Lingual supplementation may not be required after articaine buccal infiltration anesthesia for lower molar extraction: a clinical comparative study / La suplementación lingual opcional después de la anestesia por infiltración bucal con articaína para la extracción de molares inferiores: un estudio clínico comparativo

Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth. Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant. Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.

Objetivo: Investigar la efectividad anestésica de la infiltración bucal (BI) versus la infiltración bucal más lingual (BI+LI) de articaína al 4% para la extracción intraalveolar de molares mandibulares erupcionados. Material y Métodos: Ochenta pacientes fueron incluidos en este estudio clínico prospectivo. Se dividieron aleatoriamente en 1 de 2 grupos iguales: el primer grupo recibió BI de articaína al 4% 1,8 ml y LI de 0,5 ml, mientras que el segundo grupo recibió articaína al 4% 1,8 ml BI más 0,5 ml LI de solución salina normal. Se administró otro BI de articaína de 1,8 ml si la anestesia inicial era inadecuada. Las variables de resultado incluyeron el dolor, que los pacientes calificaron en 3 intervalos mediante una escala analógica visual, y la anestesia lingual y la satisfacción de los pacientes, que se midieron mediante una escala de calificación verbal de 5 puntos. Los análisis de datos utilizados fueron estadística descriptiva, prueba t, prueba χ2 y coeficiente de correlación de Pearson. Se consideró significativo el valor del valor de pinferior a 0,05. Resultados: Hubo 46 mujeres y 34 hombres y la edad media fue de 35,3 años. Todas las variables de resultado fueron comparables entre los dos grupos de estudio (p=0,05). La anestesia fue exitosa en el 78% y 88% de los casos en los grupos (BI) y (BI+LI) respectivamente sin diferencia significativa (p=0,2392). El volumen medio de articaína utilizado fue de 2,5 ml y 2,87 ml respectivamente sin diferencia significativa (p=0,090). Conclusión: La eficacia anestésica de (BI) solo y (BI+LI) de articaína al 4% fue comparable. Cuando se administra en una dosis adecuada, la articaína (BI) sola podría estar justificada para la extracción intraalveolar de molares mandibulares.

Oral and maxillofacial lesions in covid 19 infection from Mosul hospital in Iraq: epidemiological study and approach to classification and treatment / Lesiones orales y maxilofaciales en COVID 19 del hospital de Mosul en Irak: estudio epidemiológico y enfoque de clasificación y tratamiento

During the COVID-19 pandemic, many manifestations of the disease appear in the oral, perioral and maxillofacial regions, either related to the virus itself or to the drugs used in the treatment. Aim: This study aims to identify the most common oral and perioral lesions in hospitalized patients with COVID-19 in the city of Mosul and their management; and also to evaluate the incidence and prevalence of these lesions. Material and Methods: Prospective study included 338 patients (138 females, 200 males) who had positive PCR results for SARS-CoV-2, with oral manifestations. All data were analyzed taking the means, frequencies, and percentage. Results: The most common lesions were colored lesions (31%) and stomatalgia (27%). The most common oral disorder and prior comorbidity combination was stomatalgia in patients with a history of hypertension. The most common associated systemic diseases were diabetes mellitus (19%) followed by hypertension (17%). Macular lesions had a higher response to drugs (40%) followed by stomatalgia (28%), in comparison with necrotic lesions (0%). Treatment of oral lesions included surgical interventions (26%) as well as conventional medical treatment (74 %). Conclusion: Oral and perioral disorders during COVID-19 are transitory and more evidence is warranted to efficiently address these comorbidities in the short term.

Durante la pandemia de COVID-19, muchas manifestaciones de la enfermedad aparecen en las regiones oral, perioral y maxilofacial, ya sea relacionadas con el propio virus o con los fármacos utilizados en el tratamiento. Objetivo: Este estudio tiene como objetivo identificar las lesiones orales y periorales más comunes en pacientes hospitalizados con COVID-19 en la ciudad de Mosul y su manejo; y también evaluar la incidencia y prevalencia de estas lesiones. Material y Métodos: Estudio prospectivo que incluyó a 338 pacientes (138 mujeres, 200 hombres) que tenían resultados positivos de PCR para SARS-CoV-2, con manifestaciones orales. Todos los datos se analizaron tomando las medias, frecuencias y porcentaje. Resultados: Las lesiones más frecuentes fueron las coloreadas (31%) y la estomatalgia (27%). La combinación de trastorno oral más común y comorbilidad previa fue la estomatalgia en pacientes con antecedentes de hipertensión. Las enfermedades sistémicas asociadas más comunes fueron la diabetes mellitus (19%) seguida de la hipertensión (17%). Las lesiones maculares tuvieron una mayor respuesta a los fármacos (40%) seguidas de la estomatalgia (28%), en comparación con las lesiones necróticas (0%). El tratamiento de las lesiones orales incluyó intervenciones quirúrgicas (26%) y tratamiento médico convencional (74%). Conclusión: Los trastornos bucales y periorales durante el COVID-19 son tran-sitorios; se necesita más evidencia para abordar de manera eficiente estas comorbilidades a corto plazo.

Prevalence of pineal gland and choroid plexus calcification among iraqi patients attending CT scan units / Prevalencia de calcificación de la glándula pineal y del plexo coroideo entre pacientes iraquíes que asisten a las unidades de tomografía computarizada

SUMMARY: Pineal gland calcification is the most common physiological intracranial calcification followed by the choroid plexus calcification. The objective of the study was to determine the prevalence of the pineal gland and choroid plexus calcification among the Iraqi population attending computed tomography scan units in Baghdad, estimate the mean diameters of the pineal gland calcification, and to detect any correlation between these calcifications with age and sex. This multi-centric cross-sectional study examined 485 CT scans of Iraqi patients between the ages of 1 and 100 years attending CT scan units in the period 1 December 2018 to 1 April 2019. Descriptive and inferential statistics were used. The prevalence of pineal gland calcification was found to be 68 % with the 30-39 age group and male sex predominance. It was found to increase after the first decade of life without real consistency. The mean for pineal gland calcification anterior-posterior diameter was 4.55±2.13 and the mean of the right-left diameter was 3.95±1.54. These diameters were found to differ according to sex and age. Choroid plexus calcification was found to have a prevalence of 53.6 %. In most cases, choroid plexus calcification was found bilaterally (77.3 %). There was no difference in sex, but choroid plexus. In conclusion, calcification was noticed to increase gradually according to age. Both pineal gland and choroid plexus calcification have a relatively high prevalence. While pineal gland calcification formation was demonstrated to have a close relation to age and sex, choroid plexus calcification formation was noticed to relate only to age.

RESUMEN: La calcificación de la glándula pineal es la calcificación intracraneal fisiológica más común después de la calcificación del plexo coroideo. El objetivo del estudio fue determinar la prevalencia de calcificación de la glándula pineal y del plexo coroideo entre la población iraquí que asiste a las unidades de tomografía computarizada en Bagdad, estimar los diámetros medios de la calcificación de la glándula pineal y detectar la posible correlación entre estas calcificaciones con la edad y el sexo. Este estudio transversal multicéntrico examinó 485 tomografías computarizadas de pacientes iraquíes entre 1 y 100 años de edad que asistieron a unidades de tomografía computarizada en el período del 1 de diciembre de 2018 al 1 de abril de 2019. Se utilizaron estadísticas descriptivas e inferenciales. Se encontró una prevalencia de calcificación de la glándula pineal del 68 % con predominio del sexo masculino en el grupo de 30 a 39 años. Se observó que aumentaba después de la primera década de vida sin una coherencia real. La media del diámetro anteroposterior de la calcificación de la glándula pineal fue de 4,55 ± 2,13 y la media del DIÁ- METRO derecho-izquierdo fue de 3,95 ± 1,54; estos diámetros difieren según el sexo y la edad. La calcificación del plexo coroideo tiene una prevalencia del 53,6 %. En la mayoría de los casos, la calcificación del plexo coroideo se encontró de forma bilateral (77,3%). No hubo diferencia de sexo, no obstante en el plexo coroideo se observó que la calcificación aumentaba gradualmente según la edad. Tanto la calcificación de la glándula pineal como del plexo coroideo tienen una prevalencia relativamente alta. Si bien se demostró que la formación de calcificación de la glándula pineal está relacionada con la edad y el sexo, se observó que la formación de calcificación del plexo coroideo se relaciona solo con la edad.

Patterns of Maxillary Canine Impaction in Iraqi Population

Abstract Objective: To investigate the prevalence of maxillary canine impaction and whether the impacted canine cases have had a potentially good or poor prognosis if interceptive treatment was practiced at earlier ages. Material and Methods: 1755 panoramic radiographs of patients, aged 13 to 60 years, attending the University of Babylon, College of Dentistry for the period from November 2016 to July 2018 were collected and assessed for the presence of impacted maxillary canines. Subsequently, four suggested prognostic factors for each impacted canine were analyzed and recorded. Results: The prevalence of maxillary canine impaction was 119 (6.78%) with 89 unilateral impaction and 30 bilateral impaction resulting in a total of 149 impacted canines. Regarding the gender, impaction was more evident in females 70 than in males 49 with no statistical significant difference. For the side, impaction was more prevalent on the left (77) than on the right (72), also with no statistical difference (p>0.05). Following the analysis of the four prognostic factors, most of the cases, 117 (78.5%) had at least one prognostic factor to be poor. Although 82 (55%) of the cases had at least one prognostic factor to be good, only 4 had all the prognostic factors to be good. Conclusion: Although the cases that had a potentially good prognosis were little (4 cases), interceptive extraction of primary canines would mostly be beneficial for these patients as it will minimize the treatment time, cost and complications.

Clinical Evaluation of Pit and Fissure Sealants Placed by Undergraduate Dental Students in 5-15 Years-old Children in Iraq

Abstract Objective: To clinically evaluate the retention and marginal discoloration of pit and fissure sealants applied to primary and permanent teeth. Material and Methods: The study population encompassed of 5-15 years-old children. After consenting, a light-curing sealant was applied to etched pits and fissures of occlusal surfaces of selected sound teeth. The retention rate and marginal discoloration were assessed, 3 months after application of the sealants based on the criteria proposed by Simonsen's criteria (total retention: score 0, partial loss: score 1, and total loss: score 2). Each tooth was considered as an independent sample during analysis. Results: The achieved sample size was 43 children aged 5-15 years (mean age=10.0 years). Therefore, data of 100 teeth from 43 children were used for the final analysis. The percentage of completely retained sealants (59%) was higher than the percentage of partially retained sealants (23%) and completely missing sealants (18%) after 3 months follow up. Out of 100 sealed teeth, 60% were either had marginal discoloration or completely missing. Using the Mann-Whitney test, there was a statistically significant difference (p<0.05) between primary and permanent teeth in terms of retention. However, there was no statistical difference (p>0.05) between upper and lower teeth in terms of retention. Conclusion: The success rate of fissure sealants after 3 months follow-up was satisfactory.

Prevalence of impacted mandibular third molars and its association with distal caries in mandibular second molars using cone beam computed tomography / Prevalencia de terceros molares mandibulares impactados y su asociación con caries distales en segundos molares mandibulares mediante tomografía computarizada de haz cónico

This study evaluated the prevalence and eruption's pattern of impacted mandibular third molars (IMTM) and the influence of their eruption status on the distal caries of mandibular second molars (MSM) using cone-beam computed tomography (CBCT). Material and methods: CBCT images taken for different purposes in private dental practices were analyzed retrospectively. Radiographic assessment included: prevalence of IMTM, degree of angulation, level of impaction and type of IMTM. Furthermore, the distance between the cement-enamel junctions (CEJ) of second and third molars and the occurrence of caries lesion on the distal surface of MSM was also evaluated. Data were analyzed by chi square test and logistic regression was used to find the association between distal caries of MSM and eruption status of IMTM. Results: Three hundred and eight CBCTs were screened, the prevalence of IMTM was 36.88% and their angulation degree were mostly less than 90º (mesioangular). Amongst those with impaction, 58 subjects (43%) had distal caries on MSM, 29.6% in females and 30.4% in the age group 19-27 years. Caries on the distal side of MSM were significantly associated with age, level and type of impaction, angulation degree and CEJ distances (p<0.05). Conclusions: The prevalence of IMTM is high (36.88%) and there are significant relationships between angulation degree, level and type of impaction, and CEJ distances with caries on the distal side of MSM.

Introducción: Este estudio evaluó la prevalencia y el patrón de erupción de terceros molares mandibulares impactados (TMMI), y la influencia de su estado de erupción en la caries distal de los segundos molares mandibulares (SMM) mediante tomografía computarizada de haz cónico (TCHC). Material y métodos: se analizaron retrospectivamente las imágenes de TCHC tomadas para diferentes fines en prácticas dentales privadas. La evaluación radiográfica incluyó: prevalencia de TMMI, grado de angulación, nivel de impacto y tipo de TMMI. Además, también se evaluó la distancia entre la unión amelocementaria (UAC) de los segundos y terceros molares y la aparición de lesión de caries en la superficie distal de SMM. Los datos se analizaron mediante la prueba de chi cuadrado y se usó la regresión logística para evaluar asociaciones entre la caries distal de SMM y el estado de erupción de TMMI. Resultados: Se examinaron 308 TCHC, la prevalencia de TMMI fue de 36.88% y su grado de angulación fue mayoritariamente menor a 90º (mesioangular). Entre aquellos con impacto, 58 sujetos (43%) tenían caries distales en los SMM, 29.6% eran mujeres y 30.4% pertenecieron al grupo de edad de 19-27 años. Las caries en el lado distal de MSM se asociaron significativamente con la edad, el nivel y el tipo de impactación, el grado de angulación y las distancias UAC (p<0.05). Conclusiones: la prevalencia de TMMI es alta (36.88%) y existen relaciones significativas entre el grado de angulación, el nivel y el tipo de impacto, y las distancias UAC con presencia de caries en el lado distal de los SMM.

Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis

Abstract Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.

Cancer registration in Basrah 2005: preliminary results.

Cancer is a disease which shows significant variation with time and across geographical entities. In Basrah, Iraq, despite the widespread impression that cancer is increasing, researchers are not yet able to draw clear boundaries as to the extent of cancer and its determinants. In this paper, we make a start in that direction; the aim was to measure as accurately as possible the incidence of cancer (all types) in Basrah, to assess age specific incidence rates and to map the cases across different areas of the governorate. For this purpose we compiled data on every accessible case of cancer. The cancer registry in Basrah was used as the prime source of data on newly diagnosed cancer cases, supported by three other sources: the Cancer Registration Section at the Department of Pathology and Forensic Medicine, College of Medicine, University of Basrah; the Oncology Centre at Al-Sadr Teaching Hospital; and the Oncology Ward in Basrah Maternity and Child Hospital. Other minor sources were also utilized. Information on cases from these sources was subjected to meticulous verification regarding repetition, place of residence and other potential errors. The overall incidence rate was 74.3/100,000 population with a higher rate for females (80.5/100,000) than for males (68.1/100,000). The results indicate clear increase in registered cancer cases with increasing age. The lowest incidence rate was among females aged 5-14 years (10.5/100,000) and the highest was among males aged 65 years and above (660.2/100,000). The results show no major variation in the annual incidence rates of cancer in different areas of Basrah governorate. This finding may suggest a common exposure to cancer risk factors. To reach sound conclusions about extent and determinants of cancer in Basrah, immense multi-spectrum efforts are now needed.

Infantile tremor syndrome in Iraqi Kurdistan.

OBJECTIVE: To describe a rare condition that occurred for the first time in Iraqi Kurdistan during the UN Sanctions on Iraq in the nireties. Literature review was made to fine possible causes. METHODS: Patients were collected from various sources including private clinics, hospital outpatient clinics and the Centre for Handicapped Children in the city of Arbil. Clinical features and proper history were the main diagnostic tools. Different treatment regimes were used on those patients. RESULTS: 24 patients were collected; the majority was between 6-18 months. Males were more affected than females. Half of the patients were exclusively breast-fed and three quarter have received blood for anemia. CONCLUSION: Infantile tremor syndrome is a rare condition which was described both in India and outside India as well. It was observed among children in Iraqi Kurdistan during the difficult economic situation under the UN Sanctions. The condition has the same features inside and outside India. The etiology is not very clear yet.

Acute Lympoblastic Leukaemia in seventy Iraqi adults: clinical and haematological findings and outcome of therapy.

Studies on acute Leukaemia from developing and Asian countries are scarce, and generally reflect poorer outcomes of therapy compared to their Western counterparts. This study was undertaken to address the latter issue in Iraqi adults with Acute Lymphoblastic Leukaemia (ALL). It included seventy unselected Iraqi adults (aged 14-60years), diagnosed as ALL in Baghdad Teaching Hospital, Baghdad, during the period between May 1991 and June 1994. The clinical and haematological findings in the included patients were generally comparable with those reported from the West, except for the lower median age. The patients were scheduled to receive a modified intensive chemotherapy protocol, and had an overall complete remission rate of 84.3%, and all overall median survival of 24 months. Nineteen patients were still alive in complete remission after a median follow-up of 67 months, and the estimated five year disease free survival was 27.2%. The above finding compare favourably with Western studies and are among the more favourable reports from Asian countries. The study also includes a discussion of the problems facing haematologists in the management of ALL in this part of the world.

Diagnostic methods for intestinal parasites in southern Iraq with reference to Strongyloides stercoralis.

Three hundred and thirty-two stool samples were examined for the presence of intestinal parasites including Strongyloides stercoralis. Each sample was processed and examined by direct smear, formalin-ether and Harada and Mori culture methods. Nine parasites were recovered from patients attending Basrah Teaching Hospital, southern Iraq during 1989. The prevalence rate of infection was 64.2%. It was higher in rural (74.2%) than in urban (57.5%) region (p < 0.01). Sex distribution was 120 (36.1%) males and 87 (26.2%) females (p > 0.05). The most common parasites were Blastocystis hominis, Giardia lamblia, Entamoeba histolytica, Hymenolepis nana and Strongyloides stercoralis. Formalin-ether concentration method was 3.75 times better than the direct smear method in the diagnosis of helminth rather than protozoan infections. The yield obtained by the usage of the Harada and Mori culture method (4.5%) was significantly higher than that obtained by formalin-ether (2.7%) or direct smear (0.3%) methods. Therefore, the Harada and Mori culture method is recommended in patients with undiagnosed diarrhea and where strongyloidiasis is endemic or suspected. Investigation of the relationship between age of the patients and prevalence showed that the prevalence of total intestinal parasites and of Strongyloides alone had essentially levelled off by age 11-20 and 21-30 years old, respectively. Clinical symptoms associated with S. stercoralis infection were diarrhea, anorexia and abdominal pain. Thiabendazole is still a drug of choice in the treatment of strongyloidiasis.