Perforated appendicitis presenting as a thigh abscess: a lethal combination

Typical cases of acute appendicitis have excellent treatment outcomes, if managed appropriately.1 We discuss an unusual case of perforated retrocaecal appendicitis that presented as a right thigh abscess without prominent abdominal symptoms, which highlights the lethal nature of advanced appendicitis even when appropriate surgical therapy is instituted.

Intestinal volvulus after conservative management of incidental midgut malrotation discovered at laparoscopic appendectomy in a teenager

Midgut malrotation (MMR) is the abnormal rotation of the foetal midgut around the axis of the superior mesenteric artery which in symptomatic neonates requires a Ladd's procedure. We present a rare case of midgut volvulus occurring in a teenager 3 days after observational management of incidentally discovered MMR during laparoscopic appendectomy. A Ladd's procedure was performed and the patient is well at one-year follow up. We suggest prophylactic Ladd's procedure remains the treatment of choice for MMR even when discovered incidentally.

Ritual tooth modification among the Baka pygmies in Cameroon

INTRODUCTION

Ritual tooth mutilation is a relatively understudied human body mutilatory practices. The purpose of the study was to examine the effects of ritual tooth modification, teeth cleaning measures and herbal medications for their oral health problems among the Baka pygmies in Cameroon.

MATERIALS AND METHODS

This cross-sectional study was conducted between January and March, 2012 using semi-structured questionnaire as the tool of data collection. Intra-oral examinations were carried out to determine the dental hard tissue loss using Smith and Knight Tooth Wear Index (TWI).

RESULTS

Fifty-six pygmies with ritual tooth modification made of 34 males (60.7%) and 22 females (39.3%) with a mean age of 31 years were interviewed and had oral health examination. The reported age at which the tooth modification was done was between 10 and 15 years with mean age as 12 ± 1.66 years. More than half (58.9%) of the participants reported the tooth filing as painful and nearly two-thirds (64.3%) of the participants reported having persistent pain afterwards. The upper right central and lateral incisors were the most commonly modified teeth. A total of 42.9%, 12.5% and 7.1% of the participants had Smith and Knight TWI scores of 2, 3 and 4 respectively. All the participants reported cleaning their teeth at least once-daily with about two-thirds (66.1%) of them doing so with chewing stick. The majority (67.9%) of the participants reported cleaning their teeth for cosmetic reasons [to remove dirt' (60.7%) and 'to remove stains' (7.1%)]. The oral health problems among the participants in form of tooth sensitivity, toothache and dental abscess were treated with plant-based traditional medicines from Irvingia gabonensis, Ricinodendron heudoletti, Pterocarpus soyauxii, Alchornea cordifolia and Piptadeniastrum africanum.

CONCLUSION

Ritual tooth modification is a painful mutilatory practice which is culturally significant for the Baka pygmies without health benefit. There is need for intervention to stop this harmful traditional practices among the pygmies. Further studies is recommended to elucidate the medicinal and pharmaceutical benefits of plants used for tooth sensitivity and other oral health problems by the pygmies.

Oblique lip-alveolar banding in patients with cleft lip and palate

We report an oblique lip-alveolar band, a rare banding of soft tissue that involves the lip and alveolus, which we have found in five patients with cleft lip and palate (0.2%), compared with an incidence of the Simonartz lip-lip band of 5.7%). To our knowledge this has not been reported previously. In two patients the bands affected the cleft lip and alveolus bilaterally, with or without the palatal cleft, and in three the bands were unilateral cleft lip and alveolus with or without the palatal cleft.

Knowledge, attitudes and practices of oral health care workers in Lesotho regarding the management of patients with oral manifestations of HIV/AIDS

Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) have presented with oral manifestation of HIV as the first sign of the disease. Oral health workers regularly encounter patients presenting with oral lesions associated with HIV disease and therefore need to have adequate knowledge of these conditions for diagnosis and management. The aim of the present study was to determine the knowledge, attitudes and practices of oral health care workers (OHCW) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCW in 26 public and private care facilities in all ten districts of Lesotho. A self-administered questionnaire was used to gather information. The response rate was 100%. Nearly all (94.7%) agreed that oral lesions are common in people living with HIV and/or AIDS. The majority (91.3%) named oral candidiasis (OC) as the most common lesion found in PLWHA while Kaposi's Sarcoma (KS) (34.7%) and Oral Hairy Leukoplakia (OHL) (32.6%) were mentioned as the least common oral lesions of HIV. Most correctly identified the images of oral candidiasis (97.8%), angular cheilitis (86.9%) and herpes zoster (80.4%). Only 16.7% felt they had comprehensive knowledge of oral HIV lesions, although 84.8% reported having previously received training. Almost three quarters (71%) reported that there was no need to treat HIV positive patients differently from HIV negative patients. OHCW in Lesotho demonstrated high confidence levels in their competence in managing dental patients with oral lesions associated with HIV, however, they lacked an in-depth knowledge in this regard. Amongst this group there is a need for comprehensive training with regards to diagnosis and management of oral lesions of HIV including the training of other cadres of health care workers together with nurses and community health workers.

B1 but not B2 bradykinin receptor agonists promote DU145 prostate cancer cell proliferation and migration

BACKGROUND

The kallikrein-kinin system (KKS) is an endogenous pathway involved in angiogenesis and tumourigenesis, both vital for cancer growth and progression.

OBJECTIVES

To investigate the effect of two bradykinin receptor (B1R and B2R) agonists on growth and motility of prostate tumour (DU145) and micro-vascular endothelial cells (dMVECs).

METHODS

Increasing concentrations of selective B1R and B2R agonists were added to cultured cells. Cell proliferation and migration were assessed using the 3-[4,5 dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide (MTT) and modified Boyden Chamber assays, respectively. Where significant stimulation was found, the influence of an antagonist was also investigated.

RESULTS

Neither growth nor motility of endothelial cells was affected by either agonist. In DU145 cells, while the B2R agonist was without any significant effect, the B1R agonist stimulated proliferation and migration at concentrations of 10nM and 50nM respectively. Further, this effect was abrogated when cells were pre-incubated with a B1R antagonist.

CONCLUSIONS

Unlike the physiologically-active B2R, the pathologically-inducible B1R may be implicated in prostate tumourigenic events. The involvement of the KKS in malignant prostate pathology supports on-going exploration of bradykinin receptor antagonists as target candidates in the development of alternate approaches to cancer therapy.

Minors' request for confidentiality

Dentists must be cognisant of what the law requires and how they are expected to respond. When the law does not address an issue, the dentist would need to weigh the circumstances and consequences and do what he/she thinks is ethically appropriate and acceptable. The need to maintain confidentiality of any information given to us in our professional capacity is paramount. Patient autonomy and their absolute right to confidentiality must be ensured in almost all but the most exceptional circumstances. Patients have the ethical and legal right to expect a health professional to keep confidential the information provided during the course of their care. Disclosure of patient information is only permitted with the patient's consent or if there is an overwhelming public interest in disclosure as prescribed by the law.

Impact of socio-economic factors on quality of life in patients on continuous ambulatory peritoneal dialysis in an African setting

BACKGROUND

Quality of life (QOL) is an important outcome following the treatment of disease. It is influenced by physical, psychological, social and economic factors. We proposed to determine the effect of some socioeconomic factors on QOL of patients on CAPD.

STUDY DESIGN

A cross sectional study in which all patients on CAPD attending three clinics attached to the University of the Witwatersrand, Johannesburg were recruited excluding those with intercurrent illness. The WHO quality of life instrument, WHOQOL-Bref, was used to measure QOL. The patients were grouped according to marital status, highest level of education attained, income, employment, and QOL domain scores were compared using ANOVA and Student t test.

RESULTS

A total of 140 patients comprising 80 males and 40 females were assessed. The mean age of patients was 41.9 ± 11.5 years, 95%of patients were black, 44.3% married, 69.3% had secondary education, 22% were employed and 51.4% had a monthly income of less than five thousand Rand (500 US dollars). Single patients scored better in the social relationships domain compared to separated patients (p=0.02, CI: 5.6-32.9). The group with secondary education scored low in the psychological domain compared with those with primary education (p=0.02, CI: 1.35-15.8) and those with tertiary education (p=0.02, CI: 1.72-18.07).The highest income group had best scores in all domains except the physical domain. Those in employment had better scores in the physical domain (p=0.04, CI: 0.356-12.549).

CONCLUSION

Income had the most impact on QOL in study participants.