Microbiological evaluation for antifungal activity of some metal oxides nanofillers incorporated into cold cured soft lining materials: clinical based study / Avaliação microbiológica da atividade antifúngica de algumas nanopartículas de óxidos metálicos incorporadas em materiais de revestimento macio curados a frio: estudo clínico

Objetivo: O objetivo do presente estudo foi avaliar a eficácia da adição de nanopartículas de óxido de zircônio (ZrO2), óxido de titânio (TiO2) e óxido de sílica (SiO2) a um material de revestimento macio curado a frio na adesão de Candida albicans (CA). Material e Método: Cinquenta e quatro pacientes foram selecionados e divididos em três grupos de acordo com a modificação do revestimento com nanopartículas de ZrO2, TiO2 e SiO2 (18 cada). Cada paciente recebeu prótese total maxilar com três cavidades, as cavidades foram revestidas com forro macio curado a frio modificado com diferentes concentrações (0%, 3% e 7%) de nanopartículas de óxido metálico. Nos dias 14 e 28, as trocas foram retiradas do local de realinhamento e imediatamente cultivadas para avaliação fúngica. O número de colônias foi contado, os dados coletados e explorados para normalidade usando o teste de Shapiro-Wilk e a transformação logarítmica da contagem de CA foi realizada. ANOVA para medidas repetidas e de uma via (one-way) foram usados, seguidos por teste de Tukey (HSD). O teste t independente foi usado para comparar as contagens de CA em diferentes períodos. Resultados: A adesão do CA foi significativamente diminuída pela adição de nanopartículas de ZrO2, TiO2 e SiO2 em comparação com o grupo controle, também a cobertura antifúngica aumentou com o aumento da concentração de nanopartículas (p <0,005). A maior contagem de CA foi identificada no grupo SiO2 seguido por ZrO2, enquanto TiO2apresentou a menor contagem de CA (p <0,001). Conclusão: Adição de diferentes nanopartículas; ZrO2, TiO2 e SiO2para revestimento macio curado a frio é um método eficaz para reduzir a adesão de CA (AU)

Objective: The aim of the current study was to evaluate the efficacy of addition of zirconium oxide (ZrO2), titanium oxide (TiO2), and silica oxide (SiO2) nanoparticles to cold-cured soft liner on adhesion of Candida albicans (CA). Material and Methods: Fifty-four patients had been selected and divided into three groups according to the modification of soft liner with ZrO2, TiO2, and SiO2 nanoparticles (18 each of). Each patient received maxillary complete denture having three cavities, the cavities were lined using cold cured soft liner modified with different concentration (0%, 3%, and 7%) of metal oxide nanoparticles. On days 14 and 28, swaps were taken out from relining site and immediately cultured for fungal evaluation. The number of colonies were counted, data collected and explored for normality using Shapiro-Wilk test, logarithmic transformation of CA count was performed. Repeated and one-way ANOVA were used followed by Tukey HSD. Independent-t test used to compare between CA counts at different periods. Results: The CA adhesion was significantly decreased by the addition of ZrO2, TiO2 and SiO2 nanoparticles in comparison with control group, also the antifungal coverage increased with nanoparticles concentration increased (P<0.005). The highest CA count was identified in group SiO2 followed by ZrO2, while TiO2 showed the lowest CA count (P <0.001). Conclusion: Addition of different nanoparticles; ZrO2, TiO2 and SiO2 to cold-cured soft liner is an effective method for reducing CA adhesion. (AU)

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study

Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant morbidity and mortality in humans. It is an important causative agent of viral hepatitis outbreaks. This study investigates the serological and molecular prevalence of HEV in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State, Sudan. Methods: The study adopted a cross-sectional descriptive design. A structured questionnaire was used to collect data concerning demographic information and risk factors associated with HEV transmission. All enrolled participants (N = 300) were screened for HEV IgG antibodies using commercial ELISA kits, then strong positive samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT PCR. SPSS version 24.0 was used for analysis. Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG. However, only one participant was IgM positive, while the HEV RNA was negative. The highest prevalence rates of the virus were 42 (44.6%) among the age group of 31­40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in three to four multiple blood donations, and 5 (62.5%) in those who consumed water from the river source. A significant association of HEV IgG prevalence concerning the occupation of the participants being students or farmers was detected using univariate and multivariate analysis (P-value = 0.007).

Management of internal derangement of temporomandibular joint disc displacement with reduction using two different lines of treatment / Manejo do desarranjo interno do deslocamento de disco temporomandibular com redução utilizando dois tipos diferentes de tratamento

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p < 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. (AU)

Objetivo: O presente estudo comparou a eficácia da Artrocentese em relação à inserção da Placa Reposicionadora Anterior (PRA) na melhoria da Amplitude de Movimento Mandibular (AMM) para pacientes que apresentam Deslocamento de Disco Anterior com Redução (DDAcR) da Articulação Temporomandibular (ATM). Método: 36 pacientes diagnosticados como DDAcR foram recrutados e divididos aleatoriamente em dois grupos. O primeiro grupo (G1) foi tratado através da Artrocentese e o segundo (G2), tratado com a PRA. Todos os pacientes foram reexaminados após seis meses. Resultados: Com exceção do movimento protrusivo, houve diferenças significativas entre os dois grupos para as mudanças percentuais das medidas de AMM pela quantidade de abertura sem dor, abertura sem assistência, abertura máxima com assistência, movimentos laterais direitos e laterais esquerdos (p < 0,05). Conclusão: Dentro do contexto do estudo atual, a PRA, não invasiva e de menor custo, proporcionou melhores resultados na melhoria da AMM no gerenciamento de casos de DDAcR (AU)

Effect of using Photobiomodulation, stabilization, and anterior repositioning splints on the pain level of subjects with temporomandibular joint disc displacement with reduction / Efeito do uso da terapia a laser de baixa potência, placas planas e placas reposicionadoras anterior, no nível de dor de indivíduos com deslocamento anterior do disco articular com redução

Objective: was to evaluate the effect of four conservative treatment modalities on the pain level of patients with temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Material and methods:100 subjects (64 females and 36 males) were selected, divided into four groups, 25 patients of each. Subjects of Group I have been treated with behavioral therapy. Subjects of Group II had been treated with Photobiomodulation therapy (PBMT). Subjects of Group III had been treated by anterior repositioning splint (ARS). Subjects of Group IV had been treated by a stabilization splint. The pain was evaluated by visual analog score (VAS) from 0 to 10. Statistical analysis was done using one-way ANOVA test for comparison between groups. Within each group, a comparison between baseline and after treatment was done using paired t-test (p<0.05). Results: There was a statistical difference between the pain scores of the different groups after treatment (p≤0.05). Also, there were statistical differences between all groups (p≤0.05) except that between group II and group III (p˃0.05). Conclusion: The use of stabilization splint and ARS are effective non-invasive methods for reducing the pain level in the treatment of TMJ ADDwR cases.(AU)

Objetivo: avaliar o efeito de quatro modalidades de tratamento conservador no nível de dor de pacientes com deslocamento anterior do disco articular com redução. Material e Métodos: foram selecionados 100 indivíduos(64 mulheres e 36 homens), divididos em quatro grupos, 25 pacientes cada. Os indivíduos do Grupo I foram tratados com terapia comportamental. Os indivíduos do Grupo II foram tratados com terapia de fotobiomodulação. Os indivíduos do Grupo III foram tratados com placa de reposicionamento anterior. Os indivíduos do Grupo IV foram tratados com uma placa de estabilização. A dor foi avaliada pelo escala visual analógica (EVA) de 0 a 10. A análise estatística foi feita usando o teste ANOVA de uma via para comparação entre os grupos. Dentro de cada grupo, uma comparação entre a linha de base e após o tratamento foi feita usando o teste t pareado (p <0,05). Resultados: Houve diferença estatística entre os escores de dor dos diferentes grupos após o tratamento (p ≤ 0,05). Além disso, houve diferenças estatísticas entre todos os grupos (p ≤0,05), exceto entre o grupo II e o grupo III (p˃0,05). Conclusão: O uso de placa de estabilização e reposicionadora anterior são métodos não invasivos eficazes para reduzir o nível de dor no tratamento de casos de deslocamento anterior de disco articular sem redução.(AU)

Assessment of circulating MCP-1 level and 2518A>G gene polymorphism in systemic lupus erythematosus / Avaliação do nível de MCP-1 circulante e polimorfismo do gene 2518A> G no lúpus eritematoso sistêmico

Lupus nephritis (LN) is a major contributor to morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). This study aims to investigate the possible role of a functional polymorphism in the regulatory region of the monocyte chemo-attractant protein-1 (MCP-1) gene and MCP-1 blood level in the diagnosis of LN and in correlating the MCP-1 blood levels with disease activity. The study included 56 SLE patients and 56 controls. All the SLE patients suffered from LN. An analysis of MCP-1 gene polymorphism by polymerase chain reaction was performed followed by restriction fragment length polymorphism (PCR-RFLP) analysis and MCP-1 blood level was determined using the ELISA technique. Calculation of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was performed. Serologic tests included the determination of antinuclear antibody (ANA) and anti-double-stranded (ds) DNA antibodies, Complement C3 and C4 levels. A significant increase in the frequency of genotype A/G and a decrease in the frequency of genotype A/A were found among patients with active LN compared to inactive LN. There was a statistically significant difference in the blood level of MCP-1 between LN patients and controls. Also, MCP-1 blood levels were significantly higher in active LN patients than inactive LN. A significant positive linear correlation was detected between MCP-1 blood level and SLEDAI, creatinine, and 24 hours protein in LN patients. These results suggest that an A/G genotype together with the measurement of the blood level of MCP-1 can be a useful tool for detection and follow up of active LN.

A nefrite do lúpus (LN) é um dos principais contribuintes para a morbidade e mortalidade em pacientes com o Lúpus Eritematoso Sistémico (LES). Este estudo tem como objetivo investigar o possível papel de um polimorfismo funcional na região reguladora do gene da proteína quimioatraente de monócitos-1 (MCP-1) e do nível sanguíneo de MCP-1 no diagnóstico de LN e na correlação do sangue de MCP-1 níveis com atividade da doença. O estudo incluiu 56 pacientes com LES e 56 controles. Todos os pacientes com LES sofriam de LN. Uma análise do polimorfismo do gene MCP-1 por reação em cadeia da polimerase foi realizada seguida pela análise do polimorfismo do comprimento do fragmento de restrição (PCR-RFLP) e o nível sanguíneo do MCP-1 foi determinado pela técnica ELISA. O cálculo do índice de atividade da doença sistêmica do lúpus eritematoso (SLEDAI) foi realizado. Os testes sorológicos incluíram a determinação de anticorpos antinucleares (ANA) e anticorpos anti-DNA de fita dupla (ds), níveis de Complemento C3 e C4. Um aumento significativo na frequência do genótipo A/G e uma diminuição na frequência do genótipo A/A foram encontrados entre os pacientes com LN ativo em comparação com o LN inativo. Houve uma diferença estatisticamente significante no nível sanguíneo de MCP-1 entre pacientes com LN e controles. Além disso, os níveis sanguíneos de MCP-1 foram significativamente mais altos em pacientes com LN ativo do que com LN inativo. Uma correlação linear positiva significativa foi detectada entre o nível sanguíneo de MCP-1 e SLEDAI, creatinina e proteína de 24 horas em pacientes com LN. Esses resultados sugerem que um genótipo A/G, juntamente com a medição do nível sanguíneo de MCP-1, pode ser uma ferramenta útil para a detecção e acompanhamento do LN ativo

A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group -PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group –RFKBI).Results: 1-Dissection of side branchand conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4-MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes

Computed tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale for symptomatic improvement in rhinoplasty / Avaliação do ângulo e da área da válvula nasal interna por tomografia computadorizada e sua correlação com a escala NOSE na melhora sintomática pós rinoplastia

Abstract Introduction: Nasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. Objective: We aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. Methods: A prospective observational study was conducted between March 2017-May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. Results: Twenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. Conclusion: Reformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.

Resumo Introdução: A obstrução nasal é uma das queixas otorrinolaringológicas mais comuns, e o colapso ou obstrução da válvula nasal interna é a principal causa da obstrução das vias aéreas nasais. Objetivo: Objetivamos avaliar a válvula nasal interna pré, e 3 meses pós-rinoplastia utilizandotomografias computadorizadas reformatadas e avaliar sua correlação com a melhora do sintoma obstrutivo utilizando a escala NOSE, do Inglês Nasal Obstruction Symptom Evaluation. Método: Um estudo observacional prospectivo foi realizado entre março de 2017 e maio de 2018 em um centro de otorrinolaringologia de atenção terciária. Foram incluídos pacientes que apresentavam obstrução nasal secundário a colapso da valva nasal interna e deformidade nasal. Pacientes com sinusite, polipose nasal e tumores nasais foram excluídos. Resultados: Vinte pacientes consecutivos, a maioria do sexo masculino (n = 14; 70%) com média de idade de 22,2 ± 2,8 anos, foram submetidos a rinoplastia eincluídos no estudo. Não houve correlação significante entre as avaliações tomográficas pré / pós cirúrgicas do ângulo/área da valva nasal interna e os escores NOSE. Foi detectada uma diferençã altamente significante entre os escores médios da escala NOSE entre o pré e pós-operatório (p < 0,0001), mas não nos resultados da avaliação por tomografia computadorizada. Conclusão: As medidas reformatadas de tomografias computadorizadas da área e ângulo da valva nasal interna pré e pós cirúrgicas não tiveram valor. Entretanto, os escores da escala NOSE pré e pós-rinoplastia mostraram uma diferença significante ao determinar o grau de melhora do sintoma obstrutivo.

Effect of chitosan nanoparticles on microtensile bond strength of resin composite to dentin: an in vitro study / Efeito de nanopartículas de quitosana na resistência a união por microtração da resina composta à dentina: um estudo in vitro

Objective: The purpose of this study was to evaluate the effect of chitosan nanoparticles on microtensile bond strength of resin composite to dentin using self etch adhesive after aging. Material and Methods: A total number of 90 freshly extracted, sound human molar teeth. Flat tooth surface was gained after cut of the occlusal surface. Three main groups according to pretreatment of dentin before adhesive application; 0.2 % chitosan, 2.5 % chitosan and no treatment control group. Universal self etch adhesive were applied according to manufacture instruction and 4 mm of Feltik Z250 xt composite. Storage of specimens for 1 day, 3 months and 6 months in 37O C distilled water. After that, the tooth was sectioned to beams of 1 mm x8 mm sticks for microtensile bond strength test using universal testing machine. Scanning electron microscope (SEM) was used to evalute the effect of chitosan nanoparticles on dentin and smear layer. Kruskal-Wallis test was used to compare between the three groups as well as the three aging periods. Dunn's test was used for pair-wise comparisons. The significance level was set at P ≤ 0.05. Results: chitosan 0.2% is statistically significant increase in bond strength than chitosan 2.5% and control in one day group. Three months chitosan 0.2 % groups have statistically significant increase in bond strength than chitosan 2.5%. It was found in 6 months that control and chitosan 0.2 % have statistically significant increase in bond strength than chitosan 2.5%. There was statistically significant difference found between the three studied groups regarding bond strength at different storage times . Conclusion: Microtensile bond strength was influenced by different chitosan concentration. Different aging periods had no effect on the microtensile bond strength without application of chitosan and with application of 2.5% chitosan concentration. (AU)

Introdução: O objetivo deste estudo foi avaliar o efeito das nanopartículas de quitosana na resistência da microtração de união do compósito de resina à dentina usando adesivo autocondicionante após o envelhecimento. Material e Métodos: Foram utilizados um total de 90 dentes molares humanos extraídos e sadios. A superfície plana do dente foi obtida após o corte da superfície oclusal. Os dentes foram divididos em três grupos principais de acordo com o pré-tratamento da dentina e antes da aplicação do adesivo: 0,2% de quitosana, 2,5% de quitosana e nenhum tratamento foi utilizado no grupo controle. O adesivo autocondicionante universal foi aplicado de acordo com as instruções do fabricante e 4 mm de composito Feltik Z250 xt foi inserido. O armazenamento de amostras foi realizado por 1 dia, 3 meses e 6 meses em água destilada a 37 °C. Depois disso, o dente foi seccionado em peças de 1 mm x 8 mm para teste de resistência de união por microtração, utilizando máquina de teste universal. Microscópio eletrônico de varredura (MEV) foi usado para avaliar o efeito das nanopartículas de quitosana na dentina e na camada de smear layer. O teste de Kruskal-Wallis foi utilizado para comparar os três grupos e os três períodos de envelhecimento. O teste de Dunn foi usado para comparação pareada dos grupos. O nível de significância foi estabelecido em P ≤ 0,05. (AU)

Comparative study of some mechanical properties of cobalt chromium and polyether ether ketone thermoplastic removable partial denture clasps: an In-vitro Study / Estudo comparativo de algumas propriedades mecânicas dos grampos parciais removíveis termoplásticos removíveis termoplásticos de cobalto cromo e éter cetona: um estudo in vitro

Objective: was to evaluate the retentive force, fatigue resistance and deformity of clasps made from two materials cobalt chromium and poly ether ether ketone (PEEK). Material and Methods: sixteen models were fabricated,each one having lower 1st molar. Models were divided into two groups according to materials,group I (GI) for cobalt chromium (Co-Cr) and group II (GII) for PEEK. Each testing models and its clasps were mounted inside universal testing machine, the retention was measured by applying withdrawal force to it by this machine at 5 mm/min. The Fatigue resistance is measured by the reduction in retention through repeated insertion and removal cycles using robota chewing simulator. Removal and insertion cycling of clasps was carried out for 360, 730, 1080, 1,440, 2,116 and 2,880 cycles (corresponding to 3, 6, 9, 12, 18 and 24 months of simulated clinical use of a RPD) to simulate the fatigue resistance test. Deformity was measured before and after each cycling using a digital micrometer. Statistical analysis was done by 2-way-ANOVA test to detect significance effects of each variable. Results: Retention and fatigue resistance, after 360, 730, 1080, 1,440, 2,116 and 2,880 cycles totally the difference between Co-Cr and PEEK groups was statistically non-significant (P = 0.0980> 0.05) where (Co-Cr > PEEK). Deformation results, regardless to evaluation time, Co-Cr group recorded statistically significant higher deformation mean value than PEEK group (P = 0.008 < 0.05).Regardless to material group, deformation mean value changed nonsignificantly by time (P = 0.2882> 0.05). Conclusion: PEEK clasps (1.0 mm in cross section diameter) engage 0.50 mm undercut provide sufficient retention nearly similar that of Co-Cr clasps.(AU)

Objetivo: o objetivo foi avaliar a força de retenção, a resistência à fadiga e a deformidade dos grampos fabricados com dois materiais diferentes: cromo-cobalto (Co-Cr) e poliéter-éter-étercetona (PEEK). Materiais e métodos: dezesseis modelos foram confeccionados, cada um com 1º molar inferior. Os modelos foram divididos em dois grupos de acordo com o material: grupo I Co-Cr e grupo II para PEEK. Cada modelo de teste universal e seus grampos foram montados em uma máquina de teste universal. A retenção foi medida aplicando força de retirada por esta máquina a 5 mm/min. A resistência à fadiga foi medida pela redução na retenção através de ciclos repetidos de inserção e remoção usando um simulador do ciclo de mastigação. O ciclo de remoção e inserção dos grampos foi realizado por 360, 730, 1080, 1.440, 2.116 e 2.880 ciclos (correspondendo a 3, 6, 9, 12, 18 e 24 meses de uso clínico simulado de um RPD) para simular o teste de resistência à fadiga. A deformidade foi medida antes e após cada ciclo, usando um micrômetro digital. A análise estatística foi realizada pelo teste ANOVA de 2 fatores para detectar os efeitos de significância de cada variável. Resultados: A retenção e a resistência à fadiga após 360, 730, 1080, 1.440, 2.116 e 2.880 ciclos entre os grupos Co-Cr e PEEK não mostrou diferença estatisticamente significativa (p = 0,0980> 0,05), onde (Co-Cr> PEEK). Para os resultados da deformação, independentemente do tempo de avaliação, o grupo Co-Cr registrou um valor médio de deformação maior, com diferença estatística significativa, quando comparado com o grupo PEEK (p= 0,008 < 0,05). Independentemente do grupo de material, o valor médio da deformação foi alterado de forma não significativa pelo tempo (p= 0,2882> 0,05). Conclusão: os grampos PEEK (1,0 mm de diâmetro da seção transversal) engatam 0,50 mm retenção quase semelhante à dos grampos Co-Cr (AU)

Second to fourth digit ratio in female patients with acne vulgaris: Could it be a predictor of androgen receptor status?

Background: Second to fourth digit (2D:4D) ratio is the ratio of index to ring fingers length. It reflects prenatal androgen exposure and sensitivity. Androgens are important in the pathogenesis of acne vulgaris, This ratio may therefore be of significance in determining the expression of androgen receptors. Aim: To investigate the relationship between second to fourth digit ratio and androgen receptor expression in female patients with acne vulgaris and to assess its association with clinical aspects of acne vulgaris. Methods: Females patients (n = 352) with different degrees of acne vulgaris severity and 168 age-matched females were enrolled. Right, left and total second to fourth digit ratios were calculated. Biopsies from all participants were processed for androgen receptor expression by immunohistochemical method. Results: Right, left and total second to fourth digit ratios were significantly lower in acne vulgaris patients than controls (P < 0.001 for all), and each of them had a significant negative correlation with duration of acne vulgaris (P < 0.001; P = 0.013; P < 0.001, respectively). Androgen receptors were detected in epidermal keratinocytes, hair follicles, sebaceous glands and fibroblasts. Right second to fourth digit ratio showed a negative correlation with androgen receptor H score of keratinocytes (r = −0.28;P = 0.02), hair follicles (r = −0.22; P = 0.05) and fibroblasts (r= −0.37;P = 0.001), while left second to fourth digit ratio demonstrated negative correlation with androgen receptor H score of sebocytes (r = −0.397; P < 0.000) only. Limitations: Lack of follow-up and absence of male participants were the main limitations of this study. Conclusion: A masculine second to fourth digit ratio in female patients could anticipate acne vulgaris development, its duration and severity. Moreover, this ratio is associated with an upregulation of cutaneous androgen receptors. Taken together, second to fourth digit ratio could help in designing plans for treatment of acne vulgaris.

Evaluation of Loop Mediated Isothermal Amplification (LAMP) for Diagnosis of Plasmodium falciparum in Wad Medani City, Gezira State, Sudan

Plasmodium falciparumconsidered as the most serious form of species causes malaria compared with other species. Diagnosis of falciparummalaria in Sudan remain a major problem, the laboratory diagnosis depends solely on microscopy and RDTs. Loop mediated isothermal Original Research Article amplification (LAMP) assay is a molecular technique done in isothermal temperature using simple, inexpensive instruments for detection of falciparummalaria. The aim of the study is to evaluate the diagnostic performance of loop mediated isothermal amplification (LAMP) assay for detection ofP. falciparumand compare with microscopic detection. A cross sectional hospital based study conducted on 220 blood samples collected from participants suspected to have falciparum malaria attending Wad Medani Teaching Hospitalsand 26 healthy participants during the period November 2018 to January 2019. Thick blood films were done and used for P. falciparum detection. The extracted DNA by TE buffer was amplified by LAMP assay targeting 18S rRNA gene. Data were analyzed using Medical calculator (MedCalc) programs (V. 16). The results showed that the sensitivity, specificity, positive predictive value, negative predictive values were 99.1%, 84.6%, 53.2%, 99.8% respectively. Validation of LAMP diagnostic performance revealed that area under the curve is 0.919, while Weighted Kappa is 0.866. The study concluded that the LAMP assay had the identical diagnostic performance compared with microscopy in diagnosis of Plasmodium falciparum malaria. This gives a relative effortlessness application of LAMP assay in Sudan after availing the required logistics

Prevalence and Antibiotic Susceptibility of Salmonella Species among Food Handlers in Khartoum- State (Sudan)

Aims/Objectives: To screen the prevalence of Salmonella fecal carriage among healthy foodhandlers and to identify the common species of Salmonella among study population and its antibacterial susceptibility in Khartoum state by taking stool samples. Study Design: Cross-sectional study. Place and Duration of Study: Khartoum state, Sudan, from January 2009 to December 2009. Methodology: Stool samples were collected, processed and cultured on suitable bacterial culture media. Presence of colonies resembling (non-lactose fermenting) Salmonella species were further studied to identify the bacterium by using appropriate biochemical tests.Confirmation and serotyping of isolates were done by using Salmonella antisera. Antibacterial susceptibility test for common antibacterial drugs were also studied. Results: A total of 387 stool samples collected from apparently healthy food handlers werestudied. Salmonella fecal carriage among food handlers was 17 (4.4%) and the highest prevalence was noted in Umbada locality (5.1%). Salmonella Paratyphi B was the commonest 14 (3.6%), followed by Salmonella Typhi 2(0.5%) and Salmonella Cholerasuis 1 (0.3%). Our study revealed that 141 (36.4%) of food handlers were illiterate, 29 (7.5%) werepreschool, 134 (34.6%) were elementary school graduates 68 (17.6%) and 15 (3.9%) university graduates. Forty two (10.9%) of the studied cases mentioned that, they sometimes wash their hands by soap after defecation, while, 9 (2.3%) never washed theirhands. The study also, revealed that 3 (17.6%) of positive food handlers have had history ofprevious typhoid or gastroenteritis. The study demonstrated that Salmonella species isolated were sensitive to co-trimoxazole, ciprofloxacin, chloramphenicol, tetracycline, amoxicillin/ clavulanic acid, ceftriaxone and cefuroxime. Conclusion: This study demonstrated the presence of considerable number of Salmonella fecal carriage among food handlers in Khartoum state. Most of them were illiterate and had poor compliance of hand washing after toilet use. Study also revealed that isolated Salmonella species were highly susceptibility to the common first line antibiotics used in Sudan.

Anatomical Variations Of The Cystic Duct And Their Surgical Implications In Sudanese Population: A Cadaveric Study

Background: Anatomic variations of cystic ducts are common and continuously encountered during Surgical andradiological interventions. Failure to identify these clinically important variations may result in complicationsduring surgical or endoscopic procedures.Patients and methods: This is an observational descriptive cross-sectional study. 65 cadavers in the dissectingrooms of the medical colleges, in which the length and mode of insertion of cystic duct (CD) into common bileduct (CBD) were observed.Results: The mean length of the CD in the cadavers examined was (2.06 ± 1.03) with a minimum length of d” 0.5 cmand a maximum of 5 cm. Regarding the mode of insertion of CD into the CBD; 53.8% were found to have a lowjunction between the CD and common hepatic duct (CHD) which is considered the normal insertion. 46.2% foundto be abnormal variations of insertion; short CD (d”0.5 cm) observed in 10.8%; whereas in 13.8% of cadavers wefound that the CD is adherent to the CHD and runs in parallel to it. In 7.8% there was a high junction between theCD and CBD and in 9.2% we found that CD courses anterior or posterior to CBD and joins it medially.Conclusion: CD variations are not uncommon and it is important to identify these anatomical variations. Adetailed knowledge of the extra hepatic biliary tract, as well as of its variations, is important for the diagnosticand therapeutic success in many clinical situations since they allow the surgeon prompt identification ofcertain pathologies, making surgical procedures more accurate and affective.

Comparison impact of conventional versus conformal radiotherapy techniques on thyroid in breast cancer irradiation

Introduction: Adjuvant radiotherapy is considered one of treatment options for treatment of locally advanced breast cancer. Thyroid gland is not considered an organ at risk in supraclavicular (SC) nodal radiation therapy (RT) for breast cancer. Objectives: Comparison the impact of 2 different RT techniques on thyroid gland; group (I) conventional two-dimensional radiotherapy of SC node and Group (II) three-dimensional conformal radiation therapy (3DCRT) planning of SC node. Method: Twenty (20) patients with breast cancer received SC RT, with evaluation of thyroid functions in both groups, including thyroid stimulating hormone and free thyroxine prior to RT and 3, 6, 9, 12, 18 and 24 months after RT. Based on each patient's dose volume histogram (DVH),total volume of thyroid and mean radiation dose of the thyroid which received radiation doses 10-50 Gy (V10-V50) were considered for statistical analysis. The median follow-up time was 20 months (range, 12-30 months). Results: of 20 patients, 5 (20%) were diagnosed with hypothyroidism (HT), 4 group (II) and 1 group (I). The median time to the development of HT was 9 months. SC node V50 in group I was lower than average in group II (Average: 2.06% versus 55.38% p<0.001).Thyroid V20 in group I was lower than average in group II (Average: 37.65% versus 50.47%, p<0.001) mean TSH in group I was lower than mean in group II (Average: 1.60 IU/L versus 3.08 IU/L, p=0.043). Conclusion: Conformal supraclavicular RT in patients with breast cancer appear to amplify the risk of HT more than conventional, however conformal radiotherapy is better than conventional radiotherapy in locoregional control

Laser versus radiotherapy in the treatment of early glottic carcinoma

Background: Laryngeal cancer is one of the most common types of head and neck malignancy, although its optimal primary treatment is still a matter of debate. Methods: Typical patients with laryngeal SCC (90% at least) are males, over 45 years and heavy smokers. Hoarseness, voice changes, dysphagia, odynophagia, neck mass, dyspnea, referred otalgia and aspiration are the symptoms seen in laryngeal carcinoma. Glottic carcinomas are usually diagnosed earlier and hoarseness is the most common typical symptom. Results: All patients had completed the study. After comparison of the result between the 2 treatment groups, transoral laser excision shows better results than radiotherapy. There is significant difference between laser and radiotherapy in post-operative complications regarding granuloma tissue formation, tumor recurrence and web formation. In laser excision of laryngeal carcinoma, 10% of cases have post-operative granuloma while in radiotherapy, 66.6% of them have post-operative granuloma, but no cases has tumor recurrence while in radiotherapy, 33.3% of them have tumor recurrence. In laser excision of laryngeal carcinoma, 10% of cases have post-operative web formation while in radiotherapy, 22.3% of them have post-operative web formation. There is statistically significant difference between laser and radiotherapy in post-operative satisfaction about the voice (voice quality). Radiotherapy shows better results than laser in voice satisfaction. Conclusions: As regard the study, transoral laser excision of early glottic carcinoma shows better control rate and decrease recurrence and complications than radiotherapy. Keywords

Effect of protective lung ventilation on oxygenation and hemodynamics in obese patients

Background: The number of obese patients undergoing surgery, either bariatric or non-bariatric, is steadily increasing. These patients are more labile to the perioperative complications, such as hypoxemia, hypercapnia, and atelectasis. Intraoperative protective ventilation consisting of low tidal volume, high PEEP and recruitment maneuvers resulted in alveolar recruitment and optimization of intraoperative respiratory mechanics

Objective: This study tested two strategies of mechanical ventilation in obese patients during pneumoperitoneum to conclude which is better as regard gas exchange optimization and hemodynamic stability

Methods: Study was a randomized prospective comparative control study which was carried out on 50 obese patients with BMI 30-50 kg/m2. Patients were prepared for laparoscopic cholecystectomy. Patient’s selection according to attendees at time of operation as a single numbers were protective ventilation [group A] and a double numbers were conventional ventilation [group B]

Results: Study showed significance between oxygenation in both groups. Post-operative oxygenation in protective ventilation [group A]. Mean Post P [A-a] O2 in group A was 27.93 [+/- 7.76] mmHg, while in group B was 35.82 [+/- 11.98] mmHg, p value [0.022]. Hemodynamic instability observed in 24% in group A, but only occurred in 8% in group B

Conclusion: Study found that protective ventilation was superior to conventional ventilation as it was associated with better oxygenation in the post-operative in obese laparoscopic cholecystectomy. In spite of it was very effective in optimizing gas exchange, but associated with more hemodynamic affection

3-Nitro-tyrosine as a biomarker of minimal hepatic encephalopathy in patients with liver cirrhosis

Background: hepatic encephalopathy [HE] is a common complication in patient with liver cirrhosis. It comprises of a broad spectrum of neuropsychiatric abnormalities of varying severity, and affected patients usually suffer from psychomotor, cognitive, emotional, behavioural, and motor coordination dysfunctions. Patients with minimal HE [MHE], a subclinical form of HE, usually have a normal mental and neurological status upon routine clinical examination. The subtle deficits in patients with MHE can only be elicited by specialized neuropsychological tests

Aim of the Work: the aim of this study was to evaluate the role of 3-Nitro-Tyrosine as a biomarker of Minimal Hepatic Encephalopathy in patients with liver cirrhosis

Patients and Methods: our conducted study was a prospective case control study carried on 60 adult patients and 30 age matched controls. All were recruited from Internal Medicine and Hepatology and Gastroenterology Department at Ain Shams University Hospitals in the period between September 2016 and June 2018. All patients enrolled in the study were subjected to detailed history taking, full physical examination, laboratory investigations, psychometric tests for detection of MHE using specially digit symbol test [DST], Trail making test A [TMT A], Trail making test B [TMT B], serial dotting test [SDT] and 3-Nitro-Tyrosine level [3NT]

Results: our study found that the serum levels of 3-nitro-tyrosine are a good predictor of the presence of MHE in patients with liver cirrhosis, with good sensitivity [90%] and specificity [93.33%] and positive and negative predictive values were 93.1% and 90.3% respectively at a cutoff of 14.8 ng

Conclusion: determination of 3-nitro-tyrosine in serum is easy and is not time consuming. It only requires taking a serum sample from the patient and determining 3-nitro-tyrosine concentration. This procedure can be therefore easily added to the routine clinical determinations in patients with liver cirrhosis. This would also allow extending the diagnosis of MHE to most clinical settings, helping to identify patients with MHE

relationship between helicobacter pylori virulence factors and gastric carcinoma

Background: Helicobacter pylori is a gram-negative microaerophilic bacterium found usually in the stomach and use several mechanisms to survive in the stomach lumen. The presence of these bacteria in the stomach can lead to gastritis and reduction in stomach acid production

Aim of the work: this study aimed to investigate the seroprevalence of six highly immunogenic virulence factors [Cag A, Vac A, Gro EL, gGT, Hcp C and Ure A] in patients with different gastric histology in a high-risk population of gastric cancer and explore the relationship between H. pylori virulence factors and gastric carcinoma

Methods: this study included 100 patients: 25 patients were diagnosed histopathologically as gastric cancer [Group I] and 75 patients were diagnosed endoscopically as mild gastritis [Group II]. Their samples were collected from Military Armed Hospitals. Noninvasive serologic test was performed to detect immune responses to H. pylori by stool antigen test, ELISA and by Recomoline H. pylori test

Results: on comparing results of gastric carcinoma and chronic gastritis by Recomoline H. pylori test, it was found that Cag A was detected in 88% [22/25] in group I. While, in group II it was 57.33% [43/75] of cases and Vac A was detected in 80% [20/25] in group I while, it was in group II in 44% [33/75] of cases. Gro EL was detected in 72% [18/25] in group I while; it was 49.33% [37/75] group II and Urea A was 52% [13/25] in group I while, it was 52% [39/75] in group II. Hcp c was 56% [14/25] in group I while, it was 40% [30/75] in group II and gGT was 48% [12/25] in group I while, it was 34.67% [26/75] in group II

Conclusion: in this study, a statistically significant association was found between Cag A, Vac A and Gro EL antigen in the studied groups of patients. However, no such statistically significant association was found between Urea A, Hcp c and gGT antigen. [P value > 0.05]. Thus, Cag A, Vac A and Gro EL antigen proved to be virulence markers for gastric carcinoma group

Reflection for the undergraduate on writing in the portfolio: where are we now and where are we going?

Introduction: the portfolio can be seen as a tool for assessment of a variety of learning activities that differ in content, usage, and assessment. The portfolio not only meets the learner's educational needs but also the political and public reassurance demand that the health professional has achieved the required competency of the curriculum that allows him or her to practice safely with or without supervision in the health organization

Methods: an in-depth search on Google Scholar, Medline and PubMed was conducted using the terms "reflection and portfolio" with especial emphasis on undergraduates. All the manuscripts collected were critically reviewed regardless of the date of Publication

Results: even though the systematic review showed the limited effect of the educational impact of the portfolio on the undergraduate, numerous benefits can be seen, e.g. improvement in the relationship between students and tutors, an increase in general knowledge, awareness and reflection. Reflection for medical undergraduates in portfolio per se was associated with improvement in communications skills, professionalism and better achievement in postgraduate studies and increase in experiential learning. Interestingly, the portfolio was shown to be useful for undergraduate and tutors in filling the gaps of learning in clinical surgery, urology and geriatric medicine. In addition, for dental and nursing students it was associated with an increase in professionalism, clinical competency, and self-confidence. Lack of integration of reflection throughout the curriculum of the medical school was considered one of the main problems

Conclusion: further research is needed to address the following questions [i] it will be of interest to assess if there is any difference in reflective portfolio between students from problembased learning [PBL] curriculum and those from traditional curriculum. [ii] Assess the difference in reflective portfolio between community-oriented and PBL curriculum and PBL and traditional curriculum [iii] if there is any difference in the reflective portfolio in these three curriculums, it will be of interest how this can alter the evidence base of the educational effects of the portfolio. In other words, is there any curriculum that will consistently produce evidence based educational effects of the portfolio?