Undergraduates' comparative assessment, utilizing a structured rubric, of hands-on versus video-supported presentation in class II cavity preparation.

BACKGROUND: Dental education is considered as a complex, challenging and often stressful educational procedure. Acquisition of psychomotor skills by undergraduate students is an important step in many health professions to become a successful professional. During under graduation, class II cavity preparation exercise is of utmost important in dentistry. OBJECTIVE: To compare class II cavities prepared by students after hands-on live demonstration and pre-recorded video demonstration using well-organised evaluation rubrics. METHOD: Preclinical dental students (n= 50) were divided into two groups. The students in group I (n= 25) attended a hands-on live demonstration performed by one faculty while students in group II (n= 25) watched a 15-minute pre-recorded procedural video on the projector. Both groups were appealed to prepare class II cavity for amalgam involving disto-occlusal surface of mandibular second molar articulated on jaw model (TRU LON study model, Jayna industries, Ghaziabad U.P., India). Following completion of the preparations, all teeth were collected, and labelled grades of prepared cavities were given according to prespecified rubrics. The data of scores were presented as means and standard deviation. Statistical analysis of data was executed using SPSS software. A paired t-test was used to compare scores between groups. RESULTS: The study shows that the video-supported demonstration of a cavity preparation was better than the live hands-on demonstration. A higher mean response for the procedural video group was found compared to the live demonstration group (p= 0.000133). CONCLUSION: Pre-recorded video-supported demonstration along with guidance by a tutor may be a viable alternative to hands-on live demonstration in cavity preparation procedures during undergraduate dental training. Moreover, rubric methods can be implemented in the teaching of various preclinical exercises for conservative dentistry and endodontics.

A systematic review assessing the dental pulp stone prevalence in the Saudi Arabian population.

This Systematic Review (SR) was to report on the prevalence of pulp stones in the Saudi Arabian (KSA) population. The electronic databases were searched for scientific research articles during May 2021. The data search was performed in electronic search engines like PubMed, Scopus, Web of science, and Saudi Digital Library, and 6 original research articles which fulfilled the eligibility criteria were assessed for qualitative data. The prevalence of pulp stones among the KSA population ranged from 4.6% to 50.93% among the study participants and it ranged between 10.2%-13.34% in the teeth assessed. The pulp stones were more frequently reported in decayed teeth, periodontal diseases, attrition, teeth with dental restorations, and higher in the molar teeth in comparison with the premolar teeth. The data on the prevalence of pulp stones among the Saudi population will be helpful for clinicians in planning endodontic procedures.

Copper (0) Mediated Single Electron Transfer-Living Radical Polymerization of Methyl Methacrylate: Functionalized Graphene as a Convenient Tool for Radical Initiator.

Polymer nanocomposites have been synthesized by the covalent addition of bromide-functionalized graphene (Graphene-Br) through the single electron transfer-living radical polymerization technique (SET-LRP). Graphite functionalized with bromide for the first time via an efficient route using mild reagents has been designed to develop a graphene based radical initiator. The efficiency of sacrificial initiator (ethyl α-bromoisobutyrate) has also been compared with a graphene based initiator towards monitoring their Cu(0) mediated controlled molecular weight and morphological structures through mass spectroscopy (MOLDI-TOF) and field emission scanning electron microscopy (FE-SEM) analysis, respectively. The enhancement in thermal stability is observed for graphene-grafted-poly(methyl methacrylate) (G-g-PMMA) at 392 °C, which may be due to the influence ofthe covalent addition of graphene, whereas the sacrificial initiator used to synthesize G-graft-PMMA (S) has low thermal stability as analyzed by TGA. A significant difference is noticed on their glass transition and melting temperatures by DSC. The controlled formation and structural features of the polymer-functionalized-graphene is characterized by Raman, FT-IR, UV-Vis spectroscopy, NMR, and zeta potential measurements. The wettability measurements of the novel G-graft-PMMA on leather surface were found to be better in hydrophobic nature with a water contact angle of 109 ± 1°.

Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre.

The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.

Late onset congenital central hypoventilation syndrome after exposure to general anesthesia.

PURPOSE: Prolonged postoperative hypoventilation presents a challenge to anesthesiologists with regard to assessing etiology and related treatment. We present a case of recurrent episodes of postoperative hypoventilation in a previously asymptomatic child after uneventful general anesthesia. In this case, the child eventually required lifelong ventilatory support during sleep. CLINICAL FEATURES: A case of postoperative hypoventilation in a previously asymptomatic six-year-old child was investigated to determine the possible etiology. After uneventful general anesthesia for dental surgery, the child experienced recurrent episodes of hypoventilation associated with sleep. The child's lungs were mechanically ventilated due to failure of all trials of weaning. Clinical examination was unremarkable and laboratory investigations excluded the possibility of thyroid, hepatic, renal, and neuromuscular diseases. Computerized tomography, magnetic resonance imaging, and electroencephalogram studies were within normal limits. A negative pyridostigmine trial ruled out myasthenia. The child was finally diagnosed as having "late onset congenital central hypoventilation syndrome". Genetic testing revealed a PHOX2B mutation consistent with this diagnosis. The child was discharged home on mechanical ventilatory support during sleep. CONCLUSION: Congenital central hypoventilation syndrome is a rare lifelong multisystem disorder which may occur during the neonatal period as a result of severe genetic mutation in the PHOX2B gene. In mild mutations, a triggering factor, such as sedation or anesthesia, may be required for the syndrome to manifest itself. These patients often require lifelong mechanical ventilatory support, particularly during sleep.

Anesthesia for gingivectomy and dental extractions in a child with I-cell disease--a case report.

I-cell disease (mucolipidosis II) is a rare metabolic disorder resulting from the deficiency of a specific lysosomal enzyme, N-acetylglucosamine-1-phosphotransferease. Developmental delay and growth failure are common presentations of I-cell disease. Psychomotor deterioration is rapid and progressive. Some physical signs, such as hip dislocations, inguinal hernia, hepatomegaly, joint limitation, and skin changes may be present at birth. Coarse facial features and skeletal abnormalities become more conspicuous with time. The life expectancy of children with this condition is poor, with death usually occurring around the fifth year. A case report of the anesthetic management of gingivectomy with multiple dental extractions in a 5 years old Omani female, with I-cell disease, is presented. The problems faced and their management during anesthesia are described.

Combined use of remifentanil and propofol to limit patient movement during retinal detachment surgery under local anesthesia.

BACKGROUND: One of the drawbacks of performing ophthalmic surgery under local anesthesia is patient movement, which might affect optimal surgical outcome. PURPOSE: The study aims to evaluate the efficacy of the combined use of propofol and remifentanil as a sedative technique in comparison with the use of propofol alone to limit patient discomfort and movement during local anesthesia for vitreo-retinal surgery lasting for more than two hours. MATERIALS AND METHODS: A total of 140 patients scheduled for vitreo-retinal surgery under local anesthesia, with an expected surgical time of more than two hours, were included in the study. Patients were divided randomly into two equal groups: group I where patients were given propofol and remifentanil by continuous infusion and group II where patients were given propofol alone by continuous infusion. RESULTS: The two groups were comparable with regard to age, weight, gender, ASA physical status and duration of surgery. There was a significant decrease in heart rate and mean arterial blood pressure (MABP) in each group 10 minutes after the start of sedation compared with pre-sedation data and continued all through the procedure. There was an insignificant difference between the two groups with regard to changes in heart rate and MABP all through surgical procedure. There was no significant difference between the two groups with regard to the incidence of complications except for an increased incidence of breakthrough pain and discomfort which necessitated the use of fentanyl as a rescue treatment in the propofol group P<0.001. There were no instances of movements with a major effect on the surgical field, which could have affected surgical outcome, in the two groups. The number of patients who did not move was significantly higher, 56 (80%), in group I compared with 38 (54.29%) in group II with P<0.001. The ophthalmologist satisfaction scale was significantly higher in group I (4.5±0.63) compared with group II (3.7±1.04) with P=0.0016. CONCLUSION: The combined use of propofol and remifentanil as a continuous infusion before performance of the block and during lengthy vitreo-retinal surgery was associated with a lower incidence of patient discomfort, breakthrough pain, and patient movement along with high degree of surgeons' satisfaction and hemodynamic stability.

Anaesthetic management of congenital laryngeal web presenting with acute upper airway obstruction.

This is a case of failed intubation in a child of 15 months due to presence of laryngeal web. The airway was maintained by Cole Neonatal tube size 2 mm held at the available orifice of the glottis with maintenance of spontaneous respiration under general anesthesia till emergency tracheostomy was performed.

Randomized trial of superficial peribulbar compared with conventional peribulbar anesthesia for cataract extraction.

PURPOSE: Evaluate efficacy of superficial peribulbar anesthesia for cataract extraction compared with conventional peribulbar anesthesia. SETTING: Department of Ophthalmology, Al Nahdha Hospital (Tertiary Ophthalmic and ENT Hospital) and Magraby Eye & Ear Center, Muscat, Sultanate of Oman. METHODS: Patients scheduled for cataract extraction with intraocular lens implantation were randomly divided into two groups according to anesthetic technique used. The first group patients were anesthetized using superficial peribulbar anesthesia, while second group patients were anesthetized using conventional peribulbar block. The efficacy of the blockade was judged by onset and degree of akinesia and volume of local anesthetic needed to obtain acceptable akinesia, sensation of pain during surgery, effect on intraocular pressure, degree of patient satisfaction, and incidence of complications. RESULTS: Nine hundred patients scheduled for cataract extraction with intraocular lens implantation during the period of June 2003 and October 2006 were included in this study. Five hundred cases were anesthetized using superficial peribulbar anesthesia and four hundred cases were anesthetized using conventional peribulbar block. The two groups were comparable as regards age, weight, gender, duration of surgery, and degree of analgesia. Superficial peribulbar anesthesia provided faster onset, higher degree of akinesia with less volume of local anesthetics used, no need for supplementary reinjection, no effect on intraocular pressure, and better patient satisfaction score compared with conventional peribulbar anesthesia. There were no serious complications in both groups. The incidence of subconjunctival hemorrhage was significantly higher in superficial peribulbar group (18%) compared with conventional peribulbar block (0.5%). CONCLUSION: Superficial peribulbar anesthesia is a safe, simple, quick to perform, and effective method of anesthesia for cataract surgery with better patient satisfaction, better akinesia, and comparable analgesia compared with conventional peribulbar block. Subconjunctival hemorrhage is a self-limited complication associated with this technique.

Detection of malaria in Saudi Arabia by real-time PCR.

Malaria transmission occurs in Saudi Arabia and mainly endemic in the lowlands of Asir region, the Southwester Province. Imported cases have been reported. Sensitive routine laboratory techniques for rapid and accurate malaria diagnosis are therefore desirable to facilitate the identification of individuals infected with the malarial parasites and to follow up the progress of treatment of such cases with appropriate drugs. Traditional diagnosis, based on the microscopic examination of Giemsa-stained thick and thin films remains the main standard method of diagnosis used for malaria diagnosis in Saudi Arabia. Molecular diagnostic techniques based on the detection of nucleic acids (as PCR; Real-time PCR) are now highly considered. Real time-PCR a new methodology has been recently applied to detect human malaria. In this study a total of forty four samples, using whole-blood, dried blood and thick smears were examined by PCR and Real-time PCR. Both techniques showed a higher sensitivity than the microscopy. Parasites were detected in twenty nine samples out of forty four, compared to twenty six of thirty nine were positive with thin blood film. The real-time PCR assay offers a practical and positive alternative for rapid and accurate diagnosis for malaria infection. The application of such technique will be significantly valuable especially for screening for malaria infection in endemic areas.

Comparative study of 2 anesthesia techniques for pediatric refractive surgery.

PURPOSE: To compare the effectiveness of 2 anesthesia techniques for pediatric refractive surgery, propofol/fentanyl and ketamine/midazolam. SETTING: Department of Ophthalmology, Magraby Eye & Ear Center, Muscat, Oman. METHODS: This prospective clinical study was of children ranging in age range from 3 to 12 years who were followed for myopic anisometropia with amblyopia after failure of conventional correction or patients with superficial stromal corneal opacities. The children were scheduled to have refractive surgery under general anesthesia using propofol/fentanyl (P/F group) or ketamine/midazolam (K/M group). All drugs were administered intravenously. RESULTS: Thirty patients were included in the study and were divided randomly into 2 equal groups. Both groups were comparable in age, weight, sex, duration of anesthesia, and duration of surgery. Time to complete recovery was significantly shorter in the P/F group. The hemodynamic changes observed in this study were not of clinical significance. Three patients in the P/F group showed arterial oxygen (O2) saturation of less than 90% and supplemental O2 was given by nasal cannula. The incidence of postoperative agitation and vomiting was significantly higher in the K/M group, while the need for jaw thrust was significantly higher in the P/F group. The difference between both groups in the ophthalmologist satisfaction score was not significant. CONCLUSIONS: Propofol offered some advantages for brief procedures outside the traditional operating rooms. It is short acting, and has a rapid offset resulting in shorter postoperative monitoring and a smoother recovery profile. It has greater potential for respiratory depression than ketamine. Hence, greater vigilance and experience with the pediatric airway is recommended with its use.

Preemptive analgesia in rhegmatogenous retinal detachment surgery: is it effective?

PURPOSE: To evaluate the efficacy of preemptive analgesia in surgical repair of retinal detachment (RD) using scleral buckle and cryopexy under general anesthesia. METHODS: Thirty patients who were scheduled for rhegmatogenous RD surgical repair using scleral buckle and cryopexy and who were American Society of Anesthesiologists physical status I, II, or III were included in this study. The patients were randomly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in Group 2, sub-Tenon anesthesia was given as preemptive analgesia after induction anesthesia and before start of surgery. Both groups were statistically comparable as regards patient age and weight and duration of anesthesia and surgery. RESULTS: The incidences of intraoperative oculocardiac reflex and postoperative vomiting were significantly lower in Group 2 compared with Group 1 (P < 0.001 and 0.0113, respectively). The time of first postoperative analgesic dose was significantly shorter in Group 1 (46.67 +/- 18.84 minutes) compared with Group 2 (162.67 +/- 29.391 minutes) (P < 0.001). The total analgesic consumption per 24 hours was significantly higher in Group 1 compared with Group 2 (P < 0.001). The time of discharge from the hospital was significantly shorter in Group 2 (8.8 +/- 2.704 hours) compared with Group 1 (12.4 +/- 3.481 hours) (P = 0.0018). CONCLUSION: The use of sub-Tenon block as preemptive analgesia after induction of general anesthesia and before the start of rhegmatogenous RD surgical repair was effective in reducing postoperative pain and analgesic requirements compared with an unblocked group. The use of sub-Tenon block was also effective in reducing intraoperative incidence of oculocardiac reflex and postoperative incidence of vomiting.

Uterine serous papillary carcinoma: histopathologic changes within the female genital tract.

The histopathologic features of 25 patients with uterine serous papillary carcinoma (USPC) were presented, with particular emphasis on the changes seen in the remaining müllerian epithelium. The mean age at presentation was 68.9 years; 52% of patients were stage III at the time of presentation and 40% died of their disease within 24 months of diagnosis. Histologic assessment revealed: 1) pure serous carcinoma in 56% of patients and mixed differentiation of serous and endometrioid in the remainder; 2) malignant epithelium reminiscent of that of USPC and akin to carcinoma in situ, frequently seen in the remaining endometrium, cervix, and, less commonly, the fallopian tube; 3) residual endometrium that, when identified (11/25 cases), was atrophic in all cases; 4) various types of cervical involvement in 17 cases (68%); 5) tumor within the fallopian tube in three cases (12%); and 6) carcinoma with in situ-like features in five cases (20%). In conclusion, it appears that USPC is frequently associated with malignant epithelial changes (as with carcinoma in situ) in the remaining müllerian epithelium. This finding suggests either a field change or, more likely, a transepithelial tumor spread. The latter theory is preferable, because this type of spread is frequently seen on serosal surfaces in cases of serous ovarian carcinoma. Uterine serous papillary carcinoma is, therefore, biologically more akin to its ovarian counterpart.

Clinical and electrophysiological studies of diphtheritic neuritis in Jordan.

Eleven patients with acute diphtheritic neuritis were studied clinically and electrophysiologically. Decreased conduction velocity and increased distal motor latency were present in most patients within two weeks of the onset of neurological symptoms. Velocities later fell to approximately 45% of mean normal values. Wasting with electrophysiological evidence of denervation was present in 3 patients. Nerve conduction studies had returned to normal within 3 months in 8 patients. There was a striking dissociation between the time course of the clinical and the neurophysiological abnormalities: early in the illness, peripheral nerve conduction was normal in some patients despite the presence of severe weakness, and later, the maximum electrophysiological abnormalities were sometimes found after clinical recovery had commenced. The nature and sequence of the clinical and electrophysiological changes are in accord with the known pattern and distribution of the pathological changes in the disease.