A Comparative In Vitro Physicochemical Analysis of Resin Infiltrants Doped With Bioactive Glasses.

Objective This study aimed to investigate the longevity and effectiveness of bioactive glass (BAG)-based dental resin infiltrants. Materials and methods The three types of BAG - 45S5 bioglass (RIS), boron-substituted (RIB), and fluoride-substituted (RIF) - were incorporated with photoinitiated dimethacrylate monomers to create experimental resin infiltrants. ICON® (CN; DMG-America, Ridgefield Park, NJ) and pure resin (PR) were used as control groups in this study. Disc-shaped samples were prepared for the experimental and control groups. The samples were challenged with the pH cycle and immersed in the artificial saliva for 30 days. On Day 0 and Day 30, the pH cycle and artificial saliva immersion, Vicker's microhardness, surface roughness, and surface morphology were investigated. Results The RIF group's disc samples showed the highest Vicker's microhardness values (78.20 ±0.06) on Day 30 of artificial saliva immersion, whereas the CN group's values were the lowest (55.99 ±0.24). Following the pH cycling, the RIF displayed the highest hardness (64.15 ±1.89) whereas the CN group's values were the lowest (33.47 ±1.28). Regarding surface roughness, on Day 30, the RIB resin group exhibited the highest (1.14 ±0.001 µm). In contrast, the CN resin showed the lowest (1.07 ±0.06 µm) values, while immersed in the artificial saliva solution. In the same duration of time, in the pH cycling solution, PR showed the least (0.85 ±0.89 µm), while RIF showed the highest roughness value (0.94 ±0.54 µm). Morphological analysis revealed that following the artificial saliva immersion, the RIB, CN, and PR exhibited smoother surfaces compared to the RIS and RIF groups. However, when immersed in the pH cycling solution, RIB and RIF showed more resistance against acid attack. Conclusions Our results revealed that the experimental resin groups performed much better than the commercial resin infiltrants following artificial saliva and pH cycling challenges.

Hesitancy Over the COVID-19 Vaccine Among Various Healthcare Workers: An International Narrative Review.

Healthcare workers (HCWs) are role models in their communities. If they receive the COVID-19 vaccine, many people are likely to follow and have the vaccine. If HCWs are hesitant or resistant to taking the vaccine, this may impede the efforts to implement the vaccine, reach herd immunity, and eliminate the pandemic. In this narrative review, we reviewed previous studies on hesitancy over COVID-19 vaccination among different healthcare professions and people in the medical field, such as primary HCWs, dentists, nurses, and medical students. We reviewed the common reasons and associated factors for hesitancy toward the COVID-19 vaccine among different healthcare professions. The following keywords were used in the database search: COVID-19 AND vaccine AND hesitancy AND healthcare workers. We searched for articles using the PubMed, Scopus, and Google Scholar databases. We found HCW professions with various rates of hesitancy, including primary healthcare center (PHC) workers (50%), medical students (45%), nurses (21%), and dentists (18%). Hesitancy toward booster doses was also found in HCWs who had taken primary doses (2.8% to 26%). Race and ethnicity also influenced hesitancy rates, with Black individuals being the most hesitant group. The most common reasons were concerns about the safety and adverse effects of the vaccine, insufficient information, and a lack of confidence in healthcare policies. Despite varying rates of HCW hesitancy after the vaccine's release, this hesitancy is expected to negatively affect efforts to achieve widespread vaccination. The recommendations to policymakers to address these concerns are raising the awareness of PHC doctors because they are the easiest to reach and are the first line for patient information, improving communication with the HCWs through all channels (e.g., webinars, e-mails, and social media), and inviting HCWs to online meetings or workshops with the healthcare policymakers so the policymakers can listen to their concerns and recommendations. Correctly addressing the issue of HCWs' vaccination hesitancy can support efforts to contain the pandemic.

A laboratory study to assess the physical, mechanical, and 3-D structural properties of nano-apatite grafted glass fibre-based endodontic posts.

AIM: To fabricate and characterize nano-hydroxyapatite (nHA) grafted and non-grafted glass fibre-based endodontic posts. METHODOLOGY: Experimental glass fibre posts were fabricated using silanized nHA grafted (ex-HA) and non-grafted glass fibre (ex-P) reinforced resins. The structural analysis and morphological patterns were analysed with Fourier transform infrared spectroscopy and scanning electron microscopy, respectively. EverStick® glass fibre posts (eS) were used as a control group. The degree of conversion, flexural strength, and flexural modulus was investigated and the fractured structure was evaluated with a scanning electron microscope. Root canals were prepared in human extracted teeth restored with experimental and control posts. The push-out bond strength was evaluated with radicular dentine at days 7, 30, and 90, and the presence of voids at the interface were measured at day 1, 7, 30, and 90 with micro-computed tomography. The Shapiro-Wilk test and one-way ANOVA post-hoc Tukey's test were performed. The level of significance was set at 0.05. RESULTS: The SEM and FTIR confirmed the presence of a silane-coupling agent on the glass fibres. The ex-HA post had a significantly lower degree of conversion compared to the ex-P post (p = .0008), but a significantly higher conversion than the eS post (p = .0014). The maximum flexural strength value was obtained with the ex-HA post with an insignificant difference (p = .366) compared to ex-P post and a significant difference (p = .029) compared to the eS post. The flexural modulus of ex-HA, ex-P, and eS posts were significantly different (p = .037). Similarly, the ex-HA post had a significantly higher push-out bond strength at days 7 and 30 (p = .037) compared to the ex-P and eS posts. The volume of voids had a nonlinear behaviour amongst the groups with no significant difference between the posts. CONCLUSION: The fabrication of the experimental posts was successful and the ex-HA post had greater flexural strength and push-out bond strength compared to the ex-P post. The degree of conversion of the ex-HA post was lower than the ex-P and eS posts. The volume of voids of ex-HA and ex-P posts was lower than that of eS posts.

Five decades of the International Endodontic Journal: Bibliometric overview 1967-2020.

AIM: The International Endodontic Journal (IEJ) has served as a platform for research and clinical practice in Endodontics since 1967. This study provides a bibliographic analysis and overview of the publications that have appeared in the IEJ from 1967 to 2020. METHODOLOGY: A literature search was performed in Elsevier's Scopus database to locate all the publications of the International Endodontic Journal. Various bibliometric software packages including the open-source visualization software Gephi and Biblioshiny (version 2.0) were employed for data visualization and analysis. RESULTS: A total of 3739 records with citation and bibliographic details were selected and retrieved to allow a bibliometric analysis to be performed. The bibliometric analysis indicates that the IEJ has grown both in terms of productivity and influence. Over time, the journal has been associated with an increase in the number of manuscripts published and the citations they have attracted, but with minor downward fluctuations in citations in the last few years. Bibliographic coupling of the IEJ articles revealed that the major research themes published in the journal include 'endodontics', 'root canal treatment', 'calcium hydroxide', 'apical periodontitis', 'mineral trioxide aggregate', 'microbiology', 'cyclic fatigue', 'cone-beam computed tomography' and 'micro-computed tomography'. Authors affiliated to institutions in the UK were the major contributors to the journal and were linked with other countries such as Brazil, USA and Malaysia. The largest number of publications were from the University of São Paulo, Brazil. CONCLUSION: The IEJ is one of the leading journals in Endodontology and has been providing a platform for innovative research and clinical reports for more than 50 years. Publications have been associated with a wide range of authors, institutions and countries around the world.

Screening for depression, anxiety, and obsessive-compulsive disorders among secondary school students in Al-Hasa Region, Saudi Arabia.

BACKGROUND: The purpose of this study was to determine the prevalence of anxiety, depression, and obsessive-compulsive disorder (OCD) and assess their severity in both male and female secondary school students. MATERIALS AND METHODS: This cross-sectional study was conducted among secondary school students in Al Hasa region. A sample of student was selected using multi-stage sampling technique. Data were collected using valid self administered questionnaires (Patient Health Questionnaire 9, Anxiety Disorder 7, and Yale-Brown Obsessive-Compulsive scale). Study was approved by institutional ethical review committee, and informed consent was obtained from each participant. SPSS used for data entry and analysis. Chi-square test was used to test for statistical significance. RESULTS: A total of 1783 of students, 930 males and 853 females, were enrolled in the study. The prevalence of depression, anxiety, and OCD was 76.2%, 49.9%, and 61.6%, respectively. Most of the diagnosed students had mild forms of the diseases, fewer had moderate form, and very few had severe forms. The most significant risk factor was gender, but other risk factors were significant for some of the diseases. CONCLUSION: The prevalence of the three diseases is high and significantly associated with gender. Further work is needed to evaluate this high prevalence and assess the severity of the diseases and other risk factors.

Production of hyperimmune anti-SARS-CoV-2 intravenous immunoglobulin from pooled COVID-19 convalescent plasma.

Background: This study assesses the feasibility of producing hyperimmune anti-COVID-19 intravenously administrable immunoglobulin (C-IVIG) from pooled convalescent plasma (PCP) to provide a safe and effective passive immunization treatment option for COVID-19. Materials & methods: PCP was fractionated by modified caprylic acid precipitation followed by ultrafiltration/diafiltration to produce hyperimmune C-IVIG. Results: In C-IVIG, the mean SARS-CoV-2 antibody level was found to be threefold (104 ± 30 cut-off index) that of the PCP (36 ± 8.5 cut-off index) and mean protein concentration was found to be 46 ± 3.7 g/l, comprised of 89.5% immunoglobulins. Conclusion: The current method of producing C-IVIG is feasible as it uses locally available PCP and simpler technology and yields a high titer of SARS-CoV-2 antibody. The safety and efficacy of C-IVIG will be evaluated in a registered clinical trial (NCT04521309).

Psychological insulin resistance among type 2 diabetic patients attending primary healthcare centers, Al-Ahsa, Saudi Arabia.

BACKGROUND: Patients' adherence to insulin therapy is crucial to achieve good glycemic control. The present study was conducted to determine psychological insulin resistance (PIR) and the effect of doctor-patient relationship on PIR among type 2 diabetes patients attending primary health-care centers of Al-Ahsa region in Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional survey of all type 2 diabetic patients attending the primary healthcare centers of Al-Ahsa. A multistage sampling technique was used. The calculated sample size was 396. Two validated structured questionnaires were used to collect information. The degree of agreement to insulin therapy was done on the Likert 5° scale. SPSS was used for data entry and analysis. Chi-square test was used to test for stistical significane at P=0.05. RESULTS: Out of 396 patients who were given the questionnaires, 366 filled the questionnaires yielding 92% response rate. Fifty-one percent were male and about 85% were older than 35 years. Willingness to use insulin was significantly associated with age (P = 0.013) and duration of diabetes (P=0.0001). The strongest negative attitudes toward insulin therapy arose from participants having heard about a bad experience with insulin (59.34%, P < 0.05) and the fear of possible dependence (54.20%, P < 0.05). Participants who responded of "mostly appropriate" and "very appropriate" to questions on patient-doctor relationship were significantly more willing to take insulin (64.9% vs 24.5%, and 70.3% vs 22.9%, P = 0.0001). CONCLUSION: The study showed that one-third of the patients with type 2 diabetes had PIR. Since the behavior of doctor plays an important role in reducing PIR, there is a need for greater emphasis on the importance of good doctor-patient relationship and the establishment of a therapeutic education program.

Microwave-assisted synthesis and evaluation of type 1 collagen-apatite composites for dental tissue regeneration.

The aim was to develop an economical and biocompatible collagen-based bioactive composite for tooth regeneration. Acid-soluble collagen was extracted and purified from fish scales. The design was innovated to molecularly tailor the surface charge sites of the nano-apatite providing chemical bonds with the collagen matrix via microwave irradiation technique. The obtained collagen was identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis. The composites were characterized by Fourier transform infrared spectroscopy, thermogravimetric analysis/differential scanning calorimetry, and scanning electron microscopy. MC3T3-E1 cell lines were used to assess the biological effects of these materials by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetra zolium bromide (MTT) assay. Indirect contact test was performed by extracting representative elutes in cell culture media and sulforhodamine B analysis was performed. Chorioallantoic membrane assay was conducted to define the new vessels formation behavior. The purity of collagen extracts was determined and showed two α-chains, i.e. the characteristic of type I collagen. Fourier transform infrared spectroscopy showed the characteristic peaks for amide I, I, III, and phosphate for collagen and composites. Scanning electron microscopy images showed three-dimensional mesh of collagen/apatite nano-fibers. Nontoxic behavior of composites was observed and there were graded and dose-related effects on experimental compounds. The angiogenesis and vessels formation behavior were observed in bioactive collagen composite. The obtained composites have potential to be used for tooth structure regeneration.

Microwave assisted synthesis and characterization of magnesium substituted calcium phosphate bioceramics.

Hydroxyapatite is used extensively in hard tissue repair due to its biocompatibility and similarity to biological apatite, the mineral component of bone. It differs subtly in composition from biological apatite which contains other ions such as magnesium, zinc, carbonate and silicon (believed to play biological roles). Traditional methods of hydroxyapatite synthesis are time consuming and require strict reaction parameter control. This paper outlines synthesis of magnesium substituted hydroxyapatite using simple microwave irradiation of precipitated suspensions. Microwave irradiation resulted in a drastic decrease in ageing times of amorphous apatitic phases. Time taken to synthesize hydroxyapatite (which remained stable upon heat treatment at 900°C for 1h) reduced twelve folds (to 2h) as compared to traditionally required times. The effects of increasing magnesium concentration in the precursors on particle size, surface area, phase-purity, agglomeration and thermal stability, were observed using scanning electron microscopy, BET surface area analysis, X-ray diffraction and photo acoustic Fourier transform infra-red spectroscopy. Porous agglomerates were obtained after a brief heat-treatment (1h) at 900°C.

Structural and in vitro adhesion analysis of a novel covalently coupled bioactive composite.

The interfacial adhesion between a restorative composite and tooth is one of the major factors that determine the ultimate performance of composite restoration. A novel polyurethane (PU) composite material was prepared by chemically binding the nano-hydroxyapatite (nHA) to the diisocyanate component in the PU backbone by utilizing solvent polymerization. The procedure involved stepwise addition of monomeric units of the PU and optimizing the reagent concentrations. The resultant materials were characterized structurally (Raman Spectroscopy) and in vitro bioactive analysis was conducted in modified-simulated body fluid for periodical time intervals. The in vitro study evaluated the push-out bond strength of existing obturating material and novel covalently linked PU/nHA composites to dentin after long-term storage in deionized water and artificial saliva. Human extracted molar roots were filled with experimental samples and analyzed at predetermined time intervals. The shear bond strength of samples was measured and surface morphologies were evaluated. Covalent bond formation was achieved between PU and nHA without intermediate coupling agent. With the increase in concentration of nHA, the composite showed more bioactivity and adhesion toward tooth structure. Bond strength of this new composite were in accordance with obutrating material, therefore, the material can be used as an obturating material because of its direct adhesion with tooth structure.

Sedation, analgesia, and monitoring.

Endoscopic procedures are common and sedation is frequently used to minimize anxiety and discomfort, reduce the potential for physical injury during the procedure, and improve overall patient tolerability and satisfaction. In this article, the authors review the variety of options for sedation and analgesia available to the gastroenterologist or surgical endoscopist.

Comparison of the visco-elastic behavior of a pre-impregnated reinforced glass fiber composite with resin-based composite.

OBJECTIVES: The visco-elastic behavior of a pre-impregnated reinforced glass fiber composite (everStick) was compared with a resin-based particulate composite (Filtek P60) by using dynamic mechanical analysis (DMA) to determine their storage modulus (E') and damping ratio (tandelta). METHODS: These materials were subjected to three-point bend tests using a PerkinElmer DMA7. In temperature mode, the temperature was increased from 26 to 140 degrees C at 1 Hz. In frequency mode, the range was 1-10 Hz at a constant temperature of 37 degrees C. RESULTS: In both temperature and frequency modes, E' for everStick was significantly higher and tandelta was significantly lower than those for Filtek P60, indicating that the stiffness of the pre-impregnated glass fiber composite was higher and its damping property was lower than those for resin-based particulate composite. SIGNIFICANCE: The glass fiber restorative composite appears to absorb less energy in repeated stress and is less likely to retain external energy as residual stress.

Predictors of outcome for non-traumatic intracerebral hemorrhage.

OBJECTIVE: To evaluate the prognosis, neurologic outcome, and predictors of survival in patients with non-traumatic intracerebral hemorrhage. METHODS: We evaluated prospectively a cohort of 96 Saudi adult males and females with stroke during the month of July 2005 at Arar Central Hospital, Riyadh, Kingdom of Saudi Arabia. Out of 103 patients, 96 patients, who were diagnosed as having intracerebral hemorrhage (ICH) presenting to the emergency department for initial evaluation, were included, except those with recurrent intracerebral hemorrhage, arteriovenous malformation, subarachnoid hemorrhage, traumatic brain injury, hemorrhagic infarctions, and patients receiving anticoagulant therapy. No patient underwent any neurosurgical procedure. RESULTS: The results of 96 patients were analyzed. The mean age at ICH was 67.2 (+/-14.7) years (range, 30-100 years), and mean Glasgow coma scale (GCS) score on admission was 8.42 (+/-1.73) and (range, 4-13). Mean ICH volume on initial CT scan was 10.61 (+/-14.01) ml3 (range, 1-63). Mean pulse pressure on hospital arrival was 81.9 (+/-22.8) mm Hg (range, 70-120 mm Hg). In uni-variate analysis, GCS score (p=0.0005), ICH volume (p=0.001), mass effect (p=0.001), and presence of intraventricular hemorrhage (p=0.0005) were all associated with 30-days mortality, while in multivariable analysis, the most significant independent predictors of 30-day mortality were, GCS score and the intraventricular extension of hemorrhage. CONCLUSION: This model may aid in making decisions quickly and easily regarding the appropriate level of care for such patients with intracerebral hemorrhage.

Intensive behavioral therapy for primary enuresis.

OBJECTIVE: To assess the effect of intensive behavioral therapy on Saudi children with primary enuresis. METHODS: Twenty-six children, aged 6-14-years, presented with complains of bed wetting during a 12-months period from January 2001 through to January 2002, ArAr Central Hospital, Kingdom of Saudi Arabia were studied in an interventional, non-randomized trial without control. After complete verbal autopsy, physical examination and laboratory investigation, they were offered intensive behavioral therapy. They were evaluated for response, regularity, esteem and recurrence of enuresis. RESULTS: Mean age of the study group was 9.6-years (SD = +/- 2.6) and boys were affected almost twice of girls (P<0.05). Family history, social history and school performance did not show any significant (P>0.05) association with enuresis. Sixty point five percent were regular and out of those 27.9% never missed any visits. 91.7% were completely dry out of regular patients. There was 75% success rate in those, who visited 4-8 times while 25% in those, who visited 1-3 times. Ninety-six percent of the parents and 80.7% of the children were fully satisfied with this therapy. Socio-economic status seems to play a significant (P<0.05) role in regularity of follow up and response to behavioral therapy. CONCLUSION: This result shows an excellent response to intensive behavioral therapy in primary enuresis if the follow up is regular.