Hepatic Lymphomas Post Renal Transplantation May Signify Worse Disease Behavior: Analysis of Data from 26 International Studies

Introduction: Hepatic involvement by posttransplant lymphoproliferative disorders (PTLD) is an important but rarely investigated issue. In the current study, we aimed to pool data of cases of PTLD localization in liver (L-PTLD) among renal allograft recipients from different series to find new perspectives on the disease. Methods: We conducted a comprehensive search for the available data through PubMed and Google Scholar for reports of PTLD localization in the liver and surrounding lymph nodes in renal allograft recipients. Data of 232 cases from 26 international studies have been pooled and reanalyzed. Results: Patients with L-PTLD were significantly more likely to be of male gender (P=0.02). Death due to PTLD was higher in L-PTLD patients (P=0.06). Disseminated PTLD, based on our definition, was significantly more prevalent in L-PTLD than in none-liver-PTLD (NL-PTLD) (P<0.001); the same finding was noted with multi-organ involvement which was significantly higher in L-PTLD (P<0.001). L-PTLD was significantly more likely to complicate heart (P=0.03), bone marrow (P=0.002), spleen (P=0.01), and kidney allograft involvement (P=0.04). Conclusion We conclude that renal transplant patients exhibiting liver localization for PTLD should be carefully followed for multi-organ involvement. Most notably, bone marrow biopsy should be considered, and evaluations for renal allograft, heart and spleen localization for PTLD should be executed. Due to the unfavorable characters of liver localization by PTLD in renal recipients, we propose higher levels of evaluations and follow up for these patients. Prospective studies with larger patient populations are needed to confirm our results.Keywords: Kidney Transplantation; Liver Localization; Lymphoproliferative Disorder

Influence of Bovine Serum Albumin on the Antibacterial Activity of Endodontic Irrigants against Enterococcus Faecalis

INTRODUCTION: It has been demonstrated that organic content of the root canals can influence the antimicrobial capability of chemical irrigants. The aim of this study was to evaluate the effect of bovine serum albumin (BSA), as an organic material, on the antimicrobial activity of several intracanal irrigants. MATERIALS AND METHODS: Bactericidal activity of Ethylenediaminetetraacetic acid (EDTA) 17%, citric acid 10%, Sodium hypochlorite (NaOCl) 5.25%, Chlorhexidine 0.2% (CHX), Smear Clear and Cetrimide 0.5% were tested by means of dilution-neutralization method. Contact times were 10 and 30 seconds, 5, 10, 30, 60 minutes and 24 hours. First 950 λ of the medicament was mixed with 50 λ of the bacterial suspension in an Eppendorf test tube. The suspensions were thoroughly mixed. Sterile water served as negative controls. After each contact time, 100 λ of samples was transferred to the Eppendorf test tubes which contained neutralizers. After 5 minutes, 50 λ of serial dilutions were cultured on brain heart infusion agar and incubated in aerobic conditions. Then colonies were counted and reported as cfu/mL. In half of the samples, medicaments were suspended in BSA 0.5% 30 minutes before examination to assess its possible inhibitory effect on the antibacterial activity. RESULTS: NaOCl 5.25%, Cetrimide 0.5% and Smear Clear showed bactericidal activity within seconds after the incubation. BSA had no inhibitory effect on bactericidal activity of these three medicaments. CHX took 5 and10 minutes to kill all bacterial cells in the absence and presence of BSA, respectively. Citric acid and EDTA showed the least antibacterial activity. CONCLUSION: In this study, NaOCl 5.25%, Cetrimide 0.5% and Smear Clear were significantly more effective against E. faecalis than EDTA 17% and citric acid 10% in the presence and absence of BSA. Also, in the presence of BSA, bactericidal activity of CHX 0.2% against E. faecalis was significantly more than EDTA after 10 and 30 minutes of contact time. EDTA and citric acid showed the least bactericidal activity

Comparison of Antibacterial Effect of Four Irrigation Solutions in Primary Root Canal Infections: A Clinical Study

Introduction: Reducing the bacterial count from the root canal system is one of the main stages in root canal treatment. The aim of the present clinical study was to compare the antibacterial effect of four intracanal irrigants in primary endodontic infections using both microbiological culture and quantitative Real-time Polymerase Chain Reaction (qRT-PCR) technique. Methods and Materials: Forty patients with primarily infected single rooted premolars were selected and then randomly divided into 4 groups according to the intra canal irrigant used: 5.25% Sodium hypochlorite (NaOCl), Hypoclean (Ogna Laboratori Farmaceutici, Muggiò, Italy), 2% chlorhexidine glouconate (CHX) and CHX-Plus (Vista Dental Products, Racine, WI, USA). Samples were collected before and after chemomechanical preparation and were evaluated by bacterial culture and RT-PCR technique for Enterococcus faecalis and Fusobacterium nucleatum. Data analyzed by repeated measured ANOVA. The significance level was set at 0.05. Results: Four irrigation solutions significantly reduced the total numbers of cultivable bacteria (P<0.05). No statistically differences were found among the antibacterial effects of 5.25% NaOCl (99.93%), Hypoclean (99.94%), 2% CHX (99.77%) and CHX-Plus (99.83%) in reducing cultivable bacteria. Enterococcus faecalis and Fusobacterium nucleatum were no longer detected after preparation using four irrigants (100% reduction). Conclusions: All tested irrigants including 5.25% NaOCl, Hypoclean, 2% CHX and CHX-Plus significantly reduced the number of bacterial colonies in primary endodontic infections.Keywords: CHX-Plus; Endodontic Infection; Enterococcus faecalis; Fusobacterium nucleatum; Hypoclea

Female gender and Helicobacter pylori infection, the most important predisposition factors in a cohort of gastric cancer: A longitudinal study

Background: Gastric cancer (GC) is one of the most common Cancers in the world and Helicobacter pylori (HP) infection is considered a causative factor. The aim of this study was to determine the characteristics and the associated factors of (GC) in a small cohort. Methods: Overall, 54 patients with diagnosed gastric cancer were followed-up at the Department of Gastroenterology&Hepatology at Baqiyatallah University of Medical Sciences. 37 (68.5) of them were positive for H pylori infection in histopathological evaluations. Univariate and multivariate regression analyses were used to determine the associations of demographic features and HP infection status with GC characteristics and prognosis. Results: Univariate analysis showed female gender (odds ratio (OR): 6.53; 95 confidence interval (95CI): 1.59-26.8; P=0.008), and illiteracy (compared to intermediate education; OR: 5.9, 95CI: 1.37-25.43; p=0.05) were associated significantly with higher rate of HP infection. After a mean±SD follow-up duration of 254±329 months, only female gender was significantly associated with HP infection in GC (OR:4.56; 95 CI: 1.0-21.76; P=0.05). H pylori positive patients had significantly higher grade of GC (OR: 3.97; 95 CI: 1.0-16.16; P=0.05), and a trend toward greater GC stage (OR: 4.46, 95 CI: 9.39-21.23; p=0.06). There was no association between survival rate and H pylori infection. Conclusion: In the current study, we found a significant association of female gender with GN and an association of higher grade of GC with female gender. These findings may indicate a sex disparity in susceptibility to HP infection regarding GC future studies of larger populations are recommended

Pregnant Women in the Exposure to COVID-19 Infection Outbreak: The Unseen Risk Factors and Preventive Healthcare Patterns

These days, the most important health challenge in the world is the outbreak of novel coronavirus (COVID- 19) infection. In December 2019, this viral disease originated as human-to-human transmission (HHT) in China's Wuhan city and then epidemically spread around the globe [1]. Based on the WHO data, HHT happens with close contact through sneezing and producing the respiratory droplets of infected individuals. There are two possible transmission routs for COVID-19: (i) settling these droplets in the mouth or nasal mucosa and lungs of people with inhaled air, and (ii) touching the disease-ridden surfaces or infected objects and subsequently touching hands to the mouth, nose, or eyes [2]. Due to the convenient ways to transmit viral infection, the aggressive prevalence of COVID-19 pneumonia, and its extensive social and economic impacts, there is an urgent need to explore health management tactics for slowing down the transmission of COVID-19 and decreasing the related-illness and death rate. It has been proven that this viral infection has a more pronounced effect on the elderly and patients with underlying diseases (e.g., hypertension, diabetes mellitus, cardiovascular diseases (CVDs), etc.) [3] Pregnant women are one of the most critical population groups with a need to take additional precautions against the Covid-19 outbreak as a high risk of vertical transmission of COVID-19 in the late third trimester has been reported [4,5]. Besides, the presence of gestational diabetes mellitus (GDM) and preeclampsia in pregnancy may significantly weaken the immune system and increase the risk of COVID-19 infection. In the recent decade, there has been a profound demand for utilizing the in vitro fertilization (IVF) procedure among infertile couples. Studies have shown that the risk of developing GDM and preeclampsia in women treated with IVF is much greater than with women who conceived naturally [6,7]. Therefore, there is a higher risk of Accepted ManuscriptCOVID-19 infection in women undergoing IVF. The prenatal anxiety, depression, and stress are also considered as prevalent public health issues in pregnant women. These psychological reactions can result in adverse birth outcomes such as miscarriage, preterm birth, low birth weight, and fetal death. Under the COVID-19 outbreak, stressor anxiety-related concerns of mothers about their health and the health of their babies are growing exponentially. In nulliparous pregnant women, the adverse mood symptoms accompanied by childbirth fear may have irreversible effects on mother and child health. As a result, a set of health management practices in the event of COVID-19 outbreak must be adopted not only during late pregnancy but also during the first 3 months partu

Health complaints in individual visiting primary health care: population-based national electronic health records of Iran.

BACKGROUND The mission of medical schools is a sustainable commitment to orient education, research, and services based on the priorities and expectations of society. The most common complaints of patients from comprehensive health service centers (CHSCs) based on the data from electronic health records were assessed in order to determine primary health care (PHC) priorities for the educational planning of medical students in Iran. METHODS A population-based national study was designed to assess clinical complaints of patients in all age groups who were referred to CHSCs at least once to be visited by physicians. All the data in the census were extracted from electronic health records in PHC system during 2015-2020, classified by the International Classification of Primary Care 2nd edition (ICPC-2e-English), and statistically analyzed. The total number of complaints that were recorded in the system was 17,430,139. RESULTS 59% of the referring patients were women. The highest number of referrals was related to the age group of 18-59 years (56.9%), while the lowest belonged to the elderly people (13.3%). In all age and sex groups, the first ten complaints of patients with three top priorities in each category included process (follow-up, consultation, and results exam), digestive (toothache and gum complaint, abdominal pain, and diarrhea), respiratory (cough, sore throat, and runny nose), general (fever, pain, and weakness and fatigue), musculoskeletal (back pain, leg complaint, and knee injuries), endocrine and nutritional (weight gain, Feeding problem, and weight loss), cardiovascular (hypertension, palpitations, and Postural hypotension), neurological (headache, dizziness, and paralysis), sexual dysfunction (vaginal complaint, discharge, and irregular menstruation), and dermatological (pruritus, rash, and inflammation) problems. CONCLUSION High priorities in referring to PHC had a key role in assessing the country's health needs. Since this study was in line with the national pattern of complaints and patients' profile, the present findings can be helpful to amend policy-making, educational planning and curricula development in medical schools

Efficacy of ProTaper and Mtwo Retreatment Files in Removal of Gutta-percha and GuttaFlow from Root Canals

Introduction: The aim of this in vitro study was to compare the efficacy of ProTaper retreatment (ProTaper R) and Mtwo retreatment (Mtwo R) files in removing gutta-percha and GuttaFlow from endodontically treated straight root canals. Methods and Materials: The root canals of 60 human mandibular single-rooted premolars were prepared and randomly divided into two groups (n=30). In groups A and B the root canals were obturated using lateral condensation of gutta-percha plus AH 26 and GuttaFlow, respectively. The canal orifices were temporarily sealed and the roots were incubated for 3 months at 37ºC and 100% humidity. Primary cone-beam computed tomography (CBCT) images were taken after incubation period. The specimens in each group were randomly divided into two subgroups (n=15). ProTaper R files (D1, D2, and D3) were used in groups A1 and B1 while Mtwo R files (25/0.05 and 15/0.05) were used in groups A2 and B2. The time required to extirpate the root filling was also recorded. After retreatment, another CBCT scan was taken at the same position. The volume of remaining filling materials inside the canals was calculated before and after retreatment. The data was analyzed using the two-way ANOVA and independent t-test. Results: The remaining filling materials in the canals treated with ProTaper were less than Mtwo. The remaining volume of GuttaFlow was less than gutta-percha regardless of the system applied. Mtwo R files removed root fillings faster than ProTaper R. Conclusion: ProTaper R removed filling material more efficiently compared to Mtwo R which required less time to remove root filling material.Keywords: Gutta-Percha; Mtwo Retreatment Files; ProTaper Retreatment Files; Root Canal Retreatmen

Internal Evaluation of the Endodontics Department, School of Dentistry, Tehran University of Medical Sciences

Background & Objective : Internal evaluation is a process concerning information collection and judgment in order to improve educational activities. Considering some facts related to educational measurement and collecting information will lead to a better understanding of the mentioned process. In this study, we conducted the internal evaluation of the endodontics department in Tehran University of Medical Sciences, which is responsible for training dentistry students and residents. Methods : In this descriptive study, internal evaluation was conducted using 10 steps in 9 fields including management and organization, faculty members, learners, human resources and support, educational, research, and other atmospheres, facilities regarding education, research, etc., courses, educational programs, teaching and learning process, patients and finally graduates’ satisfaction. Data was collected using observation, interview, questionnaire, and checklist. Results : According to the definition of satisfactory, results of this study were mostly qualitative and in some cases they were quantitative. The average result of the internal evaluation of the endodontics department in the school of dentistry, considering 9 fields, was 73.7% which was considered as approximately satisfactory. The results for fields like faculty members and learners were satisfactory (100% and 77.8% respectively). Atmospheres and educational facilities were unsatisfactory (both were 46%) . Conclusion : According to the results, atmospheres and educational facilities which were identified as the weakest fields need more consideration and investigation. Keywords: Internal evaluation, Department, Endodontics, School of dentistry