Open Access Case Report

The Bombay Blood Group: How Rare is It? A Case Report and a Review of the Literature

Emmanuel Ekanem, Santosh Poozhikalayil, Anita Sinha

Journal of Advances in Medicine and Medical Research, Page 24-29
DOI: 10.9734/jammr/2020/v32i730445

The Bombay blood group is a rare type of blood group which is very distinct from the ABO system and was first discovered in India about five decades ago. This blood group describes individuals who lack the H antigen and thus present with the anti H antibodies in addition to anti A and anti B antibodies. Bombay blood group is sometimes mistaken for blood group O. The significance of this blood group is in its ability to potentially cause fatal blood transfusion reaction and haemolytic disease of the foetus and the neonate.

Aim: This case report aims to elucidate the rare occurrence of the Bombay blood group.

Methods: We describe a case report of the pregnancy, labour and delivery of a multiparous Indian woman with the Bombay blood group in her second pregnancy.

Results: The index case had an uneventful pregnancy, labour and delivery without the need for blood transfusion. The neonate was Rhesus D positive and did not have any complications.

Conclusion: Bombay blood group is a rare blood group which can lead to blood transfusion reactions and haemolytic disease of the foetus and newborn. Pregnancy, labour and delivery should be managed in a unit with the availability of anti H blood to avoid foetal and maternal complications.

Open Access Case Study

Hospital-acquired Sphingomonas paucimobilis Infection in a Neonate: A Case Report

Ahaneku Iherue Osuji, Jennifer Eneyi Imaji, Eyinade Kudirat Olateju, Bissallah Ahmed Ekele, Nicholas Baamlong, Yunusa Tahiru

Journal of Advances in Medicine and Medical Research, Page 42-46
DOI: 10.9734/jammr/2020/v32i730448

Introduction: The organism Sphingomonas paucimobilis formerly known as Pseudomonas paucimobilis is a strict aerobe, motile, non-spore forming, non-fermentative, Gram-negative bacillus, characterized by catalase and oxidase activities. It is an opportunistic pathogen that causes infection in healthy and immunocompromised individuals. Sphingomonas paucimobilis is ubiquitous and has been isolated from diverse sources including the hospital environment.

Presentation of Case: We describe the clinical characteristics, manifestations, laboratory findings and management of hospital-acquired Sphingomonas paucimobilis sepsis in a neonate, delivered through caesarean section and brought in from postnatal ward to special care baby unit of the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.

Discussion: The laboratory findings showed normal values for complete blood count, electrolytes, urea and creatinine but positive blood culture. Sphingomonas paucimobilis isolated from the blood was susceptible to Imipenem, Ampicilin-sulbatam, Azithromycin, Lincomycin, Ofloxacin, Ciprofloxacin and Sparfloxacin but resistant to Cefuroxime, Ceftazidime, Augumentin and Ampicillin. The isolation of this organism from the newborn whose laboratory tests were within normal acceptable values, and from the hospital environment is a case of hospital-acquired infection. The patient recovered and was discharged because of adequate treatment by the managing team and also low virulence of this organism.

Conclusion: The study thereby recommends adequate and consistent cleaning of the newborn and maternity units of the hospital, in particular, the entire hospital equipment and its environment using a potent disinfectant to minimize the risk of hospital-acquired infections.

Open Access Opinion Article

Overview of the Management of COVID-19 Efficacy and Doubts

O. A. Ayodeji, C. N. Stanley, P. C. Stanley

Journal of Advances in Medicine and Medical Research, Page 47-53
DOI: 10.9734/jammr/2020/v32i730449

Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. It was first identified during an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China. Management of COVID-19 is still unspecific as there are no vaccine or specific antiviral drugs are available for its treatment. This paper reviews the management efficacy and doubt of COVID-19.

Methods: A comprehensive search from relevant literatures, World Health Organization (W.H.O), Centre for Disease Control and prevention (CDC) official websites and announcements was performed between 1 March 2020 to 10:30 am 22 April 2020 (Nigerian time). A latest summary of 2019- nCoV and the current outbreak was drawn.

Conclusion: The covid-19 pandemic is spreading rapidly and several researchers are making efforts to discover drugs for its treatment. Chloroquine phosphate, vaccines and other forms of management strategies have been employed. However, preventive measures like social distancing, washing of hands with soap and water, wearing of face masks and psychosocial treatment should be adopted while waiting for pharmacological treatments.

Open Access Original Research Article

Dynamics of Hepatitis B Virus Surface Antigen Level with Peripheral Blood Lymphocytes in Chronic Hepatitis B Infection

Shuaibu Abdullahi Hudu, Saadatu Haruna Shinkafi, Shuaibu Umar, Babazhitsu Makun

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/jammr/2020/v32i730443

Background: Peripheral blood mononuclear cells containing an aggregate of immune competent cells, such as T lymphocytes, B cells and natural killer cells, play an important role in control or persistence of the hepatitis B virus (HBV) infection. Similarly, the expression of hepatitis B viral antigens on the surface of infected hepatocytes can invoke a cytotoxic T–cell response.

Objective: To investigate the dynamic changes in hepatitis B surface antigen (HBsAg) and peripheral lymphocyte subsets of healthy donors and chronic hepatitis B patients.

Methodology: Serum HBsAg was quantified by enzyme-linked immunosorbent assay according to the manufacturer’s guidelines. Peripheral blood lymphocyte cell phenotyping was carried out by flow cytometry for all chronic hepatitis B patients and healthy blood donors.

Results: The results of this study showed a significant correlation between HBsAg level and percentage of T and NK cells (r=0.366; P=0.01, r=-0.462; P=0.01, respectively). On the other hand, significance variation in peripheral blood lymphocyte percentage of T lymphocyte subsets in patients were found to be directly proportional to T cell subsets CD4+and CD8+ (P=0.001) compared with healthy blood donor controls.

Conclusion: In conclusion this study highlighted the role of the HBsAg level in supressing the immune cells of the innate and adaptive immune system. Understanding the interactions between HBsAg and peripheral blood cells serves as a basis for development of HBV therapeutic vaccines and a prognostic biomarker in persistent HBV infection.

Open Access Original Research Article

Prevalence and Associated Risk Factors of Dehydration among Pregnant Women in Southern Nigeria

Christopher E. Ekpenyong, Nsikak E. Udokang, Comfort A. Inyang

Journal of Advances in Medicine and Medical Research, Page 10-23
DOI: 10.9734/jammr/2020/v32i730444

Background: Despite available evidences that pregnant women are specific vulnerable target population for dehydration and the importance of adequate hydration to both the mother and the developing fetus, studies assessing the prevalence and associated risk factors of dehydration among pregnant women are limited.

Aim: The aim of the present study was to determine the prevalence and associated risk factors of dehydration among pregnant women in Uyo metropolis, Southern Nigeria.

Methods: A total of 316 pregnant women from selected obstetric centers in Uyo Metropolis met the inclusion criteria and were evaluated for socio-demographics, lifestyle-related behaviors and urinary specific gravity using standard instruments. Mean values were calculated and used for the determination of the hydration status of the participants. Univariate analysis was used to assess the relationship between socio-demographic variables and lifestyle related behaviours and prevalence of dehydration. Multiple logistic regression analysis was used to determine odds ratios (ORs) and 95% confidence interval for factors associated with dehydration in pregnancy.

Results: About 14.6% of the pregnant women were dehydrated, and factors associated with high prevalence of dehydration were age between 26 and 35 years, being married, urban residence, acquiring a tertiary education and income between 20,000 and 50,000 naira. Others were, null-parity, third trimester of pregnancy, physically active, poor dietary habits, alcohol consumption, inadequate water intake and short sleep duration. Inadequate water intake (1-2 cups of water) (OR=6.10,C.I=2.029-18.360) or 5-7cups of water (OR=4.04,C.I=1.385-11.785), consumption of mostly high carbohydrate diets (OR=3.55,C.I=1.003-12577), consumption of mostly high protein diets (OR=3.25,C.I=1.893-11.844) and craving for strange foods(OR=3.71, C.I=1.563-8.81) significantly increased the odds for dehydration among the participants.

Conclusion: Demographic, obstetric and lifestyle-related factors drive the high prevalence of dehydration among pregnant women and should be considered in designing intervention programs to prevent dehydration among pregnant women in our communities.     

Open Access Original Research Article

Association between Demographic Profile, Type of School and Dental Appearance Affecting Choice of Spouse among Undergraduates in Enugu, Nigeria

Azubuike C. Okeke, Nneka K. Onyejaka, Nkiruka Folaranmi

Journal of Advances in Medicine and Medical Research, Page 35-41
DOI: 10.9734/jammr/2020/v32i730447

Background: Aspects of life such as social interactions and choice of partners can be influenced by human appearance. This study identified the effect of dental appearance on the choice of spouse among undergraduate students in Enugu.

Study Design: This was a descriptive cross sectional study.

Place and Duration of Study: The study was at Federal College of Dental Technology and Therapy and Institute of Management and Technology, Enugu, Nigeria. The study lasted for 3 months.

Methodology: 402 final year students were recruited for the study but 4(1.0%) submitted incompletely filled questionnaires while 398(99.0%) submitted completely filled questionnaires. The mean age was 22.0± 2.24 years. More females 235(59.0%) than males 163(41.0%) participated in the study. Many were attending dental school 253(63.6%) while 145(36.4%) were attending non dental schools. All 379(95.2%) students who wished to get married believed that dental appearance can influence the choice of spouse. There was significant association between sex (P<0.001) and wish to get married and type of school (P=0.001) and dental appearance affecting choice of spouse.

Conclusion: Many of the study participants wished to get married. Those attending dental school will consider dental appearance when making choice of a spouse and scattered teeth will affect the choice of spouse most negatively.

Open Access Original Research Article

Relationship between Glycosylated Haemoglobin Levels and Perinatal Outcome among Women with Gestational Diabetes Mellitus at the University of Port Harcourt Teaching Hospital, Nigeria

Elizabeth Chioma Ezeaku, Justina Omoikhefe Alegbeleye, Goddy Bassey

Journal of Advances in Medicine and Medical Research, Page 54-63
DOI: 10.9734/jammr/2020/v32i730450

Background: Gestational diabetes mellitus (GDM) is a global health challenge and is known to affect pregnancy adversely. Glycosylated haemoglobin (HbA1c) level reflect long term glycaemic control and is a more accurate measure than Fasting Plasma Glucose and post prandial plasma glucose level.

Aims and Objectives: To determine the levels of HbA1c, perinatal outcomes and the relationship between maternal HbA1c level and perinatal outcomes in women with GDM at the University of Port Harcourt Teaching Hospital.

Materials and Methods: This was a longitudinal study of 80 pregnant women from 36 weeks of gestation with GDM attending the antenatal clinic of the University of Port Harcourt Teaching Hospital (UPTH). Blood samples from all consenting pregnant women were collected and sent to the Chemical Pathology laboratory to determine the HbA1c level. The blood samples from the babies were also sent to determine the random plasma glucose (RPG) level. A structured proforma was used to obtain socio-demographic characteristics and other information. Data collected was analyzed with SPSS version 22.0.

Results: The mean age of the women was 32.58 ± 4.95 years. A total of 57 (71.3%) women with GDM had elevated HbA1c levels (≥ 6.5%). Fetal macrosomia occurred in 17.5%, while 8.8% had birth asphyxia. The perinatal mortality ratio was 1.3%. There was a statistically significant relationship between HbA1c levels and neonatal hypoglycemia and perinatal mortality (p <0.05).                                                                                                                                      Conclusion: Despite the higher proportions of adverse perinatal outcomes occurring among those with elevated HbA1c levels, only neonatal hypoglycemia and perinatal mortality were significantly associated with elevated HbA1c.

Open Access Original Research Article

Molecular Detection of Mycological Content in Ready to Eat Garri in Bayelsa State

Alade Tolulope, Itodo Sunday Ewaoche, Oluwayemisi Agnes Olorode, Levi Deborah

Journal of Advances in Medicine and Medical Research, Page 64-72
DOI: 10.9734/jammr/2020/v32i730451

Background and Objective: Garri is a powdery carbohydrate-based food material of cassava root tubers (Manihot esculenta Crantz) consumed predominantly in West African countries. It can be processed with palm oil rich in carotenoid (Light-yellow) or without palm oil (Creamy-white). In Nigeria, garri is widely acceptable and consumed by both the poor, the middle men or average Nigerian, and also the rich because it serves as a major source of carbohydrate.

The study aimed at detecting fungal strains that produce mycotoxins in garri sourced from Southern Ijaw Local Government Area of Bayelsa State.

Materials and Methods: A total number of fifty freshly prepared and market displayed-garri samples were collected and processed using standard mycological techniques and Polymerase Chain Reaction from the 23 villages that constitute the LGA.

Results: Results showed that the moulds isolated in yellow garri samples in this study were; Aspergillus spp 9(37.50%),Cladosporium spp 5(20.83%), Fusarium spp 4(16.67%), Penicillus spp 3(12.50%), Rhizopus spp 2(8.30%) and Mucor spp 1(4.17%), while those isolated in the white garri samples were; Aspergillus spp 6(25%), Penicillium spp 8(33.3%), Cladosporium spp 4(16.7%), Rhizopus spp 2(8.3%), Mucor spp 1(4.1%), Alternaria spp 2(8.3%) and Fusarium spp 1(4.1%) with predominance of Penicillium and Asperigellus species. Twenty samples subjected to molecular analysis to determine the Internal Transcribed Spacer region (ITS) and characterization of the fungal strains were all positive (100%).

Conclusion: Fungal contamination on garri mostly results from unhealthy post-processing activity basically from poor packaging and storage. Mycotoxins from fungal strains have serious health implications on humans therefore it is paramount that proper packaging and storage of this product is publicized to reduce its mycological contamination.

Open Access Original Research Article

Relationship between Demographic, Clinical, Psychosocial Factors and Health-related Quality of Life among Persons with Epilepsy in Zaria Northern Nigeria

Emmanuel Uzodinma Iwuozo, Reginald Onyeadumarakwe Obiako, Terhemen Joseph Igbudu, Adesola Ogunniyi

Journal of Advances in Medicine and Medical Research, Page 73-82
DOI: 10.9734/jammr/2020/v32i730453

Introduction: There is a growing global interest on the effect of epilepsy on the subjective health-related quality of life (HRQoL) of the sufferers. Several demographic, clinical, and psychosocial factors have been attributed as contributory to the poor HRQoL in patients (persons) with epilepsy (PWE).

Aim: This study evaluated the relationship between demographic, clinical and psychosocial characteristics of PWE and their HRQoL.

Study Design: A cross-sectional study.

Place and Duration of Study: Study carried out at Neurology clinic of Ahmadu Bello University Teaching Hospital Kaduna State, Nigeria from September 2013 to December 2014.

Methodology: Consecutively presenting PWE on follow-up for at least 1 year, 18 years and above were recruited after obtaining ethical approval and informed consent. Structured questionnaire and the World Health Organization Quality of Life (WHOQOL-Bref) instrument were utilized for the study. The data was analyzed using SPSS version 17 with p-value set at less than 0.05.

Results: The participants were one hundred with median age of 29 years. The factors found to have significant relationship with HRQoL were demographic variables like marital status (F = 3.250, p = 0.025) and monthly income (t = - 2.883; p= 0.005); psychosocial factors like presence of perceived stigma or discrimination (χ2 = 2.427, p = 0.017), presence of depressive symptom in the preceding month (χ2 = 3.164, p = 0.002) and availability of social support (χ2 = 3.328, P = 0.001). There was no significant relationship found between clinical factors and HRQoL of PWE (p > 0.05).

Conclusion: The demographic factors (marital status and monthly income) and psychosocial factors (stigma, depression and social support) had a significant relationship with HRQoL in PWE. There is a need to offer evidence-based and focused care to the sufferers of this illness.

Open Access Original Research Article

Comparison between Pharmaco-invasive Strategy and Primary Percutaneous Coronary Intervention According to Percutaneous Coronary Intervention Related Delay

Khaled Nasr Akl, Medhat Mohamed Ashmawy, Magdy Mohamed Elmasry, Hanan Kamel Kassem, Ayman Mohamed Elsaeid

Journal of Advances in Medicine and Medical Research, Page 99-106
DOI: 10.9734/jammr/2020/v32i730455

Aim: This study aimed to compare between the effect of pharmacoinvasive strategy (PI)& primary percutaneous coronary intervention (P-PCI) according to PCI related delay (door to ballon) on the mortality and morbidity during in-hospital stay and after 30-day follow up. Moreover, left ventricular systolic function was assessed by two-dimensional echocardiography at cardiology department, Tanta University.

Patients and Methods: The study was conducted on 300 patients that were divided into 2 main groups. Group A consisted of patients had primary PCI as reperfusion therapy and further divided into three groups according to PCI related delay (door toballon). Group A1, PCI-related delay is ≤60 minute(92patients). Group A2, PCI-related delay is >60 to ≤ 90 minute. (54patients). Group A3, PCI-related delay is >90minute (78 patients). The second group (group B), include patients who under gopharmaco-invasive strategy, PCI within 24 hour after thrombolysis (76 patients). In the second group, coronary angiography was done immediately in cases of failed thrombolysis and for successful thrombolysis; coronary angiography was performed within 3 – 24 hours.

Results: During hospital stay, more patients in group A3 died than those of group B or group A1, A2 with no statistical significance. In addition, morepatients in group A3 showed heart failure symptoms with statistical significance than those of group B, A1 and A2. Bleeding complications occurred significantly more in group B. During follow up visits more patients in group A3 complained of heart failure symptoms with statistical significance than those of group B, A1, A2 patients.

Conclusion: Primary PCI without door to balloon time delay (≤90 minutes)was encouraged and had the best results on morbidity and mortality. Also, pharmacoinvasive strategy was encouraged as being better than primary PCI when door to balloon time showed marked delay( <90 minutes).

Open Access Original Research Article

Risk Perception and Willingness of Medical Students in North East Nigeria to Participate in Mitigating COVID 19 Pandemic

A. Mohammed, A Mohammed, I. U. Mohammed, M. A. Danimoh, C. H. Laima

Journal of Advances in Medicine and Medical Research, Page 107-114
DOI: 10.9734/jammr/2020/v32i730456

Background: The recent COVID 19 pandemic has negatively affected health care systems in developed and developing countries. The weak health systems in Nigeria with low Human Resource for Health (HRH) poses a threat to mitigating this pandemic with the rising number of COVID 19 cases in the country. It is therefore necessary to consider measures to improve on the availability of human resources in the health sector.

Methodology: The study was a cross sectional study which studied 475 medical students from four medical colleges across the North Eastern region. The close group whats-app platform for selected schools and classes were used to obtain information on the knowledge, perception and willingness to assist in providing health care services during this pandemic.

Results: Majority of the respondents had good knowledge and perception on COVID 19 (80.4% and 96% respectively). In addition, 78.3% of the respondents felt that they were at risk of becoming infected, however 93% of them stated that they were willing to assist in providing health care services during this pandemic. Parental disapproval and fear of becoming infected were the reasons given for those who were unwilling to be involved in provision of health care during this period. More male respondents (67.3%) were willing to participate in providing health care service during the pandemic compared to 32.7% of females and this was statistically significant with a p-value of <0.001.

Conclusion: This study has shown that majority of medical students in the North East have a good knowledge and perception on COVID 19 and are willing to assist in providing health services if needed during the COVID 19 Pandemic. These services could be specific low risk tasks and responsibilities which lie predominantly with prevention of COVID 19 in the region. Their willingness should be regarded as a great sacrifice to humanity and could go a long way in bridging the gap of low HRH in this region.

Open Access Original Research Article

Evaluation of the Effect of Melatonin on Periodontal Tissues in Rats with Periodontitis Induced Experimentally

Bianca Caroline Custodio dos Santos, Jossinelma Camargo Gomes, Angela Esmeralda Zaparolli Miola, Simone Karine Rothen, Célia Patricia Muller Rodrigues, Rose Meire Costa, Patricia Oehlmeyer Nassar, Carlos Augusto Nassar, Carlos Augusto Nassar

Journal of Advances in Medicine and Medical Research, Page 115-126
DOI: 10.9734/jammr/2020/v32i730457

Objective: To analyze the effects of melatonin administration on the periodontal tissues of rats, linked or not with ligature-induced periodontal disease.

Materials and Methods: 40 male Wistar rats aged eight weeks, divided into Control Group (GCON), Ligature Group (GLIG), Melatonin Group (GMEL) and Ligature and Melatonin Group (GLIGMEL). GLIG and GLIGMEL were induced to experimental periodontitis by placing a ligature on the lower molars for 30 days. During the experiment, after 16 days with the ligature, melatonin was administered orally for 10 mg/kg for 14 days in GMEL and GLIGMEL. In the end, euthanasia was performed and the hemi-mandibles were collected for the respective histological and radiographic analyzes; for the results, Shapiro-Wilk, ANOVA-One-Way and Tukey's multiple comparison tests were used.

Results: A significantly lower alveolar bone loss (p<0.05) was demonstrated in the animals that received the administration of melatonin, in which it had a prophylactic function against the effects of the disease, evidenced in radiographic, histomorphometric and histological analyzes in the bone cell count.

Conclusion: Results show that the therapy with administration of melatonin promotes a protective effect on the alveolar bone tissue of rats with induced experimental periodontitis.

Open Access Original Research Article

Dexterity Testing in Dental Students

Tamíris da Costa Neves, Vinícius P. Menegazzo, Juliana P. D. Novo, Danielle Wajngarten, Patricia Petromilli Nordi Sasso Garcia

Journal of Advances in Medicine and Medical Research, Page 127-135
DOI: 10.9734/jammr/2020/v32i730458

The objective of this study was to adapt a manual dexterity test to a pre-clinical training setting and to determine its reliability. Ninety-two students in the final year of their undergraduate program in dentistry at the School of Dentistry of São Paulo State University (UNESP), Araraquara, were evaluated. After the development of the Dental Manual Dexterity Assessment (DMDA), its reliability was evaluated in a reproducibility study. Two examiners evaluated twenty subjects’ test cubes in duplicate under the naked eye and using an X-ray view box and determined the subjects’ final scores on the DMDA. The examiners waited a week between their two scoring sessions, which were referred to as the first assessment and the second assessment. The intra- and inter-examiner reproducibility study was performed using an intra class correlation coefficient (ρ). A descriptive statistical analysis was performed, and the prevalence of the level of manual dexterity and the time required to complete the test were estimated using a point estimation and a 95% confidence interval. Both intra-examiner reproducibility (ρ1=0.892; ρ2=0.938) and inter-examiner reproducibility (ρ1st=0.914; ρ2nd=0.813) were classified as “good” or higher. A high prevalence of manual dexterity levels classified as “high” was observed among the subjects evaluated. The adaptation resulted in a valid and reliable instrument for measuring manual dexterity among dental students. The method is simple and may be implemented early on in undergraduate programs in dentistry.

Open Access Review Article

Review of Pathogenesis of COVID-19: Considerations

C. N. Stanley, O. A. Ayodeji, P. C. Stanley

Journal of Advances in Medicine and Medical Research, Page 30-34
DOI: 10.9734/jammr/2020/v32i730446

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a primary target on the human respiratory system. Coronavirus disease was first discovered in Wuhan, China in December 2019 and has currently become a global pandemic. A lot is still unknown about COVID -19 pathogenesis. Prompt assessment, adequate follow up, test and retest of recovered cases to corroborate immune related considerations will go a long way to understand the pathogenesis.

Open Access Review Article

Regenerative Endodontics – Looking Inward

Shivani Mallishery, Tanvi Shah

Journal of Advances in Medicine and Medical Research, Page 83-98
DOI: 10.9734/jammr/2020/v32i730454

Regenerative endodontics has become a revolutionizing tissue engineering concept in the treatment of immature permanent teeth for over two decades. It has been described as a ‘paradigm shift’ in the treatment of immature teeth, since it fosters continued root maturation. An immature necrotic permanent tooth is usually a result of trauma or infection due to which the tooth becomes non-vital before completing root development. In such cases, the root walls are left thin and weak with an open apex. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful regenerative endodontic procedure (REP) results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Various stem cells, growth factors, scaffolds and suitable environment form the tetrad of elements necessary to induce regeneration of dental pulp. While there has been some success in isolating dental pulp cells with in-vitro experiments, it has been proven to be rather difficult to implement the same in a practical perspective ex vivo. Although there has been clinical success related to REP, histologically they seem to undergo guided endodontic repair rather than true regeneration of physiologic pulp tissue. This review provides an overview of components of tissue engineering, clinical protocol and predictable outcomes for REP and recent advances in regenerative dentistry.