Comparison of two Intranasal Sedatives, Midazolam versus Dexmedetomidine, in Children with High Dental Fear: a Randomized Clinical Trial.

Statement of the Problem: Pharmacologic management of uncooperative behavior is a growing trend in dentistry. Determining the most appropriate drug, route of administration, and proper candidate for sedation have been the goal of several investigations. Purpose: The aim of this study was to compare the sedative effect of intranasal (IN) sedation of midazolam (MDZ) in compare to dexmedetomidine (DEX) while taking into consideration the effect of dental fear, and psychological status on sedation success. Materials and Method: This double-blind randomized clinical trial included 92 uncooperative dental patients aged 4-6. Study participants were randomly assigned to receive either 0.2mg/kg IN MDZ or 1µg/kg DEX. Sedation was evaluated using the Houpt sedation rating scale. Vital signs were recorded before and during sedation. Prior to sedation, the level of dental fear was determined through children's fear survey schedule-dental subscale (CFSS-DS). Psychological characteristics were screened using the strengths and difficulties questionnaire (SDQ). Data were analyzed using T-test, Mann-Whitney, Chi-square, and repeated-measures analysis of variance (ANOVA). Results: Overall ratings of sedation and subscales of sleep, crying, and movement were comparable between groups (p> 0.05); however, more acceptable behavior (overall scores (4+5+6) was observed in MDZ group compared to DEX group (64% vs. 47.7%) (p= 0.007). All participants were found to have abnormal levels of dental fear (CFSS-DS≥38). However, according to SDQ, the study participants have mainly shown normal behavioral status. A significant association was found between dental fear and sedation success (MDZ, p= 0.001, DEX, p= 0.03), while similar findings were not observed for psychological characteristics (MDZ, p= 0.09 and p= 0.41; DEX, p= 0.71 and p= 0.53). Physiological parameters remained within normal limits in both groups. Conclusion: Sedation with IN MDZ resulted in overall behaviors, which were more satisfactory in highly fearful pediatric dental patients. Despite baseline uncooperative behaviors, the psychological status of study participants were close to average and were not associated with sedation failure.

Molecular Analysis of Uropathogenic E.coli Isolates from Urinary Tract Infections.

INTRODUCTION: The aim of the current study was to investigate the prevalence of virulence genes in uropathogenic Escherichia coli (UPEC) isolates in Ilam. MATERIALS AND METHODS: For this purpose, a total of 80 UPEC isolates were collected for patients with UTIs during a 6 months period. The multiplex polymerase chain reaction (multiplex PCR) was used to detect the papEF, fimH, iucD, hlyA, fyuA, and ompT genes. RESULTS: The prevalence of fimH, papEF, iucD, fyuA, hlyA, hlyA, and ompT genes were 87.5%, 47.5%, 60%, 67.5%, 27.5%, 47.5% and 71.2%, respectively. Among all of the isolates, 27 profiles were obtained. CONCLUSION: Our findings demonstrated that the most prevalence was found for fimH, and different distribution of virulence genes suggested different ability of pathogenicity.

Evaluation of HTLV-I and HCV Prevalence in Non-Hodgkin's Lymphoma.

OBJECTIVE(S): Non-Hodgkin's lymphoma (NHL) is a lymphoproliferative malignancy in which cells undergo microscopic changes with unknown etiology, and risk factors such as age, sex, genetic and environmental factors are involved. The relationship between the presence of infectious agents and the development of lymphoproliferative diseases has been an interesting research topic. HTLV-I (Human T Cell Lymphotropic Virus Type-1) predisposes the infected individulas to opportunistic neoplasms and lymphoid malignancies. HCV (Hepatitis C Virus) the etiologic agent of hepatitis C, is hepatotropic, and long-term infection with HCV can continuously stimulate and expand lymphocyte clones, resulting in further transformation and finally aggressive malignancies. MATERIALS AND METHODS: 54 tissue samples diagnosed with NHL were selected to be studied for the presence of HTLV-I and HCV viruses. DNA and RNA were extracted from samples, cDNA was synthesized and using specific primers presence of HTLV-I and HCV viruses were investigated by PCR and nested RT-PCR methods. RESULTS: In 10 out of 54 (18.8%) samples (7 men and 3 women), HTLV-I was present, and 4 out of 54 (7.4%) samples (3 men and one woman) were positive for HCV. CONCLUSION: Based on our results, it is recommended that in patients with NHL, infection with HTLV-I and HCV viruses need to be screened.