Physicomechanical Properties of Resin-Based Pit and Fissure Sealants Reinforced with Rice Husk Derived Nano Silica and Nanohydroxyapatite

@#Resin-based pit fissure sealants (RBS) are used to prevent occlusal caries in children. The success of RBS in preventing dental caries is largely influenced by its retention on the tooth surface, which is also affected by its physicomechanical properties. The physicomechanical properties of RBS can be enhanced through the addition of fillers. With the advent of nanofillers, the physicomechanical properties were improved without altering RBS flowability. The present study developed an RBS with a 70 wt% resin matrix and 30 wt% nanofillers. The resin matrix consisted of urethane dimethacrylate (55 wt%), triethylene glycol dimethacrylate (45 wt%), camphoroquinone (0.3 wt%), and 2-(dimethylamino) ethyl methacrylate (0.7 wt%). Silane-treated rice husk-derived nanosilica (20 wt%) and nanohydroxyapatite (10 wt%) were added as fillers. Clinpro, Fissurit FX, and an unfilled sealant were controls. All RBS were tested for surface roughness, Vickers hardness, flexural strength, and flowability. Statistical analysis with oneway ANOVA revealed significant differences between groups in surface roughness, hardness, flowability (p < 0.001), flexural strength, and flexural modulus (p < 0.05). Experimental sealants had higher flexural strength (78 MPa) and flow distance (29.05+1.16 mm) than commercial controls.However, the surface roughness of experimental sealants (0.25+0.08 μm) was higher than Clinpro (0.087+0.027 μm) but lesser than Fissurit FX (0.35+0.19 μm). The Vickers hardness of experimental sealants (23+1.63 VHN) was less than Fissurit FX (28.80+1.69 VHN) but higher than Clinpro (21.74+1.68 VHN). This novel RBS had physicomechanical properties comparable to commercial sealants. The use of nanosilica from rice husk makes this pit and fissure sealer sustainable and environmentally friendly in dentistry.

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Pulsatile Chronotherapeutic Drug Delivery for Controlling Early Morning Surge in Blood Pressure; Effect of Coating on Eplerenone In-vitro, In-vivo Release and Urinary Na/K Ratio

Abstract The objective of the present study was to develop time delayed chronotherapeutic formulation of Eplerenone (Ep) to provide rapid drug release after a pre-determined lag time for the treatment of early morning hypertension. Cyclodextrin complexation was used to prepare fast release Ep core tablets. The developed core tablets were then coated with different rate-controlling polymers using compression coating technique. The developed tablets were evaluated for hardness, friability, drug content and swelling index. The in-vitro drug release was carried out to study the effect of different coating materials on drug release and lag time. Tablets selected for stability study were those showing lag time of 5-7 hours followed by complete drug release; F2, F3, F7, F8, and F12. The in-vivo study was carried out on tablets with the highest t90 as compared to commercial tablets after being administered to healthy human volunteers where plasma Ep and urinary Na/K ratio were determined. Results suggested that this approach was able to provide delayed release Ep formulations that will be useful for patients with morning surge in blood pressure.

A clinical audit of the diagnosis and management of chronic kidney disease in a primary care clinic

@#Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

Gender disparity in the prescription of secondary prevention medications in a Malaysian primary care clinic

@#Introduction: Cardiovascular disease is the leading cause of death worldwide. Despite the proven benefit of secondary prevention medications (SPMs), their utilisation remains suboptimal in many countries. This study aimed to assess the use of SPMs in a Malaysian primary care clinic and factors associated with it. Methods: A retrospective review of electronic medical records was conducted to assess the prescription of SPMs among patients with coronary artery disease who attended the clinic between 1st January 2018 and 31st December 2018. Prescriptions of SPMs were documented in numbers and percentages. Multiple logistic regressions were used to analyse factors associated with the prescription of SPMs. Results: Of the 662 patients included in the study, 99.1% were prescribed statins, 97% antiplatelets, 81.7% angiotensin-converting enzyme (ACE)-inhibitors or angiotensin Ⅱ receptor blockers (ARBs), and 78.7% beta-blockers. Male patients were more likely to be prescribed statins (OR = 8.584, 95% CI: 1.431 – 51.510) and antiplatelets (OR = 6.818, 95% CI: 2.294 – 20.257). Another significant factor for antiplatelets prescription was having diabetes (OR = 3.318, 95% CI: 1.148 – 9.590). Having hypertension was associated with ACE-inhibitors or ARBs prescription (OR = 4.008, 95% CI: 2.522 – 6.370). Conclusion: Although the majority of patients received SPMs, there were significant disparities for some SPMs prescriptions among female patients. As these medications are widely available in the Malaysian primary care setting, steps should be taken to ensure that these medications are prescribed equally for all eligible patients.

Determinants of the willingness of the general population to get vaccinated against COVID-19 in a developing country

Purpose@#Vaccination is a cost-efficient intervention to slow the spread of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the population's willingness to take the COVID-19 vaccine in Jordan and investigate potential determinants of their acceptance @*Materials and Methods@#This study used an online survey distributed in November 2020, before introducing the vaccine, with items investigating socio-demographic characteristics, seasonal flu vaccination history, COVID-19 vaccine acceptance once available, and factors affecting their decision-making. Also, “COVID-19 risk perception” and beliefs toward COVID-19 vaccine benefits and barriers were assessed. @*Results@#A total of 2,208 participants completed the survey with a participation rate of 13.1%. The mean±standard deviation age was 33.2±13.5, and 55.7% were females. Study participants were almost equally distributed between willingness, unwillingness, and indecision to take the COVID-19 vaccine (30.4%, 36.4%, and 31.5%, respectively). Younger adults, males, and those who were not married, do not have children, have a bachelor or higher education, employees or being students, healthcare workers, and those who reported receiving flu vaccine had higher rates of COVID-19 vaccine acceptance compared to their counterparts (p<0.001 for each category). COVID-19 risk perception, and perceived vaccine benefits, and barriers were significant predictors of intention. Among those undecided or unwilling to take the COVID-19 vaccine, its safety and side effects were the most common concerns. @*Conclusion@#The low rate of COVID-19 vaccine acceptance in a developing country is alarming, and a significant proportion are indecisive. Interventions to elevate vaccine acceptance by addressing its safety and efficacy and targeting vulnerable groups are recommended.

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)

Inteligência artificial: novas soluções para velhos problemas / Artificial intelligence and dysphagia: novel solutions to old problems

ABSTRACT Dysphagia management, from screening procedures to diagnostic methods and therapeutic approaches, is about to change dramatically. This change is prompted not solely by great discoveries in medicine or physiology, but by advances in electronics and data science and close collaboration and cross-pollination between these two disciplines. In this editorial, we will provide a brief overview of the role of artificial intelligence in dysphagia management.

Evaluation of serum and salivary transforming growth factor beta, vascular endothelial growth factor and tumor necrosis factor alpha in oral lichen planus / Evaluación sérica y salival del factor de crecimiento transformante beta, factor de crecimiento endotelial vascular y factor de necrosis tumoral alfa en liquen plano oral

Introduction: Lichen planus is one of the most common oral mucosal lesions. Transforming growth factor-ß (TGF- ß) has a marked effect on epithelial­mesenchymal transition and immune cells function. Vascular Endothelial Growth Factor (VEGF) is a key regulator of vasculogenesis and angiogenesis. Tumor necrosis factor-α (TNF-α) mediates T-lymphocyte homing and apoptosis of epithelial cells. Objetive: The present study was conducted in order to compare the expression of serum and salivary TGF- ß, VEGF, TNF-α between OLP patients and control individuals to investigate if saliva can be used as an alternative to serum for diagnostic purposes and for monitoring disease. Materials and Methods: 23 OLP patients and 23 control individuals were included to evaluate serum and salivary TGF-ß, VEGF, TNF-α using ELISA kits. Five milliliters of venous blood was collected and unstimulated saliva was collected by the spitting method. Results: Serum and salivary levels of TGF- ß, VEGF, TNF-α are higher in OLP patients compared to normal controls. Mean difference is higher in saliva than serum. Moreover, there was a significant difference in serum and salivary VEGF and TNF-α between symptomatic and asymptomatic groups. Conclusions: Saliva can be a used as a substitute for serum to evaluate levels of the assessed biomarkers.

Introducción: El liquen plano oral es una de las lesiones de la mucosa oral más comunes. El factor de crecimiento transformante ß (TGF-ß) tiene un efecto marcado sobre la transición epitelial-mesenquimal y la función de las células inmunes. El factor de crecimiento endotelial vascular (VEGF) es un regulador clave de la vasculogénesis y la angiogénesis. El factor de necrosis tumoral α (TNF-α) media la localización de los linfocitos T y la apoptosis de las células epiteliales. Objetivo: El presente estudio se realizó con el fin de comparar la expresión en suero y saliva de TGF-ß, VEGF, TNF-α entre pacientes con OLP y personas de control para investigar si la saliva se puede utilizar como alternativa al suero para fines de diagnóstico y monitoreo de la enfermedad. Material y Métodos: Se incluyeron 23 pacientes con OLP y 23 individuos control para evaluar los niéveles en suero y en saliva de TGF- ß, VEGF, TNF-α utilizando kits ELISA. Se recogieron cinco mililitros de sangre venosa y se recogió saliva no estimulada por el método de escupir. Resultado: Los niveles séricos y salivales de TGF-ß, VEGF, TNF-α son más altos en pacientes con OLP en comparación con los controles normales. La diferencia media es mayor en saliva que en suero. Además, hubo una diferencia significativa de VEGF y TNF-α en suero y saliva entre los grupos sintomáticos y asintomáticos. Conclusion: La saliva puede usarse como un sustituto del suero para evaluar los niveles de los biomarcadores estudiados

A challenging case of hereditary type 1 tyrosinaemia associated with persistent diarrhoea: Case report and literature review

Hereditary tyrosinaemia type 1 (HT1) is a rare inherited genetic disorder attributed to deficiency of the enzyme fumarylacetoacetate hydrolase (FAH). HT1 may present with diarrhoea in its acute form. We report on a 2.5-year-old Egyptian girl diagnosed with HT1. At the age of 1 year and 9 months, the patient started to have persistent diarrhoea with marked abdominal distension, anorexia and irritability, and with no fever or vomiting. At the onset of diarrhoea, liver synthetic functions deteriorated and ascites progressed, requiring frequent paracentesis. These manifestations did not improve after starting specific treatment for HT1 (2-(2-nitro-4-trifluoromethylbenzoyl)- 1,3-cyclohexanedione) (NTBC). Coeliac disease was diagnosed; this disorder was not previously reported as having an association with HT1

Prevalence Of Respiratory Symptoms And Pulmonary Function Status Of Restaurant Workers

@#The cooking process may emit toxic compounds and airway irritants from both the fuel combustion and cooking fumes which is harmful to the respiratory health among the restaurant workers. A cross-sectional study of 243 restaurant workers from the selected restaurants in Sungai Long, Malaysia was conducted. The standardized British Medical Research Council questionnaire on Respiratory Symptoms (1986) was used during the interview to access the symptoms and the spirometry test was performed to evaluate the pulmonary functions of the participants. The data of socio-demography and occupational characteristics were also collected. The most complaint respiratory symptoms by the restaurant workers were breathlessness, which accounted for 33.7%, followed by wheezing (14%). The mean values of all pulmonary function tests (PFT) of the restaurant workers were within the normal range (>80%), except for the Peak Expiratory Flow (PEF) (79.09%). The results of the bivariate statistical analysis, Chi-square, ANOVA and t-test, showed the determining factors of the respiratory health among the workers were workers’ age and gender in addition to the working duration and the ethnicity. The restaurant workers in Sungai Long were at risk of developing respiratory symptoms and lower pulmonary function values due to prolonged exposure to cooking fumes. Emphasis should be given to the safety and health of restaurant workers and health education should be provided to the restaurant workers and owners. Strategies to increase notification of such occurrences among these workers should be looked into by related agencies in the country.

Validity and reliability of the Patient Activation Measure® (PAM®)-13 Malay version among patients with Metabolic Syndrome in primary care

@#Introduction: The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic.Methods: This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. Results: The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser–Meyer– Olkin test was 0.767, and Bartlett’s test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach’s α was 0.79, and the intraclass correlation coefficient was 0.45. Conclusions: The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.

Predictors of Short-Term Outcome of Kasai Portoenterostomy for Biliary Atresia in Infants: a Single-Center Study / 대한소아소화기영양학회지

Purpose@#The outcome predictors of Kasai portoenterostomy (KPE) for biliary atresia (BA) are controversial. This study aimed to identify possible short-term outcome predictors of KPE for BA in infants. @*Methods@#This retrospective study included infants with BA who underwent KPE between January 2015 and December 2017 and were followed up for at least 6 months after surgery at the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Egypt. The short-term outcome was jaundice clearance within 6 months following surgery. All data were compared between the jaundice free group and those with persistent jaundice to identify the predictors of jaundice clearance. @*Results@#The study included 75 infants. The mean age at the time of surgery was 82.43±22.77 days (range, 37–150 days), and 28 (37.3%) infants cleared their jaundice within 6 months postoperative. Age at surgery did not significantly affect the outcome (p=0.518). Infants with persistent jaundice had significantly higher pre-operative levels of aspartate aminotransferase (AST) than those who were jaundice free (p=0.041). Receiver operating characteristic curve analysis showed that preoperative AST ≤180 IU/L was predictive of a successful KPE, with sensitivity 74.5% and specificity 60.7%. Infants with bile plugs in liver biopsy had a 6-fold higher risk of persistent jaundice than those without bile plugs (95% confidence interval: 1.59–20.75, p=0.008). @*Conclusion@#Jaundice clearance after KPE for BA can be predicted using preoperative AST and presence of bile plugs in liver biopsy.

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@#TEST YOUR KNOWLEDGE

Validity and reliability of the Patient Activation Measure® (PAM®)-13 Malay version among patients with Metabolic Syndrome in primary care

@#Introduction: The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic. Methods: This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. Results: The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser–Meyer– Olkin test was 0.767, and Bartlett’s test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach’s α was 0.79, and the intraclass correlation coefficient was 0.45. Conclusions: The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.

In-vitro and In-vivo Relationship of Gabapentin from Floating and Immediate Release Tablets

Gabapentiniseffectiveagainst post-traumaticspinalinjury-inducedneuropathicpain.Itrequireshighdosageand frequency inthemanagementofneuropathicpain.Thepresentresearchworkwasanattempttoformulate andevaluategabapentingastro-retentivetabletstoprolonggastricresidenceandincreasedrug absorptionand furtherincreasebioavailability.Thefloatingtabletsofgabapentinwerepreparedintwodoses(300and600mg) byusingtwopolymers(hydroxylpropylmethylcelluloseandhydroxylpropylcellulose).Immediaterelease tabletsofgabapentincontaining thesamedoseswerepreparedandusedasreferenceformulations.The physicochemicalcharacteristicsofthepreparedtabletsweredetermined(drug content,weightvariation,friability, hardness,thicknessand diameter). Drugreleasefromthepreparedtabletswasfollowed and foundthatby increasingdrug concentrationinthetabletsreleaserateincreases.Floatingtabletsshowedprolongeddrugrelease (over96%)tomorethan15hrs.Immediatereleasetabletsshowedover97%drugreleasewithin48min.In-vivoresultsshowedthatplasmaexposuretogabapentininanimalsreceivingthedrug doesnotdose proportionalandtherefore maynotreachtherapeuticallyusefullevels.AUC0-24andCmaxincaseof300mgtabletsaremorethanthoseincaseof 600 mgtablets.Thein-vivo releaseofgabapentin doesnot correlatewiththein-vitroreleaseofthedrug.

Temporomandibular joint disorder predisposing factors and clicking

This study includes 450 patients, 271 females and 179 males, ages between 13-65 years. The Helkimo index for temporomandibular disorder (TMD) diagnosis was used to quantitatively evaluate the signs and symptoms of the disorder. Clicking of the joint was diagnosed by using stethoscope. Parafunctional activity, previous trauma, missing teeth, angle's classification, crossbite, overbite and overjet were assessed and considered as variables in this research. SPSS with chi square test and Pearson's coefficient correlation were used for statistical analysis. The results of this study show no association between clicking, parafunctional habits, unilateral chewing, previous trauma, angle's classification, crossbite, overbite and overjet. These result coincide the hypothesis that the exact etiology of TMDs is still obscure and the lack of a clear single cause of TMD, specially clicking, has resulted in the proposal of a multifactorial etiology for TMD.

The effect of Niclosamide in acetic acid induce colitis: an experimental study

Ulcerative colitis is an idiopathic chronic inflammatory disease of the colon for which a lot of treatment modalities are present. However, significant side effects are associated with them, and there is a need for a search for other tretment options. This study was aimed to assess the contribution of niclosamide in experimentally established colitis in rats. Animals were categorized into 5 groups; the control group undergoes no induction of UC, colitis group in which UC was induced, and animals receive no treatment, the niclosamide group that received niclosamide and sulfasalazine group that received sulfasalazine. Each group was composed of 10 animals. After the completion of a one-month period of the experiment animals were sacrificed and the following meausres were done: the weight of the colon, determination of the area of mucosal damage by mm2, histological scoring after hematoxylin and eosin stain together with MAC score and immunohistochemistry of IL-6, TNF-alpha, MPO, MDA, CD62, and ICAM1. The results of the current study revealed that Nicosamide was able to reduce the area of mucosal damage, colon weight, histological and Mac scores and immunohistochemical scores of inflammatory and oxidative markers, significantly when contrasted to a group of colitis (P< 0.05). It has been concluded that Niclosamide was proved to have a significant effect as an adjuvant mode of therapy for colitis through its, anti-inflamatory and anti-oxidant effects (AU)

Incidence and Outcomes of Community Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease at King Abdulaziz Medical City, Riyadh

Aims: The aim of the study was to estimate the incidence of Community-acquired pneumonia (CAP) among patients with chronic obstructive pulmonary disease (COPD).Study Design: A retrospective cohort study.Place and Duration of Study: King Abdulaziz Medical City in Riyadh between January 2016 to March 2018.Methodology:From the medical file, we identified patients with COPD diagnosis who admitted to the hospital. Then we identified the patient who develop CAP after the diagnosis date of the COPD. Other variables such as demographic factors, clinical outcome, comorbidity disease, length of stay in the hospital, and mortality were identified for each patient using their electronic medical file.Results:Out of363 COPD patients, 122 (33%) had developed CAP after the date of COPD diagnosis. Based on patient characteristics, the mean age of them was 75.39 years SD was 9.76 and 65% of the patients were female. The available evidence indicates that the mortality rate was n=22 (18.0%). Among those patient, 33 patients were admitted to ICU (27.0%) the rest of patients either wards n= 59 (48.4%) or both n=28 (23.0%). Among our study population, 97.4% had hypertension, 88.6% of the patients had diabetes, and 28.9% had renal failure. Majority of the study population have been placed on non-invasive ventilation n=94 (77.0%).Conclusion:This study has been shown that COPD patients had increased risk of CAP. Patients who have multiple comorbidity diseases and got CAP withCOPD have a higher risk of morbidities and mortality rate, especially elderly patients.Mention the design of the study here.