Comparative study of two different computer-controlled local anesthesia injection systems in children: a randomized clinical trial.

PURPOSE: To compare pain perception associated with two computer-controlled local anesthesia devices, the WAND™ STA (Milestone Scientific Inc., Livingston, NJ, USA) and the Calaject (Rønvig dental MFG, Daugaard, Denmark) in young children. METHODS: A split-mouth randomized clinical trial comprising 30 patients, aged 6-12 years, received randomly, in two separate sessions, a local anesthesia injection in the maxillary using either the wand STA or the Calaject. Pain perception was evaluated using the patient's heart rate, an 11-point numerical scale (NRS), and the Sound, Eye, and Motor (SEM) body movements. Statistical difference was set at p = 0.05. Repeated measures analysis of variance were conducted to compare the mean pulse for Calaject and STA at different times. It was followed by univariate analysis and Bonferroni multiple comparisons tests. Wilcoxon tests were performed to compare NRS, SEM, and injection duration between Calaject and STA. RESULTS: There was no significant statistical difference between Calaject and STA in pulse rate before injection (p = 0.720), during injection (p = 0.767), and after injection (p = 0.757). The mean NRS score was significantly greater with STA in comparison with Calaject (p = 0.017). The mean SEM score was also significantly greater with STA in comparison with Calaject (p = 0.002). However, the mean duration was significantly longer with Calaject (p = 0.001). CONCLUSIONS: Calaject was more effective than STA in reducing pain perception associated with periapical injection in young children.

Burnout prevalence and associated factors in a sample of Lebanese residents.

OBJECTIVE: This study aims to determine the prevalence of burnout in a sample of Lebanese residents, and to identify its correlates and risk factors compared to local and international data. METHOD: A cross-sectional study was conducted at the end of the academic year 2018-2019, between the months of April and July, and targeted residents enrolled at Saint Joseph University, Faculty of Medicine (USJ- FM), in Beirut, Lebanon. Data was gathered via an anonymous online survey which was sent to all the residents through the Faculty administration on their personal email addresses. The questions dealt with demographic and mental health data. The Copenhagen Burnout Inventory (CBI) was used to measure burnout. RESULTS: 25.7% of the residents responded to the survey, two thirds of whom were female. 72.22% of the respondents suffered from personal burnout whereas as 77.78% suffered from work-related burnout. Only 26.39% residents were concerned with patient-related burnout. Money and professional problems were associated with burnout whereas suicidal thoughts were correlated with higher scores. Alcohol consumption was negatively correlated with CBI. CONCLUSION: The surveyed residents suffered from burnout which was mainly related to personal and occupational factors. Burnout was not an isolated entity; it should be considered as a whole and described as a subjective experience that varies from one person to another and results from complex biological, psychological and social interactions. It has consequences on the victims' health and quality of life.

[Attitude of psychiatrists and psychiatry residents in Lebanon towards restraint and informed consent]. / Attitude des psychiatres et internes en psychiatrie au Liban vis-à-vis de la contention et du consentement éclairé.

OBJECTIVES: Psychiatry differs from the rest of medical specialties by the unique character of its pathologies, which makes ethical reflection difficult, including the collection of informed consent and the use of restraint and the seclusion-room. This reflection can be affected by subjectivity and a variety of influences, hence the interest of studying the attitude of psychiatrists and residents in psychiatry in Lebanon with regard to restraint and informed consent. METHODS: We collected data using an anonymous questionnaire that we sent as a Google form to Lebanese psychiatrists and psychiatry residents by email and phone messages. The descriptive analysis was done using Microsoft Excel software, and the analytical analysis was done using the SPSS software and the following statistical tests: independent-sample test and the Mann Whitney U test. RESULTS: Forty people responded, including 19 men and 21 women (16 psychiatric interns, 15 university psychiatrists and 9 non-university psychiatrists). Concerning the questions related to the use of restraint, 70% did not find that it is being commonly used in hospital practice. However, 92.5% would use it to counter the patient's dangerousness and 60% to help deliver treatment. 57.5% did not find the repeated usage of restraint as a dehumanization of care, but the majority (70%) agreed with the need for temporal limitation of any form of restraint. As for the ability to consent, 90% considered a patient in a psychotic state as unfit to consent. CONCLUSIONS: Restraint is considered uncommon by psychiatrists and psychiatric residents in Lebanon and must remain an option of last resort with efforts being made upstream in order to avoid situations where the use of restraint becomes mandatory. Post critical thinking is paramount, and restraint should never respond to a lack of manpower or a security goal. Informed consent is one of the most important guarantors of the principle of autonomy, and must be sought in each patient, individually. Finally, no significant difference was found between the subgroups, which would therefore become a single population. Ethical reflection would therefore be directly linked to the population. Mental illnesses are becoming more common and an important source of morbidity worldwide. It is our role to ensure the dignity of the mentally ill. The introduction of the Psychiatric Nurse Diploma, an increase in the relational approach to the training of psychiatrists in Lebanon, and an increase in the number of health care teams may help to maximize the ability of capacity.

Metallic syringe versus electronically assisted injection system: a comparative clinical study in children.

AIM: Local anaesthesia injection necessary for pain control in paediatric dentistry may itself be painful sometimes, partly because of the pressure felt during injection; electronically assisted injection systems were developed to address this problem. MATERIALS AND METHODS: Study design: The present study is a clinical study in children that compared two types of devices for paediatric buccal infiltration anaesthesia: the aspirating syringe and an electronically assisted injection system, the Wand STA. A split mouth, randomised controlled clinical trial was conducted on 30 healthy six to eight-year-old patients (6.64 ± 0.803 years) requiring pulpotomies on two symmetrical primary maxillary molars. Each patient received the following types of anaesthesia, in separate, consecutive, randomly ordered sessions: conventional buccal infiltration by metallic aspirating syringe and buccal infiltration by computer-controlled local anaesthetic device (Single Tooth Anesthesia). Parameters assessed were: pain experienced during injection, patient's heart rate and behaviour, anaesthesia quantity required and onset time. RESULTS: No statistical differences were observed between the two techniques (p? 0.05) for all assessed parameters. CONCLUSIONS: Results suggest that computer-assisted anaesthesia may represent an alternative to conventional syringes for local buccal anaesthesia in paediatric dental treatment; comparison to other types of dental infiltration anaesthesia needs further investigation.

Evaluation of two shaping systems and two sonic irrigation devices in removing root canal filling material from distal roots of mandibular molars assessed by micro CT.

AIM: To compare two preparation systems and two sonic irrigation devices during the removal of root filling material from oval distal canals of extracted mandibular molars. METHODOLOGY: The distal canals in 40 extracted mandibular molars were shaped using the ProTaper Next system (Dentslpy Sirona, Ballaigues, Switzerland), filled with Gutta Percha X2 (Dentsply Sirona), along with AH Plus sealer (Dentsply De Trey, Konstanz, Germany) and randomly divided into two groups (n = 20) according to volume of initial filling, preparation diameter and working length. One group was retreated using the Reciproc system (VDW, Munich, Germany), and the other using the 2Shape system (Micro-Mega, Besançon, France). A micro-CT scan was taken after the initial root filling and after retreatment to evaluate the volume of filling material remnants. The teeth were divided into four groups to test the supplementary effect of two sonic irrigation devices on removing filling material: Eddy (VDW) and MM1500 (Micro-Mega). In the first and second groups, 2Shape was followed subsequently by MM1500 and Eddy; in the third and fourth groups, Reciproc was followed by MM1500 and Eddy. A third micro-CT was taken to compare the remaining root filling material in all groups. Wilcoxon's signed rank tests, Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis. RESULTS: No significant difference was found for the volume of filling material removed between the Reciproc and 2Shape in the entire canal (P = 0.355). The volume dropped significantly from its initial value after removing the bulk of the root filling by 95.8% (from 4.71 to 0.22 mm3 ) with the 2Shape (P < 0.001) and by 94.0% (from 5.05 to 0.33 mm3 ) with the Reciproc (P < 0.001). Sonic activation significantly decreased the residual volume of filling material remnants by 3.21% (P = 0.013) in the first group, 1.38% (P = 0.012) in the second group, 1.83% (P = 0.008) in the third group and 1.83% (P = 0.012) in the fourth group. At the end, the percentage of residual material was not significantly different among the groups in the entire canal (P = 0.163). CONCLUSION: In the distal oval canals of extracted mandibular molar teeth, there was no significant difference between the 2Shape and Reciproc systems in removing gutta-percha/sealer. Sonic activation with MM1500 and Eddy significantly improved filling material removal.

Three-dimensional modeling and measurements of root canal anatomy in second primary mandibular molars: a case series micro CT study.

PURPOSE: This study aimed at establishing a comprehensive specification of the root canal anatomy of second primary mandibular molars using micro computed tomography (CT). METHODS: 10 s primary molars from Caucasian young patients were selected for this purpose. Micro CT imaging with a high resolution of 20 microns was performed to observe the roots and canals according to specific criteria. The Vertucci canal configuration, the presence of lateral canals and their location, the presence of an isthmus and its location, were first observed. Then, the length of the canals, their diameter in the mesio-distal and vestibulo-lingual direction, the dentinal thickness and the direction of the minimal dentinal thickness were measured. RESULTS: The mean working length was not significantly different between the canals (p = 0.710). The bucco-lingual diameter was significantly higher when the tooth had a single distal canal at the coronal (p < 0.001), middle (p < 0.001) and apical (p = 0.012) levels. The root dentin thickness on the distal wall of the mesial root and the mesial wall of the distal roots were reduced, respectively, from the coronal to the apical thirds. CONCLUSIONS: The results obtained in this case series report clearly show a complex, sometimes unpredictable, anatomy with dangerous areas where dentin is extremely thin. The plethoric presence of anastomoses, large bands of isthmus, lateral canals at all levels induces the need for the development of instruments specific to pulpectomies on primary teeth.

[A furoncular ankle cellulitis in a teenager with a difference: Dermatobia hominis]. / Un passager clandestin à ne pas méconnaître: Dermatobia hominis, à propos d'un cas.

We report a case of botfly myiasis presenting as an ankle cellulitis in a teenager returning from Guyana. Main clinical features and therapeutic approaches are described.

[Hurler syndrome. Early diagnosis and successful enzyme replacement therapy: a new therapeutic approach. Case report]. / Mucopolysaccharidose de type I: intérêt d'un diagnostic et d'une enzymothérapie substitutive précoces. A propos d'un cas.

Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disorder due to alpha-L-iduronidase deficiency. Its severe prognosis has been significantly improved by enzyme replacement therapy using recombinant human alpha-L-iduronidase (laronidase). We report the case of a boy who was diagnosed at 19 months of age with Hurler's disease, the most severe form of MPS I, and received thereafter a treatment by laronidase, resulting in clinical and biological improvement. The aim of this case report is to draw physicians' attention on the presenting signs of Hurler's disease, in order to enable an earlier diagnosis, increasing the treatment's benefits.

[Macrolides, Pseudomonas aeruginosa and cystic fibrosis]. / Macrolides, Pseudomonas aeruginosa et mucoviscidose: concepts actuels.

Long-term low dose azithromycin treatment in cystic fibrosis patients with chronic Pseudomonas aeruginosa infection is safe and reduces the decline in lung function, the number of acute exacerbations and improves nutritional status; underlying efficacy mechanisms are multiple and synergistic.

[Varicella, acute postinfectious arteriopathy and cerebral arterial thrombosis in childhood: a unique clinical and etiologic framework to be fully acknowledged]. / Varicelle, artériopathie aiguë post-infectieuse et infarctus cérébral artériel de l'enfant: un cadre clinique et étiologique à ne pas méconnaître.

Acute arteriopathies are the etiological factor of 25% of all the cerebral arterial thrombosis cases in childhood; they give way to ischemic strokes which have specific clinical and radiological features; varicella is the etiologic factor in 60% of the cases; favorable outcome is the rule; physiopathology and treatment remain under discussion.

[Hereditary angioneurotic edema: a case report in a 3-year-old child]. / Oedème angioneurotique héréditaire: à propos d'une observation chez un enfant de trois ans.

Hereditary angioneurotic edema is a dominant autosomal disease (incidence 1/150,000), whose diagnosis is crucial as this condition can lead to fatal asphyxia within minutes. We report the case of a three-year-old girl, misdiagnosed as allergic asthma. Recognition of the syndrome led to adapted care restoring normal family and school life. Pathogenic cascades involved and therapeutic principles of this disease are reviewed.

[Aspergillosis in cystic fibrosis patients]. / Aspergillose et mucoviscidose.

Allergic bronchopulmonary aspergillosis (ABPA) should be suspected in any CF patient whose pulmonary disease deteriorates precipitously, suddenly or unexpectedly, and has to be correlated to fungal hypersensitivity biological tests. The standard therapeutic approach is based upon systemic corticosteroids. Invasive pulmonary aspergillosis (IPA) may occur mainly but not exclusively in immunosuppressed patients undergoing lung transplantation. New antifungal compounds (Triazoles, Itraconazole, Voriconazole), Echinochandins (Caspofungin) are effective, synergistic, well tolerated, should their contraindications and side effects be carefully respected and monitored.

[Home environment and acute propylene glycol intoxication in a two-year old. An unusual case report]. / Environnement domestique et intoxication aiguë au propylène glycol chez un nourrisson de deux ans. A propos d'une observation inhabituelle.

BACKGROUND: Acute propylene glycol intoxication in a two-year-old toddler underlines the potentially serious toxicity in children of this chemical agent present as a diluent in many drugs and environmental products such as cosmetics, diapers, cleansing towels, despite a common consideration of safety and lack of toxicity. CASE REPORT: A two-years-old boy previously healthy was found in the morning by his parents in his cradle, lethargic, responsive only to sharp pain. On admission, vital signs were: temperature 38.5 degrees C, lethargy, polypnea; propylene glycol intoxication through disposable cleansing towels chewing was ascertained by anamnesis and blood urine analyses which revealed metabolic acidosis and serum propylene glycol peak. CONCLUSION: Environmental acute propylene glycol intoxication must be considered and searched for in front of a metabolic acidosis case of unknown origin in children.

[Haemophilus influenzae bacterial meningitis: residual risk; case report]. / Méningite bactérienne à Haemophilus influenzae: le risque résiduel; à propos d'un cas.

UNLABELLED: Bacterial meningitis due to Haemophilus influenzae has become a rare, albeit not exceptional occurrence since generalized vaccination against that pathogen was instated, concerning as well incapsulated b and non-b Haemophilus influenzae strains, as non-incapsulated strains. CASE REPORT: A 19-month-old fully immunized infant was referred to our hospital for bacterial meningitis. CSF analysis elicited biotype III, non-incapsulated Haemophilus influenzae. CONCLUSION: Generalizing Haemophilus influenzae preventive inoculation has revolutionized the epidemiology of bacterial meningitis; however, a residual risk exists, which deserves to be taken into account.