The role of routine transanastomotic T tube ostomy in jejunoilealatresia:A prospective, randomized study

Introduction: Jejunoileal atresia (JIA) is a common cause of neonatal intestinal obstruction and is a common surgical emergency. The aim of this study was to compare primary anastomosis without resection of the dilated segment with transanastomotic T tube jejunostomy (TATTO) versus resection of the dilated segment without T tube as the control group for treatment of patients with JIA.Material and Methods: During 2008 to 2013, 105 patients were diagnosed with JIA at the time of surgery and were recruited for this study. Data relating to efficacy and procedural complications were compared among patients. The criteria for exclusion were duodenal obstruction, colonic atresia, intestinal perforation, malrotation, and also JIA patients with associated other anomalies like meconium ileous, gastroschisis and anorectal malformation.Results: A total of 125 patients were diagnosed and 16 patients were excluded. Our patients were divided into a control group (n=52) and a TATTO group (n=57). The TATTO group had a significantly shorter postoperative hospital stay (12 vs. 23 days, p=0.001) and time to start feeding (9 vs. 13 days, p=0.003) compared with the control group. Sepsis (12.0% vs. 32.7% p=0.004), other complications (3.6% vs. 15.4% p=0.001) and the associated morbidity were significantly lower in the TATTO group.Conclusion: The findings suggest that the TATTO technique was a better method for the treatment of children with JIA, as study showed lesser morbidity and mortality rates.

Fully Digital versus Conventional Workflows for Fabricating Posterior Three-Unit Implant-Supported Reconstructions: A Prospective Crossover Clinical Trial.

This study assessed the clinical variables influencing the success of three-unit implant-supported fixed dental prostheses (ISFDPs) fabricated using either fully digital or conventional workflows. The clinical trial evaluated 10 patients requiring three-unit ISFDPs in the posterior mandible. Maxillomandibular relation records, and digital and conventional impressions were obtained from each patient using an intraoral scanner (IoS) and polyvinylsiloxane (PVS), and the frameworks were fabricated using zirconia and cobalt-chromium, respectively. A 2 µm accuracy scanner scanned the conventional master casts and standard reference models. The stereolithography (STL) files of the digital and conventional impressions were superimposed on the standard model file, and the accuracy was calculated with the best-fit algorithm. The framework adaptation and passivity were assessed using the one-screw and screw resistance tests. The time required for occlusal adjustment of both types of reconstructions, including the duration of the whole treatment, was recorded. The aesthetic appearance of ISFDPs was rated by each patient and clinician using a self-administered visual analogue scale questionnaire and the FDI World Dental Federation aesthetic parameters, respectively. The sample size was based on the power calculation, and alpha was set at 0.05 for the statistical analyses. The impression accuracy, framework adaptation and passivity, and reconstructions aesthetics did not significantly differ between the digital and conventional approaches. The total fabrication time was significantly shorter using the digital workflow. Within the limitations of this clinical study, the fully digital workflow can be used for the fabrication of ISFDPs with a clinical outcome comparable to that of the conventional workflow

Debonding Time and Dental Pulp Temperature With the Er, Cr: YSGG Laser for Debonding Feldespathic and Lithium Disilicate Veneers

Introduction: The removal of ceramic veneers is a time-consuming procedure in a dentaloffice. Little research has been done in alternative removal techniques for ceramic veneers.The objective of this study was to evaluate the removal of feldspathic and lithium disilicatereinforced glass ceramic veneers by Er, Cr: YSGG and to measure debonding time and pulpaltemperature increase during veneer removal.Methods: Fifty-seven bovine incisor teeth were prepared and divided into 3 groups. Ceramicspecimens with a thickness of 0.7mm, a width of 4mm and a length of 8 mm were fabricatedfrom feldspathic ceramic, lithium disilicate reinforced glass ceramic HT (high translucency) andlithium disilicate reinforced glass ceramic MO (medium opacity) (19 for each group). Specimenswere cemented on the labial surface of incisors using resin cement. The Er, Cr: YSGG laserwas applied to each specimen at 2.5 W and 25 Hz. Debonding time was measured for eachspecimen, and the intrapulpal temperature was detected in 3 specimens for each group. Datawere analyzed via one-way analysis of variance (ANOVA) at significance level of 0.05 (α = 0.05).Results: Mean debonding time was 103.68 (26.76), 106.58 (47.22) and 103.84 (32.90) secondsfor feldspathic, lithium disilicate MO, and lithium disilicate HT respectively. There was nosignificant statistical difference among the groups (P value = 0.96). The intrapulpal temperatureincrease was less than 1°C in all groups.Conclusion: Er, Cr: YSGG can successfully be used to efficiently debond feldspathic and lithiumdisilicate reinforced glass ceramic veneers. There was no significant difference for debondingtime among these ceramic materials. During ceramic laminate veneer removal by laserirradiation, no irritating temperature rise was detected

Neuroimaging Findings of the High-risk Neonates and Infants Referred to Mofid Children’s Hospital

Abstract Objectives Neuroimaging in high-risk neonates and infants is done to help child neurologists predict the future neurodevelopmental outcome of these children. In this study, we assessed high-risk neonates and infants admitted to the NICU or neonatal wards of Mofid children’s Hospital, especially regarding clinical development and brain imaging Materials & Methods This cross-sectional study was conducted on 170 patients admitted to the neonatal and NICU ward of Mofid children’s Hospital.Considering the inclusion criteria, 112 patients were included in this project. Brain ultrasonography was performed on almost all of these babies by a single radiologist. Some patients underwent a brain CT scan, and brain MRI without contrast was done on the others. These images were interpreted and compared by a single pediatric neuroradiologist blinded to clinical data. All of these babies were followed up until 18 months of age. Results In this study, 57.1% of the patients were male and 42.9% were female. Of 44 patients who obtained Electroencephalogram (EEG) during the hospitalization period with probable seizure, 25 (56.8%) had normal EEGs. Of 89 babies who were examined by ultrasound, 19 (21.3%) had abnormal findings; ventriculomegaly and then germinal matrix hemorrhage (GMH) were the most common abnormalities.Also, 27 cases (71.1%) of 38 patients undergoing a CT scan had abnormal findings. The most common findings were a hypodense area in the white matter and ventriculomegaly. Of 41 patients who underwent MRI between 1 and 27 months, 34 cases (82.9%) had an abnormal MRI. The most common findings were periventricular hyperintensities in 17 cases (41.5%), mildly delayed myelination in 15 cases (36.6%), and severe brain atrophy or thinning of corpus callosum or white matter volume loss in seven cases (17.1%). During the follow-up period, which was 18.55 ± 6.56 months, 79 (70.5%) of the children had normal development and 33 (29.5%) were suffering from a global neurodevelopmental delay. More precisely, 49 (43.7%) and 35 (31.2%) patients had motor development delay and delayed verbal development, respectively. The abnormal findings of brain imaging in the ultrasound, CT scan, and MRI were all significantly associated with an adverse neurodevelopmental outcome (P <0.001, P = 0.02, and P <0.001, respectively). ConclusionIn this study, we showed that at any time before six months or afterone year of age, the result of brain MRI was a strong predictor of thepatient’s outcome

Iranian clinical practice guideline for amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3–5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations

Diaper Type as a Risk Factor in Urinary Tract Infection of Children

Objective: Urinary tract is one of the most common sources of infection in children under the age of two years. Many known and unknown risk factors predispose to this important disease in children. This study was conducted to determine whether using a specific type of diaper plays a role in urinary tract infection (UTI) in girls under the age of 2 years. Methods: This case control study was performed in hospitalized children; girls with their first urinary tract infection were selected as cases, and those admitted for other reasons comprised the control group. Two groups were matched for age (±1 month), and other known risk factors for UTI. Type of diapers (superabsorbent, standard disposable and washable cotton), used for these children during six months, from October 2007 to March 2008, were compared in both groups. Findings: Fifty-nine matched pair infant girls less than 2 years were selected. It was revealed that in cases with UTI superabsorbent diapers were used more frequently than in controls (Odds ratio =3.29, P-value=0.005) There were no significant differences in other factors like number of diapers used per day, the time between defecation and diaper change, mothers’ educational level, level of family income and mother’s occupation. Conclusion: The use of superabsorbent diapers could be a risk factor for urinary tract infection in infant girls

Evaluation of Symmetrical or Asymmetrical Pattern of Nursing Caries in 3-5 Year-Old Children at Kindergartens in Tehran During 2009-2010

Background and Aims: Nursing Caries (NC) is a destructive form of caries because of incorrect nutritional habits in infants that affects deciduous teeth after eruption. Familiarity with the pattern of this type of caries and evaluation of its symmetrical or asymmetrical pattern is necessary for effective and scientific diagnosis and treatment. The aim was to assess the symmetrical or asymmetrical aspects of Nursing Caries in children between3-5 years old.Materials and Methods: In this cross-sectional study, 10 kindergartens were randomly selected by the TehranWelfare Organization. 115 children with NC caries entered to study after examination. Written consents were obtained from the parents. The dmfs in upper primary incisors and upper and lower primary canines, as well as the first primary molars were assessed and the caries pattern in terms of symmetrical or asymmetrical aspects wasevaluated. The data were analyzed by ANOVA, LSD, Chi-square and Fisher tests.Results: In 53.9% of the children with NC, the anterior teeth were affected symmetrically, while 46.1% indicated an asymmetrical pattern. In general, 32.2% of the teeth were affected in a symmetrical pattern and 67.8% of them in an asymmetrical pattern. About the relationship between the breastfeeding from the right or left breast and the symmetrical pattern of the NC, 51% of the children were equally breastfed from both breasts. However, in the asymmetrical NC pattern with more impact in the right side of dentition, 50% of the children had been breastfed from the left side and in children with more caries in the left side of dentition, 50% of them had been breastfed rom the right side (P=0.01).Conclusion: NC has symmetrical and asymmetrical patterns. Direction of mother for breastfeeding affects the symmetrical and asymmetrical pattern of NC

Social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population: An application of the health action process approach model.

ObjectiveThe present study aimed to identify the social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population, based on the Health Action Process Approach (HAPA) model.BackgroundRegular dental visits and mouth self-examination can prevent oral and dental problems among the elders. Little information is available regarding the social cognitive predictive factors of these two behaviors.Materials and methodsA cross-sectional study was conducted in 24 municipality centers in Tehran, Iran in 2021. The centers were selected randomly using a multi-stage cluster sampling method and 301 elderly attendants aged 60≥years participated in the study. Data collection was done using a researcher-made questionnaire including demographic characteristics and the HAPA model constructs for two target behaviors. Data were analyzed using the Smart-PLS version 3.3.9 via correlation and PLS-SEM analysis.ResultsThe mean age of the participants was 65.3±5.33 years and 79.7% were female. The SEM analysis showed that Action Self-Efficacy [b (SD) = 0.595 (0.065), PConclusionAction self-efficacy predicted the intention for regular dental visits and mouth self-examination behaviors. The relationship between intention and both behaviors was mediated by Planning. Emphasis on improving Action Self-Efficacy and Intention formation will enhance the effectiveness of interventions aiming at promoting the oral health of the elderly population

Evaluation of Morphology and Anatomical Measurement of Nasopalatine Canal Using Cone Beam Computed Tomography

Objectives: Precise radiographic assessment of the nasopalatine canal is required to prevent implant failure. The purpose of the current study was to determine the three dimensional (3D) morphology, as well as the dimensions of the nasopalatine canal using cone beam computed tomography (CBCT). Materials and Methods: In this descriptive cross-sectional study, maxillary CBCT images from 300 patients (150 men, 150 women) were retrospectively evaluated. Sagittal and coronal views were reviewed to determine the nasopalatine canal morphology and dimensions. The difference in canal dimensions between men and women was evaluated using the Student’s t-test while the difference in canal morphology between the two sexes was assessed using Chi-square test. Results: A total of 199 (66.3%) patients had type A canal (cylindrical without a branch), 69 (23%) had type B canal (a canal with a branch in the upper part), and 32 (10.7 %) had type C canal (a canal with a branch in the middle part). Incisive foramen diameter was 4.7±1.11mm on the sagittal section. Alveolar bone width in the anterior part of the canal was 12.3±1.7mm in the upper one third, 10.7±1.7mm in the middle one third, and 9.8±1.4mm in the lower one third. The angle of canal with palate was 109.5±5.7°. On the coronal sections, canal length was 14.1±3.0mm, incisive foramen diameter was 4.6±1.0mm, and canal diameter in the nasal floor was 5.1±1.0mm.                           Conclusions: Significant differences in canal morphology were observed among the patients and CBCT was useful in determining nasopalatine canal morphology and its dimensions before implant placement.