Effect of EDDY and manual dynamic activation techniques on postoperative pain in non-surgical retreatment: a randomized controlled trial

BACKGROUND: During non-surgical retreatment process, the products such as dentin debris, root canal fillings, irrigation solutions, microorganisms and remaining pulp tissues can extrude to the apical area and can cause the postoperative pain and flare-up. Thus, the aim of this study was to evaluatethe effect of EDDY and manual dynamic activation (MDA) techniques on postoperative pain (PP) associated with retreatment. METHODS: Ninety patients scheduled for retreatment were treated at a single visit. Non-vital mandibular premolar teeth diagnosed with asymptomatic apical periodontitis were included in this study. The patients were divided into two groups (n = 45) on the basis of the need for additional irrigation activation procedures (EDDY and MDA). The patients' post-treatment pain levels were asked to rate the intensity of their pain on a 10-point numerical rating scale (NRS) at the 12th, 24th, 48th, and 72nd h and 7 days.The data were analyzed using the chi-square and Wilcoxon signed-rank test was used for within-group comparisons and Mann Whitney U test was used to compare the groups by time period. RESULTS: The difference in postoperative pain intensity between two groups was statistically significant at 12, 24, 48, and 72 h (p  0.05). Pain intensity after the treatment was lesser in the MDA groupthanin the EDDY group at 12, 24, 48, and 72 h. CONCLUSION: This study could lead us to conclude that the two activation systems can be used during endodontic retreatment with no difference at PP 7 days later. However, a comparison of the groups indicated that the EDDY resulted in significantly more PP at 12, 24, 48, and 72 h. Trial registration ClinicalTrials.gov Identifier: NCT04726670.Open Access funding provided by the Qatar National Library

Akut Astım Atağı Nedeniyle Yoğun Bakımda Takip Edilen Hastaların Özellikleri

Asthma attack is a serious reason for morbidity and mortality when it is not treated effectively at the right time. The data about efficiency of noninvasive mechanical ventilation in respiratory insufficiency due to asthma attack are scant. In this study we investigated if there is a relation between age, sex, comorbidities, asthma duration, asthma treatment, compliance to this treatment, NIV/IMV treatment efficiency if performed and its relation with severity of asthma attack, length of hospital stay and mortality. In this study we investigated the characteristics of patients with severe asthma who were treated in Hacettepe University Medical Intensive Care Unit(ICU) between January 2002 and December 2012 by reviewing the patients’records retrospectively. A total of 22 patients were included in this study. Besides medical treatment, noninvasive positive pressure ventilation (NPPV) was provided to 8 (36.6%), invasive mechanical ventilation was to 5 (22.7%) and both were provided to 5 (22.7%) patients. Four (18.1%) patients died in the ICU. In conclusion, we did not observe any relation between these parametres and length of hospital stay and mortality. Only the first and the difference of PaCO2, pH and HCO3¯ changes were significant which shows the correct and effective use of NIV/IMV. There was no relation between these and mortality which revealed that the reasons of death of the patients were not respiratory, but rather infection or comorbidity.Akut astım atağı zamanında ve doğru şekilde müdahale edilmediğinde ciddi morbidite ve mortalite nedeni olabilmektedir. Erişkinlerde astım atağı nedeniyle gelişen solunum yetmezliğinde NIV veya MV kullanılması ile ilgili yayınlanmış veriler kısıtlıdır. Bu çalışma ile yoğun bakıma ağır astım atağı ile yatırılan hastaların yaş, cinsiyet, eşlik eden komorbiditeler, astım süreleri, atak anında almakta oldukları tedaviler, tedaviye uyumları ile atağın ağırlığı arasındaki ilişki, YBÜ’de aldıkları NIV/IMV desteklerinin mortalite ve hastanede yatış süreleri üzerine etkileri belirlenmeye çalışıldı. Bu amaçla astım atağı nedeni ile yoğun bakım ünitesine (YBÜ) yatırılan hastaların özellikleri incelendi. Ocak 2002 ile Aralık 2012 tarihleri arasında iç hastalıkları yoğun bakım ünitesine astım atak tanısı ile yatırılan hastalar retrospektif olarak tarandı ve verilerine tam olarak ulaşılabilen 22 hasta çalışmaya dahil edildi. Medikal tedavilerin yanında 8 hasta NIV (noninvaziv mekanik ventilasyon), 5 hasta IMV (invaziv mekanik ventilasyon), 5 hasta önce NIV sonrasında MV desteği almıştı, 4 hasta hiçbir MV desteği almamıştı. Dört hasta yoğun bakım ünitesinde exitus olmuştu. Sonuç olarak hastaların bahsedilen demografik özellikleri ile hastanede yatış süreleri ve mortaliteleri arasında anlamlı bir ilişki tespit edilmedi. Ancak arteriel kan gazı değerlerinden yoğun bakıma yatış anında ve son olarak alınan pH, PaCO2 ve HCO3¯ giriş ve değişkenlikleri arasında anlamlı bir ilişki olduğu görüldü. Bunlar yoğun bakımda uygulanan NIV veya IMV tedavilerinin doğru ve etkin olarak yapıldığını göstermekle birlikte bunların da mortalite ile bir ilişkisi tespit edilmedi. Bu nedenle ölen hastaların ölüm sebeplerinin solunumsal problemler olmadığı, enfeksiyon veya komorbiditelere bağlı olabileceği düşünüldü

Serum concentrations of HE4 and Ca125 in uncomplicated pregnancies: a longitudinal study

In this study, we aimed to evaluate the effects of pregnancy on the serum level of HE4. Forty-six singleton pregnant women in the study group and 40 premenopausal women in the control group were included. HE4 and Ca125 levels were measured longitudinally at each trimester of pregnancy in the study group and once in the control group at the recruitment. In total 46, 38 and 33 pregnant patients blood samples were analysed in the first, second and third trimester of pregnancy, respectively. The analysis was performed in 31 of the pregnant patients (31/46, 67.4%) in each trimester of pregnancy. A comparison of the median HE4 levels of control and study group revealed that the first and second trimester levels were significantly lower than the control group (p < .001 and p = .015, respectively). There was no difference between the control group and third trimester median HE4 levels (p = .55). Impact Statement What is already known on this subject? HE4 is a novel tumour marker approved for the detection of ovarian cancer and monitoring the recurrence or disease progression in conjunction with Ca125. However, we do not know much about physiological changes of HE4 level during pregnancy. What the results of this study add? The current study showed HE4 decreases during first and second trimesters of pregnancy and does not change during third trimester of pregnancy according to healthy premenopausal women. What the implications are of these findings for clinical practice and/or further research? HE4 has a potential to be used in pregnancy but a lower cut off value should be considered in the pregnant population during the first and second trimesters of pregnancy

Is Rheumatic Mitral Valve Repair Still a Feasible Alternative? Indications, Technique, and Results

Rheumatic heart disease is still a major cause of mitral valve dysfunction in developing countries. We present our early results of rheumatic mitral valve repair

A Rare Presentation of Sarcoidosis with Nasal Bone Involvement

Background Sarcoidosis is a multisystem granulomatous inflammatory disease that is induced by infectious or noninfectious environmental antigens in a genetically susceptible host. Tuberculosis and sarcoidosis are two diseases with similar clinical and pathologic findings. The link between these two diseases has been extensively studied. Objective Herein we describe a case of sarcoidosis associated with tuberculosis, treated for tuberculosis, and, 1 year, later presented with a nasal dorsal lump and skin lesions on the extremities. Methods Case report with clinical description. Results Our patient had a history of skin and cervical lymphadenopathy symptoms 1 year earlier and was treated with antituberculosis drugs in an outer medical center. Therapy had cured cervical lymphadenopathies, with no improvement in skin lesions. On appearance of the nasal dorsal lump, she presented to our outpatient clinic. We retrieved the previous specimens of the patient, which revealed coexistence of necrotizing granulomas with non-necrotizing granulomas, which was strongly indicative of the coexistence of tuberculosis and sarcoidosis. Radiologic, histopathologic, and microbiologic investigation revealed the diagnosis of sarcoidosis with nasal, cutaneous, and pulmonary involvement. Treatment with prednisolone and hydroxychloroquine resulted in dramatic improvement of nasal bone, pulmonary, and skin lesions within 2 weeks. Conclusion The clinical presentation of sarcoidosis can be complex, and the differential diagnosis from tuberculosis can be challenging. Atypical clinical pictures also can cause delays in diagnosis and proper management. In patients with granulomatous lesions that are unresponsive to antituberculosis therapy, physicians must be alerted to the possibility of coexistent sarcoidosis