Evaluation of the masking ability, marginal adaptation, and fracture resistance of screw-retained lithium disilicate implant-supported crowns cemented to titanium bases versus preparable abutments.

BACKGROUND: Straight preparable abutments and titanium bases (ti-base) can be used to support single-unit screw-retained lithium disilicate implant-supported restorations. The choice between using both abutments depends on many factors. The purpose of this in vitro study was to compare the masking ability, marginal adaptation, and fracture resistance of screw-retained lithium disilicate implant-supported crowns cemented to straight preparable abutments and ti-bases. METHODS: Twenty laboratory implant analogs (Straumann Bone Level; Straumann AG) were randomly divided into 2 groups (n = 10 each) according to the type of the abutment used. Preparable abutment group and ti-base group. Lithium disilicate crowns were used to restore the specimens. All specimens were subjected to thermocycling (from 5 to 55 °C for 2000 cycles) followed by cyclic loading (120 000 cycles). The vertical marginal gap between the abutment finish line and the most apical part of the crown was measured in (µm) by using a stereomicroscope after cementation and after thermocycling and cyclic loading. A spectrophotometer was used to evaluate the masking ability of the specimens after cementation. The load required to fracture the crowns was measured in Newtons (N) by using a universal testing machine after thermocycling and cyclic loading. The Shapiro-Wilk test of normality was used. The appropriate statistical test was used. RESULTS: Regarding the masking ability, the color difference (∆E) showed no statistically significant difference between the ti-base group (2.6 ± 0.2) and the preparable abutment group (2.6 ± 0.3) (P = .888). The average of the microgap values (µm) was greater in ti-basegroup after cementation (13.9 ± 9.2) than preparable group (7.63 ± 1.78) with no statistically significant difference between the 2 groups (P = .49). After cyclic loading and thermocycling, the average microgap values (µm) was significantly greater in the ti base group (21.3 ± 7.4) than in preparable group (13.3 ± 1.5) (P = .02). The load required to fracture the specimens was greater in the preparable group (1671.5 ± 143.8) than in the ti-base group (1550.2 ± 157.5) with no statistically significant difference between the 2 groups (P = .089). CONCLUSION: The abutments used in the present study did not compromise the masking ability of the screw-retained lithium disilicate implant supported crowns. Moreover, the crowns cemented to preparable abutments had better marginal adaptation and higher fracture resistance when compared to those cemented to ti-bases. CLINICAL IMPLICATIONS: Straight preparable abutments are considered as an alternative to the ti-bases when restoring single screw-retained lithium disilicate implant-supported crowns with comparable fracture resistance, marginal adaptation, and masking ability.

Prevalence and global trends of polypharmacy in patients with chronic liver disease: A systematic review and meta-analysis.

BACKGROUND: Despite its central role in drug metabolism, the exact prevalence estimates and factors affecting global trends of polypharmacy in patients with chronic liver disease (CLD) have remained unexamined. The aim of this systematic review and meta-analysis is to estimate the prevalence of polypharmacy in patients with CLD and to comprehensively synthesize the socio-demographic factors that drive this. METHODS: We conducted a comprehensive search of relevant databases (PubMed, EMBASE, Science citation index, Cochrane Database of Systematic Reviews, and database of abstracts of reviews of effectiveness) for studies published from inception to May 30, 2022 that reported on prevalence estimates of polypharmacy in patients with CLD. The risk of bias was conducted utilizing Loney criteria. The primary outcome was the pooled prevalence of polypharmacy in patients with CLD. We subsequently performed a systematic review and weighted meta-analysis to ascertain the exact pooled prevalence of polypharmacy among patients with CLD. RESULTS: We identified approximately 50 studies from the initial literature search, of which 7 (enrolling N = 521,435 patients) with CLD met the inclusion criteria; of these, 58.7% were male, with a mean age of 53.9 (SD ±â€…12.2) years. The overall pooled prevalence of polypharmacy among patients with CLD was 31% (95% confidence interval [CI]: 4%-66%, I2 = 100%, τ2 ≤ 0.001, P ≤ .0001). We found higher pooled prevalence estimates among patients aged 50 years and older compared to their younger cohorts (42%, [CI 10-77]; I2 = 100%, P = <.001 vs 21%, [CI 0-70]; I2 = 100%, P = <.001). CONCLUSION: In an examination of multiple community- and hospital-based databases of patients with CLD, we found a pooled prevalence estimate of polypharmacy of approximately 31%. This represents a case burden within the range reported in the general population and will likely respond to mitigation strategies employed thus far for patients in that population.

Infective Endocarditis Presenting as Rhabdomyolysis and Muscle Abscess: A Case Report.

Rhabdomyolysis is characterized by the degradation of skeletal muscle tissue, which releases cellular contents into circulation. This condition commonly stems from various factors, including trauma, overexertion, muscular hypoxia, infections, metabolic and electrolyte imbalances, certain medications, toxins, and genetic abnormalities. Despite this, instances of rhabdomyolysis precipitated by bacteremia of infective endocarditis remain exceedingly rare. This report describes an unusual case wherein infective endocarditis manifested as rhabdomyolysis, accompanied by a muscular abscess and acute renal failure. The patient's condition was successfully managed through hydration and targeted antibiotic therapy, leading to a favorable recovery. The case underscores the importance of vigilance for extracardiac symptoms and signs of infective endocarditis, such as rhabdomyolysis and muscular abscesses. Of particular note in this case was the discovery of an atypical causal bacterium, Streptococcus dysgalactiae, in the setting of infective endocarditis. This case highlights the broad range of potential manifestations and causal factors associated with this serious cardiac condition.

Compliance with appointments and medications in a pediatric neurology clinic at a University Hospital in Riyadh, Saudi Arabia.

OBJECTIVE: The objectives of the study are to estimate the rate of epileptic patients' compliance with appointments and medications in a pediatric neurology clinic. Also to study the factors associated with non-compliance and to determine the parents' perceived reasons for non-compliance with appointments. METHODS: It is a prospective study in which 147 epileptic children who attended the neurology clinic during the first 12-months of the study period were included. Patients were recruited into the study after their parents were interviewed using a detailed questionnaire; their compliance with appointments was monitored prospectively over at least a one year from their recruitment into the study. The parents of the other 70 patients who did not attend the clinic were telephoned. Only 32 replied and were asked about the reasons for non-attendance to the clinic. RESULTS: Eighty-six percent of the patients' parents stated that they were complying with the medications while only 53% of them did not miss any appointment to the clinic during the study period. Compliers with appointments were more likely to comply with their medications too. Children with grand-mal epilepsy and absence seizures were found to be more likely to comply with taking medications than patients with febrile, rolandic and myoclonic seizures (P=0.01). Health belief model factors associated with non-compliance were 1. Children encountering side effects from their medications 2. Parents who were not satisfied with the provided services 3. Parents who thought that alternative medicine is more effective than traditional medicine 4. Parents who think that their children are not susceptible. Patients' perceived main reasons for non-compliance were wrongly registered appointments (27.5%), forgetfulness (22.5%) and busy parents. CONCLUSION: Failure to keep the clinic appointment is an indicator of poor compliance with medications. A telephone call is recommended to reduce the role of clinic non-compliance. Developing a questionnaire form to investigate parents health belief model could be used routinely by social workers and then health education could be tailored for each patient and parent.

Compliance with appointment and medications in a pediatric neurology clinic at a University Hospital in Riyadh, Saudi Arabia.

OBJECTIVE: The objectives of the study are to estimate the rate of epileptic patients` compliance with appointments and medications in a pediatric neurology clinic. Also to study the factors associated with non-compliance and to determine the parents` perceived reasons for non-compliance with appointments. METHODS: It is a prospective study in which 147 epileptic children who attended the neurology clinic during the first 12-months of the study period were included. Patients were recruited into the study after their parents were interviewed using a detailed questionnaire; their compliance with appointments was monitored prospectively over at least a one year from their recruitment into the study. The parents of the other 70 patients who did not attend the clinic were telephoned. Only 32 replied and were asked about the reasons for non-attendance to the clinic. RESULTS: Eighty-six percent of the patients` parents stated that they were complying with the medications while only 53% of them did not miss any appointment to the clinic during the study period. Compliers with appointments were more likely to comply with their medications too. Children with grand-mal epilepsy and absence seizures were found to be more likely to comply with taking medications than patients with febrile, rolandic and myoclonic seizures (P=0.01). Health belief model factors associated with non-compliance were 1. Children encountering side effects from their medications 2. Parents who were not satisfied with the provided services 3. Parents who thought that alternative medicine is more effective than traditional medicine 4. Parents who think that their children are not susceptible. Patients` perceived main reasons for non-compliance were wrongly registered appointments (27.5%), forgetfulness (22.5%) and busy parents. CONCLUSION: Failure to keep the clinic appointment is an indicator of poor compliance with medications. A telephone call is recommended to reduce the role of clinic non-compliance. Developing a questionnaire form to investigate parents health belief model could be used routinely by social workers and then health education could be tailored for each patient and parent.