Alternative root canal filling materials to zinc oxide eugenol in primary teeth: a systematic review of the literature

PURPOSE

The aim of this review was to compare the currently available root canal filling materials for primary teeth to zinc oxide eugenol (ZOE) to find a suitable alternative. The search question was: which root canal filling materials used in pulpectomy for primary teeth give better clinical and radiographic success rates than ZOE?

METHODS

A systematic search was conducted using five databases, namely Cochrane central register of controlled trials (CENTRAL), MEDLINE via PubMed, Science Direct, Scopus and EBSCOhost using a selection of "MeSH terms". The "Modified Jadad Scale" was used for the methodology assessment of the included studies.

RESULTS

Out of 480 articles identified in the initial search, 8 articles met all the inclusion criteria. The results showed that, compared to ZOE, ZOE with calcium hydroxide and iodoform had better clinical and radiographic success rates, a resorption rate similar to that of the roots, faster resorption of extruded particles and a maximum decrease in the size of pre-operative inter-radicular radiolucencies.

CONCLUSION

Numerous materials, proposed and used by clinicians in root canal filling in primary teeth, can be recommended as alternatives to ZOE. However, none of them could be the ideal material in primary teeth. Thus, more high-quality well-designed randomised clinical trials are required to develop more high-performing materials.

[Prevalenceof dental caries in children with low birth weight]

Dental caries was evaluated in 58 children with low birth weight [750-2500 g] and in a control group of 58 children with birth weights greater than 2500 g. All children were examined for their caries experience using a standardized clinical examination. The results showed a higher prevalence of caries in the children with low birth weight [77.5%] than in the children with birth weights greater than 2500 g [44.8%], the difference being statistically significant [P < 0.001]. There was a negative correlation between birth weight groups and prevalence of caries [r = -0.34]. It was concluded that children with low birth weight have a greater risk of dental caries than others

Parental stress as a predictor of early childhood caries: a systematic review

AIM

The aim of this study was to systematically review the literature to answer the question: Are parental stress associated with early childhood caries (ECC)?

METHODS

Electronic databases including MEDLINE (via Pubmed), Scopus and SciELO were searched. Cross-sectional and case-control studies that investigate the association between parental stress and ECC were included. The Newcastle-Ottawa scale was used to assess the risk of bias of the included articles.

RESULTS

Out of 498 articles identified in initial research, 7 articles met the inclusion criteria; five were cross-sectional and two were control-case in design. A statistically significant correlation between ECC and total parental stress as well as a higher level of carious activity associated with total parental stress was reported in four studies. In two studies, no significant relationship between stress and ECC was found (P > 0.05) and in one study, parental stress was inversely associated with children's ECC status with better dental outcomes significantly associated with a higher level of parenting stress.

CONCLUSION

Despite the fact that the heterogenicity of the following data precluded conclusions to be drawn, it was obvious that parenting stress or some of its domains may influence the development of carious lesions in young children.

Black stain and dental caries in primary teeth of Tunisian preschool children

AIM

To assess the prevalence of black tooth stains and to investigate its correlation with caries experience in the primary dentition of 3-5-year-old children in the region of Monastir, Tunisia.

METHODS

It was a descriptive cross-sectional study involving children in preschool establishments in Monastir, Tunisia. It consisted of an oral examination of 393 children and data collection through a questionnaire completed by parents. ANOVA test and Pearson Chi-square test were used to assess the prevalence of black stains and its association with dental caries.

RESULTS

The overall mean decayed, missing, and filled teeth (dmft) index was 1.42 ± 0.1. Caries prevalence was 49.9%. Of all the children involved, 6.1% had black stains. A statistically significant relationship was found between black stain and the prevalence of early childhood caries (p = 0.047). However, the association with the dmft index was not statistically significant (p = 0.08).

CONCLUSION

Preschool children with black tooth stain had lower dental caries experience. The results of the present study suggest that black stains are a protective factor for early childhood caries. More studies are needed to explore the risk factors of black stains.

Prevalence and Severity of Oral Diseases in the Africa and Middle East Region

This review aims to determine the prevalence and severity of oral health diseases in the Africa and Middle East region (AMER). The profile of oral diseases is not homogeneous across the AMER. There are large disparities between groups. Reliable data are scarce. The prevalence and severity of oral diseases appear to be increasing in the African region, as does associated morbidity. There are substantial differences in inequalities in oral health. Dental caries prevalence is less severe in most African countries than in developed countries, but the high rate of untreated caries reflects the limited resources available and difficulties of access and affordability to essential oral health care services. The prevalence of gingival inflammation is very high in all age groups in several African countries. The prevalence of maxillofacial trauma has increased in many countries, with a wide variation of the incidence and high prevalence of traumatic dental injuries in primary and permanent teeth. Orofacial clefts are among the most common birth defects. Annual incidence of oral cancer is estimated as 25 cases per 100,000 people in Africa. Noma is a major public health problem for the Middle East and North African (MENA) region. Data about human immunodeficiency virus/AIDS are limited, particularly in the MENA region. According to the World Health Organization Regional Committee for Africa report, some fundamental key basic knowledge gaps need to be underlined. They include inequalities in oral health, low priority for oral health, lack of adequate funding, inadequate dental student training, obstacles to medical and dental research, and poor databases. There are very few effective public prevention and oral health promotion programs in the AMER. Universal health coverage is not achievable without scientific research on the effectiveness of health promotion interventions.

Wide QRS in a 2-month infant associated with recurrent ventricular tachycardia: A case of Brugada-like syndrome

We report the case of a 2-month old infant who experienced recurrent sustained ventricular tachycardia (VT) in a structurally normal heart. Resting electrocardiogram (ECG) showed wide QRS with a complete right bundle branch bloc (RBBB) morphology. There was no family history of syncope or sudden death, but the ECGs of the father and the brother showed incomplete RBBB with negative T waves on V1 lead. This case seems to fit well with the newly defined entity of Brugada-like syndrome with a highly suspected genetic underlying disposition.

[Percutaneous closure of persistent ductus arteriosus in low-weight infants]

INTRODUCTION

The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg.

AIM OF THE STUDY

The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children.

PATIENTS AND METHODS

The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed.

RESULTS

Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure.

CONCLUSION

This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.

[Management of patients treated for acute ST-elevation myocardial infarction in Tunisia: Preliminary results of FAST-MI Tunisia Registry from Tunisian Society of Cardiology and Cardiovascular Surgery]

FAST-MI Tunisian registry was initiated by the Tunisian Society of Cardiology and Cardio-vascular Surgery to assess characteristics, management, and hospital outcomes in patients with ST-elevation myocardial infarction (STEMI).

METHODS

We prospectively collected data from 203 consecutive patients (mean age 60.3 years, 79.8 % male) with STEMI who were treated in 15 public hospitals (representing 68.2 % of Tunisian public centres treating STEMI patients) during a 3-month period at the end of 2014. The most common risk factor was tobacco (64.9 %), hypertension (38.6 %), diabetes (36.9 %) and dyslipidemia (24.6 %).

RESULTS

Among these patients, 66 % received reperfusion therapy, 35 % with primary percutaneous coronary interventions (PAMI), 31 % with thrombolysis (28.6 % of them by pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 and 358 min for PAMI, respectively. The in-hospital mortality was 7.0 %. Patients enrolled in interventional centers (n=156) were more likely to receive any reperfusion therapy (19.8 % vs 44.6 %; p<0.001) than at the regional system of care with less thrombolysis (26.9 % vs 44.6 %; p=0.008) and more PAMI (52.8 % vs 8.5 %; p<0.0001). Also the in-hospital mortality was lower (6.4 % vs 9.3 %) but not significant.

CONCLUSIONS

Preliminary results from FAST-MI in Tunisia show that the pharmaco- invasive strategy should be promoted in non-interventional centers.

Permanent cardiac pacing in a patient with persistent left superior vena cava and concomitant agenesis of the right-sided superior vena cava

Persistent left superior vena cava (PLSVC) can be incidentally detected during pacemaker implantation from the left pectoral side. Optimal site pacing is technically difficult, and lead stability of the right ventricle (RV) can lead to such a situation. We describe a case of successful single-chamber pacemaker implantation in a 76-year-old woman with a PLSVC and concomitant agenesis of the right-sided superior vena cava, after failed attempts with the conventional procedure. The pacemaker had been working well after 12 months of follow-up.

[Is PON1 a factor of cardiovascular risk in type 2 diabetes?]

OBJECTIVE

We evaluate the association between the decrease of serum paraxonase 1 activity and the risk of cardiovascular disease in type 2 diabetes.

METHODS

One hundred and fourteen patients with type 2 diabetes were included in the present study. Seventy-one of them have significant coronary disease. The control group consisted of 53 healthy adults.

RESULTS

PON1 activity was significantly reduced in diabetic patients compared to controls (P=0.021), especially in those with significant coronary disease (P=0.013). No significant variation in PON1 activity according to age was observed both in controls and in patients. When HDLc≥1.03mmol/L, the PON1 activity was significantly higher in patients without significant coronary disease compared to those with significant coronary disease (0.030). In case of significant coronary disease, a decrease of 12.23% in PON1 activity was observed in smokers compared with non-smokers, but without statistical significance. The PON1 activity did not very significantly according to the presence or absence of hypertension in patients with significant coronary disease.

CONCLUSION

The implication of diabetes in the decrease of PON1 activity seems highly probable but PON1 activity seems not to be in itself a marker of cardiovascular disease.

Smoking among dental students in Monastir, Tunisia

Dental students can help in the fight against smoking. This study aimed to estimate the prevalence of smoking and assess behaviours, knowledge and attitudes among dental students in Monastir, Tunisia. A survey using a self-administered questionnaire was conducted during November 2008. The sample consisted of 1123 dentistry students aged 18 to 28 years. About 14% of the students were smokers (38.4% of boys and 3.4% girls, P < 0.0001) with an average of 16 cigarettes smoked daily. The age at smoking first cigarette ranged from 8 to 21 years (mean 16, SD 2.3 years). Among the smoker students, 66.5% of their fathers and 3% of their mothers were also smokers. Over 80% of these students were aware that smoking is harmful to health. These results reveal a need to include classes on smoking cessation in the dental curriculum.

Goals for oral health in Tunisia 2020

In 1981, the World Health Organization (WHO) together with the Fédération Dentaire Internationale (FDI) set global dental health goals for the year 2000 within the global strategy of health for all. In 1999, a team of experts drew up new goals to be achieved by 2020, which aimed to facilitate specific oral health policy development for each country. These goals are more general and have to be adapted to local circumstances. This paper aimed to adapt the WHO/FDI/IADR's Global goals for oral health 2020 to Tunisia and draw up new national goals and targets for Tunisia based on previous national oral health surveys.

Effect of a splice site mutation in LDLR gene and two variations in PCSK9 gene in Tunisian families with familial hypercholesterolaemia

Autosomal dominant hypercholesterolaemia (ADH) is due to defects in the LDL receptor gene ( LDLR), in the apolipoprotein B-100 gene ( APOB) or in the proprotein convertase subtilisin/kexin type 9 gene ( PCSK9). The aim of this study was to identify and to characterize mutations at the origin of ADH in two Tunisian families. We found three genomic variations: (1) c.1845 + 1G > A, a splice site mutation in the LDLR gene and (2) two variations in the PCSK9 gene (p.Phe515Leu and p.Gly670Glu) that were both reported to be associated with high LDL-C levels. These results enlarge the spectrum of ADH-causative LDLR and PCSK9 variations in Tunisia. Our observations indicate that missense variations in the PCSK9 gene do not influence the clinical phenotype of ADH patients carrying a mutation in the LDLR gene.

+294T/C polymorphism in the PPAR-delta gene is associated with risk of coronary artery disease in normolipidemic Tunisians

Peroxisome proliferator-activated receptor delta (PPAR-delta) is a transcription factor implicated in metabolism and inflammation. The +294T/C polymorphism in the PPAR-delta gene is associated with risk of coronary artery disease (CAD) in dyslipidemic women and hypercholesterolemic men. Whether this polymorphism influences the risk of CAD in the absence of dyslipidemia was not known, so we investigated a possible association of this polymorphism with plasma lipid and lipoprotein levels and with risk and outcome of CAD in a normolipidemic Tunisian population. Genotyping was performed by PCR-RFLP in 112 CAD patients and 113 healthy volunteers. The C-allele was significantly more frequent in patients than in controls (0.320 vs 0.189, P = 0.001). This association remained significant after adjustment for age, gender, body mass index, smoking, hypertension, and high-density lipoprotein cholesterol. Subjects carrying either one or two copies of the C-allele had a 2.7-fold higher risk of CAD than subjects homozygous for the T-allele. PPAR-delta genotypes were not associated with lipoprotein concentrations or outcome of CAD. We conclude that PPAR-delta +294T/C polymorphism is an independent risk factor of CAD in normolipidemic Tunisian subjects. The lack of association with lipoprotein concentrations suggests that the effect of the polymorphism on CAD is not mediated through lipoprotein levels in this population and that it may influence the atherosclerotic process through mechanisms involving inflammation.

[Familial hypercholesterolemia in Tunisia]

Familial hypercholesterolemia or autosomal dominant hypercholesterolemia is characterized by raised serum LDL (low density lipoproteins)-cholesterol levels, which result in excess deposition of cholesterol in tissues, leading to accelerated atherosclerosis and increased risk of premature coronary heart disease. Familial hypercholesterolemia results from defects in the hepatic uptake and degradation of LDL via the LDL receptor pathway. Familial hypercholesterolemia is commonly caused by a loss of function in the LDL receptor gene, or by a mutation in the gene encoding apolipoprotein B (APOB) or PCSK9 gene. In Tunisia, the frequency of this disease is about one of 165 for heterozygote. It is a higher frequency compared to most European countries, which is about one of 500 for heterozygote. Only five mutations in the LDLR gene were reported in this population. No mutations in the APOB or PCSK9 gene were reported.

Long term outcome of balloon mitral commissurotomy during pregnancy: a prospective physical and mental evaluation of babies

AIM

The immediate and long-term results of balloon mitral commissurotomy (BMC) during pregnancy were evaluated in patients and in their babies looking for radiation side effects.

METHODS AND RESULTS

Sixty one patients (mean age: 28.5+/-5.0 years) had BMC at a mean age of gestation of 26.8+/-5.5 weeks. The procedure was successful in all patients except in one who had a severe mitral regurgitation and subsequent mitral valve replacement (MVR). All patients delivered at term vaginally in 58 (95.1%) cases. There was only one death in a patient who delivered at home. At a mean follow-up of 66.8+/-36.0 months, 4 patients had MVR, the remaining were in NYHA class I/II. Restenosis was found in 4 (7.2%) patients. The 63 babies (two gemellar pregnancies) had a normal weight of birth except of one case of hypotrophy. At a mean follow-up of 64.5+/-32.5 months, two babies died, 1 had hypotrophy, 2 had microcephaly, 8 had an IQ < 70 but none had a severe mental retardation (IQ <34). None of these events were radiation related.

CONCLUSION

BMC is the procedure of choice in pregnant patients with mitral stenosis. No late radiation side effects were observed in children but longer follow-up is required.

Effect of 5 years of dental studies on the oral health of Tunisian dental students

This study is a follow-up of one made in 1998-99 on first-year dental students in Monastir. Now in their fifth year, we assessed the effect of dental studies on students' oral health practices and dental health. Of the 155 students in the first study, 140 were still enrolled. Periodontal troubles, malocclusion and dental decay affected 84.3%, 80.0% and 43.0% of the students respectively. Compared with the previous study, students had achieved a better dental health status--tooth brushing rate was much higher, prevalence of dental decay and periodontal pockets had decreased, and DMF index had improved. However, the prevalence of smoking, bleeding and calculus had not changed, and the frequency of malocclusion had increased.

[Coronary angioplasty in the acute phase of a myocardial infarction on a myocardial bridge]

A myocardial bridge is usually asymptomatic but can cause myocardial ischemia, myocardial infarction or sudden death. Two occurrences of coronary angioplasty in the acute phase of an anterior myocardial infarction on a myocardial bridge are reported. The first case was first treated only with a balloon, and then with a stent 12 h later after a relapse of angina pectoris and the recurrence of a severe compression. The second case immediately benefited from a stent. A systematic control at six months has shown the absence of restenosis in the first case and an asymptomatic occlusion of the stent in the second case. Its deocclusion has revealed a myocardial bridge downstream of the stent. Myocardial stunning might have caused a decreased systolic compression by the bridge in the first case, and an underestimation of its actual length in the second case. Its regression is held responsible for these two relapses. A long active stent installed at high pressure could be used to treat myocardial bridges during myocardial infarctions.

[Recurrent pericarditis revealing a malignant mediastinal mesenchymoma]

INTRODUCTION

The malignant mesenchymoma is a malignant tumour composed of two or more types of non-differentiated tissue, associated with fibrosarcomatous elements. Its mediastinal localisation is exceptional.

OBSERVATION

In a 65 year-old woman, recurrent pericardial effusion revealed a malignant mesenchymoma measuring 11 x 9 x 4 cm, located in the mediastinum and extending towards the pericardium. The histological examination of the surgical piece showed the predominance of an osteo-sarcomatous component. Complete resection was performed with partial pericardectomy, followed by adjuvant radiotherapy.

CONCLUSION

Malignant mediastinal mesenchymoma is an exceptional tumour. Its diagnosis is based on anatomopathological study of a mass of anarchic composition, and its poor prognosis is related to its localisation and its capacity to relapse locally.

[Rheumatoid nodule and complete heart block: diagnosis by transesophageal echocardiography]

We report a case of 48 years old women with a 8 years history of rheumatoid arthritis and severe articular deformation treated during the last 6 months by prednisone (5 mg daily) and chloroquine (200 mg daily), admitted in the emergency room because of syncope. The electrocardiogram showed a complete atrioventricular block. Transesophageal echocardiography was performed and revealed an hyperechogenic mass (6 x 2.5 mm) in the interventricular septum probably related to a fibrous rheumatoid nodule. This potentially explain the atrioventricular block by infiltration of the conduction pathways. A permanent double chamber pacemaker was inserted. The chloroquine, another factor of conduction disturbances was not incriminated in this case. The conduction disturbances should be systematically detected in case of severe rheumatoid arthritis. Therefore, every patient must be submitted to a transthoracic echocardiography. Transesophageal echocardiography may be helpful to detect rheumatoid nodule.

Balloon mitral commissurotomy in juvenile rheumatic mitral stenosis: a ten-year clinical and echocardiographic actuarial results

AIMS

To evaluate the safety, efficacy and long-term actuarial results of balloon mitral commissurotomy in young patients with severe rheumatic mitral stenosis.

METHODS AND RESULTS

Event-free survival and freedom from restenosis were analyzed in 110 patients 20 years old or younger (group 1) and compared with those of 554 adults (group 2). Young patients were less frequently in atrial fibrillation (6% vs 35%, P<0.001) and had less mitral valve deformities (echo score 5.9+/-2.1 vs 7.5+/-3.0, P<0.0001). Mitral valve area index by 2D-echo was of 0.66+/-0.1cm(2)/m(2)in group 1 and 0.67+/-0.1cm(2)/m(2)in group 2 (P=ns) and was larger in group 1 (1.5 vs 1.3 cm(2)/m(2)) after the procedure (P<0.0001). There were more complications in group 2 (8.4% vs 0%, P=0.01). Procedural success was obtained in 110 (100%) patients of group 1 vs 501 (92%) patients of group 2 (P<0.0001). At follow-up mitral valve area index was 1.34 cm(2)/m(2)in group 1 and 1.16 cm(2)/m(2)in group 2 (P<0.0001). At 10 years, freedom from restenosis was 61% in group 1 vs 71% in group 2 (P=0.35) and event-free survival was 74% and 69% respectively (P=0.15

CONCLUSION

Balloon mitral commissurotomy is safe and effective in young with rheumatic mitral stenosis and provides better immediate results than in adults. However long-term outcome was similar between the 2 groups: 2/3 of patients were alive and free from clinical events at 10 years.

[Prognosis of infectious endocarditis]

OBJECTIVE

To study clinical course and prognostic factors of infective endocarditis.

PATIENT AND METHODS

Infective endocarditis was identified in 126 consecutive patients (criteria of DURACK). Of these, 73 were male, mean age was 29.9 + 15 years, 98 (77.7%) had past history of cardiac disease. The evolution has been marked by 38 deaths (30%) in spite of the recourse to surgery (69 patients). The mean follow-up period was 52 months, the event-free survival was 61% at 5 years.

RESULTS

By univariate analysis the predictors of bad prognosis: Large vegetations > 10 mm, delay of apyrexia > 10 days presence of a neurological accident and the absence of surgical treatment. Multivariate analysis: Vegetation > 10 mm (OR 1.97, 1-4.1, p = 0.05), presence of a neurological accident (OR:2.76, 1.32-5.76, p = 0.007) and the absence of surgical treatment (OR: 5.03, 2-11.4, p < 0.001).

CONCLUSION

Infective endocarditis remains a serious affection, identification of patients with poor prognosis should lead to early surgical referral: this attitude provides good immediate and long-term results.

Predictors of long-term event-free survival and of freedom from restenosis after percutaneous balloon mitral commissurotomy

BACKGROUND

Most long-term studies after balloon mitral commissurotomy (BMC) were from industrialized countries. Less is known about the long-term results of BMC from developing countries where patients are younger with fewer mitral valve deformities.

METHODS

Between December 1987 and December 1998, we performed BMC in 654 patients whose mean age was 33 +/- 13 years. Baseline and postprocedural variables were evaluated to identify predictors of event-free survival (survival without repeat BMC or mitral valve replacement) and of freedom from restenosis defined as a mitral valve area (MVA) >/=1.5 cm(2) after BMC and <1.5 cm(2) at follow-up.

RESULTS

The actuarial survival rates were 98%, 98%, and 97% at 5, 7, and 10 years, respectively. The 5-, 7-, and 10-year event-free survival rates were 85%, 81%, and 72%. Multivariate predictors of a higher 10-year event-free survival rate were lower echocardiographic score (79% for a score </=8, 61% for a score of 9 to 11, 62% for a score >/=12, P <.001) and cardiac sinus rhythm (P =.04) before BMC, lower mean left atrial pressure (P <.001), lower mitral valve gradient (P <.001), and less than or equal to grade 2 mitral regurgitation (P =.036) after BMC. Restenosis occurred in 16% of patients. The restenosis-free rates were 88%, 80%, and 66% at 5, 7, and 10 years, respectively. A higher freedom from restenosis at 10 years was associated with a lower score (77% for a score </=8, 45% for a score of 9-11 and 50% for a score >/=12, P =.03) and a larger MVA before BMC (P =.03), a larger MVA (P <.001), and a lower mitral valve gradient (P =.04) after BMC.

CONCLUSIONS

BMC produces excellent 10-year results in patients with pliable mitral stenosis and good results in patients with semipliable or calcified mitral stenosis. BMC is the procedure of choice in patients with pliable valves and it is a reasonable treatment option in young patients with unfavorable mitral valve anatomy.

[Unstable angina: study of in-hospital and short-term prognosis]

The aim of our study was to identify predictor factors of coronary ischemic events to stratify the risk. 367 patients, mean age 59 years (22-90), 288 men (88%), Coronary risk factors: Smoking (62%), diabetes (38%), hypertension (37%), hypercholesterolemia (18%). BRAUNWALD class III was predominant (60%). Electrocardiographic changes were present in 113 patients. Coronary angiography identified: 148 single-vessel disease, 92 double-vessel and 68 triple-vessel. In the hospital phase, 296 patients (80.5%) were stabilised. 65 had recurrent ischemia (17.5%), 6 myocardial infarction (1.5%) and 6 deaths (1.5%). After multivariate logistic regression the predictors factors of ischemic events were. Age > or = 65 years (p = 0.03), coronary artery bypass grafting (p = 0.05), left ventricular failure (p = 0.024), modified baseline electrocardiogram (p = 0.04), ST-segment depression (p = 0.05), without aspirin (p = 0.043) and heparin (p = 0.047). At 6 months, 181 patients were asymptomatic (59.1%), 101 had recurrent ischemia (33%), 14 myocardial infarction (4.6%) and 10 deaths (3.3%). After multivariate analysis, the predictor factors were: Age > or = 65 years (p = 0.026), previous unstable angina (p = 0.023), left main stenosis (p = 0.008) and without aspirin (p = 0.003).

CONCLUSION

Our study identified a subgroup of high risk patients who would benefit most from either low-molecular-weight heparins and Glycoprotein IIb/IIIa receptor blockers with an early revascularisation strategy.

[Profile of first year dental students in Tunisia]

The aim of this study was to assess social conditions, school history, professional choices and oral health status of first-year dental students 1998/1999. We included 155 Tunisian students, 18-22 years old. There was a higher proportion of female students [58%] whose average age [18.9 years] was younger than the males. We found that 79% came from urban environments and 41% from middle socioeconomic background. Also 48% had parents who had a high level of education. Dental studies were the first choice for 50% of the students and they were looking for prestige and security. Concerning oral heath status, 88% of the students had periodontal problems and 70% had caries. More information for students about the options available to them at university and greater efforts from teachers to motivate students in oral hygiene are needed.

[Right ventricular dilatation and intraventricular septal motion after surgical closure of atrial septal defect]

The persistence of right ventricular dilatation and paradoxical interventricular septal motion are two echocardiographic abnormalities rarely reported after surgical closure of atrial septal defects. The aim of this study was to identify the predictive factors of these abnormalities in the long-term and to study their functional consequences. One hundred and two patients aged 18 +/- 14 years (range 1-62 years) underwent closure of atrial septal defects. Thirty-five patients were under 10 years of age, 33 were 10 to 20 years of age and 34 were over 20. Fifty-six patients were female. The rhythm was sinus in the great majority of cases (97%). Three patients, all over 40 years of age, were in atrial fibrillation. Before surgery, right ventricular dilatation was observed in 95 patients (91.2%), paradoxical septal wall motion in 93 patients (91.2%), the ratio of pulmonary/systemic output was 2.7 +/- 0.6 (range 1.7 to 7.4) and over 2 in 90% of patients: pulmonary systolic pressure was 32.3 +/- 12 mmHg and over 40 mmHg in 18 patients (17.6%). Ninety-four patients were followed up regularly with a mean follow-up time of 5.5 +/- 3.6 years (1-14 years). The right ventricle remained dilated in 37 patients (39.4%) after surgery: the right ventricular dimension decreased from 36 +/- 1 to 27.8 +/- 6.2 mm (p = 0.001). The ratio of end diastolic right ventricular/left ventricular dimension also decreased from 1.07 +/- 0.31 to 0.56 +/- 0.12 (p = 0.0001). Multivariate analysis identified two predictive factors of persistent right ventricular dilatation: age > 40 years (p = 0.009) and a pulmonary/systemic flow ratio > 3 (p = 0.03). Interventricular septal wall motion remained paradoxical in 21 patients (22%). Multivariate analysis identified two predictive factors of persistent paradoxical septal motion: age > 40 years (p = 0.02) and systolic pulmonary pressures > 40 mmHg (p = 0.03). These abnormalities remained asymptomatic in all but two patients with persistent long-term hypertension and a residual atrial septal defect. The persistence of right ventricular dilatation and paradoxical septal motion was quite common, with older age at surgery, systolic pulmonary artery pressure > 40 mmHg and a ratio of pulmonary/systemic blood flow > 3, being predisposing factors. These abnormalities were clinically asymptomatic when isolated.