Bleeding after dental extractions in patients taking warfarin

OBJECTIVE

To assess the incidence of bleeding after dental extractions in subjects taking warfarin continuously before and after extractions whose International Normalised Ratio (INR) was below 4.0 at the time of extraction.

METHODS

This was a case series study of 150 patients without controls who required extraction of at least one tooth under local anaesthetic. All sockets were subsequently packed with absorbable oxycellulose and sutured.

RESULTS

A total of 58 women and 92 men were included (mean age 66 years); their ages were similar. The mean INR (S.D.) was 2.5 (0.56), although most patients had an INR less than 2.5 (n=101). Ten patients (7%) bled after extraction, enough to require a return to hospital. Five patients of 101 with an INR</=2.5, and 5 with an INR>2.5 out of 49 bled after extraction (p=0.29). Bleeding after extraction was not associated with operative antibiotics. All patients who bled were managed conservatively and none was admitted to hospital.

CONCLUSION

Patients taking warfarin whose INR is up to 4.0 and who have dental extractions in hospital do not have clinically significant bleeds post-operatively.

Hepatitis B vaccination practices in hospital newborn nurseries before and after changes in vaccination recommendations

BACKGROUND

Routine use of hepatitis B vaccine for low-risk newborns was suspended on July 7, 1999, because of concern about the potential risk of thimerosal, a mercury-containing vaccine preservative. Reinstatement of the birth dose was recommended when a thimerosal-free vaccine became available.

OBJECTIVE

To explore changes in hepatitis B vaccination practices for newborns related to the revised recommendations for low-risk infants (in this study, the terms newborn and infant are used interchangeably).

DESIGN

A telephone survey of a random sample of 1000 US hospitals.

PARTICIPANTS

Nurse managers, nursery directors, and staff nurses of the newborn nurseries.

MAIN OUTCOME MEASURES

Nursery vaccination practices before and after July 7, 1999, and the availability and use of thimerosal-free vaccine.

RESULTS

Interviews were conducted with 773 (87%) of 886 eligible hospitals. Before July 7, 1999, 78% of the hospitals reported vaccination practices that were consistent with recommendations at that time, although only 47% vaccinated all low-risk infants at birth. After July 7, 1999, almost all hospitals discontinued vaccination of low-risk infants, in accordance with the recommendation change; however, there was a 6-fold increase in the number of hospitals that were not vaccinating all high-risk infants. After the introduction of thimerosal-free vaccine, only 39% of the hospitals reported vaccinating all low-risk infants.

CONCLUSIONS

Most hospital nurseries altered their newborn hepatitis B vaccination practices consistent with changes in national recommendations. However, unintended consequences included the failure of some hospitals to continue vaccinating all high-risk infants and the delay in reintroducing vaccination for low-risk newborns after the introduction of a thimerosal-free vaccine. Assessments of the appropriateness of this country's response to the threat of thimerosal in vaccines should consider these findings.

Oral submucous fibrosis in a 12-year-old Bangladeshi boy: a case report and review of literature

Oral submucous fibrosis is commonly seen in the adult population of the ethnic minorities in the UK, although its presentation in a child is rare. Whilst the condition is considered multifactorial and irreversible, we present a case of oral submucous fibrosis in a 12-year-old Bangladeshi boy whose cessation of habitual betel nut chewing and forcible mouth chewing exercises led to an improvement in his mouth opening, although his ability to protrude his tongue remained unaltered. The clinical features, pathogenesis and management of submucous fibrosis are described. The widespread use of betel quid among Asians in the UK is summarized and the importance of its recognition as a precancerous condition is emphasized.

Associations of macro and micronutrients and antioxidants intakes with preeclampsia: A case-control study in Jordanian pregnant women

BACKGROUND AND OBJECTIVES

A study was conducted to evaluate whether preeclampsia in pregnant women is associated with dietary factors and antioxidant intake (vitamin C, vitamin E, vitamin A, and selenium).

METHODS AND RESULTS

In this case-control study, a group of 79 pregnant Jordanian women (36 preeclamptic pregnant women and 43 healthy pregnant women aged 18-45 years with a gestational age ≥20th week of pregnancy) were recruited from the obstetrics and gynecology clinics at Royal Medical Services, King Hussein Medical Center, Amman, Jordan. Information about socio-demographics, anthropometric measurements, biochemical measurements, nutritional intake, and dietary habits was collected through a structured interview. Three 24-hour dietary records were also made. Data were analyzed using Statistical Package for the Social Sciences (SPSS), and dietary intake was analyzed using ESHA software. Prepregnancy BMI, age, multiple pregnancies, energy intake, beta-carotene, vitamin C, and sodium showed significant difference between preeclamptic pregnant women and healthy pregnant women. The odds ratio (OR) and the corresponding 95% confidence interval (CI) show that a strong association with preeclampsia exists for the intake of fat (OR = 6.40, 95% CI: 1.85-22.17) and saturated fat (OR = 3.35, 95% CI: 1.0-11.54). Inverse associations with preeclampsia were found for fruit intake (OR = 0.16, 95% CI: 0.47-0.55) and olive oil intake (OR = 0.20, 95% CI: 0.05-0.78).

CONCLUSION

In this case-control study in Jordanian pregnant women, preeclampsia was associated with a high intake of fat, saturated fat, and sodium and a low intake of fruits, fiber, vitamin C, B-carotene, and olive oil.

Attitudes, practices, and preferences of pediatricians regarding initiation of hepatitis B immunization at birth

OBJECTIVES

To explore practices and attitudes of pediatricians toward administration of the first dose of hepatitis B vaccine to infants, and to identify factors influencing the decision of pediatricians to initiate immunization at birth versus at 1 to 2 months of age.

METHODS

A random sample of 600 pediatricians obtained from the American Academy of Pediatrics membership database was surveyed by mail.

RESULTS

Three hundred eighty (68%) of the 563 pediatricians who were located responded to the survey. Of these 380 pediatricians, 279 provided routine immunizations to children. Of the 270 pediatricians who vaccinated children with hepatitis B vaccine and indicated their practice regarding the birth dose, 50% offered the first dose of hepatitis B vaccine at birth to all infants; the rest either offered the vaccine at birth only to infants of hepatitis B surface antigen-positive mothers and mothers whose serostatus is unknown, or did not offer the birth dose to any infants at all. Practicing in the inner city, working for a medical school or government hospital, and living in a state with universal immunization supply policies were associated with the respondent giving the birth dose. The strongest perceived barriers to giving the birth dose in the hospital were the difficulty tracking these vaccines (39%), the increased cost (27%), and the lack of reimbursement from insurance companies (26%). If a combination vaccine that includes hepatitis B; diphtheria, tetanus, pertussis (diphtheria and tetanus toxoids and acellular pertussis vaccine); and polio (inactivated poliovirus vaccine) antigens become available in the near future, then 38% of physicians who currently give the birth dose to all infants would prefer to wait until 2 months of age to initiate hepatitis B immunization.

CONCLUSIONS

Efforts to achieve high implementation of hepatitis B birth dose administration may falter once a hepatitis B-containing pentavalent combination vaccine becomes available. Programmatic efforts should ensure prevention of perinatal hepatitis B virus transmission through universal prenatal hepatitis B surface antigen screening and immunoprophylaxis of high-risk newborn infants.

Oral self-mutilation by a 17-month-old child with Lesch-Nyhan syndrome

We report a 17-month-old boy who was a known case of Lesch-Nyhan syndrome and presented with self-inflicted oral ulcerations of his lips and cheeks. He had a normal complement of caries-free deciduous teeth. Initially a conservative approach was planned and a bite plate made, but as a result of poor compliance and persistent ulceration and after consultation with his parents it was decided to extract all deciduous teeth.

Hepatitis B vaccination coverage among United States children

BACKGROUND

In 1991 the Advisory Committee on Immunization Practices recommended vaccination of all infants with three doses of hepatitis B virus vaccine (HepB) by 18 months of age as a key component of a comprehensive strategy to eliminate hepatitis B virus transmission in the United States. The American Academy of Pediatrics and the American Academy of Family Physicians published similar recommendations soon afterward.

METHODS

Data were obtained from the National Immunization Survey, a survey that began in 1994 and is conducted quarterly by the Centers for Disease Control and Prevention to estimate vaccination coverage among noninstitutionalized US children 19 to 35 months of age.

RESULTS

The 1999 National Immunization Survey data indicate that approximately 88.1% (95% confidence interval, 87.4, 88.8) of children 19 to 35 months of age had received at least three doses of HepB (HepB3). There has been a consistent increase in HepB3 coverage since 1994. However, the rate of increase has slowed in recent years and HepB3 coverage remains lower than coverage attained with three doses of diphtheria-tetanus-pertussis and Haemophilus influenzae vaccines. HepB3 coverage varied slightly by race/ethnicity and was highest among white and Asian children (89%). Coverage also varied by state; 26 states had levels of at least 90%.

CONCLUSIONS

Since the 1991 recommendations for universal hepatitis B vaccination, there has been a dramatic increase in coverage levels among children 19 to 35 months of age. However, the Childhood Immunization Initiative goal of 90% coverage has not been reached. Therefore continued efforts are needed to protect US children against this serious but preventable infection.

Neurilemmoma involving the maxillary sinus: a case report

A case is reported of a neurilemmoma arising from the maxillary sinus. Its aetiology, presentation, histology and treatment are discussed.

Disseminated histoplasmosis presenting with oral lesions - report of a case

A case of disseminated histoplasmosis is presented in which the initial diagnosis was made on the histology from oral lesions. The clinical and microscopical differential diagnoses are discussed. Including the present case, 12 of the 13 subjects with disseminated histoplasmosis initially diagnosed in Great Britain have given a history of residence in an area where the disease is endemic. Many years of good health may intervene between the original infection and its subsequent reactivation. A diminished cellular immune response may precipitate this reactivation but could also facilitate the possibility of exogenous reinfection. The literature is reviewed.

Evaluation of a pilot oral health promotion programme 'Keep Smiling': perspectives from GDPs, health champions and school staff

OBJECTIVE

To evaluate a pilot oral health promotion programme (fluoride varnish and tooth brushing), targeting 3-7-year-olds in primary schools in a deprived area of London.

METHOD

A pilot programme was conducted among five primary schools targeting 3-7-year-old children in a deprived area of London. The programme consisted of a fluoride varnish application and tooth brushing sessions. Outcome (participation rates) and process evaluations were carried out using semi-structured interviews with school staff, health champions and dentists.

RESULTS

Overall, 79.2% of the targeted children participated in tooth brushing and 68.6% of children received fluoride varnish. The programme received positive feedback from school staff, dental teams and health champions. It raised awareness of dental health among all stakeholders and provided children with a unique experience, creating a positive image of dental teams.

CONCLUSIONS

Community engagement and collaboration between health, education and the voluntary sector is feasible and integral in developing oral health promotion programmes aimed at children attending primary schools in a deprived area of London.

Evaluation of analgesic and anti-inflammatory effects of ethanol extract of Ficus iteophylla leaves in rodents

This study was undertaken to investigate the leaf part of the plant for analgesic and anti-inflammatory. The ethanol extract of Ficus iteophylla leaves (100, 200, and 400 mg kg(-1), i.p) was evaluated for analgesic and anti-inflammatory activities. The analgesic effect was studied using acetic acid-induced abdominal constriction and hot plate test in mice, while the anti-inflammatory effect was investigated using carrageenan induced paw oedema in rats. The ethanol extract at 100 mg kg(-1), 200 mg kg(-1), and 400 mg kg(-1) significantly (P< 0.05) inhibited acetic acid induced writhes by 1.50 ± 0.43, 3.0 ± 0.82 and 1.0 ± 0.82 respectively. It also exhibited significantly (P< 0.05) anti-inflammatory by 0.11 ± 0.02, 0.11 ± 0.03, 0.08 ± 0.01 respectively. The preliminary phytochemical screening of the plant extract revealed the presence of flavonoids, steroids, tannins and saponins while the effect of flavonoids, steroids and tannins on analgesic and inflammatory has been reported. The intraperitoneal median lethal dose (LD(50)) value of the extract was found to be 3807.8 mgkg(-1) body weights. The result obtained from this study shows that the extract of Ficus iteophylla contained phytochemical constituents with analgesic and anti-inflammatory activities, therefore the leaf part of the plant could be used in the management of pain and inflammatory conditions.

Median lip fissures and their management

Median lip fissures are an uncommon condition and usually give rise to pain and episodes of bleeding. We report three cases of median lip fissures which were treated by surgical excision.