Efficacy of corticosteroids for postoperative endodontic pain: A systematic review and meta-analysis

This systematic review aimed to analyze the efficacy of corticosteroid premedication compared to placebo or no treatment to reduce postoperative pain in endodontic patients. Randomized controlled trials (RCTs) assessing corticosteroids via oral, intramuscular, subperiosteal, intraligamentary or intracanal route compared to passive or active placebo, or no treatment were included. Four databases were searched: PubMed, Web of Science, Cochrane Library and Embase up to 2/21/2018. Risk of bias was assessed with Cochrane Risk of bias tool. Fourteen RCTs with 1,462 generally healthy adults in need of endodontic treatment were included. 50% of the studies were at unclear risk and 50% at high risk of bias. Meta-analysis showed Visual Analog Scale (VAS) pain at 4–6 hours after Inferior Alveolar Nerve Block (IANB) was significantly lower by 21 points (0–100 scale) in the corticosteroid group compared to the control group (95% CI −35 to −7; P = 0.003), however this difference was not statistically significant after 24 hours (P = 0.116). The route of administration was oral and intraligament injection. Patients who received corticosteroids prior to IANB were 70.7% more likely to have none or mild pain 4–8 hours after treatment (P = 0.001) and 13.5% more likely 24 hours after IANB (P = 0.013) than patients in the control group. In conclusion, corticosteroid administration (oral or intraligamental) may clinically reduce the level of postoperative pain at 4–8 hours after IANB, however the quality of the evidence was low/moderate due to risk of bias and heterogeneity. Further studies are recommended.

Nail alterations in cutaneous B-cell lymphoma with extracutaneous relapse

Introduction: Cutaneous B-Cell lymphoma can be associated with clinically significant nail alterations, the presentation of which can be unusual and misleading. To date, only a few reports have demonstrated direct specific tumor infiltration of the nail bed with lymphoma, while there is much less information about infiltration of nail bed with diffuse large B-cell lymphoma

Case Presentation: We describe the case of a 74 years old man presenting with nail bed ulceration who developed clinically significant nail shape alterations. Light microscopy studies demonstrated the presence of a specific lymphocyte infiltrate within the nail bed. The IHC analysis demonstrated diffuse large B cell lymphoma [DLBCL]

Conclusions: Specific nail involvement should be recognized and considered in all patients with cutaneous B-cell lymphomas specially when there is refractory to conventional treatment

Fatigue, depression and sleep disturbances in Iranian patients with multiple sclerosis

Fatigue is one of the most frequent symptoms in patients with multiple sclerosis [MS] and it is difficult to clarify the nature of this symptom and manage it. This study was aimed to evaluate the frequency of fatigue, depression and sleep disturbances in Iranian patients with MS. 100 patients from the outpatient MS clinic of Sina hospital were asked to complete Beck Depression Inventory [BDI], Pittsburg Sleep Quality Index [PSQI], Sleep Disorder Questionnaire [SDQ], Modified Fatigue Impact Scale [MFIS] and Epworth Sleepiness Scale [ESS] questionnaires. Student's t-test, ANOVA, Spearman correlation and Stepwise multiple linear regressions by SPSS version 15.0 were used for data analysis. From participants, 64 had fatigue complaint during day time and 36 did not feel fatigued. BDI, PSQI, MFIS and SDQ scores were significantly higher in fatigued patients than non-fatigued group but there were no statistically significant differences in ESS, EDSS and duration of disease between fatigued and non-fatigued cases. There were significant correlations between MFIS and BDI scores [r=0.49, P=0.01], MFIS and PSQI scores [r=0.399, P=0.01] and MFIS and ESS [r=0.25, P=0.01]. This study demonstrates that depression is not the only cause of fatigue in patients with MS and it is also associated with sleep disorders, so this complaint should be carefully evaluated and managed in these patients