Platelet rich fibrin in the management of medication-related osteonecrosis of the jaw: a clinical and histopathological evaluation.

Bisphosphonates are antiresorptive pharmacological agents used in the treatment of osteoporosis. Recently, osteonecrosis of the jaw has been recognized as a potential side effect in patients on long-term bisphosphonate therapy. This condition, popularly called bisphosphonate-related osteonecrosis of the jaw (BRONJ), has been rechristened as MRONJ (medication-related osteonecrosis of the jaw) to accommodate the increasing number of cases of osteonecrosis of jaws associated with various other antiresorptive and antigiogenic pharmacological therapies. The aim of the present study was to assess the outcome of using platelet-rich fibrin (PRF) for the treatment of MRONJ in a single study group. Twenty-three consecutive patients (15 females and 8 males; aged 52-73 years) with MRONJ were enrolled in this study. These patients presented a history of bisphosphonate medication of varying duration, presence of exposed bone in the maxillofacial region for more than eight weeks, and no history of radiation therapy to the jaws. These patients were managed by surgical curettage and application of platelet rich fibrin (PRF). The outcomes were assessed using clinical and histopathological methods. On the basis of the present findings, we can conclude that PRF can act as an effective barrier membrane between the alveolar bone and the oral cavity and may offer a fast, easy and effective alternative method for the closure of bone exposure in MRONJ patients.

Characterization of human apical papilla-derived stem cells.

Dental tissues represent an alternative and promising source of post-natal Mesenchymal stem cells (MSCs) for tissue engineering. Furthermore, dental stem cells from apical papilla (SCAPs) cells can be obtained from the wisdom tooth which is unnecessary for human masticatory function and frequently extracted for orthodontic reasons or dysodontiasis. More precisely, apical papilla is the immature, mostly uncalcified, precursor of the tooth root, therefore is composed of more undifferentiated cells than dental pulp. In addition, tooth extraction, especially by piezosurgery technique, can be considered less invasive in comparison to bone marrow or other tissues biopsy. Our work is aimed to investigate the safety of and predictable procedure on surgical immature third molar extraction and to provide new insight on SCAP research for future biomedical applications. The isolated cells were examined for stem cell properties by analyzing their colony-forming efficiency, differentiation characteristics and the expression of MSC markers.

Treatment of acute Charcot foot with bisphosphonates: a systematic review of the literature.

AIM/HYPOTHESIS: We undertook a systematic review of the literature concerning the efficacy and safety of bisphosphonates in acute Charcot neuropathic osteoarthropathy. METHODS: MEDLINE, PubMed, the Cochrane Database of Systematic Reviews, and abstracts presented during the meetings of the American Diabetes Association and the European Association of Diabetes were searched for relevant publications from the period January 1990 to September 2011. RESULTS: A total of ten studies on the treatment of acute Charcot osteoarthropathy with bisphosphonates were identified and included in the analysis. Only four clinical trials were published, three of which were randomised. Bisphosphonates appeared to induce significant reductions in skin temperature and bone turnover markers compared with placebo, without serious adverse events. Nevertheless, bisphosphonates did not shorten the immobilisation time. Moreover, no data were available regarding their long-term effects. CONCLUSIONS/INTERPRETATIONS: Bisphosphonates have been shown to be effective for reducing bone turnover markers and skin temperature in some studies. Nevertheless, the long-term efficacy, specifically that regarding the occurrence of deformities and ulcerations, remains to be demonstrated as no follow-up studies have been published. Moreover, some studies have suggested that bisphosphonates may lengthen the resolution phase of the disease. In our opinion, the data are too weak to support the use of bisphosphonates as a routine treatment for acute Charcot neuroarthropathy.

Impact of the Hajj on pneumococcal transmission.

Over two million Muslim pilgrims assemble annually in Mecca and Medina, Saudi Arabia, to complete the Hajj. The large number of people in a crowded environment increases the potential for pneumococcal carriage amplification. We evaluated pneumococcal carriage prevalence with four cross-sectional studies conducted at beginning-Hajj (Mecca) and end-Hajj (Mina) during 2011 and 2012. A questionnaire was administered and a nasopharyngeal swab was collected. The swab was tested for pneumococcus, serotype and antibiotic resistance. A total of 3203 subjects (1590 at beginning-Hajj and 1613 at end-Hajj) originating from 18 countries in Africa or Asia were enrolled. The overall pneumococcal carriage prevalence was 6.0%. There was an increase in carriage between beginning-Hajj and end-Hajj cohorts for: overall carriage (4.4% versus 7.5%, prevalence ratio (PR) 1.7, 95% CI 1.3-2.3), and carriage of 23-valent pneumococcal polysaccharide vaccine serotypes (2.3% versus 4.1%, PR 1.8, 95% CI 1.2-2.7), 13-valent pneumococcal conjugate vaccine (PCV) serotypes (1.1% versus 3.6%, PR 3.2, 95% CI 1.9-5.6), 10-valent PCV serotypes (0.6% versus 1.6%, PR 2.6, 95% CI 1.2-5.3), antibiotic non-susceptible isolates (2.5% versus 6.1%, PR 2.5, 95% CI 1.7-3.6) and multiple non-susceptible isolates (0.6% versus 2.2%, PR 3.8, 95% CI 1.8-7.9). Fifty-two different serotypes were identified, most commonly serotypes 3 (17%), 19F (5%) and 34 (5%). These results suggest that the Hajj may increase pneumococcal carriage-particularly conjugate vaccine serotypes and antibiotic non-susceptible strains, although the exact mechanism remains unknown. The Hajj may therefore provide a mechanism for the global distribution of pneumococci.

A comparative study of post-operative pain in laser epithelial keratomileusis versus photorefractive keratectomy.

BACKGROUND: To compare the level of post-operative pain associated with two methods of excimer laser corneal refractive surgery: PRK (photorefractive keratectomy) versus LASEK (laser epithelial keratomileusis). METHODS: 14 patients undergoing simultaneous bilateral myopic PRK were included in the study. The first eye of each patient was randomly allocated for treatment by either LASEK or PRK with alcohol-assisted epithelial debridement and second eyes were treated with the other technique. Laser corneal ablation was performed with Nidek EC-5000 excimer laser by one surgeon (MAA) using the same algorithm. Post-operatively, all patients had declofenac sodium 0.1% eye drops four times a day, lorazepam 2mg at night and two solpadol (paracetamol 500mg and codeine phosphate 30mg) tablets every six hours orally for two days. Chloramphenicol 0.5% drops four times a day were also administered for seven days. The level of pain in each eye was assessed 2, 12, 24 and 48 hours following laser surgery using a descriptive pain score from 0 to 10. Statistical analysis was performed using paired t test. RESULTS: The mean pain score at two hours post-operatively was 3.5 +/- 2.24(SD) in the LASEK group and 5.7 +/- 2.02(SD) in the PRK group. This difference is statistically significant. At 12 hours it was 4.33 +/- 2.53 (SD) and 4.75 +/- 2.30 (SD), at 24 hours it was 3.71 +/-2.84 (SD) and 4.00 +/- 2.48 (SD), and at 48 hours it was 2.86 +/- 3.43 (SD) and 2.21 +/- 2.55 (SD). There was no statistically significant difference in the pain score at these intervals. CONCLUSIONS: Post-operative pain was less in eyes treated with LASEK than eyes treated with PRK 2 hours following laser surgery. This was statisticaly significant and there was no statistically significant difference at 12, 24 and 48 hours.

Respiratory syncytial virus infection in hospitalized children older than 2 years with community-acquired pneumonia.

BACKGROUND/AIM: Respiratory syncytial virus (RSV) is one of the main causes of bronchiolitis and pneumonia in infants and young children. The aims of the present study were to evaluate the role of RSV in children >2 years old hospitalized with community-acquired pneumonia (CAP) and to type the circulating RSV strains. MATERIALS AND METHODS: Serum and throat swab samples were taken upon admission from Greek children aged > 2 years, hospitalized with atypical CAP, and when possible, a second serum sample was also taken. RSV IgG and IgM antibodies were determined by Enzyme Linked Immunosorbent Assay (ELISA), while throat swab samples were tested by nested RT-PCR. Additional serological testing was performed to find out probable co-infections. RESULTS: A total of 101 children with atypical CAP were included in the study, aged 2.5-14 years (median 8.25). RSV IgM antibodies were detected in 21 (20.7%) cases, either in the first or/and in the second serum sample, while RSV genome was detected in 11 out of 15 (73%) IgM-positive patients, which were further tested by PCR. PCR-positive results were obtained up to the 7(th) day of illness. Among the 11 cases, one was of type B, and all the rest were of type A. The median age of the RSV-positive children was 4 years (range 3-13 years). Although RSV was detected in all seasons, the majority of cases (31%) were detected in winter. Co-infection was detected in 3 cases (two with Mycoplasma pneumoniae and one with adenovirus). CONCLUSIONS: Apart from the known role of RSV as the most important pathogen causing acute respiratory disease in infants and young children, it is also a significant viral pathogen in older children hospitalized because of CAP. Genetic typing provides further insight into the epidemiology of the disease.

Fracture of the anterior segment of the atrophic mandible related to dental implants.

Implant placement in an anterior atrophic mandible is not an uncommon procedure. Fracture secondary to such implant placement is a rare complication. The authors discuss a case referred to their surgical centre and discuss the management approaches found in the English literature.

Mycoplasma pneumoniae respiratory tract infections among Greek children.

BACKGROUND: M. pneumoniae is a common cause of respiratory tract infections (RTIs) of variable severity especially in children. New diagnostic techniques offered more reliable information about the epidemiology of infection by this pathogen. AIM: The aim of this study was to investigate the prevalence and epidemiology of acute M. pneumoniae infections among Greek children hospitalized for RTIs using more advanced techniques. MATERIAL AND METHODS: The study included 225 Greek children hospitalized for RTIs during a 15-month period. Throat swab specimens were tested by PCR for the detection of M. pneumoniae, while IgG and IgM antibodies were determined by ELISA and, in certain cases, also by western-blot. In parallel, specimens were tested for the presence of additional respiratory pathogens. RESULTS: M. pneumoniae infection was diagnosed as the only pathogen in 25 (11.1%) cases, being the second (after respiratory syncytial virus- RSV) most often detected pathogen. The proportion of cases with M. pneumoniae infection in age group 8-14 years (23.3%) was significantly higher than that in <3 years age group. CONCLUSION: During our study period, M. pneumoniae was the second causative agent of RTIs after RSV. The proportion of children with M. pneumoniae RTIs increased with age, while most cases were reported during summer and autumn.