Preventable Severe Thalassemia among Children

Abstract

This retrospective study analyzed 27 children with preventable severe thalassemia born to 24 at-risk couples between 1997 and 2017. The couples were categorized into two groups: the prenatal diagnosis (PND) group (n?=?8) and the non PND group (n?=?16). In the PND group, following comprehensive counseling on having a fetus with thalassemia, six couples decided to continue the pregnancy (n?=?6). Termination of the two remaining fetuses was excluded as the thalassemia status was reported at a gestational age of 24?weeks. In the non PND group, medical errors were found in the misdiagnosis of couples as non thalassemia carriers (n?=?4) and not offering PND to couples with known thalassemia carrier status when attending the antenatal clinic (ANC) (n?=?2). Additionally, parental ignorance was found in parents experiencing their own thalassemia, or that of their spouse or child (n?=?6). The remaining couples (n?=?4) with known carrier status either directly refused PND or were ineligible for it. A total of five divorces (5/24?=?20.8%) occurred in the PND (n?=?2) and the non PND (n?=?3) groups. Knowledge, beliefs, religion, experience of thalassemia, as well as the sex of the at-risk fetus all influenced parental decisions. Therefore, both medical personnel and parents are key in preventing new cases of thalassemia. Parents should be aware of the consequences of having children with severe thalassemia, while medical personnel should provide accurate carrier detection and PND.     

Recovery of Salmonella using a combination of selective enrichment media and antimicrobial resistance of isolates in meat in Thailand

From November 2004 to March 2005, 50 samples (chicken, pork and beef) of registered meat and non-registered meat were purchased from supermarkets and retail markets located in Bangkok, Thailand. Each sample was evaluated for Salmonella spp by a conventional method using combination of selective enrichment media (RV+MSRV) and compared with selective enrichment medium alone (DIASALM). Our study revealed the performance of RV+MSRV for the detection of Salmonella spp was significantly better than those of DIASALM alone since the recovery of Salmonella spp in both groups of meat was high using RV+MSRV, particularly in the registered meat. In addition, the recovery of serovars in registered meat was significantly higher than those in non-registered meat. Antimicrobial resistance of 62 Salmonella isolates in both groups of meat was determined for 10 antimicrobial drugs using the disk diffusion method. The results show that 100% of isolates from both groups were susceptible to amoxicillin/clavulanic acid, ciprofloxacin, cefotaxime and norfloxacin and 50-60% of isolates from both groups were resistant to tetracycline, streptomycin and ampicillin. Sixty percent of Salmonella isolates from meat showed multiresistance antimicrobial patterns.     

The repair potential of resin composite materials

Objectives

To measure the ‘repair’ strength of various combinations of composite using four manufacturers’ adhesive systems, to compare the bond strengths with the cohesive strength of the original, unrepaired products and to assess whether the chemical nature of the resin matrix influenced the repair strength.

Methods

Specimens were prepared of three composite materials Durafill, Heraeus Kulzer; P90 (Silorane) 3M ESPE; Z250 (3M ESPE) and aged in water at 60 °C for 1 month. One surface of each specimen was faced with 80-grit silicone carbide paper, one of four adhesives placed (Ecusit, DMG; Clearfil Repair, Kuraray; P90 System Adhesive; Single Bond 2, 3 M ESPE) and ‘repair’ composite added of the same type as above, such that all combinations of original and repair composite and adhesive were used. ‘Stick’ samples, approximately 6 mm × 0.8 mm × 4 mm were prepared from each repair specimen, a neck created at the junction of original and repair composites and the hour-glass sample tested in tension at 1 mm/min. The microtensile bond strength of the repair was calculated and the mode of failure (adhesive; cohesive in the original composite; cohesive in the repair composite) recorded.

Results

There was no significant difference between the cohesive strengths of Filtek P90 and Filtek Z250 (both ≈106 MPa); both were significantly stronger than Durafill (67.0 MPa). For bonding to Durafill the bond strengths ranged from 17.6 MPa to 50.9 MPa; for bonding to P90, the bond strengths ranged from 5.0 MPa to 54.2 MPa; for bonding to Z250, the bond strengths ranged from 17.2 MPa to 75.4 MPa. Clearfil Repair appeared to provide the most consistently high bond strengths, followed by the P90 System Adhesive, Single Bond 2 and Ecusit. Overall, the majority of failures (74%) was adhesive.

Significance

It appears that bonding of new dimethacrylate-based composite to old dimethacrylate-based composite can be a viable clinical procedure. However, if the original composite is silorane-based (e.g., P90), then using the silane-based adhesive may be the best repair option, and similarly if it is planned to effect a repair with a silorane-based composite, using a silane-based adhesive may give the best outcome. The null hypotheses are thus rejected.     

Laser tattoo removal in Thai students

Objective

To review the results of laser tattoo removal in Thai students.

Material and methods

This is a retrospective review study of the students participating in our tattoo removal program at Srakaew Province, Thailand. The laser used was a 1064 nm Q-switched Nd:YAG laser (spot size: 3 mm, pulse duration: 6 ns, fluence: 3.5–7.5 J/cm²). A maximum of 5 laser treatments per student was performed at 2-month intervals.The data collected included age and sex of the students and information regarding the tattoos (time of tattoo existence, person who performed the tattoo procedure, method and price of tattooing, number of tattoo figures, complications during and after tattoo procedure including cleaning methods of tattoo needle) and the laser procedure (laser parameters, pain level during laser removal assessed by pain score sheet, treatment results, complications, side effects). Correlations were analyzed between the person who did the tattoo and complications after laser tattoo removal procedure, the age of tattoo and results of laser treatment and complications, and between the pain level and the time of EMLA^® application.

Results

The 115 students involved were aged between 8 years 4 months and 19 years 11 months. The mean time of tattoo existence was 1.9 ± 1.2 years. The majority of the students were tattooed (1) by amateur practitioners and (2) by hand. The costs of tattoo procedure ranged between 0 and 118 Thai Bahts. Friends influenced the students in favor of tattooing, and both the home and school were popular places for the tattooing procedure to take place. Ankles and fingers were the most common sites for students’ tattoos. A clinical clearance of 76–100% was achieved in 75% of the treated tattoos. Observed side effects were mild to moderate. Textural changes, hyperpigmentation, hypopigmentation, and scarring occurred in 41%, 3%, 3% and 17% of the cases, respectively. There was no statistically significant correlation between EMLA^® application time and the pain score. There was also no correlation between the person who did the tattoo, or the age of tattoo to the complications or side effects after laser tattoo removal.

Conclusion

The students were influenced and had tattoos by persons familiar to them, mostly at places which they often attended, including temples and schools. The students were not primarily concerned about the social consequence of having tattoos. Laser tattoo removal by means of a Q-switched Nd:YAG laser could clinically clear tattoos in 75% of the cases. However, there were side effects, such as hypopigmentation, hyperpigmentation and scarring.     

Bite jumping appliance with lower lip bumper]

The removable bite jumping appliance with lower lip bumper is a new orthodontic appliance designed to correct the abnormal habit of lower lip biting children with mentalis muscle hyperactivity. Upper anterior teeth protrusion, mandible retrusion, lower anterior teeth lingual collapse and anterior deep bite usually are found in association with this lower lip biting habit, especially in the mixed dentition period (7-12 yrs). The function of this appliance is similar to the partial functional appliance. It is made into two parts: upper removable plate with anterior inclined bite plane and lower lip bumper attached to the upper plate. Three cases are discussed and compared before and after treatment. Changes in both skeletal and dental pattern were recorded in the following aspects: increase in the posterior rotation of mandible (increased SN-MP), stimulation of forward growth of the mandible (the increase is SNB value overcomes the increase in SNA, through reduction ANB), retroclination of upper maxillary teeth (reduced 1-NA), proclination of lower anterior teeth (increased 1-NB), the reduction of overjet. Additionally, the normal position of the lower lip provided by this appliance effectively corrects the lip biting with mentalis muscle hyperactivity.     

The effects of doxorubicin (adriamycin) on spinal fusion: an experimental model of posterolateral lumbar spinal arthrodesis

BACKGROUND CONTEXT: Malignant spinal lesions may require surgical excision and segmental stabilization. The decision to perform a concomitant fusion procedure is influenced in part by the need for adjunctive chemotherapy as well as the patient's anticipated survival. Although some evidence exists that suggests that chemotherapy may inhibit bony healing, no information exists regarding the effect of chemotherapy on spinal fusion healing. PURPOSE: To determine the effect of a frequently used chemotherapeutic agent, doxorubicin, on posterolateral spinal fusion rates. STUDY DESIGN/SETTING: Prospective animal model of posterolateral lumbar fusion. OUTCOME MEASURES: Determination of spinal fusion by manual palpation of excised spines. Plain radiographic evaluation of denuded spines to evaluate intertransverse bone formation. METHODS: Thirty-two New Zealand White rabbits underwent posterior intertransverse process fusion at L5-L6 with the use of iliac autograft bone. Rabbits randomly received either intravenous doxorubicin (2.5 mg/kg) by means of the central vein of the ear at the time of surgery (16 animals) or no treatment (16 animals; the control group). The animals were euthanized at 5 weeks, and the lumbar spines were excised. Spine fusion was assessed by manually palpating (by observers blinded to the treatment group) at the level of arthrodesis, and at the adjacent levels proximal and distal. This provided similar information to surgical fusion assessment by palpation in humans. Fusion was defined as the absence of palpable motion. Posteroanterior radiographs of the excised spines were graded in a blinded fashion using a five-point scoring system (0 to 4) devised to describe the amount of bone observed between the L5-L6 transverse processes. Power analysis conducted before initiation of the study indicated that an allocation of 16 animals to each group would permit detection of at least a 20% difference in fusion rates with statistical significance at p=.05. RESULTS: Eleven of the 16 spines (69%) in the control group and 6 of the 16 spines (38%) in the doxorubicin group fused. This difference was statistically significant (=.038). There was no significant correlation (p>.05) between the radiographic grade of bone formation (0 to 4) and fusion as determined by palpation. There were four wound infections in the control group and four in the doxorubicin group. However, solid fusions were palpated in three of these four spines in both the control and treatment groups. CONCLUSIONS: No significant differences in wound complications were noted with doxorubicin administration. A single dose of doxorubicin administered intravenously at the time of surgery appears to play a significant inhibitory role in the process of spinal fusion. If similar effects occur in humans, these data suggest that doxorubicin may be harmful to bone healing in a spine fusion if given during the perioperative period. Further investigation will be necessary to determine the effect of time to aid at determining whether doxorubicin administered several weeks pre- or postoperatively results in improved fusion rate, and whether bone morphogenetic proteins can overcome these inhibitory effects.