Comparison between rivaroxaban versus enoxaparin for venous thromboembolism prophylaxis following spine surgeries, a randomized clinical trial.

BACKGROUND: Enoxaparin is currently used for VTE prophylaxis. Rivaroxaban is more cost-effective and is as potent as enoxaparin in VTE prophylaxis. METHODS: The study was held at Al-Zahra and Kashani university hospitals in Isfahan, Iran, from January 2019 to October 2020. Two hundred ninety-six patients requiring instrumented spine surgery were enrolled; 23 were excluded (lack of consent/interfering medical situations). They were randomized into the groups of rivaroxaban (case, n = 137) and enoxaparin receiving (control, n = 136). Medical data were recorded and 244 patients (case = 123, control = 121) were analyzed value < 0.05 was meaningful. RESULTS: 150 patients were males, and 94 were females. The mean age was 52.09 ± 12.6 years. Postoperative drain volume was higher in rivaroxaban received patients than in enoxaparin (p = 0.02). Post-operation epidural hematoma was detected in 3 patients in the case and 1 in the control group, which was not meaningful(p = 0.622). All of them were evacuated surgically. POH was associated with cervical canal stenosis surgery, existing comorbidities, and new medical events. New medical events were associated with postoperative wound dehiscence (p = 0.001). Short and long-term postoperative outcomes were similar in both groups. The mean follow-up duration was 25.8 ± 7.5 months. CONCLUSION: Rivaroxaban is as effective as enoxaparin in venous thromboembolic event prophylaxis. Regarding postoperative epidural hematoma, statistical analysis showed equal safety of both drugs. Still, the authors would like to recommend more discretion in rivaroxaban administration in cervical spine laminectomy until future studies are conducted.

Histological evaluation of the effect of three medicaments; trichloracetic acid, formocresol and mineral trioxide aggregate on pulpotomised teeth of dogs.

The aim of this study was to use clinical, radiographic and histological examinations to compare the dental pulp response in 162 premolar roots of eight dogs when trichloracetic acid (TCA), formocresol, mineral trioxide aggregate (MTA) and zinc oxide eugenol were used as pulpotomy agents. The teeth were divided into four groups. Following pulpotomy, the teeth were restored with amalgam. The animals were sacrificed at 48 h, 2, 4 and 8 weeks (two dogs at each interval). Histological evaluation indicated no cases with necrosis. After 8 weeks follow up, dentine bridge formation was evident in 20%, 50% and 91.7% of formocresol, TCA and MTA cases respectively. The first signs of bridge formation were seen for MTA at 2 weeks and for TCA at 4 weeks. MTA was superior to formocresol and TCA in treating pulps in dogs. However, bridge formation was seen in 50% of TCA cases after 8 weeks which is a desirable finding in pulpotomy procedures.

The prevalence of dental caries in 5 - 18-year-old insulin-dependent diabetics of Fars Province, southern Iran.

BACKGROUND: The association of dental caries and diabetes mellitus has not received enough attention, in spite of the fact that both diseases are associated with the ingestion of dietary carbohydrates. This study was undertaken in Fars Province, southern Iran, to determine the prevalence rates of dental caries in a group of metabolically well-controlled patients with type I diabetes mellitus and in a control group. METHODS: Fifty patients (22 boys and 28 girls) with type I diabetes mellitus under follow-up of the Endocrinology and Metabolism Research Center of Shiraz University of Medical Sciences, with a mean +/- SD age of 11.72 +/- 3.36 years and mean +/- SD fasting blood sugar of 235.74 +/- 103.61 mg/dL, entered this study. A similar study was conducted to determine the prevalence of dental caries in 12-year-old school children in Shiraz, Iran who served as the control group. After completing a questionnaire, the patients were examined separately by two dentists. Before the clinical examination, bitewing radiographies were performed. Student's t- and Chi-square tests were used for statistical analysis in relation to sex, age of onset of diabetes mellitus, socioeconomic and nutritional status, family history of diabetes mellitus, and orohygiene status. RESULTS: The mean +/- SD DMFT for diabetic children was 9.64 +/- 4.64 (decayed = 8.12 +/- 3.90, missing = 0.62 +/- 1.34, and filling = 0.90 +/- 2.10). The lower permanent first molars were the most frequency decayed and the incisors were the healthiest teeth. DMFT score and the frequency of decayed teeth were higher in boys than in girls. However, the rate of filling and missing teeth were higher in girls. DMFT and the number of decayed teeth were higher in patients with poor oral hygiene. The number of healthy first permanent molars was much higher in the mixed dentition groups than in those with permanent teeth. A direct correlation was found between the health status of the first permanent molar tooth and having type I diabetes mellitus. CONCLUSION: Oral hygiene was somewhat poorer in diabetic patients than in the control group. Regular dental check-ups for preventive measures such as fluoride therapy, fissure sealant, regular medical follow-ups for proper control of metabolic abnormalities to decrease occurrence of xerostomia, omission of cariogenic substances from dietary regimen, fluoridation of drinking water, and individual and group education of diabetic patients regarding proper dental hygiene are recommended.