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Open access

Stamatis Karakonstantis, Mina Koulouridi, Kyriakos Pitsillos, Eirini Kalokyri, Anna Kozyri, Galateia Gourniezaki and Charalampos Lydakis

Abstract

Introduction: Several diagnoses have been associated with leukemoid reaction (LR). In patients with LR the diagnostic and prognostic value of detailed manual blood smear counts (such as the percentage of band cells or grading of neutrophil toxic changes) has not been studied previously.

Methods: We prospectively recorded all hospitalized adult (>18 years old) patients with LR (≥30000/ul) of neutrophilic predominance, excluding patients with pre-existing leukocytosis due to hematological malignancies. We examined the diagnoses and prognosis (in-hospital mortality and post-discharge mortality up to a year after the end of the study) of these patients as well as the value of manual peripheral smear review.

Results: We recorded a total of 93 patients with LR from January 2017 to December 2017. Infection was the most common diagnosis (70%), followed by malignancy (7.5%) and bleeding (6.5%). In-hospital mortality (45%) and post-discharge mortality (35% of those discharged) were very high. Among blood smear findings, only neutrophil vacuolation was significantly more common in patients with infections (34%), although it was also observed in many patients without any infection (13%). Blood smear findings were not associated with prognosis

Conclusion: Detailed manual smear review is a labor-intensive procedure and has limited diagnostic and prognostic value in unselected hospitalized patients with neutrophilic LR.

Open access

Mile Bosilkovski, Marija Dimzova, Marija Cvetkova, Kostadin Poposki, Katerina Spasovska and Ivan Vidinic

Abstract

Introduction: The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in Republic of North Macedonia during two different time periods.

Patients and methods: retrospectively were analysed the causes for FUO and final diagnostic approaches in 185 patients with classic FUO that were treated at the University Hospital for Infectious diseases in Skopje during two time periods. Seventy nine patients were treated during 1991 to 1995 and 106 patients during 2011 to 2015.

Results: When comparing these two periods, infections were present in 46.8% and 29.2% (p=0.014), non-infective inflammatory disorders in 22.8% and 25.5% (p=0.674), neoplasms in 10.1% and 13.2% (p=0.522), miscellaneous in 8.9% and 12.3% (p=0.461) and undiagnosed cases in 11.4% and 19.8% (p=0.124), respectively. The most common causes for FUO during the first period were abscesses (8.9%), tuberculosis and systemic lupus erythematosus (7.6% each), whereas in the second period the commonest causes were adult onset Still disease and solid organ neoplasm (7.6% each), polymyalgia rheumatica, abscesses and visceral leishmaniasis (5.7% each). The newer imaging techniques and clinical course evaluation had superior diagnostic significance during the second period.

Conclusion: A changing pattern of diseases causing FUO during the examined periods was evident. Infections continue to be the most common cause but with decreasing incidence when compared to 20 year ago. Even nowadays clinical evaluation and follow-up still remain the vital diagnostic tools in determining the etiology of FUO.

Open access

Pablo Revilla-Martí, Juana Pelegrín-Díaz, Gonzalo Rodrigo-Trallero, Jose Antonio Linares-Vicente and Jose Ramón Ruiz-Arroyo

Summary

We describe a rare case of ventricular arrhythmia in a patient with cardiac haemochromatosis related to iron overload in the myocardium and without evidence of systolic dysfunction or heart failure. This case stresses the utility of cardiac magnetic resonance imaging for the early identification of iron overload in the heart and starting appropriate treatment.

Open access

Zoi-Despoina Tzima, Nikolaos Economides, Christos Gogos and Ioannis Kolokouris

Summary

Background/Aim: To investigate the incidence of procedural errors with the use of a novel nickel-titanium rotary system (Hyflex CM, Coltene/Whaledent, Altstätten Switzerland), evaluate the technical quality of root canal treatments and assess a questionnaire completed by the participants themselves in an undergraduate dental clinic between 2014 and 2017 (Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki).

Material and Methods: 118 undergraduate students in their first year of clinical practice performed a root canal treatment on a patient’s molar (maxillary/mandibular). None of the participants had previous experience in rotary instrumentation. The periapical radiographs were taken with the use of the paralleling technique for standardization and were collected and evaluated by the investigator. After the root canal treatment was performed the students completed a questionnaire in order to evaluate their training on rotary instrumentation.

Results: The overall incidence of instrument separation, apical perforation, root perforation, straightening and ledges was 0.8%, 4.4%, 2.3%, 5.5% and 29% respectively on root canal level. Ledges were detected more often in mandibular mesiobuccal canals. The frequency of root canals with an ‘acceptable’ filling was 68.4%, while overfilled and underfilled canals were found to be 8.6% and 16.2% respectively. The response rate was high (94.9%), 35% of the participants encountered no difficulty in the use of rotary instrumentation and 98.2% would use it again.

Conclusions: The incidence of procedural errors was considerably low and the technical quality of the filled root canals was superior to that of similar studies. The responses of the questionnaire demonstrated a positive attitude toward rotary instrumentation.

Open access

Tugcenur Uzun and Orcun Toptas

Summary

Backgroung/Aim: Papillon Lefévre syndrome is a rare autosomal recessive genodermatosis. The characteristic findings of the disease are early loss of primary and permanent teeth and palmoplantar keratoderma. Notwithstanding that many etiologic factors like genetic mutations, bacterial agents, immunologic changes have been identified, the pathogenesis has not been fully understood. Although dentists play an important role in the diagnosis and treatment of Papillon Lefévre syndrome, it is appropriate to treat the disease with a multidisciplinary approach.

Case Report: In this case report, the clinical, radiological and genetic examination of the patient with Papillon Lefévre syndrome who has a homozygous mutation in the CTSC gene will be presented.

Conclusions: Dentists should have knowledge about treatment management of these patients. Teeth can be preserved longer with early diagnosis and appropriate treatment of the disease.

Open access

Aleksandar Đorđević, Mirko Mikić, Jelena Stanišić and Filip Đorđević

Summary

Background/Aim: Implant treatment expands extensively the possibilities of prosthetic treatment, which provide benefits, bigger comfort as well as general improvement of the patient’s life quality. In cases with no possibility of implantation, it is possible to improve conditions by using modern methods for bone tissue repair. One of factors important for the long-term success is proper oral hygiene, as well as raising awareness of its importance to patients. The aim of the paper is to present a patient rehabilitated with multiple implants and followed-up for a five-year period, and to point out the importance of raising patient’s awareness and motivation in order to preserve the results of the treatment.

Case Report: A 31-year-old patient was admitted to the oral surgery clinic for rehabilitation of a poor oral health status. After taking history, clinical examination and additional analysis, the following treatment plan was suggested: to remove impacted upper canines and to put an implant supported by fixed prosthesis in the upper jaw, to make two implants supported by bridges laterally and one dental supported by bridge in the inter-canine sector in the lower jaw. The treatment was carried out in several stages that involved extraction of residual roots and impacted teeth, augmentation of bone defects with bone substitutes and bio-absorbable membranes, placing implant, and prosthetic rehabilitation. By verbal communication with the patient, we pointed out the importance of proper oral hygiene and regular check-ups. The five year follow-up showed the absence of factors that could adversely affect the success of the treatment, and the patient was still highly motivated to maintain proper oral hygiene.

Conclusions: It is possible to achieve predictable results in complex cases by using a multiphase prosthetic treatment supported by implants. Concerning a long-term success, motivation, proper information and patient’s willingness to cooperate play an important role.

Open access

Hend Mahmoud Mohamed Hegazi

Summary

Background/Aim: A problem of congenitally missing lateral incisors is frequently encountered in dentistry, with several available treatment modalities, the choice depending on each case. Case Report: A young female patient with bilateral missing lateral incisors was in need for dental treatment for esthetics. She had spacing among the upper anterior teeth with class I molar relationship. Orthodontic space creation was carried out followed by two-piece mini dental implant placement. Two-stage protocol was followed. After osseointegration, implants were exposed. Healing collars were installed to allow mucosal healing. Closed tray implant level impression was taken. Zirconium crowns were chosen for optimum esthetic results. Conclusions: Mini-implants can be used successfully for restoring congenitally missing lateral incisors after space opening. Esthetic results can be enhanced using Zirconium crowns

Open access

Marizela Šabanović, Semir Saltović, Azra Avdić Mujkić, Midhat Jašić and Zerina Bahić

Summary

Propolis is a natural resinous substance collected by honey bees from buds and exudates of plant species, mixed with bee enzymes, pollen and wax. It has a complex composition with a wide range of effects, including antibacterial, antiviral, antifungal, antiflogistic, antioxidant, hepatoprotective, carcinostatic and immunomodulatory properties. It is often applied in the treatment of diseases involving the oral cavity and gums. The aim of this paper is to describe the therapeutic properties of propolis, chemical composition and its application in the oral cavity. Literature and systematic information on the composition and the effects of propolis on health were collected, with particular reference to the use in the treatment of oral cavity diseases. The chemical composition of propolis is very complex. The health impact depends on the biologically active components it contains. A particularly important application is in the treatment of diseases of the oral cavity. Studies show that propolis can help prevent dental caries and control gingivitis and plaque. It reduces halithosis (bad breath) and symptoms of periodontosis. It is also effective in fighting viruses. It can have significant application in orthodontics and restorative dentistry. A wide range of effects allows the multiple uses of propolis-based products. Recent research has been increasingly focused on diseases of the oral cavity. The development of novel propolis-based pharmaceutical forms could significantly reduce the use of antibiotics in conventional treatment of diseases of the oral cavity.

Open access

Aleksandar Sovtic, Tamara Peric, Predrag Minic and Dejan Markovic

Summary

The most frequent chronic respiratory problems in childhood are asthma and cystic fibrosis (CF). The purpose of this paper is to review basic knowledge and recent advances in oral health and associated dental morbidities in children with asthma and CF. This review considered clinical trials and systematic reviews related to oral health in children with CRD. An online base Medline was searched to determine relevant papers, using the combination of the following terms: “asthma”, “cystic fibrosis”, “caries”, “dental erosion”, and “oral health”. Oral health problems in children with chronic respiratory diseases (CRD) may be influenced by natural course of the disease, pharmacotherapy (inhalation therapy with bronchodilators and inhaled corticosteroids in asthmatic patients, systemic antibiotics and pancreatic enzyme replacement therapy in CF patients), medication administration technique and nutritional habits. Children with CRD may have higher prevalence of oral diseases. Patients and their parents, but also general paediatricians and pulmonologists, should be aware of importance of good oral health. Dental practitioners should be more informed about risk factors and specificities of oral health in these patients. Preventive measures, early diagnosis and effective treatment strategies in children with CRD can reduce occurrence of oral diseases and improve patient’s quality of life.