Comparative evaluation of cyclic fatigue resistance of thermomechanically treated NiTi rotary instruments in simulated curved canals with two different radii of curvature: An in vitro Study.

Background: This study aimed to compare the effect of heat treatment on the cyclic fatigue resistance of three different nickel-titanium rotary file systems: TruNatomy, HyFlex CM, and NeoEndo flex in simulated curved canals at two different radii of curvatures. Materials and Methods: A total of 60 NiTi rotary files of three types were used, and the samples were divided into three groups TruNatomy, HyFlex CM, and NeoEndo flex. All the instruments were subjected to cyclic fatigue testing using a stainless steel custom-made canal model with a 60° angle of curvature and two radii of curvature 5 mm and 3 mm; the number of cycles to fracture and length of the fractured segment was measured. The separated instruments were subjected to fractographic analysis under scanning electron microscope. Results: The number of cycles to failure to fracture a file at a 3 mm radius of curvature is significantly less as compared to a 5 mm radius of curvature (HCM > TRN > NE). Conclusion: Within the limitation of the present study, there was a positive correlation between the radius of curvature and fatigue life of NiTi files.

A novel method to estimate the dead layer of HPGe detector for Monte Carlo FEPE computation.

In this study, a novel method to determine the surface and lateral dead layers of p-type HPGe detector is proposed to compute the full energy peak efficiency (FEPE). The method employed standard radioactive point sources 241Am, 133Ba and FEPE measurement at low energies to estimate the thickness of frontal and lateral dead layers. The method is simple to apply, requires only two standard radioactive sources to estimate the optimum thickness of frontal and lateral dead layers. The proposed method is validated by measuring the efficiency of various point sources and a volume source in the energy range from 59 to 1408 keV. The measured efficiencies agree to simulation with relative deviation less than 4.0% at each energy. The proposed detector model enables to calibrate the detector for environmental radioactivity measurement without standard volume sources.

Cytotoxicity evaluation of Bio-C, CeraSeal, MTA - Fillapex, and AH Plus root canal sealers by microscopic and 3-(4, 5 dimethythiazol-2yl)-2, 5-diphenyltetrazolium bromide (MTT) assay.

Aim: The aim of this study was to compare the cytotoxic effect of calcium silicate-based Bio-C, CeraSeal, and mineral trioxide aggregate (MTA)-based (MTA-Fillapex) sealers to a widely used resin-based sealer (AH Plus) using 3-(4, 5 dimethythiazol-2yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and microscopic examination. Materials and Methods: A total of (n = 36) samples divided into four groups with three sealer samples per time period of 0 h, 24 h, and 7 days after mixing were extracted in cell culture medium using Dulbecco's Modified Eagle's Medium. The cytotoxicity of these sealers was evaluated using an MTT assay on L929 mouse fibroblasts, and changes in the cell morphology were observed under an inverted phase-contrast microscope (×20). The values obtained were analyzed statistically using one-way ANOVA, Tukey's post hoc, and Bonferroni's test. Results: Bio-C and CeraSeal showed a reduction in cytotoxicity from severe at 0 h to no cytotoxicity at 24 h and 7 day time period. AH Plus showed severe cytotoxicity at all time periods. MTA-Fillapex showed severe cytotoxicity at 0 h which decreased to moderate at 24 h and 7 days. The differences between groups were statistically significant (P < 0.05). Conclusions: The sealers with resin constituents (AH Plus and MTA-Fillapex) showed severe-to-moderate cytotoxicity at different time periods, whereas calcium silicate-based sealers (Bio-C and CeraSeal) were relatively biocompatible as their cytotoxicity decreased significantly from severe initially to noncytotoxic with time.

Characteristics and Management of Papillary Thyroid Microcarcinoma in the United Arab Emirates: Experience from a Large Tertiary Hospital.

Background: Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking. Objectives: To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE). Patients and Methods: This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables. Results: A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5-10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence. Conclusions: The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.

Spinal aspergillosis: a rare complication of COVID-19 infection.

BACKGROUND: Several complications have been reported in COVID-19 infection. Most of the complications include secondary infection. CASE PRESENTATION: We report an 85-year-old male who presented with cauda equina syndrome 7-months after contracting COVID-19 infection. We excised an extradural mass which on examination proved to be Spinal Aspergillosis. CONCLUSIONS: Spinal Aspergillosis should be kept in mind in patients who present with local spinal pain with or without neurological deficit after COVID-19 infection.

CDK4/6 inhibitor-induced colitis: a case report and review of the literature.

A 72-year-old woman with metastatic ER/PR-positive breast cancer who had been on ribociclib and letrozole for 1 year developed severe life-threatening colitis. She presented to emergency department with features of acute abdomen and diarrhoea. The diagnosis of colitis was confirmed radiologically as well as by histopathological examination of the biopsy specimen and the patient clinically improved after withholding ribociclib and receiving corticosteroids compatible with ribociclib-induced colitis. The mechanism of injury in CDK 4/6 inhibitor-induced colitis is unknown but may be related to recruitment of inflammatory cells. Whether the development of colitis is associated with tumour response is an interesting and unanswered question.

Gamma-ray shielding characteristics of flexible silicone tungsten composites.

Silicone being a hybrid elastomer is well known for its excellent thermal and mechanical properties, chemical resistance, compatibility with organic and inorganic fillers, nontoxicity, and flexibility. As the reported literature on silicone tungsten composite is rare, thus, a complete possible spectrum of silicone tungsten composites series with tungsten loading of 0-88.1 %wt has been fabricated by RTV method and studied as a flexible gamma shielding material. Flexible silicone/tungsten composite formulations containing different weight percentages of tungsten powder (0, 30.1, 47.8, 59.8, 68.1, and 88.1 wt %) were developed by the room-temperature vulcanization route. Two lead collimators with diameters of 0.6 cm were used to make a narrow beam geometry for gamma rays emitted from a137Cs (gamma-ray energy of 662 keV) point source. Uncollided flux was measured with a NaI(Tl) scintillation detector enclosed in lead shielding to reduce the background radiation level. The measured mass attenuation coefficient for our composites with 88.1 wt % tungsten was 0.1035 cm2/g, which is nearly 3.5% higher than that of commercially available silicone/tungsten composites named T-Flex (nearly 0.095 cm2/g) containing the same tungsten loading. Similarly, superior half value layers (HVL) of our composites with 88.1 % wt loading of tungsten i.e 1.01 cm versus 1.27 cm for the reported T-Flex counterpart with additional advantage of insitu fabrication on complex geometries. It was also found that the effectiveness of gamma-ray shielding increases with increase in density of the composites, which is due to the increase in the weight percent of tungsten powder. Our material will have applications as shielding material for both mobile and stationary radiation sources and it can also be used as fabrication material for gloves, safety shoes, coats, etc. to protect workers in a radiation environment.

Perception of dental professionals regarding integration of dental auxiliary into dental health delivery system.

BACKGROUND: The practical solution to handle increasing awareness toward dental treatment and cost of the dental treatment is integration of dental auxiliary into dental healthcare delivery system, and hence the objective of this study was to assess the perception of dental professionals regarding integration of dental auxiliaries into dental health delivery system in India. MATERIALS AND METHODS: This cross-sectional study of Indian dentists was conducted using self-administered closed-ended questionnaire. Questions were asked to assess the opinions of the dentists on expanding the roles of dental auxiliaries and its consequences on dental services. The data were analyzed using Statistical Package for the Social Sciences version 22.0. The level of significance was kept at P < 0.05. RESULTS: Of 230 dentists who participated in the study, 155 (67.39%) reported unfavorable opinion toward expanded duty dental auxiliaries. Among the studied consequences of expanding the functions of dental auxiliaries, cost-effectiveness of treatment had the highest mean score, followed by redundancy of dentists. Undergraduates reported that expanded function dental auxiliaries would lead to redundancy of dentists. CONCLUSION: It is recommended to train the auxiliaries to meet the expectations of patients, but this should be considered keeping in mind the existing situation of dental professionals in the country. Nonetheless, this study gives us information necessary to tailor health policies and improve the standards of the existing oral healthcare delivery in India.

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre.

OBJECTIVES: This study aimed to evaluate the aetiologies of hyperprolactinaemia in the United Arab Emirates (UAE). METHODS: This retrospective study used laboratory databases to identify all patients who underwent evaluation for prolactin at Tawam Hospital, Al Ain, UAE, between 2009 and 2015. Of those 2,280 patients, all patients with low or normal prolactin (n = 1,315) were excluded. Subsequently, charts of the remaining patients (n = 965) with hyperprolactinaemia were reviewed and those with incomplete work-ups or insufficient documentation of the hyperprolactinaemia's aetiology were excluded (n = 458). RESULTS: A total of 507 patients were included in the study. The average age at prolactin evaluation was 36 ± 13.2 years and the majority (67.1%) of patients were female. The most common reasons for requesting prolactin were menstrual disorders (29.5%), infertility (18%), evaluation of sellar masses (14.3%), ruling out seizures (13.4 %) and monitoring while on psychiatric medications (8.7%). The most common causes of hyperprolactinaemia were prolactinoma (17%), transient hyperprolactinaemia (14.6%), drug-induced side effects (14.4%), polycystic ovarian syndrome (11.8%) and seizure disorder (7.7%). In females, common aetiologies were prolactinomas, transient and idiopathic hyperprolactinaemia, while sellar masses, seizures, chronic kidney disease and acute illnesses were common aetiologies of hyperprolactinaemia in males. The prolactin level varied between the different aetiologies and a level of >250 ng/mL was suggestive of macro-prolactinoma. CONCLUSION: A significant proportion of patients with hyperprolactinaemia have transient hyperprolactinaemia. Before further investigations are carried out, prolactin level assessment should be repeated, especially in patients with mild hyperprolactinaemia.

Analysis of chemical composition of urinary calculi from Northern border area of Saudi Arabia.

The present study aimed to investigate the chemical composition of urinary calculi in people living in the northern border area of Saudi Arabia and to formulate suggestions for prevention of renal stones. Urinary stones were obtained from patients attending the Urology Departments of Prince Abdul Aziz Bin Musaad Hospital and Central Hospital, Arar, Saudi Arabia. Stones were analyzed using kit for semi-quantitative colorimetric determination of carbonate, calcium, magnesium, ammonium, oxalate, phosphate, uric acid and cysteine; manufactured by LTA s.r.l. Milano 15/F, 20060 Bussero (Milano), Italy. From a total of 55 urinary stones, 49 (89%) were retrieved from males, while 6 (11%) from females. Ages of patients ranged from 15 to 75 years with the mean of 50.22}14.46 and majority of patients were between 31-50 years (69.08%). Most of the patients were overweight (70.91 %) in both the genders. Calcium oxalate stones were 60%, uric acid 18.18% and calcium phosphate 10.90%, while other forms of stones were scarce. It is concluded that upper urinary tract stones were predominant, comprising mostly of calcium oxalate and urate, which could be prevented by control of obesity; moderate intake of meat, dairy products, fruit vegetables (with minimal oxalates); and plenty of fluids.

Adaptation of Single-Cone Gutta-Percha in Curved Canals Prepared and Obturated with Protaper and Heroshaper Systems by Using Cone Beam Computed Tomography.

OBJECTIVE: The aim of this study is to prepare and obturate the curved canals of the mesiobuccal root of maxillary first molar with four different file systems that is protaper hand files, rotary pro taper (RP) files, heroshaper hand files, and rotary hero shapers files and to evaluate the adaptation of their single-cone Gutta-percha by cone beam computed tomography (CBCT). MATERIALS AND METHODS: Eighty teeth were selected and were divided into two groups (G1A1, G1A2 and G2A1, G2A2 as hand and RP file system, G1A3, G1A4 and G2A3, G2A4 as hand and rotary hero shaper files system) of fourth teeth each. After access opening working length of the mesiobuccal canal was established. The distobuccal and palatal roots of the samples were removed using the diamond disc at the furcation level. "Endoanalyser" software was used to measure Schneider's angle on the preoperative radiograph. This angle was measured by drawing two lines-one parallel to the long axis of the canal, in the coronal third, and the second line from the apical foramen to intersect the point where the first line left the long axis of the canal. The canals of each group were then prepared according to the manufacturer's instructions for protaper hand files, RP files, heroshaper hand files, and rotary hero shapers files systems. Direct digital radiography image of all the samples was obtained. And then, the samples were exposed to CBCT to evaluate their single-cone adaptations. The data were analyzed using SPSS 20, IBM, Armonk, NY, United States of America. RESULTS: The null hypothesis that there will not be any gap area in the adaptation of their single-cone of different file system was rejected. Minimal gap area was seen in rotary hero shapers file system (0.001 mm2) and was maximum in hand protaper (HP) file system (0.015 mm2). CONCLUSION: CBCT is a useful tool in detecting the gap area after obturation in curved canals. The HP single-cone adaptation showed the maximum gap area and rotary heroshaper single-cone adaptation showed the minimum gap area.

Implementation of Game-based Oral Health Education vs Conventional Oral Health Education on Children's Oral Health-related Knowledge and Oral Hygiene Status.

INTRODUCTION: For the prevention of oral health problems, health education of schoolchildren has a vital role. The oral health status of the children can be improved if health promotion in schools is conducted in a comprehensive and interesting manner. OBJECTIVE: Effectivity of game-based oral health education over conventional on the oral health-related knowledge and oral hygiene status among 8- to 12-year-old schoolchildren. MATERIALS AND METHODS: A total of 150 children aged 8 to 12 years were divided into two groups. A pretest evaluation of their knowledge regarding oral health and the estimation of plaque index was carried out. Children in group I were given oral health education through PowerPoint presentation once daily for 7 days. Children in group II were educated through the play method (i.e., crosswords and quiz with PowerPoint presentation). The evaluations regarding oral health-related knowledge and plaque scores were recorded on postintervention 1 and 3 months. RESULTS: In group II, high knowledge scores of 10.32 and 9.98 were obtained by the on postintervention 1 and 3 months respectively. In both the groups, there was a significant increase in good oral hygiene scores and a significant decrease in plaque scores on postintervention 1 and 3 months follow-up, but much better scores were seen in group II compared to group I at both the follow-ups. CONCLUSION: Implementation of crossword game-based oral health education program is an easy and effective aid for teaching oral health instructions and preventing oral diseases in children as the knowledge scores of children increased considerably when the game-based teaching intervention was used. HOW TO CITE THIS ARTICLE: Malik A, Sabharwal S, Kumar A, Samant PS, Singh A, Pandey VK. Implementation of Game-based Oral Health Education vs Conventional Oral Health Education on Children's Oral Health-related Knowledge and Oral Hygiene Status. Int J Clin Pediatr Dent 2017;10(3):257-260.

Prevalence, risk factors and character of abdominal hernia in Arar City, Northern Saudi Arabia in 2017.

BACKGROUND: Abdominal wall hernias are a very common surgical condition affecting all ages and both sexes. The main risk factors of hernias include pregnancy, weight lifting, constipation, and weight gain. OBJECTIVE: The aim of this study was to determine the prevalence and risk factors of abdominal hernias, their causes, treatment and complications among both sexes of the Arar population (Saudi Arabia). METHODS: A cross-sectional study was conducted among 1,567 adults living in Arar city in 2017. Data was collected by personal interview via questionnaire translated into Arabic, and general and local examination. Data were analyzed by SPSS version 16, using descriptive statistics and Chi Square test. RESULTS: The overall prevalence of abdominal hernias was 11.7%, hernias were more prevalent in females than in males (63.4% vs. 36.6%), the most common cases were para-umbilical 33.9%, inguinal 27.3%, and umbilical in 20.8% of the cases, 51.9% were obese, 53.6% had previous abdominal surgery, 19.1% had previous abdominal trauma, 28.4% had positive family history of hernia and 39.9% were grand multipara. Hernias were significantly affected by sex, obesity, previous abdominal surgery, previous abdominal trauma, positive family history of hernias and being grand multipara (p<0.05). Treatment of hernias was surgical in 47.5% and conservative in 47.0%, complications occurred in 20.2% and 25.1% were recurrent after treatment. CONCLUSION: Abdominal wall hernias are a common clinical presentation in Arar, KSA. Abdominal hernias are more common in women than men, there is an obvious relationship between obesity and hernias. Early diagnosis, easily accessible health facilities and health education are important to prevent complications. New modality of treatment should be adopted as the standard choice of care to prevent recurrence.

Attitude among dental practioners towards use of rotary instruments and hand instruments for root canal treatment: a comparative study

Aim: The purpose of present study is to assess the attitude of general dental practioners towards use rotary instruments and hand instruments for root canal treatment. Material and Methods: It was a cross-sectional questionnaire study conducted in the private clinics in Lucknow city, Uttar Pradesh. A total of 400 clinics were visited and face to face interview schedule was conducted. Questionnaire consists of demographic details of dental professionals. Information regarding the years of experience, OPD details and number of root canal treatment done per week by dental professionals was obtained. Use of rotary and hand instruments by dental professionals was inquired. Years of experience with Rotary instruments, procedural problems with rotary instruments faced by dental professionals and reasons for not using the rotary instruments if any was also recorded. Results: 102 (33%) of the total study samples were using rotary instruments for root canal treatment and 100 (32%) using both rotary and hand instruments for root canal treatment. Dentists who are using rotary instruments are facing the procedural problem of file breakage {70 (36%)}. And those dental professionals using hand instruments are facing the problem of ledge formation {82(40%)}. Conclusions: The main procedural failure of the rotary instruments in root canal treatment, faced by dental professionals was file breakage and with hand instrument is ledge formation. Lack of expertise is the main reason which restricts dental professionals from using rotary instruments.

EGS5 simulations to design a Ce:GAGG scintillator based Compton camera.

Ce(+3): Gd3Al2Ga3O12 (Ce:GAGG) is expected to be promising scintillator for PET, SPECT, and gamma camera applications because of its attractive properties. We designed a Compton camera based on Ce:GAGG, both as scatterer and absorber, for imaging and radioactivity measurement of point sources. The two important parameters sensitivity and spatial resolution are determined for 4 × 4 pixels, each pixel of size 1 × 1 cm(2), for both scatterer and absorber. Our main focus in this paper is to image a distant source for which sensitivity is of prime importance. High sensitivity and light weight are two important advantages of Compton camera for distant source imaging and the availability of Ce:GAGG 3 × 3 mm(2) pixel size is expected to give a spatial resolution of ~ 5 mm for medical applications as well.

Measurement of radioactivity concentration in blood by using newly developed ToT LuAG-APD based small animal PET tomograph.

In order to obtain plasma time activity curve (PTAC), input function for almost all quantitative PET studies, patient blood is sampled manually from the artery or vein which has various drawbacks. Recently a novel compact Time over Threshold (ToT) based Pr:LuAG-APD animal PET tomograph is developed in our laboratory which has 10% energy resolution, 4.2 ns time resolution and 1.76 mm spatial resolution. The measured value of spatial resolution shows much promise for imaging the blood vascular, i.e; artery of diameter 2.3-2.4mm, and hence, to measure PTAC for quantitative PET studies. To find the measurement time required to obtain reasonable counts for image reconstruction, the most important parameter is the sensitivity of the system. Usually small animal PET systems are characterized by using a point source in air. We used Electron Gamma Shower 5 (EGS5) code to simulate a point source at different positions inside the sensitive volume of tomograph and the axial and radial variations in the sensitivity are studied in air and phantom equivalent water cylinder. An average sensitivity difference of 34% in axial direction and 24.6% in radial direction is observed when point source is displaced inside water cylinder instead of air.

Paraganglioma of urinary bladder.

Paraganglioma of the urinary bladder is extremely rare. In this report of a young man, hypertensive crisis and ventricular arrhythmia was provoked during cystoscopic evaluation of a bladder mass. A diagnosis of pheochromocytoma was considered following detection of high serum and urinary catecholamine levels. A preoperative meta-iodobenzylguanidine scan was, however, negative. The bladder mass was surgically removed following initiation of antihypertensive therapy. Pathological confirmation of extraadrenal pheochromocytoma was established. During a serial follow-up, serum and urine catecholamine levels were persistently elevated. This was explained by abnormalities on fluorodeoxyglucose positron emission tomography scan, which were considered to represent a metastatic malignant neuroendocrine tumour. The patient is on palliative chemotherapy for malignant paraganglioma. This case highlights variable presentation of pheochromocytoma, importance of having a high index of clinical suspicion for early recognition and prompt management and serious adverse consequence of a delayed diagnosis.

Aneurysmal coronary cameral fistula.

A 26-year-old asymptomatic man, being medically managed for ventricular septal defect since childhood, presented to the outpatient clinic for a second opinion. Clinically, he was well built with normal vital signs. Cardiac auscultation was significant for a diastolic murmur over the praecordium. An ECG showed non-specific ST changes, and a subsequent transthoracic echocardiography performed revealed diastolic flow from the left ventricular (LV) anteroseptal wall into the LV cavity. A diagnosis of coronary-cameral fistula was confirmed by a multidetector CT which showed a 2.5×2 cm aneurysmal left anterior descending artery fistula to the LV. In addition to starting aspirin, transcatheter closure with occlusion device was considered knowing the potential risk of thrombus formation in the aneurysm and subsequent systemic embolisation. The patient however refused any percutaneous or surgical intervention. He remains asymptomatic 1 year after returning to his home country.

Rare manifestation of Behcet's syndrome: insight from multimodality cardiovascular imaging.

A young Jordanian man was hospitalised with fever of 2 months duration. Preadmission diagnostic assessment including CT thorax and abdomen were inconclusive. Right-sided pleuritic chest pain was present on admission. Pulmonary embolism was suspected on a ventilation/perfusion lung scan. Lower-extremity deep venous thrombosis was, however, absent. Echocardiogram to exclude a cardiac source of pulmonary embolism showed a right ventricle mass which was also present on retrospective review of prehospitalisation CT thorax. Tissue characterisation of this mass on cardiac MRI was not helpful. Empiric anticoagulation was started without reduction in size at 3 weeks. Due to ongoing diagnostic uncertainty, surgical resection was performed. Histopathology confirmed this mass to be a thrombus. With unabated fever, right ventricular thrombosis with pulmonary embolism and cutaneous and scrotal ulceration which evolved later in the hospital course, a diagnosis of Bechet's syndrome was considered and subsequently confirmed. Response to immunosuppressive therapy was prompt.