Abstract Background In patients receiving head and neck radiotherapy, ensuring and maintaining oral hygiene is very important to minimize oral complications. In order to evaluate the clinical success of restorative materials used in the treatment of dental caries, it is important to know the toxic potential of the type and amount of ions released from the restorative material as well as their mechanical properties. The aim of this study is to determine the monomer released from the materials after radiotherapy is applied to 13 different dental restorative materials based dimethacrylate resin. Methods 13 different restorative materials were used. 20 specimens were prepared from each material and specimens were randomly divided into two equal groups: experimental and control groups (n = 10). A total of 60 Gy of radiation was applied to the experimental group. During the 6-week radiotherapy procedure, the samples were kept in 75% ethanol-water solution. The monomer analysis of the collected specimens was performed using the LC-MS/MS system. The analysis of the data obtained was performed using Mann-Whitney U and Kruskal Wallis tests (α = 0.05). Results It was determined that the amount of monomer released was mostly less in the radiotherapy group than in the control group. Significant differences were found among restorative materials in terms of monomer release (p < 0.05). In terms of monomer release amounts, the highest release was from composite resin group materials, while the least was from resin ceramic materials. Conclusion Within the limits of this study, it was found that the amounts of monomer released from the investigated materials were mostly lower after radiotherapy. In addition, the amounts of monomer release were higher in the composite group materials, while the release was lower in the resin ceramics.
Introduction
Specialised pro-resolving mediators (SPMs) are endogenously produced lipid mediators (LMs) that regulate the propagation of inflammation and promote tissue repair. We hypothesised that SPM production is dysregulated in COPD and is associated with disease severity, defined by patients with stable COPD (no exacerbations) versus patients with frequent exacerbations.
Methods
LMs were measured in plasma samples from patients with COPD (stable patients and patients with frequent exacerbations) and from healthy controls, matched for age, sex and body mass index, using liquid chromatography–tandem mass spectrometry (LC-MS/MS). The LM profiles of controls were compared with those of stable COPD patients, and the LM profiles of stable COPD patients were compared with those of COPD patients with frequent exacerbations. We explored whether or not there was an association between LM profile and ever having a severe COPD exacerbation over 4.1 years of follow-up. Data are presented as mean±sem in pg·mL−1 for LMs, or mean±sd.
Results
49 stable COPD patients had increased levels of pro-inflammatory mediators and some SPMs, compared with 28 controls (prostaglandin (PG)D2: 13.97±2.44 versus 0.53±0.13; p<0.001; lipoxins: 226.83±23.84 versus 59.84±20.25; p<0.01, respectively). 52 patients with frequent exacerbations had lower levels of PGD2 (3.07±0.97 versus 13.97±2.44; p<0.01) and SPMs (D-resolvins: 8.73±1.25 versus 34.53±8.95; p<0.01; lipoxins: 53.93±9.23 versus 226.83±23.84; p<0.01) than stable COPD patients, despite having a higher neutrophil count (5.28±2.16×109 L−1 versus 4.28±1.60×109 L−1; p=0.004). Among patients with frequent exacerbations, D-resolvin levels were independently inversely associated with occurrence of severe exacerbation (OR 0.88, 95% confidence interval (CI) 0.79–0.97; p=0.03) during follow-up.
Conclusion
These findings demonstrate distinct LM profiles of stable COPD patients and patients with frequent exacerbations. In those with exacerbations, D-resolvins were downregulated, compared with stable COPD patients, and associated with future risk of severe exacerbations during follow-up. Further work is needed to understand these findings.
Ayesha Mudasser, Mubina Laghari, Aman Ullah Siddiqui
et al.
Background: Salivary biomarkers are non-invasive molecules that indicate neurodegenerative illnesses, especially Alzheimer disease (AD) and Parkinson disease (PD).this study was conducted to determine the diagnostic precision of salivary proteomic and genomic biomarkers in terms of early AD and PD detection.
Methods: A systematic literature search was conducted in PubMed, web of science and Google Scholar, and studies included from 2016 to 2025. Research that examined salivary biomarkers in AD and PD was eligible. The data were analyzed with a random-effects model and odds ratios (OR), standard mean differences (SMD), and 95% confidence interval (CI) was estimated. Also, subgroup and sensitivity analysis were performed. To assess the risk of bias, the Newcastle-Ottawa Scale (NOS) was applied for included observational studies.
Results: A total of 11 eligible studies concerning proteomic biomarkers, including amyloid-β (Aβ42, Aβ40) and alpha-synuclein total (α-synTotal) and alpha-synuclein Oligomer (α-synOligo), and genomic biomarkers like different salivary microRNAs were included. Meta-analysis indicated that Aβ42 (OR=0.70; 95% CI: 0.41 to 1.1) and Aβ40 (OR=1.01; 95% CI: 0.97 to 1.06) had significant discriminatory potential in AD patients; but α-synOligo (SMD = 2.90; 95% CI: -0.59–6.39) and α-synTotal (SMD = 0.44; 95% CI: -3.14 to 4.02) was higher in PD patients as compared with controls. Genomic biomarkers demonstrated inconsistent findings (SMD = -0.18; 95% CI: -1.79–1.42) because of difference in microRNA types. Heterogeneity was high (I2 > 90%), which is caused by alterations in study design and in the methods to measure biomarkers.
Discussion: Salivary biomarkers were found to be an insignificant yet exceptional method of early examination of AD and PD. Nonetheless, the inconsistency of different studies points to develop standardized protocols.
Tapas K. Sarkar, Divya Pandya, Mohit Sharma
et al.
Objective:
To evaluate patient satisfaction and acceptance of acupuncture in dental practice.
Methods:
This randomized controlled study involved 30 participants (15 males, 15 females, mean age 38.2 years) requiring mandibular third molar extraction. Patients were randomly assigned to receive either real or placebo acupuncture. Pain intensity was assessed using a 4-point scale, and patients’ acceptance of and satisfaction with acupuncture were measured. The study was conducted at an oral and maxillofacial surgery clinic.
Results:
Toothache was the most common dental issue (16.7%). Participants showed moderate to high levels of acceptance toward acupuncture (mean score of 3.37 on a 4-point scale) and satisfaction with the treatment (mean score of 3.50).
Conclusion:
The study demonstrates a positive reception of acupuncture in dental settings, with moderate to high levels of patient acceptance and satisfaction. These findings suggest that acupuncture could be a valuable adjunctive therapy in comprehensive dental care, particularly for pain management and anxiety reduction. However, further research is needed to fully establish its efficacy across various dental procedures.
Saleema Rehman, Humaira Bilqis, Farah Deeba
et al.
Background: Morbidly adherent placenta (MAP) is one of the most dreaded antenatal complications leading to massive hemorrhage, immense blood transfusion, hysterectomy, intensive care unit admission, mechanical ventilation, multi-organ failure and maternal mortality. The study aimed to determine the maternal outcome in terms of complications, interventions, and mortality in patients with MAP in a tertiary care hospital.
Methods: During the study period of one year (2020-2021) a total of 68 patients with MAP were studied. Demographic profiles including age, parity, gestational age and history of previous cesarean sections were recorded. Other complications and interventions were also noted. Data was analyzed by using SPSS version 23 and a t-test was applied for comparison between the two groups. p-value <0.05 was considered statistically significant.
Results: Total number of deliveries during the study period was 20971. Among these 7183 women had a cesarian section (CS). The total number of CS done due to placenta previa was 319, out of which a total of 68(21.3%) patients were diagnosed with MAP. It was further observed that 0.6% of patients had no history of a previous uterine scar, 39.0% of patients with previous 1 scar and 80% with 4 scars (p>0.05). Peripartum hysterectomy was performed in 48.5% of patients. The complications noted were bladder injury 17.6%, ICU admission 45.5% and maternal mortality 4.4%.
Conclusion: Morbidly adherent placenta (MAP) was found directly related to cesarean section (p>0.05). Appropriate measures should be taken to reduce the primary scars to reduce the incidence of repeat scars and ultimately MAP related severe maternal outcomes.
Keywords: Morbidly Adherent Placenta (MAP); Caesarean Section; Placenta Previa.
Athira K Nair, Vasantha Vijayaraghavan, Darshana Mundhe
et al.
Background: Due to the close proximity to the oral cavity, shade guides are prone to contamination with saliva. Hence, disinfection of shade guides is important to prevent cross infection in clinics. This study has compared and evaluated the color change in VITA shade guide and the WALDENT shade guide after disinfecting with 70% isopropyl alcohol. Objectives: The objective of this study was to compare and evaluate the amount of color change in the VITA shade guide and WALDENT shade guide after disinfecting them with 70% isopropyl alcohol for the simulated time of 6 months and 1 year. Materials and Methods: Four commonly used shade tabs, namely A2, A3.5, B2, and C1 of two shade guides – VITA Classical Shade Guide and Waldent shade guides – were chosen for this study. VITA Easyshade spectrophotometer measured the shade, and the values were recorded in the International Commission on Illumination L*a*b* Scale. Baseline values of 8 shade tabs were obtained followed by surface disinfection using 70% isopropyl alcohol using gauze. The testing process was done to simulate a 6-month period and 1-year period. Results: Unpaired t-test was used for statistical analysis. It was found that shade tabs underwent significant changes in short period of time. Conclusion: Within the limitations of this study, it was found that shade guides undergo significant changes in color when disinfected with 70% isopropyl alcohol during a simulated period of 6 months. Clinical Significance: If shade guides are not periodically evaluated using a control (preferably unused) shade guide, they may have a profound impact on resulting restoration.
The recent outbreak of coronavirus disease 2019 (COVID-19) caused by the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the declaration of pandemic by the World Health Organization have made an enormous impact on medical and dental care across the world. The current COVID-19 situation may teach dental teams a better approach and optimal ways concerning the management of patients with special needs, by bringing people together to discuss and optimize standards of care, as often happens in challenging situations. We can always learn new things that turn out to be valuable and useful even in exceptionally difficult times, and in addition, dental services can benefit from enabling positive attitudes and introducing constructive changes. Clinicians just need to keep in mind that adjustment to a new future reality appears inevitable for both patients and professionals who provide care.
Objectives: This study aimed to assess the perceptions of medical interns with regards to the internship training programme offered at Saudi medical schools and to explore factors influencing their overall satisfaction with this progamme. Methods: This exploratory study was conducted at four medical schools in Saudi Arabia between July 2017 and June 2018. All medical interns undergoing internship training at the selected medical schools during the 2017–2018 academic year were invited to participate in the survey. A questionnaire covering 10 internship dimensions and including a total of 76 items and one global item was designed to assess the medical interns’ satisfaction with the training programme. Results: A total of 295 interns returned completed questionnaires (response rate: 92%). Overall, the interns’ satisfaction with all 10 internship dimensions was high (mean score: ≥3.6). A multiple regression analysis indicated that various factors were significant predictors of medical interns’ overall satisfaction with the internship training programme, including orientation, training site services, supervision, relationships with their superiors and hospital activities (P <0.050 each). Conclusion: Medical interns were highly satisfied with the internship training programme offered at Saudi medical schools, with various factors found to significantly influence overall satisfaction. The findings of this study may help policymakers in Saudi Arabia to improve the internship training programme so as to ensure medical interns’ overall satisfaction and potentially improve their learning outcomes and clinical training.
Keywords: Undergraduate Medical Education; Internship and Residency; Attitudes; Clinical Competence; Saudi Arabia.
Nury Tatiana Jiménez, Juan Carlos Munévar, José Manuel González
et al.
Three-dimensional-porous scaffolds of bone graft substitutes play a critical role in both cell targeting and transplantation strategies. These scaffolds provide surfaces that facilitate the response of stem cells related to attachment, survival, migration, proliferation, and differentiation. Objective: The aim of this study was to evaluate the in vitro behavior of human dental pulp mesenchymal stem cells cultured on scaffolds of polylactic/polyglycolic acid with and without hydroxyapatite. Method: We performed an in vitro experimental study using dental pulp stem cells obtained from samples of premolars, molars. The cells were cultured on scaffolds with osteogenic differentiation medium. Cell proliferation, adhesion and cell differentiation to an osteoblastic linage in the biomaterial were evaluated at three different time points: 7, 15 and 30 days. Each experiment was performed in triplicate. Analysis of the data was performed with the Split Plot block and MANOVA model. Results: The differentiation capability of hDPSCs towards the osteoblast lineage was better in the scaffold of PLGA/HA at 7, 15 and 30 days, as indicated by the high expression of osteogenic markers RUNX2, ALP, OPN and COL-I, compared with differentiation in the PLGA scaffold. No statistically significant differences were found in cell adhesion between the two types of scaffolds. Conclusion: The PLGA/HA scaffold provided better physical and chemical signals, as judged by the ability of dental pulp stem cells to adhere, proliferate and differentiate toward the osteogenic lineage.
Adam M. Hall, Henry T. Stelfox, Xioaming Wang
et al.
Abstract Background Admission to the intensive care unit (ICU) outside daytime hours has been shown to be variably associated with increased morbidity and mortality. We aimed to describe the characteristics and outcomes of patients admitted to the ICU afterhours (22:00–06:59 h) in a large Canadian health region. We further hypothesized that the association between afterhours admission and mortality would be modified by indicators of strained ICU capacity. Methods This is a population-based cohort study of 12,265 adults admitted to nine ICUs in Alberta from June 2012 to December 2014. We used a path-analysis modeling strategy and mixed-effects multivariate regression analysis to evaluate direct and integrated associations (mediated through Acute Physiology and Chronic Health Evaluation (APACHE) II score) between afterhours admission (22:00–06:59 h) and ICU mortality. Further analysis examined the effects of strained ICU capacity and varied definitions of afterhours and weekend admissions. ICU occupancy ≥ 90% or clustering of admissions (≥ 0.15, defined as number of admissions 2 h before or after the index admission, divided by the number of ICU beds) were used as indicators of strained capacity. Results Of 12,265 admissions, 34.7% (n = 4251) occurred afterhours. The proportion of afterhours admissions varied amongst ICUs (range 26.7–37.8%). Patients admitted afterhours were younger (median (IQR) 58 (44–70) vs 60 (47–70) years, p < 0.0001), more likely to have a medical diagnosis (75.9% vs 72.1%, p < 0.0001), and had higher APACHE II scores (20.9 (8.6) vs 19.9 (8.3), p < 0.0001). Crude ICU mortality was greater for those admitted afterhours (15.9% vs 14.1%, p = 0.007), but following multivariate adjustment there was no direct or integrated effect on ICU mortality (odds ratio (OR) 1.024; 95% confidence interval (CI) 0.923–1.135, p = 0.658). Furthermore, direct and integrated analysis showed no association of afterhours admission and hospital mortality (p = 0.90) or hospital length of stay (LOS) (p = 0.27), although ICU LOS was shorter (p = 0.049). Early-morning admission (00:00–06:59 h) with ICU occupancy ≥ 90% was associated with short-term (≤ 7 days) and all-cause ICU mortality. Conclusions One-third of critically ill patients are admitted to the ICU afterhours. Afterhours ICU admission was not associated with greater mortality risk in most circumstances but was sensitive to strained ICU capacity.
Medical emergencies. Critical care. Intensive care. First aid
Abstract Backgrounds The occlusal registration of virtual models taken by intraoral scanners sometimes shows patterns which seem much different from the patients’ occlusion. Therefore, this study aims to evaluate the accuracy of virtual occlusion by comparing virtual occlusal contact area with actual occlusal contact area using a plaster model in vitro. Methods Plaster dental models, 24 sets of Class I models and 20 sets of Class II models, were divided into a Molar, Premolar, and Anterior group. The occlusal contact areas calculated by the Prescale method and the virtual occlusion by scanning method were compared, and the ratio of the molar and incisor area were compared in order to find any particular tendencies. Results There was no significant difference between the Prescale results and the scanner results in both the molar and premolar groups (p = 0.083 and 0.053, respectively). On the other hand, there was a significant difference between the Prescale and the scanner results in the anterior group with the scanner results presenting overestimation of the occlusal contact points (p < 0.05). In Molars group, the regression analysis shows that the two variables express linear correlation and has a linear equation with a slope of 0.917. R2 is 0.930. Groups of Premolars and Anteriors had a week linear relationship and greater dispersion. Conclusions Difference between the actual and virtual occlusion revealed in the anterior portion, where overestimation was observed in the virtual model obtained from the scanning method. Nevertheless, molar and premolar areas showed relatively accurate occlusal contact area in the virtual model.
Amanda Maria de Oliveira Dal Piva, João Paulo Mendes Tribst, Marco Antonio Bottino
This study evaluated the shear stress distribution on the adhesive interface and the bond strength between resin cement and two ceramics. For finite element analysis (FEA), a tridimensional model was made using computer-aided design software. This model consisted of a ceramic slice (10x10x2mm) partially embedded on acrylic resin with a resin cement cylinder (Ø=3.4 mm and h=3mm) cemented on the external surface. Results of maximum principal stress and maximum principal shear were obtained to evaluate the stress generated on the ceramic and the cylinder surfaces. In order to reproduce the in vitro test, similar samples to the computational model were manufactured according to ceramic material (Zirconia reinforced lithium silicate - ZLS and high translucency Zirconia - YZHT), (N=48, n=12). Half of the specimens were submitted to shear bond test after 24h using a universal testing machine (0.5 mm/min, 50kgf) until fracture. The other half was stored (a) (180 days, water, 37ºC) prior to the test. Bond strength was calculated in MPa and submitted to analysis of variance. The results showed that ceramic material influenced bond strength mean values (p=0.002), while aging did not: YZHT (19.80±6.44)a, YZHTa (17.95±7.21)a, ZLS (11.88±5.40)b, ZLSa (11.76±3.32)b. FEA results showed tensile and shear stress on ceramic and cylinder surfaces with more intensity on their periphery. Although the stress distribution was similar for both conditions, YZHT showed higher bond strength values; however, both materials seemed to promote durable bond strength
Objective: Aim of this study was to assess satisfaction with facial appearance and function following cleft lip and palate (CLP) surgeries. Materials and Methods: The surgical outcome of 70 consecutive patients who had CLP surgeries between October 2008 and December 2009 were prospectively evaluated at least 4 weeks postoperatively. Data collected included age, sex, type of cleft defects and type of surgery done, and postoperative complications. For cleft lip repair, the Pennsylvania lip and nose score was used to assess surgical outcome whereas the integrity of the closure was used for cleft palate repair. Results: A total of 70 subjects were enrolled in this study with 40 females (57.1%) and 30 males (42.9%) (female:male = 1.3:1). The age of the subjects at presentation ranged from 1 day to 26 years. Majority of the study group were infants 74.3% (52) and 25.7% (18) presented after age one. 19 (39.6%) of subjects were operated within the ages of 3 months for lip repair and 10 (45.5%) subjects after 18 months for palate repair. There was a good surgical outcome of 71.4% with an overwhelming parents/subjects satisfaction of 94.8% with the treatment outcome. Twelve cases (15.6%) in which surgical outcome was rated fair, the subjects or their parents were still very satisfied with the surgical outcome. Conclusions: There was a high patient satisfaction irrespective of treatment outcome. This satisfaction reflects not only the technical competence of the cleft surgeons, but also the dedicated performance of other supporting staffs of the hospital.
Luciana Reis AZEVEDO-ALANIS, Elen de Souza TOLENTINO, Gerson Francisco de ASSIS
et al.
Although some morphological investigations on aged human sublingual glands (HSG) found eventual phenomena identified as autolysis and mucous extravasation, the exact meaning of these findings has not been elucidated.Objective The aim of this work is to investigate whether acinar autolysis and mucous extravasation are related to the aging process in human sublingual glands. We also speculate if autolytic changes may assist forensic pathologists in determining time of death.Material and Methods 186 cadavers’ glands were allocated to age groups: I (0–30 years); II (31–60), and III (61–90). Time and mode of death were also recorded. Acinar autolysis and mucous extravasation were classified as present or absent. Ultrastructural analysis was performed using transmission electron microscopy (TEM). Data were compared using Mann-Whitney U, Spearman’s correlation coefficient, Kruskal-Wallis, and Dunn tests (p<0.05).Results There was correlation between age and acinar autolysis (r=0.38; p=0.0001). However, there was no correlation between autolysis and time of death. No differences were observed between genders. TEM showed mucous and serous cells presenting nuclear and membrane alterations and mucous cells were more susceptible to autolysis.Conclusion Acinar autolysis occurred in all age groups and increased with age while mucous extravasation was rarely found. Both findings are independent. Autolysis degrees in HSG could not be used to determine time of death.
Patients with a missing tooth along with diastema have limited treatment options to restore the edentulous space. The use of a conventional fixed partial denture (FPD) to replace the missing tooth may result in too wide anterior teeth leading to poor esthetics. The diastema resulting from the missing central incisors can be managed with implant-supported prosthesis or FPD with loop connectors. An old lady reported with chief complaints of missing upper anterior teeth due to trauma. Her past dental history revealed that she was having generalized spacing between her upper anterior teeth. Considering her esthetic requirement of maintaining the diastema between 12, 11, 22, and 21, the treatment option of 06 units porcelain fused to metal FPD from canine to canine with intermittent loop connectors between 21, 22, 11, 12 was planned. Connectors basically link different parts of FPDs. The modified FPD with loop connectors enhanced the natural appearance of the restoration, maintained the diastemas and the proper emergence profile, and preserve the remaining tooth structure of abutment teeth. This clinical report discussed a method for fabrication of a modified FPD with loop connectors to restore the wide span created by missing central incisors.