Primary malignant melanoma.

Malignant melanomas (MM) of the oral cavity are extremely rare, accounting for 0.2% to 8.0% of all malignant melanomas. Malignant melanomas is more frequently seen at the level of the hard palate and gingiva. Early diagnosis and treatment are important for reducing morbidity. Malignant melanoma cells stain positively with antibodies to human melanoma black 45, S-100 protein, and vimentin; therefore, immunohistochemistry can play an important role in evaluating the depth of invasion and the location of metastases. A 76-year-old man developed an oral malignant melanoma, which was originally diagnosed as a bluish reactive denture hyperplasia caused by an ill-fitting lower denture. The tumor was removed surgically, and histopathological examination revealed a nodular-type MM. There was no evidence of recurrence over a 4-year follow-up period.

Evaluation of the effects of platelet-rich fibrin on bone regeneration in diabetic rabbits.

OBJECTIVES: This study aimed to investigate the effect of platelet-rich fibrin on bone regeneration in critical size defects in the calvaria of diabetic rabbits. STUDY DESIGN: In total, 40 male New Zealand rabbits, were divided into two groups a non-diabetic control group (Group A) and a diabetic experimental group (Group B). Two bicortical circular defects 15 mm in diameter were created in the parietal bone of each animal. Each group was further divided into four groups: subgroup E, the defect was left empty; subgroup PRF, the defects were filled only with PRF; subgroup AB, the defects were filled with autogenous bone; subgroup AB + PRF, the defects were filled with autogenous bone combined with PRF. The animals sacrificed at 4 weeks and 8 weeks. Bone formation was assessed by micro-computed tomography (micro-CT) scanning, histological and histomorphometric analysis. RESULT: The total percent of new bone was the lowest in group A-E (6.77 ± 0.21 at 4 weeks, 11.01 ± 0.37 at 8 weeks) and highest in group A-AB + PRF (21.66 ± 0.91 at 4 weeks, 37.46 ± 1.25 at 8 weeks; p < 0.05). The mean percent of new bone was greatest in group B-AB + PRF at 4 and 8 weeks (16.87 ± 0.92, 29.59 ± 1.09, respectively) and lowest in group B-E (5.83 ± 0.09 at 4 weeks, 7.36 ± 1.02 at 8 weeks). CONCLUSION: This study, despite its limitations, showed that PRF can be used safely and that PRF induced bone healing in diabetic rabbits.

Preparedness of healthcare facilities for a public health emergency in a Caribbean country

OBJECTIVE: To review basic, critical elements of emergency preparedness and response capacity in the healthcare system of Trinidad and Tobago. DESIGN AND METHODS: A descriptive study involving one major hospital and one randomly selected health centre in each Regional Health Authority (RHA). Responders were chosen by purposive sampling and structured face-to-face interviews were carried out. Data collection was undertaken using modified versions of two previously validated data collection tools. RESULTS: All 5 hospitals in each RHA and 4 of 5 health centres participated. Emergency response plans existed in all healthcare facilities reviewed; however plans were not regularly tested. An investigation team can be assembled in 24 hours and a patient referral system was in place in all hospitals. There appeared to be access to stockpiles in all facilities. There was a gap in ongoing infection control measures including the absence of regular personal protective equipment (PPE) training for staff. CONCLUSIONS: There was an urgent need for systematic rather than ad hoc measures for testing existing plans and staff training in their roles and responsibilities during an acute public health event should one occur. For infectious diseases with high case fatality rates such as avian influenza and Ebola, it is critical for front line staff to be aware of infection control measures including how to properly use PPE. Governments should take the opportunity of the Ebola outbreak in West Africa to utilize public health capacity to catalyse the systematic strengthening of core capacities for alert and response to meet their International Health Regulations (IHR) 2005 obligations.

Comparison of heat generation during implant drilling using stainless steel and ceramic drills.

PURPOSE: The purpose of this study was to compare the heat generated from implant drilling using stainless steel and ceramic drills. MATERIALS AND METHODS: A total of 40 fresh bovine femoral cortical bone samples were used in this study. A constant drill load of 2.0 kg was applied throughout the drilling procedures via a drilling rig at a speed of 1,500 rpm. Two different implant drill types (stainless steel and ceramic) were evaluated. Heat was measured with type K thermocouple from 3 different depths. Data were subjected to the independent-sample t test and Pearson correlation analysis. The α level was set a priori at 0.05. RESULTS: The mean maximum temperatures at the depths of 3 mm, 6 mm, and 9 mm with the stainless steel drill were 32.15°C, 35.94°C, and 37.05°C, respectively, and those with the ceramic drill were 34.49°C, 36.73°C, and 36.52°C, respectively. A statistically significant difference was found at the depth of 3 mm (P = .014) whereas there was no significant difference at the depths of 6 and 9 mm (P > .05) between stainless steel and ceramic drills. CONCLUSION: Within the limitations of the study, although more heat was generated in the superficial part of the drilling cavity with the ceramic drill, heat modifications seemed not to be correlated with the drill type, whether stainless steel or ceramic, in the deep aspect of the cavity. Further clinical studies are required to determine the effect of drill type on heat generation.

Effect of surgical drill guide on heat generated from implant drilling.

PURPOSE: The purpose of this study was to evaluate the heat generated in bone by 2 implant drill systems in vitro with and without using surgical drill guides. MATERIALS AND METHODS: Temperature was measured with K type thermocouple in vitro using the bovine femoral cortical bone model. A constant drill load of 2.0 kg was applied throughout the drilling procedures via a drilling rig at a speed of 1,500 rpm. Two different implant drill systems-System A (with external irrigation) and System B (with both external and internal irrigation)-were evaluated. The samples were divided into 4 groups. System A test group 1 (TG1) included the following: 20 samples for drilling with surgical drill guides; control group 1 (CG1): 20 samples for classical implant site preparation. System B test group 2 (TG2) included the following: 20 samples for drilling with surgical drill guides; control group 2 (CG2): 20 samples for classical implant site preparation. Heat was measured at the final drill in the drilling sequence (4.2 and 4.4 mm). Thermocouples were placed at a 1-mm distance from the osteotomy area at depths of 3, 6, and 9 mm. Heat measurements were recorded out to 50 uses by a software program. Data were subjected to the Mann-Whitney U and Kruskal-Wallis tests. The alpha level was set a priori at 0.05. RESULTS: The mean maximum temperatures at the depths of 3, 6, and 9 mm using surgical drill guides were 34.2 degrees , 39.7 degrees , and 39.8 degrees C, respectively, although without using surgical drill guides the values were 28.8 degrees , 30.7 degrees , and 31.1 degrees C. A statistically significant difference was found at the depths of 3, 6, and 9 mm between using surgical drill guides and classical drilling procedure. CONCLUSIONS: From a heat generation standpoint, we conclude that preparing an implant site with using surgical drill guides generates heat more than classical implant site preparation regardless of the irrigation type.

Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad / La depresión y sus factores asociados entre los pacientes que asisten a las clínicas de enfermedades crónicas en el suroeste de Trinidad

This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60and a specificity of 94. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76. The patients were primarily Indo-Trinidadian (70), over 50 years (76.4) and female (72.3). The prevalence of depression was 28.3. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics.

Este estudio determinó la prevalencia de la depresión y los factores asociados con ella, entre los pacientes que asisten a las clínicas en el suroeste de Trinidad. El mismo consistió en una encuesta transversal que utiliza una muestra de pacientes consecutivos en cuatro clínicas grandes. A fin de determinar la presencia de la depresión, validamos una escala de depresión de Zung modificada y aplicada por un entrevistador. La escala de Zung modificada, a un índice límite de 60, tiene una sensibilidad de 60% y una especificidad de 94%. Se recibieron setecientos treinta y cuatro cuestionarios respondidos, lo que equivale a una tasa de respuesta de 76%. Los pacientes fueron fundamentalmente indotrinitenses (70%), mayores de 50 años (76.4%) y mujeres (72.3%). La prevalencia de la depresión fue 28.3%. Hubo diferencias estadísticas significativas en el nivel de depresión por edad, sexo, nivel educacional alcanzado, y ocupación (p < 0.05). Hubo también diferencias estadísticamente significativas en el nivel de depresión por el número de quejas que se presentaban, el número de enfermedades crónicas, la presencia de artritis, la presencia de diabetes mellitus junto con otras enfermedades crónicas, y la presencia de cardiopatías isquémicas (p < 0.05). No se hallaron diferencias significativas en relación con la etnicidad (p = 0.97) o la presencia de diabetes mellitus por sí sola (p = 0.34). Los resultados de la regresión logística indican que los predictores independientes de la depresión (p < 0.05) fueron: el nivel educacional alcanzado, poseyendo aquellos con niveles de educación más altos, menos depresión; el número de quejas, presentándose en aquellos con más quejas, una mayor probabilidad de sentirse deprimidos; la presencia de artritis y género femenino. Es imprescindible desarrollar una política encaminada a abordar los problemas de salud mental de los pacientes que asisten a estas clínicas de enfermedades crónicas.

Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad.

This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60% and a specificity of 94%. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76%. The patients were primarily Indo-Trinidadian (70%), over 50 years (76.4%) and female (72.3%). The prevalence of depression was 28.3%. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics.

[Surgical prevention and treatment of cerebral ischemia]. / Kirurska prevencija i lijecenje ishemickog mozdanog udara.

Cerebral ischemic attack is a common disease and a major health, social and economic problem. The authors discuss the diagnostics of cerebrovascular insufficiency, and the indications for a surgical intervention. They analyse the frequency of surgical and early postoperative complications in patients undergoing surgery for stenotic changes in the arteries of the aortic arch. In 625 reconstructive procedures performed, operative and early postoperative neurologic deficits were observed in 16 (2.5%) patients. In 5 patients (0.8%), neurologic deficit disappeared during the early postoperative period, while in 11 (1.7%) patients persisted after the patient's discharge from the hospital. This paper also reports the late results of surgical treatment in a group of 62 patients followed up at 4 to 6 years or approximately for five years after operation. The authors also investigate the results of pharmacotherapy in a group of 32 patients who were not willing to accept the recommended surgery and who were followed up for a period of 3 to 6 years or approximately for 4.5 years postangiography. The results of surgical treatment were correlated with the pharmacotherapy results. There is a statistically significant difference to the advantage of surgically treated patients (P less than 0.001). It is concluded that reconstructive interventions on the cervical part of cerebral arteries indicated in the case of obliterative arteriosclerosis seem to prevent or considerably decrease the incidence of recurrent cerebral attack. In addition, the incidence of neurologic surgical deficit is considerably decreased by the routine application of a temporary intraluminal bypass.