Physical activity in women with subclinical hypothyroidism.

PURPOSE: Physical activity is associated with many health-related benefits. However, there is a shift towards inactive lifestyles around the world. Subclinical hypothyroidism (SCH) may have adverse effects similar to hypothyroidism. The presence of symptoms and reduced physical performance in SCH may contribute to an inactive lifestyle. Therefore, the present study aimed to compare physical activity levels (PALs) between women with subclinical hypothyroidism and healthy controls. METHODS: Thirty-two women with newly diagnosed SCH and 28 healthy women were enrolled in this cross-sectional study. Arterial stiffness was evaluated by pulse wave velocity (PWV). Neuromuscular symptoms were questioned. Participants wore a physical activity monitor (SenseWear® Armband) for 4 consecutive days. Handgrip and quadriceps muscle strength were assessed by dynamometer. Functional exercise capacity was assessed by 6-minute walk test (6MWT). RESULTS: There was no significant difference in sociodemographic variables between the groups. PWV was significantly higher in the SCH group (P = 0.006). Physical activity duration and number of steps were significantly lower in the SCH group (P < 0.05). There was significant difference in neuromuscular symptoms, handgrip and quadriceps muscle strength, and 6MWT distance between the groups (P < 0.05). CONCLUSIONS: This study demonstrates that women with SCH had lower PALs compared to healthy controls. Women with SCH should participate in exercise programs to increase physical activity and muscle strength to achieve adequate PALs.

Actinomycosis osteomyelitis of the jaws: Report of four cases and a review of the literature.

Actinomycosis osteomyelitis of the jaw bones, particularly in the maxilla, is an extremely rare disease. This report presents two cases of maxillary and two cases of mandibular actinomycosis osteomyelitis, with the diagnosis particularly based on histological procedures. The highly diversified pathogenicity of the phenomenon and the absence of solid diagnostic criteria are discussed. Laboratory challenges are emphasized, and a comprehensive overview of the entity including treatment alternatives is given along with a review of the relevant literature.

Changes in the lower lip soft tissue after bone graft harvesting from the mandibular symphysis.

Following the surgical release of the mentalis muscle, lip incompetence and/or an increase in lower incisor exposure may be seen due to undesirable attachment of the muscle fibres. The aim of this study was to evaluate the extent of lip ptosis, lower incisor exposure, and other soft tissue changes following bone graft harvesting from the mandibular symphysis when the mentalis muscle is reapproximated precisely to its original position. Seventeen consecutive patients who underwent bone graft harvesting from the mandibular symphysis were included in this study. The mentalis muscle was isolated, identified, marked, and reapproximated precisely during the bone harvesting operation. Digital lateral cephalograms obtained preoperatively and at 6 months postoperative were analyzed and compared by paired samples t-test to determine the horizontal and vertical soft tissue changes in the lower lip and chin. Although the soft tissue thickness at soft tissue point B and at soft tissue pogonion had increased significantly at 6 months after chin bone graft harvesting, there were no significant changes in lower incisor exposure or other positional alterations of the lower lip (P<0.05). Precise reattachment of the mentalis muscle in its original position helps to avoid significant vertical positional changes in the lower lip. Increases in soft tissue thickness can be observed following bone graft harvesting from the mandibular symphysis.

Changes in difficult airway predictors following mandibular setback surgery.

The aim of this study was to determine the effect of surgical mandibular backward movements on the predictors of a difficult airway. Thirty-seven skeletal class III patients were included in this study. The Mallampati score, body mass index (BMI), maximal inter-incisal distance, and thyromental and sternomental distances of these patients were evaluated preoperatively and at 6 months and 2 years postoperatively. A sagittal split ramus osteotomy (SSRO) without genioplasty was performed in all patients by the same surgical team, and anaesthesia was provided by the same anaesthesiologist using nasotracheal intubation. The paired samples t-test and Wilcoxon signed-rank test were used for statistical comparisons of the data. There were no statistically significant changes in BMI or sternomental and thyromental distances after SSRO. The maximal inter-incisal distance was significantly reduced at 6 months postoperatively (P<0.05), but no statistical difference was found between the values obtained preoperatively and at 2 years postoperative. A statistically significant increase in Mallampati score was observed postoperatively (P<0.05). Both the patient and practitioner should be aware of the risks associated with an increased postoperative Mallampati score in mandibular setback patients. The amount of mandibular setback in skeletal class III patients with a high preoperative Mallampati score should be limited to prevent potential postoperative airway problems.

Idiopathic root resorption of the entire permanent dentition: systematic review and report of a case.

A rare case of idiopathic root resorption affecting the entire dentition was described. Root resorptions of all of the maxillary and mandibular teeth were coincidentally diagnosed on patient's radiographic examination. The patient's medical and dental findings were non-contributory, other than the increased mobility of upper incisors. No significant familial findings could be identified. Detailed radiographic examination revealed resorption affecting the apical part of the roots, resulting in vertical shortening of the teeth. The character of the resorption was as if a tapering occurred throughout the lateral root surfaces. Involved teeth were endodontically treated and the patient was subsequently followed-up for 18 months. Following endodontic therapy, all periapical lesions demonstrated clinical and radiographic evidence of healing. Endodontic therapy resulted in a high degree of success to stop resorption process and maintain the dentition.

Perceptibility curve test for digital radiographs before and after application of various image processing algorithms.

OBJECTIVES: The aim of the present study was to compare digital radiographs before and after the application of various digital image enhancement methods by means of a perceptibility curve (PC) test. METHODS: Radiographs of an aluminium test object containing holes with sizes ranging from 0.5 mm to 1.5 mm were exposed at nine time settings, ranging from 0.05 s to 3.2 s using Digora (Soredex, Helsinki, Finland) storage phosphor system. Original digital images were then enhanced and displayed in colour-coded, contrast- and brightness-enhanced, histogram-equalized and negative modes. Thus, five series of images were created. Eight observers independently evaluated all of the images in the same random order and under the same viewing conditions. The object detail with the lowest perceptible contrast was recorded for each observer and each image type. Modified PCs were plotted according to the mean observer data. Repeated-measures ANOVA was used to compare the PCs and the perceptible number of details in original and enhanced images for each exposure (P=0.05). The Bonferroni/Dunn test was used to identify statistical differences among the groups. RESULTS: Histogram equalization showed the maximum number of perceptible details in both the lowest optimal exposure time and the widest exposure range (P<0.05). Significant differences were present in low and middle exposure ranges of images enhanced with various modalities (P<0.05), while no difference was obtained among the number of details for different enhancements in the high exposure range (P>0.05). CONCLUSION: Histogram-equalization enhancement of Digora images demonstrated subjectively superior image quality, followed by contrast and brightness enhancement.

The effect of three different sealers on the radiopacity of root fillings in simulated canals.

OBJECTIVE: The aim of this study was to investigate the effect of 3 root canal sealers on radiopacity of root fillings in simulated canals by means of direct digital radiography. STUDY DESIGN: Thirty simulated root canals in transparent acrylic blocks were prepared with a 4% tapered, size 25 instrument. A single 4% tapered, size 25 gutta-percha cone was inserted into each canal. Standardized images of the blocks with an aluminum step-wedge were obtained by using Digora storage phosphor plates. Then, 3 root canal sealers (Roeko, Diaket, Pulpdent) were mixed according to the manufacturers' instructions. The gutta-percha cones were completely coated with one of the sealers and placed in the identical canal to the full working length. The images of the blocks were reobtained after sealer application. The mean gray values (MGVs) of root fillings were measured with or without the sealer at 3 different levels (1 mm, 6 mm, and 11 mm from apex) by using the Image Tool program. Each MGV measurement was then converted to its aluminum equivalent by means of the step-wedge values. A paired t test was used for statistical analysis. RESULTS: RoekoSeal caused a significant decrease in the radiopacity of the root fillings at the 1-mm level (P < 0.01). Diaket and Pulp Canal Sealer (PCS) increased the radiopacity of the fillings at all levels significantly (P < 0.01) except 6- and 11-mm levels of the Diaket specimens (P > 0.05). CONCLUSION: The type and the thickness of root canal sealers can influence the radiopacity of the root fillings.

Comparison of remifentanil and fentanyl in anaesthesia for elective cardioversion.

This prospective, randomized, double-blind study was designed to compare the recovery characteristics of remifentanil and fentanyl in combination with propofol for direct current cardioversion. Patients undergoing elective cardioversion received either intravenous fentanyl 1 microg/kg (n=33) or remifentanil 0.25 microg/kg (n=30) and propofol was titrated to a Ramsay sedation score of 5 by slow intravenous injection. Heart rate, systolic, diastolic and mean blood pressures decreased significantly following sedation in both groups but did not show a significant difference between the groups. Time to answer a question (306 +/- 83 vs 383 +/- 131s, mean +/- SD, P=0.014) and time to sit up (412 +/- 90 vs 511 +/- 126s, P=0.002) were significantly shorter in the remifentanil group compared to the fentanyl group. Side-effects and patient discomfort were similar for both groups. Remifentanil can be used as a suitable supplement to propofol for direct current cardioversion and may provide a faster recovery profile than fentanyl.

Accuracy of proximal caries depth measurements: comparison between limited cone beam computed tomography, storage phosphor and film radiography.

The aim of this study was to compare the accuracy of limited cone beam computed tomography (LCBCT), an image plate system and F-speed film in assessing the depth of proximal carious lesions. Radiographs of a dry mandible with sound and carious teeth were obtained with all three methods. In 41 molar and premolar proximal surfaces, 2 observers independently measured lesion depth on the images from the three modalities. The correlation of measurements was assessed with Pearson's correlation analysis. Results from imaging modalities and histological sectioning (gold standard) were compared using Bland-Altman plots. Overall comparison of the depth measurements from the imaging modalities and the gold standard was done using repeated-measures ANOVA. Pairwise comparisons of systems were done by the Bonferroni t test. The correlation between the measurements of the two observers was 0.977 for film, 0.997 for image plate system and 0.998 for LCBCT. Bland-Altman plots revealed that LCBCT agreed very closely with the gold standard while the agreement between the latter and the image plate--or film--images was moderate. The mean difference and 95% limits of agreement between LCBCT and the gold standard were smaller than those between either image plate or F-speed film and the gold standard. The LCBCT method appears as a promising tool for detection and monitoring of proximal carious lesions.

Degradation of storage phosphor images due to scanning delay.

OBJECTIVE: To evaluate the degradation of storage phosphor images relative to scanning delay. METHODS: A series of exposures of an aluminium step-wedge with five 2 mm incremental steps were made using blue Digora storage phosphor plates (SPPs). After the first exposure the plates were immediately scanned. After the second the plates were scanned after a half hour delay, after the third after a 1 h delay and so on until a final delay of 8 h. Mean grey values (MGVs) of each step of the wedge and its background were compared using repeated measures analysis of variance (ANOVA). Difference between group means was assessed using Bonferroni/Dunn multiple comparison test (P<0.05). RESULTS: MGVs increased with the increase in scan delay. Repeated measures ANOVA revealed that MGVs of the background and each step of the wedge were significantly different from each other for all scan delays (P<0.0001). Bonferroni/Dunn test showed that MGVs from plates scanned half an hour after exposure were not significantly different from those scanned immediately (P>0.05). Longer delays gave rise to significant differences in MGVs (P<0.05). CONCLUSION: Digora SPPs show statistically significant degradation of grey level values and contrast in plates scanned half an hour or longer after exposure.

An ex vivo comparison of conventional and digital radiography for perceived image quality of root fillings.

AIM: To compare the subjective image clarity of two different speed films and the Digora phosphor plate images with respect to the length and homogeneity of root canal fillings. METHODOLOGY: Root canal treatment was performed on 20 extracted permanent mandibular first molar teeth. Standardized images of each tooth positioned in a dried mandible were obtained with E- and F-speed films and Digora storage phosphor plates (SPP) at 0 degrees and 30 degrees horizontal angulations using the optimal exposure time recommended for each system. Five endodontists and five radiologists rated the image clarity of E- and F-speed radiographs as well as the original and enhanced Digora images. The data were compared using the Wilcoxon signed rank test (P < 0.01). Inter-observer agreement was determined by Cohen's kappa. RESULTS: Enhanced digital images were rated as superior followed by E- and F-speed films and then the original digital images for the evaluation of both homogeneity and length (P < 0.01) of root canal fillings. Agreement among endodontists and radiologists measurements was high in all of the imaging methods (kappa = 0.87). CONCLUSION: Perceived image quality of the enhanced Digora images was superior to the original Digora and conventional film images for the evaluation of root fillings. However, E-speed film provided a significantly better image clarity in comparison with F-speed and original Digora images.

Effect of delayed scanning of storage phosphor plates.

OBJECTIVE: To test longevity of image quality in storage phosphor plates (SPPs) at various exposure settings, storage conditions, and delays in scanning. STUDY DESIGN: Fifteen Digora plates were exposed from 0.08 to 0.20 seconds and scanned immediately, 10, 30, and 60 minutes, and 24 hours after exposure. Plates were stored both in daylight and in a light-tight box. Mean gray values (MGVs) were compared using 2 x 5 x 5 factorial ANOVA. Interaction between variables was tested using Bonferroni/Dunn multiple comparisons test. RESULTS: MGVs decreased with increase in exposure but increased with the scan delay. Only MGVs of plates scanned within 10 minutes after exposure were not significantly different from the ones scanned immediately ( P > .05). MGVs increased with scan delay for all exposure times no matter how the plates were stored ( P < .05). CONCLUSION: Based on the time delays examined, it is recommended to scan the Digora SPP no later than 10 minutes after exposure. Longer periods may cause loss of quality.

Fraudulent management of digital endodontic images.

AIM: To present examples of radiographic image reconstructions in endodontic treatment, to discuss the potential problems arising from the use of image processing software and to mention some current methods to prevent such counterfeit utilization of digital endodontic radiographs. SUMMARY: Conventional Ultra-Speed periapical films of root canal treatment were digitized with flatbed scanner (Umax Powerlook II, Umax Technologies, Inc., Taiwan). Digital images were altered with PHOTOSHOP 6.0 software (Adobe Corporation, San Jose, CA, USA). Carious lesions, periapical pathoses, fake root canals and artificial fillings were created, and inadequate treatment was corrected by application of various image manipulation functions of the software. KEY LEARNING POINTS: Digital endodontic images can be altered with image processing software. The use of digital radiographic data inevitably raises concerns about security, reliability and the potential for fraud.

Dental caries and fluorosis in low- and high-fluoride areas in Turkey.

OBJECTIVE: The aim of this study was to investigate the caries prevalence of children living in either low- or high-fluoride areas and to relate caries experience to the severity of dental fluorosis. METHOD AND MATERIALS: A total of 278 12- to 14-year-old schoolchildren, 149 in a low-fluoride area (LFA) and 129 in a high-fluoride area (HFA), were included in the study. The naturally occurring fluoride concentrations in the drinking water were 0.30 to 0.40 ppm in the LFA, 1.42 to 1.54 ppm in the HFA1, and 1.55 to 1.66 ppm in the HFA2. Dental caries was recorded with the World Health Organization criteria, and dental fluorosis was measured using the Tooth Surface Index of Fluorosis. RESULTS: The percentages of children who had an average TSIF > or = 1 were 0%, 29%, and 77% in the LFA, HFA1, and HFA2, respectively. The mean decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled permanent surfaces (DMFS) were 0.84 +/- 0.98 and 1.58 +/- 2.24 in LFA, 1.30 +/- 1.46 and 1.78 +/- 2.52 in HFA1, and 1.26 +/- 1.42 and 1.97 +/- 2.60 in HFA2, respectively. There was no significant difference in caries prevalence among children living in low- and high-fluoride areas when evaluated with an analysis of covariance model, including the frequency of toothbrushing. Toothbrushing frequency had a significant effect on the decayed teeth, decayed surfaces, DMFT, and DMFS. In high-fluoride areas, there was no relationship between caries prevalence and severity of fluorosis. CONCLUSION: Increasing water fluoride levels were associated with higher prevalence and severity of dental fluorosis and had no influence on caries experience in children with poor oral hygiene.

The effects of mouthrinses on microhardness and colour stability of aesthetic restorative materials.

Detrimental effects exerted on oral and dental tissues by frequent mouthrinse use are observed, but studies about their effects on aesthetic restorative materials are limited. In this study, the purpose was to examine the effects of three proprietary mouthrinses on three different aesthetic restorative materials. Mouthrinses were used as treatment groups, while distilled water served as the control. From a total of 72 specimens, each experimental group consisting of 24 samples were prepared from each restorative test material by using metal moulds. The samples were stored in 20 mL of one of the mouthrinses for 12 h, which was reported as the equivalent time to 1 year of 2-min daily mouthrinse use. Changes between baseline and after treatment measurements of surface microhardness and colour of the test materials were established by using Vickers microhardness tester and spectrophotometer. Statistical analyses were performed by analysis of variance (anova), with Bonferroni correction. The level of significance was set as 0.05 in all tests. There were no significant interactions between the test solutions and the test materials with regard to microhardness (P > 0.05), and colour changes of the materials (P > 0.05). Effects of mouthrinses on restorative materials may differ depending on many in vivo factors that could not be replicated in vitro. Therefore, routine assessment of the effects of mouthrinses on aesthetic restorative materials is recommended.

Prevalence of Candida albicans in oral cavities and root canals of children.

The aim of this study was to examine the prevalence of C. albicans in the oral cavities and root canals of children. Twenty healthy and caries-free children and 13 children with caries, were screened. Imprint samples and sterile paper points were used to obtain the samples from oral cavities and root canals respectively. The production of germ tubes and the development of chlamydospores identified yeast cultures. Sixty-nine percent of children with caries and 5% of caries-free children were found to be Candida carriers. The difference in candidal prevalence between two groups was significant (p < 0.05). Sixty-one point five percent of children were positive for Candida in the root canal. Since, increase in the C. albicans in the oral cavity provides a potential source of the fungus particularly when resistance falls below a certain threshold, attention to strategies for the reduction of this pervasive and persistent pathogen becomes important. Therefore, reduction of caries and or introduction of antifungal agents during root canal treatment of children may be offered.

Periodontal and alveolar bone abnormalities associated with pachydermoperiostosis.

Pachydermoperiostosis (PDP) is an unusual syndrome manifested clinically by finger clubbing, extremity enlargement, hypertrophic skin changes, and periosteal bone formation. A rare case of pachydermoperiostosis (primary hypertrophic osteoarthropathy) with oral manifestations in a 47-year-old man is presented. The possible correlation between physiological mechanisms of this disease and their influence on oral periodontal tissues and alveolar bone is discussed.

The effects of captopril on serum digoxin levels in patients with severe congestive heart failure.

The effects of captopril on serum digoxin concentrations were studied in 8 patients with severe (NYHA Class IV) congestive heart failure. Serum digoxin concentrations were determined before and after the administration of captopril for 1 week in patients on chronic digoxin therapy. Each patient who was taking 0.25 mg of digoxin PO q.d., was administered 12.5 mg of captopril PO t.i.d. for 7 days. The peak serum concentration of digoxin (Cmax) before and after (on Days 0 and 7) captopril administration was 1.7+/-0.2 ng/ml and 2.7+/-0.2 ng/ml, the time to peak (tmax) was 2.4+/-0.5 h and 1.3+/-0.2 h, and the area under the 24-hour digoxin concentration-time curve (AUC0-24h) was 30.0+/-1.5 ng x h/ml and 41.7+/-3.4 ng x h/ml, respectively. While captopril caused a significant increase in peak serum concentration and the area under the digoxin concentration-time curve, it decreased the time to digoxin peak (p = 0.01, p = 0.04, p = 0.01, respectively). No patient developed evidence of digoxin toxicity. Concomitant administration of captopril with digoxin increases serum digoxin concentration in patients with severe congestive heart failure.

The effects of different image file formats and image-analysis software programs on dental radiometric digital evaluations.

OBJECTIVES: To determine if variations in radiodensity data are introduced by lossy Joint Photographic Experts Group (JPEG) compression and/or the use of three software programs. METHODS: An occlusal film with an aluminium step wedge was exposed, processed and digitized under standard conditions. Before the image was saved, the coordinates and the gray-scale value for each pixel in a 20 x 20 pixel area near the middle of the thickest step were recorded. These pixel coordinates and gray-scale values served as Truth 1. In addition, a digital simulated-radiographic image with assigned gray-scale values for each pixel was created and served as Truth 2. The digital data for the scanned radiograph and the simulated radiograph were saved as Tagged Image File Format (TIFF) and lossy JPEG files. Each file was opened with three software programs and the gray-scale values of homologous pixels were recorded. For these pixels in each image type, the mean gray-scale values and standard deviations were calculated. The pixel gray-scale values for each homologous pixel were also individually compared. RESULTS: When the TIFF images were opened with the three software programs, one program resulted in gray-scale values that were not concordant with truth. All JPEG images resulted in gray-scale values that were not concordant with truth. CONCLUSIONS: One software program added a column of 0s to data files. Lossy JPEG compression introduced potentially deleterious variations to radiodensity data, and at least two of the software programs performed JPEG image decompression differently.