Evaluating the safety of bipolar nephrostomy tract cauterization "BNTC" towards a safe tubeless percutaneous nephrolithotomy: a randomized controlled trial.

To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge.

Augmented anastomotic ureteral reconstruction using buccal mucosal graft, initial experience.

OBJECTIVE: To assess the augmented anastomotic ureteral reconstruction using buccal mucosal graft based on omental flap for managing ureteral stricture. SUBJECTS AND METHODS: This prospective cohort study was conducted on 13 patients with ureteric strictures of different lengths secondary to Bilhalziasis, iatrogenic (post endoscopy) and post inflammatory etiology in upper and mid ureteral segments were treated with buccal mucosal patch grafts and The graft is fixed to the undersurface or the posterior surface of the omentum before doing graft anastomosis to the ureteral walls as to ensure the process of graft take sticky to the principles of tissue transfer. All patients were subjected to full history taking, clinical examination for assessment of pain, lower or upper urinary track symptoms and laboratory investigation (complete blood count, CRP, liver function test and kidney function test (serum urea and creatinine). RESULTS: The mean operative time was 148.85 min and mean hospital stay was 3 days. Mean blood loss was ranged from 20 to 210 ml and Stent was removed after 8-12 weeks. The mean follow up was 13 months, all patients had a non-obstructive RI value <0.7 with a non-obstructed drainage pattern on the diuretic renogram except one patient who had severe postoperative UTI necessitating nephrostomy tube insertion his drainage curve was plateau. CONCLUSION: BMG ureteroplasty is a valuable option for a carefully selected patient. The fixation of the graft on the back surface of the omentum allows for better anatomical reconstruction without any twisting to the omental pedicle.

Heart Failure and Echocardiography Derived Myocardial Wall Stress Link in Diabetic Cases with Acute Myocardial Infarction Managed by Revascularization.

Background: Diabetes is associated with left ventricular remodeling. Myocardial wall stress is a measurable factor connected to the ventricular breadth and force and is related to myocardial thickness; it can be measured by echocardiography. The present study aimed to assess the link between heart failure (HF) and echocardiography-derived myocardial wall stress in diabetic patients with ST elevation myocardial infarction (STEMI) who were managed with revascularization. Methods: This study was a comparative prospective study that took place between February 2022 and February 2023. It included 100 diabetic patients presented with STEMI and managed by percutaneous coronary intervention (PCI). Patients were selected from the cardiology departments at Al-Azhar University Hospital, Damietta, Egypt. During the hospital stay, patients were checked for HF symptoms and signs. They were also observed for 3 months after discharge for detection of HF. Those who did not develop HF were assigned to group I, and those with HF were assigned to group II. Results: The mean value of end-systolic wall stress (ESWS) was 77.09 ± 12.22 and 97 ± 13.44, and the mean value of end-diastolic wall stress (EDWS) was 12.61 ± 2.76 and 15.87 ± 2.86 in groups I and II respectively, with significant differences between the 2 groups. The cutoff point to detect HF was 88 KPa for ESWS and 13.5 KPa for EDWS, with a sensitivity of 70% and 79% and a specificity of 80% and 61% for ESWS and EDWS, respectively. Conclusion: Elevated left ventricle (LV) myocardial stress is related to increased HF in diabetic patients whose HF was managed by PCI after STEMI. LV wall stress is a potentially helpful risk stratification tool using routine echocardiography to determine the treatment plane according to the risk status.

Predictors of surgical intervention for antenatally detected ureteropelvic junction obstruction (UPJO): A prospective multivariate analysis.

OBJECTIVE: We aimed to identify clinical and radiological predictors of the need for surgical intervention in infants with antenatally detected UPJO. MATERIAL AND METHODS: We prospectively followed infants born with antenatally diagnosed ureteropelvic junction obstruction (UPJO) presented at our outpatient clinics for evidence of obstructive injury with a standard protocol with ultrasonography and renal scintigraphy. Indications for surgery included progression of hydronephrosis on serial examinations, initial differential renal function (DFR) ⩽35% or >5% loss in sequential studies, and febrile urinary tract infection (UTI). Univariate and multivariate analyses were utilized to define the predictors for surgical intervention, while the appropriate cut-off value of the initial Anteroposterior diameter (APD) was determined using the receiver operator curve analysis. RESULTS: Univariate analysis revealed a significant association between surgery, the initial APD, cortical thickness, Society for Fetal Urology grade, UTD risk group, initial DRF, and febrile UTI (p-value < 0.05). No significant association between surgery and sex or side of the affected kidney (p-value 0.91 and 0.38, respectively). On multivariate analysis, the initial APD, initial DRF, obstructed renographic curve, and febrile UTI (p-value < 0.05) were the only independent predictors for surgical intervention. An initial APD of 23 mm can predict surgical requirement, with a specificity of 95% and sensitivity of 70%. CONCLUSION: For antenatally diagnosed UPJO, the APD value (at the age of 1 week), DFR value (at the age of 6-8 weeks), and febrile UTI during follow-up are significant and independent predictors of the need for surgical intervention. APD, when used with a cut-off value of 23 mm, is associated with high specificity and sensitivity for predicting surgical need.

Dental Technicians' Perception of the Quality of Dentists' Communication on the Fabrication of Removable Partial Dentures: A Cross-Sectional Study in Saudi Arabia.

BACKGROUND: Effective and clear communication between the dentist and dental technician plays a vital role in rendering quality prostheses for patients. When fabricating a removable dental prosthesis, it is uncertain if the information received by the dental laboratory technician is clear and sufficient. This investigation aimed to assess dental technicians' perceptions of the quality of dentists' communication on the fabrication of removable partial dentures (RPDs) in Saudi Arabia. METHODOLOGY: After obtaining the institutional review board (IRB) approval from Riyadh Elm University, Riyadh, Saudi Arabia, a cross-sectional survey on a convenient sample of 115 dental technicians registered with the Saudi Commission for Health Specialties was conducted in January 2022. The voluntary participation of 94 technicians fabricating RPDs was included. A 19-item online questionnaire was developed, including quality of written instruction, selection of impression trays, and impression materials for RPD fabrication, shared through Google Docs. Descriptive statistics were tabulated, and responses were displayed as a percentage of the total. RESULTS: Of the 94 study subjects, 35% had less than five years of experience, 44% stated that they routinely receive work authorizations with clear instructions, 13% always used digital technology to fabricate prostheses, and 58% reported difficulty with communicated work authorization by dentists having less than five years of experience. Thirty-three respondents (35.1%) reported that 75% or more of the fabricated partial dentures were cast framework partials. Thirty-three respondents (35.1%) indicated that the master casts received for partial framework construction were usually accurate. Tooth alterations, however, were reported as usually adequate by only 28 respondents (29.8%). For creating the artificial gingiva portion of cast partials, 56 respondents (59.6%) preferred heat-cured acrylic resin. Furthermore, 40 respondents (42.6%) said that 75% or more of the requested partials were entirely made out of acrylic resin. Regarding case design discussions, 26 respondents (27.7%) always engaged with dentists, while 39 (41.5%) did so occasionally. CONCLUSION: The obtained assessments pointed to the fact that dental technicians expressed a perception of inadequacy regarding the work authorizations provided by dentists for the fabrication of RPDs, where they seemingly felt that the instructions conveyed by the dentists were not sufficiently comprehensive or clear.

A Feasible and Innovative Method of Investing Wax Pattern for Removable Partial Dentures: An In Vitro Study.

Background A dental prosthesis called a removable partial denture (RPD) is used to fill the gaps left by one or more lost teeth. It serves as an option to fixed bridges and restorations supported by implants. This research was on a simple and effective method of investing RPD wax pattern and an in vitro investigation into the creation of a cutting-edge RPD technique. Methodology The method outlines the straightforward steps for waxing an RPD and validating the precision of the cast framework. The use of a laminated paper ring rather than a metallic one for investing the wax patterns is the main distinction between the novel method and the traditional ringless technique. Results A total of 30 samples were considered for investigation, with 15 in the traditional and 15 in the experimental group. The innovative wax pattern investment method exhibited a higher mean geometric orientation (9.23 ± 0.42) compared to traditional investment casting (8.90 ± 0.37 mm). Conversely, the dimensional accuracy mean was lower for the innovative wax pattern investment method (0.28 ± 0.03 mm) compared to traditional investment casting (0.31 ± 0.05 mm). The p-value was less than 0.001 for both parameters, signifying that the differences between the means of the two methods were statistically significant. The statistical power (1-ß) was the probability of rejecting the null hypothesis when it was false. The statistical power was 0.999 for both geometric orientation and dimensional accuracy, indicating that the study had a very high power to detect differences between the two methods. Conclusions This innovative method does away with the requirement for a commercially available plastic ring, reduces the price and time needed for RPD manufacturing, and offers decent marginal accuracy. However, it has some restrictions, such as the challenge of cutting and preparing the paper ring after investing, which could lower the finished product's quality.

Effect of Surface Treatments on Adhesion of Milled Polyetheretherketone Post to Different Composite Resin Core Build-Up Materials.

Background: To evaluate the effect of surface treatments on adhesion of milled PEEK post to two different composite resin core-build up materials. Material and Methods: Six PEEK posts were divided into the following groups: G1: no treatment+ Grandio core material, G2: no treatment+ Bulk-fill core material, G3: 98% sulfuric acid for 60 seconds+ Grandio core material, G4: 98% sulfuric acid for 60 seconds+ Bulk-fill core material, G5: 50 µm airborne particle abraded + Grandio core material, G6: 50 µm airborne particle abraded + bulk fill core material. The adhesion of the post to core build-up materials was tested using micro push-out bond strength. Data were analyzed using ANOVA and Tukey's test. Results: There was a significant effect for the surface treatment (p<.001), a non-significant effect for the core build-up materials (p<.289), and a significant effect for their interaction (p<.001) on the bond strength values. Conclusions: Within the limitation of this study, sulfuric acid etching group significantly increased the bond strength compared to other groups. Bulk-fill core material could be a feasible option when restoring ETT in terms of saving chair time and the treatment procedure simplicity. Key words:Bond Strength, Core material, PEEK, Surface Treatment.

Influence of surface treatment on repair bond strength of CAD/CAM long-term provisional restorative materials: an in vitro study.

BACKGROUND: The surface treatment to improve the repair bond strength may vary because CAD/CAM provisional restoration polymers exhibit a variety of microstructures. This study was conducted to evaluate the effect of surface treatments on the repairability of three different CAD/CAM polymers for long-term provisional restorations. METHODS: Thirty specimens from each provisional restorative materials (CAD-Temp, Everest C-Temp, and PEEK) were divided into three groups: C: surfaces received no treatment; SB: surfaces were airborne particle abraded with 50 µm aluminum oxide; SB-T: surfaces received the same conditions as group SB in addition to thermocycling before and after treatment. Primer and nanohybrid repair resin composite were applied to the prepared CAD /CAM surfaces. The shear bond strength and the mode of failure were assessed. ANOVA and Tukey's significant difference tests were used to evaluate the data. RESULTS: The SB group had significantly higher repair SBS values (p < .001) compared to the other groups (C and SB-T). Everest C-Temp significantly recorded the highest repair SBS (17.84 ± 0.19 MPa) in group SB, while the lowest repair SBS values (5.51 ± 1.14 MPa) for CAD-Temp were recorded in group C. PEEK significantly recorded the second highest repair SBS (15.96 ± 0.18) in the SB group. CONCLUSIONS: Everest C-Temp had the highest repair SBS after an airborne abrasion particle. Thermocycling had no significant effect on the repair SBS for PEEK. Everest C-Temp and PEEK are recommended as long-term durable provisional materials for clinical use.

Bonding durability and remineralizing efficiency of orthodontic adhesive containing titanium tetrafluoride: an invitro study.

BACKGROUND: Titanium tetrafluoride has been shown to protect tooth enamel from demineralization. This study investigated the effect of incorporating different concentrations of TiF4 (1, 2 and 3 Wt.%) into an orthodontic primer on the shear bond strength of orthodontic brackets and the enamel microhardness after cariogenic challenges. METHODS: Three different TiF4 concentrations (1, 2 and 3 Wt.%) were prepared and added to the etch and rinse orthodontic primer. Ninety freshly extracted premolars were randomly divided into five groups according to the experimental primers and ageing conditions: TF0, TF0C, TF1C, TF2C, and TF3C. The TF0C group had no TiF4 in the primer, while TF1C, TF2C, and TF3C had 1, 2 and 3 Wt.% TiF4 in the primer, respectively. In the TF0 group, specimens were immersed in deionized water for 24 h as a control group, while all other groups were immersed in a demineralizing solution for 28 days. Each of the five groups was divided into two subgroups: The first group was subjected to shear bond strength and adhesive remnant index testing (N = 50 teeth, 10/group), while the second group was subjected to enamel surface microhardness testing (N = 25 teeth, 50 tooth halves, 10 tooth halves/group). Fifteen teeth (N = 15 teeth, n = 3/group) representing the five groups were subjected to SEM and microelemental analysis (EDX). SBS, ARI, microhardness, and Ca/P ratio were measured, and the data were analyzed using ANOVA and Tukey's tests. RESULTS: The TF2C group had the highest SBS value (9.93 ± 1.23), while the TF0C (5.24 ± 0.65) and TF3C (5.13 ± 0.55) had the lowest SBS values. The enamel microhardness in the TF0C group was significantly reduced (p < .001). Enamel microhardness values were significantly (p < .001) higher in groups TF1C, TF2C, and TF3C than in TF0C. The highest Ca/P ratio was significantly recorded for the TF2C group (2.65 ± 0.02). CONCLUSIONS: Incorporation of 1 and 2 Wt.% TiF4 into the orthodontic primers showed adequate bond strength and better remineralization effect. However, 1 Wt.% TiF4 showed lower ARI values than 2 Wt.% TiF4.

Awareness of Fixed Partial Dentures and Implant Rehabilitation of Missing Teeth Among a Subset of Saudi Population.

Background  Maintaining one's sense of self requires having healthy teeth. A person's physical well-being is greatly impacted by their dental health. They are intimately related, and the socioeconomic situation of the individual largely determines how teeth are maintained. As a result, tooth loss causes injury to the stomatognathic system as well as the masticatory function. Morale is negatively impacted by psychological discomfort as well as the reduction in general quality of life brought on by tooth loss. Objectives  The purpose of this study was to assess the awareness of patients about various dental prosthetic rehabilitative procedures in Saudi Arabia, their preference(s) regarding the choice of treatment, and the motivating factors that drive them to avail of dental prosthetic rehabilitative treatment. Methods  After randomly selecting 600 individuals for the purpose of our investigation, a nine-variable questionnaire was framed by investigators to record the responses of those who consented to participate in our study. Results  Only 68.3% of the respondents were found to be aware of the several prosthodontic replacement choices. As mentioned by the majority of the respondents, the cost element was the biggest drawback for replacement. The benefits of choosing fixed partial dentures (FPD) or dental implants were judged to be aesthetics (41.1%) and the feel of one's own teeth (40.1%). Conclusion Only 68.3% of respondents reported knowing about the several prosthodontic replacement choices. The cost aspect was cited by 348 respondents as the biggest drawback to replacement. The perceived benefits of choosing FPD or dental implants were deemed to be aesthetics (41.1%) and the feel of one's own teeth (40.1%). We believe that patients' health and quality of life can be improved by raising awareness about and changing patients' attitudes toward the most cutting-edge treatment options that are readily available. This can be done by educating people about the drawbacks of delaying the replacement of missing teeth and other treatment options.

Management challenges and choices in patients with bipolar disorder: An Egyptian observational study.

BACKGROUND: Patients with bipolar disorder (BD) had contributed immensely to high health service utilization. Variation in clinical practices that miss to follow the standard guidelines all with the disorder complexity, deepened the management gap. This study aimed to provide an Egyptian epidemiological database of the ongoing clinical practices that framed different diagnostic and management choices in a sample of patients with bipolar disorder. Highlighting challenges and the need for optimized clinical practices. METHODS: Over 4 months in 2014, 20 clinicians filled in a designed sheet of their routine healthcare practice with information about; caseload /month, management guidelines knowledge background. Out of 301 patients in acute episode BD, 300 patients aged 20 to 60 years from both sexes, completed their assessment using; (1) a semi-structured interview sheet, (2) Structured Clinical Interview for DSM-IV Axis I (SCID I) for psychiatric diagnoses, (3) Global Assessment of Functioning scale for illness impact. RESULTS: Psychiatrists received 49.5 ± 37.0 (mean ± SD) patient /month. 95% of them reported positive knowledge background on BD diagnostic guidelines and treatment recommendations (G/R), 89.6% of patients had different initial diagnosis than BD.The most commonly given initial diagnosis was major depressive disorder (33%) followed by brief psychotic disorder(20.7%) and others. The median of time taken from the initial to bipolar diagnosis was 12.3 months. Majority of patients had evident functional impairment. Atypical antipsychotics were mostly used. Drug abuse and obesity were high comorbidities. CONCLUSION: The evident gap in practice and BD complexity have negative impact on clinical outcomes. Physician's continuous medical education programs and individually tailored standard medical care are recommended for optimized practices.

Violence in relation to cognitive deficits and symptom severity in a sample of Egyptian patients with schizophrenia.

BACKGROUND: Patient with schizophrenia are significantly more likely to be violent than general population; and the consequences of this violence risk are often very serious for the patients, their caregivers, and the entire community. AIM: To assess the risk of violence in patients with schizophrenia and its correlation with severity of symptoms and cognitive functions. METHODS: A cross-sectional comparative study conducted in Okasha institute of psychiatry including 50 patients with schizophrenia compared to 50 healthy control group regarding violence risk as assessed by Historical, Clinical, and Risk Management-20 (HCR-20), case group was assessed using Structured Clinical Interview for DSM-IV (SCID-I), Positive and Negative Syndrome Scale (PANSS), cognitive functions were assessed by Wechsler Adult Intelligence Scale (WAIS), Trail Making Test (TMT) Part A and B, the Wisconsin Card Sorting Test (WCST), and the Wechsler Memory Scale (WMS). RESULTS: There was a statistically significant difference between case and control groups regarding risk of violence where 58% of the case group were found to have risk of violence compared to only 18% in the control group. There was a significant correlation between this risk of violence and period of untreated psychosis, no of episodes, and history of substance use; also was significantly correlated with PANSS and Wisconsin card sorting test subscales. Regarding logistic regression analysis for factors affecting violence risk; total PANSS score and history of substance use were significant independent factors that increase violence risk. CONCLUSION: Violence risk in patient with schizophrenia is a cardinal factor that may affect life of the patients, their family, and society; this risk can be affected by different factors including severity of symptoms, no of episodes, history of substance use, and cognitive function of the patients.

International Alliance of Urolithiasis Guideline on Shockwave Lithotripsy.

Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL.

Contemporary Evidence of CAD-CAM in Dentistry: A Systematic Review.

In this systematic review, we compare the quality and accuracy of computer-aided design (CAD)/computer-aided manufacturing (CAM) techniques currently employed in dentistry with those of traditional materials. Published literature on the study topic was searched in the online MEDLINE, PsycINFO, PubMed, and Cochrane library databases and the database of Indian Council of Medical Research. For this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was applied for the assessment of studies fit for investigation. Of the total 103 papers searched, 54 underwent in-depth evaluation. Using criteria for what to include and what to leave out, we chose research that was relevant to our review and narrowed it down to 14 papers that met the review's guidelines. According to our findings and the analysis of the chosen articles, the prospects and current advances of CAD/CAM technology are fascinating and are revolutionizing the field of dentistry. Even though researchers are excited, it is important to make sure that different materials have been tested and looked at well enough before making firm claims and choices to replace materials that have been made in the past. Based on previous research, it has been determined that the CAD/CAM methodology used in the dental field is the most popular method at the moment since it is quick, simple, and efficient. Since there are different kinds of CAD/CAM systems, it is very important to choose the right one and come up with a good plan for treating a patient.

Resilient Stud Versus Bar Attachments for Inclined Implants Supporting Mandibular Overdentures. An In Vitro Study of Loading and Dislodging Strains.

PURPOSE: To evaluate strain around resilient stud and bar attachments for inclined implants supporting mandibular overdentures during loading and dislodging. MATERIALS AND METHODS: A mandibular edentulous model was printed using the laser sintering technique. Two vertical implants and two 30-degree distally inclined implants were placed in canine and premolar areas, respectively. Overdentures were attached to the implants with either a resilient stud (Locator, group 1) or a bar/clip (group 2) attachment. Three strain gauges were mounted at the buccal, lingual, and proximal surfaces of each implant. Microstrains were registered during vertical loading and dislodging force applications and compared between attachments (resilient stud and bar) and implant positions (vertical and inclined). RESULTS: For canine implants, bar overdentures recorded significantly higher microstrains than Locator overdentures during vertical loading. For premolar (inclined) implants, Locator overdentures recorded significantly higher microstrains than bar overdentures during vertical dislodging. For both groups (during loading) and the bar overdenture group (during dislodging), canine (vertical) implants showed significantly higher microstrains than premolar (inclined) implants. CONCLUSION: Within the limitations of this in vitro study, canine (vertical) implants may be at risk of increased stresses during loading if bar attachments are used for vertical and inclined implants supporting mandibular overdentures, and premolar (inclined) implants may be at risk of increased stresses during dislodging if Locator attachments are used. For both attachments, canine implants showed significantly higher microstrains than premolar implants during loading and dislodging.

Depression in Public Servants of Upper Egypt: Gender-specific Prevalence and Determining Factors.

Mental health disorders, including depression, cause more than half of worldwide disabilities. We aimed to estimate the prevalence of depression and determine its associated factors among Egyptian public servants. We collected data from 3134 subjects (1619 females and 1515 males) via a self-administered questionnaire, including the Center of Epidemiological Studies-Depression (CES-D) scale, medical history, sociodemographic, familial, occupational, and behavioral characteristics of the recruited Egyptian Public servants. We used logistic and linear regression models to assess the determinants of depression. The prevalence of depression was 43.5% (52.9% in females and 33.4% in males) among public servants. The past history of depression was a significant determining factor of depression; adjusted odds ratio (aOR): 95% confidence interval (CI) was 2.58 (1.87, 3.57) in females and 3.28 (2.20, 4.87) in males. Other determinants were daily working hours: aOR = 1.11 (1.02, 1.19) and high job demands: aOR = 2.19 (1.40-3.41) in males, and the high job control in females: aOR = 0.51 (0.36, 0.73). With the past history of depression, job demands, job control, family structure, education level, and working status of the spouse predicted 41% of the total variance in the CES-D score in females; R2 = 0.41; whereas job demands, family structure, job hours per day predicted 40% of in males; R2 = 0.40. In conclusion, the determinants of depression varied by gender. Governmental interventions aiming to improve the work environment (job demands, control, and working hours) and individual responsibilities to improve the living arrangement and education level could help to curb the emerging risk of depression.

Comparative study between skin micrografting (Meek technique) and meshed skin grafts in paediatric burns.

BACKGROUND: Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique. PATIENTS AND METHODS: A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively. RESULTS: The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001). CONCLUSION: The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.

Implications of an Anatomical Variation of the Infraorbital Nerve in Orbital Floor Reconstruction.

ABSTRACT: Fractures involving the orbital floor such as blow-out fractures may cause damage to the infraorbital nerve (ION). The integrity and course of the nerve should be evaluated preoperatively in order to prevent from such nerve injuries. The anatomy of the ION can show variations in significant number of patients, which should be taken into account in treatment planning. In this report, the authors present a patient with an isolated fracture of the orbital floor, who had abnormal anatomy of his both IONs. Our treatment approach for this patient is presented along with relevant literature findings.

Effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets to CAD/CAM provisional materials.

OBJECTIVES: To evaluate the effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets bonded to materials used for the fabrication of CAD/CAM provisional crowns. MATERIALS AND METHODS: Specimens (n = 160) from each provisional material (CAD-Temp and C-Temp) were categorized into four groups according to the surface treatment methods: C (no surface treatment), HP (37% H3PO4), DB (mechanical roughening by diamond bur), and SB (mechanical roughening by blasting). Maxillary central incisor ceramic brackets (Clarity™ Advanced ceramic brackets, 3 M Unitek) were bonded to the conditioned provisional materials according to the used adhesive system (n = 20), APC PLUS or APC flash-free. All specimens were evaluated for shear bond strength testing (SBS) and the adhesive remnant index (ARI). Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: C-Temp significantly recorded higher SBS than CAD-Temp (24.0 and 16.0 MPa, respectively) (p < 0.001). DB and SB groups utilizing flash-free adhesive significantly recorded higher SBS (18.2 and 24.0 MPa, respectively) (P < 0.05) compared to other groups in the tested materials. Higher ARI scores were recorded in CAD-Temp and flash-free adhesive. CONCLUSIONS: Mechanical surface treatments and flash-free adhesive would enhance SBS of ceramic orthodontic brackets to CAD/CAM provisional materials. The higher ARI scores reported with CAD-Temp and flash-free adhesive reduce chair time for excess removal. CLINICAL RELEVANCE: Bonding of orthodontic brackets to provisional restorations is a challenge for orthodontists in adult comprehensive cases that could be improved by an appropriate provisional material, surface treatments, and adhesive system.

The effect of surgical technique, age, and Trisomy 21 on early outcome of surgical management of complete atrioventricular canal defect.

BACKGROUND: The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes. METHODS: A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation. RESULTS: No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively. CONCLUSIONS: Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.