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By Susan Levitt
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The chinese language paintings of feng shui has develop into highly regarded within the West, yet too frequently suggestion at the topic contains overly simplistic directions for rearranging one's condo with none rationalization of the profound philosophical process in the back of those alterations. the traditional Taoists built feng shui from their realizing of the delicate interaction of energies that make up the universe, and no precise mastery of feng shui is feasible with out a wisdom of Taoism. Taoist Feng Shui offers step by step guidance for bettering your place, enterprise, backyard, estate, and local utilizing this historical procedure of information.
In Taoist Feng Shui, Susan Levitt lines the heritage of feng shui and indicates the way it is grounded in wisdom of yin and yang and the 5 Taoist components of fireside, earth, steel, water, and wooden, in addition to many different ideas necessary to Taoism. as soon as a history in Taoism is proven, readers can greater comprehend the philosophy in the back of suggestions reminiscent of deciding on the simplest shades for every room of the house, room-by-room furnishings placement, yin and yang stability, right lights, open air landscaping, the functionality of hallways and entrances, and the right kind use of mirrors, crystals, fountains, and different feng shui instruments. With in-depth examples from the author's deepest feng shui perform, Taoist Feng Shui might help all readers remodel their own environments to create peace, concord, future health, wealth, and luck.

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Do not smoke marijuana while taking Marinol, or you could overdose. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. Neuroleptic Malignant Syndrome NMS has been reported in association with Promethazine HCl alone or in combination with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmias. Eadie MJ. Could valerian have been the first anticonvulsant? diltiazem-ointment
Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 308-9. The bottom line is, 10 calories more than a cat needs in a day adds up to a pound of body fat in a year. Leathwood, P. D. and Chauffard, F. Quantifying the effects of mild sedatives. J Psychiatr. Make sure laboratory personnel and all your doctors know you use this drug. Chan, T. Y. An assessment of the delayed effects associated with valerian overdose. Int.
Cyproheptadine is used for treatment of vascular headaches, such as migraine and histamine cephalalgia. Prevention of -induced peptic ulcers. It is recommended that patients who are intermittent long-term users of Dihydroergotamine Mesylate Injection, USP and who have or acquire risk factors predictive of CAD, as described above, undergo periodic interval cardiovascular evaluation as they continue to use Dihydroergotamine Mesylate Injection, USP. You can't wake up the child. Capsules are not available in a 30 mg dose.
Many men get the condition when they use or misuse some types of medicine. Drugs that may cause priapism include the HCL or Thorazine which treats some mental illnesses. The pills or shots that treat may also cause priapism. Clemastine: 5 to 7 hours. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Brown MW, Maldonado AL, Meredith CG, et al. Effect of ketoconazole on hepatic oxidative drug metabolism. Clin Pharmacol Ther 1985; 37: 290-7. Most antihistamines cross the blood-brain barrier and produce sedation due to inhibition of histamine N-methyltransferase and blockage of central histaminergic receptors. Antagonism of other central nervous system receptor sites, such as those for serotonin, acetylcholine, and alpha-adrenergic stimulation, may also be involved. Central depression is not significant with cetirizine low doses desloratadine, or loratadine because they do not readily cross the blood-brain barrier. Also, they bind preferentially to peripheral H 1-receptors rather than to central nervous system H 1-receptors.
Used as treatment adjunct in asthma. Kaplowitz PB, Jennings S. Enhancement of linear growth and weight gain by cyproheptadine in children with hypopituitarism receiving growth hormone therapy. J Pediatr. Oral, 25 mg thirty minutes before bedtime if needed. Used for treatment of allergic rhinitis and chronic idiopathic urticaria. MK-801 binding to rat synaptic membranes. Antacids, magnesium or aluminum containing administration of fexofenadine within 15 minutes of an aluminum or magnesium containing antacid decreased fexofenadine AUC by 41% and C max by 43%. It also has a drying effect. Children 2 to 6 years of age: Oral, 1 mg every four to six hours as needed. Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery. For idiopathic and postencephalitic parkinsonism: Oral, 25 mg three times a day initially, the dose then being gradually increased to 50 mg four times a day if needed. Circosta C, De Pasquale R, Samperi S, et al. Biological and analytical characterization of two extracts from Valeriana officinalis. J Ethnopharmacol. Hydroxyzine is indicated for the relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. The effectiveness of hydroxyzine as an antianxiety agent for long-term use for example, more than 4 months has not been assessed by systematic clinical studies. Ohizumi, Y. Isolation, structural elucidation, and neuroprotective effects of iridoids from Valeriana jatamansi. Biosci. Maintenance: Oral, 4 mg every four to six hours.
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Co. Periactin cyproheptadine tablets and syrup prescribing information. West Point, PA; 1999 Sept. Older adults may be more sensitive to the effects of this medication. Medicines: For low-flow priapism, your doctor can inject drugs called alpha-agonists into your penis. They make the blood vessels narrow, bringing less blood the area and easing swelling. You might be able to take pills instead of getting an injection. Oral, 4 or 6 mg every eight to twelve hours as needed. Hering, S. Valerenic acid potentiates and inhibits GABAA receptors: molecular mechanism and subunit specificity. Plushner SL. Valerian: Valerian officinalis. Critchley, J. A. Poisoning due to an over-the-counter hypnotic, Sleep-Qik hyoscine, cyproheptadine, valerian. Postgrad. Pontius EB. Case report of an anticholinergic crisis associated with cyproheptadine treatment of desipramine-induced anorgasmia. J Clin Psychopharmacol. Adequate and well-controlled studies in humans have not been done. However, hydroxyzine is not recommended for use in the early months of pregnancy since studies in rats have shown that it causes fetal abnormalities when given in doses substantially above the human therapeutic range. What Causes Delayed Ejaculation? salmeterol
It can happen to males of all ages, including newborns. Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, other antihistamines such as diphenhydramine drugs for sleep or anxiety such as alprazolam, diazepam, zolpidem muscle relaxants, and narcotic pain relievers such as codeine. Overdose symptoms may include drowsiness, feelings of extreme happiness or sadness, fast heartbeat, memory problems, little or no urinating, constipation, loss of energy, problems with speech or coordination, or fainting. What should I avoid while taking Marinol? Dry foods are especially calorie heavy. Gupta, S; Popli, A; Bathurst, E; Hennig, L; Droney, T; Keller, P May 1998. "Efficacy of cyproheptadine for nightmares associated with posttraumatic stress disorder". Comprehensive Psychiatry. Oral, 1 capsule every twelve hours. Eur J Obstet Gynecol Reprod Biol. In dialysis patients: 20 hours. Efficacy for prophylaxis of migraine not established in randomized controlled studies, but some experts consider the drug to be effective based on consensus and clinical experience. Koetter, U. Central action of a fixed Valerian-hops extract combination Ze 91019 in freely moving rats. Ask your doctor or pharmacist about using this product safely. Kuhlmann J, Berger W, Podzuweit H, Schmidt U. The influence of valerian treatment on "reaction time, alertness and concentration" in volunteers. Mennini T, Bernasconi P, Bombardelli E, and et al. In vitro study on the interaction of extracts and pure compounds from Valeriana officinalis roots with GABA, benzodiazepine and barbiturate receptors in rat brain. Vasopressors to treat hypotension; however, epinephrine should not be used since it may further lower blood pressure. Famotidine suffers from poor 50% as it is poorly soluble in the low pH of the stomach. When used in combination with antacids, it promotes local delivery of these drugs to the receptor of the parietal cell wall. Therefore, researchers are developing innovative formulations of tablets, such as gastroretentive drug delivery systems. Such tablets are retained in the stomach for a longer period of time, thereby improving the bioavailability of drugs. Local delivery also increases bioavailability at the stomach wall receptor site and increases the efficacy of drugs to reduce acid secretion. Desloratadine's absorption is not affected by food. Renal impairment and hepatic impairment requires dosage adjustments due to increased AUC area under the concentration time curve. ewake.info imuran
Also indicated in the treatment of anxiety and psychosis-related tension; antiemetic agent and sedative-hypnotic. The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Brompheniramine: 3 to 9 hours. One time-honored technique for premature ejaculation is to distract yourself -- to think about something boring or even disgusting to delay your orgasm. While this may work for some, it has the unfortunate side effect of distancing men from their partners and the sexual experience. Take Enablex exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended. Have you ever had to stop taking this or any other medication because of an allergy or bad reaction? Alcohol can cause sleepiness and drowsiness. Valerian might also cause sleepiness and drowsiness. Taking large amounts of valerian along with alcohol might cause too much sleepiness. Factors such as stress, infection, drugs, alcohol, or certain medical procedures can trigger symptoms. Drinking alcohol can increase certain side effects of dronabinol. If there are any questions concerning the use of your Dihydroergotamine Mesylate Injection, USP, ask your Doctor or pharmacist. Dihydroergotamine Mesylate Injection, USP should not be used by patients with documented ischemic or vasospastic coronary artery disease. Conditions of Use and Important Information: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you. atomoxetine buy now store otc
Diaper A, Hindmarch I. A double-blind, placebo-controlled investigation of the effects of two doses of a valerian preparation on the sleep, cognitive and psychomotor function of sleep-disturbed older adults. Phytother Res. Drugs having anticholinergic properties should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, and bladder-neck obstruction. So instead of just masturbating efficiently to achieve orgasm, Perelman encourages men to fantasize about a sexual experience with their partners while they masturbate. He tells them to try "to approximate, in terms of speed, pressure and technique, the stimulation he likely will experience through manual, oral, or vaginal stimulation with his partner. Give , or for pain. So don't stay mum and let shame or male pride ruin your sex life and your partner's. Letting that tension build up will just make things worse. With some openness, some discussion, and maybe a few fun new techniques in the bedroom, you can overcome your ejaculation problem. That means less worry and more sex. American Journal of Psychiatry. Cardiovascular: Hypotension, palpitation, tachycardia, extrasystoles, anaphylactic shock. Dihydroergotamine Mesylate Injection, USP may cause coronary artery vasospasm; patients who experience signs or symptoms suggestive of angina following its administration should, therefore, be evaluated for the presence of CAD or a predisposition to variant angina before receiving additional doses. Similarly, patients who experience other symptoms or signs suggestive of decreased arterial flow, such as ischemic bowel syndrome or Raynaud's syndrome following the use of any 5-HT agonist are candidates for further evaluation. Intramuscular or intravenous, 10 mg initially, may be increased to 20 to 50 mg every two to three hours. Intramuscular injections should not be made into the lower or mid-third of the upper arm.
Antihistamines prevent responses to acetylcholine that are mediated via muscarinic receptors. The ethanolamine derivatives may show greater anticholinergic activity than the other classes of antihistamines. Loratadine, has no significant anticholinergic activity; cetirizine has minimal anticholinergic activity. No paradoxical reaction; sedation more pronounced with large doses. Patients sensitive to one of the antihistamines may be sensitive to others. Lindahl O, Lindwall L. Double blind study of a valerian preparation. Pharmacol Biochem Behav. CAUTION SHOULD BE EXERCISED WHEN ADMINISTERING Promethazine TO PEDIATRIC PATIENTS 2 YEARS OF AGE AND OLDER. IT IS RECOMMENDED THAT THE LOWEST EFFECTIVE DOSE OF Promethazine BE USED IN PEDIATRIC PATIENTS 2 YEARS OF AGE AND OLDER AND CONCOMITANT ADMINISTRATION OF OTHER DRUGS WITH RESPIRATORY DEPRESSANT EFFECTS BE AVOIDED. Currently available data have not demonstrated drug abuse or psychological dependence with dihydroergotamine. However, cases of drug abuse and psychological dependence in patients on other forms of ergot therapy have been reported. Thus, due to the chronicity of vascular headaches, it is imperative that patients be advised not to exceed recommended dosages. The clinical significance of these findings during long-term use of cetirizine is not known. Do you have high blood pressure? Dihydroergotamine mesylate was clastogenic in two in vitro chromosomal aberration assays, the V79 Chinese hamster cell assay with metabolic activation and the cultured human peripheral blood lymphocyte assay. Perennial and seasonal allergic rhinitis. Kenilworth, NJ, USA the “company” includes “forward-looking statements” within the meaning of the safe harbor provisions of the United States Private Securities Litigation Reform Act of 1995. Some of these sedative medications include alprazolam Xanax clonazepam Klonopin diazepam Valium lorazepam Ativan midazolam Versed temazepam Restoril triazolam Halcion and others. Diet is a major part of managing the disease. Many vets recommend that cats with diabetes eat a high-protein, low-carbohydrate diet, which may help them gain better control over the disease. Greenwood Village, CO: Thomsen Healthcare; 2013. Combinations containing any of the following medications, depending on the amount present, may also interact with this medication. It was first marketed in 1981. Pepcid RPD were released in 1999. pamelor drug price
Check the labels on all your medicines such as or -and-cold products because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely. Your doctor will have told you what dose to use for each migraine attack. Should you get another migraine attack in the same day as the attack you treated, you must not treat it with Dihydroergotamine Mesylate Injection, USP unless at least 6 hours have elapsed since your last injection. No more than 6 mL of Dihydroergotamine Mesylate Injection, USP should be injected during a one-week period. Do not use more than this amount unless instructed to do so by your doctor. Dihydroergotamine mesylate injection is not intended for chronic daily use. If no blood is seen this time, inject the medication. Geriatric patients are especially susceptible to the anticholinergic side effects, such as dryness of mouth and urinary retention especially in males of the antihistamines. If these side effects occur and continue or are severe, medication should probably be discontinued. Are you using dihydroergotamine mesylate injection, nasal spray or other dihydroergotamine mesylate containing drugs on a daily basis? Anticholinergics - Concomitant use of other agents with anticholinergic properties should be undertaken with caution. Check the expiration date printed on the ampule containing medication. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Limit beverages. Children should be supervised to avoid injury during bicycle riding or other possibly hazardous activities. The following events derived from postmarketing experience have been occasionally reported in patients receiving Dihydroergotamine Mesylate Injection, USP: vasospasm, paraesthesia, hypertension, dizziness, anxiety, dyspnea, headache, flushing, diarrhea, rash, increased sweating, and pleural and retroperitoneal fibrosis after long-term use of dihydroergotamine. Extremely rare cases of myocardial infarction and stroke have been reported. A causal relationship has not been established. Stone CA, Wenger HC, Ludden CT et al. Antiserotonin-antihistaminic properties of cyproheptadine. J Pharmacol Exp Ther. buy zanaflex cheap online
Albrecht M, Berger W, Laux P, Schmidt U, et al. Psychopharmaka und Verkehrssicherheit. Taibi DM, Bourguignon C, Gill Taylor A. A feasibility study of valerian extract for sleep disturbance in person with arthritis. Biol Res Nurs. There have been reports of pleural and retroperitoneal fibrosis in patients following prolonged daily use of injectable dihydroergotamine mesylate. Rarely, prolonged daily use of other ergot alkaloid drugs has been associated with cardiac valvular fibrosis. Rare cases have also been reported in association with the use of injectable dihydroergotamine mesylate; however, in those cases, patients also received drugs known to be associated with cardiac valvular fibrosis. Amelioration of allergic reactions to blood or plasma. Treatment period to promote weight gain should not exceed 3 months. Usual dosage is 2 mg 2 or 3 times daily; adjust as needed based on the size and response of the patient, up to maximum of 12 mg daily. 5 74 75 See Pediatric Use under Cautions. kemadrin
COPD, sleep apnea should be avoided. Dihydroergotamine Mesylate Injection, USP is indicated for the acute treatment of migraine headaches with or without aura and the acute treatment of cluster headache episodes. Hepatic cytochrome P-450 system; some renal. Keep all away from children and pets. Studies in mice and rats have not shown evidence of tumorigenicity when terfenadine was given in oral doses approximately 5 and 10 times the maximum recommended human daily dose on a mg per square meter of body surface area basis, respectively. Microbial and micronucleus test assays with terfenadine have not shown evidence of mutagenesis. Gillman PK 1999. "The serotonin syndrome and its treatment". Journal of Psychopharmacology Oxford, England. Gastrointestinal effects more pronounced; no dizziness. Hematologic: Hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia. The decline of plasma dihydroergotamine after intramuscular or intravenous administration is multi-exponential with a terminal half-life of about 9 hours. You may experience a decrease in your response to metyrapone. Up to 600 mg daily.
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Kvols, LK; Rubin, J 1991. Are you breast feeding? Serious or potentially life-threatening reductions in blood flow to the brain or extremities have been reported rarely due to interactions between dihydroergotamine mesylate and protease inhibitors or macrolide antibiotics. Dihydroergotamine Mesylate Injection, USP should not be used with peripheral vasoconstrictors because the combination may cause synergistic elevation of blood pressure. buy elavil reviews
Have the child lie down in a cool, dark room. HGPRT Forward Mutation, and Rat Lymphocyte Chromosomal Aberration assays and in vivo Mouse Bone Marrow Micronucleus assay tests, fexofenadine revealed no evidence of mutagenicity. Children up to 12 years of age: Use is not recommended.
Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 1219. Oral, 25 to 100 mg three to four times a day as needed. Formulations of famotidine in combination with were marketed by under the trade name Duexis. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
F in a well-closed container, unless otherwise specified by manufacturer. Protect from light. By the time a cat reaches his twelfth birthday, he is the equivalent of a 64-year-old human. Saline cathartics milk of magnesia are sometimes used. Garges HP, Varia I, Doraiswamy PM. Cardiac complications and delirium associated with Valerian root withdrawal.

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project 22 heavy cruiser
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History. A ship designed and intended to destroy light enemy cruisers and fight against heavy cruisers (Project 66). Project 24 (1949): 81,000-ton battleship design . Barbettes - 115mm. Project 664: Projected nuclear-powered amphibious assault submarine-minelayer. Take your favorite fandoms with you and never miss a beat. They were intended for classic cruiser tasks, defending the fleet against surface and air torpedo attacks, covering convoys, undertaking raiding operations and laying minefields. Project 1: … Ship descriptions are Russian assigned classifications when known. Tzoli Aug 9, 2014. Command center - 152mm - 75mm. Improved Implacable class aircraft carrier, https://againstallodds.fandom.com/wiki/Vladivostok_class_heavy_cruiser?oldid=14480, Draught: 21 feet 7.2 inches (6.58 meters), Displacement: 22,000 tons (Standard); 23,640 tons (Full Load), Propulsion: Oil fired boilers, geared steam turbines, 4 x shafts, 172,000 shp (128,312 kW), Range: 8,000 nautical miles (14,816 kilometers) at 10 knots (18.52 km/h), 12 x 9.4"/50-caliber Pattern 1935 naval guns, 12 x 5.1"/50-caliber B-13 Pattern 1936 naval guns, 12 x 3.9"/51-caliber Pattern 1934 dual purpose naval guns, 8 x 7.6mm/94.5-caliber Pattern 1905 anti-aircraft machine guns. UNSC Formidable (C-18) UNSC Redoubtable (C-19) UNSC Warrior (C-20) UNSC Challenger (C-21) UNSC Protector (C-22) UNSC Avenger (C-23) UNSC Conqueror (C-24) UNSC Champion (C-25) UNSC Victorious (C-26) UNSC Unity (C-27) UNSC Defender … The project abandoned when the calculations showed that 4 such cruiser would cost more then 3 Vanguard class Battleships!!! Her play style is unique at its tier, especially given the difficulty of controlling the ship. In 1947 the TsKB-17 developed no less than 40 variants of the projekt 65 cruiser with 12,800-16,850t and three or even four triple turrets of 180mm guns to be superior to the latest US cruisers of this type, the Worcester, and the British Superb, or to be armed with nine 152mm dual-purpose guns. Dorset made heavy, stable boats and this one is exceptionally suited for rough water. Dash pull-apart. Tier IX: Project 22 / 66 CA. Accessory Fusebox . Command center - 152mm - 75mm. Full - 17 350t. ), Learn how and when to remove this template message, "Russian Ship Project Numbers since 1936", https://en.wikipedia.org/w/index.php?title=List_of_ships_of_Russia_by_project_number&oldid=970144834, Russian and Soviet military-related lists, Short description is different from Wikidata, Articles needing translation from Russian Wikipedia, Articles lacking in-text citations from May 2014, Creative Commons Attribution-ShareAlike License. Project 1: … The Vladivostok was built Leningrad while Anyan and Okhotsk were constructed at Polyarny and Severodvinsk respectively. Range: 38 knots - 900nm. Both ships had three triple turrets and all design work ceased after Stalin's death. :x. Against All Odds Wiki is a FANDOM Games Community. cold water boat, cabin cruiser, sport fisher (Everett) $750 - JLA FORUMS And the Light Alexander thingy must be a joke with that caliber , that speed and that much utility as it is right now. Unlike her foreign counterparts, she boasted bigger dimensions and better armor protection. In an eerie parallel, the Navy has about the same number of surface combatants as it did in the mid-1920s when the Pensacolas were being built. (235kg, 5 shots/sec). The ship's main armament comprised the latest 127 mm dual-purpose mounts. Project 1274: Improved Klasz'ma class cable layer with mine laying capability, Project 1799A: Improved Pelym class deperming vessel, This page was last edited on 29 July 2020, at 14:46. Possibly unstable in heavy weather, but they reckoned it could top 32 knots, making it somehow a blend of the british "light battlecruisers" and the german pocket battleships. Specifications Edit. Two ships were started but none were completed due to World War II, but were completed later in the early 1950s. The cruiser was named Kirov. Project 22 was envisioned as a capital ship of over 20,000 tonnes, mounting 10-inch guns with the express goal of hunting down foreign "treaty cruisers". (The Russian term "проект" can be translated either as the cognate "project" or as "design". CL/CA - Light and Heavy Cruisers. None the less the design notes survived the war though no drawings seems to exist and such I've decided to make a drawing of this type of cruiser. Go. Displasement: Standart - 15 518t. The list of ships of Russia by project number includes all Russian ships by assigned project numbers. There is also however Project 22 but it is a very obscure design with very little information avalible on it. Crew: 715: Armor: Belt - 115mm. Project 24 (1936): 3,400-ton armoured destroyer design. The requirement for a new Soviet heavy cruiser was addressed by two designs of the 1930s: Project 22 and Project 25.Project 22 was envisioned as a capital ship of over 20,000 tonnes, mounting 10-inch guns with the express goal of hunting down foreign "treaty cruisers". • Soviet: Project 22 heavy cruiser • Soviet: Project 65 cruiser with 180mm guns • Soviet: Project 66 cruiser with 228mm guns • Soviet: Project 68, Chapayev-class • Soviet: Project 68B Sverdlov-class • Soviet: Project 82 cruiser with 220mm guns • Soviet: Light cruiser design МЛК-8-130, МЛК … When the Navy formally implemented its hull number system in July 1920, it redesignated thirteen scout cruisers (three completed in 1908, plus ten new ships which were still under construction) as "Light Cruisers" (CL), numbered in accordance with the previous scout cruiser number series. At the start of 1936, this grew to 23,000 tonnes and became Pr 22. She needs a freshen up, last rebuilt in 2011 by pelican slipways. Project 717: Projected nuclear-powered amphibious assault submarine (1970), Project 748: Projected nuclear-powered amphibious assault submarine, Project 955A: Borei II-class nuclear-powered ballistic missile submarine, Project 962: proposed radar picket ship based on the. She needs a freshen up, last rebuilt in 2011 by pelican slipways. Installation of a 120A circuit breaker, relay and 12-way fusebox, to power future electrical accessories. Crew: 715: Armor: Belt - 115mm. Turrets - 150mm - 75mm. Air Compressor. Barbettes - 115mm. It is very likely that the first Superlinkor (Russian designation for Heavy Cruiser) the Soviets will get will be Project 66. Two ships were started but none were completed due to World War II. ... which in this case is given as August 1937. Formidable-class heavy cruiser The Formidable-class heavy cruisers were the third cruiser class to enter service in the United Nations Space Command. The list of ships of Russia by project number includes all Russian ships by assigned project numbers. 233m (via waterline) x 22.3m x 6.6m: Propulsion: Steam turbines, 210 000hp. (Photo via Naval History and Heritage Command) Today’s Navy faces a similar predicament. Do not translate text that appears unreliable or low-quality. Moskva is available in the Armory for 244,000 Coal . It asked for another design, displacing 23,000 metric tons (22,637 long tons) and armed with 254-millimeter (10.0 in) guns, in early 1936, eventually designated Project 22, but this design was cancelled after the Soviets began negotiations in mid-1936 with the British that ultimately resulted in the Anglo-Soviet Quantitative Naval Agreement of 1937 and agreed to follow the terms of the Second London … Deck - 75mm. Turrets - 150mm - 75mm. Some of these studies extended into 1940. The list of ships of Russia by project number includes all Russian ships by assigned project numbers. Type: Heavy Cruiser Service Period: 1937-19XX Characteristics: Length: 740 feet (225.55 meters) Beam: 72 feet 2.4 inches (22.01 meters) Draught: 21 feet 7.2 inches (6.58 meters) my owner has ran out of energy, so a Dedicated Wooden Boat Enthusiast is needed to bring me back to beautiful, $20k asked, i'm worth much, much more feel free to call for info any time Barry. 6 dual AA 130mm/50. Project 22: Heavy cruiser design cancelled 1939; Project 23: Sovetsky Soyuz-class battleship; Project 25: Study for 30,900-ton battleship; Project 26: Kirov-class light cruiser; Project 29 Yastreb-class guard ship; Project 29K Yastreb-class guard ship (completed after WWII) Project 30: Ognevoy-class destroyer The heavy cruisers of project 22. Both ships had three triple turrets and all design work ceased after Stalin's death. 21: Study for 35,500-ton Nelson class-style battleship Project 22: Heavy cruiser design cancelled 1939 Project 23: Sovetsky Soyuz-class battleship Project Kampfgruppe (984 words) [view diff] exact match in snippet view article find links to article 21: Study for 35,500-ton Nelson class-style battleship Project 22: Heavy cruiser design cancelled 1939 Project 23: Sovetsky Soyuz-class battleship Project Douglas TBD Devastator (3,535 words) [view diff] exact match in snippet view article find links to article Dimensions: 233m (via waterline) x 22.3m x 6.6m : Propulsion: Steam turbines, 210 000hp. Project 19: NKVD large guard ship, cancelled, Project 22: Heavy cruiser design cancelled 1939, Project 24: post-World War II battleship design, Project 25: Study for 30,900-ton battleship, Project 40: Destroyer design cancelled 1944, Project 64: Battlecruiser armed with 356mm guns, improved Project 25 created in response to the, Project 71: Small aircraft carrier design cancelled 1940, Project 96M: M-class submarine (Series XV, completed after World War II), Project 97AP/2: Improved Dobrynya class icebreaker, Project 258M: Upgrading of radars on Project 258 ships, Project 304M: Amur II class repair ship with passenger facilities, Project 323B: Improved Lama class ballistic missile transport, Project 627A: November-class nuclear-powered attack submarine, Project 640T: Whiskey Canvas Bag-class communications submarine. Recent at-sea testing of the Zumwalt, with its tumblehome hull, shows excellent stability in high seas. Lützow was a German heavy cruiser ship, 1 of 5 Admiral Hipper class. The lead ship of the five-hull series was laid down by the Baltic Shipyard in Leningrad on March 26, 1974 and was commissioned in 1980. Tier X: Project 66 CA / CA-variant of Project 82 Stalingrad Edited January 1, 2016 by Xero_Snake. (The Russian term "проект" can be translated either as the cognate "project" or as "design".) It is generally similar to what became the Saipan (CVL-48) class, but with less freeboard. The 22 Project supports underserved war veterans who have traumatic brain injuries and are at risk for depression and/or suicide. ... FOR SALE - Skagit County, WA - very cool project 22' fiberglass boat! Plan dated 4 June 1942 (the first day of the Battle of Midway) for converting a Baltimore class heavy cruiser to an aircraft carrier. Step-by-step installation of an Air On Board 1.4cfm compressor, manifold and 4-litre reservoir. Project 1206.1E: export version Type 1206.1 without artillery rocket launchers. It didn't progress very far before it got dropped. Someone else might find more data, but I know almost nothing about Soviet Navy designs. 21: Study for 35,500-ton Nelson class-style battleship Project 22: Heavy cruiser design cancelled 1939 Project 23: Sovetsky Soyuz-class battleship Project Kampfgruppe (984 words) [view diff] exact match in snippet view article find links to article Full speed - 38 knots, economical -25 knots. For general information on this album, see: Bureau of Ships' "Spring Styles" Book # 3 (1939-1944) -- General Description. By designing new heavy cruisers, designated initially as project 122, Soviet designers started before the war. The cruiser's main battery surpassed foreign guns in maximum range and destructive power but had a lower rate of fire. Motor Cruiser; This elegant classic 50ft, Gardner LX6 powered is at southport drydock waiting for YOU to come and save her. It didn't progress very far before it got dropped. 1 Share this post. Project 115 was a class of six large heavy cruisers built for the Hosh Navy between 1939 to 1943 and represent the pinnacle of Hosh ship building prior to the end of the war.
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Alabama gas prices are on the slight downtick, dropping 1.3 cents per gallon in the last seven days. The average price per gallon in Alabama $3.17 on Monday, Nov. 15, according to GasBuddy's daily survey of 3,348 stations across the state Compared to a month ago, gas prices in Alabama are up 7.9 cents per gallon and up $1.33 per gallon compared to this time a year ago.
The lowest reported price per gallon in Alabama is $2.95, while the highest price per gallon is $3.69, a $0.74 per gallon difference, according to GasBuddy price reports.
The national average for the price of a gallon of gasoline has dropped 2.6 cents in the past week, averaging $3.40 per gallon. Across the country the price of is up 9.5 cents per gallon from this time a month ago. The national average for a gallon a of gas is $1.28 higher than this time a year ago.
"As of Sunday evening, the national average price of gasoline posted its first weekly decline in months. As the price of oil continues to struggle, Covid cases flare up and anxiety over demand starts rising, motorists are likely to see the declines continuing into this week," head of petroleum analysis for GasBuddy Patrick De Haan said. "While it's not known how long market conditions will continue to push gas prices down, it appears that the fall should last through Thanksgiving, just in time for millions of Americans to prepare to hit the road for the holiday. However, the damage may already be done. According to GasBuddy's Thanksgiving Travel Survey, being released tomorrow, a significant portion of Americans say the high gas prices already led them to re-think their plans."
GasBuddy’s 10-year historical gasoline prices in Alabama and the national average:
November 15, 2020: $1.84/g (U.S. Average: $2.12/g)
November 15, 2019: $2.25/g (U.S. Average: $2.61/g)
November 15, 2018: $2.38/g (U.S. Average: $2.65/g)
November 15, 2017: $2.26/g (U.S. Average: $2.57/g)
November 15, 2016: $1.98/g (U.S. Average: $2.14/g)
November 15, 2015: $1.92/g (U.S. Average: $2.16/g)
November 15, 2014: $2.72/g (U.S. Average: $2.89/g)
November 15, 2013: $3.09/g (U.S. Average: $3.19/g)
November 15, 2012: $3.20/g (U.S. Average: $3.43/g)
November 15, 2011: $3.23/g (U.S. Average: $3.41/g)

domain: news


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Whether you love them or love to hate them (or couldn't care less about what an old BF is doing), trust us-you'll still want to know this info.
By Mina Azodi
Trash Talking Him Has an Upside
You know that hating on your ex feels really good (um, the guy pretty much wore dad jeans, am I right?), and now science-not just your girlfriends-has your back. Researchers from the University of Utah found that people who expressed negative feelings about an ex were less likely to feel depressed immediately after a breakup, and they were more likely to have moved on one month later.
Keeping In Touch Isn't Always a Bad Idea
Normally we're all for cutting off contact, but if you're still kinda-sorta pining for a dude, going cold turkey can make you feel worse, suggests a University of Arizona study. Interestingly, study participants felt better if they maintained some sort of friendship with the guy. If you fall into this category, at least limit the "friendship to occasional emails or an annual "happy bday!" post on his Facebook wall. If you control the communication and keep it minimal, you're less likely to get into a weird (and hurtful) gray zone.
Related: How To Make Your Ex Jealous
Discussing an Old BF Can Bring You Closer to Your New Guy
Okay, so we're not saying you should try this on a first date, but coming clean about previous LTR baggage can actually be a good thing for your current relationship. A study published in the Journal of Experimental Social Psychology showed that when people reveal personal info-like previous relationship problems-to a new partner, they feel more intimate.
Holding on to Memories Can Hurt Your Current LTR
It's healthy to sometimes think about a past relationship when you're happily coupled up...but take note if you tend to reminisce whenever you hit a rough patch with your new bf. A recent Canadian study of both American and Canadian couples found that people tend to use those memories to soothe and validate themselves when they're going through a temporary low in their current relationship, and that this increases the odds of a break-up down the line.
Related: Should You Be Friends with an Ex?
Your Ex is Probably Facebook Stalking You...
...And we're guessing you're probably doing the same, judging by how common it's become. In a recent survey, 85 percent of respondents admitted to looking up an ex's profile-and nearly one in five checked it once a week. Obviously, curiosity plays a role in cyber-stalking, but according to a University of Missouri study, we also do it just because it feels good. The scientists hooked up nearly 40 students to sensors and measured their physiological responses while they searched the site. It turns out, the students actually felt pleasure while looking at a former partner's profile pics, wall posts, etc.
...And He Probably Wants You Back Too
Women sometimes get a bad rap for fixating on the past, but a survey of men and women proves that guys are the ones who are more likely to be wistful about an old flame. A majority of the single men questioned admitted that they wished they were still in a previous relationship (compared to only a quarter of single women). Kinda nice to think about when you're Facebook-stalking-err, casually viewing all the pics of him partying.
Read more at Cosmopolitan.com!
10 Things You Don't Know About Kissing
8 Hairstyles Men Love
How To Make Your Relationship Work
How To Look Good in Pictures With Your Guy
9 Ways Women Impress Men
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domain: psychology


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domain: finance


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Manatee Superintendent Diana Greene discusses Wakeland, Johnson merger logistics
Residents have a say in the renaming of Johnson-Wakeland International School of Baccalaureate, a new K-8 school in Bradenton.
The school resulted from a merger between Johnson Middle School and the now-closed Wakeland Elementary School.
There are four ways to submit a nomination:
- Email — firstname.lastname@example.org.
- Mail — School District of Manatee County, P.O. Box 9069, Bradenton, FL 34206.
- In-person — School Support Center, 215 Manatee Ave. W., in Bradenton.
- Town hall — Nov. 14 from 6:30 p.m. to 8 p.m. at Johnson-Wakeland, 2121 26th Ave. E.
The district hired consultants to develop a master plan in 2015, according to a recent school board agenda.
The plan addressed “existing building infrastructure needs, anticipated community development and growth, and any associated growth/decline in school district student enrollment, as well as changing and evolving educational program needs of the district,” it states.
After receiving input from consultants and local residents, the district closed Wakeland Elementary and moved its students to Johnson Middle — now an IB magnet school — this year.
School board policy requires six months of community input before a school can be renamed. Board members initiated the process on Oct. 23, and a public hearing will take place no sooner than mid-April.
A hearing was not scheduled as of Wednesday afternoon.


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There is increasing interest in identifying natural bioactive compounds that can improve mitochondrial functionality and regulate apoptosis. The brewery industry generates wastewater that could yield a natural extract containing bioactive phenolic compounds. Polyphenols act as antioxidants and have been documented to protect the human body from degenerative diseases such as cardiovascular diseases or cancer. The main aims of our research were to determine the phenolic profile of a crude extract obtained (at pilot scale) from a brewery waste stream and to evaluate the biochemical activity of this extract on the mitochondrial function of a cancer cell line (SH-SY5Y). This work is a basic translational pilot study. The total phenolic content was determined by the Folin–Ciocalteu assay, which revealed that 2.30% of the extract consisted of phenolic compounds. The polyphenols, identified and quantified by reverse-phase-high-performance liquid chromatography and mass spectrometry (RP-HPLC/MS), were mainly flavonoids. After cell culture, the tumoral cells treated with the polyphenolic extract showed enhanced mitochondrial oxidative function, which is likely related to a decrease in oxidative stress and an increase in mitochondrial biogenesis. This type of brewery waste stream, properly treated, may be a promising source of natural antioxidants to replace the synthetic antioxidants currently used in the food industry.
Dental pulp is an accessible source of multipotent mesenchymal stromal cells (MSCs). The perspective role of dental pulp stem cells (DPSCs) in regenerative medicine demands an in vitro expansion and in vivo delivery which must deal with the safety issues about animal serum, usually required in cell culture practice. Human platelet lysate (PL) contains autologous growth factors and has been considered as valuable alternative to fetal bovine serum (FBS) in cell cultures. The optimum concentration to be added of such supplement is highly dependent on its preparation whose variability limits comparability of results. By in vitro experiments, we aimed to evaluate a standardised formulation of pooled PL. A low selected concentration of PL (1%) was able to support the growth and maintain the viability of the DPSCs. The use of PL in cell cultures did not impair cell surface signature typically expressed by MSCs and even upregulated the transcription of Sox2. Interestingly, DPSCs cultured in presence of PL exhibited a higher healing rate after injury and are less susceptible to toxicity mediated by exogenous H2O2 than those cultured with FBS. Moreover, PL addition was shown as a suitable option for protocols promoting osteogenic and chondrogenic differentiation of DPSCs. Taken together, our results indicated that PL is a valid substitute of FBS to culture and differentiate DPSCs for clinical-grade use.
Hydroxyapatite (PA) has a chemical composition and physical structure very similar to natural bone and therefore it has been considered to be the ideal biomaterial able to ensure a biomimetic scaffold to use in bone tissue engineering. The aim of this study is to clinically test hydroxyapatite used as osteoconductive biomaterial in the treatment of periodontal bone defects. Clinical and radiological evaluations were conducted at 6, 12 and 18 months after the surgery.
Materials and methods
Forty patients with 2- and 3-wall intrabony pockets were enrolled in this study. PPD, CAL, radiographic depth (RD) and angular defects were preoperatively measured. After surgery, patients were re-evaluated every 6 months for 18 months. Statistical analyses were also performed to investigate any differences between preoperative and postoperative measurements.
Paired t-test samples conducted on the data obtained at baseline and 18 months after, showed significant (p<0.01) differences in each measurement performed. The role of preoperative RD was demonstrated to be a significant key factor (p<0.01). A relevant correlation between preoperative PPD and CAL gain was also found.
Within the limitations of this study, the absence of anatomical variables, except the morphology of the bone defect, emphasizes the importance of the proper surgical approach and the graft material used.
biomimetic; hydroxyapatite; intrabony pockets; clinical; radiological
The aim of this study was to evaluate the level of odontogenic differentiation of dental pulp stem cells (DPSCs) on hydrogel scaffolds derived from bone extracellular matrix (bECM) in comparison to those seeded on collagen I (Col-I), one of the main components of dental pulp ECM.
DPSCs isolated from human third molars were characterized for surface marker expression and odontogenic potential prior to seeding into bECM or Col-I hydrogel scaffolds. The cells were then seeded onto bECM and Col-I hydrogel scaffolds and cultured under basal conditions or with odontogenic and growth factor (GF) supplements. DPSCs cultivated on tissue culture polystyrene (TCPS) with and without supplements were used as controls. Gene expression of dentin sialophosphoprotein (DSPP), dentin matrix protein 1 (DMP-1) and matrix extracellular phosphoglycoprotein (MEPE) was evaluated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and mineral deposition was observed by Von Kossa staining.
When DPSCs were cultured on bECM hydrogels, the mRNA expression levels of DSPP, DMP-1 and MEPE genes were significantly upregulated with respect to those cultured on Col-I scaffolds or TCPS in the absence of extra odontogenic inducers. In addition, more mineral deposition was observed on bECM hydrogel scaffolds as demonstrated by Von Kossa staining. Moreover, DSPP, DMP-1 and MEPE mRNA expressions of DPSCs cultured on bECM hydrogels were further upregulated by the addition of GFs or osteo/odontogenic medium compared to Col-I treated cells in the same culture conditions.
These results demonstrate the potential of the bECM hydrogel scaffolds to stimulate odontogenic differentiation of DPSCs.
A good control of bacterial plaque is an essential factor for the success of periodontal therapy, therefore it is the main objective that the clinician together with the patient must get to have a healthy periodontium. The plaque control with mouthwashes is the most important home therapy as it helps to reduce the formation of plaque between the mechanical removal with a toothbrush.
Authors analyzed the clinical data from a trial carried out with 3 different mouthwashes containing 0.2% Chlorhexidine (CHX). In addition, the ADS (Anti Discoloration System - Curaden Healthcare) was tested in comparison with the other mouthwashes without this system.
Materials and methods
We tested antiplaque activity showed by 3 of the most commercialized mouthwashes, moreover, we tested the ability in reducing the dental staining related to the oral assumption of Chlorhexidine.
Discussion and conclusion
Our results demonstrated the clinical efficacy of the 3 mouthwashes with CHX. Particularly performing was the anti discoloration system (Curaden Healthcare), with a clinical detection of dental stainings significantly less than the others tested. This study demonstrated the clinical efficacy of ADS system in the reduction of tooth staining, without a loss of antiplaque activity with respect to the competing mouthwashes containing CHX.
dental plaque; oral hygiene; dental education; Chlorhexidine; dental pigmentation; dental staining
Post-radiation skin damage is the result of alterations produced in the irradiated zone. There are different studies aimed at verifying the effectiveness of several kinds of molecules in the treatment of radiation-induced skin damage. The purpose of this study is to test a mixture with a formulation containing several natural active ingredients on actinic ulcers in patients receiving radiation therapies.
Patients and methods
The authors recruited 13 patients, and randomly divided them into a test group (T1) and a control group (T2). The patients in both groups were undergoing radiotherapy. The T1 group was treated with a mixture called ozolipoile, whereas the T2 group was administered hyaluronic acid gel followed by non-ablative laser therapy. We evaluated the obtained results, the time of clinical healing, the reduction of pain, and each side effect, comparing all data between the T1 and T2 groups.
The average Visual Analog Scale results showed decrease in pain in both groups; however, while the T1 group showed a significant decrease in the values, the T2 group reported a more gradual reduction in the values, without ever reaching the minimum values obtained with the treatment with ozolipoile.
Treatment of actinic ulcers with ozolipoile mixture leads to faster control of pain and to better healing of small-size ulcers.
actinic ulcers; radiation-induced ulcers; skin wound; ozonide; wound healing
Regenerative medicine is an emerging field of biotechnology that combines various aspects of medicine, cell and molecular biology, materials science and bioengineering in order to regenerate, repair or replace tissues.
The oral surgery and maxillofacial surgery have a role in the treatment of traumatic or degenerative diseases that lead to a tissue loss: frequently, to rehabilitate these minuses, you should use techniques that have been improved over time. Since 1990, we started with the use of growth factors and platelet concentrates in oral and maxillofacial surgery; in the following period we start to use biomaterials, as well as several type of scaffolds and autologous tissues. The frontier of regenerative medicine nowadays is represented by the mesenchymal stem cells (MSCs): overcoming the ethical problems thanks to the use of mesenchymal stem cells from adult patient, and with the increasingly sophisticated technology to support their manipulation, MSCs are undoubtedly the future of medicine regenerative and they are showing perspectives unimaginable just a few years ago. Most recent studies are aimed to tissues regeneration using MSCs taken from sites that are even more accessible and rich in stem cells: the oral cavity turned out to be an important source of MSCs with the advantage to be easily accessible to the surgeon, thus avoiding to increase the morbidity of the patient.
The future is the regeneration of whole organs or biological systems consisting of many different tissues, starting from an initial stem cell line, perhaps using innovative scaffolds together with the nano-engineering of biological tissues.
Regenerative medicine; Mesenchymal Stem Cells; Bone regeneration; Dental Pulp Stem Cells; human Periapical Cysts Mesenchymal Stem Cells; hPCy-MSCs.
The multipotency of scaffolds is a new concept. Skeletal muscle acellular scaffolds (MAS) implanted at the interface of Tibialis Anterior/tibial bone and masseter muscle/mandible bone in a murine model were colonized by muscle cells near the host muscle and by bone-cartilaginous tissues near the host bone, thus highlighting the importance of the environment in directing cell homing and differentiation. These results unveil the multipotency of MAS and point to the potential of this new technique as a valuable tool in musculo-skeletal tissue regeneration.
ECM scaffold; tissue engineering; skeletal muscle; bone; cartilage
Introduction: Bioimpedance is a measure of the electrical properties of biological tissues. In the last two decades bioimpedance has been successfully introduced in clinical diagnosis of cancer. It has been demonstrated that tumoral tissues often show lower bioimpedance values than healthy tissues.
The aim of this work is to assess the bioimpedentiometric differences between healthy and Oral Lichen Planus (OLP) affected oral mucosa, taking attention to the erosive form which may represent a potential pre-cancerous condition.
Methods: 52 patients affected by OLP were recruited for bioimpedance examination of oral mucosa. Four electrical properties, resistance (R), reactance (Xc), phase angle (θ) and impedance (Z) of the tongue and of the intraoral mucosa, were measured.
Results: We observed a significant increase of Z and a significant decrease of θ values in correspondence of OLP lesions compared to healthy oral mucosa, and a marked decrease of Z values in correspondence of erosive OLP lesions.
Conclusions: These results provide evidence of the usefulness of bioimpedance assay for the characterization of healthy and clinically OLP affected mucosa. Bioimpedance is a valid aid in the early detection and clinical monitoring of the suspicious lesions which could lead to a potentially malignant evolution.
The present research article is a valuable addition to the scientific literature of cancer prevention, and our findings can be considered extremely encouraging as they represent the initial step for a more wide clinical study for better define the different cut-off values in the different precancerous conditions occurring in the oral mucosa.
Oral Pathology; Early Diagnosis; Oral Cancer; Cancer Prevention
There is no consensus regarding the use of retaining or replacing cruciate implants for patients with limited deformity who undergo a total knee replacement. Scope of this paper is to evaluate whether a cruciate sparing total knee replacement could have a reduced operating time compared to a posterior stabilized implant.
For this purpose, we performed a randomized study on 50 subjects. All procedures were performed by a single surgeon in the same conditions to minimize bias and only knees with a less than 20 varus deviation and/or maximum 15° fixed flexion contracture were included.
Surgery time was significantly shorter with the cruciate retaining implant (P = 0.0037). The mean duration for the Vanguard implant was 68.9 (14.7) and for the NexGen II Legacy was 80.2 (11.3). A higher range of motion, but no significant Knee Society Scores at 6 months follow-up, was used as controls.
In conclusion, both implants had the potential to assure great outcomes. However, if a decision has to be made, choosing a cruciate retaining procedure could significantly reduce the surgical time. When performed under tourniquet, this gain does not lead to reduced blood loss.
Incomplete tears; Meniscus in situ; Anatomic single bundle; Anterior cruciate ligament reconstruction
In the present work we analyzed the hormonal (salivary Cortisol; sC), immune (salivary Immunoglobulin A; sIgA) and cardiovascular (Heart rate, HR, and systolic blood pressure, SBP) responses induced by stress conditions in oral surgeons, randomly recruited according to their expertise level.
Materials and methods
Each surgeon performed three different surgical procedures with increasing degrees of technical difficulty and under time-limited conditions, to assess whether these variants may influence the risks of stress-induced secondary hypertension among the involved health professionals. sC and sIgA samples and cardiovascular function measurements were taken up before, during, and two hours after every surgery. Salivary samples and cardiovascular measurements were taken also during non-surgical days, as baseline controls.
We observed that more experienced surgeons showed a higher stress management ability compared to those with less experience or, generally, younger, which are more exposed to the risks of developing secondary hypertension. Nevertheless, indipendently of sex and experience, oral surgeons are constantly exposed to high risks of developing stress-related diseases.
On the basis of the issues addressed and the results obtained, we have highlighted the importance of the investigated stress biomarkers to monitor and to prevent stress-related pathologies among oral surgeons. This approach is aimed to emphasize the significance of these specific stress-biomarkers, which represent a powerful instrument to evaluate stress levels in oral surgeons, and that may help to reduce the most severe life-threatening risks to which they are daily exposed. In conclusion, final goal of this study is to suggest an useful guideline to monitor the stress levels of oral and maxillofacial surgeons in order to improve their quality of life, which is inevitably reflected on the quality of the performances provided and, finally, to prevent possible mistakes in their daily activities.
The extracellular matrix (ECM) of decellularized organs possesses the characteristics of the ideal tissue-engineering scaffold (i.e., histocompatibility, porosity, degradability, non-toxicity). We previously observed that the muscle acellular scaffold (MAS) is a pro-myogenic environment in vivo. In order to determine whether MAS, which is basically muscle ECM, behaves as a myogenic environment, regardless of its location, we analyzed MAS interaction with both muscle and non-muscle cells and tissues, to assess the effects of MAS on cell differentiation. Bone morphogenetic protein treatment of C2C12 cells cultured within MAS induced osteogenic differentiation in vitro, thus suggesting that MAS does not irreversibly commit cells to myogenesis. In vivo MAS supported formation of nascent muscle fibers when replacing a muscle (orthotopic position). However, heterotopically grafted MAS did not give rise to muscle fibers when transplanted within the renal capsule. Also, no muscle formation was observed when MAS was transplanted under the xiphoid process, in spite of the abundant presence of cells migrating along the laminin-based MAS structure. Taken together, our results suggest that MAS itself is not sufficient to induce myogenic differentiation. It is likely that the pro-myogenic environment of MAS is not strictly related to the intrinsic properties of the muscle scaffold (e.g., specific muscle ECM proteins). Indeed, it is more likely that myogenic stem cells colonizing MAS recognize a muscle environment that ultimately allows terminal myogenic differentiation. In conclusion, MAS may represent a suitable environment for muscle and non-muscle 3D constructs characterized by a highly organized structure whose relative stability promotes integration with the surrounding tissues. Our work highlights the plasticity of MAS, suggesting that it may be possible to consider MAS for a wider range of tissue engineering applications than the mere replacement of volumetric muscle loss.
extracellular matrix; niche; osteogenic differentiation; myogenic differentiation; tissue engineering; regenerative medicine
Introduction: An increased production of oxidizing species related to reactive oral diseases, such as chronic apical periodontitis, could have systemic implications such as an increase in cardiovascular morbidity.
Based on this consideration, we conducted a prospective study to assess whether subjects affected by chronic periodontitis presented with higher values of oxidative stress than reference values before endodontic treatment, and whether endodontic treatment can reduce the oxidative imbalance and bring it back to normal in these subjects.
Materials and methods: The authors recruited 2 groups of patients from private studies and dental clinics: these patients were recruited randomly. The oxidative balance in both patients with chronic apical periodontitis (CAP) and healthy control patients was determined by measuring the oxidant status, using an identification of the reactive oxygen metabolites (d-ROMs) test, while the antioxidant status in these patients was determined using a biological antioxidant potential (BAP) test. Both these tests were carried on plasma samples taken from enrolled patients. Values were measured both before the endodontic treatment of the patients with chronic apical periodontitis, and 30 and 90 days after treatment, and compared to those obtained from healthy control patients.
Results: It was found that, on recruitment, the patients with chronic apical periodontitis exhibited significantly higher levels of oxidative stress than control patients, as determined by the d-ROMs and BAP tests. Furthermore, the d-ROMs test values were shown to decrease and the BAP test values to increase over time in patients with chronic apical periodontitis following endodontic therapy. As the levels of oxidative stress in these patients tended to reduce and return to normal by 90 days following treatment.
Conclusions: This study has demonstrated a positive association between chronic apical periodontitis and oxidative stress. Subjects affected by chronic apical periodontitis are exposed to a condition of oxidative stress, which is extremely dangerous to general health. Moreover, one can infer from these findings that through proper endodontic therapy, a good oxidative balance can be restored, thereby avoiding the risk of contracting the abovementioned diseases.
Oxidative stress; chronic apical periodontitis; endodontic treatment.
Introduction. The mechanical strength and the surface hardness of commercially available yttrium-doped zirconia were investigated. Furthermore, a comparative study of eight different ceramic veneers, to be used for the production of two-layered all-ceramic restorative systems, was carried out. Materials and Methods. Four types of zirconia specimens were analyzed, according to a standard ISO procedure (ISO 6872). Besides, two-layered zirconia-veneer specimens were prepared for three-point bending tests. Results. A strong effect of the surface roughness on the mechanical strength of zirconia specimens was observed. Finally, a comparative study of eight commercially available veneering ceramics shows different modes of failure between the selected veneers. Conclusion. The results indicate that close attention should be paid to the preparation of zirconia-based crowns and bridges by CAD/CAM process, because surface roughness has an important effect on the mechanical strength of the material. Finally, the results of the mechanical tests on two-layered specimens represent an important support to the choice of the veneering ceramic.
We provide a detailed description of mesenchymal stem cells (MSCs) isolated from human periapical cysts, which we have termed hPCy-MSCs. These cells have a fibroblast-like shape and adhere to tissue culture plastic surfaces. hPCy-MSCs possess high proliferative potential and self-renewal capacity properties. We characterised the immunophenotype of hPCy-MSCs (CD73+, CD90+, CD105+, CD13+, CD29+, CD44+, CD45-, STRO-1+, CD146+) by flow cytometry and immunofluorescence. hPCy-MSCs possess the potential to differentiate into osteoblast- and adipocyte-like cells in vitro. Multi-potentiality was evaluated with culture-specific staining and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) analysis for osteo/odontogenic and adipogenic markers. This is the first report to indicate that human periapical cysts contain cells with MSC-like properties. Taken together, our findings indicate that human periapical cysts could be a rich source of MSCs.
Mesenchymal stem cells (MSCs); cyst; periapical inflammatory tissues; mesenchymal stem cells isolated from human periapical cyst (hPCy-MSCs); osteogenic differentiation; adipogenic differentiation; odontogenic cyst.
Grafting of autologous adipose tissue can be recommended in some cases of facial plastic surgery. Rhabdomyosarcoma is a type of cancer that can also affect the orbit. Enucleation of the eye can cause atrophy of the corresponding hemiface and decreased orbital growth.
We report a case of a female patient with a medical history of surgical enucleation of the right eyeball, who had received rhabdomyosarcoma radiation therapy in her youth. The patient presented with a depression in the right zygomatic region. We took a dermal-fat flap from the abdominal region, which had been previously treated.
The surgical outcome, 48 hours, and much clearly 31 days after the surgery, revealed that the right zygomatic region had returned to its proper anatomical shape, although there were still signs of postoperative edema.
Very damaged tissues, like those exposed to radiation therapy, are generally not suitable for grafting of adipose tissue.
In the described case, we achieved a technically and aesthetically satisfying result despite the patient's medical history involving several perplexities about the use of autologous dermal-fat tissues, because of prior radiation therapy exposure. The clinical case shows that even a region exposed to radiation therapy can be a valid receiving bed for dermal-fat grafting.
Dermal-fat grafts; Oncological surgery; Plastic surgery
Rhinoplasty "open" represents a surgical technique to access to the internal structures of the nose; it is an alternative to more traditional "closed" rhinoplasty. However, both these techniques have some advantages and some disadvantages. In this work the authors describe a case that shows the steps of a new surgical technique: the “semi-open” rhinoplasty.
The "semi-open" technique is performed by making an incision to access on the mucosa of both the nostrils, and through this access we separate the cartilages of the columella from the alar cartilages, debriding them at the domus. With such access we can perform any type of rhinoplasty surgery with functional or aesthetic purposes.
Traditional techniques have undoubtedly some advantages and some disadvantages. The "semi-open" technique has the several advantages of the open technique, and it does not involve the presence of post-surgical scars.
This innovative technique provides great predictability and minimal postoperative discomfort, with no aesthetic damage.
Rhinoplasty; Maxillofacial technique; Plastic surgery
Due to the request of numerous patients to improve the aspect of the perioral area in combination with other types of cosmetic and reconstructive surgery, we started to use autologous fillers. In fact, there are numerous potential fillers that can be utilized during various operations executed in many bodily areas, such as the breast, abdomen, and face. The muscular fascia as well as the dense connective tissue which the surgeon encounters in various bodily areas during some stages of the operation, in fact, can be removed and replaced both by themselves or superimposed in order to increase their thickness. The insertion of the grafts is carried out by using a needle, but other methods can also be used with the same success. The consistency of the area treated, after a few days of edema, is very similar to the host area, and the volume obtained remains uniform in time (our followup is after 24 months). The time utilized for the removal and the insertion in the chosen area was only a few minutes. The result was extremely satisfactory in all the 30 patients treated, and there was no complication or side effects.
The composite graft from the conchal cartilage is a graft that is often used, especially in surgery on the nose, due to its capacity to resolve problems of cover and tissue deficit, arising from the removal of neoplasms or as the result of trauma, burns or following over-aggressive rhinoplasty. We have started to use skin-perichondrium-cartilage graft from the ear to cover large areas of the nose with very satisfying results as well as we describe in the reported clinical case.
The operation consisted of reconstruction of the cartilaginous nasal septum, which had previously been removed, using two vestibular labial mucosa flaps to reconstruct the mucosa, and cartilage from the ear conch for the cartilaginous septum. After this, the skin edges of the fistula were turned to recreate the inner lining of the nose and form a vascular base of wide area to accept the composite graft. The case concerns a female 74-year old patient who had undergone several oncological surgery for a relapsing basal cell carcinoma on the dorsum of the nose. The operation consisted of reconstruction of the cartilaginous nasal septum using two vestibular labial mucosa flaps to reconstruct the mucosa, and cartilage from the ear conch for the cartilaginous septum.
The perichondrial cutaneous graft has shown in this surgical case very favorable peculiarities that make it usable even in facial plastic surgery.
We believe that the positive experience that we achieved in the use of composite grafts for the reconstruction of large areas of the nose could be interesting for others surgeons.
Introduction. White Sponge Nevus (WSN) is a rare pathology with a pathogenesis on genetic basis, a benign course and a localization affecting the mucosal keratin.
WSN is usually a symptomless pathology: when pain is present, some authors reported reduction of symptoms by taking penicillin or oral tetracycline rinses, suggesting that a bacterial overinfection could be at the base of possible painful symptoms.
Case Report. We describe 2 patients affected by WSN, father and son: they presented two different oral diseases associated with an infection by Staphylococcus aureus. So, we have performed a careful oral hygiene to reduce infection in the oral cavity. In the following days we prescribed 2 rinses a day with a mouthwash containing chlorhexidine digluconate at two different percentages.
Discussion. Early diagnosis of this lesion is important, because it allows us to exclude other more serious diseases. In the most part of cases, WSN requires no treatment because of its benign and asymptomatic behaviour: up to now, no protocol of treatment for this condition was standardized. Even if WSN is a painless condition, sometime a correlated painful symptomatology was reported.
Conclusions. In our experience, we have achieved excellent results even with chlorhexidine digluconate rinses, considering that our treated cases were both infected by Staphylococcus aureus.
We hypothesize that the corrugated plaques and the altered texture of the mucosa create the right conditions for the colonization and the development of microbial species such as saprophytic bacteria or fungal species.
White Sponge Nevus; Staphylococcus Aureus; Oral disease
Introduction. Maxillary bone losses often require additional regenerative procedures: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF (Platelet Rich Fibrin) was tested for the first time in France by Dr. Choukroun.
Aim of the present study is to investigate, clinically and histologically, the potential use of PRF, associated with deproteinized bovine bone (Bio-Oss), as grafting materials in pre-implantology sinus grafting of severe maxillary atrophy, in comparison with a control group, in which only deproteinized bovine bone (Bio-Oss) was used as reconstructive material.
Materials and Methods. 60 patients were recruited using the cluster-sampling method; inclusion criteria were maxillary atrophy with residual ridge < 5mm. The major atrophies in selected patients involved sinus-lift, with a second-look reopening for the implant insertion phase. The used grafting materials were: a) Bio-Oss and b) amorphous and membranous PRF together with Bio-Oss. We performed all operations by means of piezosurgery in order to reduce trauma and to optimize the design of the operculum on the cortical bone. The reopening of the surgical area was scheduled at 3 different times.
Results. 72 sinus lifts were performed with subsequent implants insertions.
We want to underline how the histological results proved that the samples collected after 106 days (Early protocol) with the adding of PRF were constituted by lamellar bone tissue with an interposed stroma that appeared relaxed and richly vascularized.
Conclusions. The use of PRF and piezosurgery reduced the healing time, compared to the 150 days described in literature, favoring optimal bone regeneration. At 106 days, it is already possible to achieve good primary stability of endosseous implants, though lacking of functional loading.
Reconstructive Surgery; Platelet Rich Fibrin; Grafting Materials; Bone replacement.
Portable firearms have a relevant medico-legal interest, being a major cause of injury. Bullet entry wounds generally have a particular appearance, including contusion, skin introflection, and simple or excoriated ecchymosis. The skin wound is typically a hole with frayed margins, whose diameter is smaller than that of the bullet.
PRESENTATION OF CASE
We report the case of a 19-year-old man with ballistic trauma. Examination of the patient's lesions indicated that the bullet had entered from the left mandibular parasymphysis, creating a small hole without the typical bullet wipe and blackening. Subsequently, the bullet seemed to have fractured the left chin region immediately below the lower alveolar process, and it finally stopped in the submandibular area in the suprahyoid region of the neck.
This case is peculiar because the distinctive features of a firearm injury were absent; the lack of bleeding and edema made the case difficult to interpret without additional diagnostic investigations.
Ballistic trauma can manifest in different ways; therefore, internal trauma should be suspected even in the absence of clear external signs. This case report shows how an unusual bullet entry hole can mask quite serious injuries.
Ballistic trauma; Maxillofacial trauma; Firearm injury
Today, we frequently find patients taking oral anticoagulant therapy (OAT), a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications.
Materials and methods
A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76) undergoing OAT for more than 5 years were managed with a standardized management protocol and a 2-months follow-up. The aim of the present study was to apply a protocol, which could provide a safe intra- and postoperative management of patients on OAT.
Among the 193 patients, only 2 had postoperative complications.
We think that the protocol used in the present study can be used for complete safety in the treatment of this type of patients.
Oral Anticoagulant Therapy (OAT); Tranexamic Acid; Oral Surgery
The expression non Hodgkin lymphoma is used to cover a wide group of lymphoid neoplasias unrelated to Hodgkin's disease, due to the huge histological variety and the tendency to affect organs and tissues that does not physiologically contain lymphoid cells.
The intraoral location is not frequent (3 - 5 percent of cases) and the initial manifestations of the disease rarely take place here.
We describe the case of a 73 years old Italian caucasian male who came to our attention with a tongue lesion. The clinical manifestation was macroglossia and bleeding, probably deriving from the tongue-bite injuries.
The patient had been complaining of dyspnea for 48 hours.
A tongue affected by non-Hodgkin's lymphoma rarely occurs. In spite of this, this possibility should always be considered for the differential diagnosis of benign and malignant lesions affecting such area.
A rapid diagnostic assessment, together with an adequate histopathologic verification, are indeed essential to improve the management and the prognosis of this disease.
Scar formation is a process consequent to the healing of soft tissues after a trauma. However, abnormal or disturbed collagen production can cause anomalies of the cutaneous surface and textural irregularities. In the presence of a depressed scar in deep tissue, we began to use a new simple technique. In the presence of adherent scars, a small incision is performed so that an undermining scissor can enter inside. The entire cicatricial area is undermined on a subcutaneous plane which, by separating the deep scar from the superficial one, completely frees it from the present adhesions so that the existing depression is totally eliminated. In order to avoid the recreation of relapses, stitches formed in a U-shape are made in Nylon or Monocril 2-3/0 are made with a large needle and are placed close together so that a wide aversion is achieved at the margins of the scar and a deep wound closure is obtained by adhering to the undermined tissue. These stitches will then be removed about 2 weeks later.
Depressed scar; plastic surgery; subcision technique

domain: literature


text:
More challenges for port
Published 10:20 pm Friday, August 31, 2012
As major operational changes loom and longshoremen plan to strike, the Port of Virginia has been thrown a major curve ball with the departure of the port authority’s executive director.
Jerry Bridges’ tenure will end on Oct. 31, the Virginia Port Authority Board of Commissioners announced in a press release Friday.
The board credits Bridges with restructuring the state agency, which owns four port facilities in Virginia and operates five, and overseeing its lease of APM Terminals, located just across the Suffolk line in Portsmouth.
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Bridges also became chairman of the board of the American Association of Port Authorities and has served on various other industry boards.
Specifically why Bridges is leaving is unclear. He did not return calls for comment.
In a phone interview, board Chair Michael Quillen said: “I think it’s more a personal situation for Jerry and his family.
“He’s given us adequate notice. I do know he’s just gotten engaged. I’m not sure, he may be relocating.”
An announcement on an interim executive director is due soon, the release stated. Quillen said that a permanent replacement for Bridges will not be appointed until the role is redefined after the dust settles on a four-way contest to operate the port.
After the state earlier in 2012 received an unsolicited proposal from Maersk subsidiary APM under its Public-Private Transportation Act, two more groups, Carlyle Infrastructure Partners, L.P., an infrastructure investment unit of the Carlyle Group, and RREEF America L.L.C., part of the Deutsche Bank Group, also lodged proposals.
Rounding out the four, Virginia International Terminals, a nonprofit, nonstock, private corporation established by the state, is also making its case to continue operating the port.
In a separate press release, the authority said preparations are under way for a possible stoppage of port workers from Oct. 1.
Wage negotiations between the International Longshoreman’s Association, which represents longshoremen on the East Coast and elsewhere, and the United States Maritime Alliance have reportedly ended without a deal.
The plan is to “do everything we can to ensure that all cargo is delivered prior to Oct. 1,” VIT President Joseph A. Dorto stated in the release.
“When we resume operations, VIT will do all possible to ensure our customers are taken care of in a timely and efficient manner. The goal is to maintain a high level of service to our customers so that there is minimal disruption to their business.”
Dorto believes port customers will “immediately” plan to shift 10-15 percent of their cargo to West Coast ports, saying the effect will not be felt locally until October as vessels currently en route to Virginia will not divert.
A long-running work stoppage stalling shipments through the port would prove devastating for Suffolk’s economy, which relies heavily on distribution and warehouse facilities.
Quillen noted that a West Coast labor dispute several years ago resulted in the relocation of businesses. “We hope it gets resolved without any disruption,” he added.
The authority and VIT have scheduled a meeting for next week for port stakeholders to discuss the labor situation and seek input on possible courses of action.


text:
|Year : 2016 | Volume
| Issue : 1 | Page : 27-29
Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases
Abdurrazaq Olanrewaju Taiwo1, Nabilla Awwal2, Ramat Oyebunmi Braimah3, Adebayo Aremu Ibikunle3
1 Department of Surgery/Dental and Maxillofacial Surgery, College of Health Sciences, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Dental and Maxillofacial surgery, Sir Yahaya Memorial Hospital, Birnin Kebbi, Kebbi State, Nigeria
3 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
|Date of Web Publication||8-Dec-2016|
Dr. Ramat Oyebunmi Braimah
Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Source of Support: None, Conflict of Interest: None
The camel is a very docile animal used extensively in the Northern region of Nigeria for farming, transport, and others. It is rarely implicated in the literature as an etiological factor for facial fracture. Hence, the aim of this report is to highlight the unusual presentation of mandibular, zygomatic, and orbital blowout fractures caused by camel aggression and discuss the various challenges involved in its management. The camel though docile should be carefully handled, especially during phlebotomy and rutting period to avoid any mishap.
Keywords: Camel, facial fracture, phlebotomy, rut
|How to cite this article:|
Taiwo AO, Awwal N, Braimah RO, Ibikunle AA. Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases. Afr J Trauma 2016;5:27-9
|How to cite this URL:|
Taiwo AO, Awwal N, Braimah RO, Ibikunle AA. Unusual case of maxillofacial injury secondary to camel aggression and attack during phlebotomy: Report of two cases. Afr J Trauma [serial online] 2016 [cited 2023 Dec 6];5:27-9. Available from: https://www.afrjtrauma.com/text.asp?2016/5/1/27/192848
| Introduction|| |
A camel is an even-toed ungulate animal within the genus Camelus, bearing distinctive fatty deposits known as "humps" on its back. The camel is a very docile animal used extensively in the Northern part of Nigeria for farming, transport, and others. It is rarely implicated in the literature as an etiological factor for maxillofacial injuries. Dog bites have been reported as the most common animal bite wound seen in any part of the body. Injuries from animals such as bear, horses, pigs, and donkeys have also been reported., Specifically, camel bite injuries are relatively scarce; few cases have been reported in the literature.,,, Therefore, the aim of this report is to highlight the rare presentation of mandibular fracture caused by camel aggression and discuss the various challenges involved in its management.
| Case Reports|| |
A 30-year-old male farmer presented with a day history of facial bleeding and swelling as a result of being flung by an adult male camel during phlebotomy. Following resuscitation and arrest of the bleeding, clinical examination showed some areas of laceration, punctured wound, and tenderness along the lower border of the mandible with swelling [Figure 1]a. Posterior-anterior view of the skull revealed bilateral parasymphyseal fracture (Between canine and first premolar bilaterally) of the mandible [Figure 1]b.
|Figure 1: (a) Clinical photograph of Case 1 patient with soft tissue injuries. (b) Posterior-anterior view of the jaws showing bilateral anterior mandibular fracture. (c) Clinical photograph showing maxillomandibular fixation using direct wiring|
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Tetanus vaccine (intramuscular tetanus toxoid 0.5 ml stat) and broad spectrum antibiotic (intravenous [IV] cefuroxime 1 g 12 hourly for 7 days and IV metronidazole 500 mg 8 hourly for 7 days) were given to the patient. After thorough surgical debridement of wound, decision was taken to close the wound primarily under local anesthesia. Intraoral layer closure of the wound was done with 3-0 chromic catgut sutures. After adequate approximation of deep structures, skin closure was achieved using 4-0 nylon suture and a gauze dressing put in place. The mandibular fracture was subsequently managed by closed reduction with maxillomandibular fixation (MMF) using direct dental wiring [Figure 1]c. He was admitted and placed on anti-inflammatory (IV dexamethasone 8 mg stat then 4 mg 8 hourly for 3 days). He had wound infection because of irregular antibiotic administration. The infection however resolved when antibiotic administration became regular.
A 26-year-old male farmer was referred from a medical center in the rural Northwest zone of Nigeria with 2 days history of facial injuries following an adult male camel attack. There was no loss of consciousness; he however bled from the face and the right nostrils. Following preliminary evaluation, a diagnosis of extensive soft tissue laceration, right zygomatic complex fracture, and right orbital blow out fracture with fractured infraorbital rim was made [Figure 2]a and b]. Patient however declined further investigations and management due to financial reasons.
|Figure 2: (a) Clinical photograph (posterior-anterior view) of case two patient with soft tissue injuries. (b) Clinical photograph (right-side view) of Case 2 patient with soft tissue injuries|
Click here to view
| Discussion|| |
The Arabian camel (Camelus dromedarius) is single-hump species and reaches up to about 2 m shoulder height, body length of 3 m, and weighs 600 kg to 1200 when fully grown. They are used extensively in rural Northern Nigeria for agriculture and transport. These animals pull ploughs, assist in irrigation of farmlands, and transport agricultural produce. Camels also provide milk, meat, hair for textiles or goods such as felted pouches. It has rarely been implicated in maxillofacial injuries as few cases have been reported., The reported cases are males and in their second and third decades of life. The high incidence of cases in this decade of life coincides with period of increased participation in farming and animal husbandry.
There are two major types of animal attacks reported in the literature which are defensive or predatory., The camel is a known docile herbivorous mammal, we then postulated that the attack to its owner was defensive as it might have perceived the iatrogenic bleeding by the owner as a hostile act in Case 1. The local belief is that bleeding the camel will make the animal very healthy and by extension makes the animal works better. Similarly, the behavior of camels can be unpredictable, especially during the rutting period. This is the period of mating were the male camel extrudes from his mouth an organ called a dulla, a large, inflatable sac when in rut to assert dominance and attract females. It resembles a long, swollen, pink tongue hanging out of the side of its mouth. Although this camel behaviour was not asked from the patient in the second case, we opined that the male camel may be in this rut period; hence its aggression. The laceration and facial bone fracture sustained could be as a result of been flung to the wall with considerable force by the big powerful camel in the two cases. This mechanism of injury by camel has been reported by Abu-Zidan et al. were the camel picks the individual and flung them.
There is still controversy regarding the management of facial injuries as a result of animal bite. Most reports agree on immediate and thorough wound irrigation, no consensus yet on the timing of subsequent wound debridement, secondary repair, or routine antibiotics. Spontaneous healing has been suggested by some authors and primary wound closure when feasible. In our report, proper assessment, thorough wound cleansing with normal saline and debridement was done with primary closure. Primary closure/reconstruction may be necessary in relatively clean facial wounds or wounds that have been thoroughly debrided and irrigated to eliminate foreign bodies such as sand, stone, and grass to decrease likelihood of infection; and achieve aesthetic. Concern for adverse outcome in facial wounds is minimal as a result of excellent blood supply in contrast to other part of the body where more conservative option of delayed primary closure/reconstruction is preferred. It has been reported that camel bite wound are associated with higher risk of infection even more than dogs, cats, and human bites. In this report, the risk of tetanus and infection are high and the history of vaccination is unknown; hence, tetanus prophylaxis and broad antibiotic cover were mandatory. The wound was complicated by abscess formation because the patient could not procure medications and drug administration was irregular. This is due to the out of pocket method of health care financing in underdeveloped or developing countries.
Because of financial limitation, MMF was employed, although the gold standard of using miniplates and screws would have been exploited. In spite of this constraint, satisfactory outcome was obtained. Satisfactory outcome of MMF have been reported by Taiwo et al. especially in resource limited setting. The second patient declined treatment because of financial reasons, this further re-emphasize the disadvantages of out of pocket method of health care financing.
| Conclusion|| |
The behavior of camels can be unpredictable, especially in the rut period. The mechanism of injury in camels is also peculiar as it bites and flung patients with its heavy weight. Care should be taken when handling camels especially during the rutting season. Furthermore, there should be universal health care coverage for all citizens by all inclusive health care insurance schemes.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
The authors are grateful to Dr. Kolawole O, the departmental chair, Dental and Maxillofacial Surgery Unit, Sir Yahya Memorial hospital, Birnin Kebbi, Kebbi State, Nigeria, for the general support provided.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]