The Use of Multiple Imputation Techniques on Short-Term Clinical Complications of Patients Presenting with Traumatic Spinal Cord Injuries

Background: With the increase in the use of secondary data in epidemiological studies, the inquiry of how to manage missing data has become more relevant. Our study applied imputation techniques on traumatic spinal cord injuries data; a medical problem where data is generally sporadic. Traumatic spinal cord injuries due to blunt force cause widespread physiological impairments, medical and non-medical problems. The effects of spinal cord injuries are a burden not only to the victims but to their families and to the entire health system of a country. This study also evaluated the causes of traumatic spinal cord injuries in patients admitted to the University Teaching Hospital and factors associated with clinical complications in these patients. Methods: The study used data from medical records of patients who were admitted to the University Teaching Hospital in Lusaka, Zambia. Patients presenting with traumatic spinal cord injuries between 1st January 2013 and 31st December 2017 were part of the study. The data was first analysed using complete case analysis, then multiple imputation techniques were applied, to account for the missing data. Thereafter, both descriptive and inferential analyses were performed on the imputed data. Results: During the study period of interest, a total of 176 patients were identified as having suffered from spinal cord injuries. Road traffic accidents accounted for 56% (101) of the injuries. Clinical complications suffered by these patients included paralysis, death, bowel and bladder dysfunction and pressure sores among other things. Eighty-eight (50%) patients had paralysis. Patients with cervical spine injuries compared to patients with thoracic spine injuries had 87% reduced odds of suffering from clinical complications (OR=0.13, 95% CI{0.08, 0.22}p<.0001). Being paraplegic at discharge increased the odds of developing a clinical complication by 8.1 times (OR=8.01, 95% CI{2.74, 23.99}, p<.001). Under-going an operation increased the odds of having a clinical complication (OR=3.71, 95% CI{=1.99, 6.88}, p<.0001). A patient who presented with Frankel Grade C or E had a 96% reduction in the odds of having a clinical complication (OR=.04, 95% CI{0.02, 0.09} and {0.02, 0.12} respectively, p<.0001) compared to a patient who presented with Frankel Grade A. Conclusion: A comparison of estimates obtained from complete case analysis and from multiple imputations revealed that when there are a lot of missing values, estimates obtained from complete case analysis are unreliable and lack power. Efforts should be made to use ideas to deal with missing values such as multiple imputation techniques. The most common cause of traumatic spinal cord injuries was road traffic accidents. Findings suggest that paralysis had the greatest negative effect on clinical complications. When the category of Frankel Grade increased from A-E, the less likely a patient was likely to succumb to clinical complications. No evidence of an association was found between age, sex and developing a clinical complication.

Cytoprotective Properties of Carnosine against Isoniazid-Induced Toxicity in Primary Cultured Rat Hepatocytes

Background: Drug-induced liver injury is a critical clinical complication. Hence, finding new and safe protective agents with potential clinical application is of value. Isoniazid (INH) is an antituberculosis agent widely used against Mycobacterium tuberculosis infection in human. On the other hand, hepatotoxicity is a clinical complication associated with isoniazid therapy. Oxidative stress and its associated events are major mechanisms identified for INH-induced liver injury. Carnosine is an endogenously found peptide widely investigated for its hepatoprotective effects. On the other hand, robust antioxidant and cytoprotective effects have been attributed to this peptide. Methods: The current study designed to evaluate the potential cytoprotective properties of carnosine against INH-induced cytotoxicity in drug-exposed primary cultured rat hepatocytes. Primary cultured rat hepatocytes were incubated with INH (1.2 mM). Results: INH treatment caused significant increase in cell death and lactate dehydrogenase (LDH) release. On the other hand, it was found that markers of oxidative stress including reactive oxygen species were significantly increased in INH-treated cells. Cellular glutathione reservoirs were also depleted in INH-treated group. Carnosine treatment (50 and 100 µM) significantly diminished INH-induced oxidative stress and cytotoxicity. Conclusion: These data mention carnosine as a potential protective agent with therapeutic capability against INH hepatotoxicity.

PEMERIKSAAN CD4 HUBUNGANNYA DENGAN STADIUM PENYAKIT HIV PENDERITA

The accurate measuring CD4 are important for knowing immune system from HIV infected person. Because there are increasing clinical complication with decreasing of CD4. Measuring of CD4 also useful for the decisions when therapy of ART started and monitoringefficacy of the medication. Also it is necessary to know CD4 and its relations to HIV stadium in HIV positive patients at Adam MalikGeneral Hospital Medan. The CD4 examination used in EDTA blood. Immunophenotyping examination carried out by Flow CytometryBD FACS CaliburTM used TritestTM BD reagent CD3/CD4/CD45 without true count tube. From 515 HIV patients, 80.5% are men, 86%from all patients between 20-40 years old with biggest risk factor are heterosexual. From 250 patients that examination of CD4, 81%patients are stadium I had amount CD4 > 350/mm. Examination of CD4 arethe important parameter to follow up condition of HIV patient for prevented not become worse, also knowing diseases progressivismand therapy progress.3 and patients stadium III had amount CD4 < 200/mm3

Supernumerary Teeth: a literature review

Summary: This is a literature review aboutsupernumerary teeth, its etiology, diagnosis, clinical complication and treatment. An earlydiagnosis is the key to an adequate treatment, and to reduce complications such tooth eruptionanomalies, dental malpositions, impacted teeth and cysts formation. It is important to perform earlya complete oral evaluation of the pediatric patient’s including the non-erupted teeth . Proper useof Periapical or Panorex Rx exams may help clinicians to determine early teeth numbers and/or teethposition anomalies. Key words: Supernumerary teeth. Impacted teeth. Eruption teethalterations.

Unusual Bilateral Paramolars Associated with Clinical Complications

Paramolars are rare supernumerary structures of maxillofacial complex that occur buccally or lingually near the molar row. Predominantly these occur singly; bilateral presentation is very rare. This paper reports two unusual bilateral presentations of paramolars with clinical complication and its management. One of the cases in the present paper also documents the cooccurrence of bilateral paramolars and microdontia of single tooth and one of its paramolars presented with multilobed crown with an anomalous buccal tubercle.