Physicochemical properties of AH plus bioceramic sealer, Bio-C Sealer, and ADseal root canal sealer.

BACKGROUND: The aim of this study was to evaluate the physicochemical properties of two newly introduced premixed calcium silicate-based root canal sealers (AH Plus Bioceramic Sealer and Bio-C Sealer) compared to a resin-based root canal sealer (ADseal root canal sealer). METHODS: Solubility, pH analysis, calcium ion release, and film thickness of each sealer were evaluated following ISO guidelines. The data were examined using the two-way ANOVA test. Furthermore, X-ray diffraction (XRD) examination was performed to investigate the crystalline phase of each type of sealer. X-ray fluorescence (XRF) analysis was done for the chemical elemental analysis of each sealer. RESULTS: The least film thickness, highest alkalinity, and highest calcium ion release were all displayed by AH Plus Bioceramic Sealer. High solubility, high alkalinity, intermediate calcium ion release, and intermediate film thickness were all displayed by Bio-C Sealer. While ADseal root canal sealer displayed the greatest film thickness, least solubility, alkalinity, and calcium ion release. CONCLUSIONS: Both AH Plus Bioceramic Sealer and Bio-C Sealer represented adequate properties to be considered a good sealer that could be used as a potential alternative to resin-based root canal sealers.

Thermal, chemical and physical analysis of VDW.1Seal, Fill Root ST, and ADseal root canal sealers.

This study aimed to evaluate the thermal, chemical, and physical properties of VDW.1Seal, Fill Root ST, and ADseal sealers. Thermal properties were analyzed using Thermogravimetric analysis (TGA) and Differential thermal analysis (DTA). Attenuated total reflection Fourier Transform Infrared Spectroscopy (ATR-FTIR) analysis was performed as a complementary test to confirm TGA/DTA analysis. The chemical composition of the set sealer material was identified using an X-ray powder diffraction (XRD) system. Other physical properties of each sealer were investigated; ten specimens were used to measure the solubility (at 24 h and 28 days), and another ten specimens were used to assess pH changes and calcium ion release (after 7 and 14 days). Film thickness was done according to ISO 6876 specs. The data were analyzed using the two-way ANOVA test. Results showed that for all sealers, TGA analysis revealed a direct relationship between sealer mass loss and temperature rise. In addition, the decomposition of the tested sealers started at 145 °C, 135 °C and 91 °C for VDW.1Seal, ADseal sealer, and Fill Root ST, respectively. XRD analysis revealed a higher degree of crystallinity for VDW.1Seal and ADseal. ADseal showed the least solubility; VDW.1Seal exhibited the highest alkalinity, calcium ion release, and the lowest film thickness.

Impact of endodontic irrigants on surface roughness of various nickel-titanium rotary endodontic instruments.

BACKGROUND: The aim of the current study is to assess the surface roughness of several recent nickel-titanium (Ni-Ti) rotary endodontic instruments, namely: Protaper next (PTN); Hyflex CM (CM); Hyflex EDM (EDM); WaveOne gold (WOG); and trunatomy (TN), before and after application of 5.25% sodium hypochlorite (NaOCl) irrigant solution. METHODS: In this in vitro study, five recently introduced rotary endodontic instruments of different metallurgical properties and designs were subjected to Atomic Force Microscopy (AFM) analysis, and then each file was rotated in 5.25% NaOCl for 15 min., with speed and torque according to manufacturer's instructions. The instruments were then subjected to AFM analysis again. The surface roughness average (Sa) parameter was calculated. Data were analyzed by Paired T test, One-way ANOVA and Tukey tests. RESULTS: There was a statistically significant decrease in the surface roughness of all rotary endodontic instruments after immersion in irrigants (P ≤ 0.05). CONCLUSION: The new TN and PTN instruments showed the least surface roughness. All tested Ni-Ti rotary endodontic instruments after irrigants exposure showed a varying increase in surface roughness.

Toxoplasma and Toxocara seropositivity in juvenile idiopathic arthritis and its relation to disease activity and type of therapies.

Juvenile idiopathic arthritis (JIA) is the most frequently encountered autoimmune rheumatic disease in children. To our knowledge, this is the first study aimed to estimate the frequency of Toxoplasma gondii (T. gondii) and Toxocara seropositivity in JIA and assess its relation to the disease activity, IL-10 levels, and type of the received therapies. This study was conducted on 43 JIA patients and 50 cases as a control group. All participants were evaluated by disease activity score (JADAS-27), and the presence of specific IgG and IgM antibodies against T. gondii and IgG against Toxocara species using an enzyme-linked immunosorbent assay. IL-10 serum levels were measured using an ELISA kit. The results show that JIA patients have significantly higher seropositivity for anti-T. gondii IgG compared to control subjects (p = 0.02) and a non-significant difference for Toxocara seropositivity (p = 0.41). All participants were negative for IgM anti-Toxoplasma gondii. Demographic parameters did not significantly affect these seroprevalence frequencies (p > 0.05). IL-10 was significantly higher among JIA patients compared to controls (p = 0.007) and seropositive anti-T. gondii JIA exhibited significantly higher IL-10 levels compared to seronegative ones (p = 0.03). Seropositive anti-T. gondii IgG JIA patients had a significantly higher disease activity score (JADAS-27) than seronegative anti-T. gondii IgG cases (p = 0.02). There was a significant positive correlation between anti-T. gondii IgG and JADAS-27 score (p = 0.009). A significant association was detected between T. gondii infection and DMARDs including the biological therapies (p < 0.05). Overall, this study supports a possible association between T. gondii infection and JIA, IL-10, disease activity score, and DMARDs therapies. It is possible that IL-10 plays a role in the development of JIA and contributes to persistent asymptomatic infection with T. gondii in JIA patients. As a result, a recommendation for screening tests for T. gondii infection among JIA patients is crucial before and during commencing DMARDs therapies and closely monitoring early signs of infection.

Effect of low-level laser physiotherapy on left ventricular function among patients with chronic systolic heart failure.

BACKGROUND: Low-level laser therapy (LLLT) is a promising noninvasive physiotherapeutic approach that has been demonstrated to improve cardiac performance. This study aimed to assess the impact of low-level laser therapy on cardiac functions and clinical status in patients with chronic left ventricular systolic heart failure who were not candidates for cardiac revascularization or resynchronization. A case series of 27 patients received a course of low-level laser physiotherapy, the clinical outcomes, echocardiographic parameters, and serum nitric oxide levels were evaluated before and after LLLT. RESULTS: Of the total patients enrolled in the study, 21 (or 77.8%) were male, with a mean age of 57.7 ± 6.89 years. NYHA classification significantly improved after low-level laser therapy, 15 patients were in class III,12 were in class IV, and no one was in class II before laser therapy while after laser therapy; 25 patients shifted to class II, two patients were in class III with P < 0.001, Six-minute walk distance test was performed, and the results showed that the mean of 6MWT was less than 200 m (148.556 ± 39.092) before the study but increased to more than 300 after laser therapy (385.074 ± 61.740), left ventricular ejection fraction before laser therapy was 26 ± 7.5 while after laser therapy it became 30 ± 8.6 but diastolic function did not change after low-level laser therapy, the mean peak TR pressure was 40.0 ± 9.0 mmHg and 33.0 ± 7.0 before and after laser therapy respectively P < 0.001. A significant change was observed in NO level from 4.1 ± 1.4 IU/ml before laser therapy to 5.2 ± 1.7 IU/ml after laser therapy P < 0.001. CONCLUSIONS: Low-level laser therapy may add benefits to improve symptoms, clinical condition, and quality of life in patients with left ventricular systolic dysfunction, further studies are necessary to evaluate the changes in cardiac functions at a longer follow-up duration.

Therapeutic Potency of Ginger, Garlic, and Pomegranate Extracts Against Cryptosporidium parvum-Mediated Gastro-Splenic Damage in Mice.

PURPOSE: Cryptosporidium parvum is a protozoan parasite infecting most mammalian hosts and causing major health issues. The present study investigated the efficacy of ginger (Zingiber officinale), garlic (Allium sativum), and pomegranate (Punica granatum) peel extracts on the development and progression of experimental cryptosporidiosis in mice. METHODS: Eighty-two mice were assigned to 6 groups: control, infected non-treated, metronidazole (MTZ), ginger, garlic, and pomegranate. The control group topically received no treatments. The infected non-treated group was experimentally infected by 104 C. parvum oocysts per mouse using a stomach tube. The MTZ group was infected with C. parvum oocysts combined with MTZ (50 mg/kg b.w./day). The ginger, garlic, and pomegranate groups daily received different plant extracts at doses of 100 mg/kg BW, 50 mg/kg BW, and 3 gm/kg BW, respectively, followed by infection with C. parvum oocysts. All treatments were applied orally one day after the infection for continuous 30 days. RESULTS: Histopathological and immunohistochemical examinations for P53 and caspase-3 expressions in stomach and spleen tissues showed that MTZ and garlic-treated mice had a more significant effect on infected mice. CONCLUSION: The garlic extract was found to exert a more pronounced effect on infected mice compared with the other treatments as well as to improve health. Garlic extracts, therefore, represent an effective and natural therapeutic alternative for the treatment of cryptosporidiosis with low side effects and without drug resistance.

Standard-Setting of Multidisciplinary Objective Structured Practical Examination.

Purpose The present work applies the standard-setting in the multidisciplinary Objective Structured Practical Examination (OSPE) of the MusculoSkeletal and Integument systems (MSK) module using Modified Ebel's method to differentiate the competent students from the non-competent ones. Materials and methods One hundred fifty-six students participated in the multidisciplinary OSPE. The MSK-OSPE consists of mid-module and final. According to the blueprint of the OSPE, the mid-module OSPE tested the knowledge and skills of the upper limb, and the final OSPE verified the knowledge and skills of the lower limb. Modified Ebel's method was used to identify the Minimum Pass Level (MPL) in each station and the whole exam accordingly. Results Fifty-seven percent (57%) of the students passed both exams, while 25.6% did not pass the mid-module exam and 31.4% did not pass the final exam, 17.9% did not pass both exams and 25% did not pass one exam. The MPL for most of the stations in both exams using modified Ebel's method of the standard-setting was more than 50% which is the conventional pass mark. However, the MPL for stations 4, and 6 in the mid-module exam (ulna and arteries of the upper limb) and stations 7, 9, and 14 (muscles of the lower limb, anatomy of ankle joint, physiology of nerve) was < 50%. While the total pass mark of the mid-module OSPE was 66% and the pass mark for the final OSPE was 60% Conclusion The minimal pass level (MPL) in mid module and final OSPE were 66% and 60% respectively which are more than the conventional cut off point (50%) that indicating that the standard-setting was effective in identifying poor performers who cannot be identified by the conventional method that led to enhance the quality of OSPE as an assessment tool. Moreover, students developed the skills to deal with standardized patients in clinical stations. However, some defects and areas of improvement were identified in some physiological and anatomical stations. The organizing committee recommended identifying the poor performers and conducting extra-tutorial sessions on the defective topics.

Association Between Giardia Genotype and Oxidative Stress Biomarkers Among Giardia-Infected Children: A Case-Control Study.

PURPOSE: Giardia duodenalis is the most common worldwide intestinal protozoal infection. The implication of free radicals in organ injury occurs through oxidative stress. Infections as Giardia may act as a triggering or promoting factor for oxidative stress, particularly in children with compromised immunity. Besides, the effect of Giardia genotype on oxidative stress status is yet to be explored. Therefore, we sought to compare the oxidative stress status between Giardia positive cases (case group) and Giardia negative cases (control group), and to explore the association between Giardia genotype and the level of oxidative stress markers in Giardia-infected children, especially those receiving immunosuppressive therapy. METHODS: Pediatric patients attending Mansoura University Children Hospital in the period from April 2015 to October 2016 were enrolled. Both case (n = 50) and control (n = 50) groups were further subdivided into immunosuppressive therapy recipients (ITR) and non-immunosuppressive therapy recipients (NITR). Genotyping of Giardia from positive stool samples by PCR was carried out, and oxidative stress markers were measured from venous blood samples. RESULTS: Giardia positive cases had higher levels of Malondialdehyde (MDA) and lower levels of total antioxidant capacity (TAC). MDA highest level was associated with mixed genotypes A and B, while the highest TAC level was associated with Giardia genotype A in both ITR and NITR cases. CONCLUSION: Elevated oxidative stress biomarkers in pediatric patients infected with specific Giardia genotypes should receive considerable attention, because if prompt treatment is not conducted, oxidative damage may occur in patients with giardiasis, especially those receiving immunosuppressive therapy.

Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study.

BACKGROUND: Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases. AIM: To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts. PATIENTS AND METHODS: The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions. RESULTS: Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037). CONCLUSIONS: Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.

Online anatomy team-based learning using blackboard collaborate platform during COVID-19 pandemic.

During the COVID-19 pandemic, many educational institutions followed the blended learning system. Using the participants' opinions, we evaluated the Blackboard (Bb) collaborate platform for online team-based learning (TBL) sessions for undergraduate students from different medical programs in the KSA. The participants were students on the MBBS Program (157 year two and 149 year three), together with 53 students in year one of the Nursing Program, 25 in year two of the Doctor of Pharmacy Program, and 11 in year two of the Medical Laboratory Sciences Program in Fakeeh College for Medical Sciences, (FCMS) KSA. To assess students' recall, engagement, and satisfaction with the sessions, an online TBL plan was designed and reviewed by the Medical Education Department. The students completed an online survey at the end of each session. All responses in this study showed a statistically significant positive difference from the neutral mid-point response (p < 0.05), reflecting high satisfaction. In the MBBS Program, the survey was completed by 40 students in year two and 76 in year three. The mean responses were 4.1 ± 0.3 and 3.9 ± 0.2 respectively (mean ± SD). In the BSN Program, 19 students completed the survey. The mean response was 4.6 ± 0.2. In the Pharm D Program, 10 students completed the survey. The mean response was 4.9 ± 0.12. In the MLS Program, eight students completed the survey. The mean response was 4.8 ± 0.12. It was concluded that online TBL using Bb collaborate is a successful anatomy-learning tool among FCMS students on different programs.

Influence of Thermomechanical Treatment on the Mechanical Behavior of Protaper Gold versus Protaper Universal (A Finite Element Study).

AIM: To compare and evaluate the influence of thermomechanical treatment of Protaper Gold file versus Protaper Universal file during testing of bending and torsion using finite-element analysis. METHODS: Two nickel-titanium NiTi rotary files (ProTaper Gold and ProTaper Universal) were used in this study. The files were imaged using stereomicroscope to produce 3D models. The behaviour of the instrument during bending and torsion was numerically analysed in CAD/CAM software package. RESULTS: Under bending, ProTaper, Gold showed higher flexibility and flexural resistance than ProTaper Universal. The highest stress was related at the cutting edge of both files. While during testing of torsion, the maximum amount of stresses was related to the base of the flutes in both files. ProTaper Gold showed higher torsional resistance than the ProTaper Universal file. CONCLUSION: Thermomechanical treatment improved the mechanical response (bending and torsional resistance) of NiTi files.

Evaluation of Flexibility, Microstructure and Elemental Analysis of Some Contemporary Nickel-Titanium Rotary Instruments.

BACKGROUND: Contemporary nickel-titanium (NiTi) rotary endodontic instruments had a revolutionary impact on the success of root canal treatment. AIM: To evaluate the flexibility, microstructure and elemental analysis of four different recent NiTi rotary instruments, namely; Wave One Gold, TF adaptive, HyFlex EDM and Gr_Reciproc Blue compared to conventional Protaper Universal (F2). MATERIAL AND METHODS: The NiTi rotary files were subjected to cantilever bending test to evaluate their flexibility. The microstructural characteristics and elemental analysis were examined via scanning electron microscopy (SEM) and energy dispersive X-ray spectrometer (EDX). RESULTS: The TF adaptive, HyFlex EDM and Wave One Gold endodontic files showed significantly lower cantilever bending values (i.e., higher flexibility) than Protaper F2 and Gr_Reciproc Blue (p < 0.05). The SEM micrographs showed that the bulk of all examined files showed multiple striations due to the cutting process, on the other hand, their external surfaces were different: The Protaper Universal F2 showed multiple voids, while the TF Adaptive surface exhibited more uniform structure. The Hyflex EDM had a crater-like surface, whereas Wave one Gold showed machining grooves with minimum defects, while Reciproc Blue displayed machining grooves with random scratch lines. There was a significant difference in bulk and surface elemental analysis of the various examined files, yet composed mainly of the same elements. CONCLUSION: Chemical composition, heat treatment, manufacturing process and geometrical design of the NiTi rotary instrument have a great influence on their flexibility and microstructure.

Philtrum length and intercommissural distance measurements at mixed dentition period.

Anthropometric measurements of the lip and mouth are of great importance in clinical dysmorphology as well as reconstructive plastic surgery. In this study, the philtrum length (PhL) and intercommissural distance (ICmD) nomograms for Egyptian children in the mixed dentition period were established. A group of 1,338 Egyptian students in primary schools (735 boys and 603 girls) were included in the study. The students were at mixed dentition period and their ages ranged from 7 to 12 years. Anthropometric norms of PhL and ICmD were developed with significant sex difference in certain groups. A ratio between PhL and ICmD was developed. These data will help facilitate both objective and subjective evaluation of the lip and mouth for proper diagnosis of orofacial anomalies and variations as well as for ideal treatment plans.

The Importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services.

INTRODUCTION: Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices. OBJECTIVES: To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies. METHODOLOGY: A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted. RESULTS: Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001). CONCLUSION: The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions.