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.

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.

Renoprotective effects of prazosin on ischemia-reperfusion injury in rats

BACKGROUND

Renal ischemia-reperfusion (IR) injury is one of the main leading causes of acute kidney injury associated with inflammation, oxidative stress and cell apoptosis. We studied the effects of prazosin, as a specific blocker of α1-AR, on renal IR injury.

METHODS

Rats were divided into normal control; untreated IR and prazosin-treated IR (1 mg/kg body weight). Prazosin was administered by intraperitoneal injection 30 min prior to IR induction. The level of urea/creatinine and oxidative factors were detected by colorimetric methods. Apoptosis-associated factors, inflammatory, and signaling proteins were analyzed in renal tissue. The abnormalities of renal histopathology were detected by immunohistochemistry.

RESULTS

Administration of prazosin to IR rats ameliorated serum urea and creatinine and IR-induced histopathological damages. Lipid peroxidation was significantly improved after treatment by prazosin in IR injury rats, however, antioxidant status was not affected. Rats subjected to IR injury activated Bax protein and NF-κB mediated inflammatory response. Moreover, treatment with prazosin inhibited renal NF-κB activation, resulting in a significant decline in pro-inflammatory cytokine of IL-6.

CONCLUSION

These findings suggest that prazosin could be a good candidate to attenuate renal IR injury due to its ability to modulate renal function, apoptosis and inflammation.

Strategies for improving the emission performance of hybrid electric vehicles

Low emission vehicle technologies need widespread adoption in the transport sector to overcome its significant decarbonisation challenges. Hybrid Electric Vehicles (HEVs) represent an intermediate technology between pure electric vehicles and internal combustion engines that have proven capability in reducing petroleum consumption. HEV customers often cite improved fuel economy as a major benefit from adopting this technology; however, outstanding questions remain regarding their respective emission levels. Through an extensive literature study, we show that several issues remain with HEV emissions performance which stem from frequent high-power cold starts, engine calibration issues and inefficient operating conditions for catalytic converters. HEVs have more NO_x, HC, CO and particle number emissions compared to conventional vehicles by up to 21.0, 5.8, 9.0 and 23.3 times, respectively. Improved engine control algorithms, after-treatment design and thermal design of three-way catalysts emerge as research priorities for improving the emissions performance of HEVs.

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.

The irradiated fuel-burnup experiment of Tehran Research Reactor using nondestructive gamma-ray spectroscopy

In this work, a nondestructive gamma scanning technique has been applied to determine the irradiated fuel burnup of Tehran Research Reactor (TRR). Thereby, a system was designed and installed at the rim of the TRR pool, which includes a High-Purity Germanium (HPGe) detector and associated electronics-devices, a proper shield, a collimator, and an elevator to radioactive fuel handling for any longitudinal and transverse fuel movement. In the system, it also was possible to measure fuel burnup for fuels with short cooling times at the minimum distance between the fuel and the detector. Five Standard Fuel Elements (SFEs) have been studied with U3O8Al fuel in burnup range of 14%-60% FIMA and cooling time range of 60 days-550 days. Then, by analyzing the gamma-ray emitted from 137Cs isotope as a fuel burnup indicator, an axial profile of fuel burnup was measured in the active fuel length of 61.5 cm and an active width of 6 cm. Finally, verification of results from reactor physics calculations was conducted based on fuel burnup measurements using a nondestructive gamma scanning technique that represents a well enough agreement between calculations and measurements.

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.

P7142-AG impacts on endothelial cell activation and endothelial cell viability in vitro and impairs endothelial repair in vivo

Background

The endocannabinoid (eCB) 2-arachidonoylglycerol (2-AG) is a known modulator of inflammation and few studies have addressed its influence on myeloid cells in the context of atherogenesis. However, the impact of 2-AG on endothelial cell function has not been studied before.

Methods

Endothelial repair was studied in two treatment groups of wildtype mice following electrical denudation of the common carotid artery at a length of 3000 μm. One group received the monoacylglycerol lipase (MAGL)-inhibitor JZL184 [5 mg/kg i.p.], which impairs 2-AG degradation and thus causes elevated 2-AG levels, the other group received vehicle. The residual endothelial gap at five days in either group was visualized by Evan's blue staining. In vitro, the effect of 2-AG on human coronary artery endothelial cell (HCAEC) viability was assessed by an XTT-based assay. Endothelial activation was studied by an adhesion assay of THP-1 monocytes to 2-AG-preconditioned HCAEC. HCAEC migration, ROS-production, expression of NADPH oxidases, and secretion of inflammatory cytokines were assessed by Boyden chamber, qPCR, and colorimetric assays.

Results

Treatment with JZL184 produced a significant increase in 2-AG levels and impaired reendothelialisation in wildtype mice following electrical injury of the common carotid artery. The residual denudation at 5 days yielded 2291±286 μm in JZL184-treated animals vs. 1505±223 μm in vehicle treated controls (n=18–19; p<0.05). In vitro, JZL184 significantly reduced viability of HCAEC at 24 hours (0.31±0.10 vs. 1.00±0.08; n=3; p<0.01). Finally, 2-AG promoted HCAEC activation resulting in a significant increase in THP-1 monocyte adhesion to HCAEC following pre-treatment of HCAEC with 2-AG (0.17±0.03 THP-1 cells per HCAEC vs. 0.07±0.01 THP-1 cells per HCAEC; n=3; p<0.05). Besides, HCAEC migration, ROS-production, expression of NADPH oxidases and secretion of inflammatory cytokines were unaffected by 2-AG.

Conclusion

Elevated 2-AG levels appear to hamper endothelial repair and to promote HCAEC activation and cell death. Our data suggest that besides its influence on myeloid cells, 2-AG is also adverse to endothelial integrity which might promote early atherosclerotic lesion formation. Thus, decreasing vascular 2-AG levels might represent a promising therapeutic strategy for the prevention of atherosclerosis and coronary heart disease.

P4140Myeloid but not endothelial expression of the CB2 receptor promotes atherogenesis in the context of elevated levels of the endocannabinoid 2-arachidonoylglycerol

Background

The endocannabinoid 2-arachidonoylglycerol (2-AG) is an inflammatory mediator and ligand to the cannabinoid receptors CB1 and CB2, which are expressed on myeloid and endothelial cells. 2-AG has recently been described to promote atherogenesis in ApoE-deficient mice. While the CB2 receptor has previously been considered to solely exert anti-inflammatory and atheroprotective effects, newer data have raised the notion, that CB2 might exert atherogenic effects in the context of elevated 2-AG plasma levels. In the present study, we investigated the atherogenic mechanisms of 2-AG and the role of the CB2 receptor on myeloid and endothelial cells in atherogenesis using cell-specific knockout mouse models.

Methods

Two mouse models with atherogenic background and distinct cell-specific knockouts of the CB2 receptor on myeloid (ApoE−/−LysMcreCB2fl/fl) or endothelial cells (ApoE−/−Tie2creCB2fl/fl) were created. Mice were treated with JZL184, which inhibits 2-AG-degrading enzyme monoacylglycerol lipase, and thereby elevates 2-AG plasma levels, or with vehicle (DMSO), while being fed a high-fat diet for four weeks. Plaque volume and plaque composition were analyzed. In vitro, macrophages were treated with 2-AG and mRNA levels of adhesion molecules, scavenger receptors and chemokines, the production of reactive oxygen species (ROS) and the release of myeloperoxidase (MPO) were determined using qPCR, fluorometric assays and ELISA respectively.

Results

Elevated levels of 2-AG promote atherogenesis in ApoE-deficient mice (JZL184 vs. DMSO: 39.6±2.1% vs. 32.6±2.4%; n=14; p<0.05). The atherogenic effect of 2-AG is abrogated in mice lacking myeloid CB2 receptor expression (35.0±2.0% vs. 34.0±2.5%; n=14–16; p>0.05) but not in mice lacking endothelial CB2 receptor expression (37.1±3.1% vs. 20.9±2.6%; n=10–12; p<0.01). In vitro, 2-AG significantly increases transcription of adhesion molecule ICAM-1 (2.09±0.42 –fold; n=5–6; p<0.05), chemokine receptor CCR-1 (2.04±0.46 -fold; n=10–11; p<0.05) and scavenger receptor CD36 (8.02±1.89-fold; n=3; p<0.05) in 2-AG-treated macrophages. These effects are mitigated by pharmacological inhibition of CB2. Furthermore, 2-AG significantly increases myeloperoxidase (MPO) release in monocytes in a CB receptor-dependent fashion (451±23 pg/ml vs. 151±8.3 pg/ml; n=3–4; p<0.01) and promotes ROS production (2698±24 pdu vs. 1981±27 pdu; n=8; p<0.01).

Conclusion

Elevated 2-AG levels show an atherogenic effect in vivo which is dependent on the presence of the CB2 receptor on myeloid cells. Our in vitro data reveal 2-AG to promote pro-inflammatory signaling in macrophages and elucidate a previously unrecognized link between the endocannabinoid system and MPO in monocytes. In summary, cell-specific effects of the endocannabinoid system will have to be taken into account to facilitate its exploitation as an anti-atherosclerotic drug target.

Acknowledgement/Funding

This work was supported by the Bonfor program of the University of Bonn [grant number O-109.0057 to JJ].

Adenosine deaminase inhibition

Adenosine deaminase is a critical enzyme in purine metabolism that regulates intra and extracellular adenosine concentrations by converting it to inosine. Adenosine is an important purine that regulates numerous physiological functions by interacting with its receptors. Adenosine and consequently adenosine deaminase can have pro or anti-inflammatory effects on tissues depending on how much time has passed from the start of the injury. In addition, an increase in adenosine deaminase activity has been reported for various diseases and the significant effect of deaminase inhibition on the clinical course of different diseases has been reported. However, the use of inhibitors is limited to only a few medical indications. Data on the increase of adenosine deaminase activity in different diseases and the impact of its inhibition in various cases have been collected and are discussed in this review. Overall, the evidence shows that many studies have been done to introduce inhibitors, however, in vivo studies have been much less than in vitro, and often have not been expanded for clinical use.

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.

Use of ultrasound for the assessment of dehydration in pediatric patients with mild to moderate dehydration

Management of children with acute gastroenteritis is based upon dehydration estimation. There is no clinical or paraclinical tool which exactly estimates the dehydration degree. Recently ultrasonographic parameters as inferior vena cava (IVC) diameter and aorta (AO) have been used in some studies for this purpose. This study aims to evaluate the efficacy of ultrasound in detecting mild and moderate degrees of dehydration in children. The study was performed in the emergency department of Dr. Sheikh’s Children Hospital, Mashhad, Iran. Children with mild to moderate degrees of dehydration according to World health Organization (WHO) clinical scale were enrolled. Their inferior vena cava diameters, aorta and IVC/AO ratio were measured before and after fluid therapy using ultrasound. Ultrasound was performed by two pediatric sonographers. 36 patients (mean age of 16.94±11.02 months) entered the study. 11 patients had mild and 25 moderate dehydration according to WHO clinical scale. All 11 patients with mild dehydration received oral rehydration. 13 patients in the moderate dehydration group received intravenous rehydration because of oral intolerance to fluids and recurrent vomiting. IVC diameter and IVC/AO ratio after fluid therapy in children with both mild and moderate dehydration degrees was significantly greater (P<0.001). However, we did not observe any significant difference in aorta diameter before and after fluid therapy. Using Receiver Operating Characteristic (ROC) curve, the proper cut-off point of IVC/AO ratio to differentiate patients with moderate dehydration from mild dehydration is equal to 0.782 with sensitivity and specificity equal to 88% and 45.45% respectively. Further, the area under the ROC curve for this cut-off is equal to 0.569. In conclusion, ultrasonography cannot differentiate between mild and moderate dehydration degrees, but studies with larger population of patients should be performed.

An efficient method for detecting damaged FAs; burnup and PPF estimations by gamma spectroscopy

The purpose of this study is to provide a quick and efficient experimental method to identify and find damaged fuel assemblies (FAs) among all assemblies of the core. This method is based on gamma spectroscopy by measuring the activity ratio of the desired fission fragments that leaked into the coolant. Using the ¹³⁴Cs/¹³⁷Cs activity ratio, and considering the history factor for each FA, we determine the fuel burnup. Furthermore, from the ¹³³I × ¹³⁵I /¹³³Xe activity ratio, the power peaking factor can be determined. This spectroscopy is carried out for the Tehran Research Reactor to find its failed FA positions. Then, the spectrum at different cooling times has been studied. Specifically, from the ¹³⁴Cs/¹³⁷Cs (0.1212 ± 0.003) activity ratio and the fuel history factor (2.1023), the fuel burnup of damaged fuel is anticipated to be 33.9%, and the result of the computational codes is found to be 33.1%; these two results are consistent with each other. The results of both experiment and code analysis show the relatively reasonable estimation of this method in finding the location of damaged FAs.

Clinical Course of Children and Adolescents with Primary Vesicoureteral Reflux: A retrospective study of 958 patients

Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant kidney scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children’s Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new kidney scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6% of patients developed new kidney scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new scars may develop.

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.

A computational continuum model of poroelastic beds

Despite the ubiquity of fluid flows interacting with porous and elastic materials, we lack a validated non-empirical macroscale method for characterizing the flow over and through a poroelastic medium. We propose a computational tool to describe such configurations by deriving and validating a continuum model for the poroelastic bed and its interface with the above free fluid. We show that, using stress continuity condition and slip velocity condition at the interface, the effective model captures the effects of small changes in the microstructure anisotropy correctly and predicts the overall behaviour in a physically consistent and controllable manner. Moreover, we show that the performance of the effective model is accurate by validating with fully microscopic resolved simulations. The proposed computational tool can be used in investigations in a wide range of fields, including mechanical engineering, bio-engineering and geophysics.

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.

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.

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.

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.

Maintaining tissue orientation during mohs micrographic surgery: scalpel versus marker

BACKGROUND

Critical to the accuracy of Mohs surgery is the ability to maintain proper orientation of excised tissue with respect to the surrounding skin. Several techniques have been described for maintaining this orientation, although no prior investigations directly compare these techniques.

OBJECTIVE

To compare the incidence of tissue orientation loss resulting from inability to identify skin score marks with that occurring from failure to identify marks made using a gentian violet marker during Mohs micrographic surgery (MMS). We also sought to determine the incidence of scars resulting from skin scoring.

MATERIALS AND METHODS

Patients undergoing MMS were prospectively randomized to have their tissue margins oriented using light scoring using a scalpel versus marking them using a gentian violet marker. Incidence of scoring scars and tissue orientation loss were the primary outcome measures.

RESULTS

Data were analyzed for 101 tumors. There were no instances of tissue orientation loss in the scalpel or marker arms, nor were there any visible score mark scars at follow-up.

CONCLUSION

Incidence of excessive scars resulting from lightly scored tissue or loss of tissue orientation caused by lost gentian violet markings appears to be low. Both methods worked well within the confines of this study.