Giant cell tumor of distal radius: En bloc resection with allograft reconstruction: A case report

Key Clinical Message

Giant cell tumor of bone (GCT) is a rare neoplasm which often presents as a lytic lesion in the epiphyseal region of long bones and which are usually accompanied by pain, swelling, and restricted movement.

Abstract

Giant cell tumor of bone (GCT) is a rare neoplasm that affects individuals in their third and fourth decades of life. Clinically, it often presents as a lytic lesion in the epiphyseal region of bones, notably the distal femur and proximal tibia. Radiologically, GCT appears as a distinct lytic lesion in the epiphyseal region. Histopathologically, GCTs are composed of mononuclear cells, macrophages, and multinuclear giant cells, indicative of osteoclastogenic stromal tumors. A 37-year-old man presented with left wrist pain, swelling, and restricted movement persisting for a year, worsening over the last 7 months. Radiographic assessments revealed a distal radius bone mass involving the radiocarpal joint. Biopsy confirmed a GCT with extension into peripheral muscle. PET/CT scan showed localized pathology without metastasis. Histopathologically, GCT exhibited multinucleated giant cells, spindle cells, and aneurysmal bone cyst-like regions with coagulation necrosis. Surgical resection involved en-bloc removal and reconstruction with a non-vascularized radius bone graft. Postoperatively, the patient showed no complications at the one-year follow-up, suggesting successful intervention.

Modified nail folding approach: A novel strategy for the treatment of subungual glomus tumors-A case series study

Key Clinical Message

The modified nail folding approach, a new surgical technique, has been shown to be safe and effective for the treatment of subungual glomus tumors, providing clinicians with a new treatment option for patients with this condition.

Abstract

Glomus tumors (GTs) are rare benign tumors that originate from the glomus body in the skin of the fingertips, toes, and nail beds. GTs are more prevalent in women than in men and can occur sporadically or as part of an inherited condition known as multiple GTs. The exact cause of GTs is unknown, but it is believed that mutations in the cells of the glomus body contribute to their development. In this study, we present the efficacy of a novel surgical technique called the modified nail folding approach for treating subungual GTs. We report a case series involving 17 patients who underwent the nail folding approach for surgical removal of subungual GTs. The primary objective of this article is to provide evidence supporting the safety and effectiveness of this technique. Additionally, we aim to introduce clinicians to a new, secure, and efficient treatment option for patients with subungual GTs.

Rare retro-patellar multiple osteochondromas in patellar tendon: A case report

Osteochondromas (OCs) are developmental anomalies that originate from the periosteum and typically form during enchondral ossification near the joints. Retro-patellar OC caused by exostosis forms in various intracapsular, intra-tendon, and joint-adjacent positions within the knee joint. In this case, a 19-year-old male presented with swelling and a mass in his left knee, which raised suspicion of bone tumors. After evaluating x-ray images and conducting histopathological examinations, the diagnosis was confirmed as retro-patellar OC.

Early closure compared to late closure of temporary ileostomy in rectal cancer: a randomized controlled trial study

BACKGROUND

A temporary loop ileostomy is one of the most common methods for the prevention of anastomotic leakage in rectal cancer patients who underwent low anterior resection. However, the optimal timing of loop ileostomy reversal remains unknown. The main objective of this study was to evaluate the debilitating complications caused by early closure of ileostomy in comparison with late closure in rectal cancer patients.

DESIGN

A randomized, controlled, unblinded, and monocentric trial.

METHODS

A total of 104 rectal cancer patients were randomly assigned to the case group of early closure of ileostomy (n = 50) and the control group of late closure of ileostomy (n = 54). This trial was undertaken in a single colorectal institution, a university-affiliated teaching hospital in Tehran, Iran. Randomization and allocation to the trial group were conducted by using variable block randomization based on quadruple numbers. The primary endpoint of this trial was determined by the complications of early ileostomy closure versus those of late closure in rectal cancer patients who had undergone low anterior resection. In early closure, loop ileostomy is reversed 2-3 weeks after the first two courses of adjuvant chemotherapy, while in late closure, the ileostomy is reversed 2-3 weeks after the last course of adjuvant chemotherapy.

RESULTS

Follow-up of 1 year demonstrated a reduction in the risk of complications and an improved quality of life in patients with rectal cancer following low anterior resection and chemotherapy (neoadjuvant and adjuvant) in the case group but did not reach a significant difference (p = 0.555). In addition, there was no significant difference in perioperative outcomes, such as blood loss, operative time, readmission, and reoperation; also, no statistically significant differences were reported between the groups in patients' quality of life or LARS score.

CONCLUSION

In summary, it seems that early closure of ileostomy is not better than late closure in improving patients' quality of life with rectal cancer following low anterior resection and chemotherapy (neoadjuvant and adjuvant); no statistical difference was observed for reduction of risk of ostomy complications. Thus, neither of these methods (early closure versus late closure) is superior to the other, and controversy still exists.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

IRCT20201113049373N1.

Rare forearm intramuscular myxoma: A case report

Key Clinical Message

Intramuscular myxoma (IMM) is a benign soft tissue tumor of mesenchymal origin that occurs mainly in skeletal muscles which can be removed through surgery after diagnosis.

Abstract

Intramuscular myxoma (IMM) is a benign soft tissue tumor of mesenchymal origin that typically occurs in skeletal muscles. Its diagnosis is based on magnetic resonance imaging (MRI) and histopathologic evaluation of the lesion. In our report, we describe the case of a 60-year-old female with an IMM in the supinator muscle of the right forearm, which was confirmed by MRI and histopathologic examination. Following surgery to remove the mass, a follow-up confirmed the patient's recovery and the absence of movement limitations in the elbow joint.

Female infertility and herbal medicine: An overview of the new findings

Infertility is defined as the failure to achieve a successful pregnancy after 12 months' sexual activity that affects 15%-17% of couples in the world and about 50% of them are related to female infertility factors. In this study, using the PRISMA checklist and MeSH keywords, 128 articles were extracted from various databases (PubMed, Cochrane library, WHO, Iranmedex, Science Direct, SID, and Google Scholar search engine) without language and time restrictions, and 128 articles were selected after eliminating duplicate studies. In this review, we present some solid evidence for role of herbal medicine in the treatment of female infertility. The results of this study showed that different parts of some plants are rich in polyphenolic compounds (isoflavones and flavonoids) and other compounds which are beneficial to in reproductive health in women. The compounds in these plants, along with regulating the female endocrine pathways, and improving symptoms of menopause, treat female reproductive disorders such as polycystic ovary syndrome (PCOS), premature ovarian failure (POF), endometriosis, hyperprolactinemia, and hypothalamic dysfunction; moreover, because of their anticancer, antioxidant, and antidepressant properties, they can be used in traditional medicine or in the pharmaceutical industry as safe compounds in women's health.

Misrepresentation of a Visceral Schistosomiasis Report in an Iranian Young Male: Observance of Publishing Conduct in Writing Scientific Articles

The article's abstract is not available.  

Chitosan-based nano-scaffolds as antileishmanial wound dressing in BALB/c mice treatment: Characterization and design of tissue regeneration

OBJECTIVES

Rapid healing of cutaneous leishmaniasis as one of the most important parasitic diseases leads to the decrease of scars and prevention of a great threat to the looks of the affected people. Today, the use of nano-scaffolds is rapidly increasing in tissue engineering and regenerative medicine with structures similar to the target tissue. Chitosan (CS) is a bioactive polymer with antimicrobial and accelerating features of healing wounds, which is commonly used in biomedicine. This study aimed to investigate the effects of CS/polyethylene oxide (PEO)/berberine (BBR) nanofibers on the experimental ulcers of Leishmania major in BALB/c mice.

MATERIALS AND METHODS

CS/PEO/BBR nanofibers were prepared by the electrospinning method, and their morphology was examined by SEM, TEM, and AFM. Then, water absorption, stability, biocompatibility, porosity, and drug release from nano-scaffolds were explored. Afterward, 28 BALB/c mice infected with the parasite were randomly divided into control and experimental groups, and their wounds were dressed with the produced nano-scaffolds. Finally, the effect of nanobandage on the animals was investigated by macroscopic, histopathologic, and in vivo imaging examinations.

RESULTS

The prepared nanofibers were completely uniform, cylindrical, bead-free, and biocompatible with an average diameter of 94±12 nm and had appropriate drug release. In addition, the reduced skin ulcer diameter (P=0.000), parasite burden (P=0.003), changes in the epidermis (P=0.023), and dermis (P=0.032) indicated significantly strong effectiveness of the produced nano-scaffolds against leishmania ulcers.

CONCLUSION

Studies showed that CS/PEO/BBR nanofibers have a positive effect on the rapid healing of leishmania ulcers. Future studies should focus on other chronic ulcers treatment.

Vesical schistosomiasis and squamous cell carcinoma associated with schistosoma haematobium: A re-emerging neglected tropical disease in Tehran, Iran

Hematobium species of this parasite tends to bladder and mesenteric arteries and it causes lesions in the bladder wall, urethra, and renal tubes. A 25-year-old man living in Tehran (a non-endemic and very rare area for schistosoma) suffers from symptoms such as hematuria with suprapubic pain, dysuria, fever, nausea and vomiting. Urine analysis showed a lot of red blood cells, after using cystoscopy of the area and receiving a bladder biopsy, a definitive diagnosis of schistosomiasis was made and after determining the extent of damage to the urinary tract, appropriate treatment with surgery and praziquantel (40 mg/kg) were prescribed.

Effects of abundances of OCT-4 mRNA transcript on goat pre-implantation embryonic development

Unlike in mice, the function of pluripotent markers in early embryonic development of domestic animals remains to be elucidated and this may account for the failure to establish embryonic stem cell lines for these species. To study the functions of the OCT-4 protein which has important actions in maintenance of pluripotent and self-renewal processes during early embryonic development, there was induced reduction in relative abundance of OCT-4 mRNA transcript during goat early embryonic development by using RNA interference techniques. The injection of OCT-4 siRNA into goat IVF presumptive zygotes resulted in a decrease in the relative abundance of OCT-4 mRNA transcript; however, there was development of these embryos to the blastocyst stage at the same rate as there was in the control group. The blastocysts from the treated groups had a similar number of TE, ICM, and total cells compared to those from the control group. Although there was a greater relative abundance of NANOG, REX1, and CDX2 mRNA transcript in the embryos injected with siRNA at the 8-16 cell stage, the relative transcript abundances were similar for the control and treatment groups at the blastocyst stage. The relative abundance of SOX2 mRNA transcript was similar for the treatment and control group. It, therefore, is concluded that inhibition of abundances of OCT-4 mRNA transcript to about 20 % of that of the untreated control group did not affect blastocyst formation rate in goats. The functions of OCT-4 in maintaining ICM and TE integrity, however, remains to be assessed.

Case report: Xanthogranulomatous pyelonephritis masquerading as cystic renal cell carcinoma

Background: Xanthogranulomatous pyelonephritis (XGP) is a rare chronic bacterial inflammation of the renal parenchyma and is often a diagnostic dilemma.Case Presentation: We present a challenging case of a patient with XGP. Initially thought to have had renal cell cancer she was treated accordingly with a partial nephrectomy. However, on the final pathology, she was found to have XGP and required further antibiotic therapy and referral to the infectious disease service.Discussion: Management of XGP and diagnostic pitfalls are discussed.Conclusion: XGP is a diagnostic and therapeutic dilemma. Partial Nephrectomy may be appropriate in management of XGP in select cases.

Hemodynamic Changes and Early Recovery of Liver Graft Function after Liver Transplantation

BACKGROUND

Patients with liver cirrhosis experience a hyperdynamic circulation.

OBJECTIVE

To investigate the association between early hemodynamic changes and graft function after liver transplant.

METHODS

Those patients who underwent liver transplantation in 2016 were enrolled in the study. Liver function indices measured in postoperative days (POD) 1, 3, 5, 7, 9, and 11 along with hemodynamic indices including pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and central venous pressure (CVP) measured q6h in the first 3 days after transplantation were recorded.

RESULTS

57 deceased-donor liver recipients with a mean±SD age of 41.4±11.8 years including 33 (58%) males were enrolled in the study. The mean±SD aspartate and alanine aminotransferases, alkaline phosphatase, and lactate dehydrogenase were significantly decreased from 1879±670.5, 369.2±40.5, 174.9±18.8, and 1907.6±323.1 U/L in POD 1 to 37.2±10.7, 243.4±37.3, 207.5±19.5, and 382.4±59.8 U/L in POD 3, respectively (p=0.028, <0.001, 0.002, and 0.001, respectively). During this period, the pulse rate of the patients was significantly (p<0.001) decreased by a median (IQR) of 28.7 (8.5-39.7) beats/min; it was significantly correlated with a decrease in serum hepatic enzymes activities during this period. SBP, DBP, and CVP were significantly increased (p<0.001 for all) during this period. Liver graft function improved significantly earlier in those patients with a mean pulse rate of 87 beats/min compared with others (p=0.03).

CONCLUSIONS

There may be an association between changes of hemodynamic indices, especially reduction of pulse rate, and improved graft function early after liver transplantation.

HPV Status Improves Classification of Head and Neck Gray Zone Cancers

In epidemiologic studies, patients with head and neck squamous cell carcinoma (HNSCC) are classified mainly by the International Classification of Diseases (ICD) codes. However, some patients are of an unclear subsite, the “gray zone” cases, which could reflect ICD coding error, absence of primary subsite, or extensive primary tumors that cross over multiple subsites of the oral cavity and oropharynx. Patients with gray zone squamous cell carcinomas were compared with patients with oral cavity squamous cell carcinoma (OSCC) or oropharyngeal squamous cell carcinoma (OPSCC) and stratified by human papillomavirus (HPV) status that was determined by p16 immunostaining or HPV serology. Comparisons consisted of clinicodemographic features and prognostic outcomes presented by Kaplan-Meier curves and Cox proportional hazards regression models, reported as hazard ratios. There were 158 consecutive patients with gray zone HNSCC diagnosed at the Princess Margaret Cancer Center between 2006 and 2017: 66 had subsite coding discrepancies against the clinician’s documentation (“discrepant” cases; e.g., the diagnosis by the clinician was OSCC, while the classification by ICD coding was OPSCC), while 92 were squamous cell carcinoma of unknown primary of the head and neck (SCCUPHN) after complete diagnostic workup. Comparators included 721 consecutive OSCC and 938 OPSCC adult cases. All HPV-positive cohorts (OPSCC, discrepant, and SCCUPHN) had similar clinicodemographic characteristics and better 3- and 5-y overall survival and disease-free survival than their HPV-negative counterparts. In contrast, HPV-negative discrepant cases had prognostic outcomes most similar to HPV-negative OPSCC cases, while HPV-negative SCCUPHN had survival outcomes most similar to those of patients with OSCC in this study. HPV-positive status can improve the classification of patients with unclear or discrepant oral/oropharyngeal subsite, an improvement over classification systems that are solely clinician defined or conducted through ICD coding. However, due to clinical practice, we could not make definitive reclassification for patients with HPV-negative gray zone HNSCC.

SYNTHESIS, OPTICAL PROPERTIES AND THERMOLUMINESCENCE DOSIMETRY FEATURES OF MANGANESE DOPED Li2B4O7 NANOPARTICLES

Lithium tetraborate (Li2B4O7) nanoparticles (NPs) doped with manganese (Mn) were prepared for the first time by the solid-state sintering method. NPs were characterized using X-ray diffraction, scanning electron microscopy, photoluminescence and thermoluminescence (TL) techniques. The synthesized NPs exhibited highest TL response at 0.3 wt% of Mn dopant under gamma irradiation. TL dose response is linear for the absorbed dose from 1 Gy to 20 kGy and beyond this range behaves sub-linear. Such feature makes the synthesized nanophosphor as a promising material for high-dose dosimetry applications. Low fading and good reusability were obtained for the synthesized NPs. Tm-Tstop and computerized glow curve deconvolution procedures were utilized to identify the component TL glow peaks and kinetic parameters of the produced phosphor. Other TL dosimetry features of the prepared NPs are also presented and discussed.

Effects of black seed (Nigella sativa), ginger (Zingiber officinale) and cone flower (Echinacea angustifolia) on the immune system of rainbow trout, Oncorhynchus mykiss

ABSTRACT This study was carried out to evaluate the effects of dietary essential oils of ginger (Zingiber officinale), black seed (Nigella sativa) and cone flower (Echinacea angustifolia) on the immune system of cultured rainbow trout, Oncorhynchus mykiss. A total of 360 fish were divided into 4 groups and 3 replicates each containing 30 fish. The fish were fed for 21 days with 1% of the herbal essential oils and with unsupplemented diet as the control group. Haematological and immune parameters including serum lysozyme, number of phagocytic bacteria, Hb, PCV, MCV, MCH, MCHC, number of RBC and WBC were studied. Treatments recorded enhancement in immune parameters compared to the control group. Significantly higher serum lysozyme level and phagocytic germs were detected in the groups fed black seed, ginger and cone flower (P<0.05). However, no significant difference was found in RBC, Hb, PCV, MCV, MCH and MCHC of fish fed the diets containing essential oils and the control group (P>0.05). The results of this study demonstrated that essential oils might strengthen the non-specific immunity of rainbow trout.

Association of SRD5A2 gene mutations with risk of hypospadias in the Iranian population

BACKGROUND

Hypospadias is one of the most common forms of congenital malformation of the male external genitalia worldwide. The ratio in the Iranian population is one in 250 live male births. The conversion of testosterone to dihydrotestosterone (DHT) in the presence of steroid 5α-reductase 2, which is encoded by SRD5A2 gene, plays an important role in the normal development of the male reproductive system.

METHODS

We examined whether SRD5A2 gene mutations (V89L and A49T polymorphisms) are associated with the risk of hypospadias in the Iranian population. We performed exons sequencing for SRD5A2 gene in 109 hypospadias patients.

RESULTS

We identified two new mutations in the subgroups of affected cases: including a substitution of the nucleotide T > A in the codon 73 [c.219T > A (p.Leu73_Ser74insHisPro)] and an insertion of an extra A nucleotide in the codon 77 [c.229insA* (p.Gly77*)]. Additionally, we performed PCR-RFLP for the two identified polymorphisms and revealed that V89L [OR = 5.8, 95% CI (3.8-8.8), p value < 0.001] and A49T [OR = 10.16, 95% CI (3.94-26.25), p value < 0.001] are significantly associated with hypospadias occurrence in patients. Our haplotype analysis further indicated that the Leu-Ala haplotype increases risk of hypospadias; conversely, the Val-Ala haplotype decreases the risk of hypospadias in the studied patients.

CONCLUSIONS

This study demonstrates that polymorphisms in the SRD5A2 gene could be considered as a risk factor for hypospadias disease emergence.

Zeolite Nanoparticles for Selective Sorption of Plasma Proteins

The affinity of zeolite nanoparticles (diameter of 8-12 nm) possessing high surface area and high pore volume towards human plasma proteins has been investigated. The protein composition (corona) of zeolite nanoparticles has been shown to be more dependent on the plasma protein concentrations and the type of zeolites than zeolite nanoparticles concentration. The number of proteins present in the corona of zeolite nanoparticles at 100% plasma (in vivo state) is less than with 10% plasma exposure. This could be due to a competition between the proteins to occupy the corona of the zeolite nanoparticles. Moreover, a high selective adsorption for apolipoprotein C-III (APOC-III) and fibrinogen on the zeolite nanoparticles at high plasma concentration (100%) was observed. While the zeolite nanoparticles exposed to low plasma concentration (10%) exhibited a high selective adsorption for immunoglobulin gamma (i.e. IGHG1, IGHG2 and IGHG4) proteins. The zeolite nanoparticles can potentially be used for selectively capture of APOC-III in order to reduce the activation of lipoprotein lipase inhibition during hypertriglyceridemia treatment. The zeolite nanoparticles can be adapted to hemophilic patients (hemophilia A (F-VIII deficient) and hemophilia B (F-IX deficient)) with a risk of bleeding, and thus might be potentially used in combination with the existing therapy.

Presentation of a novel model of chitosan- polyethylene oxide-nanohydroxyapatite nanofibers together with bone marrow stromal cells to repair and improve minor bone defects

OBJECTIVES

Various methods for repairing bone defects are presented. Cell therapy is one of these methods. Bone marrow stromal cells (BMSCs) seem to be suitable for this purpose. On the other hand, lots of biomaterials are used to improve and repair the defect in the body, so in this study we tried to produce a similar structure to the bone by the chitosan and hydroxyapatite.

MATERIALS AND METHODS

In this study, the solution of chitosan-nanohydroxyapatite-polyethylene oxide (PEO) Nanofibers was produced by electrospinning method, and then the BMSCs were cultured on this solution. A piece of chitosan-nanohydroxyapatite Nanofibers with BMSCs was placed in a hole with the diameter of 1 mm at the distal epiphysis of the rat femur. Then the biomechanical and radiographic studies were performed.

RESULTS

Biomechanical testing results showed that bone strength was significantly higher in the Nanofiber/BMSCs group in comparison with control group. Also the bone strength in nanofiber/BMSCs group was significant, but in nanofiber group was nearly significant. Radiographic studies also showed that the average amount of callus formation (radio opacity) in nanofiber and control group was not significantly different. The callus formation in nanofiber/BMSCs group was increased compared to the control group, and it was not significant in the nanofiber group.

CONCLUSION

Since chitosan-nanohydroxyapatite nanofibers with BMSCs increases the rate of bone repair, the obtained cell-nanoscaffold shell can be used in tissue engineering and cell therapy, especially for bone defects.

Effect of various ratios of carbohydrate-protein supplementation on resistance exercise-induced muscle damage

AIM

Previous studies have indicated that exercise-induced muscle damage might be attenuated by coingestion of protein and carbohydrate supplement. The purpose of this study was to compare the effect of three various ratios of carbohydrate-protein (CHO+PRO) supplements on resistance exercise-induced muscle damage indices.

METHODS

Twenty-eight untrained male students voluntarily participated in this study and were randomly assigned to one of the four groups: 1) CHO+PRO 2:1 ratio, N.=7; 2) CHO+PRO 3:1 ratio, N.=8; 3) CHO+PRO 4:1 ratio, N.=7; 4) placebo group, N.=6. They performed a single bout of resistance exercise (whole body: 3 set×8-10 reps with 70-75% 1RM), with eccentric concentration. Every group consumed prepared CHO/PRO beverages (9% concentration, 10 mL/kg/bw-1 at different ratios) or the same amount of placebo beverage before and in 15 min intervals during exercise. Blood samples were taken before the exercise bout and also at 1 and 24 h post-exercise. In addition, muscle soreness scores were recorded before and 1, 24, and 48 h postexercise. Repeated measures ANOVA (between-within design) and Bonferroni post hoc test were used to analyze dependent measures (α=0.05).

RESULTS

Serum creatine kinase (CK) and myoglobin (Mb) increased in all groups compared with pre-exercise but the significant difference among groups was observed in 24 h postexercise, in a way that both CK and Mb levels were higher in placebo group. Muscle soreness increased for all groups from pre to postexercise, but there was not any significant difference among groups at any time point.

CONCLUSION

Findings of this study showed that CHO+PRO decreased serum CK and Mb at 24 h post exercise, but did not affect muscle soreness at any time points after exercise. Moreover, there were no significant differences between various ratios of CHO-PRO supplementation.

Unerupted primary molar teeth positioned inferior to the permanent premolar: a case report

Primary tooth impaction is a rare finding during the development of primary dentition. Several factors contribute to the impaction of a deciduous tooth. This report describes the diagnosis and treatment of a 10-year-old boy who presented an impacted second primary mandibular molar. This tooth, located inferior to the second premolar together with an odontoma, was positioned superior to the premolar teeth. Treatment consisted of surgical removal of the impacted deciduous tooth and odontoma and placement of a passive lower lingual holding arch. Periodic examination was indicated for follow-up. Early intervention was recommended to manage orofacial disfigurement and to avoid consequent problems.

Optimal dose of pre-incision/post-incision gabapentin for pain relief following lumbar laminectomy: a randomized study

BACKGROUND

Gabapentin has been introduced as an effective agent for post-operative pain control. This study aimed to test the effects of pre- and post-incision administration of different doses of gabapentin on post-operative morphine requirement and pain following lumbar laminectomy.

METHODS

In this randomized clinical trial, 175 patients were allocated into seven groups of 25 patients each to receive placebo or gabapentin 600, 900 or 1200 mg pre- or post-incision. Total patient-controlled intravenous morphine consumption during the first 24 post-operative hours, and the time to the first demand for morphine were recorded. Pain score at rest (visual analogue scale) was recorded every 30 min in the first 4 h and then every 2 h until 24 h post-operatively. Side-effects were observed.

RESULTS

In the first 12 h, morphine consumption was less, pain scores were lower and the time to the first demand for analgesia was longer in groups receiving gabapentin 900 or 1200 mg either pre- or post-incision, compared with placebo and gabapentin 600 mg (P<0.001). There was no difference between gabapentin 900 and 1200 mg. Pain score, morphine consumption and time to the first demand for analgesia in equal pre- or post-incision doses of gabapentin were not significantly different. No differences in the side-effects were observed between groups.

CONCLUSION

Gabapentin 900 or 1200 mg, administered either pre- or post-incision, was found to be effective in pain management following lumbar laminectomy. Similar doses of gabapentin provide the same post-operative analgesia whether administered pre- or post-incision.

Restless Legs Syndrome in shift workers: A cross sectional study on male assembly workers

Background

Restless Legs Syndrome (RLS) is a common neurological movement disorder characterized by symptoms that follow a circadian pattern. Night and rotating shift work schedules exert adverse effects on functions of the human body by disturbing circadian rhythms, and they are known to cause sleep disturbances and insomnia. In this paper, we investigate the possible association between shift work and RLS.

Methods

This cross sectional study was conducted in an automobile manufacturing factory in Tehran, Iran. A total of 780 male assembly workers were recruited in three groups, each with 260 workers: workers on a permanent morning shift (A) and two different rotating shift schedules (B and C) with morning, afternoon and night shifts. We used the international RLS study group criteria for diagnosis of RLS, and the severity scale for severity assessment in subjects with RLS. Self administered questionnaires were used to gather information on age, smoking, work history, medical condition, and existence and severity of RLS symptoms.

Results

The prevalence of RLS was significantly higher in rotational shift workers (15%) than workers with permanent morning work schedule (8.5%). In workers suffering from RLS, we found greater mean values of age and work experience, higher percentages of drug consumption, smoking, and co-morbid illnesses compared with subjects who did not have RLS, although these differences were statistically significant only for age, work experience and drug consumption.

Conclusion

Rotational shift work acts as a risk or exacerbating factor for Restless Legs Syndrome.

A novel technique for the removal of fractured instruments in the apical third of curved root canals

AIM

To report on a conservative approach for removal of a fractured file in the severely curved apical portion of the distobuccal canal of a mandibular molar.

SUMMARY

With the assistance of stainless steel hand files and a chloroform-dipped gutta-percha cone, a fractured rotary NiTi instrument was successfully removed. The use of this technique may assist in removal of loose instrument fragments that are not easily accessible to other removal techniques.

KEY LEARNING POINTS

Instrument fractures do not always lead to an unfavourable prognosis and their removal from the apical third of curved canals should not be routinely attempted. The case highlights that it is possible to conservatively remove loosely bound objects from the hard-to-reach areas of the root canal system.