Trends of maxillofacial trauma: An update from the prospective register of a multicenter study in emergency services of Chile

Background

Determine the behavior of the maxillofacial trauma of adults treated in 3 tertiary care centers in the central zone of Chile.

Material and Methods

Descriptive, cross-sectional, multicenter study, based on the prospective records of maxillofacial trauma cases attended between May 2016 and April 2017 by dental and maxillofacial clinical teams of Adult Emergency Units of hospitals Dr. Sótero del Río (metropolitan region), Carlos Van Buren and Dr. Gustavo Fricke (region V). Age, sex, date of occurrence, type of trauma according to ICD-10, etiology, legal medical prognosis and associated injuries were recorded, stratifying by sex and age. Chi square and unpaired Wilcoxon tests were used to compare by groups.

Results

2.485 cases and 3.285 injuries were investigated. The male: female ratio was 1.7: 1 with age under 30 predominant, followed by older adults. Variability was observed in the yearly, weekly and daily presentation. The highest frequencies were in January and September, weekends and at night. The main etiologies were violence (42.3%), falls (13.1%) and road traffic crashes (12.9%) with differences by age and sex (p<0.05). 31,9% of the injuries occurred in hard tissue, being fractures in nasal bones predominant (S02.2).

Conclusions

The profile of the maxillofacial trauma in Chile seems to be mixed by age, affecting young people and the elderly. The male sex predominates; the main cause, which varies by age group, is violence. Their surveillance is possible from hospital emergency records.

Key words:Maxillofacial trauma, emergency department, multicenter study.

A Feasibility Study of High-Strength Bi-2223 Conductor for High-Field Solenoids

We performed a feasibility study on a high-strength Bi2-x Pb x Sr2Ca2Cu3O10-x (Bi-2223) tape conductor for high-field solenoid applications. The investigated conductor, DI-BSCCO Type HT-XX, is a pre-production version of Type HT-NX, which has recently become available from Sumitomo Electric Industries (SEI). It is based on their DI-BSCCO Type H tape, but laminated with a high-strength Ni-alloy. We used stress-strain characterizations, single- and double-bend tests, easy- and hard-way bent coil-turns at various radii, straight and helical samples in up to 31.2 T background field, and small 20-turn coils in up to 17 T background field to systematically determine the electro-mechanical limits in magnet-relevant conditions. In longitudinal tensile tests at 77 K, we found critical stress- and strain-levels of 516 MPa and 0.57%, respectively. In three decidedly different experiments we detected an amplification of the allowable strain with a combination of pure bending and Lorentz loading to ≥ 0.92% (calculated elastically at the outer tape edge). This significant strain level, and the fact that it is multi-filamentary conductor and available in the reacted and insulated state, makes DI-BSCCO HT-NX highly suitable for very high-field solenoids, for which high current densities and therefore high loads are required to retain manageable magnet dimensions.

Scanning electron microscopy of bacteria Tetrasphaera duodecadis

This study reports the characterization of the Tetrasphaera duodecadis bacteria and the techniques used therein. In order to evaluate the morphological characteristics of the T. duodecadis bacteria scanning electron microscope (SEM) was used throughout its different growth stages. These microorganisms were grown in vitamin B12 broths with 1% tryptone, 0.2% yeast extract, and 0.1% glucose. The turbidimetric method was employed for the determination of bacterial concentration and growth curve. The SEM results show small agglomerates of 0.8 ± 0.05 µm during the lag phase, and rod-like shapes during the exponential phase with similar shapes in the stationary phase.

Adherence to disease-modifying therapies in spanish patients with relapsing multiple sclerosis: two-year interim results of the global adherence project

The post-marketing international Global Adherence Project investigated adherence to disease-modifying therapy for relapsing-remitting multiple sclerosis. We report adherence data from the first 2 years in the Spanish subset of patients (n = 254 at baseline). The overall adherence rate was 85.4%. Patients taking intramuscular (IM) interferon-β (IFNβ)-1a were significantly more adherent (96.4%) compared with patients taking subcutaneous (SC) IFNβ-1a 22 μg (79.1%; p = 0.0064), SC IFNβ-1a 44 μg (79.6%; p = 0.0064) and glatiramer acetate (82.7%; p = 0.0184). At year 1 (n = 142), the overall adherence rate was 86.6%. Patients on IM IFNβ-1a were significantly more adherent than patients on SC IFNβ-1a 22 μg (93.9 vs. 66.7%; p = 0.0251). At year 2 (n = 131), the overall adherence rate was 82% (87.5% for IM IFNβ-1a, 80.0% for SC IFNβ-1a 22 μg, 77.8% for SC IFNβ-1a 44 μg, 85.2% for IFNβ-1b, and 80.0% for glatiramer acetate). In conclusion, adherence remained high among all disease-modifying therapies over the first 2 years of the study and was significantly higher for IM IFNβ-1a, at visit 1, compared with SC IFNβ-1a.

[Global adherence project to disease-modifying therapies in patients with relapsing multiple sclerosis: 2-year interim results]

BACKGROUND

In this article we report adherence data from the first 2 years in a subset of patients from the Global Adherence Project (GAP; n=2,648) in Spain.

METHODS

A questionnaire assessing adherence to Disease-modifying therapies (DMTs), was distributed annually to patients and their treating neurologists. Non-adherence was defined as missing a DMT injection or changing a dose in the four weeks prior to completing the survey. Patients signed informed consent and Ethics Committees approved annual follow-ups, visit 1 (V1) and visit 2 (V2) in 15 out of 18 centres in Spain.

RESULTS

A total of 254 patients were enrolled in Spain. Patients had a mean age of 37.9 years and 70.4% were female, and had been on their treatment for a median time of 28 months, and the overall adherence rate was 85.4%. Patients taking intramuscular interferon beta (IFNB)-1a (Avonex®) were significantly more adherent (94.6%) compared with patients taking subcutaneous (s.c.) IFNB-1a 22.g (Rebif®22) (79.1%; p=0.0064), s.c. IFNB-1a 44.g (Rebif®44) (79.6%; p=0.0064) and glatiramer acetate (GA) (82.7%; p=0.0184). At V1 (n=142), the overall adherence rate was 86.6% and patients on Avonex® were significantly more adherent than patients on Rebif®22 (93.9% versus 66.7%; p=0.0251). At V2 (n=131), the overall adherence rate was 82.4% (Avonex®, 87.5%; Rebif®22, 80%; Rebif®44, 77.8%; Betaferon®, 85.2%, and Copaxone®, 80%) without significant differences.

CONCLUSIONS

Adherence remained high over the first 2 years of the study. It was highest with Avonex®, being significant on first assessment, after 40.5 months of therapy, on average compared with other DMTs and at year 1 compared with Rebif®22.

[Indication for bone scans in early breast cancer staging]

OBJECTIVE

Evaluate the indication for bone scanning during staging of early breast cancer in the light of scientific evidence to assess the need to modify practices with scant effectiveness.

MATERIAL AND METHODS

The bone scans carried out in our Nuclear Medicine Department in 2007 on patients with primary breast cancer were reviewed retrospectively. Results were analyzed in relation to the clinical and histopathologic findings for each tumor. Bone scan results of tumors >2 cm y <or=5 cm (T2) were analyzed in two groups stratified by tumor size, <or=3 cm or >3 cm, and pre-treatment clinical stage.

RESULTS

Out of 245 bone scans of patients with breast cancer, 237 (97%) were negative for metastatic disease and 8 (3%) were positive. Lesions <2 cm (Tis and T1) were diagnosed in 131 patients (53.5%), none of which had bone metastasis at time of diagnosis. Lesions >2 cm and <or=5 cm (T2) were diagnosed in 84 patients (34%), of which 3.6% had bone metastasis. There were no differences in the rate of bone metastases in patients with stage T2 disease and lesions <or=3 cm vs. >3 cm. The bone scan findings did not modify staging in any of the 66 patients with T2 tumors stage IIA, but it did modify staging in 2 of 12 patients with stage IIB tumors. Twenty percent of 15 patients with T3 tumors and 13% of patients with T4 tumors had bone metastasis at time of diagnosis.

CONCLUSIONS

Ineffective practices should be modified and bone scanning should not be indicated in patients with early breast cancer Tis, T1 and T2 with tumor <or=2 cm, clinical stage IIA. Pre-treatment bone scanning is still indicated in T2 IIB, T3 and T4 disease.

Moraxella pluranimalium sp. nov., isolated from animal specimens

Four unusual Gram-negative, catalase-positive, oxidase-positive, coccus-shaped bacteria isolated from one sheep and three pigs were characterized using phenotypic and molecular genetic methods. On the basis of cellular morphology and biochemical criteria, the isolates were tentatively assigned to the genus Moraxella, although the organisms did not appear to correspond to any recognized species. Comparative 16S rRNA gene sequencing studies demonstrated that the isolates represent a novel subline within the genus Moraxella. The most closely related species in phylogenetic terms was Moraxella cuniculi, with 16S rRNA gene sequence similarity of 97.9 % to the type strain CCUG 2154(T), although the DNA-DNA relatedness value was only 29 %. The novel isolates were readily distinguished from all recognized Moraxella species by means of physiological and biochemical tests. On the basis of molecular genetic and phenotypic evidence, therefore, the four isolates represent a novel species of the genus Moraxella, for which the name Moraxella pluranimalium sp. nov. is proposed. The type strain is 248-01(T) (=CECT 7295(T) =CCUG 54913(T)).

[Validity of the Child Psychiatric Hospital Teacher Questionnaire for the assessment of ADHD. Teacher's version]

INTRODUCTION

Teacher's rating scales for the evaluation of attention deficit and superactivity disorder (TDAH) and conduct disorders have been shown to be useful and valid tools. The Child Psychiatric Hospital Teacher Questionnaire (CPHTQ) of the Hospital Psiquiátrico Infantil Dr. Juan N. Navarro was designed for the assessment of ADHD symptoms, externalizing symptoms and school functioning difficulties of children and adolescents.

METHODS

Internal consistency, criterion validity, construct validity and sensitivity of the scale to changes in symptom severity were evaluated in this study.

RESULTS

The scale was administered to 282 teachers of children and adolescents aged 5 to 17 years who came to a unit specialized in child psychiatry. The validity analysis of the instrument showed that the internal consistency measured by Cronbach's alpha was 0.94. The factorial analysis yielded 5 factors accounting for 59.1% of the variance: hyperactivity and conduct symptoms, predatory, conduct disorder, inattentive, poor functioning and motor disturbances. The CPHTQ scores on the scale showed positive correlation with the Clinical Global impression (CGI) scale in the patients' response to drug treatment.

CONCLUSIONS

The CPHTQ shows adequate validity characteristics that demonstrate its utility in the evaluation of patients with ADHD and its comorbidity with other behavior disorders.

Test strip for determination of nitrite in water

A disposable test strip is proposed for the determination of nitrite in waters. The strip is an inert rectangular strip of polyester with a 6 mm o.d. circular, transparent and colorless film attached to its surface. This film contains the chemicals required for reaction and fixation of the dye formed, sulfanilamide, N-(1-naphthyl)ethylenediamine on Nafion. When the test strip is placed in an acidified (pH 2.0) sample solution containing nitrite a red-violet color develops; the absorbance of this is measured at 536 nm. The linear range of the method depends on the time of equilibration of the test strip with the sample solution. When the equilibration time was 45 min, the linear range was 8.9-500 microg L(-1) whereas for an equilibration time of 60 min it was 4.7-200 microg L(-1). The detection limit was 1.4 microg L(-1) for an equilibration time of 60 min. The precision of the method, expressed as RSD, was 8.8 % at 100.0 microg L(-1). The method was applied, and validated chemometrically, for the determination of nitrite in different types of water (spring, mineral, tap, well, and sea).

Single-use optical sensor for the determination of iron in water and white wines

A new method, based on the use of a disposable sensor, for the determination of Fe(II) in waters and wines is proposed. The sensor is formed by an inert rectangular strip of polyester (Mylar) and a circular film (6 mm in diameter) adhered on its surface. This film, which contains the required reagents for the fixation of the analyte by means of a complexation reaction, forms the sensing zone of the sensor. When the sensor is introduced in an acidified (pH 2.5) sample solution containing between 4.0 and 300.0 micrograms/L of Fe(II), a violet-red colour develops in the initially colourless sensing zone. The linear range of the method depends on the equilibration time of the sensor with the sample solution. Thus, when the equilibration time was 5 min, the linear range was 41.0-300.0 micrograms/L, while for 60 min the range was 4.0-50.0 micrograms/L. Detection and quantification limits were 12.0 and 41.0 micrograms/L, respectively, for an equilibration time of 5 min. The precision of the method, expressed as relative standard deviation of ten samples of 100.0 micrograms/L of Fe(II), was 4.9%. Interferences produced by other species usually present in waters or wines have been studied. Cu(II) and Co(II) interfered seriously at concentration levels higher than 100.0 and 150.0 micrograms/L, respectively. The method was applied to the determination of Fe(II) in different types of waters and wines, using atomic absorption spectrometry as a reference method.

C282Y and H63D mutation frequencies in a population from central Spain

OBJECTIVES

To determine the frequency of hereditary hemochromatosis gene mutations, C282Y and H63D, from 125 autochthonous blood donors originating from a Central region of Spain, to provide epidemiological data about HFE gene in the Iberian Peninsula.

METHODS

DNA extracted from blood samples was analyzed by PCR-RFLP. Restriction enzymes were Snab I and Bcl I for C282Y and H63D, respectively. Results were visualized with Ethidium Bromide staining after gel electrophoresis.

RESULTS AND DISCUSSION

C282Y frequency was 0.02 and that of H63D was 0.16. Result for C282Y mutation falls within the range of variation of the Mediterranean populations. H63D frequency agrees with those reported for other European populations. In both cases frequencies obtained are the lowest of compared Spanish data.

CONCLUSIONS

This study is useful to compare expected versus presented C282Y and H63D frequencies in Spanish populations and to contribute to the knowledge of Spanish variability, rarely analyzed until now for HFE gene mutations.

[Lipodystrophy and hyperglycemia produced by protease inhibitors]

BACKGROUND

HIV-1 protease inhibitors (PI) have been recently associated with a syndrome of anomalous body fat distribution or lipodystrophy (LD), which sometimes is associated to hyperglycemia. Many aspects of this syndrome remain obscure. The objective of the study is to describe the prevalence, clinical patterns, derangement of glucose metabolism associated and follow-up.

METHODS

Patients taking at least one PI during January 1998 were asked a questionnaire about any body change, and a physical exam looking for fat changes was performed. In patients found to have LD, basal plasma glucose, cholesterol, triglycerides and cortisol were studied, and an oral glucose tolerance test (OGTT) was performed. In those cases with breast enlargement, prolactin and estradiol were measured.

RESULTS

Among 272 patients, five cases (1.8%) of LD were detected. The syndrome appeared associated with all the IP available at the time of the study, a medium of 4.2 months after the introduction of the drug. The most common pattern was fat accumulation in abdomen and breast, and fat loss in arms, legs and face. Basal glycemia was normal in all 5 patients, but OGTT showed carbohydrate intolerance in two (both of them had family antecedents of type 2 diabetes mellitus). Only one patient need treatment withdrawal because of progressive deforming changes.

CONCLUSIONS

The LD can appear in patients taking any IP. Body changes are usually self limited and in many patients PI don't need to be stopped.

Cystic degeneration of a uterine leiomyoma masquerading as a postmenopausal ovarian cyst. A case report

BACKGROUND

Leiomyomas are the most common of uterine neoplasms and a major cause of visits to gynecologists. While most often straightforward in their presentation and management, they can undergo various kinds of asymptomatic degeneration that drastically alters their appearance and muddies the process of diagnosis.

CASE

A 51-year-old woman was referred with a large adnexal mass that appeared on ultrasound to be a simple ovarian cyst. Because of its 10-cm diameter in a postmenopausal patient who could not guarantee close follow-up, surgery was performed. Normal ovaries were encountered, along with a large uterine cyst, identified as a degenerative leiomyoma.

CONCLUSION

Our case appears to be the largest simple cystic degenerative uterine leiomyoma reported and illustrates the possible diagnostic confusions. Subtle clues may differentiate uterine from adnexal cystic structures sonographically, but this case illustrates that while extremely valuable, sonographic evaluation in gynecology is not infallible.

Serum ferritin as a component of the insulin resistance syndrome

OBJECTIVE

In epidemiological studies, serum ferritin was the second-strongest determinant of blood glucose (after BMI) in regression models and the third-strongest determinant of serum insulin (after BMI and age). Its concentration also correlated positively with plasma triglycerides and apolipoprotein B concentrations, and negatively with HDL2 cholesterol. We hypothesized that serum ferritin could be a marker of insulin resistance.

RESEARCH DESIGN AND METHODS

Oral glucose tolerance and insulin sensitivity (SI, minimal model method) were prospectively evaluated in 36 healthy subjects. The relationship between serum ferritin and metabolic control (as measured by HbA1c levels) was also studied in 76 consecutive NIDDM patients.

RESULTS

In healthy subjects, log-transformed serum ferritin (LOGFER) correlated with basal serum glucose (r = 0.44, P = 0.007), but not with BMI, age, systolic or diastolic blood pressure, total cholesterol, VLDL cholesterol, HDL cholesterol, total triglycerides, VLDL triglycerides, serum insulin, or HbA1c (all P = NS). Identical results were obtained when the two lowest quartiles of serum ferritin were evaluated separately. However, in the two highest quartiles, LOGFER correlated with BMI (0.50, P = 0.02), diastolic blood pressure (r = 0.8, P < 0.0001), serum LDL cholesterol (r = 0.57, P = 0.01), VLDL cholesterol (r = 0.48, P = 0.03), total cholesterol and HDL2 and HDL3 subtractions of HDL cholesterol (r = -0.68, -0.76, -0.55, P = 0.001. < 0.0001, and 0.01, respectively), total triglycerides (r = 0.60, P = 0.006), HDL2/HDL3 quotient (P = -0.71, P = 0.001), VLDL triglycerides (r = 0.65, P = 0.004), and serum uric acid (r = 0.51, P = 0.03), but not with systolic blood pressure (r = 0.38, P = 0.15). After adjusting for BMI, only the correlations between LOGFER and diastolic blood pressure (r = 0.7, P = 0.002) and HDL2/HDL3 quotient (r = -0.63, P = 0.01) remained significant. Strong correlations between LOGFER and glucose area under the curve during oral glucose tolerance test (Pearson's r = 0.73, P = 0.001) and SI (r = -0.68, P = 0.001), which remained significant after controlling for BMI, were observed. LOGFER (beta = -0.44, P = 0.01) and BMI (beta = -0.52, P = 0.004) constituted independent predictors of insulin sensitivity in a multivariate analysis (R2 = 0.68). In 76 consecutive NIDDM outpatients, serum glucose (P < 0.00001) and LOGFER (P = 0.03) independently predicted the value of HbA1c (R2 = 0.40) in a multiple linear regression analysis.

CONCLUSIONS

The correlations among serum ferritin and diastolic blood pressure, HDL quotient, glucose area under the curve, and SI suggest that serum ferritin could be a marker of the insulin resistance syndrome. Serum ferritin may also be an independent determinant of poor metabolic control in the diabetic patient.

Heterozygous P0 knockout mice develop a peripheral neuropathy that resembles chronic inflammatory demyelinating polyneuropathy (CIDP)

Demyelinating peripheral neuropathies are clinically divided into inherited and acquired types. Inherited demyelinating neuropathies are caused by mutations in genes expressed by myelinating Schwann cells, whereas acquired ones, including chronic inflammatory demyelinating polyneuropathy (CIDP), are probably caused by autoimmune mechanisms. We find that heterozygous P0 knockout (P0+/-) mice develop a neuropathy that resembles CIDP. By one year of age, P0+/- mice develop severe, asymmetric slowing of motor nerves, with temporal dispersion or conduction block, which are features of acquired demyelinating neuropathies including CIDP. Moreover, morphological analysis of affected nerves reveals severe and selective demyelination of motor fibers, focal regions of demyelination, and inflammatory cells. These data suggest that immune-mediated mechanisms may contribute to the pathogenesis of the neuropathy in P0+/- mice.

Microheterogeneity and AMP-FLP analysis of the 3' flanking interleukin-6 VNTR polymorphism in central Spain

The 3' flanking region of the interleukin-6 gene is polymorphic due to the existence of a hyper-variable region consisting of a number of A + T rich variable repeated DNA sequences (VNTR). We used specific primers to amplify this particular VNTR system by PCR in 222 unrelated normal Spaniards from Madrid, Spain. A model of inheritance comprising of five different allele classes was proposed and frequencies evaluated as follows: B4, 0.635; B3.1, 0.029; B3, 0.270; B2, 0.038; B1, 0.027. Also, examples of inheritance of mendelian microheterogeneity are shown. Heterozigosity index was calculated (H = 0.5) and no departure from Hardy-Weinberg equilibrium was observed (chi 2 = 0.091, d. f. 1, p > 0.75).

Polymorphism analysis of the VNTR locus D17S5 in central Spain

The fragment length polymorphism YNZ22 (D17S5) was analysed for a sample of 207 unrelated individuals living in Madrid (Spanish Caucasians) using PCR-methodology and high resolution separation. Hardy-Weinberg expectations (HWE) were calculated after pooling alleles into four groups. No deviations from HWE were detectable using the conventional chi 2-test. The power of discrimination was estimated as 0.96 and the mean paternity exclusion chance as 0.7587. A comparison of the allele frequency distribution with those of other Caucasian groups revealed no major differences.

The Transcription Factors SCIP and Krox-20 Mark Distinct Stages and Cell Fates in Schwann Cell Differentiation

We have studied the transcription factors SCIP and Krox-20 in differentiating Schwann cells-during normal development, in experimentally induced degenerating and regenerating peripheral nerves, and in cell culture-and have compared the expression of these regulators to a battery of genes that mark distinct stages in Schwann cell differentiation. In the myelinating Schwann cell lineage, we find that SCIP is initially induced by contact with axons and first appears near the last round of cell division in immature cells. This expression is transient-it is maximal in "promyelinating" cells and is then extinguished as Schwann cells overtly differentiate and myelinate axons. In contrast, Krox-20 appears in cells 24-36 h after they become SCIP+ and continues to be expressed in mature myelinating cells. These differences in regulation are seen in normal development, in regenerating nerves following nerve crush, and in cultured Schwann cells stimulated to adopt a myelination phenotype by elevation of intracellular cyclic AMP. Importantly, transient SCIP expression is also observed in the nonmyelinating Schwann cell lineage, but Krox-20 expression is not. Together with the myelination phenotypes exhibited by SCIP and Krox-20 mutant mice, these results suggest that SCIP preferentially acts during the predifferentiated phases of Schwann cell development, while in contrast, Krox-20 is associated with the later commitment to myelination and may therefore function as a direct transactivator of myelination genes.

Tst-1/Oct-6/SCIP regulates a unique step in peripheral myelination and is required for normal respiration

The terminal differentiation of myelinating glia involves complex interactions that culminate in the formation of myelin. The POU domain transcription factor Tst-1/Oct-6/SCIP is expressed transiently during myelination, and we report here that it has a critical role in this developmental process. Deletion of the Tst-1/Oct-6/SCIP gene produces a severe defect in peripheral myelination by arresting Schwann cell maturation before axonal wrapping. Unexpectedly, the activation of major myelin-specific genes appears to be unaffected by the Tst-1/Oct-6/SCIP mutation, demonstrating that multiple, independently regulated events are required for terminal differentiation of Schwann cells. In addition, aberrant differentiation and migration of specific neurons in Tst-1/Oct-6/SCIP mutant homozygotes is associated with a fatal breathing defect, providing a model for investigating the regulation of pulmonary homeostasis.

Prenatal exclusion of paternity by PCR-FLP analysis of VNTR

A prenatal paternity test was requested by a 30-year-old woman. Variable number of tandem repeat (VNTR) systems were used for DNA analysis by means of amplification and electrophoresis followed by ethidium bromide staining or Southern blotting and oligonucleotide hybridization. Exclusion of paternity could be established on the basis of the great polymorphism and heterozygosity indexes of these genetic systems. This rapid method presents several advantages in contrast with other recombinant DNA techniques such as HLA class II oligotyping or RFLP.

An improved method for subtyping Pi in old bloodstains

Immunofixation procedures were used for detecting alpha-1 antitrypsin protease inhibitor (Pi) phenotypes in bloodstains. Neuraminidase elution of bloodstains, together with isoelectric focusing, immunofixation, and silver staining techniques, makes possible Pi subtyping in old bloodstains. No extra bands appear when the storage time is no longer than three months.