Accuracy of high definition near infrared transillumination camera in detection of hidden proximal caries.

Background: Early caries detection became mandatory in modern dentistry. However, the traditional methods in caries detection had many limitations. Hence,a novel approach based on Near Infrared technology was introduced to overcome such limitations. Material and Methods: Proximal surfaces of 102 posterior teeth from 36 adult participants who fulfilled the eligibility criteria were assessed by two examiners using three diagnostic methods. Teeth were examined visually according to the criteria of the International Caries Detection and Assessment System (ICDAS-II) then examined by bitewing digital radiograph (BW) and near infrared light transillumination (NIRT) camera (Vista Proxi iX HD smart). Inter and intra observer agreements were assessed using Kappa test.Dignostic accuracy parameters and Area Under the ROC curve (AUROC) with 95% confidence interval (95% CI) were evaluated for the different caries assessment methods. Results: The results of inter-observer agreement showed an excellent agreement in the different groups. There was a statistically significant difference in the score distribution between ICDASII and VistaCam modalities (P-value <0.05). While there was no statistically significant difference in the score distribution between bitewing radiography and VistaCam modalities (P-value >0.05). ROC curve analysis revealed that VistaCam when compared with ICDASII had sensitivity (99.0%), specificity (50.0 %), diagnostic accuracy (98.0%) and Area under the ROC curve (AUC) was 0.745 with 95% Confidence Interval (0.649 - 0.826).When VistaCam compared with bitewing radiography, it showed sensitivity (100.0%); specificity (40.0%), diagnostic accuracy (97.1%) and AUC (0.700) with 95% confidence interval (0.601 - 0.787). Conclusions: NIRT based diagnostic modality is a promising method for detection of hidden proximal lesions overcoming the hazards of radiograph. Key words:Bitewing radiography , ICDAS II , Near-infrared transillumination, proximal caries, VistaCam® iX Proxi.

Hydralazine-Induced Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Case Report and Literature Review.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a disease that typically presents with multiorgan involvement. It can be idiopathic and at times drug-induced. Drugs that have been reported to cause AAV include propylthiouracil, minocycline, allopurinol, hydralazine, as in our case here, and many others. Other than stopping the offending agent, guidelines regarding treating drug-induced vasculitis (DIV) remain unclear. We present to you a case of hydralazine-induced vasculitis causing severe respiratory failure due to pulmonary hemorrhage, purpuric rash, and possible renal disease although not confirmed by biopsy. Our patient was successfully treated with rituximab and plasma exchange. This disease can be life-threatening, and aggressive treatment may be warranted at times.

TNF inhibitor treating osseous sarcoidosis and dactylitis: case and literature review.

A 49-year-old African American male with multiorgan sarcoidosis presented with recurrent episodes of dactylitis and arthritis. Imaging had shown sarcoid osseous involvement of both hands. This would improve temporarily with high-dose corticosteroids but once tapered, he would experience recurrent flares. Despite several different oral immunosuppressant regimens, significant improvement was only observed after the initiation of adalimumab. Not only was adalimumab successful in symptomatic relief, in addition, patient continues to be in remission with no recurrent episodes of dactylitis. Prednisone was successfully tapered from 40 to 3 mg daily. This improvement with TNF inhibitors has been reported with other manifestations of sarcoidosis including pulmonary and ocular involvements. Osseous sarcoidosis is a very rare presentation, and little information regarding treatment with TNF inhibitors is available. TNF inhibitors should be considered as the next-step therapy in resistant cases of osseous sarcoidosis and dactylitis not responding to corticosteroids and traditional immunosuppressant therapy.

Chylous Ascites in Systemic Lupus Erythematosus: A Diagnostic Challenge.

Systemic lupus erythematous (SLE) is a chronic inflammatory disease of unknown etiology. It can affect nearly any organ. Gastrointestinal (GI) involvement in SLE is frequent but is mostly related to medication side effects and concomitant infections. Chylous ascites is a rare form of ascites that is milky appearing due to the high concentration of triglycerides. Chylous ascites as a complication of SLE is atypical. Our case highlights an extremely rare presentation of chylous ascites in SLE as an initial manifestation of the disease itself, posing diagnostic and therapeutic challenges. Through this case, we aim to raise awareness of SLE as a rare but reversible cause of chylous ascites.

Pulmonary manifestations in a group of patients with Behcet's disease.

AIM: In this study we investigated the frequency and characteristics of pulmonary manifestations in a group of patients with Behcet's disease (BD) who were admitted to Cairo University Hospital. METHODS: Fifteen patients were included in our study, 14 men (93.3%) and one woman (6.66%).Their mean age was 30.06 ± 9.8 years and the mean age of onset of BD was 23.7 ± 5.54 years. All patients were subjected to full history taking, clinical examination, plain chest X-ray and helical computed tomography (CT) study of the chest. RESULTS: Pulmonary involvements were detected in 11 patients with BD, 73.3% of cases: 10 men (90.9%) and one woman (9.09%).Their mean age was 28.8 ± 8.07, the mean age of onset of BD was 23.2 ± 5.59 years and the mean disease duration until lung manifestations appear was 3.7 ± 4.8 years. The main pulmonary and constitutional symptoms in these 11 patients were as follows: dyspnea 81.8%, cough 63.6%, weight loss 63.6%, chest tightness 54.5%, hemoptysis 45%, massive hemoptysis 27.2%, fever 36.3% and expectoration 36.3. Analysis of both vascular and parenchymal lung lesions in helical CT scan in the 11 patients with BD were as follows: pulmonary artery aneurysm (PAA) occurred in 5/11 patients (45.4%), pulmonary nodules occurred in 3/11 patients (27.2%), pleural effusion occurred in 3/11 patients (27.2%), pulmonary embolism and infarction occurred in 1/11 patients (9.09%) and pneumonitis occurred in 1/11 patients (9.09%). CONCLUSION: The higher frequency of pulmonary manifestations in our patients (73.3%) and the higher frequency of PAA (33.3%) could be related to the fact that this study was conducted on a group of patients who were admitted to the hospital with more severe illnesses.

Activated protein C resistance in Behcet's disease.

Behcet's disease is a chronic multi-system disorder of unknown etiology with protean manifestations. Venous thromboembolism is more common than arterial thrombosis, with deep vein thrombosis being the most frequent. Endothelial dysfunction resulting from vascular inflammation is considered to be an important factor of thrombosis, although the endothelial injury itself cannot completely explain the hypercoagulable state of the disease because other vasculitis syndromes do not increase the risk of thrombosis. The aim of this study is to evaluate the prevalence of activated protein C resistance (APC-R) in Egyptian patients with Behcet's disease. Also, to detect hyperhomocysteinemia in selected cases (with vascular complications) to assess their relationship with thromboembolic complications. The APC resistance ratio mean in the group of patients with vascular involvement was 2.6 ± 0.8 which was less than the group with no vascular involvement 2.8 ± 0.6, with non- significant P-value (0.5). There was more incidence of ocular lesions in the group of patients with high homocysteine level than the group of patients with normal homocytsteine level with significant P-value (0.08).

Ortner's syndrome as a presenting feature of giant cell arteritis.

Hoarseness due to left recurrent laryngeal nerve paralysis (LRLN) caused by identifiable cardiovascular disease is described as Ortner's syndrome or cardiovocal syndrome. This was first reported by Ortner in 1897 to describe left recurrent laryngeal nerve palsy secondary to mitral stenosis. This case report describe a patient with giant cell arteritis with initial presentation of Ortner's syndrome.

Successful use of etanercept for the treatment of Reiter's syndrome: a case report and review of the literature.

The treatment of severe and refractory cases of reactive arthritis is not well defined. There is a limited data about the use of tumor necrosis factor-α (TNF-α) blockers in reactive arthritis. Herein is a description of a patient with severe case of Chlamydia trachomatis-related reactive arthritis that was refractory to nonsteroidal anti-inflammatory drugs, sulfasalazine, prednisone, and methotrexate and was successfully treated with etanercept.

Relapsing polychondritis: a description of a case and review article.

Relapsing polychondritis (RPC) is a rare autoimmune disease in which the cartilaginous tissues are the target for inflammation and destruction, the associated immune reaction causes inflammation in non-cartilaginous tissues like kidney and blood vessels. This article provides a description of a case of RPC and a review article about the disease.

Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy.

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus (HCV) infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult, especially with recent onset RA before articular damage and erosions develop. The objective of the study is to assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor (RF) in distinguishing between rheumatoid arthritis (RA) and HCV-related polyarthropathy. Anti-cyclic citrullinated peptide (CCP) antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared with RF (95.4 vs. 18.2%). However, the sensitivity of anti-CCP was comparable to that of RF (83.3 vs. 90%). In conclusions, anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy.

Clinical features of Behcet's disease in Egypt.

Behcet's disease (BD) is a chronic relapsing multisystem disease of unknown etiology. Ethnic origin is one of the factors that may modulate the prevalence and the expression of BD. To study the clinical characteristics of Egyptian patients with BD, and compare the pattern of the disease in Egyptians with studies from other countries. Sixty-three patients with BD were studied over a 4-year period. A rheumatologist, dermatologist, neurologist and other specialists as indicated assessed the patients clinically. Laboratory and radiological examinations were done to confirm the diagnosis to rule out any condition that may mimic BD. Sixty-one patients were men, two were women, the mean age of the patients was: 32.8 +/- 8.3 years, age of onset of the disease varied between 17 and 37.4 years. The initial presenting manifestation was oral ulcers in 39.7% of patients, followed by orogenital ulcers in 23.8%, followed by deep venous thrombosis in 7.9% Throughout the study period, the commonest manifestation was oral ulcers (100%), followed by genital ulcers (96.8%), vascular lesions (57.1%), cutaneous (55.5%), ocular (47.6%), joint (36.5%), neurological (34.9%), gastrointestinal (19%) and cardiac (6.3%). BD in Egyptians shows higher male-to-female ratio and higher incidence of vascular and neurological lesions.

Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome) associated with hypogammaglobulinemia and elevated serum tumor necrosis factor-alpha levels.

Pyogenic aseptic arthritis, pyoderma gangrenosum, and cystic acne (PAPA) syndrome is an unusual triad that was recently mapped to a chromosome 15q mutation. We describe a patient from this kindred in whom hypogammaglobulinemia and elevated tumor necrosis factor-alpha serum levels were detected. The patient responded well to intravenous gammaglobulin and intra-articular corticosteroid therapy. Immune abnormalities can be found in PAPA syndrome and could be the consequence of the chromosomal abnormalities affecting candidate genes on this chromosome with subsequent abnormalities in cytokine or chemokine secretion. Rheumatologists should be alert for this syndrome. Correction of the immune abnormalities may be effective in controlling the disease manifestations.