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Journal of Hand Surgery Global Online Nov 2023We sought to investigate the role of prophylactic antibiotics for distal fingertip crush injury or transphalangeal amputation treated outside of an operating room and...
PURPOSE
We sought to investigate the role of prophylactic antibiotics for distal fingertip crush injury or transphalangeal amputation treated outside of an operating room and better understand the factors that contribute to antibiotic-prescribing decisions. We hypothesized that prophylactic antibiotics do not meaningfully reduce the incidence of infection and that antibiotics are prescribed in a predictable way.
METHODS
This is a retrospective review of all patients treated in a MedStar-affiliated emergency department or urgent care for nonsurgical distal fingertip trauma in 2019. Patient demographics, comorbidities, injury characteristics, interventions, and follow-up details were recorded. Exclusion criteria included signs of infection at the time of presentation, minor injuries not requiring intervention, bite wounds, one-time intravenous antibiotic administration without oral course, and surgical intervention. Outcomes included infection and interventions at follow-up. Chi-square analysis was performed, comparing antibiotic and no-antibiotic groups. A stepwise binomial regression was used to evaluate for variables predictive of antibiotic prescription.
RESULTS
We identified eight infections in 323 patients included in the study (2.5% incidence of infection). There was no statistically significant difference in the incidence of infection between patients treated with antibiotics (2.7%) and those who did not receive antibiotics (2.2%). However, due to the low incidence of infections, we were likely underpowered for this analysis. We also created a model to predict antibiotic prescribing, which achieved an area under the receiver operating characteristic curve of 0.86 ( < .0001) based on age, bleeding disorders, depressive disorders, open wound status, amputation, fractures, and encounter type.
CONCLUSIONS
The low incidence of infection (2.5%) and lack of a meaningful difference between the groups call into question prophylactic antibiotic prescribing after these distal fingertip injuries. Our model does predict provider prescribing habits, identifying areas for potential practice pattern change.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic III.
PubMed: 38106926
DOI: 10.1016/j.jhsg.2023.07.010 -
Open Veterinary Journal Oct 2023is a Gram-negative bacterium that causes Lyme disease or borreliosis in domestic and wild animals, including dogs, with the possible transmission to humans.
BACKGROUND
is a Gram-negative bacterium that causes Lyme disease or borreliosis in domestic and wild animals, including dogs, with the possible transmission to humans.
AIM
This study was conducted to investigate the infection rate of Spirochetes and B. burgdorferi in stray dogs in Nineveh province, Iraq.
METHODS
During the period from May to October (2022), a total of 55 stray dogs were selected randomly from different areas in Nineveh province, Iraq. Blood samples were collected from cephalic venous and tested molecularly using the conventional polymerase chain reaction technique.
RESULTS
The present study revealed that the total infection rates of Spirochetes and were 41.82% and 27.27%, respectively. Concerning age, values of infection rate, odds ratio, and relative risk of were increased significantly in dogs aged ? 4 months (42.86%, 3.505%, and 2.438%, respectively), while decreased in dogs of ? 1-3 (12.5%, 0.337% and 0.42%, respectively) and ? 3 (13.33%, 0.32% and 0.409%) years old when compared to dogs aged 5-12 months (27.27%, 1% and 1%, respectively). While concerning dogs sex, a significantly higher infection rate, odds ratio, and relative risk of were shown in females (32.56%, 5.495% and 6.792%, respectively) compared to males (8.33%, 0.182% and 0.147%, respectively).
CONCLUSION
To the best of our knowledge, this represents the first Iraqi study on the prevalence of spirochetes, in particular , in stray dogs in Nineveh province (Iraq). However, additional studies of infection in other animals as well as vectors such as ticks in different geographic areas, appear necessary to detect variation in the distribution patterns of infection. In addition, owners and veterinarians should be aware of zoonotic diseases transmitted from wild and domestic animals, in particular those with tick-bite histories.
Topics: Humans; Male; Female; Animals; Dogs; Borrelia burgdorferi; Iraq; Lyme Disease; Animals, Domestic; Animals, Wild; Dog Diseases
PubMed: 38027409
DOI: 10.5455/OVJ.2023.v13.i10.11 -
Cureus Oct 2023This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites. A systematic review of the studies...
This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites. A systematic review of the studies on "pediatric fracture dog bite" based on a search of PubMed and OVID Medline databases was performed by adhering to PRISMA guidelines. Articles in English describing pediatric long bone fractures due to dog bites were included. Studies not differentiating pediatric from adult patients and not describing long bone fractures due to dog bites were excluded. Study characteristics, fracture epidemiology, management decisions, and follow-up data were extracted. Additionally, a seven-year retrospective chart review of cases treated at our level one pediatric trauma center was performed. Data on fracture characteristics, surgical management, choice of antibiotic therapy, and follow-up were collected. Five studies that met our criteria were analyzed. Pediatric long bone fractures from dog bites were identified in 0.35% (11/3,156) of patients. Such fractures most commonly involved the upper extremity (9/11, 82%). None of the studies described the choice of antibiotics, surgical decision-making, or wound closure preference for an underlying fracture. Our chart review elicited three cases of long bone fractures due to dog bites. Pediatric long bone fractures after dog bites are a rare injury pattern in the United States. These injuries should be treated as contaminated open fractures, and urgent immunization, intravenous antibiotic administration, wound care, and fracture stabilization should be provided. We recommend meticulous surgical debridement in the operating room, as wounds often probe deep into the bone. Nevertheless, there is much that remains unclear about these injuries. Hence, further research with greater power is needed to improve treatment decisions.
PubMed: 38022042
DOI: 10.7759/cureus.47230 -
Cureus Oct 2023Animal bites can cause severely contaminated open fractures, especially in the hand, wrist, and lower extremities, requiring expert orthopedic care. This case report...
Animal bites can cause severely contaminated open fractures, especially in the hand, wrist, and lower extremities, requiring expert orthopedic care. This case report emphasizes the unique issues posed by such injuries, particularly in low-income areas with limited access to comprehensive medical services. Pediatric examples, such as open tibiofibular fractures caused by animal encounters, highlight the significance of individualized treatment techniques. Crocodile bites, though infrequent, present an extreme peril and potential fatality. In Sri Lanka, where various crocodile species inhabit the waters, such incidents are rare but present. Long bone fractures caused by crocodile bites are significant and complicated injuries. The enormous force of a crocodile's jaw can cause substantial damage to bones, tendons, and surrounding tissues, often resulting in significant bone and soft tissue loss. Managing such injuries is extremely difficult, especially in low-resource settings. The use of a locking plate as an external fixator is a novel approach in the treatment of open fractures, nonunion, septic arthritis, and even as a distraction osteogenesis adjuvant. While it is not as common in typical fracture fixation textbooks, it is critical in specialized instances. This study describes a unique case of a 13-year-old boy with a Gustilo-Anderson Type IIIA crocodile bite who was treated in a low-income environment with a locking plate as an external fixator.
PubMed: 38021673
DOI: 10.7759/cureus.47511 -
Case Reports in Dentistry 2023Supernumerary teeth can have normal or abnormal morphologic structure and characteristics, and their impacted form is diagnosed usually during X-ray examinations. In...
Supernumerary teeth can have normal or abnormal morphologic structure and characteristics, and their impacted form is diagnosed usually during X-ray examinations. In this case report, the presented patient is a 16-year-old female with anterior and right posterior open bite and bilateral posterior crossbite, upper right supernumerary paramolar, and impacted second and third molars. The paramolar development was the reason for the asymmetric growth of the alveolar bone in the upper jaw. The development of the bone is connected with the development of the teeth, and one additional tooth leads to extensive development in the maxilla. There is a risk of gingival recession occurrence when leveling the lower incisors due to the thin gingival biotype. A combined surgical-orthodontic treatment was done according to the following plan: extraction of supernumerary paramolar, germectomy of the upper right third molar (18) and at the same time periodontal graft in the lower anterior segment. A digitally three-dimensional (3D) printed appliance for rapid maxillary expansion was used for the transverse insufficiency of the upper jaw. The upper dental arch expander was designed with distal extension in the area of the upper right second molar (17). The extension was used as an anchorage during the orthodontic traction of the second molar. The treatment continued with a fixed orthodontic appliance-braces in the upper and lower jaw. With the extraction of the impacted and supernumerary teeth in the right maxillary segment, the eruption of 17 was stimulated and a change in the height of the alveolar bone was achieved. This favored the vertical changes and normalization of the occlusion. The maxillary expansion was also a significant factor in normalizing the occlusion. Observations on paramolar behavior showed that more often they develop in the bone and do not erupt. Each clinical case is highly individual, and patients seek orthodontic treatment at different stages of dentition development and corresponding development of the supernumerary teeth.
PubMed: 38020964
DOI: 10.1155/2023/8824900 -
Rhode Island Medical Journal (2013) Dec 2023The complications of wound infections caused by animal related trauma are well known and explored. Of the numerous polymicrobial etiologies, Neisseria animaloris and...
The complications of wound infections caused by animal related trauma are well known and explored. Of the numerous polymicrobial etiologies, Neisseria animaloris and Pasteurella canis oralis have been reported only in a limited number of cases. This manuscript explores the rare finding of these species in the case of an 83-year-old male with a diabetic foot wound complicated by infection from the saliva of his pet dog. The case highlights the first instance of P. canis oralis without the setting of a penetrating animal bite, emphasizing the vulnerability of open lesions in patients whose comorbidities impair proper wound healing. These bacteria are susceptible to beta-lactams with beta-lactamase inhibitors and can be treated once identified. It is crucial to recognize rare pathogens and initiate appropriate treatment early, and to emphasize proper wound care, especially in the context of pet interactions.
Topics: Male; Animals; Humans; Dogs; Aged, 80 and over; Saliva; Pasteurella; Osteomyelitis
PubMed: 38015784
DOI: No ID Found -
Journal of Personalized Medicine Nov 2023Anterior open bite malocclusion is a complex dental condition characterized by a lack of contact or overlap between the upper and lower front teeth. It can lead to...
Anterior Open Bite Malocclusion: From Clinical Treatment Strategies towards the Dissection of the Genetic Bases of the Disease Using Human and Collaborative Cross Mice Cohorts.
Anterior open bite malocclusion is a complex dental condition characterized by a lack of contact or overlap between the upper and lower front teeth. It can lead to difficulties with speech, chewing, and biting. Its etiology is multifactorial, involving a combination of genetic, environmental, and developmental factors. Genetic studies have identified specific genes and signaling pathways involved in jaw growth, tooth eruption, and dental occlusion that may contribute to open bite development. Understanding the genetic and epigenetic factors contributing to skeletal open bite is crucial for developing effective prevention and treatment strategies. A thorough manual search was undertaken along with searches on PubMed, Scopus, Science Direct, and Web of Science for relevant studies published before June 2022. RCTs (clinical trials) and subsequent observational studies comprised the included studies. Orthodontic treatment is the primary approach for managing open bites, often involving braces, clear aligners, or other orthodontic appliances. In addition to orthodontic interventions, adjuvant therapies such as speech therapy and/or physiotherapy may be necessary. In some cases, surgical interventions may be necessary to correct underlying skeletal issues. Advancements in technology, such as 3D printing and computer-assisted design and manufacturing, have improved treatment precision and efficiency. Genetic research using animal models, such as the Collaborative Cross mouse population, offers insights into the genetic components of open bite and potential therapeutic targets. Identifying the underlying genetic factors and understanding their mechanisms can lead to the development of more precise treatments and preventive strategies for open bite. Here, we propose to perform human research using mouse models to generate debatable results. We anticipate that a genome-wide association study (GWAS) search for significant genes and their modifiers, an epigenetics-wide association study (EWAS), RNA-seq analysis, the integration of GWAS and expression-quantitative trait loci (eQTL), and micro-, small-, and long noncoding RNA analysis in tissues associated with open bite in humans and mice will uncover novel genes and genetic factors influencing this phenotype.
PubMed: 38003932
DOI: 10.3390/jpm13111617 -
Microbiology (Reading, England) Nov 2023is an obligate intracellular pathogenic bacterium that causes heartwater, a fatal disease of ruminants in tropical areas. Some human cases have also been reported. This... (Review)
Review
is an obligate intracellular pathogenic bacterium that causes heartwater, a fatal disease of ruminants in tropical areas. Some human cases have also been reported. This globally important pathogen is primarily transmitted by ticks of the genus and threatens American mainland. replicates within eukaryotic mammal or tick cell is a membrane-bound vacuole, where it undergoes a biphasic developmental growth cycle and differentiates from noninfectious replicative form into infectious elementary bodies. The ability of to hijack host cellular processes and avoid innate immunity is a fundamental, but not yet fully understood, virulence trait of this stealth pathogen in the genomic era.
Topics: Ehrlichia ruminantium
PubMed: 37994906
DOI: 10.1099/mic.0.001415 -
Cureus Oct 2023Patients presenting to the emergency department (ED) with an orangutan bite require a series of prophylactic treatments. We present a unique case of an orangutan bite...
Patients presenting to the emergency department (ED) with an orangutan bite require a series of prophylactic treatments. We present a unique case of an orangutan bite in a 29-year-old male ED patient who was brought by Emergency Medical Services (EMS) for evaluation of an orangutan bite to the right upper extremity with a suspected fourth proximal phalanx fracture. He was referred to hand surgery for a washout and open reduction. Upon discharge, prophylactic medical treatments for unusual pathologies such as herpes B were considered. Appropriate evaluation and treatment of this unique ED condition is necessary to prevent additional patient morbidity.
PubMed: 37954713
DOI: 10.7759/cureus.46857 -
Progress in Orthodontics Nov 2023To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of... (Review)
Review
AIMS
To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events.
METHODS
A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal.
RESULTS
A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low.
CONCLUSIONS
Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.
Topics: Humans; Maxilla; Root Resorption; Tooth Movement Techniques; Orthodontic Anchorage Procedures; Malocclusion; Open Bite; Molar
PubMed: 37953383
DOI: 10.1186/s40510-023-00490-3