Can STOP Trial Velocity Criteria Be Applied to Iranian Children with Sickle Cell Disease? / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Sickle cell disease (SCD) is strongly linked to stroke across all haplotypes in the pediatric population. Transcranial Doppler (TCD) ultrasound is known to identify the highest risk group in African-Americans who need to receive and stay on blood transfusions, but it is unclear if the same flow velocity cut-offs can be applied to the Iranian population. We aimed to evaluate baseline TCD findings in Iranian children with SCD and no prior strokes. METHODS: Children with genetically confirmed SCD (Arabian haplotype, homozygote) and without SCD (controls) were prospectively recruited from pediatric outpatient clinic over a period of 9 months. We performed TCD in both groups to determine flow velocities in the middle cerebral (MCA) and terminal internal carotid arteries (TICA). RESULTS: Of 74 screened children, 60 met the inclusion/exclusion criteria (62% female; mean age 10+/-4 years). Baseline characteristics did not differ between the cases and controls, except hemoglobin (Hb) which was significantly lower in the SCD group (P<0.001). The right MCA TAMM (Time Averaged Maximum Mean) was significantly higher than in controls (125+5.52 cm/s vs. 92.5+1.63 cm/s, P<0.001). Left MCA did not show differences. The TICA TAMM was also different between cases and controls (P<0.05). CONCLUSIONS: Among Iranian children with asymptomatic SCD and without receiving recent transfusion TCD velocities are higher as compared to healthy controls but appear much lower than those observed in STOP (Stroke Prevention Trial in Sickle Cell Anemia) studies. We hypothesize that some children at high risk may be present with velocities lower than 170-200 cm/s thresholds. A prospective validation of ethnicity-specific prognostic criteria is warranted.

[Impact of two types of sodium and ultra filtration profiles on systolic and diastolic blood pressure in patients during hemodialysis]

Intradialytic hypotension is the most frequent complication in patients receiving haemodialysis [HD]. This complication not only contributes to the illness of the patients, but also decreases the efficacy of the HD. So, hypotension prevention is a major challenge for medical team, especially for nurses. One of the preventive methods that have recently been presented is the use of sodium profile and ultra filtration [UF] profile. The aim of this study was to compare the effects of linear sodium + UF profile [type1] with stepwise sodium + UF profile [type3] on systolic and diastolic blood pressure in HD patients. In this crossover design study, 26 HD patients from two dialysis centers at Esfahan University underwent three kinds of treatment: [1] control, constant dialysate sodium concentration of 138 mmol/L with constant UF; [2] linear sodium profile + UF profile [type1], a linearly decreasing dialysate sodium concentration [146-138 mmol/L] in combination with a linearly decreasing UF rate; and [3] stepwise sodium profile + UF profile [type2], a stepwise decreasing dialysate sodium concentration [146-138 mmol/L] in combination with a stepwise decreasing UF rate. Eachtreatment was applied in three dialysis sessions. Data were analyzed using repeated measure ANOVA test in the SPSS. Twenty six patients participated in the study. A total of 234 dialysis sessions were analyzed. There were no significant differences in the systolic blood pressure between three groups during predialysis and first and the second hours [P>0.05]. The mean of systolic blood pressures were higher in the third hour and postdialysis during two types of profiles [1 and 3] compared with the routine care group [P<0.05]. The mean of diastolic blood pressure was also higher in postdialysis during two types of profiles [1 and 3] compared with the routine group [P<0.05]. There was no significant difference between the profiles 1and 3 [P>0.05]. In conclusion, sodium profile + UF profile is a simple and cost-effective method that modulate the dialysate sodium and ultra filtration rate and preserve the homodynamic status and blood pressure of patients during dialysis. Therefore, using sodium profile + UF profile [type1 and type 3] is recommended in order to prevent hypotension and reduce nursing work during hemodialysis process

[Effect of linear and stepwise sodium and ultra filtration profiles on intradialytic hypotension and muscle cramps in renal disease patients]

Intradialytic hypotension and muscle cramps are most frequent complications in patients receiving haemodialysis [HD]. So, preventing of these complications is one of the main challenges of the treatment team, especially for nurses. One of the preventive methods that have been recently introduced is the use of sodium profile and ultra filtration [UF] profile. The aim of this study was to evaluate the effects of two types of sodium and UF profiles on Intradialytic hypotension and muscle cramps. In this clinical trial study, twenty six stable HD patients from two dialysis centers [Ali Asghar and Al-Zahra Hospitals] of Isfahan University underwent three different treatments: [1] control, constant dialysate sodium concentration of 138 mmol/l with constant UF, [2] linear sodium profile + UF profile [type1], a linearly decreasing dialysate sodium concentration [146-138mmol/l] combination with a linearly decreasing UF rate. [3] a stepwise sodium profile + UF profile [type2], a stepwise decreasing dialysate sodium concentration [146-138 mmol/l] combination with a stepwise decreasing UF rate. Each treatment was applied in 3 dialysis sessions. Data were analyzed using ?[2] test using SPSS software. A total of 26 patients [14 men, 12 female] were participated in this study. The mean age of patients was 46.8 +/- 19 years. In each group, 78 dialysis sessions and a total of 234 dialysis sessions were analyzed. The incidence of intradialytic hypotension and cramps was significantly reduced during two type of profiles compared with control group [P<0.05, respectively]. However, there was no significant differences between profiles [P>0.05]. Sodium profile and UF profile are simple and cost effective method that modulate the dialysate sodium and ultrafiltration rate and preserve the homodynamic status of patients during dialysis. So, using of sodium profile and UF profile groups [linear and stepwise] is recommended for prevention of hypotension and cramps during dialysis process

[Systemic manifestations and oral findings in hypophosphatasia: a case report]

Hypophosphatasia is a rare inherited disorder characterized by deficient activity of tissue non-specific alkaline phosphatase [found in the bone, liver and kidney] which leads to abnormal bone and tooth mineralization. The symptoms are highly variable in their clinical manifestation, ranging from stillbirth without mineralized bone to early loss of primary teeth without bone symptoms. The diagnosis is based on low levels of serum alkaline phosphatase and increased serum or urine concentrations of phosphoethanolamine, pyridoxal 5 '-phosphate and inorganic pyrophosphate. Six clinical forms of Hypophosphatasia are currently recognized: prenatal [lethal], prenatal benign, infantile, childhood, adult and odontohypophosphatasia. A 27-month-old girl was referred to the Paediatric Dentistry Department of Shiraz Dental School with chief complaint of spontaneous loosening and shedding of anterior deciduous teeth. In clinical examination, it was noticed that, teeth number 61, 62, 71, 72 and 81 were absent. There was no sign of gingival inflammation. According to the height and weight curves, growth of patient was below the normal rate. About 1 year delay in the date of her standing or walking capability was recorded in the patient's medical history. Also there was a history of foot pain and early fatigue. CBC, serum alkaline phosphatase and urine phosphoethanolamine tests were requested for the patient. Results showed decreased serum alkaline phosphatase and increased urine phosphoethanolamine. In histological survey of exfoliated teeth, the absence of cementum on root surfaces was detected. Also, the patient's physician reported skeletal deformities and defective mineralization in her hands and feet

Assessment of a low dose of IV midazolam used orally for conscious sedation in pediatric dentistry

Midazolam is preferably used in pediatric dentistry for quick onset of action and recovery. The aim of this prospective, observer-blind and placebo-controlled study was to assess the efficacy of a low dose of oral midazolam in modification of the behavior of young pediatric dental patients. Forty children aged 3 to 5 years who displayed ratings 1 or 2 on the Frankl Scale and were healthy by the American Society of Anesthesiologists-I status were randomly divided into two experimental and control groups of 20 each. All children required pulpotomy and restoration of D and E teeth and received either 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup or the syrup alone. Subjects were continuously observed and monitored with pulse oximetry. Houpt's Behavioral Ratings was used to determine the overall behavior, the degree of crying and movement during treatment. Mann-Whitney U test was used for statistical analysis. Patients who received 0.25mg/kg of the prepared oral midazolam significantly behaved better during treatment than the placebo controls [P<0.05]. In comparison with the placebo group, reduced movement and crying were observed in the midazolam group [P<0.05]. No adverse effects were observed and treatments were completed successfully. A low dose of 0.25mg/kg of a 15mg/3ml IV midazolam mixed in black cherry syrup was found to be effective in conscious sedation of young pediatric dental patients

comparative study of two suture configurations in zone II flexor tendon repair in adults

Although the increase in the number of core sutures during flexor tendon repair increases the tensile strength of the repair, both increased handling at the time of repair and increased bulk at the repair site have been hypothesized as affecting clinical outcomes by increasing gliding resistance. The purpose of our study was to assess whether increasing the number of core sutures from two strands to four strands in zone II flexor tendon repair could improve the clinical results. A total of 42 patients with 60 flexor tendon lacerations in zone II were enrolled in this study. The injured tendon randomly underwent surgical repair by using one of the 2-strand or 4-strand modified Strickland techniques. Postoperative rehabilitation was the active extension-rubber band flexion method of Kleinert in all patients. The average duration of follow up was 8 months. The mean total active motion was 155.16° in 2-strand group [excluding two ruptures] and 154.33° in 4-strand group [P > 0.05]. Using Strickland's original score, this corresponds to excellent result in 83.3% and 86.6% of patients in 2-strand group and 4-strand group, respectively. Statistically, there was no significant difference between the clinical outcomes obtained in these groups. Concerning the tendon rupture after the repair, all of the ruptures [2 cases] occurred in the 2-strand group [P > 0.05]. We concluded that both suture strength and gliding resistance have influence on the result of flexor tendon repair in zone II, and increasing the number of core sutures and the resulting suture strength may be negatively affected by increase in gliding resistance

Comparison of the efficacy of lidocaine patch and benzocaine gel reducing injection pain in children

The most important aspect of behavior management in children is pain. control. The most recent topical material used for reducing injection pain is Dentipatch. No study has been performed on the efficacy of this material in Iran. The purpose of this study was to evaluate and compare the effectiveness of Dentipatch with 20% Benzocain gel. For this clinical trial study, sixty children in need of bilateral posterior infiltration of maxillary buccal mucosa were selected. All children completed the General and Dental Anxiety Scale tests, and then received bilateral buccal infiltration either following 10 minutes application of Dentipatch or 2 minutes application of Benzocaine gel. For measuring pain, children were asked to complete a Visual Analogue Scale [VAS] after each injection, and to report which injection was more painful. The tests were performed by two trained observers. For comparison of pain reduction, the data were statistically analyzed using Paired t.test and Wilcoxan Sign Rank test. According to VAS, in children without dental anxiety, the scores of the gel and patch were 66.85 and 29.92 respectively p < 0.001. The dental anxious children reports were 70.85 for the gel and 25.91 for the patch [p < 0.001]. According to child's report, in children without dental anxiety, the gel score was 2.31 and the patch score was 0.54, whereas in dental anxious children the scores changed to 2.81 and 0.66 with a statistically significant difference [p < 0.001]. The effect of Dentipatch in reducing pain was more pronounced than Benzocaine gel. Further investigations are necessary in order to decrease the Dentipatch application time

[Cytomegalovirus infection in renal recipients in Al-Zahra Hospital of Isfahan]

Patients with renal transplant who receiving immunosuppressive drugs are prone to any opportunistic infections such as CMV. This study is planed to detect the prevalence of anti CMV before transplantation and long term follow up of active CMV disease incidence. In this descriptive analytic study, all of the 70 patients who candidate for renal transplantation during 1381-1384 studied in Al-Zahra Hosptial of Isfahan. After filling questionires, Elisa test for anti CMV [IgM, IgG] performed and prevalence of these antibodies calculated. Also prevalence of these antibodies calculated according to age and gender and six months follow up was done for incidence of acute CMV disease following transplantation. 70 patients studied among them 64 [91/4%] had IgG-anti CMV [59/4% male and 40/6% female]. 2 person had IgM-anti CMV that both of them were female [100%]. There was relationship between anti CMV IgG prevalence and age [P<0/01] and no relationship of anti CMV IgG and gender. There was no any relationship of anti CMV IgM and age/gender, 2 cases [2/8%] of active CMV disease occurred after transplantation and one of them rejected the transplant. According to the prevalence of anti CMV IgG among studied patients there was high risk of reactivation which causing sever complication and transplant rejection so this recommendable to rapid diagnosis, prevent sever infection and mortality by performing CMV serology before transplant, detecting antigenemia PP [65] and PCR weekly as a screening test

[Inhibitory effects of NaF-varnish and APF-gel on cariogenic bacteria: an in vitro study]

While there are multiple components of preventive programs developed for caries prevention in children, perhaps none is as important and effective as the appropriate use of fluoride. The primary caries preventive effects of fluoride result from its topical contact with enamel and through its antibacterial actions. Till now bulk of research exists which has compared the antibacterial effects of ordinary topical fluoride gels and solutions. Little or no evidence is seen to tell us which topical fluoride including varnishes is more antibacterial. We suggested further research about antibacterial effect of APF gel and NaF varnish against cariogenic microorganisms [streptococcus mutans and lactobacillus], so use of these may have benefit in reduction of caries. Comparison of inhibitory effect of NaF-varnish versus APF-gel on concentration of cariogenic bacteria [streptococcus mutans and lactobacillus], was the primary goal of this research. In this exprimental study, twenty premolars were sectioned buccolingually. With the use of "window method" certain surfaces of enamel were covered with APF-gel and NaF-varnish. Then, the number of streptococcus mutans and lactobacillus were counted after 18, 24 and 48 hours. In the "Disk diffusion" method the streptococcus mutans with the concentration of 108/ml and volume of 0.1cc were introduced to the M.S.Media culture after application of APF gel and NaF varnish. Then the inhibition zone, measured. Statistical analysis in this research was multilevel modeling. The comparison between gel and varnish after 18, 24 and 48 hours showed that gel has more effect than varnish over the number of lactobacillus. The difference with lactobacillus was statistically significant [p<0.005], but with streptococcus Mutans was not. APF gel was more effective [70.23%] than NaF varnish. Based on the obtained results, APF gel can be used with more thrust than NaF varnish in caries prevention

[Comparative evaluation of manual and rotary techniques on cleaning ability and instrumentation time in deciduous molars]

New Ni-Ti rotary instrument systems have been designed for ease of canal preparation in permanent teeth. Evaluation of the ability and effectiveness of such newely introduced devices in pulp treatment of deciduous teeth seems to be logic and necessary approach as well. The purpose of this study was to compare the manual [K-file] and rotary [protaper] techniques on cleaning ability and instrumentation time in deciduous molar teeth. After injection of Indian ink into root canals of 49 teeth of 56 selected deciduous molars, the teeth were randomly devided into three experimental groups [14 teeth and 42 canals in each], and two control groups [each of 7 teeth and 21 canals]. Canal preparations were done manually [K-files] in group one, and by protaper rotary files in group two. In group three canals were only irrigated with normal saline, but no cleaning or irrigation of the canals were done in groups four and five [control groups]. Instrumentation time was recorded for groups one and two. After clearing procedure, canals contents were observed with a stereomicroscope at X10 magnification, and results were analyzed using T-test, ANOVA and Tukey HSD test. Mean cleaning amount of apical, midle and coronal thirds of the canals for protaper rotary files group [two] was more than that of manual K-files group [two] and normal saline group [three]. The differences between groups one and two and groups two and three were statistically significant [P<0.001]. Mean cleaning amount of all parts of canals for K-file manual instrumentation group [one] was more than that of normal saline group [three]. Statistical difference between groups one and three was also significant [p<0.001]. mean recorded instrumentation time in group two [rotary protaper group] was 70 seconds, while it was 130 seconds for manual K-file instrumentation group [p<0.001]. results suggest that rotary protaper can efficiently be used for endodontic treatment of deciduous teeth

Surveying Desferal production increment by inducing mutation in Streptomyces griseoflavus

Desferal or Desferrioxamine B mesylate is an iron chealator drug. This medicine decreases the iron overload in the thalassemia patients who have been blood transfused; the excess of iron is excreted through bile or urine. Novartis is the sole company which produces desferrioxamine B mesylate in the world and our country is importer of such drug. Thus we tried to increase Desferal production by inducing mutation in Streptomyces griseoflavus. This is an applied research carried out at pilot level. The organism is a Gram-positive bacterium that was supplied in lyophilized by Persian Type culture Collection, Iranian Research Organization for Science and Technology [IROST], Tehran, Iran bearing the code no. PTCC1130, which was cultured on Des4 medium. The organism was mutated by UV irradiation hence selective techniques and markers were employed to distinguish marked strains from parent S. griseoflavus. When the mutated organisms were selected according to their characteristics and used to fuse their protoplasts in order to obtain high yield desferrioxamine producing recombinant Streptomyces griseoflavus. The varied parameters were bacterial growth rate and desferal concentration in the culture broth. Our study showed that the rate of desferal production in mutant's strains called C7031 and S7011 and fusants srains called FP10 and FP9 was higher than wiled type Streptomyces griseoflavus. The increment in production of desferrioxamine was found to be 68% in FP9 and 81% in FP10 fusants. The mutation and protoplasts fusion of Streptomyces griseoflavus caused increment in production of desferrioxamine. The infrared spectrum, thin layer chromatogram of desferrioxamine extracted from culture broth was similar to that of standard desferrioxamine [Novartis] from the point of molecular identity

[Acanthosis nigricans, tripe palms and leser-trelat sign in patient with carcinoid tumor]

Acanthosis nigricans [AN], Tripe palm [TP] and sign of lesser trelat [LT] are rare dermatoses which are often seen with malignant conditions. Acanthosis nigricans occurs both on the skin and mucus membranes as velvety hyper pigmented lesions in the flexors and around the neck, or papillomatous and verrucous lesions on the lips and buccal mucosa. These para neoplastic dermatoses are generally linked with intra - abdominal malignancies, especially gastric adenocarcinomas and improvement of the associated dermatoses after treatment of the malignancy has been frequently observed, although it has also been observed with other malignancies. We report the case of a 44 year old woman who initially came to be treated for her mucocutaneous lesions, and with diagnosis of malignant AN was further studied for the initial malignancy and finally, her main malignancy was determined as carcinoid tumor

Comparison of the success rate and cleaning time of pulpectomy in necrotic primary molar teeth using manual and rotary instruments

Canal preparation is one of the most important and time-consuming steps in endodontic treatment of primary teeth. Regarding the difficulties in behavior management of some children, rotary [nickel-titanium] files proved more facilities and speed and hence more success in the root canal treatment of primary teeth. The purpose of the present study is comparison of the success rate and cleaning time of pulpectomy in necrotic primary molar teeth using manual and rotary instruments. In this study which is an interventional in vivo clinical trial, 40 patients, mean age 5.7 +/- 0.92, were randomly selected and divided into two equal groups [I, II]. In the first visit, pulpotomy of the necrotic teeth was done for all of the cases. In the second appointment after local anesthesia and isolation of the teeth with rubber dam, preparation of the canals was done with pro-taper nickel-titanium files [S[1], S[2], F[2]] in the first group and with stainless steel manual K-files [10-30] in the second group. The total time needed for debridement was calculated exactly by chronometer. The canals were then filled with ZOE by using lentulo spirals and periapical radiography was prepared for all of the cases. The patients were followed-up in 3 and 6 months intervals and the statistical analysis were done by Non-Parametry Mann-Whitney test. The success rates of manual and rotary instruments were 85% and 90% respectively after 3 months. The success rate of the two groups [I, II] was 100% after 6 months follow-up and all of the signs and symptoms including pain, abscess, fistula and perapical radiolucency disappeared. The time needed for canal preparation was calculated 4.12 minutes [251.75 +/- 32.58 seconds] with Pro-Taper and 9.21 minutes [563.05 +/- 70.03 seconds] with manual instruments. The difference was statistically significant. The success rate of manual and rotary instruments was 100% in both groups but the preparation time [which is an important clinical factor for patients management] significantly reduced using rotary instruments. Hence, pulpectomy of the primary teeth using rotary instruments [Pro-Taper files] is recommended for root canal treatments in children

[Analytic evaluation of the prevalence of head and neck cancers among patients with different kinds of cancers visited in radiotherapy department of Nemazee hospital, 2003-2004]

Statement of Problem: Head and neck cancers represent approximately 2-5% of neoplasms which is more in some countries. For example, 50% of cancers in India are of oral cavity and pharyngeal origin. Head and neck cancers are more prevalent in men, but in some regions of oral cavity, this ratio may be reversed. The majority of patients diagnosed with Head and neck cancers were over the age of 40 years

Purpose: This study was undertaken to determine the number of persons with head and neck cancer who were admitted in Radiotherapy Department of Nemazee Hospital during 2003-2004. Materials and Methods: In this retrospective study from 2003 to 2004, 496 subjects with head and neck cancers referred to Radiotherapy Department of Nemazee Hospital were evaluated. All patients were categorized according to sex, age, dose of irradiation and localization of the tumor

Results: The mean age of patients was 49 for men and 43 years for women. The most common site of the head and neck cancers was the brain [228 cases, 46%], followed by neck [57 cases, 11.5%] and larynx [56 cases, 11.3%]. Squamous cell carcinoma [SCC] was the most common tumor followed by astrocytoma, meningioma and lymphoma. It was shown that, comparison with other results, there were some similarities as well as differences in some instances

Conclusion: This research revealed that approximately 13.5% of patients who were admitted in Radiotherapy Department of Nemazee Hospital suffered from head and neck cancers. Due to complications of radiotherapy specially osteoradionecrosis, proper dental management plans before and after treatment seems necessary

Neurogenic tumors of the nose and postnasal space

Non-epithelial, benign extracranial neurogenic tumors of the nasal cavities are reported in the literature with extreme rarity. These tumors differ from the more common congenital gliomas, encephaloceles, etc. in that they sometimes are detached from the brain tissues. These tumors have intracranial origins. They are congenital or acquired and may involve any of the nerves inside the nose. These tumors can grow to quite a large size and in such cases, lateral rhinotomy is often necessary for complete excision