Clinical Performance of Glass Ionomer Cement in Load-Bearing Restorations: A Systematic Review.

Glass ionomer cement (GIC) is a self-adhesive dental restorative material composed of a polyacrylic acid liquid and fluoro-aluminosilicate glass powder. It is commonly used for cementation during dental restoration. This study aimed to systematically review the existing literature regarding the clinical performance of GIC in load-bearing dental restorations. A comprehensive literature search was conducted in EBSCO, PubMed, Embrace, and Cochrane databases. Only randomized controlled trials (RCTs) were included in the search, and a broad search technique was used, where inclusion and exclusion criteria were applied. After a thorough evaluation, 12 RCTs were extensively reviewed, and whether GIC is suitable for load-bearing restorations was determined. Significant variations in staining surface or margin, color match, translucency, esthetic anatomical form, retention, material fracture, marginal adaptation, surface luster, occlusal contour, wear, and approximal anatomical form indicated the unsuitability of GIC. By contrast, significance differences in patient view and periodontal response indicated that GIC is suitable. No significant differences in postoperative sensitivity, recurrence of caries, or tooth integrity were observed. Nevertheless, the results of the review demonstrated that the clinical performance of GIC is comparable to that of traditional restorative materials with regard to the parameters analyzed. GIC is a suitable restorative material for load-bearing restorations regarding surface margin, esthetic anatomical form, material retention and fracture, marginal adaptation, occlusal contour, wear, and approximal anatomical form. It reduces other parameters, such as postoperative sensitivity, recurrence of caries, and tooth integrity.

Mucoepidermoid Carcinoma of Minor Salivary Gland in a Patient with Asymptomatic Palatal Swelling - A Case Report.

Incidence of abundant minor salivary gland tissues in the posterior part of hard palate surges the likelihood of salivary gland neoplasm especially in this part of the oral cavity. Minor salivary gland tumor accounts for virtually 15% of all the salivary gland neoplasm, wherein mucoepidermoid carcinoma comprises of 35.9%. Current paper reports a case of mucoepidermoid carcinoma of the posterior part of the hard palate which was an incidental finding. It presented as well-defined smooth swelling, the preliminary radiographic investigation revealed no appreciable bony changes and offered an impression of a benign tumor. Histopathological investigation displayed features of mucoepidermoid carcinoma of intermediate grade. The lesion was surgically excised and the patient was under regular follow up for 3years. The paper focus on the magnitude of swift clinical diagnosis of specific lesions, so increasing the survival rate and reducing the morbidity.

The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review.

BACKGROUND: Migraine is a disabling primary headache disorder often associated with triggers. Diet-related triggers are a common cause of migraine and certain diets have been reported to decrease the frequency of migraine attacks if dietary triggers or patterns are adjusted. OBJECTIVE: The systematic literature review was conducted to qualitatively summarize evidence from the published literature regarding the role of diet patterns, diet-related triggers, and diet interventions in people with migraine. METHODS: A literature search was carried out on diet patterns, diet-related triggers, and diet interventions used to treat and/or prevent migraine attacks, using an a priori protocol. MEDLINE and EMBASE databases were searched to identify studies assessing the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Only primary literature sources (randomized controlled trials or observational studies) were included and searches were conducted from January 2000 to March 2019. The NICE checklist was used to assess the quality of the included studies of randomized controlled trials and the Downs and Black checklist was used for the assessment of observational studies. RESULTS: A total of 43 studies were included in this review, of which 11 assessed diet patterns, 12 assessed diet interventions, and 20 assessed diet-related triggers. The overall quality of evidence was low, as most of the (68%) studies assessing diet patterns and diet-related triggers were cross-sectional studies or patient surveys. The studies regarding diet interventions assessed a variety of diets, such as ketogenic diet, elimination diets, and low-fat diets. Alcohol and caffeine uses were the most common diet patterns and diet-related triggers associated with increased frequency of migraine attacks. Most of the diet interventions, such as low-fat and elimination diets, were related to a decrease in the frequency of migraine attacks. CONCLUSIONS: There is limited high-quality randomized controlled trial data on diet patterns or diet-related triggers. A few small randomized controlled trials have assessed diet interventions in preventing migraine attacks without strong results. Although many patients already reported avoiding personal diet-related triggers in their migraine management, high-quality research is needed to confirm the effect of diet in people with migraine.

Does exercise make migraines worse and tension type headaches better?

Many non-pharmacological treatments have been implicated in the treatment of primary headache, with exercise being a common recommendation. In this review we first provide an overview of the relationship between exercise and primary headaches. We then review the physiology of pain modulation, with focus on the endogenous opioids, endocannabinoids, and neuropeptides calcitonin gene-related peptide (CGRP) and brain-derived neurotrophic factor (BDNF), and their associations with primary headache and exercise. Finally, we summarize current literature evaluating effects of exercise on primary headache in an effort to understand the benefits and disadvantages of exercise in primary headaches.

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study.

BACKGROUND: The ongoing debate between routine and selective users of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has not yet come to an end. Routine users argue that IOC decreases the rate of biliary complications such as bile duct injury, biliary leak and missed common bile duct (CBD) stones, a claim that selective users do not fully support. On the other hand, a third policy that was adopted by many other centers is performing LC without IOC. In this retrospective study, we are exploring the results of a relatively large multicenter series of LC without IOC regarding major biliary complications. METHODS: We performed a retrospective analysis of LC cases operated by experienced laparoscopic surgeons, without resorting to IOC, in four surgical units of university hospitals in Egypt during a 6-year period (January 2004 through December 2009). Excluded from the study were cases with positive predictors of CBD stones, namely, sonographically detected CBD dilatation and/or CBD stones, elevated bilirubin and/or alkaline phosphatase, persistent biliary pancreatitis, cholangitis, and those who had preoperative magnetic resonance cholangiography. RESULTS: Of the 2,955 cases of LC reviewed, 241 were excluded, leaving 2,714 cases enrolled in the study. Fifty-five cases (2%) were converted to open surgery. Five cases (0.18%) had major bile duct injuries requiring surgical repair. Postoperative bile leakage was encountered in seven cases (0.26%). Missed CBD stones were reported in six cases (0.22%). There was no perioperative mortality in the present study. CONCLUSION: LC can be performed safely without the use of IOC, with acceptable low rates of biliary complications provided that proper detection of patients with silent CBD stones is done and facilities for pre- and postoperative endoscopic retrograde cholangiopancreatography are available.

Thoracoscopic sympathectomy is a valuable addition in the management of recreational intra-arterial drug injection. Pilot study.

BACKGROUND: Intra-arterial Injection (IAI) of illicit substances by drug abusers may result in acute ischemia, limb loss or permanent functional deficit. No prospective human studies have shown that any specific treatment is superior to another. Thoracoscopic sympathectomy (TS) has proven efficacy in upper limb ischemia due to organic blockade. This is a pilot study to evaluate the effect of thoracoscopic sympathectomy addition to the management protocol of recreational intra-arterial drug injection. PATIENTS AND METHODS: A total of 11 victims of upper limb IAI of recreational drug were recruited (10 males) with age range from 18 to 43 years old (average 30+/-8.3 years). Tissue Ischemia Score (TIS) was used for pretreatment assessment of the degree of ischemic injury and severity of pain was evaluated pre- and post-operatively using visual analog score (VAS) and compared using Student's t test. Pre-operative VAS score was 6.9+/-1.8. All enrolled patients were treated according to the following protocol; anticoagulation, calcium channel blocker, opiates for pain, and TS. Patients received the stated protocol for minimum of 72h (range 3-8 days; mean 5; average 4.7+/-1.5 days). Freedom of amputation and improvement of pain scores were the study endpoints. RESULTS: No mortality, yet one case had bleeding secondary to anticoagulant and one case of post-operative pneumothorax that required chest tube drainage for 24h. No patients had wet gangrene or spreading infection. Freedom of amputation was achieved in nine patients, 81% (7 patients had normal outcome and other two had permanent neurological deficit). Two patients (18%) had tissue necrosis with dry gangrene and mummification of the affected digits with eventual amputation. Postoperative VAS pain score was 2.09+/-1.37 (p<0.05). Pain medications were suspended in 6 patients (54.5%), reduced in 4 (36%) and unchanged in 1 (9%). All patients with TIS score 2 or less had a normal outcome while those with scores 3 and 4 had a variable outcome. Using regression analysis, initial TIS was significant for outcome prediction (p=0.043) while age, arterial site, drug injected and time delay were not significant. CONCLUSION: The addition of TS was an attempt to halt the ischemic process after IAI which permitted, in our belief, optimal symptom control with maximum tissue salvage. Because the procedure is minimally invasive, safe, and associated with a low complication rate; it worth consideration whenever IAI is encountered.