Vol 18, No 3 (2014)

Background and objective: Bone sialoprotein is a mineralized tissue-specific protein expressed in differentiated osteoblasts that appear to function in the initial mineralization of bone. The aim of this study was to investigate the effect of local bone sialoprotein on increasing the rate of anchorage during orthodontic tooth movement.

Methods: This study used 14 dogs wearing orthodontic appliance for 40 days. They were divided equally into two groups; experimental group that injected with 0.1 µg /10µL sialoprotein around the anchoring tooth in three different time intervals, while the other control group received normal saline injection. Different clinical measurements including loss of anchorage, space closure, rotation, tipping and extrusion were done on the stone casts of each dog before and after tooth retraction.  

Results: Clinical measurements revealed a highly significant difference between experimental and control group regarding loss of anchorage and space closure. The sialoprotein injected group showed less loss of anchorage than control group and the space closure was higher in experimental group than in the control group.

Conclusion: This study showed that the local injection of sialoiprotein reduced movement of the anchoring tooth during orthodontic treatment and provided higher stability for the anchoring tooth.

Background and objective: Deltopectoral flap is a two staged flap requiring skin graft of the donor site. This study was conducted to evaluate the possibility of primary closure of the deltopectoral flap-donor site without skin grafting.

Methods: The operations were conducted at Rizgari Teaching Hospital in the center of Erbil City, Kurdistan Region of Iraq. From January 2009 to December 2012, 14 deltopectoral flaps for reconstruction of oral/facial cancer ablative defects were done. Data on the age, gender, tumor site, and postoperative complications related to primarily closed deltopectoral flap-donor site (fistula, dehiscence, or hematoma leading to impairment of wound healing) and postoperative hospital stay were recorded.

Results: Of the 14 head-and-neck tumours, 10 were squamous cell carcinomas and four were ameloblastomas. Eleven of the patients were males and only three were females. The mean age (±SD) of the patients was 59±13 years. There was no evidence of partial or complete loss of the flap in any of the patients studied. There was no case of breakdown of the primarily closed donor site. The only registered complication was slight localized dehiscence at the most proximal and distal part of the primarily sutured flap donor site in one patient.  

Conclusion: Primary closure of deltopectoral flap donor site is possible with minimal complication that overcomes the problem of skin grafting. Minimal wound breakdown in younger patients had been noted and left to heal by secondary intention.  

Background and objective: Tissue expanders are useful adjuvant in reconstruction after burn. The technique provides tissue of similar texture and color to the defect to be covered and has the added advantage of minimal donor site morbidity. The study aimed to assess the outcome and complications of using tissue expansion for head and neck postburn reconstruction. 

Methods: Thirty patients with head and neck burn scar, treated with thirty eight tissue expanders, were included in this prospective study at the Plastic Surgery Department in Rizgari Teaching Hospital in Erbil from April 2009 to November 2012, with the mean age of 14 years. Statistical package for social sciences (SPSS version 18) was used for data entry and analysis.

Results: The commonest use of tissue expander was for treating postburn scar alopecia (18 patients, 60%), followed by postburn cheek scar (six patients 20%). The scar size ranged from 4x10cm to 16x24cm. Complete burn scar excision was possible in 80% of cases with single or multiple sessions of expansion. Early exposure of the expander followed by infection occurred in three cases (10%), which led to interruption of the expansion and expander removal. Satisfactory results were achieved after reconstruction in 90% of cases.

Conclusion: Tissue expansion, if carefully planned and conducted, is one of the treatments of choice for post-burn reconstruction of the head and neck, allowing an expanded flap suitable for versatile coverage.

Background and objective: Herpes simplex virus type 2 linked to the genital tract infection may produce significant acute or chronic cervicitis. Identification of the virus is important due to its association with genital tract disease and sexual transmission. The virus establishes lifelong latency with periodic reactivation. Therefore, it causes significant physical and psychological morbidity. The aim of this study was to assess and compare cytological examination with serological test in the diagnosis of genital herpes simplex   virus type 2.

Methods: This study included 104 women. Pap smear was collected from 24 healthy women as a control group (group A), 40 patients with severe cervicitis on cytological examination (group B) and 40 patients with atypical cervicitis (group C). Blood sample was obtained from the patients and the control group and tested for Herpes simplex virus type 2 specific serology. The ages of the studied groups ranged from 21-53 years. They were referred to the Maternity Teaching Hospital and private laboratories in Erbil city, Kurdistan region, Iraq during the period from December 2011 to December 2012.

Results: Herpes simplex virus type 2 IgG antibodies were found in 10 sera from patients with nonspecific cervicitis (group-B) and only in three patients with atypical cervicitis (group-C). No positive serological test was identified in the control group. All Pap smear results showed features suggestive of cervicitis but without viral cytopathic herpetic changes.

Conclusion: The serological test was superior to cytology for the diagnosis of Herpes    simplex virus type 2 infection in women presented with cervicitis with no clinically apparent genital ulcer or blisters.

Background and objective: Acne vulgaris is a common skin disorder. Combination therapy with topical retinoid and antibiotic is recognized as an effective treatment of acne vulgaris. The aim of this study was to compare the efficacy and tolerability of topical clindamycin solution as a monotherapy with the combination gel of clindamycin/adapalene for the treatment of mild to moderate acne of the face.

Methods: This comparative therapeutic trial was conducted at the out patient department of Dermatology and Venereology at Rizgari Teaching Hospital in Erbil City from November 2008. Hundred patients with mild to moderate acne of the face were enrolled in the study and were divided in to two groups; group I (n=50); apply clindamycin phosphate solution 1%, and group II (n=50); apply a combination gel of clindamycin1% /adapalene 0.1%; once daily at night for 12 weeks.

Results: Of 100 patients, 89 patients completed their treatment as per protocol, 45 patients in group I, and 44 patients in group II. At the end of the 12 weeks; the mean percent reductions of noninflammatory, inflammatory, and total lesion count were greater in group II than in group I. A significantly greater reduction of total (P = 0.008), and noninflammatory lesions (P = 0.002) were seen in group II than in group I. Both treatments were well tolerated, and few side effects were reported.

Conclusion: This study demonstrates that the combination of topical clindamycin and adapalene is more effective than clindamycin solution alone, and provides faster benefit in treatment of mild to moderate acne.

Background and objective: It is well known that oral candidiasis increase in many situations, like obesity, debility, leukemia, viral infection, use of certain drugs in addition to diabetes mellitus. The aim of this study was to estimate the prevalence of Candida albicans in the oral cavity of diabetic and non-diabetic subjects and to identify factors predisposing to colonization in the diabetic patient. The variables evaluated include absolute white blood cell counts and differentials, glycosylated hemoglobin levels, serum glucose, blood urea, serum creatinine and duration of diabetes.

Methods: One hundred subjects of type II diabetes mellitus and one hundred non-diabetic subjects (control) were studied for isolation of Candida albicans from oral cavity. Further investigations for diabetic group were done regarding serum glucose, HbA1c, and total and differential white blood cell counts.

Results: This study showed 56 (56%) out of 100 diabetic subjects and 30 (30%) out of 100 in non-diabetic subjects were found to carry Candida in their oral cavity. In the diabetic group, no relationship was found to total or differential white blood cell count, recent use of antibiotics, serum glucose and HbA1c values. A significant relationship was found in diabetic patients who had chronic renal disease.

Conclusion: Colonization of Candida albicans in the oral cavity was found to be higher in diabetic subjects than in non-diabetic. However, glycaemic control in diabetes, total and differential white blood cells were found to bear no relation with carriage of Candida in the oral cavity.

Background and objective: Accuracy of working length determination is important in successful endodontic treatment. The aim of this study was to clinically compare working length determination in dry and wet canals with radiography and i- Root apex locater and in cases of presence or absence of peri apical lesion (An in vivo study).

Methods: This study was conducted in the Department of Endodontic in the College of Dentistry at Hawler Medical University, Erbil, Iraq. A total number of 45 single rooted teeth with single canals have been evaluated. An access cavity was then prepared and the pulp was extriped with barbed broach. Initial electronic measurements have been done under a wet condition; the root canals were rinsed with normal saline and then dried with paper points. i-Root TM apex locator had been used to estimate the working length. Each measurement was repeated three times and the mean value was calculated and computed. Then the K- file was selected for each tooth according to the size of each canal and peri apical radiograph had been taken to measure the length for each canal and compared with recorded length by apex locater. Statistically analysis included the used of paired sample t-test. A P value of ≤0.05 was considered statistically significant.

Results: There was no significant difference between working length determination by radiography and i-Root TM electronic apex locator in dry and wet canals and in case of presence or absence of peri apical lesion.

Conclusion: This study did not show any difference between radiography, i-Root TM and direct visualization in working length determination.

Background and objective: Many bacterial isolates show an increased antimicrobial resistance due to biofilm production. Repeated exposure to sub lethal concentrations of antimicrobial agents certainly contributes to the resistance as compared to planktonic bacteria. The aim of this study was to test whether the bacterial phenotypes of P. aeruginosa can be changed during exposures to the concentrations at sub lethal doses of chlorhexidine.

Methods: Sheep blood agar plates were used for evaluation of haemolysin assay for isolates of P. aeroginusa. A 96-flat bottom well microtiter plates were used for determination of MIC of antibiotic and biofilm formation. 

Results: All tested isolates were able to lyse RBCs after exposure to sub-MIC of chlorhexidine. Effectiveness of sub-lethal doses of chlorhexidine on biofilm formations varied depending on the contact time. In general, long contact time exhibited increasing biofilm than short time. No significant difference in biofilm was detected among contact times: day I, day II and day III (P = 0.132, P = 0.139 and P = 0.125, respectively). The most effective sub-MIC of CHX was against azithromycin, since the resistance increased significantly (P = 0.008).

Conclusion: Surviving P. aeruginosa to low concentration of chlorhexidine can exhibit stronger biofilm and increased resistance to antibiotics.

Background and objective: The term hemangioma refers to the common tumor of infancy that exhibits rapid postnatal growth and slow regression during childhood. Hemangioma has a perinatal incidence of 1%-3% and affecting 10% of infants by one year of age. The aim of this study was to evaluate treatment outcomes following various managements of hemangiomas.

Methods: One hundred four patients were included in this prospective study. Based on clinical management, each patient was assigned to different treatment groups: steroid, surgical, and combined therapy. Treatment outcomes were evaluated based on improvement in size and color, by a blinded panel of three raters including two doctors and one patient or patient’s parents. Finally, comparison of outcomes between groups was analyzed statistically. A p value ≤ 0.05 was considered statistically significant. 

Results: The results revealed that there was reduction in size and improvement in color following intervention in each group. Comparison of treatment outcomes between treatment groups revealed statistically significant difference among the groups regarding improvement in color (P <0.01) and reduction in size of hemangioma (P <0.01), and surgical treatment was better (among 31 patients, 17 got moderate improvement and 11 excellent improvement) compared with steroid therapy (among 36 patients, 19 got moderate improvement, and 3 excellent improvement).

Conclusion: A favorable outcome can be achieved following appropriate intervention during all stages of development of hemangiomas.

Background and objective: Infiltration anesthesia for the posterior region of the mandible has been routinely avoided because of its questionable effectiveness related to the dense cortical bone of the mandible. The aim of this study was to evaluate the effectiveness of infiltration anesthetic technique on mandibular posterior non-vital teeth.

Methods: Forty four patients aged between 13and 73 years who attended the Department of Oral and Maxillofacial Surgery in the College of Dentistry, Hawler Medical University for extraction of posterior non vital tooth were included in this study. For the infiltration anesthetic technique, patient’s approval was taken. The patients were equally divided into two groups. Group (1) received 0.6 ml out of 1.8 ml of 2% lidocaine with 1:80000 adrenaline injection bucally and the same amount infiltration lingually opposite the intended tooth. Group (2) received 1.5 ml out of 1.8 ml of 2% lidocaine with 1:80000 and the remaining 0.3 ml was injected for long buccal nerve anesthesia.

Results: In group (1), 68.2% had no pain during extraction, showed statistically highly significant difference (P = 009). Gender showed no significant difference. In group (2), 100 % of the patients had no pain during extraction. 

Conclusion: Infiltration anesthesia for non-vital mandibular molars is effective as a substitute for inferior alveolar block technique.  

Background and objective: Infiltration anesthesia for the posterior region of the mandible has been routinely avoided because of its questionable effectiveness related to the dense cortical bone of the mandible. The aim of this study was to evaluate the effectiveness of infiltration anesthetic technique on mandibular posterior non-vital teeth.

Methods: Forty four patients aged between 13and 73 years who attended the Department of Oral and Maxillofacial Surgery in the College of Dentistry, Hawler Medical University for extraction of posterior non vital tooth were included in this study. For the infiltration anesthetic technique, patient’s approval was taken. The patients were equally divided into two groups. Group (1) received 0.6 ml out of 1.8 ml of 2% lidocaine with 1:80000 adrenaline injection bucally and the same amount infiltration lingually opposite the intended tooth. Group (2) received 1.5 ml out of 1.8 ml of 2% lidocaine with 1:80000 and the remaining 0.3 ml was injected for long buccal nerve anesthesia.

Results: In group (1), 68.2% had no pain during extraction, showed statistically highly significant difference (P = 009). Gender showed no significant difference. In group (2), 100 % of the patients had no pain during extraction. 

Conclusion: Infiltration anesthesia for non-vital mandibular molars is effective as a substitute for inferior alveolar block technique.   

Background and objective: Herbal medicine is a traditional or folk medicine practice based on the use of plants’ seeds, berries, roots, leaves, barks, flowers and plant extracts for medicinal purposes. This survey highlights the traditional phytotherapy practices by traditional healers of Erbil-Kurdistan region in the treatment of various disorders.

Methods: An ethnobotanical survey was undertaken to collect information from traditional healers on the use of medicinal plants in Erbil-Kurdistan region. The indigenous knowledge of local traditional healers and the native plants used for medicinal purposes were collected through questionnaire and personal interviews.

Results: The investigation revealed that the traditional healers were not professionally authorized and 32 plants belonging to 23 families were used to treat various diseases in traditional medicine. The plants reported have been identified and presented in a table with the vernacular names, useful parts, dosage preparations and medicinal uses.  

Conclusion: Many recorded species of plants are used in Erbil- Kurdistan region in traditional medicine but lack phyto-therapeutic evidence. Most indigenous plants remain to be studied which may yield many exciting data for further investigation.