Effect of Framework's Manufacturing Technique on Screw's Preload of Implant Supported Prosthesis.

BACKGROUND: Implant supported prosthesis is a common treatment modality. Nowadays, new manufacturing techniques are available to fabricate them. AIMS: To evaluate the effect of different manufacturing techniques of implant supported frameworks (ISF) on the preload of abutment's screws. MATERIALS AND METHODS: A mandibular edentulous acrylic model with four dental implants temporarily stabilized in the interforaminal area was used. One ISF was fabricated using the conventional technique; implants were removed from the model and reassembled into the framework; this framework served as the passively fitting framework (PF). Three additional frameworks were constructed: conventional cast framework (CF), milled framework (MF) and 3D-printed framework (3D-PF). The gap between the frameworks and the neck of the implants were recorded in microns using a digital microscope. A tightening torque (TT) of 35 N·cm was applied to all the four abutments' screws and the screw's preload was recorded using two methods, by strain gauges (SGs) that were attached to the neck of each implant and fed into a stain book in microstrain (µÉ›) and by removal torque (RT) using a digital torque meter. RESULTS: The frameworks' gap means from the lowest to the highest were PF, CF, 3D-PF, and MF. The RT was significantly lower than the TT in all frameworks (P ≤ 0.05). One-way analysis of variance (ANOVA) revealed that the PF had the lowest RT, while the CF and the 3DPF both had the highest RT, and those differences were found to be statistically significantly (P ≤ 0.05). When preload of the frameworks was recorded by SGs, one-way ANOVA revealed that PF had the highest preload value, while both 3D-PF and MF had the lowest preload values, those differences were also found to be statistically significant (P ≤ 0.05). CONCLUSION: The fabrication of implant-supported frameworks using milling or selective laser melting computer aided design/computer-aided manufacturing technologies did not necessarily enhance the screw's preload. This lack of enhancement could be attributed to the great amount of marginal gap in the frameworks fabricated by both techniques.

Transradial Neuroendovascular Procedures in Adolescents: Initial Single-Center Experience.

BACKGROUND AND PURPOSE: The feasibility and safety of transradial angiography is not established outside the adult literature. The objective of this study was to assess the feasibility and safety of transradial access for neuroangiography in adolescents. MATERIALS AND METHODS: A retrospective case-control study was performed, comparing transradial neuroendovascular procedures in adolescents (age range, 10-18 years) with an age- and procedure-matched cohort of transfemoral neuroendovascular procedures. Clinical and procedural details, including type of procedure, conversion rate, fluoroscopy time, radiation dose, complications, and readmissions, were reported by descriptive statistics or measures of central tendency and compared using a t test or nonparametric equivalent. A P value < .05 was considered statistically significant. RESULTS: Twenty adolescents (mean age, 14.6 [SD, 1.7] years, M/F ratio = 9:11) who underwent transradial neuroangiography were compared against 20 adolescents (mean age, 14.4 [SD, 2.1 ] years, M/F ratio = 12:8) who underwent transfemoral neuroangiography. We found no significant difference in procedural success (0% conversion rate), fluoroscopy times (33.7 [SD, 40.2] minutes versus 23.3 [SD, 26.2] minutes, P = .34) and radiation dose (150.9 [SD, 133.7] Gy×cm2 and 122.9 [SD, 79.7] Gy×cm,2 P = .43) There were 2 self-limiting postprocedural complications in the transradial group. There were no major hemorrhages, need for further interventions, or readmissions in either group. CONCLUSIONS: The benefits of transradial angiography described for adults can likely be safely extended to adolescents. These are important data before transitioning to smaller children and should be prospectively evaluated in a larger cohort.

Research training, productivity and challenges among trainees of pediatric residency programs across Saudi Arabia.

BACKGROUND AND OBJECTIVES: Research provides skills for lifelong learning and promotes patient care. In Saudi Arabia, until recently, research training has not been integrated effectively in postgraduate medical education. The aim of this study was to investigate the factors involved in research training, productivity, challenges, and attitude among trainees in pediatric residency programs across Saudi Arabia. MATERIALS AND METHODS: This is a cross-sectional, multicenter study using a questionnaire designed to assess several aspects of research training among trainees of the national pediatric residency program in Saudi Arabia from September to December 2013. RESULTS: Eighty-three residents from seven training centers participated (response rate of 65.5%). Ninety percent of participants agreed that research training must be mandated in each residency program. The majority of participants (85.5-89.2%) agree that research is beneficial because it improves patient care, enhances the pursuit of academic careers, and improves fellowship acceptance rates and success. More than half (51.8%) of participants believe that research training will interfere with their efforts to become a medical expert in their fields. The survey indicated low research involvement by trainees, with 86.7% of participants having never published scientific manuscripts. The majority of participants (73.5%) reported a lack of regular, structured research activity in their training curriculum. The main challenge in research training was the lack of protected time (according to 86.7% of respondents). The majority of participants (85.6%) agreed that training in research methodologies represents their top educational need. CONCLUSION: This study represents a "needs assessment" phase in the development of a research training curriculum for the Saudi pediatric residency program. The majority of participating residents have a positive attitude toward research. Research productivity and training were found to be low. A dedicated research curriculum within the residency program represents an effective and evidence-based solution.

Anatomical variation of pulmonary venous ostium and its relationship with atrial arrhythmia in the Saudi population.

PURPOSE: To assess the anatomical variation of the ostial pattern of pulmonary veins observed on coronary computed tomography (CT) angiogram and to estimate the relationship of atrial arrhythmia with similar ostial variants in the Saudi population. MATERIALS AND METHODS: Thin-section (0.625 mm) contrast enhanced CT scans of 151 consecutive patients obtained over a span of a two-year period (January 2009-January 2011) for the diagnosis of ischemic heart disease, aortic regurgitation, infective endocarditis, aortic aneurysm, fibrosing mediastinitis, and pericardial defect. The retrospective study was focused on the identification of the number of venous ostia on either side of the left atrium and the drainage patterns of pulmonary veins. The frequency of each pattern was tabulated, and significance of their relationship with atrial arrhythmias was assessed with the X(2) and Fisher's exact tests. RESULTS: Out of 151 patients analyzed, 26 patients (17.2%) had anatomical variation of the pulmonary venous ostia. Atrial arrhythmia was recorded in 16 of 26(61.5%) patients (p = 0.000). The association of higher anatomical variation of pulmonary venous ostia was recorded as higher (p = 0.034) in the female group (n = 15, 57.7%). CONCLUSION: The association between anatomically varied venous ostia and atrial arrhythmia was significant (p = 0.000) with a significantly higher anatomical variation of pulmonary venous ostia in the female Saudi population (p = 0.034).

Replacing nebulizers by MDI-spacers for bronchodilator and inhaled corticosteroid administration: Impact on the utilization of hospital resources.

BACKGROUND AND OBJECTIVES: Metered-dose inhalers plus spacers (MDI-spacer) are as effective as, or better than, nebulizers in aerosol delivery. The selection of aerosol delivery system for hospitalized children can have a significant impact on the utilization of healthcare resources. DESIGN AND SETTING: A quality improvement project to evaluate the impact of conversion to MDI-spacer to administer bronchodilators (BDs) and inhaled corticosteroids (ICSs) to hospitalized children on the utilization of hospital resources. The project was conducted in a tertiary pediatric ward from April to May 2013. MATERIALS AND METHODS: The project was conducted over a six-week period. In the first two weeks, data were gathered from all hospitalized children receiving BDs and/or ICSs by nebulizers. This data collection was followed by a two-week washout period during which training of healthcare providers and operational changes were implemented to enhance the conversion to MDI-spacer. In the last two weeks, data were gathered from hospitalized children after conversion to MDI-spacer. The primary outcomes included the mean time (in minutes) of medication preparation and delivery. Secondary outcomes included the following: need for respiratory therapy assistance, estimated cost of treatment sessions, and patient/caregiver satisfaction. RESULTS: Five hundred seventy-five treatment sessions were enrolled (288 on nebulizers, 287 on MDI-spacer). The nebulizer group had more male predominance and were slightly older compared to the MDI-spacer group (male: 59% vs. 53% and mean age: 52 vs. 40 months respectively). The duration of treatment preparation and delivery was significantly lower in the MDI-spacer group (2 min reduction in preparation time and 5 min reduction in delivery time; p < 0.01). Caregivers mastered MDI-spacer use after an average of two observed sessions, eliminating the need for respiratory therapy assistance during the hospital stay. Medication cost analysis showed savings in favor of MDI-spacer (cost reduction per 100 doses: 50% for albuterol, 30% for ipratropium bromide, and 87% for ICSs). The patient satisfaction survey showed "very good" to "excellent" levels in both groups. CONCLUSIONS: Conversion to MDI-spacer for BDs and ICSs administration in hospitalized children improve hospital resource utilization.