Surgical Option in the Management of a Giant Vesical Calculus Post Augmentation Cystoplasty.

We describe a rare instance of enormous, calcified stone development in an enlarged urinary bladder. The patient was a 24-year-old female suffering from the development of vesical calculus as a result of complicated bladder augmentation. She had a small bladder capacity and had undergone augmentation ileocystoplasty in childhood. The abdomen was examined using X-ray and computerized tomography, which revealed a significantly huge urinary bladder stone. An open cystolithotomy was performed and a giant vesicle calculus was extracted along with another small stone. Although stone development is a typical side effect following augmented bladder, it may be avoided with frequent bladder irrigation and attentive aftercare.

Knowledge and Attitudes Regarding Do-Not-Resuscitate Decisions Among Clinical-Year Medical Students and Interns in the Western Region of Saudi Arabia.

Background The directive to withhold emergent interventions in the case of cardiac and/or respiratory arrest with the continuation of standard care and therapy is known as do-not-resuscitate (DNR). The diversity of DNR guidelines depends on moral and religious factors. In Saudi Arabia, a DNR policy was published in 2017 which corresponds to the religious and ethical aspects of Islamic law. To augment future awareness regarding DNR decisions, as they are an essential element in critical care medicine, the foundational principles of DNR must be provided during the clinical years of medical school. Objectives The current study aims to assess and evaluate the knowledge and attitudes regarding DNR decisions among clinical-year medical students and interns in the Western Region of Saudi Arabia. Methods A cross-sectional study was carried out from October to December 2023, utilizing a self-administered online survey distributed via social media platforms. After receiving ethical approval from the institutional review board, data were collected from clinical-year medical students and interns in the Western Region of Saudi Arabia, and an appropriate statistical analysis was performed. Results A total of 397 participants were enrolled in this study. More than half (n = 251, 63.2%) were from Umm Al-Qura University, while the remaining (n=79, 19.9%) were from Taibah University. Of the total, 258 (65%) were male participants, and 139 (35%) were female. A total of 152 (38.3%) were fifth-year medical students, and 102 (25.7%) were interns. The vast majority (n = 364, 91.7%) had heard the term DNR, with the most reported source of information being from healthcare providers (n = 306, 83.2%), while a minority (n = 33, 8.3%) had not. Of the respondents, 226 (56.9%) identified the presence of a clear DNR policy in Saudi Arabia, and 77 (19.4%) had previously had experience with DNR. Most of the studied population (n = 333, 83.9%) expressed a willingness to take a lecture/session regarding DNR. Most of our participants, 347 (87.4%), believe it is essential to consider legal concerns when making a DNR decision. Interestingly, 152 (38.5%) of the participants think it is acceptable to be conservative in investigations and treatments with patients who are labeled as DNR, and 223 (56.2%) agree that patients should be aware of their DNR status. Approximately three-quarters of the study population (n = 290, 73%) agreed that it is stressful to discuss the possibility of a DNR order. In the association of who heard about DNR more, 101 (99%) of the interns had heard about the term DNR, while only 53 (75.7%) of the fourth-year medical students had. At the same time, 74 (72.5%) of the interns showed a positive attitude regarding the DNR definition, compared to 33 (47.1%) of the fourth-year medical students. Conclusion This study highlights the necessity of integrating educational interventions into DNR decisions in addition to clinical placement in the intensive care unit as part of the medical school curriculum.

Comparison of Shear Bond Strength of Three Types of Adhesive Materials Used in the Restoration of Permanent Molars after Treatment with Silver Diamine Fluoride: An In Vitro Study.

BACKGROUND: Permanent blackish discoloration of the tooth structure post application of silver diamine fluoride (SDF) is one of its drawbacks. Several restorative materials have been used to restore and mask the blackish discoloration of SDF-treated teeth. Recently, a new self-adhesive material has been introduced and is marketed as an all-in-one etchant, adhesive, and restorative material indicated for use in all clinical situations. This study aimed to assess the shear bond strength of the new self-adhesive restorative material and compare it with adhesive restorative materials- resin-based composite and resin-modified glass ionomer cement to dentin of extracted permanent teeth treated with 38% SDF. METHODS: Thirty-nine caries-free extracted teeth (n = 39) were grouped into three groups. Following 38% SDF application, the specimens were loaded with resin-based (Group I), the new self-adhesive restorative material (SDR) Surefil (Group II), and resin-modified glass ionomer cement (RMGIC) (Group III). Shear bond strength (SBS) was calculated, and failure modes were evaluated using the universal testing device (3) Results: The composite showed the highest bond strength, followed by Group II while Group III had the lowest bond strength of all tested materials. Regarding failure type, the composite showed 100% adhesive failure, while Group III and Group II showed mostly adhesive failure with some combination. (4) Conclusions: RBC had a significantly stronger SBS to demineralized dentin surfaces of permanent molar teeth treated with SDF when compared to SDR Surefil and RMGIC.

Tooth autotransplantation in a diabetic patient with 2-year follow-up.

Tooth autotransplantation is the movement of a tooth from its socket into another socket within the same patient. This case report discusses the viability of tooth autotransplantation in a patient with diabetes mellitus. A 23-year-old woman presented with the chief complaint of pain from a carious mandibular right second molar, which was deemed nonrestorable. Autotransplantation of a viable third molar was therefore suggested as the treatment of choice. Six months after surgery, the patient was recalled for reevaluation of the reimplanted tooth. Pulpal sensitivity was assessed, revealing a normal pulpal response. The patient reported no pain or symptoms of infection. At the 1-year and 2-year follow-ups, clinical examinations confirmed that the transplanted tooth was vital, and the patient was able to chew food normally without experiencing pain on the mandibular right side. Dental autotransplantation may be considered a conservative approach to replacing a missing tooth, especially for young patients with growing jaws or patients with limited financial means who cannot afford other treatment options.

Laparoscopic ureterolithotomy for large proximal ureteric stones: Surgical technique, outcomes and literature review.

INTRODUCTION: We evaluated the efficacy and safety of laparoscopic ureterolithotomy (LPU) for the treatment of large proximal ureteric stone. METHODS: A retrospective multicenter analysis for patients with solitary impacted proximal ureteric stone ≥15 mm who underwent LPU from 2016 to 2019 was performed. Primary outcome was to estimate the stone-free rate (SFR). SFR was defined as absence of residual stones on postoperative computed tomography scan. Secondary outcome was to assess the perioperative outcomes, as well as to review literature data of randomized controlled trials and meta-analyses comparing LPU to other treatment options. RESULTS: Forty-four patients were included in our study. Mean stone size was 22.9 ± 5.8 mm and median follow-up was 14 months. Three patients had previous abdominal surgery, one patient had severe degree of scoliosis and six patients failed primary therapy. All stones were extracted successfully (SFR = 100%) without need of auxiliary treatments. Mean operative time and estimated blood loss were 86.6 ± 14.1 minutes. and 11.9 ± 14.7 mL, respectively. No intraoperative complications or conversion to open surgery were reported. No major postoperative complications (≥grade 3) were reported. Mean length of hospital stay was 2 ± 0.8 days. CONCLUSIONS: For treatment of large ureteric stones, our study showed that LPU achieves 100% stone-free status. When performed by well-trained laparoscopic surgeons, it is safe and has no major perioperative complications. According to our results and literature data, when counseling patients with large impacted proximal ureteral stones, LPU should be advised as the procedure that has the higher SFR, lower auxiliary treatments, and comparable complication rates to other treatments.