Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial.

Background: Improvement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling. Purpose: This study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients. Methodology: Two equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained. Results: Both groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of <0.001. Conclusion: Systematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.

Effect of Extracorporeal shock wave on upper trapezius trigger points in patients with cervicogenic headache: A Randomized Clinical Trial.

OBJECTIVE: A recent study was designed to ascertain the impact of extracorporeal shock wave therapy (ESWT) on upper trapezius trigger points in cervicogenic headaches patients. DESIGN: A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20-40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (four weeks). RESULTS: Significant improvement of headache disability index, visual analogue scale scores, and upper trapezius electromyographic characteristics with p-value <.05 in both groups, in favor of the shock wave group. CONCLUSION: Extracorporeal shock wave therapy (ESWT) could be used for clinical and research concerns because it's positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients.

Disinfection of 3D-printed surgical guides using virgin coconut oil (in vitro study).

BACKGROUND/OBJECTIVE: Disinfection of a 3D-printed surgical guide is of utmost importance as it comes into contact with hard and soft tissue during implant placement so it poses a potential risk of pathogenic transmission. Methods used for disinfection in the surgical field should be reliable, practical, and safe for the instruments and the patients. The objectives of this study were to compare the antimicrobial potential of 100% Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol used to decontaminate 3D-printed surgical guides. MATERIALS AND METHODS: Thirty identical surgical guides were printed and cut into two halves (N = 60). Both halves were then contaminated with a defined amount of human saliva samples (2 ml). The first half (n = 30) was sub-grouped into three study groups which were immersed in one of the three disinfectants for 20 min as follows; group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. The second half (n* = 30) was sub-grouped into three control groups which were immersed in sterile distilled water as follows group VCO*, group GA*, and group EA*. The microbial count was expressed as colony-forming units per plate and the comparison of the antimicrobial potential of the three tested disinfectants between the three study and three control groups was done using the One-Way ANOVA test. RESULTS: The culture results of three study groups revealed no bacterial growth with the highest % of reduction in the mean microbial count of the oral microorganisms (about100%) and an uncountable bacterial growth was shown between the three control groups (more than 100 CFU/plate) representing the baseline of the oral microorganisms. Therefore; statistically significant differences were found between the three control and three study groups (P < .001). CONCLUSION: The antimicrobial potential of Virgin Coconut Oil was comparable and equivalent to Glutaraldehyde and Ethyl Alcohol with a significant inhibitory action against oral pathogens.

The microbiological effect of virgin coconut oil on the morphological and volumetric dimensional changes of 3D printed surgical guides (in vitro study).

BACKGROUND/OBJECTIVES: Disinfection of surgical guides is mandatory for intraoperative use. Virgin Coconut Oil may be a potent alternative disinfectant; however, its effect has not been fully discussed in dentistry. The objectives of this study were to compare the morphological and the volumetric dimensional changes of 3D printed surgical guides after immersion in three disinfectants: 100%Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol and to assess the antimicrobial effectiveness of the tested disinfectants. MATERIALS AND METHODS: A surgical guide was designed using open platform software to print thirty guides and then cut them into two halves (N = 60). Pre-disinfection scans of the first half of the three study groups (n = 30) were performed using Cone-beam Computed Tomography, then immersed for 20 min in three disinfectants as follows: group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. Post-disinfection scans of the first half of the three study groups (n = 30) were performed and then compared morphologically and volumetrically using an analyzing software program The second half of the three control groups (n* = 30) were soaked for 20 min in sterile distilled water as follows: group VCO*, group GA*, and group EA* for the assessment of the antimicrobial effectiveness of the three tested disinfectants. RESULTS: At the morphological assessment of the dimensional changes, group VCO were the most accurate with the lowest mean deviation value of 0.12 ± 0.02 mm and root mean square value of 0.12 mm, group GA and group EA were less accurate with mean deviation value of = 0.22 ± 0.05 mm and = 0.19 ± 0.03 mm and root mean square value of 0.22 and 0.20 respectively (p < 0.001). At the volumetric assessment, group VCO showed lower volumetric changes with a mean deviation value of 0.17 ± 0.10 mm, root mean square value of 0.19 mm, than group GA with mean deviation value of 0.23 ± 0.10 mm, root mean square value of 0.25 mm and group EA with mean deviation value of 0.27 ± 0.11 mm, root mean square value of 0.29 mm, however, no statistically significant differences were found between the three study groups (p = 0.10). The antimicrobial effectiveness of the three tested disinfectants showed a hundred percent (100%) reduction in the total microbial count in the first half of the three study groups treated with the three disinfectants revealing no bacterial growth, however, statistically significant differences were found between the second half of the three control and the first half of the three study groups. (p < 0.001). CONCLUSIONS: Virgin Coconut Oil showed higher morphological dimensional accuracy of the tested surgical guides than Glutaraldehyde and Ethyl Alcohol without causing any volumetric dimensional changes in the 3D printed surgical guides after disinfection for 20 min and the antimicrobial effectiveness was the same between the three tested disinfectants without showing any microbial growth.

Evaluation of retention and wear of a titanium-formed stud overdenture attachment with different interimplant angulations after simulated clinical use: An in vitro study.

STATEMENT OF PROBLEM: How implant alignment impacts stud attachment retention and wear-induced alterations, notably when the attachment exhibits metal-to-metal frictional interlocking, is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the interimplant angulation on retention forces and wear changes before and after 2 years of simulated clinical use of implant overdentures retained by titanium stud overdenture attachments. MATERIAL AND METHODS: The canine regions of 3 identical edentulous mandibular models were used to receive 2 dental implants analogs with TiTach attachments (Dental Evolutions, Inc) at interimplant angulations of 0, 30, and 60 degrees. Six identical overdentures were constructed over each model (n=6). A universal testing machine was used to determine overdenture retention forces at 0, after 1440, and after 2880 insertion and removal cycles to simulate the average insertion and removal cycles in 12 and 24 months. A stereomicroscope, a laser microscope, and a scanning electron microscope were used to evaluate the wear in the attachments. A linear regression model, ANOVA, and the Kruskal-Wallis tests were used to analyze the data (α=.05). RESULTS: All groups demonstrated reduced retention over the study duration (P<.001). The retention forces of the 0- and 30-degree groups were not significantly different after 2880 insertion and removal cycles, but both were significantly higher than those of the 60-degree group (P=.002). Within each group, the wear pattern of the matrix cap was more noticeable than that of the patrix abutment, with increased wear changes as interimplant angulation increased (P<.001). CONCLUSIONS: TiTach attachments could retain overdentures on parallel and divergent implants with a 30-degree angle of interimplant angulation. However, at a 60-degree angle of interimplant angulation, considerable reduction in retention forces and increased wear changes were observed after 2 years of simulated clinical use.

Biomimetic Coating of Titanium Surface Using Bioactive Glass Nanoparticles.

PURPOSE: The aim of this study was to coat titanium substrate with bioactive glass nanoparticles and characterize the deposited surface coat. MATERIALS AND METHODS: Amorphous bioglass nanoparticles < 20 nm in diameter were prepared using a modified sol-gel technique followed by a ball-milling process. The prepared nanoparticles were used to coat airborne particle-abraded titanium disks. The in vitro bioactivity of the bioglass nanopowder was confirmed using simulated body fluid. Coated surfaces were characterized in terms of microstructure, composition, thickness, phase structure, surface roughness, wettability, and tissue behavior in a rabbit model. RESULTS: Bioglass nanoparticles showed apatite formation under a scanning electron microscope (SEM) after 5 days, confirming that bioactivity was enhanced with increasing degradation rate for up to 2 weeks. An optimized deposition technique and heat-treatment process produced a homogenous coating with a uniform thickness of 32 to 39 µm. Chemical analysis confirmed the presence of silicon and calcium on the coated disks. Amorphous coated surfaces exhibited porous nano/microroughness with microcracks and super-hydrophilicity. The interface of the coated disks with subcutaneous tissue revealed good tissue adhesion, high cellular activity, and rich vascularization, with multinucleated cells in the microenvironment surrounding the coat, as confirmed using histomorphometric analysis. CONCLUSION: The results of this study show that it is feasible to coat titanium surfaces with bioactive glass nanoparticles with super-hydrophilicity and high biologic activity. These particles may promote the regenerative environment around dental implants.