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.

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.

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.

Treatment of pre-eruptive intracoronal resorption: A scoping review.

AIM: Pre-eruptive intra-coronal resorption (PEIR) is a rare condition that can affect children's dentition. Showing the same aspect of dental caries, these lesions are diagnosed in non-erupted teeth. The aetiology is not yet defined and no consensus on their treatment is available. Thus, the aim of the present scoping review of the literature was to try to establish a protocol for treatment and management of PEIR defects. METHODS: The search was performed on Medline via PubMed, Science Direct and EBSCOhost' databases using the appropriate Medical Subject Headings (MESH) terms. Studies that described the PEIR were considered eligible and the data from the selected papers were extracted and analysed independently by two authors. RESULTS: Out of 172 articles identified in initial research, 15 articles were selected for reviewing. Interventions varied from preventive treatment to extraction, depending on the lesion severity and its proximity to the pulp. CONCLUSION: Non-operative procedures, conservative approaches and extractions were recommended for the management of PEIR, depending on the extent of the lesions. Overall, further researches should be conducted to explore the effectiveness of the approaches of PEIR management.

[Prognostic factors of advanced stage non-small-cell lung cancer]. / Facteurs pronostiques du cancer bronchique non à petites cellules au stade avancé.

INTRODUCTION: Primary lung cancer is the leading cause of cancer death in men in the world. Although the introduction of new drugs, new therapeutic strategies and despite therapeutic advances, the prognosis is relatively improved during the last years. AIM: To evaluate the prognosis of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and to identify prognostic factors at these stages. METHODS: A retrospective study, including 140 cases of locally advanced or metastatic NSCLC diagnosed in our department between 2003 and 2013. RESULTS: The average age was 61±10 years (35 to 90 years). Sex ratio was 18. The delays management were 80±25 days for presentation, 45±20 days for the diagnostic, while the treatment delay was 8±2.33 days. The cancer was at stage IIIA in 14%, IIIB in 27% and IV in 59%. Six months and one-year survival was between 50 and 74% and between 9 and 25%, respectively. Better survival was observed in patients with NSCLC on stage III, having better performance status, having comorbid conditions, with prolonged delays management, a short therapeutic delay and patients who received specific antitumor treatment. CONCLUSION: The prognostic factors in locally advanced and metastatic NSCLC in our patients were: stage of cancer, performance status, comorbid conditions, delay of management and specific antitumoral treatment. These factors should be considered in the management of patients with advanced NSCLC.

[Respiratory symptoms and obstructive ventilatory disorder in Tunisian woman exposed to biomass]. / Symptômes respiratoires et trouble ventilatoire obstructif chez la femme tunisienne exposée à la biomasse.

INTRODUCTION: In some Tunisian cities, especially semi-urbanized, the exposure to the smoke produced during combustion of the biomass, main source of pollution of indoor air, remains prevalent among non-smoking women. AIM: To assess the relationship between exposure to biomass smoke and the presence of obstructive ventilatory disorder in the non-smoking women in semi-urban areas of Tunisia. METHODS: Cross etiological study, using a questionnaire, including 140 non-smoking women responsible for cooking and/or exposed during heating by traditional means with objective measurement of their respiratory functions. RESULTS: We found 81 women exposed to biomass for a period > or equal to 20 hours-years and 59 unexposed women. Exposed women reported more respiratory symptoms namely exertional dyspnea and/or chronic cough than unexposed. Of the 140 women, 14 women have an FEV/FEV6 <70 % of which 13 are exposed to biomass. We found a correlation between respiratory symptoms and obstructive ventilatory disorder in exposed women. CONCLUSION: The air pollution inside the home during the traditional activities of cooking and/or heating is a respiratory risk factor for non-smoking women over the age of 30 years. Exposure to biomass smoke can cause chronic respiratory symptoms and persistent obstructive ventilatory disorder that can be consistent with COPD.

[Respiratory symptoms and obstructive ventilatory disorder in Tunisian woman exposed to biomass]. / Symptômes respiratoires et trouble ventilatoire obstructif chez la femme tunisienne exposée à la biomasse.

INTRODUCTION: In some Tunisian cities, especially semi-urbanized, the exposure to the smoke produced during combustion of the biomass, main source of pollution of indoor air, remains prevalent among non-smoking women. AIM: To assess the relationship between exposure to biomass smoke and the presence of obstructive ventilatory disorder in the non-smoking women in semi-urban areas of Tunisia. METHODS: Cross etiological study, using a questionnaire, including 140 non-smoking women responsible for cooking and/or exposed during heating by traditional means with objective measurement of their respiratory functions. RESULTS: We found 81 women exposed to biomass for a period of≥20 hours-years and 59 unexposed women. Exposed women reported more respiratory symptoms namely exertional dyspnea and/or chronic cough than unexposed. Of the 140 women, 14 women have an FEV/FEV6<70% of which 13 are exposed to biomass. We found a correlation between respiratory symptoms and obstructive ventilatory disorder in exposed women. CONCLUSION: The air pollution inside the home during the traditional activities of cooking and/or heating is a respiratory risk factor for non-smoking women over the age of 30 years. Exposure to biomass smoke can cause chronic respiratory symptoms and persistent obstructive ventilatory disorder that can consistent with COPD.

Solid tumors after chronic lymphocytic leukemia patients: Report of six cases and review of the literature.

INTRODUCTION: Malignancies have been reported to occur with increased frequency in chronic lymphocytic Leukemia (CLL) patients. The aim of this study was to describe which second malignancies occur in patients with CLL, whether these malignancies are related to CLL, its treatment, or both. We also attempt to study factors predicting the development of other malignancies. PATIENTS AND METHODS: Between 1995 and 2009, six cases of CLL associated with solid tumor were diagnosed in Hematology Department of Military Hospital of Tunis. The diagnosis of CLL was made by immunophenotyping of peripheral blood circulating B cells, and the diagnosis of solid tumors was made by biopsy with anatomopathological exam and immunohistochemical study. RESULTS: The mean age of patients was 71 years. Five patients were male. The CLL was classified Stage A in one case, Stage B in three cases and Stage C in two cases. Two patients had abnormal karyotype. Three patients have not received specific treatment for their CLL. Solid tumors were represented by skin cancer in three cases, lung cancer in two cases and breast cancer in one case. The median time between diagnosis of CLL and that of solid tumor was 53 months. CONCLUSION: Patients with CLL have an increased risk of developing a second cancer. Awareness of risk factors could permit early detection.

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.

[Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. / Incidence de la maladie thromboembolique veineuse chez des hommes admis dans un service de pneumologie pour affection respiratoire aiguë

BACKGROUND: Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD: The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS: Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION: VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.

[Hypertrophic osteoarthropathy associated with pulmonary tuberculosis]. / Ostéoarthropathie hypertrophique pneumique associée à la tuberculose pulmonaire.

Hypertrophic osteoarthropathy is a syndrome frequently described in intrathoracic diseases, especially malignant ones. The association with lung tuberculosis is rarely reported. The authors describe the case of a 35-year-old patient, a smoker, hospitalised for lung cavitation associated with hypertrophic osteoarthropathy. The assessment of the aetiology was negative and the patient underwent lung surgery. The histopathological examination concluded as to chronic pulmonary tuberculosis. This report aims at alerting physicians about the possibility of hypertrophic osteoarthropathy in non malignant diseases, especially pulmonary tuberculosis which is still endemic in our country.

Spontaneous pneumothorax in adulthood varicella.

Varicella is a generalized viral infection that is generally benign if it occurs in childhood, but it has a severe outcome in adulthood. Pneumonia is the main complication of adulthood varicella and may lead to respiratory failure. Spontaneous pneumothorax is a rarely reported complication during varicella in adult patients. Only one case of spontaneous pneumothorax associated with varicella pneumonia (VP) was published in 1990. We report a new case of pneumothorax in VP.

[Epithelioid hemangioendothelioma mimicking hypersensitivity pneumonitis]. / Hémangioendothéliome épithélioïde pulmonaire mimant une pneumopathie d'hypersensibilité

Epithelioid haemangioendothelioma is a rare vascular tumour of slow growth and unfavourable outcome. The diagnosis of the pulmonary localisation is difficult and can mimic by clinical and radiological features other diagnosis as hypersensitivity pneumonitis. We report the case of a 28-year-old man, farmer handling with palm tree pollens, admitted to the hospital for dry cough. Clinical and thoracic computed tomography findings revealed diffuse infiltrating pneumopathy; bronchoalveolar lavage results and professional exposure were suggestive for hypersensivity pneumonitis. Surgical lung biopsy with immunochemistry study concluded to pulmonary epithelioid haemangioendothelioma. Extra pulmonary localisation research was negative. No treatment was indicated. At three years, the patient is steel asymptomatic. Epithelioid haemangioendothelioma is a tumour of intermediate malignancy, of which pulmonary localisation has a nonspecific clinical presentation mimicking diffuse infiltrating pneumonitis. Diagnosis is essentially made by surgical lung biopsy with pathological and immunohistochemical study.

Desmoid tumour of the chest wall in a patient with a previous aortocoronary bypass: a complication or a coincidence?

Desmoid tumour is an uncommon, locally invasive non-metastasizing neoplastic lesion. The pathogenesis of this tumour is unclear and its treatment is controversial. In this paper, the authors report a new case of chest wall desmoid tumour in a 67-year-old man previously operated by sternotomy for a triple aortocoronary bypass. To the best of our knowledge only two cases of thoracic desmoid tumours following aortocoronary bypass have been reported in literature. The correlation between the site of the surgical approach and the tumour, and the time interval between surgery and presentation, supports the hypothesis of a causal role of surgical trauma in the occurrence of this tumour. The Authors discuss the pathogenesis of this tumour with review of the current literature.

Asthma in Tunisian elite athletes.

Several studies in the past few decades have shown that very intense and repeated exercise, particularly when performed over many years, could cause respiratory health problems. The prevalence of exercise-induced asthma has increased in the athletic population, particularly in elite athletes and has not been published in North African athletes. The aim of this study was to determine the prevalence of exercise-induced asthma and/or exercise-induced bronchoconstriction in Tunisian elite athletes. Each participant responded to a questionnaire about respiratory symptoms and medical history and underwent a resting spirometry testing before exercise. Exercise-induced bronchoconstriction was defined as a decrease of at least 15% in pre-exercise forced expiratory volume in one second at any time point after exercise. Post-exercise spirometry revealed the presence of exercise induced bronchoconstriction in 14 out of 107 (13%) elite athletes, while only 1.8% of the subjects reported having previously diagnosed asthma. The prevalence of exercise-induced bronchoconstriction was 19% (8/42) among those athletes training outdoors and 10% (6/65) among those training indoors. In conclusion, our findings indicate that a significant number of Tunisian athletes had exercise-induced bronchoconstriction while not diagnosed before.

[Acute chest syndrome as the inaugural sign of sickle cell anemia. A case report and review of the literature]. / Syndrome thoracique aigu révélateur d'une drépanocytose. A propos d'un cas avec revue de la littérature.

Acute chest syndrome is a frequent complication of sickle cell disease. This syndrome is characterized by recent infiltrate on chest X-ray with chest pain or fever or dyspnea. We report the case of a 26-year-old man in whom an acute chest syndrome with fat embolism was the inaugural sign of sickle cell disease. This report illustrates the frequency of potentially serious fat embolism in the acute chest syndrome and the importance of bronchoscopy and bronchoalveolar lavage (fatty macrophages) for determining the etiology of acute chest syndrome.

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.

[Hydatid pulmonary embolisms. Seven cases]. / L'embolie pulmonaire hydatique. A propos de 7 observations.

Hydatid pulmonary embolism is a rare condition. Diagnosis is difficult and there is no consensus on treatment. Prognosis is generally poor. We conducted a retrospective analysis of patients hospitalized between 1994 and 2002 who had a diagnosis of hydatid pulmonary embolism. Seven cases were identified. All patients had a cyst which spontaneously ruptured into the bloodstream. All patients were symptomatic. Chest x-ray revealed images of metastatic pulmonary echinococciasis in all patients. Thoracic CT and/or angioscan provided the diagnosis in five patients. In one, the diagnosis was established with pulmonary angiography. For one other, the diagnosis was established at the pathology examination of the surgical specimen. Searching for the primary localization of the hydatid disease revealed hepatic cysts in all patients, associated in one with a cyst in the right atrium. The cardiac cyst was not operated and all hepatic cysts were removed. Embolectomy was performed in one patient. Medical treatment with albendazole was given in five patients. The clinical course was marked by death in two patients, due to abundant hemoptysia. The five other patients are followed regularly and were doing well at six months to five years. The diagnosis of hydatid pulmonary embolisms is basically obtained with imaging. Treatment is surgical resection of the embologenic focus then embolectomy. The role of medical treatment is not clearly defined. The short- and mid-term prognosis is generally poor.

[Asthma and atmospheric pollution]. / Asthme et pollution atmosphérique.

Alteration of the air we breathe, due mainly to the transformation of the environment by mankind, is a increasing cause of concern for physicians, public health deciders and government agencies responsible for environmental protection. Modifications of air composition have a proven harmful effect on health and provoke predominantly respiratory symptoms. Asthma is considered as a disease resulting from complex interactions between genetic and environmental factors. Since asthma-related morbidity and mortality have risen constantly over the past decades, many studies were conducted to identify and evaluate the factors responsible for the onset and/or aggravation of the underlying inflammation. Various atmospheric toxic compounds appear to be responsible, and some experts think that asthmatics are excellent indicators for atmospheric pollution and its intensity. Doses and conditions of experimental exposure are however often quite different from real population exposure, implicating very critical evaluation of demonstrated effects and extreme prudence when extrapolating results.