Low molecular weight heparin: current evidence for its application in orthopaedic surgery

Low molecular weight heparin (LMWH) is used in orthopaedic surgery largely for prophylaxis of venous thromboembolism (VTE). The purpose of this study was to review the available evidence to better define its role. The most recent American College of Chest Physicians Evidence-Based Practice guidelines for the most current recommendations for the application of LMWH to orthopaedic surgery are reviewed. A systematic review of the literature was undertaken using MEDLINE database and manual searches, the terms low molecular weight heparin, orthopaedic procedures, venous thromboembolism, and thromboprophylaxis were used as keywords. A total of 34 studies were identified, including prospective, randomized controlled clinical studies comparing LMWH with other treatment methods in orthopaedic surgery patients, meta-analysis and health economic related studies. There is clear supporting evidence for the application of LMWH for DVT prophylaxis in orthopaedic surgery. Although newer agents such as oral thrombin inhibitors are being developed for DVT prophylaxis, it will take some time to adequately assess the clinical efficacy, safety, and cost-effectiveness of these newer agents. Whether these agents will ultimately supplant the widespread application of LMWH to orthopaedic surgery remains to be seen.     

Ritscher-Schinzel (cranio-cerebello-cardiac, 3C) syndrome: report of four new cases with renal involvement

Ritscher-Schinzel (cranio-cerebello-cardiac, 3C) syndrome is a multiple congenital anomaly syndrome that is considered to be autosomal recessive although no genetic defect has yet been identified. In a consanguineous Saudi family, we have identified four patients who meet the diagnostic criteria of 3C syndrome and who also have alopecia, camptodactaly and significant renal involvement. Interestingly, two otherwise normal female siblings have unilateral renal agenesis only. This report expands the phenotypic spectrum of 3C syndrome.     

Does donor race still make a difference in deceased-donor African-American renal allograft recipients?

Background

Prior studies have demonstrated that African-American (AA) donor kidneys are independently associated with an increased risk for graft loss.

Methods

We examined outcomes in comparable groups of AA deceased-donor (DD) kidney transplant patients receiving an AA donor (n = 35) versus a Caucasian donor (C group; n = 150) organ.

Results

There were no differences between AA and C groups in patient survival, new-onset diabetes, or BK nephropathy. The AA group demonstrated a significantly higher 6-month and overall incidence of acute rejection (AR), increased cytomegalovirus (CMV) infection, and decreased graft survival. Recurrent or de novo focal segmental glomerulosclerosis (FSGS) accounted for a significantly higher fraction of graft losses in the AA versus C group.

Conclusions

AA DD renal allograft recipients have equivalent patient but decreased graft survival when transplanted with an AA versus C kidney using current immunosuppression. This may be the result of increased AR, CMV infection, and recurrence/development of FSGS.     

Prevalence of Dental Fluorosis Among Primary School Children in Rural Areas of Chidambaram Taluk, Cuddalore District, Tamil Nadu, India

Background:

Fluorosis is one of the common but major emerging areas of research in the tropics. It is considered endemic in 17 states of India. However, the Cuddalore district of Tamil Nadu is categorised as a fluorosis non-endemic area. But clinical cases of dental fluorosis were reported in the field practice area of Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram. Since dental fluorosis has been described as a biomarker of exposure to fluoride, we assessed the prevalence and severity of dental fluorosis among primary school children in the service area.

Materials and Methods:

Children studying in six primary schools of six villages in the field practice area of Rural Health Centre of Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Every child was clinically examined at the school by calibrated examiners with Dean''s fluorosis index recommended by WHO (1997). Chi-square test, Chi-square trend test and Spearman''s rank correlation coefficient test were used for statistical analysis.

Results:

Five hundred and twenty-five 5- to 12-year-old school children (255 boys and 270 girls) were surveyed. The overall dental fluorosis prevalence was found to be 31.4% in our study sample. Dental fluorosis increased with age P < 0.001, whereas gender difference was not statistically significant. Aesthetically objectionable dental fluorosis was found in 2.1% of the sample. Villages Senjicherry, Keezhaperambai and Kanagarapattu revealed a community fluorosis index (CFI) score of 0.43, 0.54 and 0.54 with 5.6%, 4.8% and 1.4% of objectionable dental fluorosis, respectively. Correlation between water fluoride content and CFI values in four villages was noted to be positively significant.

Conclusion:

Three out of six villages studied were in ‘borderline’ public health significance (CFI score 0.4-0.6). A well-designed epidemiological investigation can be undertaken to evaluate the risk factors associated with the condition in the study region.     

Trans-antral temporalis transfer for the repair of adult cleft palates

Temporalis muscle transfer is a versatile technique frequetly used for reconstructive procedures in the maxillofacial region. However the thickness of the pedicle may interfere with masticatory function when used anteriorly in the oral cavity. To repair full-length mid-palatal defects in fully dentate patients the flap can be passed through the maxillary sinus and combined with local repair of the soft palate, thus avoiding any occlusal trauma from the posterior teeth.
The operation is a single stage procedure with low morbidity and few complications, and is a useful technique for repairing the large untreated clefts frequently encountered in developing countries. The procedure is used by members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons Bangladesh Project who have operated in Dhaka teaching hospitals on a regular basis since 1991.