Evaluation of the mandibular condyles trabecular structure in patients with severe class III pattern: a computed tomography (CT) fractal analysis study

Class III malocclusion is a combination of dental and skeletal disorders that causes discrepancies in occlusion. Malocclusion can affect the structure of the Temporomandibular joint (TMJ) resulting in many problems, one of which is affecting the internal structure of the bone. This study aimed to examine the morphological features of class III patients' trabecular structure of the mandibular condyle in comparison with normal class I individuals using fractal analysis (FA). To study the internal structure of the mandibular condyle bone, Computed Tomography (CT) scans of 45 severe class III patients (age: 16-46) who were the candidates for orthognathic surgery were selected and matched by age and sex with 45 normal class I individuals. The trabecular bone structure of the left and right mandibular condyles in three CT planes of the study group and control group were evaluated employing the FA. The result of the present study indicated that the fractal dimensions (FD) values of class III patients were lower than those of the normal class I individuals in axial (class I: 1.31 ± 0.02, class III: 1.28 ± 0.02), sagittal (class I: 1.25 ± 0.03, class III: 1.19 ± 0.08), and coronal (class I: 1.5 ± 0.06, class III: 1.45 ± 0.07) planes (P < 0.001). There were no significant differences between the FD values of the males and females. The intra-group evaluation revealed that there was no correlation between age and FD values. No evidence of laterality was found regarding the FD values of the right and left condyles. Given the noticeable differences between the FD values, it can be implied that severe class III malocclusion may affect the trabecular pattern of the cancellous bone of the mandibular condyle compared to class I individuals. Therefore, due to the altered trabecular structure, clinicians should be cautious when planning treatments for these patients.

The evaluation of alveolar fractures of trauma patients in Iran

BACKGROUND

Alveolar bone plays a vital role in mastication and supporting the teeth. The alveolar process is one of the most challenging regions of facial bone to reconstruct due to the deformity involves both hard and soft tissues. However, the etiology, gender, and age distribution vary between different regions, cultures, and countries. This study aims to investigate the prevalence of alveolar trauma in Shahid Rajaee Hospital, Shiraz, Iran, for three years.

METHODS

In a retrospective cross-sectional study, patients with alveolar fractures referred to Shahid Rajaei Hospital in Shiraz were included in the study. Age, sex, site of alveolar fractures, and etiology factors of trauma explored. The collected data was analyzed by SPSS software. Mean [Formula: see text] SD calculated for the inferential statistics, and the data compared using Chi-square and Exact Fisher. A p-value of < 0.05 was considered statistically significant with a 95% reliability.

RESULTS

A total of 165 patients had alveolar fractures in this study. We found that the most common cause of alveolar fracture was road accidents (32.3%) and the lowest reason was violence (9%). Most people with alveolar trauma were male and in the 21-30 years. The prevalence of mandibular and maxillary alveolar fractures was 17.61 and 17.01%, respectively, with the most anterior area of injury.

CONCLUSION

Alveolar trauma is one of the most common injuries among trauma patients. Early diagnosis and treatment plans are necessary to reduce the complications of facial trauma. Early training for a young adult is essential to prevent the severity of trauma.

The effects of orthognathic surgery on auditory function

BACKGROUND

Orthognathic surgery is widely used in treating functional and skeletal problems. Any surgical procedure could cause side effects.

OBJECTIVES

This study aimed to evaluate the potential changes in orthognathic surgery on the hearing function of patients.

MATERIALS AND METHODS

Thirty-one orthognathic surgery candidates were recruited in this study. Patients underwent either single or double jaw surgery. Pure tone audiometry (PTA), tympanometry, and Eustachian Tube Dysfunction Test (ETFT) were performed postoperatively at 24 h, 6 weeks, and 6 months after surgery. Patients were tabulated based on the type of maxilla and mandibular surgical movements (vertical and horizontal).

RESULTS

PTA evaluation, based on horizontal or vertical movements, did not show significant differences, although vertical movements resulted in less change in hearing threshold. In other words, no significant changes occurred in patients' hearing threshold after surgery. No significant difference was also observed between horizontal and vertical movements in the results of tympanometry. Negative changes were found in the results of ETFT in vertical movements, which returned to pre-surgery values in the final test.

CONCLUSIONS

The risk of minor changes in hearing function is probable during the first week after orthognathic surgery, but these negative changes will either totally fade or remain negligible. Patients gave informed consent preoperatively, and reassurance postoperatively is prudent.

The impact of COVID-19 pandemic on dental practice in Iran: a questionnaire-based report

Background

The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), besides the fact that dental procedures commonly generate blood and saliva droplets that could lead to the contagion have resulted in the closure of many dental clinics. In the present study, we aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on dental practice by conducting an online questionnaire among the Iranian dental practitioners and finding their perspectives on the subject.

Methods

This report is based on a questionnaire that was conducted among Iranian dentists. The survey included questions that evaluate the dentists’ perceptions and attitudes toward the COVID-19 pandemic and its effect on their personal life, financial status, and the quality of dental services for patients.

Results

Overall, 240 dentists contributed to this study (214 general dentists and 26 specialists). The majority of the participants (n = 170, 70%) did not perform non-emergency procedures during the pandemic. The dental practitioners have suggested several strategies to decrease the risk of contagion, such as reducing treatment sessions (n = 90, 37%), strict triage of patients (n = 156, 64%), and using personal protective equipment (n = 108, 45%). However, most of the dentists (n = 210, 87%) had problems, providing personal protective equipment during the pandemic. Moreover, 97% (n = 234) of the participants reported that they encountered a decrease in their financial income since the eruption of the pandemic.

Conclusion

Dental health care workers are at the highest risk of contracting COVID-19. Thus, dental practitioners ought to execute the standard protocols more cautiously during the pandemic. They could also lower their work hours and limit dental procedures to emergency treatments to reduce the risk of COVID-19 transmission. Besides, the public organizations should provide proper equipment for the dental practitioners to decrease the risk of contagion.

Tapia's Syndrome after Cosmetic Malar Augmentation: a Case Report

Tapia's syndrome is an infrequent complication of airway manipulation. It is usually due to an extra-cranial ipsilateral injury to the hypoglossal nerve and the recurrent laryngeal branch of the vagal nerve, which can happen after any surgery. It is usually characterized by unilateral paralysis of the muscle of the tongue and vocal cords although it can also occur bilaterally. We present a patient with postoperative unilateral hypoglossal and recurrent laryngeal nerves palsy that occurred after cosmetic malar augmentation for esthetic correction of the left cheek flatness with an uncomplicated transnasal intubation. We report the first case of Tapia's syndrome after porous polyethylene implantation for cosmetic cheek reconstruction. The patient was treated immediately after the diagnosis with 0.5mg dexamethasone for two weeks. After three months, the movements of the vocal cord and tongue movement started to improve and the patient's hoarseness fully recovered after six months.

Deceased Organ Donation From Pediatric Donors: Does the Literature Really Help Us? Implication for More Powerful Guidelines

BACKGROUND

Brain-dead pediatric donors have always been the focus of attention because of the higher quality, utility, and possibility of their organ donation. However, donors under the age of 5 years always necessitate making more challenging management efforts, which are not clearly implied in most parts of the guidelines.

METHODS

The data obtained from 79 brain-dead pediatric donors of the Organ Procurement Unit of Masih Daneshvari Hospital, Tehran, Iran, were assessed. The donors were divided into 2 groups, including donors under 5 years of age (group A) and those between 5 and 12 years of age (group B). Metabolic, hemodynamic, hematologic, and electrolyte status as well as the suitability for donation were compared in the study groups.

RESULTS

Of 1252 donors, 6.3% were under 12 years of age. Trauma and drug toxicity were the two primary causes of brain death in group A. In comparison, trauma and brain tumor were the leading causes of brain death in group B. The prevalence of both hyperglycemia and respiratory acidosis was significantly higher in group A (P < .05). However, severe anemia and coagulopathy were more prevalent in group B (P < .05). The high-dose inotropic administration was used for 42.4% of the donors in group A, whereas only 26% of the donors in group B needed a high dose of inotropes (P < .05). The mean quantity of organ harvested per donor was 2.1 and 2.25 in groups A and B, respectively. Furthermore, donor loss was not significantly different in both groups.

CONCLUSIONS

The occurrence of different complications in donors under the age of 5 years requires special treatment considerations that should be the center of attention in the related guidelines. Organ donation per donor indicates that donors under the age of 5 years are a valuable resource for organ procurement.

Efficacy of recruitment maneuver for improving the brain dead marginal lungs to ideal

BACKGROUND

Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation.

METHODS

From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%.

RESULTS

The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted.

CONCLUSIONS

Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.

Effects of sulfur water extraction on anthocyanins properties of tepals in flower of saffron (Crocus sativus L)

A sulfur solution with different metabisulfite concentrations (100, 400, 700, 1,000 and 2,000 ppm) was used to extract anthocyanins from saffron tepals. The extraction process was compared with acidified ethanol solution at similar extraction times of 20, 40, 60, 120, and 180 min at 40 °C. The recovery of anthocyanins with sulfur solution was higher than ethanol extraction and reached to 700 mg anthocyanins/100 g, when the sulfur concentration and extraction time were 700 ppm and 60 min, respectively. HPLC analysis showed that anthocyanins extracted with sulfur solution followed by partial desulfurization and reducing sulfur content (to less than 250 ppm) had around 100 % more cyanidin 3 glucosides and 100 % less pelargonidin 3,5 glucosides in comparison with ethanol extraction. Additionally, the color of low-sulfured anthocyanins had more saturation (chroma), less lightness, and more stability than the one extracted with ethanol solution. While monomeric and polymeric anthocyanins extracted with sulfur solution had less than 1 % changes after 3 h extraction time, they had more than 12 % changes when they extracted with alcoholic solution at similar conditions. Overall, the sulfur method had a potential to extract stable anthocyanins from waste and discarded saffron tepals in aqueous solvent, and with higher quantity and quality (more attractive color) than conventional ethanol extraction method.

Microbial pattern of bronchoalveolar lavage in brain dead donors

BACKGROUND

We assessed bronchoalveolar lavage (BAL) cultures of brain dead donors seeking to achieve better donor management and decrease transplant complications. Determining the most common source of some postoperative infections causing morbidity and mortality among lung recipients would help to reach this goal.

MATERIALS AND METHODS

This prospective study was performed on 80 brain dead donors from August 2008 to August 2009. Donors with partial pressure of arterial O2 to the fraction of inspired O2 (PaO2/FIO2)>300 mm Hg and a normal chest x-ray underwent bronchoscopy to obtain a BAL.

FINDINGS

The mean donor age was 30±14 years and 50 (63%) were males with 21 (26%) showing a positive history for smoking and 32 (40%) with turbid tracheal secretions. Chest x-ray was abnormal in 49 (61%). Positive culture BAL results were observed among 30 (38%) patients: there were 17 (90%) bacterial and 6 (22%) fungal. Finally, 16 donors (20%) were considered suitable lung donors, allowing 10 lung transplantations.

CONCLUSION

Only 20% of donors had acceptable lungs for transplantation. The high rates of positive bacterial and fungal BAL cultures in donors suggest the need for more aggressive critical care management and antibiotic therapy which may be beneficial to prevent future infections in recipients. Further prospective studies are needed to assess the correlation between donor BAL results and posttransplant morbidity and mortality.

Causes of family refusal for organ donation

INTRODUCTION

Family refusal represents a barrier for organ donation together with other cultural and religious factors possible ignorance and clinical obstacles.

METHODS

We performed this retrospective study by phone employing our organ procurement unit database, using a list of families of potential organ donors who had refused organ donation.

RESULTS

In 2009, 146 potential organ donor families refused donation. We contacted 81 families. The main reason expressed by there families to justify the refusal to donate the deceased's organs was denial and rejection of brain-death criteria (44.4%). Other causes were believing in a miracle (13.6%); fear about organ trade and unknown organ destination (9.9%); religious beliefs (8.6%); insecutrity about the brain-death diagnosis (6.2%); unstable family mood (6.2%); unknown donor wishes about donation (4.9%); belief in body integrity after death (3.7%); and fear of objection by other family members (2.5%).

CONCLUSION

Our findings showed several reasons for family refusal for organ donation; among the main cause is poor acceptance of brain death. It seems that increasing the knowledge of people about brain death and organizing strategies to confirm brain death for families are necessary to meet the organ shortage.

Eight years of lung transplantation: experience of the National Research Institute of Tuberculosis and Lung Diseases

BACKGROUND

Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006.

OBJECTIVE

To describe our 8-year experience in lung transplantation.

PATIENTS AND METHODS

During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation.

RESULTS

The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection.

CONCLUSION

Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.

Organ retrieval from brain-dead patients by a single organ procurement center in Iran

INTRODUCTION

The majority of transplantations depend solely on cadaveric organs. In recent years, special focus has been directed toward brain-dead patients in Iran, but it seems that there is limited information regarding the characteristics of cadaveric organ donation in our country.

MATERIALS AND METHODS

This is a retrospective analysis of data of our Organ Procurement Unit (OPU), which is one of the most active organ procurement units in Iran. We incorporated the data on all organ donations from brain-dead patients between 2004 and 2008 into the present study. Demographic characteristics of the patients along with data regarding brain death and organ donation were extracted from already registered data on patients.

RESULTS

Among 93 brain-dead patients registered in the database of the OPU, organs were retrieved from 85% (n = 79). Out of the 14 patients from whom no organ was retrieved, the cause for this failure was death before donation in 85% (n = 12). The numbers of donated organs varied between zero and six (mean +/- standard deviation = 3.1 +/- 1.7). The most donated organs in terms of frequency and count were: right kidney (n = 68; 73.1%), left kidney (n = 67; 72%), liver (n = 63; 67.7%), heart (n = 40; 43%), pancreas (n = 5; 5.4%), and lung (n = 4; 4.3%).

DISCUSSION

The overall organ retrieval rate from brain-dead patients by this OPU was comparable to that of developed countries; however, we still believe we can improve this rate/scale.

Spoligotyping of Mycobacterium tuberculosis in anthracotic bronchitis

BACKGROUND

Mycobacterium tuberculosis infection has been shown to be associated with anthracotic bronchitis. However, the typical manifestation of infection is not usually present in infected patients, which raises the question of whether a particular strain of M. tuberculosis is associated with this group of patients.

OBJECTIVE

To determine whether a particular strain of M. tuberculosis is associated with anthracotic bronchitis.

DESIGN

We assessed the predominant space oligonucleotide (spoligotype) patterns of M. tuberculosis complex isolated from patients with anthracotic bronchitis and compared the results with tuberculosis (TB) subtype patterns in Iran and other countries.

RESULTS

During a 7-month period (April--October 2006), we enrolled 87 patients (30 men and 57 women) with anthracotic bronchitis, 26% (n = 23) of whom had TB. Spoligotyping of M. tuberculosis among these 23 patients showed four distinct patterns: East-African-Indian (11, 47.8%) and Central-Asian (7, 30.4%), Haarlem I (4, 17.4%) and T-1 (1, 4.3%). When compared with spoligotype patterns of M. tuberculosis in Middle Eastern countries, including Iran, anthracotic bronchitis had similar patterns.

CONCLUSION

Our results indicate that the atypical manifestations of TB in anthracotic patients are not caused by any particular subtypes of M. tuberculosis. We conclude that anthracotic bronchitis is actually an atypical presentation of tuberculous infection with common subtypes inside the bronchial mucosa.

Deoxynivalenol and other Fusarium toxins in wheat and rye flours on the Danish market

Information on the contamination of Danish cereals and cereal products with Fusarium toxins is limited and the last survey is from 1984/1985. In the present study, the occurrence of deoxynivalenol (DON), nivalenol (NIV), HT-2 toxin, T-2 toxin and zearalenone (ZON) was investigated in flour of common wheat, durum wheat and rye. The samples were collected from 1998 to 2001 from both mills and the retail market in Denmark. A total of 190 flour samples were analysed for DON and NIV and about 60 samples for HT-2, T-2 toxin and ZON. DON was most frequently detected with an incidence rate of 78% over all samples for all years. The contamination level varied considerably from year to year, and for wheat and rye the highest incidence and DON concentrations were found in samples from the 1998 harvest. There were regular and heavy rainfalls in Denmark during the flowering period of the crops that year, and DON was found in all samples, with mean concentrations in wheat and rye flour of 191 microg kg(-1) (n=14) and 99 microg kg(-1) (n=16), respectively. Comparison of data from each harvest year showed higher contents of DON in samples of wheat (range 20-527 microg kg(-1)) than in rye (20-257 microg kg(-1)). Contents of NIV, HT-2 toxin and ZON in samples of wheat and rye were generally low, and even in positive samples the contents were close to the detection limit of the methods. The T-2 toxin was detected in only a few of the wheat samples and in low amounts. However, the toxin was found in about 50% of the rye samples collected during 1998-2000, with a mean content of 49 microg kg(-1) (n=25). Durum wheat flour showed the highest DON contamination level, and all samples (n=33) collected during 2000 and 2001 contained DON with means and medians above 1100 microg kg(-1). Over 70% of the samples contained more than 500 microg kg(-1) DON, and the highest observed concentration was 2591 microg kg(-1). The concentration of T-2 toxin in durum wheat flour was also high with five of the 10 analysed samples containing more than 100 g kg(-1).