A Survey over the Dentists’ and Endodntists’ Approaches towards the Management of Endodontic Emergencies in Mashhad, Iran

Introduction: Pain or swelling caused by various stages of inflammation/infection of the pulp/periradicular area is called endodontic emergencies. Determining the most effective method of emergency treatment is a challenging issue in endodontics. The goal of this study was to determine and compare the level of knowledge in general dentists and Endodontists about endodontic emergency treatment plan in Mashhad, Iran in 2012-2013. Methods and Materials: In this cross-sectional descriptive study, 152 questionnaires were distributed among 120 general dentists and 32 Endodontists of Mashhad. The questionnaire contained two separate parts. The first part included demographic information and in the second part different treatment protocols were suggested for 12 various conditions of pulp/periapical emergencies, and the participants were asked to choose the correct option(s). To determine the relationship between qualitative variables, the chi-square analysis was used. The level of significance was set at 0.05. Results: There were significant differences between treatment plans presented by general dentists and Endodontists about endodontic emergencies, especially in cases of necrotic pulp and subsequent swelling. Conclusion: Level of knowledge of dentists about the indications of incision and drainage, intra-canal medicament, root filing beyond the apical foramen and antibiotic prescription was not enough. These findings highlight the importance of refreshing courses for general dentists to improve their competency in the management of endodontic emergencies.Keywords: Emergency; Endodontics; Endodontists; Flare Up; General Dentists; Level of Knowledg

The effect of oral royal jelly on clinical disease activity index (CDAI) and morning stiffness in patients with rheumatoid arthritis (RA); A randomized double-blind, placebo-controlled trial

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease which can cause articular destruction and disability in patients. Current therapies are relatively effective and sometimes harmful. Royal Jelly with anti-inflammatory and anti-oxidative properties may be used as an adjunct therapy. The aim of this study was to assess the effect of Royal Jelly on Clinical Disease Activity Index (CDAI) and morning stiffness in patients with rheumatoid arthritis. Methods: According to American College of Rheumatology (ACR) 1987 classification criteria, 80 patients with RA, who had active disease (CDAI > 2.8), were randomly assigned to receive Royal Jelly or placebo beside background treatment for 3 months. Morning stiffness, tender joint count (TJC), swollen joint count (SJC), evaluator global assessment (EGA) and patient's global assessment (PGA) based on visual analogue scale (VAS) were determined before and after 3 months of intervention. The changes in aforementioned indexes were analyzed by SPSS software. Findings: 65 patients completed the study (35 in Royal Jelly and 30 in placebo group). The sex, age, residence, disease duration and drug consumption had no significant changes (P > 0.050). In the first group, CDAI (P = 0.012), SJC (P = 0.024), TJC (P = 0.027), and morning stiffness (P = 0.004) had significant statistical changes; but only changes in morning stiffness were statistically different between the two groups (P < 0.05). Conclusion: Royal Jelly has good effect on morning stiffness but not on CDAI and may be a suitable adjunct therapy. Further studies may demonstrate more significant results

Inflammatory Myofibroblastic Tumor Report of a Rare Case in Kidney

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm mostly seen in the lungs, but also in extrapulmonary sites. The most common genitourinary site of IMT is the bladder, but it may rarely be seen in the kidneys. We report a case of a 15-year-old girl presented with flank pain and hematuria, in which computed tomography scan revealed a mass in the left kidney. The patient underwent left nephrectomy for a diagnosis of Wilms tumor. Further assessment of the tissue demonstrated a pathologic diagnosis of IMT. Despite improvements in imaging technology, the preoperative diagnosis of IMT remains difficult and surgery is the only way for the diagnosis and treatment. Considering the role of the pathologic examination in making the definite diagnosis of IMT, we should be aware of this entity and it must be considered in the differential diagnoses

Phenotypic and Molecular Characterization of Extended-Spectrum beta-Lactamase Produced by Escherichia coli, and Klebsiella pneumoniae Isolates in an Educational Hospital

Background: Extended-spectrum beta-lactamases (ESBLs) are a group of enzymes that hydrolyze antibiotics, including those containing new cephalosporins, and they are found in a significant percentage of Escherichia coli and Klebsiella pneumoniae strains. With the widespread use of antibiotics, difficulties with infection therapy caused by drug resistant organisms, especially those that have acquired resistance to beta-lactams, such as broad-spectrum cephalosporins, have amplified the above-mentioned organisms. Objectives: This study was conducted to characterize ESBLs among E. coli and K. pneumonia isolates by molecular and phenotypic methods. Materials and Methods: Different strains of E. coli and K. pneumonia were collected from patients with urinary tract infections. The ESBL phenotype was determined by a double disk diffusion test (DDDT). In addition, polymerase chain reaction (PCR) analysis specific for beta-lactamase genes of the TEM and SHV family was carried out. The PCR products were run on agarose and examined for DNA bands. Results: A total of 245 E. coli and 55 K. pneumonia strains were isolated from different samples. In total, 128 of the 300 isolates were confirmed as potential ESBLs producers as follows: 107 (43.67%) E. coli and 21 (38.18%) K. pneumonia. ESBLs genes were found in 24 isolates (18.75%): 21 E. coli and 3 K. pneumonia isolates. The TEM gene was present in 13 (12.14%) E. coli strains, but it was not detected in K. pneumonia. In addition, the SHV gene was present in 8 (7.47%) E. coli and 3 (14.28%) K. pneumonia isolates. Five (4.67%) of the E. coli isolates harbored both TEM and SHV genes. All isolates (100%) were susceptible to imipenem. The lowest rates of resistance to other antibiotics were observed for; piperacillin-tazobactam (6.25%), amikacin (12.5%) and gentamicin (14.84%). The rates of resistance to other antibiotics were as follow: nitrofurantoin (16.4%), nalidixic acid (23.43), co-trimoxazole (25%), cefepime (32%), ciprofloxacin (55.46%), ampicillin (69.53%), ceftazidime (100%), and cefotaxime (100%). Conclusions: The results of this study indicate the widespread prevalence of ESBLs and multiple antibiotic resistance in E. coli and K. pneumoniae. Therefore, beta-lactam antibiotics and beta-lactamase inhibitors or carbapenems should be prescribed based on an antibacterial susceptibility test

A Comparison of RAMP Troponin Test Results with Highly Sensitive Laboratory Troponin in Patients Suspected of Acute Myocardial Infarction

Introduction: Current guidelines recommend using high-sensitivity troponin (hs-cTnl) assays to manage patients with acute coronary syndrome (ACS) symptoms. Despite this, bedside testing (POC) is commonly used in the emergency room, as it reduces the patient's response time and hospital stay. This study seeks to compare the results of the RAMP- cTnI test with the results of laboratory troponin (hs-cTnl) as the gold standard.Methods: The present study was performed on 148 patients with suspected acute coronary syndrome referred to Shiraz Namazi Hospital between March and July 2021. Blood samples were taken immediately from patients referred to the emergency department for POC and high-sensitivity troponin test (as gold standard). Enzyme-Linked Fluorescent Assay (ELFA) was used to evaluate troponin (cTnl). The POC test was performed using a RAMP device, which allows the rapid measurement of cTnl in the patient's bedside within 10 minutes using a whole blood sample.Results: Of the 148 patients, 35 were hs-cTnI positive. Sensitivity, specificity, the positive and negative predictive values of RAMP- cTnI compared to high sensitivity test with 95% confidence interval were 91.42 (93.63-85.84), 94.69% (97.95%-87.55), 84.21% (93.56-77.82) and 97.27% (99.56-87.82), respectively.Conclusion: The study showed that the quantitatively new RAMP- cTnI method was statistically acceptable with hs - cTnI regarding the accuracy of acute myocardial infarction. RAMP- cTnI was found to be suitable for detecting acute myocardial infarction in the emergency department

Association between neutrophil geletinase-associated lipocalin and iron deficiency anemia in children on chronic dialysis

Background: Iron deficiency anemia (IDA) in children with chronic kidney disease (CKD) is common and associated with higher risk of death. Neutrophil geletinase-associated lipocalin (NGAL) is a small 25 kDa glycoprotein, a member of lipocalin superfamily that released at the response of cellular stress from different cells. In addition, NGAL was studied as an iron regulatory glycoprotein and regulator of iron related gene. The aim of the current study was to determine any association between serum NGAL and body iron status markers in children on chronic dialysis. Materials and Methods: This correlation study was carried out between May 2012 and May 2013 and evaluated all dialysis patients less than 19 years in pediatric dialysis centers in Isfahan that didn’t have exclusion criteria. They were 40 children, including 23 persons on hemodialysis (HD) and 17 persons dialyzed by peritoneal dialysis (PD). Furthermore, we selected 40 children as healthy controls. We examined the relationship between plasma NGAL levels and indices of anemia such as ferritin, transferrin saturation (TSAT) and serum iron (SI) in dialysis children. Results: Serum NGAL level in children on chronic dialysis (group including both PD and HD patients) was significantly higher than healthy controls (P = 0.008). Furthermore, in this group Serum NGAL level had inverse correlation with TSAT (P = 0.04, r = −0.22), SI (P = 0.04, r = −0.2), white blood cells (P = 0.045, r = −0.26) and serum ferritin (P = 0.006, r = −0.3). In addition, HD patients had higher serum NGAL level than PD patients (P = 0.048). Conclusion: High serum NGAL level in low TSAT group demonstrated that NGAL probably has an important role in IDA in children on chronic dialysis; therefore, it can be a new marker for diagnosis of IDA in CKD

Periosteal Releasing Incision With Diode Laser in Guided Bone Regeneration Procedure: A Case Series

Introduction: Periosteal releasing incision (PRI) is nearly always essential to advance the flap sufficiently for a tension-free flap closure in bone augmentation procedures. However, hematoma, swelling, and pain are recognized as the main consequences of PRI with scalpel. The aim of this case series was to investigate the effectiveness of laser-assisted PRI in guided bone regeneration (GBR) procedure. In addition, postoperative hematoma, swelling, and pain and implant success were assessed.Methods: Seventeen patients needed GBR were included in this study. Diode laser (940 nm, 2 W, pulse interval: 1 ms, pulse length: 1 ms, contact mode, 400-μm fiber tip) was used in a contact mode to cut the periosteum to create a tension-free flap. Facial hematoma, swelling, pain, and the number of consumed nonsteroidal anti-inflammatory drugs (NSAIDs) were measured for the six postoperative days. Six months after implant loading, implant success was evaluated.Results: Minimal bleeding was encountered during the procedure. A tension-free primary closure of the flap was achieved in all cases. The clinical healing of the surgical area was uneventful. None of the patients experienced hematoma, ecchymosis, or intense swelling after surgery. The mean value of maximum pain (visual analogue scale – VAS) was 20.59 ± 12.10 mm (mild pain). Patients did not need to use NSAID after four postoperative days. All implants were successful and functional and none of them failed after 6 months of implant loading.Conclusion: This study revealed the effectiveness of laser-assisted PRI in GBR procedure. This technique was accompanied with minimal sequelae at the first postoperative week. All implants were successful and no complication was noted during the course of this study

Cloning of the Recombinant Cytochrome P450 Cyp141 Protein of Mycobacterium tuberculosis as a Diagnostic Target and Vaccine Candidate

Background: Tuberculosis has been announced as a global emergency by World Health Organization and the second infectious agent of mortality worldwide. The general policy in the development of new vaccines is to develop some vaccines with higher efficiency not only for infants but also for adults compared with the Bacillus Calmette-Guerin vaccine. Recently, cytochrome P450 cyp141 has been introduced as a new target for detecting Mycobacterium tuberculosis from clinical samples. Objectives: The aim of this study was to clone this gene in order to pave the way for more evaluation. Materials and Methods: M. tuberculosis H37Rv DNA was extracted by a standard phenol-chlorophorm protocol. After designing the specific primers, P450 cyp141 gene was replicated by PCR. The purified PCR products were then subcloned into the pTZ57R/T plasmid vector. After extraction, enzyme digestion, and recombinant pTZ57R/T-cyp141 plasmid vector sequencing, the aforementioned products were cloned into a pET-26b plasmid vector. Then, the recombinant pET26b-cyp141 plasmid molecules were transformed to Escherichia coli strain BL21 (DE3) using the transformation method. Next, the recombinant pET26b-cyp141 plasmids were purified and evaluated by the enzyme digestion analysis. Results: The cloning of P450 cyp141 gene was confirmed by the enzyme digestion and sequencing of the recombinant pTZ57R/T-cyp141 and pET26b-cyp141 plasmid vectors. Conclusions: The results of this study demonstrated that the P450 cyp141 gene was successfully cloned into a pET26b plasmid vector as an expression vector. In this paper, for the first time in Iran, this gene was cloned for more purposes, including the expression and purification of the recombinant cytochrome P450 cyp141 protein