The efficacy of non-narcotic analgesics on post-operative endodontic pain: A systematic review and meta-analysis: The efficacy of non-steroidal anti-inflammatory drugs and/or paracetamol on post-operative endodontic pain.

The objective of this review was to evaluate the efficacy of non-narcotic analgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post-operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta-regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta-analysis was performed using a random-effect inverse variance method. Meta-regression analysis was conducted to examine the associations between effect sizes and study-level covariates (P < 0·05). The results showed that administration of non-narcotic analgesic was more effective than placebo in the management of post-operative pain, resulting in a lower pain scores with a standardised mean difference of -0·50 (95% CI= -0·70, -0·30), -0·76 (95%CI= -0·95, -0·56), -1·15 (95% CI= -1·52, -0·78), -0·65 (95% CI= -1·05, -0·26) for immediately after the procedure, 6-, 12- and 24 h post-operative follow-ups (test for statistical heterogeneity: P = 0·000, P = 0·000, P = 0·000 and P = 0·001), respectively. Our meta-regression analysis provided the evidence for association between some study covariates with treatment effect, each at different follow-ups. We concluded that the clinicians can manage post-operative endodontic pain by administration of NSAIDs and/or paracetamol. However, analgesic regimens should be considered as important determinants when prescribing a pharmacological adjuvant.

Effects of dietary inclusion of silymarin on performance, intestinal morphology and ileal bacterial count in aflatoxin-challenged broiler chicks.

This study was conducted to investigate the effect of dietary supplementation of silymarin on performance, jejunal morphology and ileal bacterial population in broiler chicks intoxicated with a mix of aflatoxins. A total of three hundred thirty six 7-day-old Ross broiler chicks were randomly distributed between seven experimental groups with four replicates of 12 birds each. Experimental treatments consisted of a control group (unchallenged), and a 2 × 3 factorial arrangement, including two aflatoxin levels (0.5 and 2 ppm) and three levels of silymarin (0, 500 and 1000 ppm). Birds were challenged with a mix of aflatoxins from 7 to 28 days of age. Results showed that increasing aflatoxin level resulted in decreased average daily feed intake (ADFI) and weight gain (ADWG), consequently impaired feed conversion ratio (FCR) throughout the trial period. Dietary supplementation of silymarin resulted in the marked increases in ADFI and ADWG, and improved FCR values in aflatoxin-challenged chicks. Ileal bacterial populations at days 28 and 42 of age were increased by incremental levels of aflatoxins. On the other hand, dietary silymarin supplementation suppressed ileal populations of Escherichia coli, Salmonella, Klebsiella and total negative bacteria in aflatoxicated birds. Increase in dietary aflatoxin level resulted in the decreased villi height, villi height-to-crypt depth ratio (VH:CD), villi surface area and apparent villi absorptive area, while it increased crypt depth, goblet cell count and lymphoid follicular diameter. Feeding silymarin at the level of 1000 ppm increased villi height and VH:CD in aflatoxicated birds. Present results indicate that dietary inclusion of silymarin could improve performance by suppressing ileal bacteria and enhancing absorptive surface area in aflatoxin-challenged broiler chicks.

Ameliorative effects of Nigella sativa on dyslipidemia.

INTRODUCTION: Dyslipidemia is an established risk factor for ischemic heart disease. Nigella sativa (NS) is a medicinal plant that has been used for the treatment and prevention of a variety of diseases, in particular hyperlipidemia. METHODS: We reviewed the existing literature published until 2014 by using the following keywords: ''Nigella sativa'', ''black cumin'', ''black seeds'', ''thymoquinone'', and ''lipid''. RESULTS: In the conducted studies, different preparations of NS including seed powder (100 mg-20 g daily), seed oil (20-800 mg daily), thymoquinone (3.5-20 mg daily), and seed extract (methanolic extract especially), were shown to reduce plasma levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides, but the effect on high-density lipoprotein cholesterol (HDL-C) was not significant. NS and thymoquinone have been reported to be safe and well tolerated with no severe adverse effect. In clinical trials, NS was found to be effective when added as adjunct to standard antihyperlipidemic and antidiabetic medications. Lipid-modifying effects of NS could be attributed to the inhibition of intestinal cholesterol absorption, decreased hepatic cholesterol synthesis, and up-regulation of LDL receptors. CONCLUSIONS: Overall, the evidence from experimental and a clinical studies suggests that NS seeds are a promising natural therapy for dyslipidemic patients.

Comparison of pulp response to mineral trioxide aggregate and a bioceramic paste in partial pulpotomy of sound human premolars: a randomized controlled trial.

AIM: This randomized clinical trial evaluated clinical sign/symptoms as well as histological pulp reactions in terms of inflammation and mineralized bridge formation after partial pulpotomy of sound human premolars and placement of a bioceramic paste (iRoot BP) or tooth-colored ProRoot MTA as pulp-covering biomaterials. METHODOLOGY: Twenty-four human sound premolars were randomly allocated into two experimental groups (n = 12) treated either with iRoot BP or MTA subsequent to partial pulpotomy. Six weeks after treatment, clinical sign/symptoms and radiographic changes were evaluated. The teeth were then extracted and examined histologically for inflammatory status of the pulp, formation of hard tissue bridge and appearance of the bridge. In terms of pulp inflammation and dentinal bridge formation, the Mann-Whitney U, and for clinical signs, the chi-square test was used (α = 0.05). RESULTS: In terms of pulp inflammation, formation of hard tissue bridge and its appearance, the differences between the two experimental groups were not significant. However, clinical sensitivity to cold was significantly less for teeth treated with MTA (P < 0.05). All cases had formed a hard tissue bridge, and none of the specimens in either group had pulpal necrosis. CONCLUSION: When treating teeth with healthy pulps, the response to partial pulpotomy treatment with both MTA and iRoot BP was favourable. However, pulps covered with iRoot BP were more sensitive to cold stimuli.

MTA and ferric sulfate in pulpotomy outcomes of primary molars: a systematic review and meta-analysis.

OBJECTIVE: Methods of systematic review and meta analysis were employed to compare the success rate of pulpotomy of primary molars using mineral trioxide aggregate (MTA) and ferric sulfate (FS) as two regenerative and preservative agents, respectively. STUDY DESIGN: After raising a PICO question (In pulpotomy of vital carious-exposed primary molars, how does MTA compare to FS in terms of clinical and radiographic outcomes?) and determining the search strategy, MeSH-matching keywords were searched in four electronic databases and retrieved papers were examined in titles, and if necessary abstracts and full texts, to be relevant. Randomized clinical trials (RCTs) evaluating pulpotomy of vital primary molars after carious/traumatic exposure conducted with either FS or MTA, with at least a 6-month recall, tooth restorability, and those considering clinical and radiographic signs/symptoms, were included. The nonrandomized allocation and absence of comparison between the treatment groups caused the exclusion of the article. The quality of the RCTs and also their risk of bias (low, moderate, high), were assessed using a modification of van Tulder list; for meta-analysis of the matching studies, the extracted data were analyzed by Mantel Hanszel analysis. RESULTS: A total number of 620 articles were found. After exclusion of the common titles and application of the eligibility criteria, 4 RCTs [12-month follow-up: n=3, 24-month follow-up: n=4, in total: 264 teeth) comparing MTA and FS, were selected. It was showed that the 12-month outcome of both materials were similar [RR= 0.642 (CI 95%: 0.225-1.833, P=0.407)], while the two-year follow-up results revealed significant differences in treatment outcome, in favor of MTA [RR was 0.300 (CI 95%: 0.132-0.683, P=0.004)]. CONCLUSION: MTA demonstrated superior long-term treatment outcomes in pulpotomy of primary molars than FS.

Comparative evaluation of cervical pulpotomy and pulpectomy for primary molars with irreversible pulpitis: a multicentre randomised controlled trial.

PURPOSE: The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP). METHODS: A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates. RESULTS: The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05). CONCLUSION: In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP. TRIAL REGISTRATION NUMBER: Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.

Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial.

AIM: To compare the treatment outcomes of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA) as pulp dressing biomaterials in vital pulpotomy of carious primary molars. STUDY DESIGN: split-mouth randomised clinical trial. MATERIALS AND METHODS: Forty children aged 4-8 years with 2 carious teeth requiring pulpotomy were selected and randomly assigned to MTA (n = 40) or CEM (n = 40) groups. After coronal pulp removal, the remaining radicular pulp was covered with an appropriate biomaterial; the teeth were then permanently restored. Clinical/radiographic success/failures were blindly evaluated at 6-, 12- and 24-month follow-ups. STATISTICS: the recorded data were analyzed with McNemar test and GEE. RESULTS: A total of 36, 33 and 35 patients were available for 6-, 12- and 24-month follow-ups, respectively. At the 12-month follow-up only one and three teeth in the CEM and MTA groups had pathologic external root resorption, respectively. The resorbed teeth were then missed due to extraction/exfoliation at the 24-month follow-up; all other treated teeth were sign/symptom-free. Overall, clinical and radiographic outcomes in both MTA/CEM groups were comparable at the three follow-ups without significant differences. Time had no significant effect on the success. CONCLUSION: MTA and CEM demonstrated favourable treatment outcomes for pulpotomy of carious primary molars; CEM may be an effective pulp dressing biomaterial.

Apexogenesis of a symptomatic molar with calcium enriched mixture.

AIM: This article describes the apexogenesis of a mandibular right second molar in a 12-year-old girl who was referred with a history of lingering pain and pain on chewing. SUMMARY: Clinical and radiographic examinations revealed extensive coronal caries and immature roots. Treatment was performed under rubber dam isolation and included caries removal followed by pulp exposure and access cavity preparation. Pulpotomy was completed, and the remaining radicular pulp was capped with calcium enriched mixture (CEM) cement (BioniqueDent, Tehran, Iran). Clinical and radiographic examinations at 3, 6, and 12 months revealed the tooth was functional with no clinical signs or symptoms of pulpal disease. The final examination confirmed complete root development as well as formation of a calcified bridge beneath the CEM cement.

A comparative study of dental pulp response to several pulpotomy agents.

AIM: To examine the in vivo response of dental pulps in dogs to three pulp-capping agents: calcium hydroxide (CH), mineral trioxide aggregate (MTA) and a new endodontic calcium enriched mixture (CEM) cement. METHODOLOGY: Thirty-six second and third premolar teeth in six beagle dogs were randomly assigned to three experimental groups; CH, MTA or CEM cement. Following isolation and exposure, pulp tissues were removed with a fissure bur and haemostasis achieved. The pulps were dressed with appropriate materials, and the access cavity restored with amalgam. Histological analysis was performed 8 weeks after treatment; the samples were assessed by an independent observer for calcified bridge formation, pulp vitality and pulp inflammation. The data were analysed by Kruskal-Wallis, Mann-Whitney and one-way anova tests. RESULTS: The number of root canals that showed calcified bridge formation, pulp vitality and lack of inflammation was significantly higher for teeth capped with either MTA or CEM cement in comparison with CH (P < 0.05). No significant difference was found between the CEM cement and MTA in terms of calcified bridge formation, pulp vitality and lack of inflammation (P > 0.05). CONCLUSIONS: Mineral trioxide aggregate and CEM cement were associated with a similar favourable biological response to pulpotomy treatment and demonstrated a more effective induction of dentinal bridge formation compared to CH.

Effect of dietary supplementation of mannanoligosaccharides on hepatic gene expressions and humoral and cellular immune responses in aflatoxin-contaminated broiler chicks.

The present study was conducted to investigate the effects of dietary supplementation of mannanoligosaccharides (MOS) on expression of hepatic immunological genes and immune responses in aflatoxin-contaminated broiler chicks. A total of 336 seven-day-old Ross broiler chicks were randomly allotted to 7 experimental treatments with 4 replicates and 12 birds per replicate. Experimental treatments consisted of 2 aflatoxin levels (0.5 and 2 ppm) and 3 supplemental MOS levels (0, 1 and 2 g/kg) as a 2 × 3 factorial arrangement in comparison with a control group (unchallenged group). The chicks were challenged with a mix of aflatoxins during 7-28 d of age. Results showed that aflatoxin challenge resulted in the lower antibody titers against infectious bronchitis (IBV) and bursal (IBD) diseases viruses. In addition, aflatoxin-contaminated birds had a lower (P < 0.0001) lymphocyte percentage and a decline in (P < 0.01) interleukin-2 (IL-2) mRNA abundance. Likewise, heterophil proportion, heterophil to lymphocyte ratio and gene expressions of hepatic interleukin-6 (IL-6) and C reactive protein (CRP) were raised (P < 0.001) by increasing dietary aflatoxin level. Dietary inclusion of MOS increased (P < 0.05) antibody titers against IBV, IBD and Newcastle disease virus. Lymphocyte proportion and hepatic IL-2 gene expression were greater (P < 0.0001) in MOS-supplemented birds. Furthermore, supplemental MOS decreased hepatic IL-6 and CRP abundances. Additionally, inclusion of 2 g/kg MOS resulted in the upregulation (P < 0.01) of hepatic IL-2 gene expression in birds contaminated with 0.5 ppm aflatoxin. The present results indicate that supplemental MOS could improve cellular immunity via the upregulation of hepatic IL-2 gene expression in birds challenged with aflatoxins.

Ethanolic extract of Artemisia aucheri induces regression of aorta wall fatty streaks in hypercholesterolemic rabbits.

Artemisia aucheri is a native-growing plant which is widely used in Iranian traditional medicine. This study was designed to evaluate the effects of A. aucheri on regression of atherosclerosis in hypercholesterolemic rabbits. Twenty five rabbits were randomly divided into five groups of five each and treated 3-months as follows: 1: normal diet, 2: hypercholesterolemic diet (HCD), 3 and 4: HCD for 60 days and then normal diet and normal diet + A. aucheri (100 mg x kg(-1) x day(-1)) respectively for an additional 30 days (regression period). In the regression period dietary use of A. aucheri in group 4 significantly decreased total cholesterol, triglyceride and LDL-cholesterol, while HDL-cholesterol was significantly increased. The atherosclerotic area was significantly decreased in this group. Animals, which received only normal diet in the regression period showed no regression but rather progression of atherosclerosis. These findings suggest that A. aucheri may cause regression of atherosclerotic lesions.

Prognostic value of infection and inflammation markers for late cardiac events in an Iranian sample.

We evaluated the serum levels of IgG antibodies to Helicobacter pylori, Chlamydia pneumoniae and cytomegalovirus and the level of the inflammatory markers C-reactive protein and fibrinogen in 57 patients with acute coronary syndrome, 65 with unstable angina, 60 with stable angina and 44 healthy controls, and whether these markers were associated with cardiac instability 6 months after admission. acute There was a significant increased risk of late coronary events (cardiac death or readmission with coronary events) associated with seropositivity to C. pneumoniae (adjusted odds ratio 2.12; 95% confidence interval: 1.16-4.08). Other parameters were not significantly associated with late cardiac events after adjustment for age, sex, diabetes mellitus, hypertension, hyperlipidaemia and smoking behaviour.

Effects of alfalfa on lipoproteins and fatty streak formation in hypercholesterolemic rabbits.

Alfalfa (Medicago sativa) is a leguminous plant with high contents of phytoestrogen and saponin which are both useful in preventing cardiovascular disorders. This study was designed to evaluate the preventive effect of dietary alfalfa on the development and the progression of atherosclerosis in hyperlipidemic rabbits. Twenty male rabbits were obtained and kept under standard conditions. After 2 weeks of accommodation to the new place, the animals were semi-randomly distributed into four groups of five each. Animals in Group 1 received basic diet and the ones in Group 2 received the same diet to which 1% cholesterol was added. Groups 3 and 4 received similar diets as Groups 1 and 2 respectively, but supplemented with alfalfa. Each of the four groups was fed with its respected diet for a period of 12 weeks. Fasting blood samples were collected from all animals at the beginning and at the end of the study and blood factors were measured. At the end of the study samples from the right and the left coronary arteries as well as the aorta were collected from all animals for pathological evaluations. Though dietary alfalfa decreased total cholesterol, LDL and triglyceride and this effect was not significant, but dietary alfalfa significantly increased HDL. The formation of fatty streaks in the aorta, the right and the left coronary arteries were significantly reduced under the influence of dietary alfalfa. The indication that dietary alfalfa may have preventive effects on the progression of fatty streak formation calls for more studies to clarify the mechanisms of the effect.

Improvement of hypertension, endothelial function and systemic inflammation following short-term supplementation with red beet (Beta vulgaris L.) juice: a randomized crossover pilot study.

Hypertension is a major risk factor for cardiovascular disease and has a prevalence of about one billion people worldwide. It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure (BP). This study aimed to investigate the effect of raw beet juice (RBJ) and cooked beet (CB) on BP of hypertensive subjects. In this randomized crossover study, 24 hypertensive subjects aged 25-68 years old were divided into two groups. One group took RBJ for 2 weeks and the other group took CB. After 2 weeks of treatment, both groups had a washout for 2 weeks then switched to the alternate treatment. Each participant consumed 250 ml day(-1) of RBJ or 250 g day(-1) of CB each for a period of 2 weeks. Body weight, BP, flow-mediated dilation (FMD), lipid profile and inflammatory parameters were measured at baseline and after each period. According to the results, high-sensitivity C-reactive protein (hs-CRP) and tumour necrosis factor alpha (TNF-α) were significantly lower and FMD was significantly higher after treatment with RBJ compared with CB (P<0.05). FMD was significantly (P<0.05) increased, but systolic and diastolic BP, intracellular adhesion molecule-1 (ICAM-1), vascular endothelial adhesion molecule-1 (VCAM-1), hs-CRP, interleukin-6, E-selectin and TNF-α were significantly (P<0.05) decreased with RBJ or CB. Total antioxidant capacity was increased and non-high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol (TC) were decreased with RBJ but not with CB. Although both forms of beetroot were effective in improving BP, endothelial function and systemic inflammation, the raw beetroot juice had greater antihypertensive effects. Also more improvement was observed in endothelial function and systemic inflammation with RBJ compared with CB.

Evaluation of hepatoprotective potential of HESA-A (a marine compound) pretreatment against thioacetamide-induced hepatic damage in rabbits.

HESA-A, a marine compound, has been shown to exhibit antihepatic cancer, antitumor and anti-Parkinson effects. The hepatoprotective potential of HESA-A pretreatment at doses of 125 mg and 250 mg per day orally for a period of 40 days was evaluated against thioacetamide-induced liver damage in rabbits. Biochemical parameters such as serum glutamate oxaloacetate transaminase and lactate dehydrogenase in serum were estimated to assess liver function and lipid peroxidation products (malondialdehyde [MDA]) and the antierythrocyte lysis effect of plasma for measurement of antioxidant potential capacity. Data on the hepatic biochemical parameters revealed the hepatoprotective potential of HESA-A pretreatment against thioacetamide-induced hepatotoxicity in rabbits. There was an increase in total antioxidant and antierythrocyte lysis and a decrease in MDA in plasma after HESA-A treatment. These results strongly suggest that HESA-A has a protective action against preoperative damage to biomembranes.

Protective effect of flavonoids against red blood cell hemolysis by free radicals.

BACKGROUND: Flavonoids are polyphenolic substances with antioxidant properties, and they are found in different vegetables and fruits. Epidemiological studies have shown that the consumption of flavonoids reduces the prevalence of cardiovascular diseases. The use of synthetic antioxidants, however, has been limited because of their toxicity. Therefore, medical researchers have intensified their quest to find natural antioxidants. OBJECTIVES: To investigate the effect of several pure flavonoids, such as kaempferol, quercetin, morin and rutin, on red blood cell hemolysis and evaluate their -SH capacity as an indicator of membrane protection. METHODS: The rate of hemolysis and cell membrane -SH capacity were determined by spectrophotometry. Red blood cell peroxidation was induced using 2,2'-azo-bis-(2-amidinopropane) dihydrochloride. The effect of each flavonoid on hemolysis was examined at three concentrations (0.5 mug/mL, 5 mug/mL and 10 mug/mL), however, only the greatest concentration (10 mug/mL) of each flavonoid was used to study the effect on -SH groups. RESULTS: In all cases, the antioxidant activity was dose-dependent. Rutin showed the highest inhibitory effect on hemolysis among flavonoids (42.5%). The protective effect of kaempferol, rutin and morin against -SH group oxidation measured 7.7%, 23.3% and 26.4%, respectively. CONCLUSIONS: Results showed that flavonoids and flavonoid-containing plants can be used as natural antioxidants for the treatment and prevention of disease conditions, the pathogenesis of which is mediated by lipid peroxidation.

Effects of cigarette smoke, nicotine and cotinine on red blood cell hemolysis and their -SH capacity.

BACKGROUND: Smoking is a leading cause of premature death. Red blood cell (RBC) membrane lipids are rich in polyunsaturated fatty acids; therefore, the effect of oxygen on RBC membranes is more prominent than on other body tissues. The attachment of peroxidants to RBC membranes can result in hemolysis. OBJECTIVES: The present study was conducted to assess the sensitivity of RBCs to 2,2'-azo-bis-(2-amidinopropane) dihydrochloride in smokers and nonsmokers. The effect of cigarette smoke, nicotine (1 mug/mL, 1.5 mug/mL and 2.5 mug/mL) and cotinine (1.25 mug/mL, 2.5 mug/mL and 5 mug/mL) on RBC hemolysis was also examined. RESULTS: RBC hemolysis in smokers was 21.6% higher than in non-smokers (P<0.05). Cigarette smoke increased 2,2'-azo-bis-(2-amidino-propane) dihydrochloride-induced RBC hemolysis by 281.7%. Nicotine inhibited RBC hemolysis by 36.7% at the highest concentration used, but increased RBC hemolysis at the lower concentrations. Cotinine caused a 13.8% increase in RBC membrane peroxidation at the highest concentration used and its effects were dose-dependent. At their highest concentrations, nicotine and cotinine decreased -SH groups by 50%. CONCLUSIONS: The present study confirms the results from previous studies of the oxidative and destructive effects of cigarette smoke, which are detrimental to the health of both active and passive smokers.