Clinical Performance of Direct Anterior Composite Restorations Using Esthetic Dual-Shade versus Polychromatic Natural Layering Technique: a split mouth randomized controlled clinical tria / Avaliação clínica do comportamento de desgaste do esmalte humano e lascamento da zircônia de cobrimento contra a zircônia monolítica (ensaio clínico randomizado controlado)

Objective: to evaluate the clinical performance of the dual shade layering and polychromatic resin composite layering techniques using a randomized controlled trail. Material and Methods: 42 participants (84 restorations) of class IV or class III through and through within a pair of anterior contra-lateral teeth were randomly allocated into two groups according to technique of composite restoration placement: control "polychromatic layering" and intervention "dual-shade layering". Follow-up was done at 1 month (baseline) and 1 year. Restorations were evaluated using Visual Analog Scale (VAS), restoration color shade match using Vita Easyshade V ®, and blinded assessor using FDI criteria for assessment of dental restorations measuring (aesthetic properties). Chi-square test was used to compare between restorations of both techniques. Results: There was no statistically significant difference between restorations of both techniques for patient satisfaction outcome, restorations color match outcome, and for all tested FDI outcomes except surface luster with 100% success. Conclusion: Bothdual-shade layering and polychromatic natural layering techniques, exhibited acceptable clinical and esthetic performance (AU)

Objetivo: Avaliar o comportamento de desgaste do esmalte humano e lascamento de zircônia de cobrimento e monolítica para restaurações posteriores de cobertura total. Material e métodos: Trinta e quatro restaurações de zircônia de cobertura total (dezessete em cada grupo) foram fabricadas. Os pacientes foram divididos em dois grupos de acordo com o tipo de zircônia utilizada; grupo 1 (grupo comparador) coroas com zircônia de cobrimento e grupo 2 (grupo de intervenção) coroas únicas de zircônia monolítica. Todas as coroas foram fabricadas e polidas em laboratório. Para medidas de desgaste de dentes opostos, foi utilizado um perfilômetro 3D sem contato, onde réplicas de resina epóxi foram construídas para o arco oposto imediatamente após a cimentação das coroas, três, seis e doze meses. O lascamento da restauração foi medido usando critérios modificados dos Serviços de Saúde Pública dos Estados Unidos (USPHS). Resultados: Todas as restaurações foram relatadas como alfa sem lascamento. Não houve diferença estatisticamente significativa entre (Grupo 1) e (Grupo 2) para o teste de desgaste. Conclusão: As restaurações monolíticas e de cobrimento revelaram propriedades mecânicas satisfatórias sem lascamento após um ano de uso clínico. O desgaste do esmalte oposto foi clinicamente aceitável para ambos os materiais (AU)

[Maternal health care indicators, causes of maternal mortality and quality of medical records; at Women's Health Hospital, Assiut University, 2012]

Introduction: Maternal mortality is a preventable tragedy; measuring maternal mortality and identifying its causes is essential, and should be calculated regularly for the purpose of planning, monitoring, and evaluation of provided maternal health care

Objectives: To calculate maternal morality ratio, identify causes of maternal mortality, quality of care indicators such as maternal mortality index, case fatality rate and direct obstetric case fatality rate and to identify the main its in medical records

Methodology: A descriptive study was done through reviewing the records maternal mortality cases in the hospital using validated specific criteria published in WHO bulletin [2000] and data of cases that were admitted to the hospital's intensive care unit was collected for one [2012], followed by performing dissemination meetings

Results: In year 2012, there were 479 vaginal deliveries and 9, 908 caesarean sections, and 20,887 live births. The Maternal morality ratio was [225/100,000]. The Leading causes of maternal death were obstetric hemorrhage [38.3%], complications after caesarean sections, [27.7%] and pre-eclampsia/ eclampsia [23.4%].The age of maternal mortality was 29.3 +/- 8.5. Nearly half [42%] of the deaths occurred during vacation days. Quality indicators revealed poor quality of health care. The main deficits in the medical records included no recording of time of informing staff members and start of management, observational chart and management plan

Conclusions and recommendations: Maternal mortality is alarmingly high. Obstetric hemorrhage and complications after caesarean section were the two main causes of death that require strict and quick management protocols

Evaluation of DNA damage by DNA fragmentation and comet assays in experimental Toxoplasmosis with virulent strain

The outcome of toxoplasmosis is strongly dependent on the virulence of Toxoplasma gondii strains. Infection of mice with the high-virulence T. gondii RH strain induces inflammatory cytokine over production and causes their rapid death. The outcome of toxoplasmosis is strongly dependent on the virulence of Toxoplasma gondii strains. Infection of mice with the high-virulence T. gondii RH strain induces inflammatory cytokine over production and causes their rapid death. T. gondii induced apoptosis was studied, and DNA damage in spleen and peripheral blood leukocytes was evaluated by analysis of DNA fragmentation. The level of DNA damage was assessed by the extent of DNA migration in peripheral blood leukocytes using comet assay. This study was carried out on 2 groups [II and III] of mice experimentally infected with T. gondii RH tachyzoites strain, sacrificed at 2[nd] and 7[th] days post-infection [PI], respectively. In addition, none infected control group [I] was sacrificed at 7[th] day PI. Infection with high virulence T. gondii strain caused apoptosis and high level of DNA damage especially with prolongation of acute infection. Greater DNA fragmentation and intensity of apoptotic laddering was recorded in splenocytes and blood leukocytes of group III compared to those of group II. In infected groups, there was significant increase in DNA migration in comet tail in peripheral blood compared with the control group. Strongly damaged spots were significantly higher in group III than in group II. Additionally, caspase 3 immunostain showed positive reaction in splenic section of infected groups. Infection with virulent strains of T. gondii caused DNA damage with a genetic hazard to infected blood leukocytes. Apoptosis detected in splenocytes explains the rapid lethality of infected mice during acute infection

Worm and larval burden, histopathological and ultrastructural evaluation of T spiralis vaccination using crude worms and/or larvae antigens: experimental studies

Currently, there is no vaccine for T spiralis; however, several studies have been made towards understanding the immune mechanisms that contribute to host protection against it. The aim of the present study is to evaluate the protective effect of vaccination by T spiralis adult, larval and combinea adult and larval crude antigens against trichinellosis in experimental mice. Swiss male albino mice [No. = 125] were divided mm 5 groups. Groups A, h and C were immunized by T spiralis crude larval antigen, crude worm antigen, and combined larval and worm antigens, respectively. One week after the last dose of injection, each mouse was injected orally with 150-200 larvae. Two other groups [D and E] served as infected non immunized control groups. Group E. received adjuvant and phosphate buffer saline before infection. At the 8tn day post-infection [PI], 12 mice from each group were sacrificed and the intestinal worm burden was assessed, while the muscle larval burden was evaluated at 28th day P1 in the remaining mice of each group. Intestinal and skeletal muscle specimens were prepared for histopathological study. Meanwhile, adults and larvae were examined by scanning electron microscopic [SEM] and infected muscle sections were examined by transmission electron microscope [TEM]. Combined antigen gave the highest reduction% in intestinal worm and larval muscle burdens 92% and 96%, respectively], followed by larval antigen [86% and 91%], then worm antigen [73% and 88%], compared with infected non immunized control groups. Compared with groups [A and B], group C gave significant reduction in both intestinal and muscle burdens. Histopathological examination revealed marked decrease in intestinal inflammatory infiltrates, and marked reduction of encysted larvae with mild infiltration around the degenerated larvae in mice of group C. SEM and TEM results confirmed the significant effect of the combined vaccine [Group C]. Vaccination with combined worms and larval antigens gave the most protective action against T spiralis challenge infection. The use of combined antigen in mass vaccination of reservoir animals may decrease the risk of human infection

Quality improvement program in an emergency department

To describe the quality assurance/improvement program in our emergency department ED. This program involved monthly data collection and analysis, data-driven process change, staff education in the core concepts of quality, and data reanalysis from the years 2003 to 2006 at the King Abdul-Aziz Hospital, Al-Ahsa, Kingdom of Saudi Arabia. Data captured during the program included census data, chart review, and focused clinical audits. Continuous quality improvement measures collected at the beginning of the program and quarterly included: 1 quality indicators length of stay [LOS] and rates of left against medical advice [AMA] or left without being seen [LWBS], 2 percentage of patients that stay ?3 hours in ED, unscheduled returns within 48 hours, inter-hospital transfer data, sentinel events tracking rates, and 3 nature of patient complaints. During the study period, the program demonstrated improvement in all measured areas. Despite an increase in patient volume of 47% to 51,698 visits/year, the mean monthly LOS remained static, the unscheduled returned visits dropped by 50% 2% to 1%, and patients leaving AMA decreased from 1.5% to 1.2%, and LWBS decreased from 1.6% to 0.8%. The rate of complaints dropped by 5 fold 1.3 per 1000 patients to 0.25. Our program demonstrated improvement in all the measured parameters

Microscopical changes in the renal tissue due to schistosoma haematobium infestation in adult golden hamsters and the curative effect of myrrh [mirazid] on these changes

Mirazid is a trade name of the purified oleo-gum resin extract from myrrh of commiphora molmol tree. It is used for treatment of schistosomniasis either haematobium or mansoni. This experimental model was done to demonstrate the histological, histochemical and ultrastructural changes of mirazid on the kidney of both adult golden hamsters and those infested with schistosoma haematobium. Forty two groups. adult male golden hamsters were used in this study. Half of them were divided into The control animals were given normal saline and the, treated animals were given mirazid. The rest of animals were infested with schistosoma haematobium parenterally.Eight weeks post infestation they were divided into two equals groups, the infested non-treated animals were given normal saline and the fourth group infested treated animals were treated with mirazid. All animals were given the treatment by intraperitoneal injection once daily for 3 days. After 24 hours from the last dose, kidney specimens were prepared to demonstrate the histological, histochemical and ultrastructural changes. Light microscopic examination of kidney slices of the infested non treated animals showed variable degrees of glomerular degeneration. There was hyaline material deposition in renal tubules. There was an increase in collagenous fibers depsition in the glomerular capillary tufts and in Bowmanis capsule. PAS reaction was decreased in the basement membranes of renal tubules and in brush borders of proximal convoluted tubules. The infested treated animals showed an obvious improvement in the glomeruli with marked reduction in hyaline immaterial deposition. There was a decrease in collagenous fibers deposition and PAS reaction in the renal glomeruli and tubules. Electron microscopic examination of the infested non treated kidney showed enlarged and, broad podocytes around a thick basement membrane of the capillary endothelium. The filteration slits were markedly decreased in number or completely disappeared. After treatment, the majority of podocytes regained their numerous minor processes and filteration slits inbetween. In conclusion, mirazid could be considered a safe and effective schistosomicidal drug

role of pyrimidine, purine and'amino-acid complexes in nutrition

The complexes of Mn, Fe, Co, Ni, Cu, Zn and Cd with some pyrimidine, purine and amino acid ligands have been prepared and tested as feed [food] additives. Bioactivities of complexes have been examined against Salmonella typhimurium and Aspergillus flavus. The present complexes showed no antimicrobial activities against bacteria except Zn-methionine and Co-Ni adenine barbital complexes, which showed antimicrobial activity against Salmonella typhimurium. The chelates showed no antifungal activities, and were more effective against aflatoxin. The antitoxin activity was in the order: Zn-methionine [44.4%] > Zn- barbital and Zn-methionine barbital thiouracil [38.8%] > Co /Ni adenine barbital [27.7%] Mn-methionine barbital > [13.3%]> Mn-barbital [8.3%]. The free ligand [barbital], Cd-barbital, and Cd methionine barbital thiouracil complexes showed no antifungal activities

Study of the possible association between systemic lupus erythematosus and Epstein-barr virus

Background and systemic lupus erythematosus [SLE] is an autoimmune rheumatic disease with no known cure. In predisposed individuals, the initial stimulus is likely to be one or more of the environmental agents interacting with susceptibility genes. For many years, investigators have suspected that Epstein-Barr virus [EBV] might somehow by involved in the aetiopathogenesis of systemic lupus. Studies have examined this possibility from various angles and have arrived at different conclusions. The present work was carried out to evaluate the role of EBV as an environmental risk factor for lupus in our population and to assess the role of this virus in the clinical course of the disease. the study included 25 lupus patients satisfying the American College of Rheumatology criteria for diagnosis of SLE. Twenty age and sex matched healthy subjects were chosen as controls. All patients were subjected to complete history taking and full clinical assessment. Routine laboratory investigations were carried out as well as study of immunologic parameters including antinuclear antibodies, anti-double stranded DNA and complement components C3 and C4. in all study subjects, serology for EBV viral capsid antigen [VCA] IgG was performed using both enzyme linked immunosorbent assay [ELISA] and indirect immunofluorescence assay [IFA]. EBV DNA was detected in peripheral blood mononuclear cells by polymerase chain reaction using primers specific for EBV nuclear antigen-1 gene. Besides, interleukin-10 [IL-10] levels were determined in sera by ELSA. Results and twenty three lupus patients [92%] were positive for EBV DNA compared to 12 control subjects [60%], the difference being statistically significant [p= 0.14]. Virtually all study subjects had seroconverted against EBV. When antibody titres were expressed as the geometric mean titre [GMT] after logarthmic transformation, patients with SLE had a significantly higher GMT compared to control subjects [mean +/- SD 3.46 +/- 0.34 vs 2.93 +/- 0.25, t = 5.12, p < 0.001]. When the anti-VCA titre of lupus patients was correlated with different clinical and laboratory findings, a significant positive correlation was detected with disease activity as measured by SLE disease activity index [SLEDAI], while a significant inverse correlation existed with each of C3 and C4. IL-10 levels in SLE patient were significantly higher than those in controls [mean +/- SD 61.37 +/- 90.65 vs 9.73 +/- 20.33 pg/ml. p = 0.002]. Moreover, elevated IL-10 levels correlated significantly with SLEDAI and with titre of anti-VCA in lupus patients. This study provide evidence that EBV infection contributes to the aetiology and/or pathogenesis of SLE and that the presence of the virus may influence the clinical course of the disease

Influence of microabrasion on shear bond strength of composite resin to dentin

The purpose of this study was to determine the influence of microabrasion on shear bond strength of composite resin to dentin. Ninety noncarious recently extracted human molars were selected. The occlusal surface of teeth was ground, exposing flat dentin surface to accommodate bonded restorative material. The teeth were divided into nine groups of 10 teeth each. The dentin surfaces of the first group were conditioned with Total Etch for 10 seconds, then washed and dried to serve as control. Air abrasion conditioning of the remaining 8 groups was accomplished with "Micro Prep Director+" air abrasion device using 0.4mm nozzle tip perpendicular to sample surface and 1cm away from it. Surface abrasion was performed using a 27 micro m aluminum oxide particle stream at 60 psi for 10 seconds in two groups, and for 20 seconds in another two groups. Air pressure was then increased to 120 psi to abrade surfaces of another two groups for 10 seconds, and for 20 seconds in the remaining two groups. Additional conditioning with Total Etch was performed to the surfaces of the last four groups combined with air abrasion treatment. Three teeth from each of the nine groups were mounted in a profilometer and three Ra values were recorded for dentinal surface roughness before and after surface treatment. Remaining samples were prepared for bonded composite restorations, and shear bond strengths were determined using a testing machine. Results revealed significantly higher roughness of etched surface than air abraded dentin. Meanwhile acid etching created bond strengths to dentin that were almost twice as high as those achieved by air abrasion. It could be, thus, suggested that cavities prepared by air abrasion should also be acid etched to achieve adequate bonding with resinous materials

Hepatitis E antibodies in Egyptian adolescent females: their prevalence and possible relevance

Hepatitis E virus has been implicated as a frequent cause of acute sporadic hepatitis among Egyptian children. Moreover, an extraordinarily high ear prevalence rate was previously reported in a semiurban Nile Delta population. A conspicuous feature of hepatitis E is the high morbidity and mortality it can cause among infected pregnant women. We therefore evaluated the prevalence of HEV antibodies in adolescent females using a solid-phase enzyme linked immunoassay based on two recombinant hepatitis E virus antigens. A high prevalence rate [38.9%] was found in 95 apparently healthy adolescent females. The mean age of the study subjects was 21.81 +/- 2.5 [SD] range 16-25 years. Eighty [84.2%] subjects resided in Alexandria, while 15 [15.8%] came from semiurban villages of Alexandria Governorate. An increased prevalence was noted with age, as anti-HEV antibodies were detected in 32.1% and 41.8% of study participants in the second and third decades of life, respectively, similarly, those illiterate or having received less than primary education exhibited a higher HEV prevalence than those with higher education [46.3% VS 29.3%]. The majority o subjects having serological evidence of HEV infection denied previous history of jaundice which shows that HEV infection was subclinical in those cases. Ten [55.6%] pregnant females participating in the study, as well as 48 [62.3%] non pregnant females lacked serological, evidence of HEV infection; i.e., 60.01% [10+48 out of 95] of women in the childbearing age may be susceptible to infection. This report suggests that HEV is endemic in Alexandria, Egypt; the epidemiologic risk factors associated with HEV infection need further exploration