Numb Chin Syndrome in Sickle Cell Disease: A Systematic Review and Recommendations for Investigation and Management

Numb chin syndrome (NCS) is a rare sensory neuropathy resulting from inferior alveolar or mental nerve injury. It manifests as hypoesthesia, paraesthesia, or, rarely, as pain in the chin and lower lip. Several case reports suggest that sickle cell disease (SCD) could be a cause of NCS. However, information about NCS is scarce in this population. Our objectives were to synthesize all the available literature relevant to NCS in SCD and to propose recommendations for diagnosis and management based on the best available evidence. A systematic review was performed on several databases to identify all relevant publications on NCS in adults and children with SCD. We identified 73 publications; fourteen reports met the inclusion/exclusion criteria. These described 33 unique patients. Most episodes of NCS occurred in the context of typical veno-occlusive crises that involved the mandibular area. Radiological signs of bone infarction were found on some imaging, but not all. Neuropathy management was mostly directed toward the underlying cause. Overall, these observations suggest that vaso-occlusion and bone infarction could be important pathophysiological mechanisms of NCS. However, depending on the individual context, we recommend a careful evaluation to rule out differential causes, including infections, local tumors, metastatic disease, and stroke.

Shifting paradigm from biomedical to decolonised methods in Inuit public health research in Canada: a scoping review

Background

The National Inuit Strategy on Research focuses on advancing Inuit governance in research, increasing ownership over data and building capacity. Responding to this call for Inuit self-determination in research, academic researchers should consider cultural safety in research and ways to promote Inuit-led methods.

Methods

This scoping review collated academic literature on public health research in Inuit communities in Canada between 2010 and 2022. A critical assessment of methods used in public health research in Inuit communities examined cultural safety and the use of Inuit-attuned methods. Descriptive and analytical data were summarised in tables and figures. Knowledge user engagement in the research process was analysed with thematic analysis.

Results

356 articles met the inclusion criteria. Much of the published research was in nutrition and mental health, and few initiatives reported translation into promotion programmes. Almost all published research was disease or deficit focused and based on a biomedical paradigm, especially in toxicology, maternal health and chronic diseases. Recent years saw an increased number of participatory studies using a decolonial lens and focusing on resilience. While some qualitative research referred to Inuit methodologies and engaged communities in the research process, most quantitative research was not culturally safe. Overall, community engagement remained in early stages of co-designing research protocols and interventions. Discussion on governance and data ownership was limited. Recent years saw emerging discussions on these issues. Knowledge user capacity-building was limited to brief training on conventional data collection methods.

Conclusions

The last decade of published public health research has not responded to the National Inuit Strategy on Research. Participatory research is gaining ground, but has not reached its full potential. A shift from biomedical to decolonised methods is slowly taking place, and public health researchers who have not yet embraced this paradigm shift should do so.

Factors that influence uptake of routine postnatal care: Findings on women's perspectives from a qualitative evidence synthesis

BACKGROUND

Effective postnatal care is important for optimal care of women and newborns-to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care.

METHODS

We undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach.

FINDINGS

Of 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women's desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care.

CONCLUSIONS

Factors that influence women's utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings.

REGISTRATION

This protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.

A Portrait of Sentinel Surveillance Networks for Vector-Borne Diseases: A Scoping Review Supporting Sentinel Network Design

Vector-borne diseases (VBDs) are continuing to emerge globally, requiring new surveillance systems to follow increasing VBD risk for human populations. Sentinel surveillance is an approach that allows tracking of disease risk through time using limited resources. However, there is no consensus on how best to design a sentinel surveillance network in the context of VBDs. We conducted a scoping review to compare VBD sentinel surveillance systems worldwide with the aim of identifying key design features associated with effective networks. Overall, VBD surveillance networks were used most commonly for malaria, West Nile virus, and lymphatic filariasis. A total of 45 criteria for the selection of sentinel unit location were identified. Risk-based criteria were the most often used, and logistic regression showed that using risk-based criteria dependent on host animals is particularly correlated with surveillance system sensitivity (p < 0.018). We identify tools that could prove valuable for sentinel surveillance network design, including a standardized approach for evaluating surveillance systems and a tool to prioritize criteria for selecting optimal geographic locations for spatial sentinel units.

Exploring the Facilitators and Barriers to Home Dialysis: A Scoping Review

A meta-synthesis of qualitative literature from 2004-2014 was conducted to identify the facilitators and barriers related to patients' uptake and continued use of home dialysis. These factors were addressed from the patient perspective using a systematic scoping review. A total of 848 citations were retrieved, and 12 studies were ultimately included. Data were analyzed descriptively by content analysis. The most commonly reported barriers were Burden of Care, Invasion of Body, and Disruption of Lifestyle, while the most common facilitators were Support, Physical and Mental Well-Being, Ability to Maintain a Normal Life, and Autonomy. Nursing implications are discussed for supporting facilitators and addressing barriers.

[Naso-ethmoido-maxillary protrusion (NEMP): a specific dysmorphosis]

Naso-ethmoido-maxillary protrusion (NEMP) is a rare dental and facial dysmorphosis, with excessive growth of basicranium, ethmoid, maxillary, and nasal bones. The clinical presentation includes nasal and upper lip protrusion, telecanthus, a class 2 malocclusion with maxillary protrusion and exoclusion. The craniofacial field is increased in Delaire's analysis. Contrary to isolated maxillary protrusion secondary to membranous ossification dysfunction, NEMP is a constitutional anomaly resulting from an excessive primary growth of the chondrocranium. The therapeutic management of NEMP should take into account these specificities.

Resistance of trichostrongyles to benzimidazoles in Italy: a first report in a goat farm with multiple and repeated introductions

Anthelmintic resistance is widely distributed in small ruminants throughout the world. The extension of resistance seems lower in southern European countries and has not been reported previously in Italy. In the present study, resistance to benzimidazoles, levamisole and ivermectin was evaluated in a multi-breed goat farm of southern Italy. The farm had a history of repeated goat introductions from other flocks and a moderate regimen of anthelmintic treatments using alternatively the three above-mentioned drugs. Resistance of gastrointestinal strongyles was studied on the basis of faecal egg counts, egg hatch assay and necropsies. Resistance to anthelmintics was evidenced for benzimidazoles only, and Trichostrongylus colubriformis was the only resistant strongyle species. Single drug and single species resistance suggest that resistance is on its beginning and that measures for reducing the spread of resistance are of interest and should be promoted.

Evolution of nematode community in grazing sheep selected for resistance and susceptibility to Teladorsagia circumcincta and Trichostrongylus colubriformis: a 4-year experiment

Field trials were undertaken to compare nematode population dynamics in two experimental flocks of rams selected for high and for low faecal egg counts (FECs) following two doses with 20000 infective larvae, 12000 Teladorsagia circumcincta (Tcirc) and 8000 Trichostrongylus colubriformis (Tcol) separated by a treatment. The selection was done by dosing 200 ram lambs (INRA 401 breed) and FECs proceeded with egg identification on days 28 and 35 post-each-infection. The 30 lambs with the lowest FECs constituted the group of permanent resistant rams (R), the 30 with the highest values the group of susceptible ones (S). Each group grazed separated pastures from April to November, this during 4 consecutive years. The contamination (number of eggs deposited) was estimated every 3 weeks on each pasture. The larval populations was measured by successive groups of tracer lambs. The infection of the permanent rams was done by slaughtering eight R and S rams on mid and end of each grazing season. Each autumn, new R and S ram lambs were selected to complete the R and S groups before turning out in spring. On third year, a third species (Haemonchus contortus, Hcon) was added to compare its behaviour with the two others. The regulation of parasite populations were studied by comparing what happens in R rams and pasture to S ones. The selected R ram lambs had a FEC of Tcirc 50% lower than S ones. This induced a similar lowered pasture contamination, a 25% decrease of infective larval population in years 2 and 3, and the worm burdens in R rams were the half of that in S rams after 2 years. The FEC of Tcol was 75% lower at the selection and induced similar difference in pasture contamination, but 65 and 96% reduction in L3 population, respectively, after 1 and 2 years. The worm burden was reduced by 99%. Adding Hcon species during the third year, in year 4, the L3 population was half in R pasture compared with S one, and R rams had 60% less worms of this species than S ones. This selection without any drench prevent outbreaks observed in young tracer lambs on S pasture. The comparison of selected resistant rams to selected susceptible ones and not to unselected controls gave more rapid information about the tendency of the regulation of the communities of nematode parasites.

Acute pericarditis with transient constriction

Transient constrictive pericarditis is a rare entity. It is characterized by clinical and echocardiographic features similar to constrictive pericarditis, but is distinguished by its transient nature. This feature is important to recognize for avoiding unnecessary pericardectomy. The case of a patient who presented with acute myopericarditis and typical echocardiographic features of constriction is described. Within weeks, all signs of constriction disappeared spontaneously.

Relationship between helminth species diversity, intensity of infection and breeding management in dairy goats

Helminth infection, species diversity (proportion of each species in the community), species number, intensity of infection and anthelmintic resistance were investigated in 16 dairy-goat farms of south-western France. The aim of the study was to estimate which breeding management factors may affect diversity and intensity of infection. Anthelmintic resistance was investigated because this factor may modify composition of nematode communities. Farm history and breeding management were recorded by means of a questionnaire. Natural and experimental infections were compared to determine which strategy was the best to estimate diversity index and number of species from nematode community of a whole herd. A total of 17 species of helminths, among which 14 nematodes, one cestode (Moniezia spp.) and two trematodes (Paramphistomum daubneyi and Dicrocoelium lanceolatum) were recovered in the 26 necropsied culled goats. One culled goat worm burden represented conveniently species number but not species diversity (Shannon index) of parasite community harboured in the whole herd. Experimental sheep infection with larvae from pooled faeces of 15 goats was the best strategy to estimate species diversity in farms. Diversity could be predicted from the number of farms from which goats originated at constitution of the herd, the duration of goat winter withdrawal from pastures, and intensity of infection. Anthelmintic resistance was correlated with the number of farms of origin, area of permanent pastures and intensity of infection. The strategy adopted for the herd constitution was a critical step as species diversity and risk of anthelmintic resistance increased with the number of farms of origin. Intensity of infection was negatively correlated with species diversity. This suggested that more diverse communities were better controlled by the host, in agreement with the widespread statement that diversity would beget stability.

Segmental myocardial contractility versus perfusion in Kawasaki disease with coronary arterial aneurysm

The impact of Kawasaki-related coronary injury on the myocardium was evaluated in 13 patients with persistent coronary aneurysm after a follow-up period of 7.92+/-3.97 years (range 1.8 to 14.3). Myocardial segmental perfusion and contractility integrity were assessed by resting and exercise echocardiography and technetium-99 (Tc-99m) sestamibi scan. Eight patients (61.5%) had giant aneurysms (> or = 8 mm) and 9 had multivessel involvement; the mean diameter of the largest aneurysm was 8.6+/-2.5 mm (range 5 to 14). During the acute phase, myocardial infarction occurred in 1 patient and coronary thrombosis in another. At the latest echocardiographic evaluation, the mean aneurysm diameter was 6.8+/-2.4 mm (range 4.5 to 12), there was persistent giant aneurysms in 5 of 8 patients, and 3 of 9 patients had multivessel involvement. Coronary angiography demonstrated stenosis in 7 of 10 patients, with multiple levels in 2. At sestamibi scan, all 13 patients had perfusion anomalies at rest, whereas only 7 had detectable hypokinesia on echocardiography. With exercise, perfusion returned to near normal in 3 patients, improved in 3, remained unchanged in 4, and worsened in 3 patients. Segmental contractility similarly deteriorated in the latter 3 patients but also in 2 patients whose perfusion scan had improved with exercise. Three patients, normal at rest, developed segmental hypokinesia during exercise. When present, the location of observed changes in contractility on stress echocardiography corresponded to that of perfusion defect. In conclusion, abnormal myocardial perfusion is present long term after complicated Kawasaki disease, the worst anomalies accompanying persistent giant aneurysms. Unfavorable perfusion response was coupled with abnormal contractility; however, enhanced perfusion with exercise correlated poorly with segmental contractility response.

Mitral valve repair: Intermediate to long-term echocardiographic follow-up

OBJECTIVE

To review intermediate to long term echocardiographic follow-up after mitral valve repair for mitral regurgitation.

DESIGN

Nonrandomized, retrospective and prospective observational study.

SETTING

Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec.

PATIENTS

Echocardiographic findings in 37 patients (mean age 62.1 +/- 10 years) three to 197 months (median 45) after mitral valve repair were reviewed.

INTERVENTIONS

Preoperative data were collated from hospital records. Between October 1994 and March 1995, all patients had a clinical evaluation and a complete transthoracic echocardiogram done by a cardiologist.

RESULT

There was a significant reduction in the dimensions of the left-sided cavities compared with preoperative data. Left atrial diameter decreased from from 50.9 +/- 7.7 to 46.3 +/- 8.1 mm (P = 0.01), left ventricular end-diastolic diameter from 59.6 +/- 7.1 to 51.2 +/- 6.3 mm (P < 0.001) and left ventricular end-systolic diameter from 35.3 +/- 7.9 to 32.8 +/- 7.8 mm (P = 0.07). On colour Doppler echocardiography, nine patients had no mitral regurgitation, 25 had mitral regurgitation grade I to II/IV, and three had grade III/IV. The mean mitral valve gradient was 4.2 +/- 1.8 mmHg and the pressure half-time 121.9 +/- 48 ms. There was no difference in gradient, mitral valve area and mitral regurgitation in patients with degenerative (29) compared with rheumatic (five) mitral valve disease.

CONCLUSIONS

Mitral valve repair is highly effective in reducing mitral regurgitation in the long term and is associated with a reduction in the dimensions of the left atrium and the left ventricle. However, it leaves a mild degree of mitral valve obstruction.

Salmonella endocarditis of a ventricular aneurysm: a case report and review of the literature

A 63-year-old man with salmonella endocarditis of a ventricular aneurysm is presented. The patient had a documented apical aneurysm with mural thrombus and left ventricular dysfunction following a previous myocardial infarction. His condition was unresponsive to maximal medical therapy and was cured by surgery. A review of the English-language literature revealed that only two other published cases of nonvalvular salmonella endocarditis resulted in patient survival. This report underscores the importance of suspecting a cardiovascular origin in cases of salmonella bacteremia to avoid delay in diagnosis and surgical intervention in this deadly condition.

Host, season and year do not play an important role on genetic variability in a trichostrongyle nematode as assessed from allozymes

The isolates of the trichostrongyle nematode Teladorsagia circumcincta in sheep may vary from one site to another as assessed from allozyme studies. This genetic variability could be host (on the parasitic stages) or/and environmentally (on the free-living stages) induced. In the present study the role of host (susceptible to the establishment of the parasite and partly resistant ones) and environmental changes expressed by season (Autumn versus Spring) or year of sampling (1990 or 1992) were investigated. Five polymorphic enzymes were studied: glucose-phosphate-isomerase (GPI), lactate dehydrogenase (LDH), malate dehydrogenase (MHD), mannose-phosphate isomerase (MPI), and phosphoglucomutase (PGM). No significant difference in allelic frequencies was recorded between 4 susceptible lambs from a flock grazed in 1990 as well as in 3 lambs selected on their susceptibility or resistance to natural infection in a flock grazed in 1992. The mode of infection (natural--frequently repeated small infections, versus experimental--3 repeated large infections) did not modify the allelic frequencies of the nematodes. The allelic frequencies remained stable along the seasons and during the 2 years investigated. The largest distance of Rogers (0.07) and Fst (0.012) were recorded between worms originating from susceptible and resistant lambs or in Autumn versus Spring populations of worms (0.08 and Fst 0.010). A deficiency in heterozygotes of the same magnitude was recorded in the worm populations obtained from the different infections. The stability of allelic frequencies and genetic structure are surprising when one considers the evolution of the same parasite in several generations of laboratory conditions. This stability could be related to the fact that levels of disturbance on parasitic and free-living stages are neither too low (as in laboratory conditions) nor too high (as in farms when anthelmintic treatment are used regularly and destroy the adult stages).

Studies on multispecific resistance of gastrointestinal nematodes to benzimidazoles on dairy-goat farms

Multispecific resistance to benzimidazoles was studied in three selected farms. These farms had bred dairy goats for more than 15 years. The helminths were introduced with the goats at the establishment of the farms which afterwards remained isolated. Nematode resistance could then be related to their own management practices. Faecal egg count tests and egg hatch assays were performed to assess intensity of resistance. The generic (infective larvae in faecal cultures) and specific richness (adult worms) were assessed. The resistant species were Trichostrongylus colubriformis, Teladorsagia circumcincta, Haemonchus contortus and Oesophagostomum venulosum. Faecal egg count reduction tests and egg-hatch assays did not match exactly. Faecal larval counts after treatments gave a distorted picture of multispecific resistance: Haemonchus and Oesophagostomum were very largely over represented. The number of species found in the three farms was relatively low compared with other reports in goat farms of the area. This reduction of diversity might also be due in part to characteristics of breeding management and history (use of permanent pasture and introduction of goats at the establishment of farm).