Associations between the 3D position of the mental foramen with sagittal skeletal relationships (classes I, II, and III) and vertical facial growth patterns (normal, long, and short faces) in different ages and sexes: a retrospective cohort study of 360 CBCTs.

BACKGROUND: The 3D position of the mental foramen (MF) is of significant clinical value in dental implantology and mandibular surgeries or in local anesthesia. Despite its importance, it is not clearly known how the position of MF can alter in different individuals, since the literature on the associations between the MF position with vertical growth patterns is non-existent and those on links between the MF position and skeletal malocclusions are scarce. Therefore, we aimed to investigate these, for the first time, on cone-beam computed tomographies (CBCTs). METHODS: Archival CBCTs of 9 sub-groups (i.e., 3 skeletal Classes I, II, and III × 3 vertical growth patterns 'long face, short face, normal face') were collected by evaluating patients' SNA, SNB, ANB, facial angle, lower facial height, and FMA (n = 9 × 40 = 360). Included cases were older than 17 years and without any history of orthodontic/orthognathic treatments (243 women, 117 men, mean age: 22.28 ± 2.80 years). Perpendicular distances between the MF and 3 fixed bony structures (the mandibular symphysis [S/width], the mandibular ramus [R/length], and the mandibular lower cortex [C/height]) were measured on different sectional planes on both hemimandibles. Left- and right-side measurements were combined. Data were analyzed using the 3-way ANCOVA, Bonferroni, one-way ANOVA, Tamhane, Pearson, and t-test (α = 0.05). RESULTS: Width was the smallest in Class II and greatest in Class III cases (all P values < 0.000001, Bonferroni). It was the shortest in long faces and longest in short faces (all P values ≤ 0.00008). The inferior-superior height was larger in Class III than both Classes I and II (both P values ≤ 0.003); there was no significant difference between Classes I and II in terms of height (P = 0.684). Height was the largest in long faces and smallest in short faces (all P values < 0.000001). The anterior-posterior length was the largest in Class III and smallest in Class II (all P values < 0.000001). Length was larger in short-face people versus normal- or long-face individuals (P ≤ 0.00003); nevertheless, long and normal faces did not differ in terms of length (P = 0.448). Subjects' age was not correlated with their MF positions (P ≥ 0.579, Pearson coefficient). Sex dimorphism existed only for height (P = 0.009, t-test) but not for length or width. CONCLUSIONS: The MF position may considerably differ in various horizontal or vertical growth patterns and sexes. This should be noted in mandible surgeries.

Effect of bleaching with 15% carbamide peroxide on color stability of microhybrid, nanohybrid, and nanofilled resin composites, each in 3 staining solutions (coffee, cola, red grape juice): A 3-phase study.

Background: The literature on the effect of bleaching on stainability and color stability of any composites is scarce and controversial. In the case of some composites and/or bleaching agents or staining solutions, there is no previous study. Therefore, this rather large study was conducted for the first time to examine simultaneously the effects of bleaching and 3 staining solutions on 3 composite types. Materials and Methods: This 3-phase experimental in vitro study was performed on 18 groups of 5 specimens each: 90 composite discs with 10 mm diameter and 1 mm thickness were fabricated from 3 resin composites (microhybrid, nanohybrid, and nanofilled). Forty-five discs underwent bleaching with 15% carbamide peroxide, and the remaining 45 were immersed in distilled water at room temperature. The color assessment was performed before and after this step, and Δa, Δb, and ΔL color parameters were calculated for each specimen. The specimens were then immersed in coffee, cola, and red grape juice for 2 weeks, and underwent colorimetry again. The simultaneous effects of bleaching and staining agents and composite types on ΔE (color changes) of composite specimens were analyzed using an independent-samples t-test, a Mann-Whitney U-test, and two-way and one-way analysis of variances followed by a Tukey and a Dunnett's T3 tests (α = 0.05). Results: Bleaching had no significant effect on color changes of microhybrid, nanohybrid, or nanofilled composites (P > 0.05). The stainability of composites did not increase after bleaching (P > 0.05). Regardless of the composite type and the presence of bleaching, coffee had the worst effect on color of composite specimens, while cola had the smallest staining effect (P < 0.05). Conclusion: Stainability of microhybrid/nanohybrid/nanofilled composites did not increase after bleaching with 15% carbamide peroxide. Coffee should be consumed with care, as far as composite coloring is a concern, regardless of the type of composite in use or its bleaching history. Cola was the weakest stainer. Coffee always caused perceptible staining (ΔE >3.7), regardless of the composite in use or its bleaching history. Red grape juice caused such perceptible colorations in most cases. Cola did not cause any perceptible discoloration in most cases.

Bullous Systemic Lupus Erythematosus: A Case Report.

Bullous systemic lupus erythematous (BSLE) is a very rare autoimmune disease characterized by vesiculobullous lesions on mostly sun-exposed areas of skin. We present a case of a 36-year-old female who developed vesiculobullous lesions after previously having poorly controlled lupus. Dapsone was added to her treatment plan, and the lesions healed in a few weeks without scarring or pigmentation.

5-Alpha reductase deficiency; an important cause of 46, XY DSD: Report of three cases within a family.

Key clinical message: 5-Alpha reductase deficiency is an important cause of 46, XY disorder of sex development. Timely diagnosis and proper management by a multidisciplinary team can lead to a favorable outcome. Sex assignment should be deferred until puberty because spontaneous virilization occurs and the patient can engage in the decision-making process. Abstract: 5-Alpha reductase deficiency is a genetic disorder causing 46, XY disorder of sex development (DSD). Typical clinical feature is a male with ambiguous genitalia or undervirilization at birth. Here we report three cases of this disorder within a family.

Effect of low-level diode laser on streptococcus mutans and lactobacillus acidophilus growth: An invitro study.

Introduction: Caries lesions are high prevalent dental infectious. Gram-positive bacteria are the most common pathogenic microorganisms causing caries lesions. Low-Level laser therapy has been shown to have a significant bactericidal effect without causing damage to the oral tissues. This study was designed to evaluate the efficacy of diode laser (980 nm) at different times and doses on Streptococcus (S.) Mutans and (Lactobacillus) L. Acidophilus microorganisms. Methods: This study was performed on two groups of microorganisms, including S. mutans and L. acidophilus, at a concentration of 108 CFU/ml, which exposed to a diode laser source with a central wavelength of 980 nm to investigate three different energies with the following time-exposures (at doses of 5, 10 and 20 J/cm2 with irradiation times of 5, 10 and 20 s). The growth of bacteria (CFU/ml) was calculated. Results: A significant decrease in CFUs/ml of two microorganisms was observed immediately and 24 h after irradiation (p-value < 0.05). The most effective laser radiation for S. mutans immediately and 24 h after exposure was seen at 5 s with 20 J/cm2 and 20 s with 5 J/cm2, respectively. The most effective laser radiation for L. acidophilus was the time of 5 s with 10 J/cm2 both immediately and 24 h after exposure. Conclusion: In the present study, we demonstrated that diode laser (980 nm) has great efficacy in the growth reduction of S. mutans and L. acidophilus at different times and doses.

Efficiency and side effects of a novel method for maxillary central root torque (a horizontal box loop of round wire) in comparison with the conventional rectangular wire: A finite element study.

INTRODUCTION: Applying root torque using conventional methods (rectangular wire) has side effects such as inverse and destructive forces, undesirable torque on adjacent teeth, heavy forces that are limited in range and duration, and needing too many sessions. We introduce a new method (a horizontal box loop [HBL]) that is designed to reduce many of these side effects; we tested its efficiency and side effects using finite element analysis. METHODS: An HBL was created from a 0.018-in round stainless steel archwire, in the form of an equilateral triangle of 7 mm sides, for the permanent maxillary left central incisor. As a control, a SS rectangular wire (19 × 25-in) was used. First, a pilot simulation was performed to standardize the torque in both models as 31.099 N mm. The extent of twisting by the rectangular wire, of which the same amount of moment would be applied, was estimated at 28.282°. The main study evaluated the effects of the 31.099 N.mm moments applied by both models to the left central incisor on stresses, dental movements (buccolingually, mesiodistally, and extrusive or intrusive), and intercanine or intermolar widths. RESULTS: Under standardized conditions, the HBL causes a greater palatal root torque of the central incisor than the rectangular wire. The HBL does not apply reverse root torque on adjacent teeth, whereas the rectangular wire causes reverse root torque in neighboring teeth. The HBL also causes less extrusion and expansion in the molar area than does the rectangular wire. The HBL increases intercanine width, whereas the rectangular wire might not change it. CONCLUSIONS: HBL of round wire seems an appropriate appliance and hence its clinical assessment is recommended.

Characteristics and Dynamics of Full Arch Distalization Using Transpalatal Arches with Midpalatal and Interradicular Miniscrews as Temporary Anchorage Devices: A Preliminary Finite Element Analysis.

INTRODUCTION: Miniscrews have proved quite effective in fixed orthodontic treatment. They can be placed in areas like palatal interradicular zones or midpalatal suture. Despite the value of these methods and their ever-increasing use, their characteristics are not assessed before when implanted in palatal interradicular areas or in the midpalatal suture. We aimed to assess, for the first time, the dynamics of full arch distalization using such miniscrews. METHODS: A 3D model of maxilla with all permanent dentition was created from a CT scan volume. Tissues were segmented and differentiated. Afterward, miniscrews and appliances were designed, and the whole model was registered within a finite element analysis software by assigning proper mechanical properties to tissues and orthodontic appliances. The full arches were distalized using transpalatal arches with miniscrews as anchorage devices (in two different models). The extents of stresses and patterns of movements of various elements (teeth, miniscrews, appliances, tissues) were estimated. Results and Conclusions. Comparing the two models, it is obvious that in both models, the stress distribution is the highest in the TPA arms and the head of the miniscrew where the spring is connected. In comparison with the displacement in the X-axis, the "mesial in" rotation is seen in the first molar of both models. But there is one exception and that is the "mesial out" rotation of the right second molar. In all measurements, the amount of movement in Model 2 (with palatal interradicular miniscrews) is more than that in Model 1 (with midpalatal miniscrew). In the Y-axis, more tipping is seen in Model 2, especially the anterior teeth (detorque) and the first molar, but in Model 1, bodily movement of the first molar is more evident. Along the Z-axis, the mesial intrusion of the first molar and the distal extrusion of this tooth can be seen in both models. Again, the displacement values are higher in the second model (with interradicular miniscrews). In comparison with micromotion and stress distribution of miniscrews, in Model 1, maximum stress and micromotion is observed at the head of the miniscrew where it is attached to the spring. Of course, this amount of micromotion increases over time. The same is true for Model 2, but with a lower micromotion. As for the amount of stress, the stress distribution in both miniscrews of both models is almost uniform and rather severe.

Ultrasonic Synthesis and Characterization of 2D and 3D Metal-Organic Frameworks and Their Application in the Oxidative Amidation Reaction.

Ultrasound irradiation as an environmentally friendly and inexpensive method successfully applied for the synthesis of two-dimensional (2D) and three-dimensional (3D) metal-organic frameworks (MOFs). Sonochemically synthesized AM-Co1 and AM-Co2 powder has been employed as a green heterogeneous catalyst for the oxidative amidation reaction. The results show that AM-Co1 with a two-dimensional (2D) structure can act as an excellent catalyst for this reaction under ultrasonic irradiation compared to AM-Co2 with a three-dimensional (3D) structure. According to green principles, we used water as a green solvent and air as an oxidant for the oxidative amidation reaction. A wide variety of aldehydes and amines have been used for the synthesis of amides in good to excellent yields (75-90%). Also, the MOF catalyst could be recovered and reused several times without loss of activity.

Response to sapropterin hydrochloride (Kuvan®) in children with phenylketonuria (PKU): a clinical trial.

Background Phenylketonuria (PKU) is one of the most common types of inborn error of metabolism. The mainstay of therapy for PKU has been dietary phenylalanine (Phe) restriction. Sapropterin dihydrochloride has been shown to be effective in reducing Phe levels in PKU patients. Methods This study was a clinical trial performed in the pediatric endocrine clinic of Imam Reza Hospital, Mashhad, Iran. Results All children between 1 and 10 years of age with a diagnosis of PKU whose serum Phe levels were between 120 and 360 µmol/L, in Khorasan Razavi province in the north-east of Iran, were enrolled. Twenty-four patients were enrolled in the study. Intervention: A free diet for 72 h was allowed and then a 20-mg/kg/day dose of Kuvan® was administered. More than 30% reduction in blood Phe levels was described as responsive. Eight patients responded to the loading test and were eligible for the second stage of the study. In this stage, Phe powder in combination with Kuvan was provided. Patients' serum Phe was measured weekly for 3 months. All eight patients showed Phe tolerance in 3 months, and their serum Phe levels remained within the range. Conclusions Treatment with Kuvan can help reduce blood Phe levels in our pediatric PKU population and allows patients to follow a more liberal diet.

Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case.

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a rare malignancy in children. Nasal obstruction, otitis media with effusion, pain in the ear, hearing problems, and unusual neck mass are among the signs and symptoms of this malignancy. CASE REPORT: We report the case of a 13-year-old girl with NPC who later developed acute lymphoblastic leukemia (ALL) through the course of her disease. To our knowledge, this is the first report of ALL following childhood nasopharyngeal carcinoma in the English-language literature. CONCLUSION: Reports of secondary malignancies at the site of radiotherapy for NPC exist, but this is the first report of ALL following NPC.

Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration.

BACKGROUND: Neonatal hypernatremic dehydration (NHD) is a dangerous condition that can lead to severe weight loss, renal impairment, and central nervous system complications. We aimed to evaluate the consequences of NHD in infants in their second year of life. MATERIALS AND METHODS: This was a prospective case-control study in Ghaem hospital, Mashhad, Iran. Sixty-five healthy breastfed neonates (serum sodium concentration <150 mmol/L) and 65 hypernatremic (serum sodium concentration ≥150 mmol/L) neonates were followed up from 2008 to 2011. Maternal and neonatal factors were compared between the two groups together with their growth parameters, and developmental milestones (using Denver II developmental assessment scores) were assessed and compared in ages 6, 12, 18, and 24 months, respectively. RESULTS: The weight of infants at 6 months of age was significantly different between the two groups (7,264 ± 1,089 g vs. 7,596 ± 957 g, p = 0.009). Twenty-five percent of infants in the group who had developed NHD had a delay in development at 6 months of age, with corresponding values of 21% at 12 months, 19% at 18 months, and 12% at 24 months of age. Developmental delay was ∼0.3% for the control group at similar ages. The severity of hypernatremia was strongly correlated with poor developmental outcome at 6 months (p = 0.001). Serum sodium concentration of neonates was 153-195 mg/dL in the NHD group. Median peak serum sodium was 158 ± 16 in case group and 141 ± 9 in control group. Serious complications were cerebral edema (five cases), hemorrhage (five cases), and kidney stones (six cases). Hypernatremic dehydration has an adverse effect on child development especially in the first year of life, their prevalence decreases with advanced age. Growth problems are also present during their first year of life. The major signs and symptoms of infants with poor prognosis on admission were poor feeding (8 infants, 61.5%), seizure (3 infants, 23.1%), hyperthermia (1 infant, 7.7%), and lethargy (1 infant, 7.7%). CONCLUSIONS: NHD affects growth parameters and developmental milestones of children. Occasionally the child's weight gain was normalized by the end of first year of life; although developmental delay continued, its severity was reduced, with age.

Comparison between infants receiving traditional supplements (camel thorn, flix weed, and sugar water) and exclusively breast fed infants.

OBJECTIVE: Although breast milk is considered the best nutritional option for neonates, use of traditional supplements such as sugar water, camel thorn, and flix weed in the first week of life of infants is quite common in Iran and many other countries. The aim of this study was to evaluate whether consuming such supplements has any impact on infant's breastfeeding behavior. MATERIALS AND METHODS: Four hundred fifty four term infants who were referred to the neonatal clinic of Ghaem hospital were enrolled and divided into two groups. Control (exclusively breastfed infants, N=243) and case (breast milk feeding plus traditional remedies such as sugar water, camel thorn, and flix weed, N=211). Spss 19.5 was used for statistical analysis. T-test and Man-Whitney tests were used. A p-value of <0.05 was considered as significant. RESULTS: The two groups were similar in their baseline data. Regarding duration of breastfeeding and breastfeeding frequency, use of these supplements resulted in a reduction in both breastfeeding frequency and duration (p<0.05). Breastfeeding problems such as poor let-down reflex and incorrect breastfeeding position were more common among mothers feeding these supplements to their infants. Moreover, infants with delayed initiation of first breastfeeding were more likely to receive these supplements. CONCLUSION: Based on the results of this study, feeding infants with sugar water, camel's thorn, and flix weed is clearly associated with breast feeding problems such as poor let down reflex and incorrect breast feeding position. Use of these supplements resulted in a reduction in frequency and duration of breast feeding. Infants with delayed initiation of breast feeding are more likely to receive these supplementations. Therefore, any attempts to improve the community's culture would be of great benefit to the health and well being of our babies.

Hypercalciuria following ceftriaxone a fact or myth.

INTRODUCTION: Nephrolithiasis is a common worldwide problem both in children and adults. Ceftriaxone as a widely used antibiotic can contribute to the formation of renal stones and hypercalciuria. OBJECTIVES: To find the effect of ceftriaxone, a widely used antibiotic, on urinary calcium excretion rate in children. PATIENTS AND METHODS: 84 infants and children over 3 months admitted to hospital for non-renal problems. They were all previously healthy children affected with a condition mandating hospitalisation. They were randomly divided into 2 groups; those who received ceftriaxone according to their physician decision as the case group and those who did not receive antibiotics as the control group. The patients urinary calcium excretion was determined as calcium to creatinine ratio in a random urine sample in the first and third day of their admission. All data was expressed by mean ± SD and analysed by t independent and chi-square tests by SPSS 16. P P value less than 0.05 was significant. RESULTS: Eighty-four cases were analysed. Calcium excretion in received and non-received ceftriaxone groups was 0.13 ± 0.06 and 0.14 ± 0.02 respectively at first day of admission ( P = 0.1). After 3 days, the urine calcium to creatinine ratio increased to 0.27 ± 0.2 and 0.26 ± 0.08 in received and non- received ceftriaxone groups ( P = 0.8). CONCLUSION: In children, urinary calcium excretion increases 2 times in average in a short time after admission because of gastroenteritis, and ceftriaxone is not different to other antibiotics for increase urinary calcium excretion in 3 days after admission.

Labial adhesion and bacteriuria.

OBJECTIVE: The purpose of this study is to evaluate the clinical presentation, laboratory findings, and response to treatment in girls with labial adhesion younger than 23 months. MATERIAL AND METHODS: A retrospective chart review of all girls younger than 23 months with the diagnosis of labial adhesion was referred to Dr Sheikh children's clinic in Mashhad in northeast Iran between 1998 and 2013. RESULTS: Sixty-three patients were diagnosed with labial adhesion during the review period. Most patients were diagnosed by physicians during the physical examination or during the evaluation for their voiding problems. The most prevalent symptom among patients was dysuria and restlessness while voiding. Twenty-one (33.3%) patients had a history of urinary tract infection. 17 (26.9%) patients had sterile pyuria and 69.8% showed presence of bacteria in their urine samples. CONCLUSION: Physicians may frequently encounter pre-pubertal girls whose urinalysis may show sterile pyuria or presence of bacteria with colony counts <105 in the absence of urinary tract infection symptoms. In these cases, labial adhesion should always be suspected and genital examination should be performed.

Delayed Diagnosis of Hypothyroidism in Children: Report of 3 Cases.

INTRODUCTION: Hypothyroidism is the most common endocrine disorder in children and presented with various sign and symptoms; its diagnosis needs a high index of suspicion. CASE PRESENTATION: We report 3 cases with unusual presentations of hypothyroidism and with delay in diagnosis that referred to Pediatric Endocrine Outpatient Clinic in Mashhad University of Medical Sciences, Mashhad, Iran with different clinical manifestations. They had decreased Thyroxin (T4) and increased thyroid stimulating hormone (TSH) levels. One case had mental retardation and deafness, but the other two cases had normal neurodevelopment. Some additional interesting findings were as follows: short stature, delayed bone age, teeth eruption impairment, hair loss, anemia and hypercholesterolemia, persistent and long-term constipation that had led to several abdominal surgeries. After a year of hormonal replacement therapy, their growth parameters and hematological values improved. CONCLUSIONS: We recommend thyroid hormonal evaluation for any children with short stature, especially with delayed bone age, in order to detect and treat hypothyroidism at the right time. It seems that more attention to pediatric growth is necessary.

Teaching final-year medical students in a paediatric ambulatory care unit.

BACKGROUND: The importance of community-based ambulatory experiences for medical students has been emphasised in the past few decades. Although such teaching programmes are assumed to be better for medical students, there is little evidence comparing the out-patient and in-patient experiences in student education. OBJECTIVE: We carried out a study to compare the educational experiences between two in-patient and out-patient clinical units. METHODS: Over a 12-week paediatric clerkship, 38 senior medical students attending the paediatric ward were divided into two groups. One group attended a 15-day paediatric out-patient clinic while the other group attended the in-patient programme. RESULTS: Those who took part in the out-patient clinic programme obtained better scores in a test on common paediatric ambulatory problems when compared with the students who exclusively attended the in-patient teaching programme. The former group all agreed that this ambulatory paediatric course was a beneficial learning experience and consistent with their future career needs.

Acute suppurative thyroiditis with thyroid abscess: a case report and review of the literature.

INTRODUCTION: Thyroid gland is well known to resist infections by rich blood supply and lymphatic drainage, high glandular content of iodine which can be bactericidal and separation of the gland from other structures of neck. Primary thyroid abscess resulting from acute suppurative thyroiditis (AST) is an unusual type of head and neck infection and it is a rare condition in children so that progression to abscess formation is even more uncommon. CASE REPORT: In this article we report a 9 years old girl who presented with thyroid abscess. She had fever, painful swelling in the neck, sore throat, tachycardia ,restriction of neck movements and dysphagia for 6-7 days with a history of mild fever from 10 days, prior to that. The responsible organism was found to be staphylococcus aureus. Treatment began with Intravenous antibiotics and continued with incision and drainage. Thus the process led to an uncomplicated recovery. CONCLUSION: Although thyroid abscess is rare, but must be considered. Most common organism that cause is staphylococcus aureus. With early diagnosis and proper treatment, it can be prevented from complications. Since this disease can be associated with anatomic abnormalities such as pyriform sinus fistula, must be roule outed.

Rapid Intravenous Rehydration to Correct Dehydration and Resolve Vomiting in Children with Acute Gastroenteritis.

OBJECTIVES: The objective of this study is to evaluate the effect of rapid intravenous rehydration to resolve vomiting in children with acute gastroenteritis. METHODS: This randomized control trial was conducted in the pediatric emergency department in a tertiary care center in Tabriz, North-West of Iran. The study participants' were 150 children with acute gastroenteritis and vomiting who were moderately dehydrated, had not responded to oral rehydration therapy and without any electrolyte abnormalities. 20-30 cc/kg of a crystalloid solution was given intravenously over 2 hours and the control group was admitted in the emergency department (ED) for a standard 24 hour hydration. Effectiveness of rapid intravenous rehydration in the resolution of vomiting in children with acute gastroenteritis was evaluated. RESULTS: In 63 children of the intervention group (out of 75) vomiting was resolved after rapid IV rehydration and they were discharged. Among them, 12 that did not tolerate oral fluids were admitted. In the control group, 62 patients' vomiting was resolved in the first 4 hours after admission, and there was no significant difference between the two groups regarding resolution of vomiting. CONCLUSIONS: Rapid intravenous rehydration in children with moderate dehydration and vomiting due to gastroenteritis is effective in reducing admission rates in the ED.