Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria

Objective: To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting. Design: Cross-sectional study among patients with COPD. Setting: The Respiratory clinic of the Lagos University Teaching Hospital. Participants: Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants. Intervention: None Main outcome measure: COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation. Results: The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis. Conclusion: Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting.

Atypical Kawasaki syndrome in COVID-19 infection: a case report of a multisystem inflammatory syndrome in a child (MIS-C)

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10- year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care.

Conduta cirúrgica em terceiro molar incluso com geminação / Surgical conduct for impacted third molar with gemination

Este trabalho objetiva apresentar o relato de paciente, sexo feminino, 29 anos de idade que compareceu para exodontia do elemento 38 parcialmente erupcionado. Na radiografia panorâmica observa-se o 38 associado a elemento dentário extranumerário, que se estende do rebordo a bem próximo a basilar, ultrapassando os limites do canal mandibular. Na tomografia cone beam observa-se coroa com diâmetro mesiodistal comproporções elevadas, sendo uma coroa dentária, uma câmara pulpar ampliada e três raízes, compatível com geminação. Duas das raízes estavam acima do canal mandibular e uma abaixo. A conduta cirúrgica proposta foi remoção da coroa e das raízes superiores e sepultamento da inferior, para evitar fratura mandibular e parestesia. Realizou-se acesso, osteotomia para exposição da coroa dentária até a região das furcas, seguida odontosecção para separação da coroa das raízes, clivagem e remoção da coroa. Na remoção do fragmento coronário observa--se presença da raiz mais profunda aderida a coroa, não sendo possível realizar clivagem total. As raízes superiores ao canal foram removidas sem maiores problemas. O alvéolo foi curetado, o retalho reposicionado na sua posição, seguido de sutura. Ressalta-se a importância da solicitação de exames de imagem e do planejamento de modo a evitar possíveis complicações no ato cirúrgico.

This paper reports the case of a 29-year-old female patient who visited the dental clinic for the extraction of partially eruption tooth 38. The panoramic radiograph revealed that tooth 38 was associated with an extranumerary tooth extending from the rim to near the basal lamina, surpassing the limits of the mandibular canal. Cone-beam tomography revealed a dental crown with a large mesio-distal diameter, large pulp chamber and three roots, compatible with gemination. Two of the rootswere above the mandibular canal and one was below. The proposedsurgical conduct was the removal of the crown and upper roots and burying of the lower root to avoid mandibular fracture and paresthesia. The region was accessed and osteotomy was performed to expose the dental crown to the furcation region, followed by sectioning for the separation of the crown from the roots, cleavage and removal of the crown. During this procedure, it was noted that the deepest root was adhered to the crown and complete cleavage was not possible. The roots above the canal were removed without incident. The alveolus was curetted and the flap was repositioned and sutured. This case underscores the importance of imaging exams and adequate planning toavoid possible complications during the act of surgery.

Effect of low-level laser therapy on the modulation of the mitochondrial activity of macrophages / Efeito da laserterapia em baixa intensidade na modulação da atividade mitocondrial de macrófagos

BACKGROUND: Macrophages play a major role among the inflammatory cells that invade muscle tissue following an injury. Low-level laser therapy (LLLT) has long been used in clinical practice to accelerate the muscle repair process. However, little is known regarding its effect on macrophages. OBJECTIVE: This study evaluated the effect of LLLT on the mitochondrial activity (MA) of macrophages. METHOD: J774 macrophages were treated with lipopolysaccharide (LPS) and interferon - gamma (IFN-γ) (activation) for 24 h to simulate an inflammatory process, then irradiated with LLLT using two sets of parameters (780 nm; 70 mW; 3 J/cm2 and 660 nm; 15 mW; 7.5 J/cm2). Non-activated/non-irradiated cells composed the control group. MA was evaluated by the cell mitochondrial activity (MTT) assay (after 1, 3 and 5 days) in three independent experiments. The data were analyzed statistically. RESULTS: After 1 day of culture, activated and 780 nm irradiated macrophages showed lower MA than activated macrophages, but activated and 660 nm irradiated macrophages showed MA similar to activated cells. After 3 days, activated and irradiated (660 nm and 780 nm) macrophages showed greater MA than activated macrophages, and after 5 days, the activated and irradiated (660 nm and 780 nm) macrophages showed similar MA to the activated macrophages. CONCLUSIONS: These results show that 660 nm and 780 nm LLLT can modulate the cellular activation status of macrophages in inflammation, highlighting the importance of this resource and of the correct determination of its parameters in the repair process of skeletal muscle. .

CONTEXTUALIZAÇÃO: O macrófago tem papel de destaque dentre as células inflamatórias que invadem o músculo após as lesões. Por outro lado, o laser em baixa intensidade (LBI) tem sido muito utilizado na clínica para acelerar o reparo muscular, e pouco se conhece sobre seu efeito nos macrófagos. OBJETIVO: Avaliar o efeito do LBI sobre a atividade mitocondrial (AM) de macrófagos ativados para simular um processo inflamatório. MÉTODO: Macrófagos J774 foram tratados com lipopolissacarídeo (LPS) e IFN-gamma (ativação) por 24 horas para simular um processo inflamatório e então foram irradiados com LBI (780 nm; 70 mW; 3 J/cm(2) e 660 nm; 15mW; 7,5 J/cm(2)). A AM foi avaliada pela técnica MTT após um, três e cinco dias das irradiações. Foram realizados três experimentos independentes, e os dados, submetidos à análise estatística. RESULTADOS: Após um dia de cultivo, os macrófagos ativados e irradiados com o laser de 780 nm mostraram AM menor que os somente ativados, já os macrófagos ativados e irradiados com o laser de 660 mostraram AM semelhante aos somente ativados. Após três dias, os macrófagos ativados e irradiados (660 e 780 nm) mostraram AM maior que os macrófagos ativados; já após cinco dias, os grupos ativados e irradiados (660 e 780 nm) mostraram AM semelhante aos macrófagos somente ativados. CONCLUSÕES: Esses resultados mostram que tanto o LBI de 660 nm como o de 780 nm são capazes de modular a ativação celular de macrófagos em situação de inflamação, ressaltando a importância desse recurso e da determinação de seus parâmetros dosimétricos no processo de reparo do músculo esquelético. .

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention / Resultados en cuanto al desempeño de mujeres inmigrantes maltratadas y sus hijos, 4 meses después de iniciada una intervención

OBJECTIVE: To measure the impact of shelter intervention and protection orders on the mental health functioning, resiliency, and further abuse of documented and undocumented immigrant women and their children in Houston, Texas, United States. METHODS: A prospective cohort study initiated in 2011 examined a subsample of 106 immigrant mothers, primarily from Mexico and Central America, and evaluated their functioning with a battery of 13 well-established instruments as they accessed either shelter or justice services; followed-up was conducted 4 months later to measure improvement. Data were analyzed with a series of repeated measures 2 x 2 x 2 factorial analysis of variance tests. RESULTS: Large effect size improvements were observed in abused immigrant women’s mental health, resiliency, and safety, regardless of whether the intervention accessed was safe shelter or justice services, and regardless of duration of shelter stay and whether or not a protection order was issued. Similarly, large effect size improvements were observed in child functioning, independent of which type of intervention, the duration of shelter stay, or the issuance of a protection order. CONCLUSIONS: Accessing protective services has the potential to improve the health of immigrant women and their children, regardless of documentation status. Global policy for improved access and acceptability of shelter and justice services is essential to promote immigrant women’s safety and to maximize functioning of women and children.

OBJETIVO: Determinar la repercusión de la intervención de albergue y las órdenes de protección sobre el desempeño en cuanto a la salud mental, la resiliencia y el maltrato adicional de mujeres inmigrantes, documentadas e indocumentadas, y sus hijos, en Houston, Texas, Estados Unidos. MÉTODOS: En un estudio prospectivo de cohortes iniciado en el 2011, se examinó una submuestra de 106 madres inmigrantes, procedentes principalmente de México y Centroamérica, y se evaluó su desempeño mediante una serie de 13 instrumentos bien establecidos cuando accedían a los servicios de albergue o de justicia; cuatro meses después, se llevó a cabo su seguimiento con objeto de medir el grado de mejora. Los datos fueron analizados mediante pruebas de análisis de la varianza, con una serie de mediciones repetidas, según un diseño factorial 2 x 2 x 2. RESULTADOS: Se observaron mejoras de gran magnitud de efecto sobre la salud mental, la resiliencia y la seguridad de las mujeres inmigrantes maltratadas, independientemente de si la intervención correspondía a un albergue seguro o a servicios de justicia, e independientemente del tiempo de permanencia en el albergue y de la expedición de una orden de protección. De manera análoga, se observaron mejoras de gran magnitud de efecto sobre el desempeño de los niños, independiente del tipo de intervención, el tiempo de permanencia en el albergue o la expedición de una orden de protección. CONCLUSIONES: El acceso a los servicios de protección puede mejorar la salud de las mujeres inmigrantes y sus hijos, independientemente de su situación en cuanto a documentación. Resulta esencial el establecimiento de una política mundial dirigida a mejorar el acceso y la aceptabilidad de los servicios de albergue y de justicia para promover la seguridad de las mujeres inmigrantes y potenciar al máximo su desempeño y el de sus hijos.

No effect of low-level lasers on in vitro myoblast culture.

Effects of phototherapy using low-level lasers depend on irradiation parameters and the type of laser used. The aim of the present study was to evaluate the effect of phototherapy on the proliferation of cultured C2C12 myoblasts under different nutritional conditions using low-level GaAlAs and InGaAlP lasers with different parameters and incubation periods. C2C12 cells cultured in regular and nutrient-deficient medium were irradiated with low-level GaAlAs (780 nm) and InGaAlP (660 nm) lasers with energy densities of 3.8, 6.3 and 10 J/cm2, and 3.8, 10 and 17.5 J/cm2, respectively. Cell proliferation was assessed 48 and 72 h after irradiation by MTT assay. There were no significant differences in cell proliferation between laser-treated myoblasts and control cultures for any of the parameters and incubation periods. Further studies are necessary to determine the correct laser parameters for optimizing the biostimulation of myoblasts.

Association between temporomandibular disorder and body mass index in institutionalized children

Temporomandibular disorders (TMD) is a term applied to functional changes of the temporomandibular joint (TMJ) and associated structures of mastication. Aim: To investigate the correlation between body mass index (BMI) and TMD in children. Methods: 70 children between 6 and 14 years enrolled in the Rogationist Benevolent Institute of charity in the city of São Paulo (Brazil) underwent clinical examination by one calibrated examiner for the use of Research Diagnostic Criteria for TMD. Weight and height were determined by anthropometric assessment for the diagnosis of nutritional status, and BMI was calculated by dividing weight in kilograms by height in meters squared (kg/m2). Descriptive analysis (mean and standard deviation) was used to characterize the sample. ANOVA complemented by the Least Significant Difference test was used to compare the mean anthropometric measurements between the genders and the groups with and without TMD. The significance level was set at 0.05. Results: We found a significantly high prevalence of TMD, as well as a significant association between TMD light and low body weight. Conclusions: The results show a high prevalence of TMD and a slight association between TMD and children with low body weight.

Aesthetic restoration of deciduous anterior teeth after removal of carious tissue with Papacárie.

The development of conservative techniques for the removal of carious tissue and the improvement of dental restoration materials allow better preservation of the dental structure. Chemomechanical caries removal is a conservative and atraumatic alternative. Papacárie is a papain-based material developed to act only on the carious dentin, allowing its easy removal with a blunt curette. This study aims to present a clinical case of aesthetic restoration of both upper deciduous central incisors after the removal of carious tissue with Papacárie.

Cancer risk assessment and the genetic counseling process: using hereditary breast and ovarian cancer as an example

While only a small proportion of cancers can be attributed to a hereditary susceptibility, identifying high-risk individuals plays an essential role in medical management and has a significant impact on the patient as well as their immediate and extended family members. This paper aims at increasing the medical professionals' knowledge of the components of a genetic counseling session, with particular attention toward identifying at-risk individuals and understanding the complexities of the testing process. In addition, tools are provided to assist in identifying these individuals in clinical practice and streamlining the referral process to a cancer genetics center

Choice of intracanal medication and obturation techniques amongst Jordanian dentists

To gather information about root canal treatment performed by Jordanian dentists. A questionnaire was distributed to dental practitioners randomly regarding the provision of endodontic treatment in their practices. The collected data were analyzed using the statistical package SPSS version 12, simple descriptive statistics together with Chi-square [x2] test were used. A total of 201 questionnaires were collected, three of the questionnaires were not completed because the respondents did not perform endodontic treatment, giving a completion rate of 98.5%. The most commonly used inter-appointment medicament was Tricresol formaline [55.4%]. Gutta-percha was used by the majority of the respondents [92.4%]; the most commonly used obturation technique was cold lateral condensation [70.4%]. The majority [52%] of the respondents used Sealapex root canal sealer. While the most commonly used temporary filling material was Zinc oxide-eugenol [71.5%]. Almost all the respondents [99%] restored the access cavity by themselves and 59.2% of them did the restoration one week after the obturation. Majority of the respondents [75.4%] don't take a post-operative radiograph for their patients or follow them up. The main cause, which predominated among 51.1% of the respondents, was the lack of motivation of the patients. The most common reason for referral to specialist treatment was retreatment. About half of the respondents believed that their endodontic treatment should be improved. Current practice lies below the international standards and quality assurance guidelines. More emphasis should be placed on undergraduate endodontic teaching, also, establishing a postgraduate education is needed

Barium peritonitis--following barium enema of the proximal colon through a colostomy

Perforation with extravasation of barium is a rare complication of contrast enema examination of the large bowel with a high associated mortality rate. The experience of performing a re-laparotomy in a patient previously exposed to barium peritonitis is even less common. We describe an elderly male patient with a Hartmann's procedure performed a year previously, presenting with peritonitis following barium enema evaluation of the proximal colon via an end descending colon stoma. Emergency laparotomy, segmental bowel resection and liberal peritoneal toilet resulted in a satisfactory outcome. The patient had a subsequent successful reversal of his Hartmann's procedure nine months later despite the presence of dense barium induced adhesions. This potentially preventable iatrogenic complication is discussed in this report, which is supplemented by a brief review of the English literature.

Estudio clínico de la panela en el biberón como inductor potencial de caries / A clinical study of the brown sugar in nursing bottle as a potential caries inductive

La caries de biberón es una entidad patológica comunmente identificada en Colombia, la cual produce destrucciones en las estructuras de los dientes de avance rápido, que compromete el estado de salud general del menor. Se tomó como muestra 100 niños pertenecientes al ICBF (Instituto Colombiano de Bienestar Familiar), se observó la presencia o no de consumo de biberón, se analizaron los diferentes contenidos de éste, y su relación con la incidencia de dicha patología. Dentro de los hallazgos más importantes se destacan que la "panela" (extracto solidificado por calor de la caña de azúcar) se encuentra con una alta frecuencia en su consumo, y es evidente la relción directa que tiene como inductor potencial de caries. Se plantea además los riesgos y consecuencias que la caries de biberón, como entidad patológica, tiene a largo plazo sobre el menor

Colocaçäo do filtro de veia cava inferior na profilaxia da embolia pulmonar: relato de três casos / Use of vena cava filter in the prophylaxis of pulmonary embolism: three cases reports

A utilizaçäo de filtros de veia cava inferior para prevenir o deslocamento de êmbolos para a circulaçäo pulmonar é a principal alternativa terapêutica nos pacientes com contra-indicaçäo para a anticoagulaçäo plena ou na ineficácia desta. Relatam-se os três primeiros casos de colocaçäo de filtro (Kimray-Greenfield) em veia cava inferior no Hospital de Clínicas de Porto Alegre, devido a recidiva de embolia pulmonar sob anticoagulaçäo. Tanto a colocaçäo por dissecçäo de veia jugular (um caso) quanto por via femoral com técnica transcutânea (dois casos) foram bem sucedidas. Os pacientes tiveram boa evoluçäo do quadro clínico e mantiveram-se assintomáticos após a alta

Monitoragem fetal anteparto: falso-reativo na cardiotocografia de repouso; relato de um caso / Antepartum fetal monitoring: false-reactive in the nonstress cardiotocography: report of a case

É relatado um caso de paciente cardiopata com toxemia gravídica associada. Com 31 semanas de gestaçäo foi submetida á avaliaçäo clínica e das condiçöes de vitalidade e maturidade fetal. A cardiotocografia de repouso mostrou um feto reativo. Doze horas após o teste, foi constatado um deslocamento prematuro de placenta (DDP) sendo realizada operaçäo cesariana de urgência, com retirada de feto morto apresentando duas circulares de cordäo no pescoço. Säo descrito os exames realizados imediatamente antes do acidente, amniocentese e ultrasonografia, cujos resultados näo demonstraram quaisquer alteraçöes da vitalidade fetal. Os testes com resultados falso-reativos incidem numa frequência muito baixa principalmente nas eventualidades descritas: DDP e Patologias do cordäo umbilical

Funçäo do córtex adrenal em recém-nascidos prematuros de mäes pré-eclâmpticas / Adrenal cortex function in premature infants of mothers with pre-eclampsia

Com a finalidade de avaliar a influência da pré-eclâmpsia sobre a funçäo adrenal fetal, estudaram-se 51 recém-nascidos prematuros, nascidos de parto cesariano, sem uso antenatal de corticosteróides, dosando-se os níveis de cortisol e sulfato de deidroepiandrosterona no sangue do cordäo umbilical. Os recém-nascidos de mäes com pré-eclâmpsia apresentaram diminuiçäo dos níveis de sulfato de deidroepiandrosterona sem alteraçäo significante nos níveis de cortisol. Com base neste achado, sugere-se que a excreçäo urinária subnormal de estriol apresentada pelas gestantes pré-eclâmpticas se deve, em parte, à depressäo da funçäo adrenal fetal

A influência do tipo de parto sobre o meio hormonal do recém-nascido prematuro / The influence of the type of labor upon hormonal level of the premature newborn infant

O efeito da presença ou näo de trabalho de parto sobre os níveis de PRL, DS e cortisol no sangue de cordäo umbilical foi estudado em 169 recém-nascidos prematuros Determinou-se que näo há influência da presença de trabalho de parto ou do tipo de parto sobre os níveis séricos de PRL. Entretanto, os níveis séricos no cordäo umbilical de DS e cortisol foram significantemente mais elevados em recém-nascidos prematuros nascidos por parto vaginal mesmo quando comparados com recém-nascidos prematuros nascidos de parto cesariano com trabalho de parto prévio. Sugere-se que o parto vaginal seja um estímulo à funçäo adrenal do feto prematuro

Funcao adrenal em recem-nascidos prematuros submetidos a tratamento esteroide intra-utero. / Adrenal function in premature infants subjected to intra-uterine steroid treatment

A funcao adrenal de recem-nascidos prematuros submetidos a tratamento pre-natal com esteroides foi investigada.Trinta e um recem-nascidos foram estudados: o grupo A foi formado por 12 recem-nascidos cujas maes haviam sido tratados com betametasona o grupo B foi constituido por 19 recem-nascidos nao submetidos a tratamento esteroide antes do parto. O nivel de cortisol do sangue de cordao umbilical foi dosado. Ambos os grupos eram comparaveis quanto a idade gestacional, peso de nascimento, incidencia de DMH e PIG, entretanto o nivel de cortisol no grupo B foi significante superior. Os achados sugerem um bloqueio da funcao adrenal fetal pelo uso pre-natal de betametasona

Influencia da ruptura de membrana amniotica sobre a funcao adrenal fetal. / Influence of the rupture of amniotic membrane on the fetal adrenal function

O efeito da ruptura de membrana amniotica sobre os niveis de cortisol e DHAS no sangue de cordao umbilical de recem-nascidos prematuros foi investigado.O grupo A constituido de 25 recem-nascidos cujas maes tiveram a membrana amniotica rota por um tempo igual ou maior do que 12 horas, apresentou um nivel serico de cortisol significativamente superior ao grupo B, constituido de 23 recem-nascidos cujas maes tiveram membrana amniotica rota por um tempo inferior a 12 horas. Os niveis sericos de DHAS nao diferiram significativamente entre os dois grupos. Sugere-se que a ruptura de membrana amniotica determina um aumento na producao de cortisol fetal que pode ser importante na prevencao da DMH

Relacao glicorraquia glicemia em recem-nascidos com encefalopatia hipoxico-isquemica. / Glycorrachia glycemia relation in newborn infants with ischemic hypoxic encephalopathy

Foi investigada a relacao glicorraquia/ glicemia em recem-nascidos de termo severamente asfixiados.Doze recem-nascidos com indice de Apgar menor do que cinco no 1o.e 5o. minuto de vida tiveram a sua relacao glicorraquia/glicemia comparada com um grupo de 13 recem-nascidos do termo nao asfixiados que tiveram puncao lombar efetuada para investigar infeccao neonatal mas apresentaram exame liquorico normal. A relacao glicorraquia/glicemia nao diferiu entre os dois grupos estudados. Sugere-se que a encefalopatia hipoxico-isquemica nao altera o transporte de glicose do sangue para o liquor