveolar lavage samples. Additionally, platelet survival in blood platelet accumulation in affected lung tissue, and gross and microscopic lung lesions were determined.

RESULTS

Administration of TF monoclonal antibodies (MAB) TF1-1F7 prevented the decrease in platelet survival and the increase in bronchoalveolar lavage fluid TF-dependent procoagulant activity observed in calves not treated with MAB TF1-1F7 antibody, but did not attenuate the increase in lavage fluid neutrophil numbers and total protein concentration, MAB TF1-1F7 administration reduced the percentage of lung affected by pneumonic lesions from 51.81% to 10.40% and attenuated intra-alveolar deposition of fibrin, neutrophils, and erythrocytes.

CONCLUSION

Intra-alveolar fibrin deposition and activation of coagulation in cattle with pneumonic pasteurellosis is, at least in part, mediated by TF.

CLINICAL RELEVANCE

Treatments that neutralize TF activity may attenuate lung injury in cattle with pneumonic pasteurellosis.

In vitro expression and inhibition of procoagulant activity produced by bovine alveolar macrophages and peripheral blood cells

Local and systemic activation of coagulation is frequently associated with bacterial sepsis. The coagulopathy is due, at least in part, to expression of tissue factor (TF) by monocytes and macrophages. The purpose of this study was to evaluate the expression of procoagulant activity by bovine alveolar macrophages, leukocytes and platelets, and to determine the relative potency of three chemical inhibitors of TF expression (pentoxifylline, retinoic acid, and cyclosporin A). Bovine alveolar macrophages were stimulated with lipopolysaccharide (LPS) derived from Pasteurella haemolytica or recombinant bovine tumour nervous factor (TNF) and dose- and time-dependent effects on TF expression were studied. LPS and TNF induced TF expression in alveolar macrophages and LPS treatment of whole blood induced TF expression in mononuclear cells. Neutrophils and platelets also expressed procoagulant activity, but this activity was not inhibited by anti-bovine TF monoclonal antibody. Pentoxifylline (40 mumol/L), retinoic acid (0.01 mmol/L) and cyclosporin A (0.08 mumol/L) inhibited TF expression when added concurrently with LPS or TNF, but not when added 4 h after stimulation. TF mRNA was not detected in unstimulated alveolar macrophages by Northern blot analysis. In contrast, exposure to LPS or TNF for 6 h induced marked expression of TF mRNA, which was inhibited by treatment with pentoxifylline, retinoic acid and cyclosporin A. Expression of TNF by alveolar macrophages stimulated with LPS was also inhibited by these compounds. Our results indicate that procoagulant activity expressed by alveolar macrophages and monocytes is associated with expression of TF, whereas procoagulant activity expressed by neutrophils and platelets is not. The concentrations of pentoxifylline and retinoic acid necessary for inhibition of TF expression in vitro may not be achievable in vivo owing to their toxic effects. However, the in vitro concentration of cyclosporin A that inhibited TF expression did not exceed the plasma concentration observed in humans, and therefore may be useful for inhibition of TF expression in vivo.

Attitudes toward people with AIDS and implications for school-based youth AIDS education

This study examines attitudes toward people with AIDS (PWAs) of a group of 853 7th, 8th, and 9th graders living in high-risk communities in the suburbs of a large Midwestern city. Females appear to be more tolerant than males, and whites appear to be more tolerant than other racial/ethnic groups with respect to attitudes toward PWAs. Although knowledge about actual modes of human immunodeficiency virus (HIV) transmission is not correlated with attitudes toward PWAs, students with greater knowledge about HIV transmission through casual contact, transmission of HIV through blood products, ways of preventing HIV infection, and myths about HIV prevention have more tolerant attitudes toward PWAs. Students who have ever had sexual intercourse are significantly less tolerant of PWAs. Implications of these findings for youth AIDS education are presented.

Quercetin, an in vitro inhibitor of CYP3A, does not contribute to the interaction between nifedipine and grapefruit juice

Quercetin, a flavonoid present in various fruits, is a potent in vitro inhibitor of CYP3A. Its role in the reported interaction between grapefruit juice and nifedipine has been determined in vivo in humans. Eight healthy volunteers were given in random order 10 mg nifedipine orally, either alone or with 200 ml double strength grapefruit juice, or with 400 mg quercetin. The area under the plasma concentration-time curve (AUC) for nifedipine with grapefruit juice (mean 320 ng ml(-1) h) was increased significantly (P < 0.01) compared with the AUC when nifedipine was given alone (mean 218 ng ml(-1) h). The time to peak plasma concentration for nifedipine with grapefruit juice (1.5 h) was also increased (P < 0.05) compared with control (0.5 h) suggesting delayed absorption. Although quercetin delayed the time to peak nifedipine concentration (1.3 h) it did not alter the AUC of either the parent drug (mean 209 ng ml(-1) h) or its first-pass metabolite. The results suggest that quercetin does not contribute to the effects of grapefruit juice (which contains <10 mg of quercetin 200 ml(-1)) on the metabolism of nifedipine. Oral doses of quercetin, similar to those possible from the ingestion of other fruits such as strawberries, do not produce in vivo inhibition of CYP3A mediated metabolism of nifedipine.

Awake fibreoptic intubation for a rare cause of upper airway obstruction--an infected laryngocoele

The anaesthetic management of a patient with an infected laryngocoele is presented. The relevance of this condition to the anaesthetist is discussed.

Anxiety, type A personality and endocrine responses to surgery

Twenty-seven patients underwent major abdominal surgery. Trait Anxiety and Type A personality were measured pre-operatively, and plasma cortisol, adrenaline and noradrenaline were measured pre-, per- and post-operatively. Anxiety correlated positively with noradrenaline but negatively with cortisol and adrenaline. Type A also showed opposite correlations with adrenaline and noradrenaline.

The relationship of preoperative distress to endocrine and subjective responses to surgery: support for Janis' theory

To test Janis' theory that preoperative worry can improve postoperative recovery, endocrine and subjective responses were measured in 27 patients undergoing major abdominal surgery which entailed threat to their health or longevity. Questionnaires to assess emotional and somatic state were completed preoperatively and for 7 days postoperatively. Plasma cortisol, noradrenaline, adrenaline, and glucose were measured pre-, per-, and postoperatively. Preoperatively, noradrenaline correlated positively with pain and distress, and adrenaline negatively. Postoperatively, endocrine levels and distress were not clearly related. Nevertheless, preoperative pain negatively correlated with postoperative adrenaline and cortisol levels. This, and the negative correlation between preoperative distress and postoperative pain are consistent with Janis' theory. In addition, we found that the longer patients waited on the day of surgery, the greater were the cortisol, noradrenaline, and glucose responses.