Pulpotomy versus pulpectomy in carious vital pulp exposure in primary incisors: a randomized controlled trial

BACKGROUND

Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors.

METHODS

Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months.

RESULTS

39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2).

CONCLUSIONS

Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors.

TRIAL REGISTRATION

The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022.

Isolation and molecular identification of Brucella spp. in bovine herds kept at householders in the Delta region of Egypt by MALDI-TOF and AMOS-PCR

Brucellosis is a widespread disease in Egypt which cause huge economic losses in the dairy industry. The present study aims at isolating and identifying Brucella (B.) spp. circulating in bovine and buffalo dairy herds kept at farmers houses in four districts of the Delta region of Egypt. One hundred and five tissue specimens were collected from seropositive cattle and buffaloes. The samples included 10 vaginal swabs, 3 placentas, 3 uteri and 86 supra-mammary lymph nodes from dams, as well as 3 stomach contents from aborted fetuses. Matrix-assisted laser desorption ionization (MALDI) and the conventional biotyping techniques were used for preliminary identification of isolates into the genus level. AMOS-PCR was applied to differentiate Brucella isolates into species level. Nineteen Brucella strains have been identified, four B. abortus strains were recovered from cattle and 15 B. melitensis strains were isolated from both cattle (n = 8) and buffaloes (n = 7). The predominant occurrence of B. melitensis in bovines raises the fact that B. melitensis clone can cross species barriers and can establish a permanent reservoir in cattle and buffaloes. Presence of culture-positive animals at householders represent a high-risk factor for human infection. This knowledge is of significant importance in the control of brucellosis in bovines.

Subclinical hepatitis C virus infection in Egyptian patients with rheumatic diseases: a multi-center study

Background

Hepatitis C virus (HCV) infection is highly prevalent in Egypt. It was found to be 7.0% in a study done in 2015. There are some studies on the prevalence of HCV in rheumatoid arthritis, but to our knowledge, no previous study was done to detect it in other rheumatologic diseases. This study aims at detecting the prevalence of subclinical HCV infection in Egyptian patients with different rheumatic diseases. In the current study, eight hundred and three patients with different rheumatic diseases collected from five—geographically different—Egyptian rheumatology departments were studied. Patients with known current or previous HCV infection were excluded from the study. Screening for the positive anti-HCV antibodies was done for all patients. Screening for the presence of HCV ribonucleic acid (RNA) was done in patients with positive serology by reverse transcriptase-polymerase chain reaction.

Results

In the studied population, 675 (84.1%) patients were women. The mean age [± SD] was 44.2 [± 12.9] years. Hepatitis C antibody positivity was found in 73 (9.1%) of the patients, while 67 (8.3%) were having positive HCV-RNA quantitative PCR tests. The highest prevalence of seropositive HCV was found in drug-induced vasculitis (DIV) and cryo-vasculitis (100%), while in RA, HCV antibodies and PCR were found to be positive in 9.1% and 8.3% of patients, respectively.

Conclusions

Detection of the presence of HCV infection in 9.1 % of the studied middle-aged Egyptian patients with rheumatologic conditions points to the importance of screening for HCV in such population for early detection and intervention especially for those patients that are planned to start biologic therapy.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies  in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpectomy in treatment of carious vital pulp exposure in primary incisors.

Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure. The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method.

Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure. For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis.

Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies  in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure. The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure. For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

Robust fuzzy output feedback controller for affine nonlinear systems via T-S fuzzy bilinear model: CSTR benchmark

In this paper, a robust H∞ fuzzy output feedback controller is designed for a class of affine nonlinear systems with disturbance via Takagi-Sugeno (T-S) fuzzy bilinear model. The parallel distributed compensation (PDC) technique is utilized to design a fuzzy controller. The stability conditions of the overall closed loop T-S fuzzy bilinear model are formulated in terms of Lyapunov function via linear matrix inequality (LMI). The control law is robustified by H∞ sense to attenuate external disturbance. Moreover, the desired controller gains can be obtained by solving a set of LMI. A continuous stirred tank reactor (CSTR), which is a benchmark problem in nonlinear process control, is discussed in detail to verify the effectiveness of the proposed approach with a comparative study.

Prenatal diagnosis for thalassaemia in Egypt: what changed parents' attitude?

OBJECTIVES

To present the current status of the prenatal diagnosis services and results from the largest thalassaemia center in Egypt treating 3000 patients. Traditionally, prenatal diagnosis has not been successful in reducing the births of affected children in Egypt, because the majority of women undergoing prenatal diagnosis continued to have affected pregnancies.

METHODS

Seventy-one pregnant mothers at risk for β-thalassaemia underwent prenatal diagnosis by chorionic villus sampling (n=57) or amniocentesis (n=14) between 11 to 14 weeks of gestation. Molecular characterization of fetal DNA by reverse dot blot hybridization and polymerase chain reaction-amplification refractory mutation system techniques was conducted in all cases.

RESULTS

Twenty-four women (33.8%) were found to have affected fetuses; 100% of these women opted to terminate the pregnancy. The change in attitude towards termination of pregnancy was related to in-depth counseling of the religious aspects towards prenatal diagnosis and termination of pregnancy. Forty-eight women (66.2%) with normal or carrier fetuses for β-thal requested human leukocyte antigen typing of the fetal material to determine if the fetus was a human leukocyte antigen match for their existing thalassaemic siblings.

CONCLUSION

This study demonstrates that prenatal diagnosis is feasible and acceptable in Egypt, a Muslim country, provided an in-depth discussion, which also addresses the religious considerations of prevention, is held with the couples.

Expression of apoptosis regulatory markers in the skin of advanced hepatitis-C virus liver patients

BACKGROUND

Hepatitis-C virus (HCV) infection is considered a major worldwide public health problem with a global prevalence. Maintenance of skin homeostasis requires a delicate balance between proliferation, differentiation, and apoptosis. Meanwhile, it is unclear if there is an altered keratinocyte proliferation/apoptosis balance in advanced liver disease with HCV infection.

AIM

This work aimed to evaluate the epidermal thickness and changes in the expression of apoptosis regulatory markers as well as apoptotic index in skin samples of advanced HCV liver patients compared to normal controls.

MATERIALS AND METHODS

Twenty biopsies were taken from apparently normal skin of advanced HCV liver disease patients, as well as five healthy control subjects. These specimens were used for histometric epidermal measurement, immunohistochemical staining of apoptosis regulatory proteins (Bax, Fas, p53, Caspase-3, Bcl-2, Bcl-xL) as well as the TUNEL technique for detection of apoptotic cells.

RESULTS

The mean epidermal thickness was significantly lower than the control group (P=0.000). There were significant overexpression of pro-apoptotic markers (Bax, Fas, P53, and Caspase-3) in patients (P=0.03, 0.03, 0.003, 0.003 respectively), with increased apoptotic index in HCV liver patients (P=0.002) when compared to normal controls. On the other hand, no statistically significant difference were encountered in the expression of antiapoptotic markers (Bcl-2, Bcl-xL) in HCV patients when compared to normal controls (P=0.5, 0.9, respectively).

CONCLUSION

These findings suggest that an alteration in the proliferation/apoptosis balance is present in the skin of HCV liver patients.

Chronic neutrophilic leukaemia: an Egyptian case

Chronic neutrophilic leukaemia (CNL) is a rare myeloproliferative disorder of elderly patients characterised by sustained neutrophilia. The diagnosis of CNL requires the exclusion of BCR/ABL positive chronic myelogenous leukaemia and leukemoid reaction. We present here a case of a 61-year-old Egyptian man with CNL and 21 months of follow-up. The main symptom of our patient was purpura. Splenomegaly, hepatomegaly and lymph node enlargement were not detected at presentation or throughout the patient's course. Thrombocytopenia was a considerable problem in our patient, causing recurrent bleeding and affecting the hydroxyurea dose adjustment. While hydroxyurea decreased the total leucocytic count, it could not affect the fatal course of the disease. The survival course of our patient extended to 21 months after presentation. The cause of death was attributed to disease progression.

The mutagenic versus protective role of vitamin A on the induction of chromosomal aberration in human lymphocyte cultures

The present study was carried out to evaluate the role of vitamin A (VA) on the induction of chromosomal aberrations (CA) in lymphocyte culture system and to investigate its modulating effect on chromosomal damage induced by gamma irradiation. Lymphocyte cultures from five healthy normal adult males were either treated with VA at a dose level of 2.0, 8.0 or 24.0 microg/ml or exposed to gamma-irradiation of 3.0 Gy, then followed immediately by a treatment with one of the above mentioned doses of VA. Non-treated cultures and cultures exposed to gamma-irradiation served as control for the two sets of experiments. Cultures were set up in duplicates and incubated for 48 h for assessment of CA. Treatment with VA alone increased CA demonstrating a dose-response effect. Addition of VA to gamma-irradiated cultures resulted in an inverse protective effect as the low dose of 2 microg/ml reduced the CA induced by radiation to about 1/3 rd whereas a dose of 8 microg/ml had a protective effect of 40% of the total damage and the large dose of 24 microg/ml had no or little effect. These results suggest that a proportion of the added VA may interfere with the radiation induced free radicals and other reactive metabolites which elevate CA. On the other hand, excessive amounts of VA increased toxicity and reduced effect on repair enzymes.

[Rectal endosonography in differential diagnosis of surgical diseases of the pelvis]

Rectal endosonography was performed in 35 patients in whom a pathologic process in the pelvis was suspected. Pathologic findings were shown in various cases: abscess, tumours, ascites. It was shown that rectal endosonography can provide information that is not revealed by such established examinations as abdominal sonography and computed tomography. We recommend that the indications for transrectal endosonography can be extended beyond the established use in rectal tumours and diseases of the pelvic floor. Further systematic examinations are required.

Traumatic intrapericardial diaphragmatic hernia

Traumatic intrapericardinal diaphragmatic hernia is a rare occurrence following blunt thoracoabdominal injuries. We have reviewed 59 cases reported in the literature and added three. Emphasis is placed on the diagnostic difficulties encountered, with some discussion regarding the management and surgical approach.

Recurrent streptococcal cellulitis complicating radical hysterectomy and radiation therapy

Reported is a rare complication of radical hysterectomy and radiation therapy, recurrent streptococcal cellulitis. Two patients had 14 episodes over a nine-year period, characterized by high fever and systemic toxicity. The streptococcal cellulitis was atypical in its presentation and its causative organism. The rash was bilateral in patches, flat, irregular in outline, and without induration. The causative microorganisms, a group B and G streptococcus, were isolated from blood and skin cultures. Therapy in such patients may have to be prolonged because of the alterations in normal anatomy resulting from surgery and radiation.