Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty‑four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty‑one percent were male. Motorized vehicles caused 51% of injuries in males. Forty‑one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty‑seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long‑term follow‑up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work. Conclusion: Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

Effectiveness of tooth wipes in removing babies' dental biofilm

PURPOSE To assess the effectiveness of tooth wipes in removing dental biofilm from babies' anterior teeth, as well as to evaluate the babies' behaviour and the guardians' preference concerning hygiene methods. MATERIALS AND METHODS In this random blind cross-over study, 50 high caries risk babies, from 8 to 15 months old, were divided into two groups: babies with oral hygiene performed by caregivers (n = 25) or by their mothers (n = 25). The caregivers and mothers removed biofilm using three methods of oral hygiene (tooth wipes, toothbrushes and gauze), one in each experimental phase. Professional cleaning was done before each phase, which had 2 days of biofilm accumulation and 1 experimental day, when caregivers and mothers used one method to remove biofilm. Examiners blinded to the study design assessed the biofilm index at baseline, prior to and following biofilm removal using each method. The babies' behaviour and the mothers'/caregivers' preference were assessed. RESULTS The tooth wipes, toothbrushes and gauze significantly reduced the amount of biofilm (P < 0.001). The mothers' group removed more biofilm than the caregivers' group, using toothbrushes or tooth wipes (P < 0.05). Babies in the mothers' group had better behaviour using tooth wipes than toothbrushes (P < 0.05). Mothers and caregivers preferred to use tooth wipes. CONCLUSIONS Tooth wipes are effective in removing biofilm from babies' anterior teeth and are the method best accepted by mothers, caregivers and babies.

Prevalence and severity of dental fluorosis among students from João Pessoa, PB, Brazil

The aim of this study was to determine the prevalence and severity of dental fluorosis among 12-15-year-old students from João Pessoa, PB, Brazil before starting a program of artificial fluoridation of drinking water. The use of fluoridated dentifrice was also surveyed. A sample of 1,402 students was randomly selected. However, 31 students refused to participate and 257 were not permanent residents in João Pessoa, thus leaving a final sample of 1,114 students. Clinical exams were carried out by two calibrated dentists (Kappa = 0.78) under natural indirect light. Upper and lower front teeth were cleaned with gauze and dried, and then examined using the TF index for fluorosis. A questionnaire on dentifrice ingestion and oral hygiene habits was applied to the students. The results revealed that fluorosis prevalence in this age group was higher than expected (29.2%). Most fluorosis cases were TF = 1 (66.8%), and the most severe cases were TF = 4 (2.2%). The majority of the students reported that they had been using fluoridated dentifrices since childhood; 95% of the participants preferred brands with a 1,500 ppm F concentration, and 40% remembered that they usually ingested or still ingest dentifrice during brushing. It was concluded that dental fluorosis prevalence among students in João Pessoa is higher than expected for an area with non-fluoridated water. However, although most students use fluoridated dentifrices, and almost half ingest slurry while brushing, the majority of cases had little aesthetic relevance from the professionals' point of view, thus suggesting that fluorosis is not a public health problem in the locality.

Efeito de agentes de controle sobre a qualidade reprodutiva de rainhas de Apis mellifera L. (Hymenoptera: Apidae) africanizadas

The agriculture with the use of products with less environmental impact is expanding. In it, the producers offer their products without the use of synthetic chemical inputs, solving the phytosanitary problems with the use of biological or alternative control agents such as parasites, predators, entomopathogenic, alternative products, plant extracts and essential oils. These products can be considered safe to non-target organisms, but studies are needed to find these features on natural enemies and on the beneficial insects such as bees, common frequenter of cultures. In this sense, this study aims to evaluate the effects of control over reproductive quality queens of Apis mellifera L. (Hymenoptera: Apidae) Africanized. For this, it tested the action of control products on the production of A. mellifera queens, using the commercial entomopathogenic fungus Boveril® 1,0x108 (Beauveria bassiana) and aqueous extract of pomegranate (Punica granatum) at a concentration of 5% sterile distilled water with Tween (0.01%) and sterile distilled water (controls). The treatments were incorporated into a tissue type gauze, wrapped in an acrylic plate and packed inside minirrecrias type colonies for the production of queens on the day before the transfer of larvae. The next day were introduced battens with 30 domes with larvae to produce queens, so the workers have contacted the agent tested. From the emergence of all the queens, they were monitored to determine the measures of body weight (mg), length and width of wing and abdomen, length, width and height of the chest (mm) as well as the time of emergence of queens. The next step was evaluated the influence of the control agents in production creates, performing measurements of creating areas in cm2 for six straight weeks. It was found that the area creates Queens did not differ among the treatments. Histological analysis of hipofaringeanas of workers glands that came into contact with the control agents and the midgut of virgin queens were also held. Histological analysis differences were observed in the tissues when the treatments were compared with the respective controls.

Profile of High Street from centre of 8th St. to the corporation line and thence continued to a point near Wm. Homitters small house /

Covers Wisconsin Avenue north of R Street N.W., Georgetown, Washington D.C.

Plan of the city north of K Street next the Creek (R) : [West End, N.W. Washington D.C.].

Shows block numbers and dimensions.