Coincident Tick Infestations in the Nostrils of Wild Chimpanzees and a Human in Uganda

Ticks in the nostrils of humans visiting equatorial African forests have been reported sporadically for decades, but their taxonomy and natural history have remained obscure. We report human infestation with a nostril tick in Kibale National Park, Uganda, coincident with infestation of chimpanzees in the same location with nostril ticks, as shown by high-resolution digital photography. The human-derived nostril tick was identified morphologically and genetically as a nymph of the genus Amblyomma, but the mitochondrial 12S ribosomal RNA or the nuclear intergenic transcribed spacer 2 DNA sequences of the specimen were not represented in GenBank. These ticks may represent a previously uncharacterized species that is adapted to infesting chimpanzee nostrils as a defense against grooming. Ticks that feed upon apes and humans may facilitate cross-species transmission of pathogens, and the risk of exposure is likely elevated for persons who frequent ape habitats.     

Diagnostic yield and characteristic features in a series of decomposed bodies subject to coronial autopsy

A study was undertaken of 629 cases autopsied at Forensic Science SA, Adelaide, Australia over a 10-year period from 1994 to 2004 where significant decomposition had been documented. The age range of victims was 10 months to 92 years (mean 51.5 ± 18.1 years). There were 498 males (79%) and 131 females (21%) (M:F = 3.8:1). Deaths in 289 of the 629 cases (46%) were due to natural causes, with 179 suicides (28%), 83 accidents (13%), and 36 homicides (6%). The cause of death was ascertained in 89% of cases and the manner of death in 93% of cases. In 35 cases (6%) both the cause and manner could not be determined. Numbers of suicides were higher in younger age groups while deaths from organic illnesses predominated in later life. The number of cases in summer was significantly greater than in winter. Despite technical difficulties in handling decomposed bodies, and artifactual alteration of tissue structure and microscopic features, the autopsy was still a useful diagnostic exercise. While it is likely that more information may be gleaned from fresh bodies in perfectly preserved states, decomposed bodies may reveal significant anatomical and pathological features that enable both the cause and manner of death to be established.     

Evaluation of ABM/P-15 versus autogenous bone in an ovine lumbar interbody fusion model

A prospective, randomized study was performed in an ovine model to compare the efficacy of an anorganic bovine-derived hydroxyapatite matrix combined with a synthetic 15 amino acid residue (ABM/P-15) in facilitating lumbar interbody fusion when compared with autogenous bone harvested from the iliac crest. P-15 is a biomimetic to the cell-binding site of Type-I collagen for bone-forming cells. When combined with ABM, it creates the necessary scaffold to initiate cell invasion, binding, and subsequent osteogenesis. In this study, six adult ewes underwent anterior-lateral interbody fusion at L3/L4 and L4/L5 using PEEK interbody rings filled with autogenous bone at one level and ABM/P-15 at the other level and no additional instrumentation. Clinical CT scans were obtained at 3 and 6 months; micro-CT scans and histomorphometry analyses were performed after euthanization at 6 months. Clinical CT scan analysis showed that all autograft and ABM/P-15 treated levels had radiographically fused outside of the rings at the 3-month study time point. Although the clinical CT scans of the autograft treatment group showed significantly better fusion within the PEEK rings than ABM/P-15 at 3 months, micro-CT scans, clinical CT scans, and histomorphometric analyses showed there were no statistical differences between the two treatment groups at 6 months. Thus, ABM/P-15 was as successful as autogenous bone graft in producing lumbar spinal fusion in an ovine model, and it should be further evaluated in clinical studies.     

Clinical and radiological outcomes of axial lumbar interbody fusion

Axial lumbar interbody fusion is a novel percutaneous alternative to common open techniques, such as anterior, posterior, and transforaminal lumbar interbody fusion. This minimally invasive technique uses the presacral space to access the L5-S1 and L4-L5 disk space. The goal of this study was to examine outcomes following axial lumbar interbody fusion. The charts of all patients who underwent axial lumbar interbody fusion surgery at our institution between 2006 and 2008 were reviewed. Clinical outcomes included visual analog scale (VAS) and Oswestry Disability Index (ODI). Radiographs were also evaluated for disk space height, L4-L5 and/or L5-S1 Cobb angle, and fusion. Of the 50 patients (32 women, 18 men; mean age, 49.29 years) treated with axial lumbar interbody fusion, 48 had preoperative VAS scores and 16 had preoperative ODI scores available. Complete radiographic data were available at the preoperative, initial postoperative, and final postoperative time points for 46 patients (92%). At last follow-up (average, 12 months), ODI scores were reduced from 46 to 22, and VAS scores were lowered from 8.1 to 3.6. Of the 49 patients with postoperative radiographs, 47 (96%) went on to a solid fusion. There were no significant differences between pre- and postoperative disk space height and lumbar lordosis angle. The most common complications were superficial infection and pseudoarthrosis. Other complications were rectal injury, hematoma, and irritation of a nerve root by a screw. Overall, we found the axial lumbar interbody fusion procedure in combination with pedicle screw placement to have good clinical and radiological outcomes.     

Social support, ethnicity and mental health in adolescents

Objective In this study, we explored whether social support varied with ethnic group in young people, and if it explained ethnic differences in prevalence of psychological distress. Methods A representative sample of 2790 East London adolescents (11–14 years) completed a classroom-based self-report questionnaire for this cross sectional survey. Social support was assessed using the Multidimensional Scale of Perceived Social Support (MSPSS). Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Short Moods and Feelings Questionnaire (SMFQ). Results High levels of social support were reported by most participants, with some variation by ethnic group and gender. Participants reporting low family and overall social support had an increased likelihood of psychological distress compared with those who reported high support. Low support from friends, family and overall was also associated with depressive symptoms. These relationships did not alter with adjustment for ethnic group. Conclusions This study identified an independent association between different sources of social support and mental health in a young, ethnically diverse sample. Differences in social support did not explain ethnic differences in psychological distress.     

The predictive power of preoperative hip range of motion for the development of heterotopic ossification

Postoperative development of heterotopic ossification can compromise the success of total hip arthroplasty (THA). Heterotopic ossification has been associated with decreased postoperative hip range of motion (ROM), potentially leading to poor patient satisfaction with outcome. Many risk factors predisposing to heterotopic ossification have been discussed in the literature, including sex, age, operative time, surgical approach, and preoperative function. The goal of this study was to examine if preoperative ROM is a risk factor for the development of severe heterotopic ossification after THA, and the impact of severe heterotopic ossification formation on the gain in ROM following THA. In a retrospective study of a single surgeon's 20-year experience, all patients who developed type III heterotopic ossification after THA were evaluated for hip ROM preoperatively and at 1-year follow-up. Total ROM was classified according to the modified Merle d'Aubigne score, and Harris Hip Scores were calculated. A statistically significant difference was found in preoperative external rotation in the study group compared to the control group (P<.001). At 1 year postoperatively, hip ROM differences were significant in external rotation (P<.001), internal rotation (P<.001), and abduction (P<.05). The modified Merle d'Aubigne score was significantly different between the groups (P<.001). Although many factors have been shown to influence the development of heterotopic ossification following THA, we found that a decrease in preoperative external rotation may point to an increased risk. Surgeons should consider this data when considering the use of prophylactic treatment to avoid the development of heterotopic ossification.     

The component separation technique for hernia repair: a comparison of open and endoscopic techniques

The open components separation technique (CST) for hernia repair allows for autologous tissue repair with approximation of the midline fascia in patients with complex hernias. CST requires creation of large undermining skin flaps, whereas the endoscopic component separation technique (ECST) is performed without division of the epigastric perforating vessels and may minimize wound morbidity. A review of patient demographics and outcome measures of patients undergoing CST and ECST between November 2008 and February 2010 was performed. Twenty-five patients were identified who underwent either CST (14 patients) or ECST (11 patients). There were no differences in body mass index (CST 34.8 kg/m(2), ECST 37.5 kg/m(2), P = 0.45), operating room times (CST 268 minutes, ECST 252 minutes, P = 0.54), or hospital length of stay (CST 5 days, ECST 5.8 days, P = 0.78). Wound complications occurred less with ECST (9 vs 57%, P = 0.03). The time to resolution of wound complications in ECST was reduced *1 vs 4 months). No recurrences were seen in either group with a mean follow-up of 4months (range, 1 to 12 months). ECST and CST require similar operative times and hospital lengths of stay. ECST is associated with reduced wound complications compared with CST. Short-term recurrence rates with CST and ECST are comparable.