Dental Public Health in Action: Utilising a telephone triage system to run an Urgent Dental Care Hub during the COVID-19 pandemic

This paper aims to explore the outcome of a telephone triage system used by different team members to run an Urgent Dental Care Hub (UDCH) during the first wave of the COVID-19 pandemic. It will also look at the adjustments made to the system because of the challenges faced. Data were collected from the telephone triage proforma and clinical notes of patients that were triaged from 2nd April to 10th June 2020. With 65% of telephone triaged and accepted patients receiving definitive treatment that alleviated the presenting complaint, the value of telephone triage is highlighted in streamlining an urgent dental care service during a viral pandemic. Public health competencies being illustrated: Dental public health intelligence, Developing and monitoring quality dental services.

QUALIDADE DA ÁGUA PARA FINS DE IRRIGAÇÃO EM REGIÕES ÁRIDAS E SEMIÁRIDAS

Objetivou-se com este trabalho revisar e levantar dados referentes à qualidade da água para fins de irrigação de regiões áridas e semiáridas. Os aspectos físico-químicos são os principais parâmetros de avaliação da qualidade da água para irrigação e os mais estudados são os valores de sais solúveis e sua concentração, no entanto, outros fatores devem ser observados como conjunto de processos que fazem baixar a qualidade da água para fins de irrigação. E devem ser levados em consideração os aspectos de sólidos suspensos, pH, sólidos solúveis, manganês, tipos de bactérias que existem na água de irrigação. O irrigante deve antes de qualquer coisa coletar água da fonte desejada para poder tomar as melhores decisões após receber o laudo da qualidade da água que deseja utilizar na irrigação.

Genomewide association study for production and meat quality traits in Canchim beef cattle

The commercial value of the bovine carcass is determined by a set of traits, such as weight, yield, back fat thickness, and marbling; therefore, the genetic improvement of growth, meat, and carcass quality traits is an important tool to add value to the supply chain. Genomewide association studies (GWAS) enable the identification of loci that control phenotypic expression of quantitative traits (QTL). Therefore, the objective of this work was to perform a GWAS to identify genomic regions and genes associated with growth, carcass traits, and meat quality in Canchim beef cattle. These traits were yearling weight (YW), rib eye area (REA), back fat thickness (BFT), and marbling (MARB). To increase sample size and marker density, genotype imputation was performed, and only markers imputed with greater than 95% accuracy were used. Genomewide association study was performed using a Bayesian approach, by the Bayes B statistical method, incorporating genotypes and phenotypes from 614 animals from both the Canchim breed and the MA genetic group (offspring of Charolais bulls and one-half Canchim + one-half Zebu cows). This investigation identified 1 and 4 genomic regions explaining 0.23 and 7.35% of the genetic variance for REA and YW, respectively. These regions harbor a total of 19 genes, 7 of which were classified for biological functions by functional analysis. Significant associations were not observed for BFT and MARB. The identification of QTL that had been previously described in the literature reinforces associations found in this study.

[Advantages of video assisted thoracic surgery in the treatment of spontaneous pneumothorax]

Spontaneous pneumothorax (SP) is a disabling condition mostly affecting young, thin and otherwise healthy males. It is usually caused by ruptured pleural blebs. The first treatment is the insertion of a chest tube (ICT) but in a great number of patients there is recurrence of the disease. We believe that the video assisted thoracoscopy (VATS) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence. In order to prove it, 40 patients admitted in a five-year period, with a SP, were randomly assigned to be treated by ICT or VATS. The ICT patients were in the hospital a mean time of 7.5 (4 to 15) days and the VATS patients, 5.3 (2 to 7) days (P < .05). ICT patients required analgesic drugs during 76.8 +/- 31 hours and VATS patients 38.4 +/- 13 hours (p < .05). From the ICT group, 8 (53%) patients had recurrence of the disease and 6 (40%) had a prolonged air leak, while none of the patients of the VATS group had any complication (< .001). Cost of ICT and VATS were $ 850 and $ 1730, respectively. According to these results, VATS should be the treatment of choice in SP patients. It treats the cause of the disease. It also reduces the hospitalization time, the use of analgesic drugs post surgery, decreases recurrence of the disease and the cost of the treatment. Moreover, the patients were back to work in less than 10 days.

Evaluation of the polarographic technique for assay of the viability of freeze-dried BCG vaccine: II. Viability of the vaccine assessed by polarography, Warburg respirometry and colony counting

A comparative study of the viability of 34 lots of freeze-dried BCG vaccine has been carried out using an oxygen electrode polarographic technique, Warburg respirometry and colony counting. There were no statistical differences between the results obtained with the polarographic and Warburg techniques. Both methods gave reliable and similar results and showed a positive correlation (r = 0.8615). Comparison between the polarographic and colony-counting methods showed a positive correlation (r = 0.6530); for comparison between the Warburg and colony-counting methods, the correlation value was r = 0.6868. All the tests were significant at the level of alpha = 0.05. The advantages of the polarographic technique are that it is much less time- and material-consuming than other methods. It is a reliable, inexpensive and convenient method for BCG vaccine quality control.

Allergies and skin testing: a Nairobi experience

A prospective study of 72 consecutive patients with symptoms of allergy is presented. Patients aged 20-39 years formed the bulk of the study population (55.6%). Most patients had allergic rhinitis (48.6%); bronchial asthma and atopic dermatitis occurred in 29 patients (40.3%) each. Drug allergies were found in 22 patients (30.6%), urticaria in 15 (20.8%), food allergies in 13 (18.1%), contact dermatitis in 10 (13.9%) and allergic conjuctivitis in 6 patients (8.3%). In many cases more than one allergic condition appeared simultaneously. Skin and prick tests and skin patch tests were done on 46 (63.9%) and 65 (90.3%) patients respectively. Soaps were most frequently implicated in positive reactions (75.0%); D. pteronyssinus, drugs, animal dander and foods gave positive reactions in 40.3%, 30.6%, 19.4% and 18.1% respectively. The need to have a high index of suspicion towards allergic conditions, especially extrinsic bronchial asthma, is stressed.

Allergic conditions in a general practice in Nairobi: a pilot study

This is a study of 574 randomly selected patients seen in a private practice. The incidence of allergic conditions was found to be 18.8%. The distribution of the allergic conditions was as follows: 35 suffered from bronchial asthma, 33 had dermatological allergic conditions, and 30 were reported as having drug allergies. A significant number of these patients had multiple allergic conditions.

Ventricular function during supine bicycle exercise in univentricular connection with absent right atrioventricular connection

Fourteen patients with univentricular connection, absent right connection (tricuspid valve atresia) and normally related great arteries underwent rest and supine bicycle exercise equilibrium radionuclide blood pool studies. Ejection fraction, heart rate, systemic blood pressure and oxygen saturation (ear oximetry) were measured. There were 6 male and 8 female patients. Mean age +/- standard error of the mean was 14.5 +/- 1.1 years (range 6.3 to 21.1). Eight patients (group 1) had systemic to pulmonary shunts placed as palliation 8.2 +/- 2.2 years before study and 6 patients (group II) had caval to pulmonary shunts placed 11.8 +/- 1.6 years previously. Ejection fraction at rest was 54 +/- 2% and an abnormal response to exercise (failure of ejection fraction to increase greater than or equal to 5% from rest to peak exercise) was found in 9 of 14 patients. When analyzed separately, ejection fraction at rest in group I was higher than in group II; however, this difference disappeared at peak exercise. There was a significant negative correlation between ejection fraction at peak exercise and the interval since palliative surgery, although it was not apparent at rest. These data suggest that ventricular function is compromised during exercise and that abnormal performance is influenced by long-standing volume overload. Importantly, this abnormal state is concealed at rest and the choice of palliative shunting procedure appears to have little effect on normalizing pump performance.

Congenital adrenal hyperplasia family studies using the short ACTH test

Because of the increasing use of 17-hydroxyprogesterone (17OHP) levels with the short adrenocorticotrophic hormone (ACTH) test in the detection of 21-hydroxylase deficiency, the diagnostic efficiency of the test was evaluated in patient and family studies of congenital adrenal hyperplasia due to 21-hydroxylase deficiency and of congenital adrenal hyperplasia due to 11-hydroxylase (11OH) deficiency (the latter disorder now overlaps basally with the milder non-classical 21-hydroxylase deficiency [NC-CAH]). Stimulated 17-hydroxyprogesterone level (17OHP30), 17-hydroxyprogesterone increase (delta 17 OHP) and the ratio 17-hydroxyprogesterone increase to cortisol increase (delta 17OHP/delta cortisol) were the parameters from the short ACTH test derived for assessment. 17-OHP30 provided complete differentiation of NC-CAH from the controls and heterozygotes, but overlap between NC-CAH and 11-OH occurred. Complete differentiation of NC-CAH from 11-OH was achieved using delta 17OHP. The heterozygotes showed best differentiation from the controls using delta 17OHP/delta cortisol with a diagnostic accuracy of 70%, however marked overlap of heterozygotes and NC-CAH with 11-OH was found. The short ACTH test proved to be a valuable technique with the further detection of homozygotes (n = 3) and heterozygotes (n = 5) in the 13 families studied. However, when interpreting the short ACTH test a careful choice of parameters should be made. It should be kept in mind that mild NC-CAH patients can only be differentiated from 11OH patients by using delta 17OHP.

[Serial determination of anthracycline poisoning in children]

Dose-related cardiotoxicity limits enthracycline administration in patients with solid tumours or leukaemia. Many patients (70%) would probably benefit by receiving more than a total accumulative dose of 500 mg/m2. As a measure of myocardial function the left ventricular ejection fractions (EF) were determined from serial radionuclide angiograms in 62 children who had at least 3 studies (mean age 8.4 +/- 5.4 years). Seven patients who had clinical evidence of cardiac involvement and/or a marked decline in their EF underwent endmyocardial biopsy (9 x). The EF declined progressively from 63 +/- 7% prior to chemotherapy to 60 +/- 5%, 58 +/- 7% and 54 +/- 7% after low, medium and high-dose anthracycline, respectively in the non-biopsied children vs 58 +/- 4%, 54 +/- 7% and 48 +/- 4% in the biopsied patients. Anthracycline dosage was 129 +/- 42, 307 +/- 68 and 471 +/- 61 mg/m2 and 103 +/- 64, 303 +/- 73 and 536 +/- 93 mg/m2, respectively. The biopsies were obtained at a mean anthracycline dose of 408 mg/m2 when the EF was 46 +/- 5%, and graded according to the modified Billingham score; grade 1 (6 x), 1.5 (2 x) and 2.5 (1 x). A decline in the EF was seen in 89% of our patients throughout their chemotherapy course, with a statistical significance of p less than 0.02 in the biopsied patients after medium dose therapy which was not seen in the non-biopsied children until they were receiving anthracyclines.

Noninvasive measurement of blood flow and extraction fraction

We describe the theory of a technique for the noninvasive measurement of organ blood flow which is based on the principle of fractionation of cardiac output and is applicable with any recirculating gamma emitting tracer. The technique effectively determines the count rate that would be recorded over the organ if the tracer behaved like radiolabelled microspheres and was completely trapped in the organ's vascular bed on first pass. After correction for organ depth, the estimated first pass activity plateau, expressed as a fraction of the injected dose, is equal to the organ's fraction of the cardiac output (CO). By extending the theory, organ extraction fraction of extractable tracers or mean transit time of nonextractable tracers can be measured. Renal blood flow (RBF) to the normal left kidney in 18 subjects without evidence of renal disease was estimated by the technique to be 10.4% CO (S.D. 1.2), for the right kidney 9.0% CO(S.D. 1.1), and for both, 19.4% CO (S.D. 1.5). In a separate series of eight patients, RBF values were highly reproducible when obtained on successive days (standard deviation of change: 0.67% CO for the left kidney, 0.63% CO for the right and 0.78% CO for both). The extraction fraction of DTPA (filtration fraction) was 8.5% (1.7) in the left kidney and 9.7% (2.1) in the right kidney. This parameter was less reproducible than RBF, with standard deviations of the changes equal to 1.17% for the left kidney and 1.31% for the right. Stable, well-functioning, renal allografts in children had a mean blood flow of 20.6% CO (S.D. 3.7). Transplant blood flow in eight patients with rejection was less than 5.2% CO. In patients without splenomegaly, splenic blood flow, splenic extraction fraction of sulphur colloid and splenic red cell mean transit time were 4.3% CO (S.D. 0.9), 41% (S.D. 13.8), and 36.9 s (S.D. 4.6), respectively.