Cone-beam computed tomography evaluation of shaping ability of kedo-S square and fanta AF™ baby rotary files compared to manual K-files in root canal preparation of primary anterior teeth.

BACKGROUND: Pediatric rotary file systems were developed to solve manual file limitations. With many systems available, it may be tricky to select the most appropriate one. AIM: to assess & compare Kedo-S Square, Fanta-AF™-Baby rotary files with manual K-file concerning removed dentin amount, canal transportation, centric ability & root canal taper using CBCT in primary anterior teeth. DESIGN: Extracted Seventy-five upper primary anterior teeth with intact 2/3 root length were collected and divided into three groups based on root canal instrumentation, group-I: prepared using K-file, group-II: prepared using Kedo-S Square, and group-III: prepared using Fanta AF™ Baby file. The teeth were imaged with CBCT before & following canal instrumentation. Then, the removed dentin amount was calculated at each root-canal level. The Kruskal-Wallis test was utilized to statistically analyze study data. RESULT: The difference among the three groups was highly statistically significant at cervical & apical thirds concerning dentin thickness changes on both mesial & distal sides following canal preparation with the least removed dentin in the Kedo-S Square group(P < 0.0001). Regarding transportation & centering ability, a non-significant difference between the three groups was found. 80% of the Fanta AF™ Baby group had good-tapered preparation compared to the Kedo-S Square (72%) and K-file (40%) groups(P < 0.05). CONCLUSION: Kedo-S Square was preferable to Fanta-AFTM-Baby & manual K-files in primary root canal preparation.

Zinc oxide-ozonated olive oil as a new root canal filling material in primary molars: a clinical randomized controlled trial.

OBJECTIVES: The complex root canal anatomy of primary teeth keeps it very tricky to attain appropriate cleansing by biomechanical instrumentation, so obtaining an obturating material with excellent antimicrobial properties is a challenge in current clinical pulpectomy practice. So, this study aimed to assess the clinical and radiographic performance of zinc oxide-ozonated olive oil as a primary root canal filling material. MATERIALS AND METHODS: Ninety non-vital primary molars in children ranging from 4 to 8 years were allocated into three groups in which root canals were filled with zinc oxide-ozonated olive oil, zinc oxide-olive oil, and zinc oxide-eugenol (ZOE) according to each group after pulpectomy procedure. Clinical and radiographic evaluations were done at 3-, 6-, and 12-month follow-up periods. Statistical analysis was performed for the collected data. RESULTS: All study groups showed a significant improvement regarding clinical signs and symptoms during follow-up periods. Ozonated-olive oil group revealed a significant increase in furcation radiodensity and a decrease in periodontal ligament space at 3-, 6-, and 12-month follow-up intervals compared to other groups. CONCLUSION: Zinc oxide-ozonated olive oil and zinc oxide-olive oil paste had shown good clinical and radiographic success for primary teeth pulpectomy. CLINICAL RELEVANCE: The intricate torturous primary root canal anatomy, in addition to the child's negative behavior, interferes with the complete debridement, so the long-lasting antibacterial effect of the primary root canal filling material aids in the pulpectomy success.

Assessment of clinical and radiographic efficiency of manual and pediatric rotary file systems in primary root canal preparation: a randomized controlled clinical trial.

INTRODUCTION: The success of primary teeth pulpectomy is strongly reliant on instrumentation techniques and their impact on obturation quality & postoperative pain. Recently, pediatric rotary file systems have been implemented. AIM: to compare two pediatric rotary file systems (Kedo-S-Square & Fanta AF™ Baby) with manual K-files concerning obturation quality, instrumentation time, and postoperative pain in root canal preparation of primary molars using cone beam computed tomography (CBCT). METHODS: A randomized clinical trial was conducted with the trial registration number (TRN: NCT05619796 and date of registration: (17/11/2022) on sixty primary lower 2nd molars in healthy children aged 4-7 years. Molars were assigned randomly to three groups (n = 20). Group-I and -II were prepared with Kedo-S-Square & Fanta AF™Baby rotary systems respectively while group-III was prepared with a manual K-file. Instrumentation time was recorded using a stopwatch. CBCT was used to assess obturation quality immediately & recorded as optimal, underfilled, or overfilled. Postoperative pain was evaluated at 6, 12, 24, 48 h-time intervals using a four-point pain intensity scale. Statistical analysis was performed for the collected data. RESULTS: Among the three groups, group-I revealed a greater number of optimally filled teeth (85%) & less instrumentation time (74.75 s) followed by group-II & manual-K file group (p < 0.05). The hand K-file group had significantly more postoperative pain than the two rotary groups (p < 0.05). CONCLUSION: the tested rotary file systems resulted in better obturation quality, less instrumentation time, and less postoperative pain compared to manual-K files during primary teeth pulpectomy.

Beta Thalassemia Carrier Rate: Problem Burden among High School Children.

Background & Aim of the Work: ß-Thalassemia (ßT) is highly prevalent in some countries like Egypt. Accurate data about actual disease prevalence and heavily prevalent geographic locations are essential to help in early detection and in setting up effective preventive programs. We aim for screening ßT carriers among Egyptian high school students in the Delta region. SUBJECTS AND METHODS: A cross-sectional multicenter study was carried out on 4320 randomly selected students from four governorates of the Nile Delta region, Egypt. All patients were to be tested for their complete blood count. Those with microcytic hypochromic anemia not caused by iron deficiency were tested for ßT carrier status using high-performance liquid chromatography. RESULTS: The total prevalence of ßT carrier rate was 6.13%. The highest prevalence was detected in Al-Sharkia Governorate, reaching 7.89%, followed by 6.90% in Al-Gharbia Governorate. Al- Dakahilia and Al-Menoufia showed lower rates of 4.86% and 3.73%, respectively. CONCLUSION: Despite the premarital national screening program for ßT in Egypt, the carrier rate is still high. More effort should be done into the proper implementation of national prevention programs.

Age estimation of children based on open apex measurement in the developing permanent dentition: an Egyptian formula.

BACKGROUND: Cameriere's original formula based on open apex measurements is a reliable, clinically applicable method for dental age estimation in different populations children. Dental development may differ between Egyptian children and other ethnic populations which may affect dental age accuracy using Cameriere's formula. AIM: Firstly, to verify Cameriere's original formula on large Egyptian children sample, secondly, to develop an Egyptian-specific formula based on Cameriere's method. MATERIAL AND METHODS: A prospective cross-sectional study of 762 good quality Orthopantomograms (OPGs) of 5-15 aged healthy Egyptian children selected from Nile Delta governorates between August 2020 and December 2021. Chronological age (CA) was calculated by subtracting birth date from radiograph date. OPGs were analyzed for N0, S, Xi morphologic variables using Sidexis program after that dental age was calculated using Cameriere's formula then compared to CA. Multiple linear regression model was used to adapt Cameriere's formula to construct an Egyptian formula. The same sample was used to verify the new formula accuracy. RESULTS: A total of 1093 OPGs were collected; 762 OPGs which met inclusion criteria were analyzed. Cameriere's original formula revealed - 0.59- and - 0.53-year underestimation of females and males dental age (DA) respectively (p < 0.001). Regression analysis using the morphologic variables showed that X4, X7, N0 contributed significantly to CA yielding Egyptian-specific formula. New formula showed - 0.12-year male underestimation and 0.1-year female overestimation (p > 0.05). CONCLUSION: Egyptian formula was more accurate than Cameriere's formula in Egyptian children. CLINICAL RELEVANCE: Egyptian-specific formula decreases the gap between CA and DA, so a relative approximate age is obtained that helps proper diagnosis and treatment planning for orthodontic and pediatric dentistry problems.

Prevalence of iron deficiency anemia and beta thalassemia carriers among relatives of beta thalassemia patients in Nile Delta region, Egypt: a multicenter study.

BACKGROUND: Screening of ß thalassemia among close relatives is more feasible in highly prevalent countries with limited resources. The purpose of this study is to determine the prevalence of ß thalassemia carriers and iron deficiency anemia among relatives of ß thalassemia patients in Mid Delta, Egypt. METHODS: This is a cross-sectional multi-center study conducted on 2118 relatives of patients with ß thalassemia from different Egyptian governorates in the Mid Delta region. They were subjected to history taking with precise determination of geographic location, general examination, and the following investigations: complete blood counts, serum ferritin for those who showed microcytic hypochromic anemia, and high-performance liquid chromatography for those who were not diagnosed as iron deficiency anemia. RESULTS: The total prevalence of iron deficiency anemia among close relatives of confirmed ß thalassemia patients in the Nile Delta region was 17.19%. The highest prevalence of iron deficiency anemia (45.05%) was reported in Al-Gharbia Governorate, followed by Al-Menoufia Governorate (21.67%), and the lowest prevalence was that of Al-Sharkia Governorate (4.91%). The differences were highly statistically significant (p < 0.001). ß thalassemia carrier prevalence rate in the studied relatives was 35.84%, with the highest prevalence detected in Al-Sharkia Governorate (51.32%), followed by Kafr-Alsheikh and Al-Dakahilia Governorates (41.78%, 37.13%) respectively, while Al-Menoufia Governorate had the lowest prevalence rate (25.00%). These differences were also highly statistically significant (p < 0.001). CONCLUSION: More than one-third of relatives of patients with ß thalassemia are carriers of the disease, while 17.19% suffer from iron deficiency anemia. This study demonstrates the importance of tracing the high number of beta thalassemia carriers among relatives of patients with ß thalassemia in Egypt.

Validation and adaptation of the Arabic version of the Tonsil and Adenoid Health Status Instrument.

OBJECTIVES: Validation and cross-cultural adaptation of the Tonsil and Adenoid Health Status study tool, in Arabic while studying its psychometric properties. STUDY DESIGN: prospective -validation study. SETTINGS: Multiple tertiary centers. PATIENTS/AND OTHER PARTICIPANTS: 63 consecutive patients who underwent tonsillectomy or adenotonsillectomy operation (pre-operative and 6 months post-operative) and 65 asymptomatic controls. INTERVENTION/METHODS: FOLLOWING: Guidelines for the cross-cultural adaptation process, to translate the original English language version into an Arabic language one. MAIN OUTCOME MEASURES: We assessed the psychometric properties of the Arabic version of the TAHSI (A-TAHSI) its feasibility, reproducibility, internal consistency, reliability, discriminatory validity and responsiveness to change. RESULTS: The Mann-Whitney test showed a statistically significant difference for the mean score between the patients and the control group denoting good clinical validity. The Cronbach's coefficient value for the A- TAHSI for 63 cases was 0.983, demonstrating good internal consistency. The Wilcoxon signed-rank test showed a marked improvement in the patients' scores 6 months post-operatively. Spearman's rank and Pearson's correlations were used to correlate the level of resemblance of the mean score of the A-TAHSI, which showed statistically significant results. CONCLUSIONS: The A-TAHSI is a valid instrument for evaluating the subjective effect of tonsillectomy on the health and quality of life and hence is recommended to be used in tonsillectomy research and daily practice. LEVEL OF EVIDENCE: 3b.

Job stress among resident physicians in Tanta University Hospitals, Egypt.

Resident physicians are the first-line health service providers, subjected to prolonged working hours, sleep deprivation and high job demands. Work stress causes reduction in productivity, suboptimal patient care and medical errors. To determine the level of stress among residents and associated factors and stressors. A cross-sectional study at Tanta University Hospitals recruited residents (n = 278), between December 2016 and February 2017. Job stress was assessed using a predesigned questionnaire. The mean age was 26.53 ± 1.35, and 46.4% were males. The majority reported they work more than 48 h/week, do not get a break during work and have a night shift periodically (87%, 83.1% and 94.2%, respectively). Only 4 (1.4%) had low stress while 169 (60.8%) had moderate and 105 (37.8%) had high stress. The study revealed a statistically significant association between high level of stress and being a single resident (p = 0.017), belonging to surgical departments (p = 0.001) and an absence of break during working hours (p = 0.001). The prime sources of stress were underpayment for the job (87.4%), serving to large number of patients (85.2%), disruption of home life due to long hours at work (83.9%), conflict of responsibilities (81.3) and complying with increasing bureaucratic procedures (78.8%) besides no available fund for research (74.8%). Medical residents experienced moderate to high level of job stress. Thus, there is a need for stress management programs during residency training period taking in consideration main sources of stress.

Validation and cross-cultural adaptation of the arabic version of the nasal obstruction symptom evaluation scale.

OBJECTIVES/HYPOTHESIS: Validation and cross-cultural adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) scale into the Arabic language with studying of its psychometric properties. STUDY DESIGN: Prospective instrument-validation study. METHODS: Guidelines for the cross-cultural adaptation process from the original English language scale into the Arabic language version were followed. We assessed the psychometric properties of the Arabic version of the NOSE scale (A-NOSE) (feasibility, reproducibility, internal consistency, reliability, discriminatory validity, responsiveness to change) in 101 consecutive patients who underwent septal surgery (preoperatively and 3 months postoperatively) and 102 asymptomatic controls. RESULTS: The Mann-Whitney test showed a statistically significant difference for the mean score between the patients and the control group denoting good clinical validity. The Cronbach's α coefficient value for the A-NOSE scale for 101 cases was 0.995, demonstrating good internal consistency. The Wilcoxon signed rank test showed a marked improvement in the patients score 3 months postoperatively. Correlation and level of agreement of the mean score of the A-NOSE scale for each question were studied using Spearman's rank correlation for each question, and Pearson's correlation for the total score showed statistically significant results. CONCLUSIONS: The A-NOSE scale is a valid instrument for evaluating the subjective severity of nasal obstruction and is recommended to be used in rhinology research and daily practice. LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:2455-2459, 2017.

Prevalence of hepatitis C infection among children with ß-thalassaemia major in Mid Delta, Egypt: a single centre study.

BACKGROUND: Transfusion dependant patients are at a higher risk of acquiring bloodborne infections even under conditions of safe transfusion. This study was designed to determine sero-prevalence of hepatitis C infection and possible associated risk factors in thalassaemic children. METHODS: One hundred and twenty five children with ß thalassaemia major (ß-TM) were recruited from the Haematology/Oncology Unit, Paediatric Department, Tanta University Hospital, Egypt, between April 2010 and October 2011. Patients underwent history taking, full clinical examination, routine investigations and venous blood sampling. Serum was stored at -20°C till tested for hepatitis C (HCV Ab) and B (HBsAg) by ELISA. HCV Ab positive cases were confirmed by PCR. RESULTS: All patients were HBsAg negative. HCV Ab ELISA was positive in 76%, negative in 20% and equivocal in 4%. Fifty patients (40%) had positive PCR for HCV. PCR showed low viraemia in 78%, moderate viraemia in 20% and high viraemia in 2%. A positive family history of HCV, history of minor operative intervention and/or dental procedures were significantly associated with higher frequency of HCV infection in thalassaemic children, while amount and frequency of transfused blood, age at transfusion and chelation state were not. CONCLUSION: HCV infection is highly prevalent in children with ß-TM in Egypt despite strict pre-transfusion blood testing. This should arouse the attention for environmental and community acquired factors. Quality management to insure infection control in minor operative procedures and adding more sensitive tests for blood screening are recommended.

Patterns of diseases and preventive measures among domestic hajjis from Central, Saudi arabia [complete republication].

OBJECTIVES: To identify the occurrence of upper respiratory tract infections (URTI), diarrheal diseases and trauma during the Haji season, and the practice of some preventive measures by pilgrims. METHODS: A cohort study during November and December 2009 among hajjis registered while visiting Primary Health Care Centers of Riyadh, Kingdom of Saudi Arabia to get mandatory meningococcal meningitis vaccination. On return from hajj, hajjis were contacted on telephone to collect information on occurrence of URTI and diarrhea along with other associated activities in Hajj. RESULTS: Out of 1507 hajjis, 54.7% developed symptoms; 97% reported upper respiratory tract symptoms, and 9.3% reported diarrheal symptoms. Those < 40 years of age were more likely to develop an URTI. The incidence of diarrheal diseases or trauma was not statistically associated with age. No statistical difference for educational level was found for U RTI or trauma, but there was a statistically significant difference for diarrheal diseases. There was no statistical difference for nationality in relation to diarrheal diseases and trauma, but there was a statistically significant difference for URTI. There was a statistically significant difference of URTI between those pilgrims who used the face mask most of the time and those who used it sometimes. CONCLUSION: Upper respiratory tract infections is a common health problem among studied domestic hajjis. Generally, there is room for improvement in the adoption of preventive measures by hajjis; and there is still limited information on the use of facemasks in spite of the fact that using it significantly decreases the risk for URTI.

HIV case notification rates in the Kingdom of Saudi Arabia over the past decade (2000-2009).

OBJECTIVE: To study trends in HIV case notification rates in the Kingdom of Saudi Arabia. DESIGN: A ten year retrospective review of annual HIV case notification returns to the Ministry of Health, Kingdom of Saudi Arabia. METHODS: Annual Registry statistics covering the period 2000 to 2009 were reviewed. Annual incidence trends were stratified according to the following demographics: age, nationality, geographical region of residence, gender, and mode of disease acquisition. RESULTS: 10,217 new HIV cases (2,956 in Saudi nationals and 7,261 in non-Saudis) were reported. Africans of Sub-Saharan Africa origin accounting for 3,982/7,261 (53%) of non-Saudi cases constituted: Ethiopians (2,271), Nigerians (1,048), and Sudanese nationals (663). The overall average annual incidence was <4 cases per 100,000; 1.5 cases per 100,000 for Saudis (range 0.5-2.5), and 13.2 per 100,000 for non-Saudis (range 5.7-19.0). Notifications increased yearly from 2000 for both groups until a plateau was reached in 2006 at 1,390 new cases. Case notification in Saudi nationals increased from 20% in the early 2001 to 40% in 2009. 4% (124/2,956) of cases were reported in Saudi children. The male to female ratio was 1.6:1 for non-Saudi nationals (43.8% male, 27.3% female) and 4.4:1 for Saudis (23.5% male, 5.4% female). CONCLUSIONS: Whilst the numbers of reported HIV cases have stabilised since 2006, HIV/AIDS remains an important public health problem in KSA, both in migrants and Saudi nationals. HIV transmission to Saudi children is also of concern. Optimization of data collection, surveillance, and pro-active screening for HIV is required.

Patterns of diseases and preventive measures among domestic hajjis from Central, Saudi Arabia.

OBJECTIVES: To identify the occurrence of upper respiratory tract infections (URTI), diarrheal diseases and trauma during the Hajj season, and the practice of some preventive measures by pilgrims. METHODS: A cross-sectional study during November and December 2009 among hajjis registered while visiting Primary Health Care Centers of Riyadh, Kingdom of Saudi Arabia to get mandatory meningococcal meningitis vaccination. On return from hajj, hajjis were contacted on telephone to collect information on occurrence of URTI and diarrhea along with other associated activities in Hajj. RESULTS: Out of 1507 hajjis, 54.7% developed symptoms; 97% reported upper respiratory tract symptoms, and 9.3% reported diarrheal symptoms. Those <40 years of age were more likely to develop an URTI. The incidence of diarrheal diseases or trauma was not statistically associated with age. No statistical difference for educational level was found for URTI or trauma, but there was a statistically significant difference for diarrheal diseases. There was no statistical difference for nationality in relation to diarrheal diseases and trauma, but there was a statistically significant difference for URTI. There was a statistically significant difference of URTI between those pilgrims who used the face mask most of the time and those who used it sometimes. CONCLUSION: Upper respiratory tract infections is a common health problem among studied domestic hajjis. Generally, there is room for improvement in the adoption of preventive measures by hajjis; and there is still limited information on the use of facemasks in spite of the fact that using it significantly decreases the risk for URTI.

Awareness of healthcare workers regarding preventive measures of communicable diseases among Hajj pilgrims at the entry point in Western Saudi Arabia.

OBJECTIVE: To determine the level of knowledge of healthcare workers (HCWs) towards preventive measures for communicable diseases among pilgrims, and to highlight the difficulties faced by HCWs in implementing preventive measures at entry point. METHODS: A cross-sectional study was conducted at King Abdulaziz International Airport Hajj Terminals in Jeddah, Kingdom of Saudi Arabia during Hajj season from October to November 2009 including 325 healthcare workers (HCWs). Data were collected using a self-administered questionnaire. RESULTS: Difficulties reported by HCWs were refusal of vaccine, or chemoprophylaxis by some pilgrims, language barriers, and difficulties in organizing pilgrims. The different items related to meningococcal meningitis were answered correctly by most HCWs except for preventive measures applied to infants and children. Less than one half were aware of the period of validity for Yellow Fever vaccine certificate and measures to be taken for unvaccinated pilgrims. Only 32.9% were aware of preventive measures that should be applied against influenza A (H1N1). Physicians, those reading guidelines, and those with high experience a showed significantly better level of knowledge than other categories. CONCLUSION: The HCWs have difficulties in some preventive measures, especially among non-physicians, those with less years of experience, and those who did not read the written guidelines, which highlighted the importance of training courses before Hajj season.

Evaluation of syndromic management of sexually transmitted infections in Saudi Arabia.

BACKGROUND: STIs can lead to acute symptoms, chronic infection and serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer and the untimely death of infants and adults. OBJECTIVES: To identify the points of strength and weakness in the system for management of sexually transmitted infections (STIs) and pattern of distribution of reported cases in Saudi Arabia. METHODS: Data of 5377 reported cases of STIs from all regions of the kingdom during the year 2009 were collected. The original data collection sheets were collected from primary health care centers in all regions of the kingdom, entered into Epi-Info software computer program, organized and statically analyzed. RESULTS: Average monthly reporting was variable between 163.4 cases and 3.3 cases. Age group of 20-40 represented 70.7% of reported cases with the majority Saudis (92%), females (92.9%), literate (59.2%) and married (91.0%). Housewives represented 62% followed by the unemployed (17.3%). The age at first sexual experience ranged from 15 to 25 (81.0%) which was mostly with other sex (95.1%). HIV testing was performed by only 3.0% of reported cases. Vaginal discharge was the most frequent diagnosis (77.6%) followed by lower abdominal pain (42.3%). Urethral discharge and lower abdominal pain differed significantly in relation to sex while scrotal swelling and lower abdominal pain were statistically different in relation to nationality. Vaginal discharge, cervical inflammation and abdominal pain differed significantly in relation to age. CONCLUSION: Syndromic surveillance of STIs is essential to decrease STIs and control human immunodeficiency virus (HIV) infections. There is a need to build capacity of primary health care workers to collect accurate and valid data. Monitoring and evaluation activities are essential to promote program activities.