Reasons for Repeated General Anesthesia for Dental Treatments of Uncooperative Children.

Objectives: In some cases, dental treatment of children under general anesthesia (GA) should be repeated due to treatment failures. This study evaluated the reasons leading to dental retreatment under GA in children under 12 years of age. Materials and methods:In this retrospective study, the records of all children who underwent dental treatment under GA between 2011-2021 in Tabriz Dental Faculty Hospital, Iran, were collected. The records of children treated under GA for the second time or more were analyzed. Collected data included age at first treatment, mental and/or physical disabilities, type of treatments and participation in follow-up sessions. Data were analyzed using Stata SE version 17. Results:In a group of 667 children who underwent general anesthesia for the first time (GA1), 41% (95% confidence interval [CI] 37.2%-44.9%) required retreatment. Among all age groups, 1-3-year-old children were more likely to require a second GA (GA2) compared to other age groups (all P < 0.05). Children with physical and mental disabilities were around eight times more likely to require a second GA (P < 0.05). Conclusion:Younger age, mental and physical disabilities, no or irregular participation in follow-up sessions and treatments such as composite resin restorations or pulpotomy were factors influencing repeated dental treatments under general anesthesia.

CXCL9 and its Receptor CXCR3, an Important Link Between Inflammation and Cardiovascular Risks in RA Patients.

Cardiovascular disease (CVD) is the most common cause of mortality in rheumatoid arthritis (RA), and Inflammation has a decisive role in its pathogenesis. CXCL9 contributes to multi aspects of inflammatory reactions associated with the pathogenesis of CVD. In the current study, we evaluated the association of plasma CXCL9 and CXCR3 gene expression with Cardiovascular risk factors in RA patients for the first time. Thirty newly diagnosed, 30 on-treatment RA patients, and 30 healthy subjects were recruited in this study. The plasma concentration of CXCL9 and CXCR3 gene expression were measured using ELISA and Real-Time PCR, respectively. The CVD risk was evaluated using Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE). The plasma levels of CXCL9 were significantly higher in the newly diagnosed and on-treatment RA patients compared to the control group (P < 0.0001 and P < 0.001, respectively). Also, The CXCR3 gene expression was strongly elevated in newly diagnosed and on-treatment patients (P < 0.001 and P < 0.01, respectively). The CXCL9 and CXCR3 were significantly associated with RA disease activity (P = 0.0005, r = 0.436; P = 0.0002, r = 0.463, respectively). The FRS was remarkably higher in newly diagnosed and on-treatment patients (P = 0.014 and P = 0.035, respectively). The CXCR3 gene expression significantly correlated with age, systolic blood pressure, FRS, and SCORE (P = 0.020, r = 0.298; P = 0.006, r = 0.346; P = 0.006, r = 0.349; P = 0.007, r = 0.341, respectively). The CXCL9 plasma concentration had a significant negative correlation with plasma HDL and LDL levels (P = 0.033, r = -0.275; P = 0.021, r = -0.296, respectively). CXCL9 and CXCR3 correlates with different variables of CVD in RA.

Effects of topical fluoride treatment on the bond strength of pit and fissure sealants: A systematic review.

Background: This systematic review aimed to evaluate the available scientific evidence concerning the effects of topical fluoride treatment on the bond strength of pit and fissure sealants. Prevention of dental caries is one of the crucial issues in pediatric dentistry. Pit and fissure sealant and fluoride therapies are two caries prevention procedures that may be performed in one session. However, fluoride therapy may affect the bond strength of pit and fissure sealants. Methods: An electronic search for in vitro studies published in English and Persian on topical fluoride therapy and the bond strength of pit and fissure sealants was performed via PubMed/ Medline, Web of Science, Google Scholar, Embase, and Scopus databases until May 2022. The articles were independently reviewed for quality by two reviewers. Textual data were analyzed manually, and the bond strength of sealants placed after fluoride application was compared with control groups. Results: A total of 8482 articles were initially identified and reviewed by two independent reviewers, and 13 were selected for full-text evaluation. Finally, six articles were included in the systematic review. A total of 250 teeth were studied, 148 of which were in the case group (fluoride group) and 102 in the control group. Tensile and shear bond strengths were compared between groups in the studies. Conclusion: In the studies in which the tooth surfaces were washed after applying fluoride, there was no change in the fissure sealant bond strength. However, in studies in which fluoride was not washed, the bond strength decreased significantly, independent of the fluoride type.

Mini-Review: Role of Drugs Affecting Renin-Angiotensin System (RAS) in Traumatic Brain Injury (TBI): What We Know and What We Should Know.

Traumatic brain injuries (TBIs) are among the most important clinical and research areas in neurosurgery, owing to their devastating effects and high prevalence. Over the last few decades, there has been increasing research on the complex pathophysiology of TBI and secondary injuries following TBI. A growing body of evidence has shown that the renin-angiotensin system (RAS), a well-known cardiovascular regulatory pathway, plays a role in TBI pathophysiology. Acknowledging these complex and poorly understood pathways and their role in TBI could help design new clinical trials involving drugs that alter the RAS network, most notably angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. This study aimed to briefly review the molecular, animal, and human studies on these drugs in TBI and provide a clear vision for researchers to fill knowledge gaps in the future.

The efficacy of intrathecal methyl-prednisolone for acute spinal cord injury: A pilot study.

Study design: Randomized clinical trial. Objectives: To evaluate the safety and effectiveness of intrathecal methyl-prednisolone compared to intravenous methyl-prednisolone in acute spinal cord injuries. Setting: Imam Reza Hospital, Tabriz University of Medical Sciences. Methods: Patients meeting our inclusion and exclusion criteria were enrolled in the study and divided randomly into two treatment arms: intrathecal and intravenous. Standard spinal cord injury care (including surgery) was given to each patient based on our institutional policy. Patients were then assessed for neurological status (based on ASIA scores, Frankel scores) and complications for six months and compared to baseline status after injury. To better understand the biological bases of methyl-prednisolone on spinal cord injuries, we measured two biomarkers for oxidative stress (serum malondialdehyde and total antioxidant capacity) in these patients at arrival and day three after injury. Results: The present study showed no significant difference between the treatment arms in neurological status (sensory scores or motor scores) or complications. However, the within-group analysis showed improvement in neurological status in each treatment arm within six months. Serum malondialdehyde and total antioxidant capacity were analyzed, and no significant difference between the groups was seen. Conclusion: This is the first known clinical trial investigating the effect of intrathecal MP in acute SCI patients. Our finding did not show any significant differences in complication rates and neurological outcomes between the two study arms. Further studies should be conducted to define the positive and negative effects of this somehow novel technique in different populations as well.

Accuracy of Teledentistry for Diagnosis and Treatment Planning of Pediatric Patients during COVID-19 Pandemic.

Teledentistry is a new technology in the dentistry field, which has great benefits during pandemic such as the coronavirus disease 2019 (COVID-19). The overall purpose of the study was to assess the diagnostic sensitivity and specificity of virtual (mobile phone teledentistry) compared with clinical examinations during COVID-19. The basic design of the study was based on the comparison treatment plans by the students and the gold standard (clinical treatment plan of an expert pedodontist with 10 years of clinical experience). This double-blind clinical trial was conducted on 20 children (aged 6 to 12 years) with a chief complaint of dental caries with or without pain. An appropriate radiograph and five standard intraoral photographs (frontal view occlusion, maxillary occlusal view, mandibular occlusal view, right lateral view, and left lateral view) were prescribed for each patient according to the guidelines of the American Association of Pediatric Dentistry. Then, the treatment plan for the carious teeth was recorded for each patient. Each patient underwent a clinical examination at first and was followed randomly by a virtual examination by two dental students. Then, the clinical and virtual treatment plans were compared with each other, and also with the gold standard. The sensitivity and specificity values were calculated for each group. The accuracy of the diagnosis was measured by applying Cohen's kappa. Interexaminer reliability was measured using the intraclass correlation coefficient (ICC) and Cronbach's alpha. The mean kappa coefficient for the interexaminer agreement (for 24 teeth) was 0.62 in clinical and 0.69 in virtual examinations. The results showed no significant difference in the treatment plans of students and the gold standard (P > 0.05). The diagnostic sensitivity and specificity were 73.22% and 95.8% for clinical and 76.44% and 92.9% for virtual treatment plans showing no significant differences between virtual (mobile phone teledentistry) and clinical examinations (P > 0.05). The intraexaminer reliability of the examiners was found to be 0.92 by calculating the ICC. Then, teledentistry can be considered as a supplement to clinical examinations of pediatric dentistry, finally resulting in better patient management. However, more studies are necessary for teledentistry.

Factors Affecting the Duration of Fixed Orthodontic Treatment in Patients Treated in a University Department between 2016 and 2020.

Objective:The aim of this study was to assess the effect of possible influential factors on duration of fixed orthodontic treatment. Methods:This cross-sectional retrospective study included 505 female and 183 male orthodontic patients (a total of 688 persons) referring to a university department of orthodontics during 2016-2020. The study population included only those who had undergone fixed orthodontic treatment of both maxillary and mandibular arches. Information including age, gender, total treatment duration, number of missed treatment sessions, incidences of bracket debonding, and type of treatment plan were collected from patient records. Data were analyzed using SPSS software version 21 at 0.05 significance level. Results:The mean duration of orthodontic treatment was significantly longer in men than women (19.09±5.6 versus 18.22±4.56 months, respectively; P=0.040). The treatment duration was also longer in patients with a treatment plan including teeth extraction compared to non-extraction treatment plans (19.85±4.30 versus 17.56±5.02 months, respectively; P<0.001). Duration of treatment in patients with more than one missed treatment appointment was significantly longer than those who had . one missed session (P<0.001). Duration of treatment in patients with bracket debonding was significantly longer (P=0.030). Also, the duration of treatment had a significant correlation with the frequency of both missed sessions (r=0.365, P<0.001) and bracket debonding (r=0.098, P=0.01). Conclusion:Based on the results of the present study, missed sessions, treatment plan, and bracket debonding have the greatest effect on the duration of fixed orthodontic treatment.

Risk factors of dislocation after total hip arthroplasty in patients with developmental dysplasia of the hip.

PURPOSE: Dislocation following total hip arthroplasty (THA) is a well-known complication. However, there is little data on its rate and predictors in patients with developmental dysplasia of the hip (DDH). The current study is aimed to determine the rate and specific risk factors of dislocation following THA in DDH patients. METHODS: All the medico-surgical records of primary THAs from January 2014 to January 2019 were retrospectively reviewed. They were categorized into three main groups: primary OA, DDH, and others. Pre-operative and post-operative radiographs, past medical and surgical history, and surgical notes were reviewed in DDH cases. RESULTS: In a total of 171 patients with DDH, 21 suffered from dislocation after THA (12%) which was significantly more frequent than those with primary OA. In univariate analysis, higher grade of dysplasia, smaller head size, intra-operative fracture, Wagner Cone stem, failure of offset restoration, and implanting the cup outside the Lewinnek's safe zone were identified as predictors of dislocation. In multiple regression analysis, however, only higher Crowe grade, intra-operative fracture, and post-operative acetabular offset less than 16 mm were independent predictors of dislocation. CONCLUSION: Dysplastic hips can be more prone to post-THA dislocation than those with primary OA. Higher grades of dysplasia, failure of offset restoration, and intra-operative fracture can increase the rate of dislocation in this group of patients.

Vital pulp therapy following pulpotomy in immature first permanent molars with deep caries using novel fast-setting calcium silicate cement: A retrospective clinical study.

OBJECTIVES: To compare the success rate of vital pulp therapy following complete pulpotomy in immature first permanent molars, during caries treatment, using novel fast-setting calcium silicate cement (Novel CSC) versus MTA. METHODS: Six- to eight- years old children, who received pulpotomy of first immature permanent molar using one layer novel CSC (Protooth) or two layers slow-setting MTA (MTA Angelus) covered with glass ionomer were recalled for radiographic and clinical evaluation after two years. The effects of cement type, age, gender, jaw, anesthesia type, and restoration type were assessed on the clinical success of pulpotomy and continued root formation (apexogenesis) as the treatment outcome. RESULTS: Out of 366 included teeth in the study, 316 teeth were available for statistical analysis. The mean observation time was 28.2 ±â€¯2.7 months. Novel CSC showed significantly higher clinical success rate (93.1%) compared to MTA (84.5%). Restored teeth with stainless steel crowns after pulpotomy and treatments performed under general anesthesia had a statistically significant effect on treatment outcome in contrast to age, gender, and jaw type. CONCLUSION: The observations of this retrospective study suggested that the success rate of vital pulp therapy following complete pulpotomy using one layer fast-setting novel CSC was significantly higher than slow-setting MTA covered with glass ionomer. Treatment under general anesthesia and restoration using stainless steel crowns influenced the treatment outcome. CLINICAL SIGNIFICANCE: Novel fast-setting calcium silicate cement is a promising new biomaterial for vital pulp therapy in immature permanent molars that allows complete root formation overtime with apexogenesis. Clinicians must also be aware of the importance of immediate definitive restoration and proper sealing and isolation in vital pulp therapy.

Pull-Out Bond Strength of Titanium Post Cemented with Novel Fast-Setting Calcium Silicate Cement.

OBJECTIVE: The aim of this study was to compare the pull-out bond strength of prefabricated titanium posts cemented with novel fast-setting calcium silicate, zinc phosphate, or glass ionomer cements. METHODS: Sixty extracted human maxillary incisors were selected and received root canal treatment. Post space was prepared for titanium ParaPost XP size 5 (diameter=1.25 mm). The posts were cemented using novel calcium silicate cement, zinc phosphate cement, or glass ionomer cement (n=20). Specimens were stored in phosphate-buffered saline for 4 weeks. Subsequently, the posts were subjected to axial tensile force until bond failure. Data were analyzed by one-way ANOVA followed by multiple comparisons. RESULTS: The posts cemented with novel calcium silicate cement (10.5±3.8 MPa) demonstrated significantly higher bond strength than zinc phosphate (8.0±2.6 MPa) and glass ionomer cements (8.0±2.7 MPa) (P<0.05). CONCLUSION: Within the limitation of the study, the pull-out bond strength of titanium post cemented with novel calcium silicate cement in endodontically treated teeth was superior to zinc phosphate and glass ionomer cements.

Chronically altered NMDAR signaling in epilepsy mediates comorbid depression.

Depression is the most common psychiatric comorbidity of epilepsy. However, the molecular pathways underlying this association remain unclear. The NMDA receptor (NMDAR) may play a role in this association, as its downstream signaling has been shown to undergo long-term changes following excitotoxic neuronal damage. To study this pathway, we used an animal model of fluoxetine-resistant epilepsy-associated depression (EAD). We determined the molecular changes associated with the development of depressive symptoms and examined their response to various combinations of fluoxetine and a selective neuronal nitric oxide synthase inhibitor, 7-nitroindazole (NI). Depressive symptoms were determined using the forced swim test. Furthermore, expression and phosphorylation levels of markers in the ERK/CREB/ELK1/BDNF/cFOS pathway were measured to determine the molecular changes associated with these symptoms. Finally, oxidative stress markers were measured to more clearly determine the individual contributions of each treatment. While chronic fluoxetine (Flxc) and NI were ineffective alone, their combination had a statistically significant synergistic effect in reducing depressive symptoms. The development of depressive symptoms in epileptic rats was associated with the downregulation of ERK2 expression and ELK1 and CREB phosphorylation. These changes were exactly reversed upon Flxc + NI treatment, which led to increased BDNF and cFOS expression as well. Interestingly, ERK1 did not seem to play a role in these experiments. NI seemed to have augmented Flxc's antidepressant activity by reducing oxidative stress. Our findings suggest NMDAR signaling alterations are a major contributor to EAD development and a potential target for treating conditions associated with underlying excitotoxic neuronal damage.

Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis.

BACKGROUND: Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. METHODS: In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. RESULTS: A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5-8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24-55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. CONCLUSIONS: Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

Protective Effects of Leukadherin1 in a Rat Model of Targeted Experimental Autoimmune Encephalomyelitis (EAE): Possible Role of P47phox and MDA Downregulation.

BACKGROUND: Reactive oxygen and nitrogen species (ROS and RNS) are involved in pathologic mechanisms underlying demyelination and exacerbation in multiple sclerosis (MS) lesions. P47phox is the most important subunit of an ROS-producing enzyme (NADPH oxidase) which is reportedly upregulated in MS plaques due to the intense activity of infiltrated immune cells and resident microglia. Leukadherin1 is a specific CD11b/CD18 agonist that inhibits signaling and transmigration of inflammatory cells to sites of injury. Based on this mechanism, we evaluated therapeutic effects of leukadherin1 in an animal model of targeted experimental autoimmune encephalomyelitis (EAE) through focal injection of inflammatory cytokines to the spinal cord. METHODS: For model induction, Lewis rats were first immunized with 15µg MOG 1-125 emulsion. Twenty days later, animals were subjected to stereotaxic injection of IFNγ and TNFα to the specific spinal area (T8). One day after injection, all animals presented EAE clinical signs, and their behaviors were monitored for eight days through open-field locomotion and grid-walking tests. Leukadherin1-treated animals received daily intraperitoneal injections of 1mg/kg of the drug. The specific spinal tissues were extracted on day 5 in order to measure nitric oxide (NO), malon di-aldehyde (MDA), and TNFα concentrations alongside P47phox real-time PCR analysis. In addition, spinal sections were prepared for immunohistochemical (IHC) observation of infiltrated leukocytes and activated microglia. RESULTS: Leukadherin1 exhibited promising improvements in EAE clinical scores and behavioral tests. Demyelination, CD45+ leukocyte infiltration, and Iba1+ microglia activation were reduced in spinal tissues of leukadherin1-treated animals. Furthermore, P47phox expression levels, MDA, and NO amounts were decreased in treated animals. However, TNFα concentrations did not differ following treatment. CONCLUSION: Based on our results, we suggest that leukadherin1 may be used as a novel therapeutic agent in tackling the clinical challenge of multiple sclerosis, especially during the acute phase of the disease. This effect was possibly mediated through decreased leukocyte infiltration and oxidative stress.

A narrative review on the management of Acute Heart Failure in Emergency Medicine Department.

The main urgent symptom presented to an emergency department is acute heart failure (AHF). In that considerable risksof morbidity and mortality, it is important to plan precision medicine to achieve the most suitable outcomes. The object of this review is to provide a summary of contemporary management procedures of emergency medicine in a department of acute heart failure. Heart failure could be presented with a broad range of symptoms, in particular a sudden worsening of those of Chronic Obstructive Pulmonary Disease. The treatment should focus on acute and chronic underlying disorders with instructions focusing on haemodynamics and blood pressure status. Treatment of patients suffering with worsening symptoms of AHF mainly focuses on intravenous diuretics. In emergency situations, patients suffering with AHF with low blood pressure must receive emergency consultation and a primary fluid bolus therapy (range 250-500 mL) followed by inotropic therapy with or without antihypotensive agents. For treatment of severe heart failure and cardiogenic shock in patients treated with noradrenalin, when blood pressure support is required, a direct-acting inotropic agent, dobutamine, could be applied effectively. When non-invasive positive pressure ventilation is needed, suppliers must track for any possibility of sudden worsening, i.e., for acute decompensated heart failure. When cardiac output is high the disorder could be treated with vasopressors.

Closed Antegrade/Retrograde intramedullary fixation of central metatarsal fractures: Surgical technique and clinical outcomes.

BACKGROUND: Intramedullary fixation with k-wires is a surgical option in the management of fractures of the shaft and neck of central metatarsals. The current study aimed at investigating the clinical outcomes of closed antegrade/retrograde intramedullary pinning technique. PATIENTS AND METHODS: A total of 34 patients (26 males and eight females) with 58 metatarsal neck and shaft fractures (28 shaft and 26 neck fractures) were operated using the antegrade/retrograde intramedullary fixation technique. At the final follow-up visit, pain intensity was assessed using the visual analog scale (VAS) and foot function was evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system. RESULTS: Mean follow-up period was 18 months, ranged 12 to 34. Mean time to clinical fracture healing was 6.5 weeks, ranged 5 to 9. Bony union was occurred in all the cases. No surgical site infection was noted. Mean VAS score at the final follow-up visit was 0.28, ranged 0 to 3. At the final follow-up, the mean AOFAS score was 95.2, ranged 81 to 100. CONCLUSION: Closed antegrade/retrograde intramedullary pinning is a minimally invasive technique to manage central metatarsal fractures. Using this technique, metatarsal alignment can be restored and good clinical outcome is achieved.

Comparison of Effects Exerted by 4% Articaine Buccal Infiltration and 2% Lidocaine Inferior Alveolar Nerve Block on Pain Perception and Behavioral Feedback of Children during Pulp Treatment of Mandibular Second Primary Molars.

Background: One of the most impressive factors discouraging many people from seeking dental treatment is the fear of experiencing pain during dental procedures. Thus, the use of an effective method for pain control is vital in this regard. Articaine, which has an additional ester and thiophene groups that increase its biosolubility and permeability compared to older anesthetic agents, can be more effective on inducing anesthesia during dental treatment. Given the inconsistent currently available information on this concept, the present study was designed to compare the efficacy of articaine with that of lidocaine on pain control during pulp treatment of deciduous molar. Methods and materials: In this cross-sectional study, 38 patients who needed pulpotomy in both mandibular second molar of primary teeth were randomly divided into two groups, using the Randlist software. In the first meeting, infiltration with articaine 4% (epinephrine 1/100 000) was performed for all patients in group 1 on the left side of the mandible. At the next appointment, inferior alveolar nerve block was done with lidocaine 2% on the right side of the mandible (epinephrine 1/80 000). Notably, for all patients in the second group, the first injection was performed on the right second primary molar with articaine 4% (epinephrine 1/100 000), and inferior alveolar nerve block was also done with lidocaine 2% on the left side of the mandible (epinephrine 1/80 000). Results:Of the 38 patients included in the current study, 10 (26.3%) subjects in the lidocaine group and nine (23.6%) in the articaine group complained of pain during their dental treatment procedures, but this difference was not statistically significant. Conclusion: According to the findings of this study, buccal infiltration of 4% articaine had a comparable anesthetic outcome to that of 2% lidocaine for inferior alveolar nerve block in pulp treatment of the second primary mandibular molars.

PIRO, SOFA and MEDS Scores in Predicting One-Month Mortality of Sepsis Patients; a Diagnostic Accuracy Study.

INTRODUCTION: Different scoring systems based on clinical and laboratory findings are designed for prediction of short-term mortality of patients with severe sepsis and septic shock. This study aimed to compare the screening performance characteristics of PIRO, SOFA and MEDS Scores in predicting one-month mortality of sepsis patients. METHODS: This diagnostic accuracy study was performed on septic shock and severe sepsis patients referring to emergency department of Loghmane Hakim Hospital, Tehran, Iran, from 2017 to 2018. The performance of MEDS, SOFA, and PIRO models in predicting 30-day mortality of patients was evaluated using discrimination and calibration indices. RESULTS: 200 patients with the mean age of 71.03±15.59 years were studied (61% male). During the 30 days, 66 patients died (mortality rate=33%). The area under the ROC curve of PIRO, MEDS, and SOFA scores were 0.83 (95% CI=0.78-0.89), 0.94 (95% CI=0.91-0.97) and 0.87 (95% CI=0.81-0.92), respectively. Based on Brier, BrierScaled and Nagelkerke's R2 of the models, the best performance in predicting one-month mortality belonged to MEDS score. C-statistic showed that MEDS score had the highest value in the differentiation between the survived and non-survived cases. CONCLUSION: This study showed that MEDS score performs better than PIRO and SOFA scores in predicting one-month mortality of patients with severe sepsis and septic shock.

Prognosis in children with traumatic injuries referring to the emergency department.

PURPOSE: Trauma may lead to serious complications in children patients. The purpose of this study was to investigate prognosis in children with traumatic injuries. METHODS: This cross-sectional study was conducted on all of the children (<18 years old) who had suffered traumatic injuries and transferred to the emergency department of Imam Hussein Hospital by emergency medical services. After selecting the children, a checklist including information such as demographic characteristics, trauma type, consciousness level, and final outcome was recorded. Finally, the data were analyzed using t-test, Chi-square test and ANOVA. RESULTS: In total of 564 children were investigated. Among them, 70% were males, and 33.2% were in the age range of 5-12 years. The mechanism of injuries in 97.9% of the cases was blunt trauma. The most common chief complaint among the affected children was nausea. The majority of them had stable vital signs and normal neurological tests results. However, 1.06% of them died during hospitalization. The results indicated that the final outcome in the children affected by traumatic injuries is significantly related to the type of trauma, the location of traumatic event, the vehicle used to transport them to emergency departments and their Glasgow coma scale score (p < 0.05). CONCLUSION: Considering the young age of the child patients and over half of trauma happened at home, it is important to raise parents' awareness about the risky places and activities, which were likely to result in traumatic injuries for children.

Chitin Prevalence and Function in Bacteria, Fungi and Protists.

Chitin is an important structural polysaccharide, which supports and organizes extracellular matrices in a variety of taxonomic groups including bacteria, fungi, protists, and animals. Additionally, chitin has been recognized as a molecule that is required for Rhizobia-legume symbiosis and involved in arbuscular mycorrhizal signaling in the symbiotic interaction between terrestrial plants and fungi. Moreover, it serves as a unique molecular pattern in the plant defense system against pathogenic fungi and parasites, and in the innate and adaptive immune response of mammals and humans. In this review, we will focus on the prevalence and structural function of chitin in bacteria, fungi, and protists, with a particular focus on the evolution of chitin synthases and the function of chitin oligosaccharides as a signaling molecule in symbiosis and immunity.

HPLC profiling of phenolics and flavonoids of Adonidia merrillii fruits and their antioxidant and cytotoxic properties.

In this study the antioxidant and cytotoxicity activity of the Adonidia merrillii fruits were investigated using different solvent polarities (methanol, ethyl acetate and water). The results showed that the total phenolic and flavonoid contents of the methanolic extract was higher compare with other extract with respective values of 17.80 ± 0.45 mg gallic acid equivalents/g dry weight (DW) and 5.43 ± 0.33 mg rutin equivalents/g DW. Beside that The RP-HPLC analyses indicated the presence of gallic acid, pyrogallol, caffeic acid, vanillic acid, syringic acid, naringin and rutin. In the DPPH, NO2 and ABTS scavenging assays, the methanolic extract exhibited higher antioxidant activity as compared to the ethyl acetate and water extracts. The extracts exhibited moderate to weak cytotoxic activity in the assays using human hepatocytes (Chang liver cells) and NIH/3T3 (fibroblasts cell) cell lines. The findings showed the Adonidia merrillii fruit extracts to possess considerable antioxidant and cytotoxicity properties. The fruit, therefore, is a potential candidate for further work to discover antioxidant and cytotoxic drugs from natural sources.