Self-reported percutaneous injuries of students and interns at the School of Dentistry in Trinidad: A follow up study of an updated sharps protocol

Objective: To report the results of a survey of all percutaneous injuries that occurred between 2009 ­ 2014 among students and interns at the dental school in Trinidad and to evaluate compliance with the protocol for the management of percutaneous injuries. Methods: Data was collected via questionnaires administered to 186 clinical students and interns in 2012 and 2014. Data were analysed using SPSS® 17.0 Statistical software. Results: A 90% response rate was obtained. Forty-eight persons (29%) reported one or more sharps injuries at the dental school. Of the 76 sharps injuries reported, 55 were percutaneous. Needle sticks and burs accounted for the majority of injuries and mostly occurred while working on patients. There were no significant relationships (p>0.05) between sex nor student year with the occurrence of injuries. 76% of the respondents described their concern for contracting blood borne injuries from sharps injuries as "high." After injury, 41% of the respondents followed the school's protocol for sharps injuries. Conclusion: The prevalence of percutaneous injuries among students and interns at the UWI dental school in Trinidad is 23% and occur most commonly while working on patients. Compliance with the protocol for percutaneous injuries needs to be improved. The protocol needs to be audited to improve efficiency and reinforced to the students, interns and clinical supervisors during their clinical years.

Employer and graduate perceptions of the competence of graduates from a dental school in Trinidad

Objective: The objective of this study was to evaluate employers' and graduates' perceptions of the competence of dental graduates from the School of Dentistry, University of the West Indies (UWI). Method: Anonymous questionnaires were sent to employers of the dental graduates in 2013. Similar questionnaires were also completed by graduates of the class of 2011 and 2012. Respondents were asked to rate employees or self assess the UWI School of Dentistry (SoD) curriculum's 23 competency areas and 6 domains of dental practice including: professionalism, assessment of a patient, establishment and maintenance of oral health. Results: Response rates of 48.3%, 100% and 95.7% were obtained from the employers, class of 2011 and class of 2012 respectively. The graduates' self-rated competency means were satisfactory or higher (better) in all competency areas. Employers rated the competency of UWI graduates higher than average in all competency areas except temporomandibular joint/occlusion therapy, orthodontic therapy and dental office administration. Overall, the graduates consistently rated themselves significantly higher than the employers except for periodontal therapy, minor oral surgery, removable prosthodontics and dental office administration. The graduating class of 2011 rated themselves significantly higher than class of 2012 in most (15 out of 23) competency areas. Conclusion: Employers and graduates rated UWI dental graduate competency above average in all areas except orthodontics and dental office administration. UWI dental graduates have a better perception of their competency than do their employers. The School of Dentistry needs to pay particular attention to the areas highlighted and review the curriculum accordingly.

Comparison of human and southern sea otter (Enhydra lutris nereis) health risks for infection with protozoa in nearshore waters.

Cryptosporidium and Giardia spp. are waterborne, fecally-transmitted pathogens that cause economic loss due to gastroenteritis and beach closures. We applied quantitative microbial risk assessment (QMRA) to determine the health risks for humans and sea otters due to waterborne exposure of Cryptosporidium and Giardia spp. when swimming in three types of surface waters: river, stormwater and wastewater effluent during the wet and dry seasons in the central coast of California. This is the first application of QMRA to estimate both the probability of infection in Southern sea otters and the probability of illness in humans, using microbial source tracking (MST) as a variable. Children swimming close to stormwater discharges had an estimated Cryptosporidium-associated illness probability that exceeded the accepted U.S. EPA criteria (32 illnesses/1000 swimmers or 3.2%). Based on the assumption that sea otters are as susceptible as humans to Cryptosporidium infection, the infection probabilities were close to 2% and 16% when sea otters were swimming at the end of points of rivers and stormwater discharges, respectively. In the case of Giardia, infection probabilities of 11% and 23% were estimated for sea otters swimming at the end of point of wastewater discharges, assuming that sea otters are as susceptible as gerbils and humans, respectively. The results of this QMRA suggest that 1) humans and sea otters are at risk when swimming at outflow sites for rivers, stormwater and treated wastewater effluent; 2) reduced loads of viable protozoan cysts and oocysts in recreational water can lessen the probability of infection of humans and sea otters; and 3) the risk of infection of humans and sea otters can be reduced with the treatment of wastewater to decrease oocyst and cyst viability before effluent is released into the sea.

The Establishment of the Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS): A Pilot Project on Poultry Farms, Slaughterhouses and Retail Market.

The development of antimicrobial resistance among bacteria (AMR) is currently one of the world's most pressing public health problems. The use of antimicrobial agents in humans and animals has resulted in AMR which has narrowed the potential use of antibiotics for the treatment of infections in humans. To monitor AMR and to develop control measures, some countries, such as the USA, Canada and Denmark, have established national integrated surveillance systems (FDA, , CIPARS, 2007, DANMAP,2002). The components of these programs monitor changes in susceptibility/resistance to antimicrobial agents of selected zoonotic pathogens and commensal organisms recovered from animals, retail meats and humans. The rapid development of Colombia's animal production industry has raised food safety issues including the emergence of antibiotic resistance. The Colombian Integrated Surveillance Program for Antimicrobial Resistance (COIPARS) was established as a pilot project to monitor AMR on poultry farms, slaughter houses and retail markets.

Molecular epidemiology of Cryptosporidium spp. and Giardia spp. in mussels (Mytilus californianus) and California sea lions (Zalophus californianus) from Central California.

Cryptosporidium and Giardia are of public health importance, with recognized transmission through recreational waters. Therefore, both can contaminate marine waters and shellfish, with potential to infect marine mammals in nearshore ecosystems. A 2-year study was conducted to evaluate the presence of Cryptosporidium and Giardia in mussels located at two distinct coastal areas in California, namely, (i) land runoff plume sites and (ii) locations near sea lion haul-out sites, as well as in feces of California sea lions (CSL) (Zalophus californianus) by the use of direct fluorescent antibody (DFA) detection methods and PCR with sequence analysis. In this study, 961 individual mussel hemolymph samples, 54 aliquots of pooled mussel tissue, and 303 CSL fecal samples were screened. Giardia duodenalis assemblages B and D were detected in hemolymph from mussels collected near two land runoff plume sites (Santa Rosa Creek and Carmel River), and assemblages C and D were detected in hemolymph from mussels collected near a sea lion haul-out site (White Rock). These results suggest that mussels are being contaminated by protozoa carried in terrestrial runoff and/or shed in the feces of CSL. Furthermore, low numbers of oocysts and cysts morphologically similar to Cryptosporidium and Giardia, respectively, were detected in CSL fecal samples, suggesting that CSL could be a source and a host of protozoan parasites in coastal environments. The results of this study showed that Cryptosporidium and Giardia spp. from the feces of terrestrial animals and CSL can contaminate mussels and coastal environments.

Surface Properties of Dental Nanocomposites After Finishing With Rigid Rotary Instruments

This study evaluated the surface characteristics of three nanoparticle resin composites (Z350, Heritage 7 Nanohybrid, and Ice) using profilometry and scanning electronic microscopy (SEM) after subjecting them to sequential finishing procedures using rigid rotary instruments. Fifteen 8 mm·8mm·2mmspecimens were fabricated for each tested composite and subjected to one of the following finishing regimens: finishing with green stones followed by white stones, finishing with 45-lm diamond followed by 15-lm diamond, finishing with a 12-fluted carbide followed by a 20-fluted carbide. After finishing, the surfaces were subjected to profilometric testing. Eight parallel tracings were used to scan the finished surface of each specimen. For each recorded profile, the average roughness (Ra ) and extreme value descriptor (Rmax ) were recorded. On completion of the profilometric testing, two specimens from each group were randomly selected for qualitative assessment by SEM. Profilometric data was analyzed using aone-way analysis of variance and post hoc Scheffe tests. The results demonstrated that the three control groups of the tested nanocomposites behaved as a coherent group with respect to surface roughness. With the exception of the nanohybrid Heritage 7 finished with the carbide instruments, all composites showed an increase in surface roughness. The Z350 and Ice finished with the carbide finishing instruments showed no statistically significant increase in Ra , but both of these composites showed significantly rougher surfaces when finished with diamonds compared with controls. The nanohybrids Ice and Heritage 7 demonstrated significantly higher roughness in terms of Rmax when finished with stones. The SEM correlated well with roughness measurements. The conclusion may be drawn that diamonds and stones produce unacceptable surfaces in terms of roughness on the tested nanocomposites whereas finishing carbides produce acceptable surfaces.

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad.

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2 per cent had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad.

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2% had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.

Studies of self-incompatibility in wild tomatoes: I. S-allele diversity in Solanum chilense (Dun.) Reiche [corrected] (Solanaceae).

We characterized the molecular allelic variation of RNases at the self-incompatibility (SI) locus of Solanum chilense Dun. We recovered 30 S-RNase allele sequences from 34 plants representing a broad geographic sample. This yielded a species-wide estimate of 35 (95% likelihood interval 31-40) S-alleles. We performed crosses to confirm the association with SI function of 10 of the putative S-RNase allele sequences. Results in all cases were consistent with the expectation that these sequences represent functional alleles under single-locus gametophytic SI. We used the allele sequences to conduct an analysis of selection, as measured by the excess of nonsynonymous changes per site, and found evidence for adaptive changes both within the traditionally defined hypervariable regions and downstream, near the 3'-end of the molecule.

Tooth surface loss in adult subjects attending a university dental clinic in Trinidad.

OBJECTIVES: To determine the prevalence of tooth surface loss (TSL) in a sample of subjects attending a university dental clinic in Trinidad and to investigate the relationship to tooth brushing, medical history, parafunction and dietary habits. DESIGN: Tooth surface loss was measured clinically by the index used in the 1998 UK, Adult Dental Health Survey. SETTING: Trinidad, West Indies. PARTICIPANTS: Convenience sample of adult subjects attending The University of the West Indies Dental School Polyclinic, Mount Hope. METHODS: A questionnaire was administered and tooth surface loss measured clinically. MAIN OUTCOME MEASURES: mild, moderate and severe tooth surface loss. RESULTS: 155 subjects were examined (mean age 40.6 years) of whom 72% had some degree of TSL with the majority (52%), exhibiting mild, 16% with moderate and 4% with severe TSL. There were associations found between TSL and age (OR=3.14), reflux (OR=1.37), parafunction (OR=1.06), weekly consumption of citrus fruits (OR=1.31) and soft drinks (OR=1.78), daily consumption of alcohol (OR=1.40) and a vegetarian diet (OR=2.79). CONCLUSIONS: Tooth surface loss in this Trinidadian population group appears to be common. Data supports an association between TSL and age, reflux parafunction and certain dietary patterns.

The development of non-carious cervical lesions in a bruxer following episodes of gastric reflux [abstract]

This paper describes a patient suffering from gastric reflux presenting with non-carious cervical lesions. The relationship between gastric reflux and tooth wear is clearly established in the literature. This type of erosion may also play an aetiological role in the development of non-carious cervical lesions. This case describes a patient who has a known bruxer for years but developed tooth sensitivity associated with non-carious cervical lesions following year-long episodes of gastric reflux. It is concluded that patients with gastric reflux should be referred to their dental practitioners to prevent the development of tooth surface loss as a result of acid erosion. (AU)

Immediate replacement of a central incisor using a resin retained prosthesis [abstract]

This paper describes a technique for replacing an upper permanent central incisor immediately upon extraction of a non-salvable tooth without the use of a provisional denture. The preferred treatment of this type of case is the wearing of an interim denture during the period of bone remodelling and healing after the extraction, which can be up to four months. Many patients find the extra cost and inconvenience of having to adapt to an interim prosthesis objectionable. A method of fabrication and the delivery of the definite prosthesis as an immediate replacement for an extracted anterior tooth is described. (AU)

Reactivity to recombinant house-dust-mite allergens in asthma and rhinitis in a tropical environment.

BACKGROUND: House-dust mites contain components that are allergenic in mite-sensitive patients, and a number of these have been produced in recombinant form. METHODS: In the present study, we evaluated by skin prick testing the positivity to native Der p 2 and recombinant Der p 2, Der p 5, and Der p 7 allergens of Dermatophagoides pteronyssinus in patients with rhinitis, asthma, or a combination of these diseases, who were positive to whole-mite extract. RESULTS: In all patients, the positivity to both native and recombinant Der p 2 was high. In patients with either rhinitis or asthma, the reactivity to Der p 5 and 7 was significantly lower than to Der p 2. However, in patients with combined disease, the positivity to the minor allergens was almost as high as that to Der p 2. CONCLUSIONS: These results raise the question of whether patients with combined allergic rhinitis and asthma, when compared to those with either of these diseases alone, are predisposed to react to a wider range of mite allergens, or, inversely, whether patients who respond to the minor allergens are more susceptible to suffering the combined disease.

An epidemic of Oroya fever in the Peruvian Andes.

Between February and October 1987, a febrile illness killed 14 persons and seriously affected at least 14 others in Shumpillan, a remote Peruvian mountain village of 353 people. The illness was characterized by fever, headache, chills, and pallor. The fatality rate of untreated cases was 88%. The patients, 71% of whom were male, were 1-75 years of age. Fatal illnesses progressed from lethargy to coma to death in 3-60 days. Patients treated empirically with chloramphenicol survived. Bartonella bacilliformis was isolated from the whole blood of 3 patients. A serologic study revealed a high prevalence of antibodies to B. bacilliformis in the villagers. It is concluded that the villagers suffered from an epidemic of Oroya fever.