Comparison of Peri-Implant Soft Tissue Around Zirconia and Titanium Abutments in the Aesthetic Zone: A Narrative Review.

This narrative review compares the peri-implant soft tissue responses around zirconia and titanium abutments in the aesthetic zone, emphasizing their mechanical, biological, and aesthetic properties. Titanium abutments, known for their excellent mechanical strength and fatigue resistance, have traditionally been the standard in dental restorations but face challenges in aesthetic integration due to their metallic appearance and potential for higher inflammatory responses. Zirconia abutments, emerging as a promising alternative, offer superior aesthetic outcomes, reduced plaque accumulation, and lower inflammatory responses, making them ideal for use in visible areas with thin soft tissue biotypes. However, zirconia's mechanical properties, such as lower fracture resistance, necessitate careful clinical application. The review also highlights rare instances of titanium allergies, underscoring the importance of individualized treatment planning and regular monitoring to ensure the longevity and success of implant restorations.

Rapid Onset and Recovery Linezolid-Induced Thrombocytopenia: A Large-Sample, Single-Center Retrospective Cohort Study.

Introduction: Thrombocytopenia is a common and potentially severe adverse effect of linezolid, but the time to onset during treatment has varied substantially across studies. Moreover, the time to recovery after linezolid withdrawal has not been examined in a larger patient sample. Objective: The first objective of this study was to measure the mean time to linezolid-induced thrombocytopenia (LIT) and the second was to measure the mean time to recovery after linezolid discontinuation. Methods: A retrospective observational cohort study was conducted between January 2017 and December 2022 at Dammam Medical Complex using the medical records of hospitalized adults with normal baseline platelet counts receiving intravenous linezolid for a minimum of 48 hours. All patients included in the analyses received daily platelet count monitoring for up to 14 days after linezolid initiation and 14 days after discontinuation. Thrombocytopenia was defined as a drop in platelet count to <150 × 109/L or <50% of baseline within 14 days. The dose duration-risk relationship and recovery rate were analyzed by constructing Kaplan-Meier survival curves. Results: In total, 334 patients met study inclusion criteria. The mean time to develop thrombocytopenia after starting linezolid was five days, and the mean time of recovery was also 5 days. The cumulative risk of thrombocytopenia reached 100% by day six of therapy, and cumulative recovery reached 100% by day six after linezolid withdrawal, with half of the study population recovering by day four. Conclusion: Thrombocytopenia can develop rapidly during linezolid treatment, but recovery after discontinuation is also rapid. Rapid thrombocytopenia is a common adverse effect of linezolid that must be considered prior to prescription, and routine monitoring of platelet count is recommended so that linezolid treatment can be discontinued, if thrombocytopenia occurs.

Persistent median artery in carpal tunnel syndrome for a patient with end stage renal disease after thrombosis of the left radiocephalic AV forearm loop graft: A case report.

INTRODUCTION & IMPORTANCE: Carpal tunnel syndrome (CTS) is the most common neuropathy in the world and is caused by compression of the median nerve. It has many known risk factors, including hemodialysis and a persistent median artery (PMA), which can be an incidental finding during carpal tunnel release (CTR). CASE PRESENTATION: A 65-year-old woman with end-stage renal disease (ESRD) on dialysis for seven months presented with typical signs and symptoms of carpal tunnel syndrome. Nerve conduction studies (NCS) displayed severe neuropathy. Upon carpal tunnel release (CTR) a rare superficial non-calcified persistent median artery critical to the circulation of the hand was found. The patient's symptoms resolved completely within four weeks of the operation. CLINICAL DISCUSSION: The PMA is a relatively common anomaly and could cause carpal tunnel syndrome by: directly pressing the median nerve, thrombosing, or in the setting of an aneurysm. Although usually found deep to the flexor retinaculum, the PMA could also be found superficially. It can be critical to the blood supply of the hand and should therefore be dealt with carefully. CONCLUSION: Surgeons should be aware of the possibility of finding a PMA when performing CTR. The PMA could be deep or superficial to the transverse carpal ligament. Where possible, the PMA should be preserved. Especially if its contributions to the blood supply of the hand are undetermined.

The diagnostic accuracy of stress myocardial perfusion scintigraphy in patients with end-stage renal disease.

OBJECTIVE: This study examined the diagnostic accuracy of myocardial perfusion scintigraphy (MPS) in end-stage renal disease (ESRD) patients and the incidence and clinical and biochemical predictors of myocardial perfusion abnormalities. METHODS: We evaluated 500 asymptomatic ESRD patients on hemodialysis referred for MPS for cardiac risk stratification before renal transplant surgery. Patients with abnormal MPS and an additional few patients without abnormal MPS underwent invasive coronary angiography (ICA). RESULTS: Sixty-nine patients (13%) showed abnormal MPS (reversible or fixed defect). The majority of patients had cardiovascular risk factors. There were statistically significant differences in age, male gender, hypertension, diabetes, hypercholesterolemia, and left ventricular ejection fraction (LVEF) (P < 0.05 for each) between patients with normal and abnormal MPS. Multivariate regression analysis showed that age (≥ 62 years) and low LVEF (≤ 47%) were independent predictors for abnormal MPS. ICA was performed in 112 subjects; the sensitivity, specificity, positive predictive value, and negative predictive value of MPA to detect CAD is 72%, 70%, 79%, and 61%, respectively. CONCLUSIONS: In ESRD, the incidence of myocardial perfusion defects is 13%. In addition to other traditional CAD risk factors, such as diabetes and hypertension, age, and LVEF are the strongest predictors of MPS abnormalities. Initial risk stratification can be cost-effective for identifying high-risk patients who will benefit from more imaging with CAD risk factors and LVEF. In ESRD patients, MPS diagnostic performance is relatively poor. To further evaluate the utility of MPS in diagnosis and risk stratification in ESRD, more data is therefore required.