Journal of Kerman University of Medical Sciences
Volume:27 Issue: 6, Nov Dec 2020

Determining the location of mandibular canal and mental foramen in the implant treatment is important to prevent any damage to the mental foramen and mandibular canal. The interpretation of a radiographic image depends on the individual interpretation of the observer. The aim of this study was to assess the agreement between two radiologists on the identification of mental foramen and mandibular canal. In this study, 95 digital panoramic images ofedentulous patients were evaluated by two radiologists to determine the type of mental foramen according to the Yosue and Brooks classification as well as the type of mandibular canal according to the classification of Angelopoulos. Data were analyzed using SPSS version 17. The most common appearance of mental foramen was continuous type. The intra-examiner agreement on the type of mental foramen on the right and left sides was as much as 0.60 and 0.72, respectively. The highest frequency was observed in the anterior and middle one-third of the superior border of the mandibular canal related to type zero and posterior one-third related to type three. Type three in the inferior border of mandibular canal was the most frequent type in all one thirds. There was also a significant difference in the anterior, middle, and posterior one-third of the superior and inferior borders of mandibular canal observations. The most common appearance of mental foramen on panoramic images was continuous type. The posterior one-third of mandibular canal was more clearly in panoramic images.

Simultaneous co-consumption of abused substances is common among drug users. This study examined the effects of co-administration of marijuana/ nicotine and morphine on some cytokines in rats. Ninety eight rats were randomly divided into fourteen experimental groups including control (saline 1 ml/kg, i.p.), morphine (1, 3 and 5 mg/kg, i.p.), nicotine (0.5, 2 and 4 mg/kg, i.p.), marijuana (2.5, 5 and 10 mg/kg, i.p.) and the combination groups in which the rats received the combination of either effective or sub-effective doses of nicotine/ marijuana and morphine. Inflammation was induced via formalin injection into the left hind paw of all the control and the treated rats. The serum concentrations of some cytokines (TNF-ɑ, IL-1, and IL-6) were measured by using an enzyme-linked immune-sorbent assay (ELISA) technique. A significant reduction in TNF-ɑ, IL-1, and IL-6 concentration was observed in marijuana, nicotine and morphine treated rats. Also, the co-administration of effective doses of marijuana/ nicotine and morphine caused a significant reduction in cytokines, indicating either an additive or a synergistic effect. The clinical application for the combined use of these substances has not been determined yet and further research is needed to clarify the efficacy, safety and tolerability of these combinations in inflammatory process.

The purpose of this study was to investigate and predict ventilator-associated pneumonia (VAP) in the two groups of patients who received either proton pump inhibitors (Pantoprazole) or histamine H2 antagonist (Ranitidine).
Patients in ICU received Pantoprazole or Ranitidine as stress-related mucosal injury and GI bleeding prophylaxis. The incidence rate of VAP and GI bleeding was estimated in each group during ICU stay. Chi-Square and Multivariate Logistic Regression Test were used for data analysis. P.value less than 0.05 was considered significant. Data analysis was performed through SPSS version 19.0.
The incidence rate of VAP in the Ranitidine and Pantoprazole groups was 44.7% and 37.3% respectively (p=0.3). According to the multivariable logistic regression analysis, length of mechanical ventilation ≥ 4 days was a predictive factor for VAP only in the Pantoprazole group (OR: 1.8, 95% CI: 1.56-1.90, p=0.006). No relationship between GI bleeding incidence and stress ulcer prophylaxis was found (p=0.4). Kaplan-Meier curve showed no significant difference between the two groups of Ranitidine and Pantoprazole (p=0.4) in survival time according to the length of ICU stay.
According to the results, there was no difference between the two groups in terms of VAP, GI bleeding and stress ulcer. Due to the lower cost of Ranitidine, it may be a more appropriate choice for GI bleeding prophylaxis in ICU patients.

Local anesthetics have been proven as a method to reduce postoperative pain and opioid use. It reduces side effects associated with drug use and may improve patient health and reduce hospital length of stay. The aim of this study was to evaluate the effect of intraperitoneal bupivacaine on post-operative pain in laparoscopic colorectal surgery.
In this prospective randomized control trial, 63 patients aged 20-70 years candidates for laparoscopic proctectomy or rectopexy surgery, were divided into two groups. In the case group, anastomosis site was washed with 50 mL of bupivacaine 0.2% intraperitoneally. In the control group, equal volume of normal saline was used as placebo. Intravenous autofuser pain control filled with 3 g paracetamol was considered for all patients. Visual analogue scale (VAS) was recorded at 2, 8, 24 hours and narcotic usage was recorded totally for the first 24 hours after the operation.
There was no significant difference between pain scores according to the VAS criteria at 2, 8, and 24 hours after the operation in the case and control groups (P>0.05). Total pethidine consumption during the first 24 hours after the operation was lower in the bupivacaine group (49.03 ± 45.77) compared to the control group (77.74 ± 63.50), but the difference was not significant (P>0.05). However, the total dose of pethidine used after 24 hours after proctectomy (not rectopexy) was significantly lower in the bupivacaine group than that in the control group (P<0.05).
Intraperitoneal lavage with bupivacaine during the operation reduced post-operative total narcotics use in patients who underwent laparoscopic proctectomy, not in rectopexy.

Glomerulonephritis is the one of disorders associated with diabetes. The present study was conducted to investigate the effect of 8-week high-intensity interval training (HIIT) and caffeine supplementation on the levels of serum creatinine (Cr) and blood urea nitrogen (BUN) and morphological changes of kidney tissue in diabetic rats.
50 diabetic rats as streptozotocin (STZ)-induced diabetic rats were randomly assigned to 5 equal groups including control, diabetic, diabetic + caffeine, diabetic + training, and diabetic + training + caffeine. The groups were given supplements (intraperitoneal injection of 70 mg/kg of caffeine powder for five days in each week) and underwent training (5 sessions including 6 to 12 times of 2-minutes training at the rate of 85-90% of maximal speed each week ) for 8 weeks. The serum Cr and BUN levels and the morphological changes of kidney tissue after 48 hours of the last training session were measured. Statistical analysis was performed by one- and two-way ANOVA (P<0.001).
It was revealed that HIIT reduced the levels of Cr (P=0.001) and BUN (P=0.013), as well as the urinary tract area (P=0.015) in diabetic rats. Although caffeine supplementation significantly reduced glomerular area (P=0.001) but increased BUN level (P=0.001) and Bowman's capsule (P=0.001) in them. There was a significant interaction between treatments regarding BUN level and urinary tract area changes (P=0.001, P=0.014, respectively).
HIIT and caffeine supplementation had significant effects on the serum Cr and BUN levels and morphological changes in rats' kidney tissues, but given doses and time of consumption of caffeine, as well as duration and intensity of training were more effective than the other indicators.

There are many therapeutic modalities for oral lichen planus under trial; however, none has resulted in complete remission of lesions yet. The aim of this study was to evaluate the combination therapy with topical triamcinolone acetate comparing to topical triamcinolone acetate alone in the treatment of oral lichen planus.
Patients were randomly divided into the two groups to receive either 0.1% triamcinolone alone (group TO) or 0.1% triamcinolone with 0.05% retinoic acid (group TRO). Participants were instructed to apply medication thrice daily and were visited at baseline and after 1, 2, 3, and four weeks of treatment. The size of lesions and symptoms were recorded at each session. Relaps was followed up in a 2-month period. Data were analyzed using Mann–Whitney U-test and through SPSS 13.0 software.
The decrease in pain and burning sensation in both groups was similar four weeks after the treatment (P=0.71). All patients in the TRO group (100%) and 85% of patients in the TO group were improved to score 1 & 0. The decrease in the size of keratosis, atrophic, and erosive form of lesions were different in the two groups significantly (P<0.0001). In the 2nd month follow up, 10% of the TRO group and 15% of the TO group had relapsed which was not statistically significant (P=1).
According to the results, retinoid improves the efficacy of the corticosteroid in the suppression of inflammation in oral lichen planus patients and combination of them improves lichen planus lesions more than triamcinolone acetonide alone.

Patients with symptomatic ectopic pregnancy are treated surgically through either salpingectomy or salpingostomy. There is evidence that laparoscopic salpingectomy may reduce fertility due to the absence of one tube and in regard to the recurrence, some investigations have showed higher recurrence of ectopic pregnancy in salpingostomy than salpingectomy but some others have reported equal recurrence in both techniques. This study compares the effects of laparoscopic salpingectomy and laparoscopic salpingostomy on fertility outcome and recurrence of ectopic pregnancy.
This was a comparative study on a sample of pregnant women with tubal ectopic pregnancy who underwent a surgical treatment in a teaching hospital affiliated to Tehran University of Medical Sciences between 2014 and 2017. Women underwent either laparoscopic salpingectomy (group 1) or laparoscopic salpingostomy (group 2). Fertility outcome and the rate of recurrence of ectopic pregnancy were compared between the two groups.
In whole, 390 pregnant women were treated surgically for ectopic pregnancy. Of these, 213 patients attempted to become pregnant after the surgery and were entered into the study (107 in group 1 and 106 in group 2). The frequency of intrauterine pregnancy was 55 in group 1 and 64 in group 2 while the frequency of ectopic pregnancy recurrence was 4 in group 1 and 3 in group 2 (P = 0.45).
The findings indicated that laparoscopic salpingectomy and laparoscopic salpingostomy did not significantly differ in recurrence of ectopic pregnancy and intrauterine fertility.

Ankylosis of temporomandibular joint describes the pathological development of bony connections or fibrosis that occurs in the region between the condylar head of the mandible and the glenoid fossa of the temporal bone. This condition can severely affect the function of temporomandibular joint and its mobility. The aim of this study was to evaluate the practicality of CBCT imaging in different types of temporomandibular joint ankylosis.

This cross-sectional study involved 32 cases of ankylosed temporomandibular joint from 26 patients (12 males and 14 females) aged 8-65 years (mean age: 29.8±14.3) who had visited a private maxillofacial clinic between 2013 and 2016 for CBCT images of temporomandibular joint and had been diagnosed with ankylosis by a maxillofacial surgeon. The present study relied on both Dongmei’s and Sawhney’s classifications to assess the different types of joint ankylosis. A number of morphological parameters, including: D1 (the mediolateral diameter of the condyle), D2 (the width of the bony fusion area), D3 (the degree of calcification in the bony fusion area) and D4 (the D2/D1 ratio) were also defined and registered.

All of the four variables (D1, D2, D2/D1 and D4) showed a negative correlation with the extent of mouth opening, but the amounts were non-significant (P>0.05). The level of agreement between the two classification approaches was significantly low (P=0.003). The highest degree of coronoid hyperplasia was seen in types II and III according to both Sawhney’s and Dongmei’s classifications. The greatest measure of condylar head displacement was observed in types II and III of Sawhney’s, and type III of Dongmei’s classification. Connection in the lateral side of the joint in type III of both Sawhney’s and Dongmei’s classifications was the most frequent case. More severe cases of ankylosis were commonly associated with older ages, but the relationship was not significant (P>0.05).

CBCT seems to be the most advantageous modality of imaging as far as temporomandibular joint abnormalities are concerned, including ankylosis. Although the application of the two conventional classifications (Sawhney’s and Dongmei’s) produced little agreement in terms of radiological findings, it seems that the employment of such classifications in conjunction with CBCT imaging is a promising method for the diagnosis and evaluation of temporomandibular joint ankylosis.

Primary central nervous system lymphoma is a rare brain tumor and the most common risk factor is immune system deficiency. This tumor can be seen in normal people however it is mainly seen in an age range of 50-70 years and predominantly in the male gender. The incidence of this disease in different ages is also influenced by race. As reported, at the age below 50-years blacks have had higher overall incidence rates in comparison to whites. Although analysis of CSF and hematologic tests can help diagnosis the only definite diagnosis tool is biopsy. The tumor cell’s high susceptibility to corticosteroid-dependent apoptosis. Corticosteroids have not been used before biopsy. The main treatment strategy is high dose methotrexate (HD-MTX) - based chemotherapy and whole brain radiation and surgery is restricted to biopsy for diagnostic purposes only. Here we present a case of a young female without immune deficiency who was diagnosed with primary central nervous system lymphoma.