Massively parallel sequencing of autosomal STRs and identity-informative SNPs highlights consanguinity in Saudi Arabia

While many studies have been undertaken of Middle Eastern populations using autosomal STR profiling by capillary electrophoresis, little has so far been published from this region on the forensic use of massively parallel sequencing (MPS). Here, we carried out MPS of 27 autosomal STRs and 91 identity-informative SNPs (iiSNPs) with the Verogen ForenSeq™ DNA Signature Prep Kit on a representative sample of 89 Saudi Arabian males, and analysed the resulting sequence data using Verogen’s ForenSeq Universal Analysis Software (UAS) v1.3 and STRait Razor v3.0. This revealed sequence variation in the composition of complex STR arrays, and SNPs in their flanking regions, which raised the number of STR alleles from 238 distinct length variants to 357 sequence sub-variants. Similarly, between one and three additional polymorphic sites were observed within the amplicons of 37 of the 91 iiSNPs, forming up to six microhaplotypes per locus. These further enhance discrimination compared to the biallelic target SNP data presented by the primary UAS interface. In total, we observed twenty-two STR alleles previously unrecognised in the STRait Razor v3.0 default allele list, along with nine SNPs flanking target iiSNPs that were not highlighted by the UAS. Sequencing reduced the STR-based random match probability (RMP) from 2.62E-30 to 3.49E-34, and analysis of the iiSNP microhaplotypes reduced RMP from 9.97E-37 to 6.83E-40. The lack of significant linkage disequilibrium between STRs and target iiSNPs allowed the two marker types to be combined using the product rule, yielding a RMP of 2.39E-73. Evidence of consanguinity was apparent from both marker types. While TPOX was the only locus displaying a significant deviation from Hardy-Weinberg equilibrium, 23 out of 27 STRs and 63 out of 91 iiSNPs showed fewer than expected heterozygotes, demonstrating an overall homozygote excess probably reflecting the high frequency of first-cousin marriages in Saudi Arabia. We placed our data in a global context by considering the same markers in the Human Genome Diversity Panel (HGDP), revealing that the Saudi sample was typical of Middle Eastern populations, with a higher level of inbreeding than is seen in most European, African and Central/South Asian populations, correlating with known patterns of endogamy. Given reduced levels of diversity within endogamous groups, the ability to combine the discrimination power of both STRs and SNPs offers significant benefits in the analysis of forensic evidence in Saudi Arabia and the Middle East region more generally.     

Influence of oral hygiene on oral health of recruits and professionals in the Croatian Army

OBJECTIVES: Good oral health of soldiers would decrease the number of urgent dental interventions and absences from training and the battlefield and would improve the security of the whole formation. This study shows the habits for maintaining oral health and the oral status of the examined population in the Croatian Army. METHODS: The data were obtained from examinations and questionnaires of 912 Croatian soldiers, 650 of whom were recruits and 262 professional soldiers of the Croatian Army land forces. RESULTS: The results showed that the oral health of the examined population was mostly bad, as a consequence of inadequate prevention of illnesses of the oral cavity associated with insufficient oral hygiene. The most common disease was dental caries (5.84 carious teeth per recruit and 2.71 per professional). Only 14 (1.53%) of 912 examinees had completely healthy teeth. Only one-third of the examinees had no bleeding when tested with a periodontal probe. Acute pain of odontogenic origin was present for 23.5% of examinees. Such oral health makes most of the soldiers unreliable for peace operations that would last >6 months, because it lowers their combat readiness. CONCLUSION: Oral hygiene and oral health are poor. Consequently, combat readiness is low because of the need for frequent dental interventions, which could further lead to absence from the field and appointed tasks. The results emphasize the need for obligatory regular check-ups to improve oral health in the Croatian Army.     

Influence of oral health on combat readiness in the Croatian army

The impact of the acute stomatological conditions on the reducing of the combat readiness is an important responsibility for the military planners. Classification of dental health is the primary condition for research and assessment of the army dental readiness for combat. Clinical examination of teeth and mouth included 912 soldiers, 650 of whom were recruits and 262 active duty military personnel. According to their oral status, the examinees were divided into three classes. Class 1 included all those examinees that did not require any dental treatment or reevaluation within 12 months. Class 2 included all of the examinees whose oral health was such that if regularly controlled or followed up, they were not expected to have a dental emergency within 12 months. Class 3 included all of the examinees that required dental treatment to correct both their dental and oral health because the present condition was likely to cause acute stomatological conditions during the 12-month period. This survey designated 130 (14.3%) of the examinees to class 1,178 (19.5%) to class 2, and 604 (66.2%) to class 3. The combat readiness of the 604 (66.2%) examinees in the third class was reduced because a dental emergency can cause the need for dental treatment. The recruits do not have satisfactory dental status even at the beginning of their army service. Unfortunately, active duty military personnel do not have satisfactory dental status either, although they have access to cost-free dental care (prosthetics and orthodontics are not included). This increases the possibility for development of dental emergencies that would have a negative impact on combat readiness.     

A rubber-covered ceramic weapon reduces the incidence of dental trauma in recruits during combat basic training

The effect of a rubber-covered ceramic weapon was assessed on the incidence of dental trauma during basic training, since soldiers are more at risk of impact from a personal weapon. Dental files of soldiers (n = 4,542), who completed 8 months of training during 2008, were analyzed for incidence and type of dental trauma from a personal weapon. A rubber-covered ceramic weapon (n = 2,972) or a conventional one (n = 1,570, control) was used. Dental trauma was 0.4% per 8 months (0.6% per year) from the ceramic weapon and 1.5% per 8 months (2.3% per year) from the conventional one (p<0.001). The most prevalent type of injury was a simple/noncomplicated crown fracture (82% in study group, 75% in control group). The ceramic weapon significantly reduced dental trauma by diminishing the impact while in direct contact with the teeth or by absorbing and/or distributing the impact force. In conclusion, when possible a rubber-covered ceramic weapon should be preferred for basic combat training.     

The value of dental radiographic equipment in a Navy field hospital.

The portable dental X-ray machine has been used to augment standard field x-ray equipment. This allows for more rapid assessment of combat casualties. The data presented describe the use of the portable dental X-ray machine during the 100-hour ground war against Iraq.     

Acanthamoeba keratitis in a U.S. Army soldier after unauthorized use of contact lenses in the combat theater

A 25-year-old active duty Army E-5 developed severe infectious keratitis in his left eye secondary to soft contact lens (CL) wear while deployed in Iraq, necessitating evacuation to Walter Reed Army Medical Center for further evaluation and treatment. Initial clinical examination at Walter Reed Army Medical Center was suggestive of Acanthamoeba keratitis, a serious corneal pathogen associated with CL wear. In vivo confocal microscopy demonstrated Acanthamoeba cysts in the epithelium and anterior stroma, and smears and cultures from an epithelial biopsy specimen confirmed the diagnosis of Acanthamoeba keratitis. To our knowledge this is the first reported case of Acanthamoeba keratitis in a soldier wearing CLs in the combat theater. Because of the inability to maintain proper lens hygiene in a combat or field environment, the risk of developing a potentially sight-threatening corneal infection is significant. This unfortunate case of a devastating eye infection serves as a reminder of the current Army policy, which prohibits the use of CLs during gas chamber exercises, field training, and combat.     

U.S. Army dental emergency rates in Bosnia.

OBJECTIVE: Our objective is to report on overall dental emergency rates and rates by dental classification of a U.S. Army peacekeeping operation longer than 6 months in the year 2000. MATERIALS AND METHODS: This study was a retrospective cohort analysis of dental emergencies experienced by soldiers of the 3rd Armored Cavalry Regiment as a part of Stabilization Force VII. Before the deployment, all soldiers received dental examinations and the necessary dental treatment to make them class 1 or 2. A dental emergency was identified from field treatment records when a soldier presented to the clinic for a "sick call," emergency, or trauma visit. RESULTS: Retrospective review of the records identified 211 dental emergencies. Class 1 soldiers experienced 75 dental emergencies and class 2 soldiers experienced 136 emergencies. 3rd Armored Cavalry Regiment soldiers spent an average of 201.95 days deployed. The overall emergency rate was 156 dental emergencies per 1,000 soldiers per year. Class 1 and 2 rates were 121 and 185 dental emergencies per 1,000 troops per year, respectively. CONCLUSIONS: The results tend to confirm that dental emergencies continue to be a threat to overall readiness in deployed environments. Military planners need to ensure that the dental component of future forces are sufficient to care for the expected emergencies.     

Endodontics and dental readiness

The primary mission of the Dental Corps--maintaining the dental health of our soldiers at an optimum level to ensure their readiness to deploy and fight--is more important than ever in today's downsized, high-operational-tempo Army. A review of the literature indicates that 20 to 25% of all soldiers will report on dental sick call during a 1-year deployment, and approximately half will require endodontic intervention. This could cost a division more than 18,000 man-days of combat effectiveness in a theater of battle, an unacceptable loss. Approximately three-fourths of these sick call visits could be prevented if selected conditions were identified and treated before deployment. Endodontic conditions, which result in the majority of dental sick call complaints, should be given priority for treatment in garrison, and the identified soldier should be placed in dental fitness class 3 until the tooth is definitively treated.     

Estimation of the beta+ dose to the embryo resulting from 18F-FDG administration during early pregnancy.

Although 18F-FDG examinations are widely used, data are lacking on the dose to human embryo tissues in cases of exposure in early pregnancy. Although the photon component can easily be estimated from available data on the pharmacokinetics of 18F-FDG in female organs and from phantom measurements (considering the uterus as the target organ), the intensity of embryo tissue uptake, which is essential for deriving the beta+ dose, is not known. We report the case of a patient who underwent 18F-FDG PET/CT for tumor surveillance and who was later found to have been pregnant at the time of the examination (embryo age, 8 wk). METHODS: The patient received 320 MBq of (18)F-FDG. Imaging started with an unenhanced CT scan 1 h after the injection, followed by PET acquisition. PET images were used to compute the total number of beta+ emissions in embryo tissues per unit of injected activity, from standardized uptake value (SUV) measurements corrected for partial-volume effects. A Monte Carlo track structure code was then used to derive the beta+ self-dose and the beta+ cross-dose from amniotic fluid. The photon and CT doses were added to obtain the final dose received by the embryo. RESULTS: The mean SUV in embryo tissues was 2.7, after correction for the partial-volume effect. The mean corrected SUV of amniotic fluid was 1.1. Monte Carlo simulation showed that the beta+ dose to the embryo (self-dose plus cross-dose from amniotic fluid) was 1.8E-2 mGy per MBq of injected 18F-FDG. Based on MIRD data for the photon dose to the uterus, the estimated photon dose to the embryo was 1.5E-2 mGy/MBq. Thus, the specific 18F-FDG dose to the embryo was 3.3E-2 mGy/MBq (10.6 mGy in this patient). The CT scan added a further 8.3 mGy. CONCLUSION: The dose to the embryo is 3.3E-2 mGy/MBq of 18F-FDG. The beta+ dose contributes 55% of the total dose. This value is higher than previous estimates in late nonhuman-primate pregnancies.     

Dental emergency rates at two expeditionary medical support facilities supporting operations enduring and Iraqi Freedom

This study reports dental emergency rates and distribution of causes of dental emergencies at two expeditionary medical support facilities supporting operations Enduring Freedom/ Iraqi Freedom. A retrospective cohort analysis of 9948 soldiers deployed to Prince Sultan Air Base, Kingdom of Saudi Arabia, and 1467 soldiers at Baghdad International Airport, Iraq, was accomplished from a phased deployment from January 2003 to September 2003. Procedures were divided into 11 categories: endodontic, extraction of teeth other than third molars, extraction of third molar teeth, restoration of teeth (caries), restoration of broken teeth (not caries), orthodontic bracket/wire problem, sensitive teeth, temperomandibular pain, periodontal, oral pathology, and prosthodontic. The dental emergency rates for Prince Sultan Air Base and Baghdad International Airport were 153 and 145 dental emergencies per 1000 soldiers per year, respectively. Most of the emergencies were because of dental caries. Pain from third molars was the second most common reason for visiting the dental clinic.     

Application of the Kvaal method for adult dental age estimation using Cone Beam Computed Tomography (CBCT)

Different non-invasive methods have been proposed for dental age estimation in adults, with the Kvaal et al. method as one of the more frequently tested in different populations.The purpose of this study was to apply the Kvaal et al. method for dental age estimation on modern volumetric data from 3D digital systems. To this end, 101 CBCT images from a Malaysian population were used. Fifty-five per cent were female (n = 55), and forty-five percent were male (n = 46), with a median age of 31 years for both sexes. As tomographs allow the observer to obtain a sagittal and coronal view of the teeth, the Kvaal pulp/root width measurements and ratios were calculated in the bucco-lingual and mesio-distal aspects of the tooth. From these data different linear regression models and formulae were built. The most accurate models for estimating age were obtained from a diverse combination of measurements (SEE ±10.58 years), and for the mesio-distal measurements of the central incisor at level A (SEE ±12.84 years). This accuracy, however is outside an acceptable range in for forensic application (SEE ±10.00 years), and is also more time consuming than the original approach based on dental radiographs.     

The role of the military dental surgeon in treating facial injuries: a case report

This article describes the circumstances surrounding an intense, constant pain in the temporal region (visual analog scale 9-10) experienced by a 22-year-old combat officer in the Israel Defense Forces following a mild facial injury. The officer's wound included penetration of shrapnel particles into the facial skin, causing severe pain. Evaluations performed by a general surgeon, neurologist, psychiatrist, and otorhinolaryngologist did not reveal the source of this pain. Finally, a dental examination revealed that shrapnel had penetrated into the intraoral buccal mucosa near the right upper first molar. A "cold test" indicated the need for endodontic treatment of this tooth. After the treatment was completed, the patient's headache disappeared immediately, and the patient did not experience pain during a 6-month follow-up period. This case emphasizes the need for a dental surgeon to perform a meticulous intraoral examination in cases involving facial wounds.     

Survey of dental radiographic equipment and radiation doses in Finland

The radiation dose exposure, and the faults in about 1,700 dental units inspected at dental surgeries by the Finnish Centre for Radiation and Nuclear Safety in 1981-1985, were analysed. The mean value of skin doses in the bite-wing projection was about 6.2 mGy, the range 0.5 to 151 mGy. The mean energy imparted per bite-wing examination was estimated as 0.68 mJ and that per panoramic examination as 1.2 mJ. That gives a total imparted energy of about 600 J per year for conventional dental examinations and about 420 J per year for panoramic examinations. This gives a total of 0.13 mJ from conventional and 0.089 mJ from panoramic examinations per inhabitant per year. The collective effective dose equivalent was calculated as about 9 manSv for conventional dental examinations and about 6 manSv for panoramic examinations. Twenty per cent of units had some fault which was capable of decreasing radiation safety. Forty per cent of units were served reparation orders or other remarks were made in inspection documents. Large doses were usually accounted for by incorrect film processing and malfunction of the exposure timer.     

Dental fractures on acute exposure to high altitude

There is little in the literature on dental restoration breakage in the aviation environment since reports of problems in combat aviators in War World II. We report two cases of dental fractures during acute exposure to a hypobaric environment. Case 1 was a young officer who suffered an amalgam restoration breakage during a 25,000-ft decompression chamber simulation. Case 2 occurred in an experienced aviator who had a tooth cusp fracture in a molar with a defective amalgam restoration during an unpressurized helicopter flight to 18,000 ft. In both cases, after removing the defective fillings, deep secondary caries were found; both teeth were successfully restored. Because hard-tissue tooth fracture during a high-altitude flight is a rare event, few flight surgeons or dentists are familiar with this phenomenon. We recommend regular dental examinations with careful assessment of previous dental restorations in aircrew subject to decompression.     

1992 assessment of radiation risk from dental radiography.

Recent studies suggest that the lifetime cancer risks from exposure to low levels of ionizing radiation may be greater than previously estimated. This review first summarizes the findings of these studies as they pertain to dental radiology, then uses their concepts in combination with dosimetry from the dental literature to estimate the radiation risk from dental radiology. Estimation of risk from groups of exposed individuals requires use of mathematical models that fit the epidemiological data. The ICRP estimates that a single brief whole-body exposure of 1 Gy to 10,000 people results in about 500 additional cancer deaths over the lifetime of the exposed individuals, assuming a dose rate effectiveness factor of 2 for cancers other than leukaemia. Leukaemias are seen as a wave from 5 to 30 years following exposure. Cancers other than leukaemia typically start to appear about 10 years following exposure and remain in excess for as long as most exposed populations are followed, presumably for the lifetime of the exposed individuals. The gonadal dose is so small from dental radiography that the risk of heritable defects is negligible in comparison with the somatic risk. The dental literature contains several studies reporting sufficient dosimetric data for radiosensitive sites in the head and neck to allow estimation of the risk of fatal cancers from intra-oral and panoramic radiography. The highest estimated risks (using the ICRP data) are for leukaemia (bone marrow), thyroid and bone surface cancer. The total risk is estimated to be 2.5 fatal malignancies per 10(6) full-mouth examinations made with D-speed film and round collimation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of a laterally luxated upper incisor caused by the hit of a rifle stock

Lateral luxation is the displacement of the tooth in a direction other than axial, which is accompanied by comminution or fracture of the alveolar socket. Lateral luxation is one of the most prevalent dental injuries among the general population, resulting in up to 27% of all dental wounds. All physical activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces. Just like any other training activities, military training exercises present a significant risk of dental traumas, which comprise 2% to 8% of all military dental emergencies. The aim of this report was to present a case of a dental lateral luxation caused by the hit of a rifle stock during close combat training. The tooth was extruded from its bony lock, temporarily filled with a calcium hydroxide-based paste, replaced into its original anatomic position, and secured with Ivy loop wirings. The permanent endodontic treatment was performed 4 weeks after repositioning. At the end of the 8-months follow-up, the tooth was asymptomatic and any pathological alterations were absent.     

The psychologist's role in the Garrison mission of combat stress control units

Active duty psychologists frequently are called upon to provide services that extend beyond the model of direct patient care. Army psychologists in combat stress control teams or division mental health services, Navy psychologists deployed to surgical companies, and Air Force psychologists deployed with air-transportable hospitals or mental health rapid response teams may find themselves acting as organizational consultants as well as clinicians. Psychologists assigned to hospitals and clinics also have opportunities to make contact with their units for purposes of consultation and education. Organizational consultations that offer interventions for improving unit readiness and/or increasing combat effectiveness are often welcomed by commanders and provide a mechanism for the application of training and experience directly to military populations. Transferring skills from patient care to performance enhancement may not be a clear progression for many clinicians. This article describes the strategies and materials developed as part of a combat stress control garrison mission at Fort Lewis, Washington, as an example of one approach to working with combat units. The article also calls for the development of a formal mechanism to train psychologists for such roles and for the maintenance and dissemination of research materials to support organizational interventions.     

Falciparum malaria: an outbreak in a military population on an operational deployment

BACKGROUND: In May 2000, the United Kingdom deployed a joint force to Sierra Leone on an operation covering four phases. Each phase was characterized by high exposure risk of falciparum malaria but with varying risks due to the combat environment that affected implementation of malarial protection policy. AIM: This study will describe the risks managed concerning malarial protection for the force and match these to the attack rates (AR) suffered by the force. METHODS: The evidence concerning current malarial protection will be revisited. The risks attributable to disease and combat environment will be described and AR calculated using disease notifications as the numerator and operational personnel returns as the denominator. RESULTS: ARs appeared to be higher where the risk of hostile activity was higher. The evidence base concerning the use of malarial protection measures remains valid. The AR associated with deployment of a force to a high malaria risk area with a high associated risk of hostile action appears to be 0.78 cases per person-years exposure. The AR for personnel deployed to a high malaria risk area with a low risk of hostile action appears to be 0.078 cases per person-years exposure.     

A literature review of dental casualty rates

The ability to determine dental casualty rates for the Australian Defence Force in a given situation is vital for military planners. This article reviews the literature and the available Australian Defence Force data on the subject to give some guide to planners. The review found the studies to be fairly consistent in that a well-prepared dentally fit force can expect 150 to 200 dental casualties per 1,000 soldiers per year. If the force were less prepared, as in the case of a reserve call out, this figure would be likely to increase; in the extreme case of an ill-prepared force or a force assisting in humanitarian aid, the emergency rate could be five times that figure. The literature also indicates a change in the nature of dental casualties. Although maxillofacial cases have remained steady at 25%, dental disease has decreased and endodontic cases have had a corresponding increase.     

Biodistribution and radiation dosimetry of <Superscript>68</Superscript>Ga-PSMA HBED CC—a PSMA specific probe for PET imaging of prostate cancer

Purpose

Positron emission tomography (PET) agents targeting the prostate-specific membrane antigen (PSMA) are currently under broad clinical and scientific investigation. ⁶⁸Ga-PSMA HBED-CC constitutes the first ⁶⁸Ga-labelled PSMA-inhibitor and has evolved as a promising agent for imaging PSMA expression in vivo. The aim of this study was to evaluate the whole-body distribution and radiation dosimetry of this new probe.

Methods

Five patients with a history or high suspicion of prostate cancer were injected intravenously with a mean of 139.8?±?13.7 MBq of ⁶⁸Ga-PSMA HBED-CC (range 120–158 MBq). Four static skull to mid-thigh scans using a whole-body fully integrated PET/MR-system were performed 10 min, 60 min, 130 min, and 175 min after the tracer injection. Time-dependent changes of the injected activity per organ were determined. Mean organ-absorbed doses and effective doses (ED) were calculated using OLINDA/EXM.

Results

Injection of a standard activity of 150 MBq ⁶⁸Ga-PSMA HBED-CC resulted in a median effective dose of 2.37 mSv (Range 1.08E-02 – 2.46E-02 mSv/MBq). The urinary bladder wall (median absorbed dose 1.64E-01 mGv/MBq; range 8.76E-02 – 2.91E-01 mGv/MBq) was the critical organ, followed by the kidneys (median absorbed dose 1.21E-01 mGv/MBq; range 7.16E-02 – 1.75E-01), spleen (median absorbed dose 4.13E-02 mGv/MBq; range 1.57E-02 – 7.32E-02 mGv/MBq) and liver (median absorbed dose 2.07E-02 mGv/MBq; range 1.80E-02 – 2.57E-02 mGv/MBq). No drug-related pharmacological effects occurred.

Conclusion

The use of ⁶⁸Ga-PSMA HBED-CC results in a relatively low radiation exposure, delivering organ doses that are comparable to those of other ⁶⁸Ga-labelled PSMA-inhibitors used for PET-imaging. Total effective dose is lower than for other PET-agents used for prostate cancer imaging (e.g. ¹¹C- and ¹⁸F-Choline).