Detachable Palatal Ramp of Teeth to Improve Comfort in a Completely Edentulous Patient with a Segmentally Resected Mandible

The rehabilitation of a completely edentulous patient with segmental resection of the mandible (without osseous reconstruction) poses a considerable challenge to the restoring prosthodontist. Due to the absence of natural teeth in both arches, it is difficult to correct the mandibular deviation with the aid of guidance prostheses. Prosthetic management of such patients usually consists of a maxillary complete denture and mandibular segmental denture occluding in the deviated position itself. An additional ramp or row of denture teeth is placed on the palatal surface of the maxillary denture to facilitate this; however, patient comfort levels (during functions such as phonation) are found to be adversely impacted due to the encroachment of the tongue space by the position of the ramp. This report describes an innovative technique to overcome this problem by fabrication of a detachable ramp of additional denture teeth in the maxillary denture. The patient could wear the denture comfortably without the palatal ramp throughout the day and could attach the palatal ramp while eating.     

Selection for resistance to oseltamivir in seasonal and pandemic H1N1 influenza and widespread co-circulation of the lineages

Background

In Spring 2009, a novel reassortant strain of H1N1 influenza A emerged as a lineage distinct from seasonal H1N1. On June 11, the World Heath Organization declared a pandemic - the first since 1968. There are currently two main branches of H1N1 circulating in humans, a seasonal branch and a pandemic branch. The primary treatment method for pandemic and seasonal H1N1 is the antiviral drug Tamiflu^® (oseltamivir). Although many seasonal H1N1 strains around the world are resistant to oseltamivir, initially, pandemic H1N1 strains have been susceptible to oseltamivir. As of February 3, 2010, there have been reports of resistance to oseltamivir in 225 cases of H1N1 pandemic influenza. The evolution of resistance to oseltamivir in pandemic H1N1 could be due to point mutations in the neuraminidase or a reassortment event between seasonal H1N1 and pandemic H1N1 viruses that provide a neuraminidase carrying an oseltamivir-resistant genotype to pandemic H1N1.

Results

Using phylogenetic analysis of neuraminidase sequences, we show that both seasonal and pandemic lineages of H1N1 are evolving to direct selective pressure for resistance to oseltamivir. Moreover, seasonal lineages of H1N1 that are resistant to oseltamivir co-circulate with pandemic H1N1 throughout the globe. By combining phylogenetic and geographic data we have thus far identified 53 areas of co-circulation where reassortment can occur. At our website POINTMAP, http://pointmap.osu.edu we make available a visualization and an application for updating these results as more data are released.

Conclusions

As oseltamivir is a keystone of preparedness and treatment for pandemic H1N1, the potential for resistance to oseltamivir is an ongoing concern. Reassortment and, more likely, point mutation have the potential to create a strain of pandemic H1N1 against which we have a reduced number of treatment options.

     

Influence of subcortical auditory processing and cognitive measures on cocktail party listening in younger and older adults

Objective: The study aimed to investigate the influence of subcortical auditory processing and cognitive measures on cocktail party listening in younger and older adults with normal hearing sensitivity.

Design: Tests administered included quick speech perception in noise test to assess cocktail party listening, speech auditory brainstem response to assess subcortical auditory processing and digit span, digit sequencing and spatial selective attention test to assess cognitive processing.

Study sample: A total of 92 participants with normal hearing sensitivity participated in the study. They were divided into two groups: 52 young adults (20–40 years) and 40 older adults (60–80 years).

Results: The older adults performed significantly poorer than, the younger adults on the quick speech perception in noise test and various cognitive measures. Further, cognitive measures correlated with speech perception in noise in younger and older adults. The results of this study also showed that there was a significant deterioration in brainstem encoding of speech with ageing. Further, it was also noted that the fundamental frequency of the speech auditory brainstem response correlated with speech perception in noise.

Conclusions: It can be concluded from this study that subcortical auditory processing and cognitive measures play a role in cocktail party listening.     

Lipoprotein(a) in type 2 diabetic subjects and its relationship to diabetic microvascular complications

AIM: To estimate the level of serum lipoprotein (a) [Lp (a)] in type 2 diabetes mellitus patients and to determine the relationship between Lp(a) in type 2 diabetes mellitus patients and micro-vascular complications. METHODS: A cross sectional study was performed that enrolled 144 subjects with type 2 diabetes mellitus above the age of 25 years attending outpatient clinic of Government Medical College, Kozhikode. Lp(a) levels were measured quantitatively in venous samples using Turbidimetric Immunoassay in all subjects. Each patient was evaluated for micro vascular complications, namely diabetic retinopathy, nephropathy and neuropathy. The relationship between Lp(a) levels and the micro vascular complications was assessed by univariate analysis. RESULTS: Mean age of cases was 53.93 ± 10.74 years with a male to female ratio of 1.3:1. Mean duration of diabetes was 9.53 ± 7.3 years. Abnormal Lp(a) levels (≥ 30 mg/dL) were observed in 38 (26.4%) diabetic subjects. Seventy-eight (54.16%) cases had diabetic nephropathy and significantly higher Lp(a) levels were found among these cases [Median 28.2 mg/dL (Interquartile range; IQR 24.4-33.5) vs 19.3 mg/dL (IQR 14.7-23.5); P < 0.05]. Retinopathy was present among 66 (45.13%) cases and peripheral neuropathy was detected among 54 (37.5%) cases. However, Lp(a) levels were not significantly different among those with or without retinopathy and neuropathy. Positive correlation was found between higher Lp(a) levels and duration of diabetes (r = 0.165, P < 0.05) but not with HbA1c values (r = - 0.083). CONCLUSION: Abnormal Lp(a) levels were found among 26.4% of diabetic subjects. Patients with diabetic nephropathy had higher Lp(a) levels. No association was found between Lp(a) levels and diabetic retinopathy or neuropathy. Longer duration of diabetes correlated with higher Lp(a) levels.     

Hemihypertrophy and primary small intestinal lymphangiectasia in incontinentia pigmenti achromians

A rare occurrence of primary small intestinal lymphangiectasia in an 8-year-old girl with incontinentia pigmenti achromians is reported. In addition, she had right sided hemihypertrophy. Though intestinal lymphangiectasia is known to have a few syndromic associations, its co-existence in a child with incontinentia pigmenti achromians has not yet been reported in the literature. Hemihypertrophy is also extremely rare in the latter and only very few instances of an association between the two have been documented previously.     

Serum alkaline ribonuclease activity during pregnancy

Alkaline ribonuclease activity in 257 samples of sera obtained from 64 pregnant women in 19th to 42nd week of pregnancy was determined by a simple method. Pregnant women showed a significantly higher (15%, P < 0.02) activity than nonpregnant women of reproductive age. There is a gradual and significant increase in activity from weeks 10–20 to 21–30 and then to 31–42 of pregnancy. The pattern of enzyme level during weeks 10–42 of pregnancy does not show a continuous and regular increase as shown by enzymes and hormones of exclusively placental origin but is punctuated with many irregular rises and falls. Enzyme activities in a group of women showing complicated pregnancies were determined and compared with those found in normal pregnant women.     

The attitudes of British surgical trainees about the treatment of HIV-infected patients

Purpose

As the incidence of HIV increases, the occupational risk of human immuno deficiency virus (HIV) infection also increases, leading to heightened anxiety within surgical practice. This study assessed the attitudes of surgeons treating HIV-infected patients.

Methods

Seventy surgical trainees working in two district general hospitals were requested to complete a survey assessing their attitudes regarding the surgical management of HIV-infected patients.

Results

A needle-stick injury was reported by 64% of the trainees. Fifty-four percent of trainees were concerned about acquiring HIV from patients when performing a surgical procedure. There was a significant difference between the number of trainees worried about treating a patient with HIV and the number of trainees wearing eye protection when performing invasive procedures (p?Conclusion There appears to be increasing concern among surgical trainees about carrying out surgical procedures on HIV-infected patients. Despite equipment being fully available, many trainees are not considering the full use of protective theatre garments to minimize the risk of HIV contamination. Further education and training is required to stress the importance of the increasing HIV prevalence and the need for safety during surgical practice.