The effect of preoperative oral administration of prednisolone on postoperative pain in patients with symptomatic irreversible pulpitis: a single-centre randomized controlled trial

AIM

This single-centre randomized, double-blind, placebo-controlled clinical trial assessed the effect of a preoperative, single, oral dose of prednisolone on postoperative pain and postoperative analgesic intake in patients with symptomatic, irreversible pulpitis in mandibular molars.

METHODOLOGY

Four hundred participants, randomly assigned to two equal groups, received either 40 mg prednisolone or placebo tablets 30 min before single-visit root canal treatment. Patients recorded their pain level 6, 12 and 24 h after treatment on a 100-mm visual analogue scale. All patients received a sham capsule to take if needed as a postoperative analgesic, and, if the pain persisted, an analgesic was prescribed. The relative risk reduction and 95% confidence intervals (CI) were estimated for binary data. Mann-Whitney U-test was used to compare postoperative pain intensity between groups.

RESULTS

The relative risk reduction in pain incidence was 20.31% (95% CI: 12.03%, 27.82%) at 6 h, 23.39% (95% CI: 14.75%, 31.16%) at 12 h and 28.85% (95% CI: 18.08%, 38.20%) at 24 h. Prednisolone had significantly less post-obturation pain intensity compared to placebo at 6, 12 and 24 h (P < 0.001). The relative risk reduction in sham-capsule intake was 54% (95% CI: 38%, 66%) and of analgesic intake was 55% (95% CI: 3%, 79%). No adverse effects were recorded.

CONCLUSION

Preoperative oral administration of a single dose of 40 mg prednisolone was beneficial to control short-term post-obturation pain after single-visit root canal treatment in patients with symptomatic irreversible pulpitis reducing pain incidence after 24 h by approximately 30% and postoperative analgesic intake by approximately 55%.

Variations in the β-globin genes of sickle cell anaemia patients in Zaria, Northwestern, Nigeria

CONTEXT

Sickle Cell Anaemia (SCA) is a genetic disorder with a life-long disability, which is of public health importance. The diversity in its clinico-pathologic and laboratory presentations may be due to the interplay between additional genetic differences and environmental factors. The genetic factors may be within the β-globin gene itself, the β-globin gene cluster or elsewhere in the genome.

AIM

To characterize the β-globin gene for variations associated with the Sickle Cell mutation.

SETTINGS AND DESIGN

A cross-sectional descriptive study involving 51 adult SCA patients attending Sickle Cell Clinic of Haematology Department Ahmadu Bello University (ABUTH) Zaria, Kaduna State, Nigeria.

METHODS AND MATERIAL

The buccal swab specimens were collected and β-globin gene DNA sequencing was done. The sequences obtained were compared with a Genbank Reference β-globin gene (NC_000011.9) using Basic Local Alignment Search Tool (BLAST), and variations noted. Data generated were analyzed using SPSS Version 20.0.

STATISTICAL ANALYSIS USED

Data generated was summarized by using charts, means±2SD, and 95% confidence intervals.

RESULTS

There were 40 (78.43%) females and 11 (21.57%) males. The mean age of the participants was 25.35 ± 7.67 years, 95% CI (23.20, 27.51). The classic sickle cell mutation A T was present in all participants. The mean number of β-Globin gene variations was 8.61±11.30, 95% CI (5.43, 11.78). The number of Substitutions were 122 (27.79%), insertions 184 (41.91%), and deletions 133 (30.30%). These occurred in various combinations. The mean number of substitutions, insertions, and deletions were 2.39±3.23, 3.61±7.66, and 2.60±2.46 with 95% CIs of (1.48, 3.30), (1.45, 5.76), and (1.92, 3.30) respectively.

CONCLUSIONS

There are β-globin gene variations in SCA patients in Zaria, and locally relevant genetic database of the SCA population will be the cornerstone in understanding genotype-phenotype interactions in this disorder.

Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study

This study aimed to determine whether follicular output rate (FORT) can predict the clinical pregnancy rate in women with unexplained infertility undergoing IVF/ICSI. This was a prospective study conducted at Dar El Teb subfertility centre in Cairo between June 2014 and July 2016. A total of 303 women with unexplained infertility, who were undergoing IVF/ICSI, were divided into three groups according to FORT tertile values. FORT was calculated as pre-ovulatory follicle count/antral follicle count × 100. There was a progressive and significant increase from the low to the high FORT groups in the clinical pregnancy rate (29.9%, 43.3% and 57.8%; P < 0.001), number of retrieved oocytes (5.4 ± 1.5, versus 6.8 ± 2.8, and 7.4 ± 2.1; P < 0.001), and fertilization rate (48.4 ± 21.8 versus 55.3 ± 20.3 and 57.4 ± 19.2; P = 0.006). Multivariate logistic regression analysis revealed that the correlation between FORT and pregnancy was independent of potential confounding factors (P = 0.008). We concluded that FORT is an independent variable affecting the clinical pregnancy rate in IVF/ICSI cycles. Higher FORT values had better oocyte yield and clinical pregnancy rates in women with unexplained infertility undergoing IVF/ICSI with potentially normal ovarian response.

The potential protective effect of α-lipoic acid against nanocopper particle-induced hepatotoxicity in male rats

The present research task is aimed to evaluate the role of exogenous α-lipoic acid (ALA) (100 mg/kg body weight) as hepatoprotective and potent antioxidant in amelioration of copper nanoparticle (CNP)-induced hepatotoxicity. Forty male rats were randomly assigned into four equal groups: group I (control), group II received CNPs, group III received CNPs + ALA, and finally group IV received ALA for 2 months. At the end of the experimental period, the rats were decapitated, and blood and liver tissue samples were collected for measurement of liver function tests, antioxidant status, lipid peroxidation (LPO), copper content, expression of some apoptotic genes, and histopathological analysis. CNPs induced marked hepatic damages as evident by severe alteration in hepatic biomarkers. This was accompanied by a significant elevation in hepatic LPO and induced nitric oxide, copper content, and expression level of apoptotic genes (C-myc and C-jun). In contrast, marked depletion for antioxidant parameters was detected. These findings were confirmed with severe pathological alterations. Coadministration of ALA as a powerful antioxidant attenuates the hepatotoxic effects of CNPs through improvement of liver parameters, oxidative status, genetic changes, and preservation of liver integrity through histopathological analysis. These results suggest that consumed ALA could be used as an applicable hepatoprotective agent against oxidative damage mediated by nanoparticles intoxication.

ID: 16: INAPPROPRIATE DEFIBRILLATION DUE TO ELCTRO-MAGNETIC INTERFERENCE FROM NEARBY ALTERNATING CURRENT

Introduction

Implantable cardioverter-defibrillator (ICD) to monitor and promptly treat life-threatening arrhythmia has been a very successful approach. However, inappropriate defibrillation could increase morbidity and mortality. Most common causes of inappropriate defibrillation are: supra-ventricular arrhythmia and device malfunctions.

Case Description

A 31-year-old female with arrythmogenic right ventricular cardiomyopathy (ARVC) status post dual chamber ICD presented after her ICD had fired. Patient was sitting near a public swimming pool and suddenly felt a jolt, “getting hit at the back of the head”. On further ICD Interrogation revealed a high frequency artifact on the intra-cardiac electrogram which was sensed by the device as ventricular fibrillation, and subsequently it was defibrillated. Other parameters including sensing and pacing thresholds, lead impedances were all within normal limits.

Discussion

Alternating current from a nearby electric generator created Electro-magnetic interference (EMI) which led to inappropriate defibrillation. High frequency oscillating artifact is the hallmark of EMI from alternating current. We should be aware of all possible causes that can interfere with cardiac devices. .

ID: 66: HENOCH-SCHONLEIN PURPURA (HSP) PRESENTING AS A LARGE PERICARDIAL EFFUSION IN AN ADULT

Introduction

Henoch-Schonlein Purpura (HSP) is the most common form of systemic vasculitis in children. It is characterized by a tetrad of palpable purpura, arthralgia, abdominal pain and renal disease. It rarely presents with significant pericardial disease, especially in adults, and is a rare entity with only a few reported cases.

Case Description

A 49 year old Male presented with a two month history of progressive dyspnea, polyarthralgia, fatigue, and skin rash. Physical exam showed cardiac dullness beyond the apical point of maximal impulse, elbow joints with limited range of motion and swelling, periungal erythema and palpable purpura over his extremities. He was found to have a large pericardial effusion on an echocardiogram with respiratory variation requiring drainage. Laboratory evaluation revealed markedly elevated C-Reactive Protein of 225. Biopsy of the skin purpura was consistent with IgA leukocytoclastic vasculitis with intense deposition of IgA within the superficial dermal blood vessel walls. Pericardial fluid was consistent with acute inflammation with several neutrophils but no growth on culture. The patient was started on high dose steroids with marked improvement in his symptoms including a decreased pericardial effusion. A repeat echocardiogram was obtained which showed only trivial pericardial effusion with no signs of tamponande.

Discussion

HSP is a rather common disease in children with systemic hypersensitivity vasculitis in the skin and other organs including the kidneys. It rarely involves the myocardium or pericardium and is even rarer to present as a large pericardial effusion, especially in an adult. HSP presenting as pericardial disease has only been reported in a few cases. Although the pericardial involvement of Henoch-Schonlein Purpura seen in this patient is rare, any collagen vascular disease can present with pericardial effusion and might respond to appropriate anti-inflammatory therapies including steroids if recognized promptly.

Pre-eclampsia and the vascular endothelial growth factor: a new aspect

Pre-eclampsia (PE) is a multi-system disorder of human gestation characterized by hypertension, proteinuria, and edema, which resolves with placental delivery. This disease affects 3-14% of all pregnancies worldwide and 5-8% in the USA. Furthermore PE remains one of the leading causes of maternal and neonatal mortality and morbidity worldwide. One of the most important goals in obstetrics is the early identification of the patient with an increased risk for PE. This paper unifies the essential and validated findings of past and current scientific investigation which encompass the relationship between PE and the vascular endothelial growth factor (VEGF). VEGF and its receptors have acquired great interest due to their vital role in neovascularization (vasculogenesis and angiogenesis) in a variety of physical and pathological processes such as the female reproductive cycle, PE, and tumorigenesis. VEGF is secreted in response to tissue hypoxia and endothelial cell damage. Alterations in the circulating levels of this factor may therefore identify those pregnancies with a high possibility of developing PE. This review will summarize the present authors' current understanding of the role of circulating VEGF in the pathogenesis, clinical diagnosis, and prediction of PE.

A model for the coupling of the Greater Bairam and local environmental factors in promoting Rift-Valley Fever epizootics in Egypt

OBJECTIVES

Rift-Valley Fever (RVF) is a zoonotic mosquito-borne disease in Africa and the Arabian Peninsula. Drivers for this disease vary by region and are not well understood for North African countries such as Egypt. A deeper understanding of RVF risk factors would inform disease management policies.

STUDY DESIGN

The present study employs mathematical and computational modeling techniques to ascertain the extent to which the severity of RVF epizootics in Egypt differs depending on the interaction between imported ruminant and environmentally-constrained mosquito populations.

METHODS

An ordinary differential system of equations, a numerical model, and an individual-based model (IBM) were constructed to represent RVF disease dynamics between localized mosquitoes and ruminants being imported into Egypt for the Greater Bairam. Four cases, corresponding to the Greater Bairam's occurrence during distinct quarters of the solar year, were set up in both models to assess whether the different season-associated mosquito populations present during the Greater Bairam resulted in RVF epizootics of variable magnitudes.

RESULTS

The numerical model and the IBM produced nearly identical results: ruminant and mosquito population plots for both models were similar in shape and magnitude for all four cases. In both models, all four cases differed in the severity of their corresponding simulated RVF epizootics. The four cases, ranked by the severity of the simulated RVF epizootics in descending order, correspond with the occurrence of the Greater Bairam on the following months: July, October, April, and January. The numerical model was assessed for sensitivity with respect to parameter values and exhibited a high degree of robustness.

CONCLUSIONS

Limiting the importation of infected ruminants beginning one month prior to the Greater Bairam festival (on years in which the festival falls between the months of July and October: 2014-2022) might be a feasible way of mitigating future RVF epizootics in Egypt.

Comparison of a fluorometric assay kit with high-performance liquid chromatography for the assessment of serum retinol concentration

BACKGROUND

Although high-performance liquid chromatography (HPLC) is the commonly used method for the analysis of retinol in biological samples, simple and rapid test kits are available.

OBJECTIVES

This study compared a rapid test kit (ICHECK Fluoro®) to HPLC for the assessment of serum retinol concentrations.

METHODS

For the analysis by HPLC, sample preparation included standard deproteinization and extraction phases. The analysis by ICHECK was performed by injecting serum into IEX reagent vials (n=89) and mixing manually for separation. After precipitation of the proteins, the vial was introduced into the chamber of the ICHECK Fluoro and analysed at 0 min (ICHECK0min) and 15 min later (ICHECK15min). Bland and Altman approach was applied to test the agreement between HPLC and ICHECK.

RESULTS

Mean HPLC, ICHECK0min and ICHECK15min values were 421.2±106.0 µg/L, 423.1±118.3 µg/L and 413.2±107.6 µg/L, respectively. Retinol concentrations significantly decreased in the IEX solution over time (p<0.001). No significant proportional bias was observed between HPLC and ICHECK0min (r-0.038, p=0.73) and ICHECK15min (r=-0.024, p=0.82). Fixed biases (HPLC minus ICHECK) for ICHECK0min and ICHECK15min were respectively -1.9±23.1 µg/l (p=0.45) and 8.0±22.7 µg/l (p=0.002).

CONCLUSION

ICHECK Fluoro may offer a reliable mean for assessing serum retinol for measurements performed with no significant time delay.

Diet and cannibalism in plainfin midshipman Porichthys notatus

The macroscopic and microscopic diversity of potential food items available in the nests of plainfin midshipman Porichthys notatus were quantified and compared with items that were found in the stomach and intestine (digestive tract) of the guarding males. In this species, males occur as one of two possible reproductive morphs: guarder males that care for young and sneaker males that parasitize the courtship and care of guarder males. Although it was predicted that guarder males would have fewer feeding opportunities due to their confinement to the nest, they in fact had more food items in their digestive tracts than did sneaker males and females. Date in the breeding season (a proxy of care duration) and body condition were not correlated with the amount of food consumed by guarder males. The main type of food consumed was P. notatus embryos; 69% of all guarder males sampled had cannibalized offspring. By comparing the diet of both sexes and tactics, this study sheds light on some of the strategies designed to cope with the costs of providing parental care.

Processing movement related cortical potentials in EEG signals for identification of slow and fast movements

The extraction of intended kinetic information from an EEG signal can have several applications related to the rehabilitation for subjects with various neurological disorders. However, the task is mainly constrained by the low signal-to-noise ratio for the EEG signals. It is well known that the cortical activity takes place at a very low frequency since it is characterized by the dropping of movement related cortical potential (MRCP) across the sampled EEG signal. The strong variations in the MRCP is indicative of the noise due to various sources. The aim of this work is to remove this noise from the EEG signals using empirical mode decomposition, which decomposes a signal into harmonics (intrinsic mode functions--IMF) of various frequencies. The IMFs pertaining to small frequencies are later used for features extraction where we extract the spatial and spectral features from the selected IMFs. The features are later used for classification using support vector machines (SVM). Our experiments show superior results to the benchmark method for the underlying dataset that has been used in this research.

Effect of environmental air pollution on type 2 diabetes mellitus

OBJECTIVE

Air pollution is a novel risk factor for insulin resistance and occurrence of type 2 diabetes mellitus (T2DM), but the evidence is limited and diverse. Therefore, the aim of this study was to assess the effect of environmental air pollution on incidence of type 2 diabetes mellitus.

METHODS

In this study, we identified 102 published studies through a systematic data base search including ISI-Web of Science, EMBASE and PubMed. We searched the related literature by using the key terms including diabetes mellitus, air pollution, occupational and environmental pollution, gaseous, NO2, particulate matter pollutants PM2.5, and PM10. Studies in which diabetes mellitus, insulin resistance, air pollution, occupational and environmental pollution was discussed were included in the study. No confines on publication status, study design or language of publication were considered. Descriptive and quantitative information were extracted from the selected literature. Finally we included 21 publications and remaining studies were excluded.

RESULTS

Air pollution is a leading cause of insulin resistance and incidence of type 2 diabetes mellitus. The association between air pollution and diabetes is stronger for traffic associated pollutants, gaseous, nitrogen dioxide, tobacco smoke and particulate matter.

CONCLUSIONS

Exposure to air pollutants is significantly associated with increased risk of type 2 diabetes mellitus. It is suggested that, environmental protection officials must take high priority steps to minimize the air pollution, hence to decrease the incidence of type 2 diabetes mellitus.