Obstructive Sleep Apnea in Primary Health Care Settings

Background: Obstructive sleep apnea (OSA) despite being the most common type of sleep disorder, may presenta myriad of clinical features, ranging from simple fatigue and lack of concentration to per-sonality changes andheart diseases. The association between the genetic, physiological built, so-cial status, and behaviour plays themajor role in disease risk factors diagnosis and management plans. The most often used treatment method of OSAis Continuous Positive Airway Pressure (CPAP) aimed at monitoring respiratory effort and Apnea-HypopneaIndex (AHI) measuring the number of apnea and hypopnea events per hour of sleep or the RespiratoryDisturbance Index (RDI). Objective: The focus of this paper is providing a review on obstructive sleep apnea,different treatment ap-proaches and the recent perspectives with regard to family physicians’ enrolment inmanagement and modulation of pain in OSA patients. Methodology: PubMed database was used for articlesselection using the keywords obstructive sleep apnea, its evaluation, management, and diagnosis. Conclusion: Insummary, family doctors and primary care providers play a major role in controlling OSA and are involved indealing with CPAP, AHI measurement and RDI. Obstructive sleep apnea re-quires a high cost which may furthercontribute to late detection, complications deterioration, and increasing in the drop of follow-ups. Increasingawareness of the primary care providers especial-ly family physicians would help to avoid such outcomes. OSAremains a common condition that requires attention, identification, and more directed research.

Influence of different orientations and rates of bidirectional distraction osteogenesis of the mandibular corpus: a three-dimensional study

Objective: The objective of this study was to evaluate the biomechanical effect of mandibular corpus distraction osteogenesis with different orientations and rates. Materials and Methods: A three-dimensional model of the mandible was created. The vertical surgical cut was made, the force was applied horizontally in a bidirectional manner within two orientations: parallel to the occlusal plane and parallel to the inferior border of the mandible with three rates (0.5mm, 1mm and 1.5mm). Results: The maximum values for von Mises stress when the force was applied parallel to the inferior border of the mandible with all three rates were smaller than those with force direction parallel to the occlusal plane. The displacement in all three directions x, y, and z were not parallel and prominent in the anterior part of the mandible, while the movement at the posterior part is negligible, x and z displacement were bigger when force was applied parallel to the inferior border of the mandible, z displacement was more prominent than x and y displacement, both directions produced upward rotation of the mandible, this rotation was more noticeable when the force was applied parallel to the inferior border of the mandible. Conclusions: A vertical cut can be used in the patient with a long anterior face. This site of distraction achieves more lengthening of mandible than expansion.

Effect of diode laser irradiation of bonding agents before curing versus standard bonding protocol on the shear bond strength between resin cement and dentin / Efeito da irradiação com laser de diodo sobre sistemas adesivos antes da cura versus protocolo de adesão padrão na resistência ao cisalhamento entre o cimento resinoso e a dentina

Objective: This study aimed to evaluate the effect of diode laser irradiation (970 nm) of a one-step self-etch adhesive (Clearfil S3 Bond/CS3B) and of the bonding agent of a two-step self-etch adhesive (Clearfil Liner Bond F/CLBF) placed on dentin before polymerization on the shear bond strength. Material and methods: Forty sound premolars were sectioned buccally to obtain flat dentin surfaces. The specimens were divided into 4 groups (n = 10): Group (OS) ­ CS3B + polymerization. Group (OS-L) ­ CS3B + laser + polymerization. Group (TS) ­ CLBF (bonding agent only) + polymerization. Group (TS-L) ­ CLBF (bonding agent only) + laser + polymerization. The diode laser was irradiated through an 8 mm bleaching tip for 10 seconds, (0.4 W, 10 Hz, 4 J). All samples were cemented to composite blocks and submitted to 4000 thermal cycles. The samples were tested for shear bond strength in a universal testing machine. Data obtained was analyzed using Twoway (ANOVA) (p < 0.05) and the Bonferroni posthoc test. Representative samples from each group were analyzed using scanning electron microscopy (SEM). Results: Group TS-L ­ (7.43 MPa) displayed statistically significant higher shear bond strength in comparison to that of group TS ­ (5.13 MPa). No statistically significant difference was found between group OS-L ­ (6.49 MPa) and group OS ­ (7.28 MPa). Group TS-L exhibited the highest resin penetration beyond the hybrid layer under SEM. Conclusions: Diode laser irradiation of a bonding agent placed on dentin without prior priming increased the bond strength to dentin and is promising as a new dentin adhesion protocol. (AU)

Objetivo: Este estudo teve como objetivo avaliar o efeito da irradiação com laser de diodo (970 nm) sobre um adesivo autocondicionante de um passo (Clearfil S3 Bond / CS3B) e de um outro adesivo autocondicionante de dois passos (Clearfil Liner Bond F / CLBF) aplicado na dentina, antes de sua polimerização, na resistência ao cisalhamento. Material e métodos: Quarenta pré-molares hígidos foram seccionados vestibularmente para obtenção de superfícies dentinárias planas. Os espécimes foram divididos em 4 grupos (n = 10): Grupo (OS) - polimerização de CS3B +. Grupo (OS-L) - laser + CS3 + polimerização. Grupo (TS) - CLBF (apenas agente de adesão) + polimerização. Grupo (TS-L) - CLBF (somente agente de adesão) + laser + polimerização. O laser de diodo foi irradiado através de uma ponta de branqueamento de 8 mm durante 10 segundos (0,4 W, 10 Hz, 4 J). Todas as amostras foram cimentadas a blocos de compósitos, submetidos a 4.000 ciclos térmicos. As amostras foram testadas quanto à resistência ao cisalhamento em uma máquina universal de ensaios. Os dados obtidos foram analisados utilizandose Two-way (ANOVA) (p < 0,05) e o teste post-hoc de Bonferroni. Amostras representativas de cada grupo foram analisadas por microscopia eletrônica de varredura (MEV). Resultados: O grupo TS-L - (7,43 MPa) apresentou resistência ao cisalhamento estatisticamente significativa maior em relação ao grupo TS (5,13 MPa). Não houve diferença estatisticamente significativa entre o grupo OS-L - (6,49 MPa) e grupo OS - (7,28 MPa). O grupo TS-L exibiu a maior penetração de resina além da camada híbrida em MEV. Conclusões: A irradiação com laser de diodo de um agente adesivo colocado sobre a dentina sem o uso prévio de primers aumentou a força de adesão à dentina e é promissora como um novo protocolo de adesão dentinária. (AU)

Neurologic Etiology of Episodic Abdominal Pain: Epilepsy vs Migraine

The temporal lobe has a vital role in epilepsy, and is the most common lobe involved in focal onset seizures. Patients with temporal lobe epilepsy (TLE) usually have auras, an epigastric-rising sensation is the most common aura reported. Semiology of TLE is abdominal pain. Thus, TLE has to be suspected in patients with unexplained episodic paroxysmal abdominal pain associated with symptoms such as loss or changing of consciousness, and migraine-like symptoms. This case reports a 14-year-old boy who has been diagnosed with abdominal migraine for 7 years. He initially presented with episodic severe abdominal pain and right-sided headache. The abdominal pain is periumbilical, and not associated with vomiting or diarrhea. There are no other gastrointestinal complaints, and all the abdominal investigations were negative. Drugs were of no significance on the long term. Recently, the patient was found to have a benign brain tumor, and correlation with an electroencephalography (EEG) that gave abnormal results due to the presence of bilateral spike-and-wave discharges confirmed the diagnosis of temporal lobe epilepsy manifested by abdominal pain. Our patient did not fulfill the International Classification of Headache Disorders Third Edition (Beta Version) (ICHDIIIb) diagnostic criteria for abdominal migraine, although his case was reviewed by many physicians over the years. In conclusion, this case shows how important it is to follow the diagnostic criteria of diseases and disorders. It also focuses on how seizures can have a wide spectrum of manifestations. Thus, neurological causes have to always be on the differential diagnoses.

Evidence-based dentistry: Reality and dilemmas

The concept of evidence-based practice [EBP] relies on rendering treatment, the effectiveness is solidly demonstrated by rigorous research, not just empirical experience. The aim of this paper is to review the foudation of EBP and the reality of its application. Evidence is commonly ordered up in a "hierarchy" from expert opinion to case report, case series, case-control study, cohort study, randomized controlled trial, and systematic review/meta-analysis. We stratify this hierarchy into 3 categories ascending from perspective, to investigation then synthesis. Depending on the type and feasibility of research, the higher levels of evidence do not negate the value of lower strata. The application of evidence is illustrated in two representative areas of dentistry: timing of early orthodontic treatment and immediate loading of osseointegrated implants. The clinician faces dilemmas in the need to ground treatment into unquestionable basis and the difficulty of relating this basis to the individual treatment. Reasons for this dichotomy include the scale of variation around mean results delivered by the most sophisticated research and the potential for new more encompassing research to deviate from prior findings. While research sets central tendencies, individual variation favors interpretation of the evidence. In the face of viewpoints on EBP ranging from support to rejection, the clinician should not indict a needed process, but rather use judgment to apply the average response shown in investigations to the individual circumstances of patients

Cell-mediated immune responses to complex and single mycobacterial antigens in tuberculosis patients with diabetes

To evaluate cell-mediated immune [CMI] response in diabetic and non-diabetic tuberculosis [TB] patients and healthy subjects in response to complex, fractionated and single antigens of Mycobacterium tuberculosis. Peripheral blood mononuclear cells [PBMC] were obtained from patients suffering from pulmonary TB and type II diabetes [n = 7], pulmonary TB without diabetes [n = 10] and healthy subjects without TB and diabetes [n = 10]. PBMC were assessed for CMI responses in antigen-induced proliferation assays in response to complex mycobacterial antigens [whole cells, cell walls and culture filtrate of M. tuberculosis], a battery of naturally purified or recombinant produced secreted [ESAT6, MPT59, MPT64 and MTB38] and cytosolic [MTB10, MTB70, ML10, ML28, ML36, ML65 and MB65] mycobacterial antigens and fractionated culture filtrate proteins [fractions F1-F10] of M. tuberculosis. The majority [>70%] of diabetic and non-diabetic TB patients and healthy subjects responded to the complex antigens of M. tuberculosis. However, among the single antigens, ESAT6 was most frequently recognized by TB patients with and without diabetes, but least recognized by healthy subjects. The secreted antigens MPT59 and MPT64 were recognized by all the groups, whereas the cytosolic antigens were recognized best by healthy subjects. When tested with fractionated secreted proteins present in the culture filtrate of M. tuberculosis, the best responses in both diabetic and non-diabetic TB patients were obtained with fractions containing low-molecular-weight proteins. Diabetic and non-diabetic TB patients respond frequently to secreted low-molecular-weight ESAT6 antigen of M. tuberculosis, indicating that this antigen may be useful in the diagnosis of TB in both the groups

Root resorption during orthodontic tooth movement: a literature review

External root resorption [ERR] of permanent teeth is an unpredictable consequence of orthodontic treatment, usually diagnosed on periapical radiographs. The etiological and biochemical mechanisms are still unclear. Theories include excessive force that leads to the development of an avascular area referred to as hyalinized, resulting, through a cascade of cellular events, in increased cementoclast-osteoclast activity. Yet, risk .factors are incriminated that may be classified in two major categories: constitutional factors [gender, chronologic and dental ages, genetics, individual susceptibility, systemic factors, tooth structure, alveoloar hone density, specific tooth vulnerability to root resorption]; physiologic and environmental factors [nutrition, habits, occlusal trauma, endodontic treatment, trauma prior to orthodontic treatment, mechanical pressure such as types of orthodontic movement, appliances, and forces, duration of orthodontic treatment, repeated orthodontic treatment]. When resorption is detected, treatment objectives should be modified to maintain appropriate crown-to-root ratio and periodontal health, while light forces are used and root length monitored

Correlation between CT scan and automated perimetry in supratentorial tumors.

An attempt was made to correlate various types of visual field defects on automated perimetry with the findings of computed tomography in 44 patients of supratentorial tumors. All the patients above the age of 10 years were subjected to complete neurological examination including investigations like plain X-rays and CT scan, however, MRI and angiography were performed wherever indicated. Ocular examination particularly pertaining to neuro-ophthalmological profile was carried out with special emphasis on automated perimetry on Humphrey field analyser. The results indicated that automated perimetry was capable of reliably detecting and quantitating the visual field defects and thus established the location of the tumor in 72% patients when compared to CT scan. Hence, any patient with neuro-ophthalmic features should be subjected to automated perimetry for early diagnosis and probable location of intracranial space occupying lesion affecting visual pathways.

Causes of death amongst women in the reproductive age in Mosul

Content: Under registration of death is high in Mosul, which makes it imperative to compute Cause Specific Proportional Mortality Rate [CSPMR] to identify the leading causes of death in a specific age and sex group like women in the reproductive age. List in priority order, the causes of death amongst women in the reproductive age, 15-44 years, in Mosul. Examine any change that might have occurred in recent years in leading causes of death by comparing causes of death in this age and sex specific groups in 1992 with those of 1995. Design: Biometry-analysis of available data of registered deaths. Setting and participants: Death certificates of women in the age group 15-44 years who died in Mosul city in Ninevah Governorate, north of Iraq in the whole year of 1995 [364certificates], Ninevah population in 1995, number of live births, infant deaths, total deaths, deaths for each sex and deaths amongst women in reproductive age for Ninevah in 1995 are also utilized. Main outcome measures: CSPMR expresses the number of deaths by a disease in relation to the total number of deaths rather than to the population base. The CSPMR is used to determine the leading causes of death in women in the reproductive age 15-44 years. Burns, malignant neoplasm and renal failure were among the top five causes of death. Obstetrics causes and pulmonary tuberculosis were among the top ten causes in 1995, while they were both absent from the list of 1992. ConcIusion: The great potential of CSPMR as valid practical measuring instrument of causes of death in areas with under registration of deaths lies in its use in different time periods and in different geographical areas. It is suggested, therefore, that similar studies like this one to be carried out in Mosul covering different times and in other localities of Iraq to establish leading causes of deaths among women during their reproductive period on firm basis

Activity of endothelial cells and immune system in patients with chronic heart failure

Levels of soluble intercellular adhesion molecule-1 [sICAM-1], an endothelial product expressed by cytokinesis action, thus representing an useful market for both, were assessed in plasma of 20 patients with chronic heart failure [CHF] [left ventricular ejection fraction [LVEF] < 45%, determined by echocardiography] classified into 2 equal groups, using New York Heart Association functional classification: Mild [class II] and severe [class III or IV]. The study included also, 10 matched healthy volunteers as control. Plasma levels of sICAM-1 were assessed by enzyme linked immunosorbent assay. Results showed that plasma levels of sICAM-1 increased significantly with the severity of CHF [control, 356 +/- 28.5 ng/ml, mild CHF, 441 +/- 14.5 ng/ml, and severe CHF, 509 +/- 25 ng/ml]. Significant negative and positive correlations were noticed between sICAM-1 and each of LVEF [-0.671, P <0.01] and functional class [+0.545, P <0.05], respectively. In conclusion, these findings indicated that plasma levels of sICAM-1 are increased with the severity of CHF and can provide valuable prognostic information. It may also suggested increased activity of both endothelial cells and immune system in patients with CHF, a point which requires further studies for clarification

Effect of dialysis on thyroid profile

Several parameters of thyroid function were estimated in 44 patients underwent hemodialysis and 8 patients underwent peritoneal dialysis, serum concentration of T4, T3, TSH, and T3RU Were measured before and after dialysis. The same measurements were performed, too, after 78hrs in 17 patients who were on hemodialysis. FT4I was calculated. T4 and FT4I was significantly increased after hemodialysis [5.9 +/- 1.9] [1.6 +/- 0.2] compared with the level before dialysis [5.1 +/- 1.3], [1.4 +/- 0.3], respectively. P<0.04, whole there was significant reduction in T3 after 68hr [0.5 +/- 0.3], P<0.04. Changes in other parameters were not significant. Apart from the subnormal levels of T3 before and after peritoneal dialysis, there was no significant change in any other parameters. We conclude that the increase in T4 after hemodialysis is likely due, in part, to the competitive binding exerted by heparin. And the relative long intervals between consecutive peritoneal dialysis caused a subnormal levels of T3