Comparison of flare up incidence in patients treated by different practitioners

Statement of Problem: Flare up is an acute exacerbation of an asymptomatic pulpal and/or periapical pathosis after commencement or termination of root canal therapy. Its incidence may be different in patients treated by different practitioners regarding their graduation status

Purpose: The aim of this study was to compare flare up incidence in patients treated by dental students of Shiraz Dental School and those whom were treated by endodontists

Materials and Method: Patients' information including age, gender, and previous history of pain and pulp vitality were taken before treatment of 383 patients. 230 of them were treated by senior dental students of Shiraz Dental School and 153 of them were treated by endodontists. Students employed conventional step back technique whereas specialists had a chance to select variety of techniques. Data, regarding the quantity of pain experienced by patients were collected 48 hours after treatment. Case was considered a flare up if the patient had experienced severe pain which hadn't been reduced either by analgesic medication or by consequent swelling. Chisquare statistic tests were used to analyze the receiving data

Results: 41 individuals [10.7%] out of 383 patients depicted flare up. 13.5% of these patients were treated by students and 6.5% were treated by endodontists. The difference was statistically significant

Conclusion: Different rate of flare up in two groups is probably due to the dissimilarity in skills, techniques and materials used by different operators

Comparison of the percentage of voids following root canal obturation with Gutta percha and ah26 sealer using four different sealer placement techniques

Different techniques are employed for sealer placementinto the root canal system. The purpose of this study was to compare the percentage of voids following root canal obturation with gutta percha and AH26 sealer using four different sealer placement techniques. In this laboratory experimental study, root canals of 50 mandibular second premolars were prepared using the step-back technique. The teeth were assigned to 4 experimental groups of 10 and one control group based on sealer placement technique. After sealer application and canal obturation with lateral condensation technique, specimens were horizontally cut into 3 mm slices. Sections were evaluated under a digital microscope at 150X magnification for void detection in apical, middle and coronal thirds. Kruskal Wallis and Bonferroni tests were applied to compare the percentage of voids between different groups. No significant difference was found in void percentage in one-thirds or total sections between the four methods [P=0.276]. Overall, no significant difference was noted in void percentage between the four techniques of sealer placement

[Evaluation and comparison of apical leakage following root canal dressing with different calcium hydroxide preparations]

The use of calcium hydroxide as an intra-canal medication can lead to leakage of permanent obturation of the canal and failure of the treatment. The purpose of this study was to evaluate the rate of the remained calcium hydroxide in radiographic views and their effect on apical leakage. For this study, 75 human extracted premolar teeth were divided into 5 groups randomly. All the teeth were prepared by step back technique and apical foramen enlarged to number 30 file. Aria dent calcium hydroxide was introduced into the canal in group 1. In group 2, Barium sulfate was added to calcium hydroxide powered in 1 to 9 proportion and the methods was gone on the same as in group 1. Dentsply calcium hydroxide was mixed with glycerin-based aqueous and introduced into the canal in group 3. Calcium Hydroxide paste [Pulpdent] was introduced into the canal with its special needle. In group 4 and 5, there was no calcium hydroxide as a control group. The canals were prepared with one sixe larger than master apical file, MAF [35 file size] to remove calcium hydroxide. The remaining of calcium hydroxide was accessed radiographically and compared using Kruskal Wallis test. Dye leakage in the 5 groups was compared, using ANOVA and Tukey tests. There was no significant difference between the five groups when dye leakage was compared, but calcium hydroxide paste [Pulpdent] shows more remained material when evaluated radiographically. The use of calcium hydroxide paste with methyl cellulose base for intra-canal medicament is not recommended

Prevalence of Helicobacter pylori infection among children in Rasht, northern Iran

Helicobacter pylori [H. pylori] infection usually occurs during childhood, especially in developing countries. The aim of this study was to evaluate the prevalence of H. pylori infection among children in primary schools of Rasht, a northern Iranian city. This cross-sectional study was conducted among 961 primary school students in Rasht. Samples were randomly selected and stored at -20°C until analysis. The stool assay was performed using the HP AgT kit. Overall 475 boys and 486 girls, aged 7 to 11 years were evaluated. A total of 384 [40%] children were diagnosed as H. pylori positive by the stool test. A higher prevalence of H. pylori was found in the stools of individuals who consumed well water and municipal tap water when compared to boiled water [p<0.05]. There was no significant difference between the rate of H. pylori infection and individuals' ages, gender or socioeconomic levels. The results of this study suggest that the source of drinking water may play a role in transmission of H. pylori. Transmission can be minimized with the use of boiled or mineral water

[Intravitreal bevacizumab [avastin] injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment for diabetic macular edema; an interim analysis]

To report the efficacy of a single intravitreal injection of bevacizumab [IVB] alone or in combination with intravitreal triamcinolone acetonide [IVT] versus macular laser photocoagulation [MPC] as primary treatment for diabetic macular edema [DME]. This randomized three-arm clinical trial included 103 eyes of 97 patients with clinically significant DME and no previous treatment. The eyes were randomly assigned to one of the three study arms: the IVB group received 1.25 mg IVB [37 eyes], the IVB/IVT group received 1.25 mg IVB together with 2 mg IVT [33 eyes], and the MPC group underwent focal or modified grid laser photocoagulation [33 eyes]. Primary outcome measure was change in best-corrected visual acuity [BCVA]. Changes in BCVA [logMAR] at 12 weeks were -0.22 +/- 0.23, -0.13 +/- 0.31 and +0.08 +/- 0.31 in the IVB, IVB/IVT and MPC groups, respectively. The marginal regression model based on generalized estimating equation analysis demonstrated that changes in visual acuity was statistically significant in the IVB group at both 6 [P<0.001] and 12 [P=0.024] weeks but only at 6 weeks in the IVB/IVT group. Significant decrease in central macular thickness [CMT] was observed in the IVB and IVB/IVT groups at 6 weeks. Up to 12 weeks, IVB treatment in eyes with DME yielded better visual outcome than laser photocoagulation, although it was not associated with a significant decrease in CMT. IVT seemed to have no further beneficial effect in combination with IVB

[Patient satisfaction with outpatient/inpatient ophthalmologic services at labbafinejad medical center]

To assess patient satisfaction with ophthalmologic services at Labbafinejad Medical Center. The present study was a cross-sectional study conducted during the summer of 2008. Patients with ophthalmic problems were selected by systematic random sampling according to the admission list. A trained investigator interviewed patients in the hospital or clinic. The data collection tool was based on a standard PSQ-18 questionnaire. Primary outcomes were measured as the level of satisfaction domains on a 5-point scale [1 = lowest satisfaction, 5 = greatest]. Of 539 patients [98% response rate] with mean age of 44.7 +/- 23 years age, 167 patients [31.2%] were completely satisfied, 215 [39.9%] were satisfied, 95 [17.5%] were partially satisfied, 29 [5.2%] were unsatisfied, and 33 [6.2%] were completely unsatisfied. The mean score and standard deviation of general satisfaction was 4.05 +/- 1.1. Mean score in different domains of satisfaction were as follows respectively, interpersonal manner [doctor-patient] 4.6 +/- 0.77, financial aspects 4.5 +/- 1.1, communication 4.3 +/- 0.96, time spent for patient 4.3 +/- 0.97, technical quality and professionalism 4.1 +/- 0.99, accessibility 3.8 +/- 1.1, and convenience 2.6 +/- 1.2. The patients were relatively highly satisfied with the ophthalmologic services overall; however, certain aspects such as accessibility and convenience should be improved

[Assessing Iranian ophthalmologists' perception of english language presentations in scientific congresses]

To assess the English language competence of Iranian ophthalmologists and their points of view regarding the need for and importance of holding ophthalmologic congresses in English. A descriptive-analytic, cross sectional study was conducted during the 17th Iranian Ophthalmology Congress, Tehran. Data collection was performed via a standard self administered questionnaire. Five-hundred question forms were distributed among ophthalmologists and answers were graded using an ordinal five-level score. The response rate of this study was 94.6%. The English competence of 200 [42.3%] of the responders was good or perfect. Overall, about 90% of the responders agreed on holding ophthalmologic congresses in English; 72 [15.2%] individuals proposed holding speeches in English at all sessions, 189 [40.0%] preferred holding the main hall speeches in English and 162 [34.2%] said that the best way is to have only foreign guests' speeches in English. Most ophthalmologists implied that holding ophthalmic congresses in English and inviting foreign lecturers is of great importance and the best form of performance is holding all lectures in the main hall in English. It seems that improving the English abilities of ophthalmologist together with holding English congresses and inviting foreign lecturers may help improve international communications and update their knowledge

[Medication error following intraocular surgery at a tertiary eye care center]

To evaluate the incidence of medication error in patients who underwent intraocular surgery based on different methods of drug instruction [hand-written versus orally explained] at Labbafinejad Medical Center. During a 6-month period, we evaluated 204 postoperative patients who underwent cataract or glaucoma surgery. Patients were randomly assigned to two groups; in group I, patients and their attendants received oral and written instruction in addition to the prescription, while the patients and their attendants in group II only received oral instruction besides the prescription. One to 3 days after the operation, the overall incidence of medication errors was determined and compared between the groups using Fisher's exact test. Overall 204 patients including 114 [55.9%] male and 90 [44.1%] female subjects were studied. Mean age of the patients and their attendants was 53.5+22.1 [range 1-90] years and 39.1+12.2 [range 19-79] years, respectively. Actual medication errors occurred in 7 patients including 3 [3%] in the group with written instruction and 4 [3.9%] in the group with oral instruction [P=0.511]. Dispensing errors were the cause in 5 [71.4%] patients including 3 in group I and 2 in group II [P=0.491] but the 2 [28.6%] other cases were due to misconsumption [all in group II]. Overall, 3 medication errors were detected and corrected [intercepted errors] by the patients or their attendants [all in group I] thus; nonintercepted errors were 4 [all in group II]. Cases of actual medication errors were female in 6 [85.7%] and illiterates in 4 [57.1%]. It seems that using a written instruction in addition to the prescription may reduce the incidence of medication errors following ocular surgery

[Visual outcomes of 4 therapeutic approaches for central retinal vein occlusion]

To compare the visual outcomes of four different therapeutic modalities for central retinal vein occlusion [CRVO] with each other and with the natural course of the disease. This study was conducted on 63 eyes of 63 patients including 13 eyes in the radial optic neurotomy [RON] group, 10 eyes in the combined RON and intraocular triamcinolone injection [RON/IOT] group, 12 eyes in the combined internal limiting membrane peeling, RON and IOT [ILMP/RON/IOT] group, 14 eyes in the intravitreal triamcinolone injection [IVT] group and 14 untreated control eyes. All patients were followed for six months. Final best-corrected visual acuity [BCVA] was better in the IVT group as compared to the RON [P=0.037], RON/IOT [P=0.401], ILMP/RON/IOT [P=0.023] and control [P=0.025] groups. However, after adjusting final BCVA for baseline BCVA, only the RON/IOT group showed significant visual improvement after 1 [P= 0.025], 3 [P= 0.023] and 6 [P= 0.054] months as compared to controls. Among the four different approaches evaluated in this study, RON/IOT may entail better visual outcomes in the management of CRVO within six months

[Combined sutureless 25-gauge vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation for management of uveitic cataracts associated with posterior segment disease]

To report the visual outcomes and complication of one-stage surgery for management of uveitic cataracts associated with posterior segment disease. In this retrospective interventional case series, 19 eyes of 19 patients with posterior segment involvement due to chronic uveitis underwent sutureless scleral tunnel incision phacoemulsification combined with total vitrectomy using 25-gauge instruments and posterior chamber intraocular lens [PCIOL] implantation. Membrane peeling and endolaser photocoagulation were performed when indicated. Outcome measures were visual acuity, inflammatory activity, macular edema and surgical complications. After a minimum 12-month follow-up, visual acuity was >/=20/100 in 12 eyes [63.2%] and >/=20/40 in 6 eyes [31.6%]. One grade of decrease in postoperative inflammatory activity was observed in 8 eyes [42.1%]. Cystoid macular edema was present in 16 eyes preoperatively and in 12 eyes postoperatively. Early postoperative complications included transient corneal edema in 10 eyes [50.3%], posterior synechia in 9 eyes [47.3%] and fibrin reaction in 3 eyes [15.8%]. Glaucoma was the most common late postoperative complication [3 eyes, 18.8%]. Nine eyes [47.4%] needed YAG laser capsulotomy during the first year. Combined sutureless 25-gauge vitrectomy, phacoemulsification, and PCIOL implantation may be a well tolerated procedure with an acceptable complication rate for visual restoration in selected uveitic eyes with significant cataract and coexisting posterior segment disease

[Apical leakage in obturated canals using two different sealers after immediate and delayed post space preparation]

Successful endodontic therapy depends on a well-adapted filling in conjunction with root canal. The proper restoration requires the placement of a post and core. Therefore, the time of post space preparation, and its possible effect on the quality of the apical seal is important. The purpose of this study was to compare the effect of immediate and delayed post space preparations on apical seal using two currently used sealers; AH26 and Apexit sealers. Seventy six extracted anterior teeth were used in this experimental study. Teeth were randomly divided into four groups and all canals were prepared by step back method, and then filled with gutta percha by lateral condensation technique. AH26 was the sealer used in groups 1 and 2, while in groups 3 and 4 Apexit sealer was used. In groups 1 and 3, post spaces were immediately prepared. But in groups 2 and 4 they were prepared after one week. After preparation, the teeth were immersed in India ink for 3 days and finally, were cleaned. The extent of dye penetration was determined by stereomicroscope. The data were obtained and analyzed statistically with ANOVA, Tukey and T.tests. The results showed that the lowest and highest rates of dye penetration were detected in groups 1 and 4 respectively. There was significant difference in apical leakage between the AH26 immediate, and Apexit delayed post space preparation. According to the results of this study, the immediate preparation of post space after obturation and before setting of the sealer is recommended