Search

Aim To evaluate Save-A-Tooth ( SAT), EMT Toothsaver ( EMT) and Hank's Balanced Salt Solution ( HBSS) for their influence on the viability and proliferative capacity of human periodontal ligament fibroblasts (HPDLFs). Methodology Primary HPDLFs were seeded into 96-well cell culture plates and exposed to SAT, EMT, HBSS and water (negative control) for 0.5, 1, 3, 6, 12 and 24 h at room temperature (22 °C). After each exposure time, cell viability was measured through quantifying adenosine triphosphate ( ATP) using a luminescent dye. The proliferative capacity was also quantified using the PrestoBlue assay after 12 or 24 h storage in each medium. The data were analysed statistically by two-way anova and post hoc Least Significant Difference ( LSD) test ( P < 0.05). The morphology of the cells after 12 h storage was also investigated through live/dead viability/cytotoxicity kit together with fluorescence microscopy. Results There was no significant difference in cell viability amongst HBSS, SAT and EMT groups up to 6 h. SAT was effective in maintaining cell viability only up to 12 h and then became detrimental to HPDLF; after 24 h, the effectiveness of SAT in maintaining cell viability was similar to that of water ( P > 0.05). Amongst all the media, only EMT could maintain the proliferative capacity of HPDLFs significantly higher than the negative control, that is water ( P < 0.05) after 24 h storage. Conclusion EMT maintained the proliferative capacity of HPDLFs after 24 h storage. [ABSTRACT FROM AUTHOR]

Background: Bromocriptine, as an Ergot alkaloid, suppresses prolactin synthesis. Some clinical studies support the role of prolactin in the development of rheumatoid arthritis (RA) disease activity. Therefore, this study aimed to examine the effect of bromocriptine on disease activity in RA. Materials and Methods: This double-blind interventional study was performed on 174 patients with rheumatoid arthritis referred to Shahid-Beheshti hospital in Kashan during 2011-2012. The patients were allocated into the two groups through block randomization. One group received bromocriptine 2.5 mg two times a day and another group received a placebo. All patients were examined at the beginning and during the second and six months of the study for swelling, tenderness, pain severity based on disease activity score (DAS), erythrocyte sedimentation rate (ESR) and visual analogue scale (VAS), respectively. Results: Results indicated that in bromocriptin group, initial swelling, pain severity and initial DAS significantly decreased from 3.7 to 0.59; 82.1 to 23.15; 3.8 to 3.5, respectively after 6 months compared with those in the control group. Moreover, no significant decrease was observed in the ESR and tenderness parameters. Conclusion: Bromocriptine can reduce swelling, pain severity and DAS in RA. [ABSTRACT FROM AUTHOR]

Background: IL-4 is an important mediator of inflammatory cytokine derived from T helper cells and mast cells which triggers IgE synthesis. IL-4 plays an important role in allergic immune response for its ability to prevent apoptosis of T lymphocytes. IL-4 also plays a role in lymphocytes cell differentiation, cytokines and IgE production. This study aimed to evaluate the relation between the serum levels of IL-4 and IgE with disease severity in patients with allergic asthma. Materials and Methods: In this case-control study, 110 asthmatic patients referred to Asthma and Allergy Clinic in Kashan and 70 healthy controls were randomly selected. Blood sample (5 ml) was taken from all the patients and healthy subjects; the serum levels of IL-4 and IgE were measured using the standard laboratory kits and ELISA method, respectively. Results: The IL-4 and IgE mean levels were not significantly associated with age and sex. The mean IgE level increased from moderate to severe with increasing asthma severity (P=0.847). Moreover, the IL-4 level in patients with severe asthma was higher than the other patients (P=0.002). Conclusion: IL-4 level was increased with increasing asthma severity, but this was not the case for IgE. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice is a very common condition in neonates. Serum bilirubin measurement in neonates is invasive and increases the risk of infection. Therefore, recognizing the highly accurate noninvasive methods has been considered by the researchers. This study aimed to evaluate the correlation between the transcutaneous and serum bilirubin before and during phototherapy in icteric neonates. Materials and Methods: This descriptive correlational study was conducted on 200 icteric term neonates (age 1-7 days) referred to Kashan Shahid-Beheshti hospital from July 2010 to January 2011. Blood and transcutaneous bilirubin samples were taken from the forehead and sternum of the neonates on admission and 8 hours after phototherapy. Data were analyzed using the Pearson correlation coefficient. Results: Among 200 neonates, 102 were female and 98 male (mean age, 4.5±1.7 days). There was a significant correlation between the serum bilirubin before phototherapy and forehead transcutaneous bilirubin (r=0.83) and with sternum transcutaneous bilirubin (r=0.71, P0.001). Moreover, there was a significant correlation between the serum bilirubin after phototherapy and forehead transcutaneous bilirubin (r=0.76) and sternum transcutaneous bilirubin (r=0.49, P0.001). Conclusion: Transcutaneous bilirubinometery is a suitable alternative in measuring serum bilirubin in term icteric neonates who need treatment. Transcutaneous bilirubinometery especially through forehead can be used for screening of icteric neonates and their follow-up during phototherapy. [ABSTRACT FROM AUTHOR]

Objective: Systemic sclerosis (SSc) is a multi-systemic autoimmune disease with high morbidity and healthcare costs. Inconsistent quality care delivery, including inadequate screening and monitoring, necessitates improvement. This study aimed to enhance the uptake of validated quality indicators (QIs) for SSc., Methods: An interrupted time series study was conducted at 4 scleroderma clinics across 2 hospitals using the Model for Improvement methodology, employing Plan-Do-Study-Act (PDSA) cycles. A retrospective chart review assessed baseline frequencies of selected QIs. The primary aim was to increase rates of seven baseline and five follow-up QIs to 80%. Root-cause analysis identified barriers to QI uptake, leading to interventions including provider education, equipment procurement, and care standardization with reminder systems. Real-time data tracking was facilitated via run charts., Results: The average completion rate of baseline QIs increased from 48% to 83% over eight months, with sustained improvements post-PDSA cycle 3. Monitoring and treatment QI completion improved from 41% to 77%. Process measures saw increases: baseline spirometry and DLCO rates improved from 63.5% to 92%, documented weekly BP self-measurement counseling increased from 18.8% to 86.6%, referrals to hand motion exercise programs rose from 53.6% to 92%, baseline CK measurement rates increased from 52.1% to 88%, and oxygen saturation documentation rose from 31.1% to 65%. Stakeholders reported high satisfaction (median rating of 4) with minimal additional time per patient (median 2.5 minutes)., Conclusion: This QI study significantly improved SSc care through low-cost, applicable interventions, setting a precedent for future work on long-term sustainability and broader application in chronic disease management.

Background: Systemic sclerosis-associated Raynaud phenomenon (SSc-RP) confers poor outcomes, including ulceration, gangrene, autoamputation, and hand disability. Prostaglandin analogues (PG) are a group of prostacyclin-derived drugs with properties that may address underlying complex mechanisms of SSc-RP. This systematic review and meta-analysis evaluated the efficacy and tolerability of PGs in SSc-RP. Methods: We systematically reviewed randomized control trials (RCTs) evaluating PG use in SSc-RP. The primary outcome was the severity of RP attacks. The secondary outcomes were the frequency and duration of RP attacks, healing of digital ulcers, development of new digital ulcers, change of capillary blood flow, patient health-reported outcome measure (PROM-VAS), and tolerability. Results: Eleven RCTs were included, reporting a total of n = 1081 individuals with SSc. PG confers a beneficial effect on RP severity in the short-term, weighted Mean difference (WMD) -0.63 (95% CI -0.99, -0.27, I 2 0%), with no difference in tolerability compared to placebo OR 1.88 (95% CI 1.00, 3.55, I 2 = 1%). PG has nonsignificant trends towards improvement in RP frequency WMD of -0.32 (95% CI -0.76, 0.13, I 2 = 0%), RP duration WMD -4.78 (95% CI -14.69, 5.14, I 2 = 1%), PROM-VAS WMD -4.81 (95% CI -11.31, 1.69, I 2 = 67%), and new or recurrent digital ulcers OR 0.92 (95% CI 0.48, 1.76, I 2 = 34%). Conclusion: PGs are beneficial in the short term to reduce the RP severity and are tolerable. Larger, adequately powered trials are needed for higher certainty evidence across SSc-RP outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Hana Alahmari et al.)

Objective: Profileplasty traditionally involves improving a nasal hump or an underprojected chin. However, this procedure can correct other facial defects like saddle nose or prognathism. To establish the best overall profile, the nose, the midface, and the chin should be considered altogether. This study aimed to describe typical facial profiles and propose an algorithm for targeted correction., Methods: Patients who underwent rhinoplasty, with or without other facial procedures performed by the senior author were reviewed. Patients with pre and postoperative photographs and clinical follow-up were included. Images were analyzed using Goode and Steiner analyses and E and S lines to assess and categorize nasal and facial profiles. A treatment algorithm for each sub-group was proposed based on expert opinion. Adherence to the algorithm was validated by reviewing patients' charts., Results: A total of 426 rhinoplasty patients were included, with 72 also undergoing orthognathic surgery, including genioplasty. There were 2 general groups of patients: (1) poor nasal profile with a balanced facial profile and (2) poor nasal profile with an unbalanced facial profile. Group 1 included (1a) prominent (n = 298) or (1b) flat (n = 56) nasal dorsum. Group 2 included (2a) convex profile (n = 38), (2b) concave profile (n = 32), and (2c) "pseudo-dorsum" (n = 2). Proposed treatments for group 1 involved balancing the nasal dorsum and nasofrontal angle, whereas group 2 involved modifying the nasal dorsum and repositioning the maxilla/mandible. Of patients, 98.6% followed the proposed treatment algorithm., Conclusion: This study describes common profile patterns and highlights a profileplasty algorithm that offers systematic treatment planning for most patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: Systemic sclerosis (SSc) can restrict employment participation. Our objectives were to comparatively evaluate health factors, work factors, and workplace accommodations between those who are employed and those who recently gave up employment., Methods: A cross-sectional study was conducted of employed and recently working, but now unemployed, individuals with SSc. Demographics, employment sectors, health factors, flare frequency, work context, and information about the need, availability, and use of workplace supports were collected., Results: Participants were 140 individuals (108 [77.1%] women, 32 [22.9%] men), of whom 110 (78.6%) were employed and 30 (21.4%) were unemployed. Participants worked in education/health/sciences/arts (n = 51, 36.4%), sales/retail (n = 23, 16.5%), banking/insurance/business/technology (n = 22, 15.7%), government (n = 15, 10.7%), construction/utilities (n = 10, 7.1%), and manufacturing/agriculture/mining/logging (n = 10, 7.1%). Employed participants had a lower mean age (48.4 vs 54.3 yrs), and higher level of education (77.3% with postsecondary education vs 22.7% without). Those who had no flares were more frequently employed (41.7%), compared to those who had 1 to 2 flares (35.2%) and ≥ 3 flares (23.1%). The availability of workplace accommodations differed significantly between the employed and unemployed: flexible hours (74.5% vs 40%, P = 0.0005), more rest periods (73.6% vs 46.7%, P = 0.0001), special equipment (82.7% vs 46.7%, P < 0.0001), and work schedule flexibility (66.4% vs 33.3%, P = 0.003)., Conclusion: Health factors alone do not differentiate those who are employed and those who gave up employment. This study lays the groundwork for where SSc-specific efforts in workplace policies and practices should be directed, especially workplace support., (Copyright © 2024 by the Journal of Rheumatology.)

Background: Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction., Methods: PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar., Results: Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent)., Conclusions: The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.

Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma.

Acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. We report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. Complete ultrasound of abdomen and pelvis was normal. In plain Radiographs of chest and abdomen with the exception of Air-filled stomach and intestine, there was no abnormality. Due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and Surgical exploration revealed perforated appendix. Appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion.

Omental torsion is caused by the rotation of the greater omentum on its axis which may lead to tissue infarction and necrosis. It is a rare cause of acute abdomen. Signs, symptoms and paraclinical data are not specific. The patients usually undergo laparotomy for acute abdomen of poorly defined origin. High index of suspicious is required for the diagnosis of this entity. The diagnosis is usually confirmed after an explorative laparotomy. We present clinical characteristics and imaging findings of omental torsion in a young man following repeated blunt abdominal trauma.

Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred., Objectives: The aim of this study was to evaluate the various aspects of chest trauma in patients admitted to two main trauma centers located in the Isfahan Province, Iran., Patients and Methods: During a six month period, a cross-sectional study of 100 patients who had sustained a chest injury was carried out. Data, including; age, sex, time of accident, trauma mechanism, organ injury, hospitalization length, complications, and patient outcomes were recorded and analyzed., Results: The mean ages of the patients were 24.7 ± 3.1 years. Men were injured four times more often than the women. Blunt trauma was the most common type of injury. The incidence of hemothorax was 38% in blunt traumas, and 45% (P = 0.01) in penetrating ones. The incidence of pneumothorax was 43% in blunt traumas and 20% in penetrating ones (P = 0.03). The length of hospitalization was 7.2 ± 3.2 days for blunt and 10.1 ± 3.1 days for penetrating chest traumas. Five patients (5%) died during hospitalization, three of those deaths were due to arterial injuries and two cases were due to lung contusions., Conclusions: Since hemothorax is the main complication of blunt chest trauma in young men, we recommend that special consideration needs to be made to any case of chest trauma, especially blunt chest injuries.

The midgut microbiota associated with Anopheles stephensi and Anopheles maculipennis (Diptera: Culicidae) was investigated for development of a paratransgenesis-based approach to control malaria transmission in Eastern Mediterranean Region (EMR). Here, we present the results of a polymerase chain reaction (PCR) and biochemical-based approaches to identify the female adult and larvae mosquitoe microbiota of these two major malaria vectors, originated from South Eastern and North of Iran. Plating the mosquito midgut contents from lab-reared and field-collected Anopheles spp. was used for microbiota isolation. The gram-negative and gram-positive bacterial colonies were identified by Gram staining and specific mediums. Selected colonies were identified by differential biochemical tests and 16S rRNA gene sequence analysis. A number of 10 An. stephensi and 32 An. maculipennis adult mosquitoes and 15 An. stephensi and 7 An. maculipennis larvae were analyzed and 13 sequences of 16S rRNA gene bacterial species were retrieved, that were categorized in 3 classes and 8 families. The majority of the identified bacteria were belonged to the γ-proteobacteria class, including Pseudomonas sp. and Aeromonas sp. and the others were some closely related to those found in other vector mosquitoes, including Pantoea, Acinetobacter, Brevundimonas, Bacillus, Sphingomonas, Lysinibacillus and Rahnella. The 16S rRNA sequences in the current study aligned with the reference strains available in GenBank were used for construction of the phylogenetic tree that revealed the relatedness among the bacteria identified. The presented data strongly encourage further investigations, to verify the potential role of the detected bacteria for the malaria control in Iran and neighboring countries.

Patients with inflammatory bowel disease (IBD) are at increased risk of developing osteopenia and osteoporosis. The aim of the study was to investigate the prevalence of decreased bone density and related risk factors in Iranian IBD patients. A total of 126 ulcerative colitis (UC) and 39 Crohn's disease (CD) patients were enrolled. Dual-energy x-ray absorptiometry technique was used to measure bone density, and blood samples were obtained to measure biochemical markers. To find predictive variables for bone mineral density (BMD), stepwise regression analysis was carried out. A total of 53 IBD patients (32.1%) had diminished bone mineral density at either lumbar spine (L1-L4) or femoral neck. Of these, 9 (5.4%) had osteoporosis; however, 44 (26.7%) were osteopenic. Femoral neck bone density was significantly decreased among CD patients (p<0.04). There was no significant difference in BMD between men and women. We have found significant differences in BMD T scores at lumbar L1-L4, L2-L4, and femoral neck in corticosteroid ever-users (p<0.002, p<0.001, p<0.003, respectively). There was no significant difference in biochemical markers between UC and CD patients, except that more CD patients were hypocalcemic (p<0.001). Stepwise regression analysis has revealed lumbar spine T score was predicted by age (p<0.0001), corticosteroid use (p<0.002), and body mass index (BMI) (p<0.005); however, femoral neck was predicted by age (p<0.0001), BMI (p<0.0001), smoking (p<0.009), and corticosteroid use (p<0.028). Low bone density in Iranian UC and CD patients is in accordance with Western societies. Treatment with corticosteroid has increased this possibility in both groups. Corticosteroid use, age, smoking, and BMI are predictive factors for low bone density.