Acute appendicitis secondary to Entamoeba histolytica infestation.

Acute appendicitis secondary to amoebic infestation is a rare possibility, especially in endemic areas. If left untreated, significant postoperative morbidity and mortality can result from the spread of amoebic trophozoites and subsequent tissue reaction. Histopathological examination of the resected appendix with demonstration of invasion by the parasite is mandatory for establishing a diagnosis. Careful examination of the specimen is thus of paramount importance.

Acute Hospital Outcomes for Renal Transplantation in Patients With Moderate or Severe Congenital Heart Disease.

Children and adults with congenital heart disease (CHD) are increasingly recognized to be at risk for acute and chronic renal injury. Some of these may progress to the need for renal transplantation. We hypothesized that patients with underlying moderate or severe CHD who undergo renal transplantation will have worse acute hospital outcomes. Using a national administrative database, we queried for admissions aged 0 to 50 years with moderate or severe CHD and renal transplantation and compared these to admissions without CHD. There were 56 admissions for renal transplantation in the CHD group (0.04%) and 26,285 admissions in the group without CHD (0.21%, p<0.001). The CHD group were younger, had a higher proportion of Whites, longer length of stay, higher complication rates, higher in-hospital mortality, and higher costs. In conclusion, although renal transplantation is still relatively uncommon in the CHD population, there is an increasing recognition of severe chronic renal disease in the setting of CHD, making it important to understand the potential implications of these findings.

The soft tissue esthetic outcome with and without immediate provisionalization in immediate implants: A systematic review and meta-analysis.

Aim: This systematic review and meta-analysis aimed at checking influences of immediate provisionalization on the primary esthetic outcome by Pink Esthetic Score (PES) as well as other secondary soft tissue outcomes such as bleeding on probing, probing depth, plaque index, mesial papillary recession, distal papillary recession, and midfacial mucosal recession of the peri-implant mucosa around immediately placed implants in the anterior maxilla. Setting and Design: This systematic review and meta-analysis was evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Materials and Methods: The relevant studies were found in the databases such as MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, Science Direct, and Google Scholar. The search was restricted to studies published in English only, with no time constraints. A second hand search was conducted on individual journals and study reference lists. The Evidence Project risk-of-bias tool was used to assess the risk of bias in included studies. The level of evidence was determined using the GRADEpro GDT: GRADEpro Guideline Development Tool (software). McMaster University, 2020 (developed by Evidence Prime, Inc.,). Statistical Analysis Used: The statistical meta-analysis was conducted by using Review Manager (RevMan) (Computer Program). Version 5.4. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2020. Results: Nine studies were finalized. Seven studies were selected out of nine in the meta-analysis for PES. The results of the current meta-analysis for primary outcome observed that immediate implant placement (IIP) followed by immediate provisionalization improves the esthetic outcome, with forest plot favoring immediate provisionalization and demonstrating a statistically significant difference (mean difference [MD] =1.54, [95% confidence interval (CI): 0.82-2.27], P < 0.0001). Statistically insignificant result was observed for secondary outcomes; bleeding on probing (MD = 4.00, [95% CI: -1.15-9.15], P = 0.13), probing depth (MD = 0.17, [95% CI: -0.13-0.48], P = 0.26), plaque index (MD = -1.00, [95% CI: -7.56-5.56], P = 0.77), mesial papillary recession (MD = -0.10, [95% CI: -0.31-0.10], P = 0.33), midfacial mucosal recession (MD = -0.47, [95% CI: -1.01-0.07], P = 0.09). However, for distal papillary recession (MD = -0.32, [95% CI: -0.50--0.13], P = 0.0007), the result was statistically significant with forest plot favoring immediate provisionalization. Conclusion: When the implant is placed in the esthetic zone, IIP with immediate provisionalization provides the best gingival (pink) esthetics.

Total Autologous Fascia Lata Sacrocolpopexy for Treatment of Pelvic Organ Prolapse: Experience in Thirty-Four Patients.

OBJECTIVE: To develop a technique for open/robotic sacrocolpopexy using autologous fascia lata autograft. We report our experience in our first 34 patients. METHODS: The operation utilizes a 4-5-cm x 15-18-cm piece of fascia lata harvested through a 3-4-inch lateral upper thigh incision. The graft is configured into a traditional Y-shaped configuration using CV-2 Goretex sutures and is used to perform sacrocolpopexy. Patients were followed by history and physical, POP-Q scores, and symptoms related to thigh harvest including visual analog pain (VAP) scores. Treatment failure was defined as symptomatic pelvic organ prolapse (POP) involving apical descent. RESULTS: Autologous fascia lata sacrocolpopexy was performed on 34 patients with a mean age of 62. Mean follow-up was 13 months (range 2-42). Thirteen cases were open sacrocolpopexies, and 21 were robotic. Concurrent procedures included hysterectomy (9), vaginal mesh excision (7), bowel resection and rectopexy (5), and autologous sling (5). POP symptoms resolved in all 34 patients, and there were no treatment failures. The overwhelming majority of harvest site issues were minor and managed expectantly. Mean VAP score at the harvest site was 0.4 (range 0-3). Three patients developed non-bothersome thigh bulges. One patient developed a harvest site seroma. Twelve patients reported mild, non-bothersome harvest site paresthesias. No thromboembolic events occurred. CONCLUSION: Autologous fascia lata sacrocolpopexy is an efficacious treatment for patients who desire non-mesh POP repair. Most harvest site issues are minor and typically resolve with expectant management alone. Continued follow-up of this series is ongoing to determine long-term success of this operation.

Comparative evaluation of the remineralizing potential of different calcium and fluoride-based delivery systems on artificially demineralized enamel surface; an in vitro study.

Background: Enamel is the hardest and vastly mineralized structure of the human body. Inorganic salts make up the majority of it. Water and ions pass right through the enamel. The enamel undergoes demineralization and remineralization cycle throughout life. Recently, the interest in the development of calcium, phosphate, and fluoride remineralization technology has been increased leading to the development and reintroduction of various remineralizing agents such as fluoride, casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), nano-hydroxyapatite (nano-HA), xylitol, bioglass, Ozone, etc. Aim: The aim of this study is to evaluate and compare the potential remineralization of CPP-ACPF, calcium sucrose phosphate (CaSP), amine fluoride (AmF), and nano-HA. Settings and Design: The design of this research is experimental. This is an in vitro study. The research was carried out at the Dental Teaching Institute. This study involved human teeth. No demographic data were obtained. One hundred and twenty premolars were selected from the tooth bank of the Department of Oral and Maxillofacial Surgery. The teeth included in the study were noncarious, nonrestored, and nonfractured extracted teeth. Teeth excluded from the study were extracted teeth with any visible or detectable caries, white spot lesions, microcracks, attrition, abrasion, erosion, or abfraction. Materials and Methods: One hundred and twenty enamel samples were taken; they were divided into six groups (n = 20). The demineralization process was carried out on Groups II, III, IV, V, and VI. The remineralization process was carried out on Groups III, IV, V, and VI for 14 days using CASP, AmF, and nano-HA, respectively. No surface treatment was performed in Group I causing it a positive control group, whereas Group II was considered a negative control with only enamel surface demineralization and no remineralization. The microhardness of enamel was measured using Vickers microhardness testing machine after a 14-day remineralization regimen. Statistical Analysis: In the statistical analysis, one-way analysis of variance and post hoc Tukey's tests were performed. Results: The mean microhardness values in declining order: positive control > nano-HA > AmF > CaSP > CPP-ACPF > negative control. Conclusion: All remineralizing agents exhibited enhanced surface remineralization. Nano-HA showed the highest remineralization potential followed by AmF, CaSP, and CPPACPF.

Mandibular implant-supported overdenture: A systematic review and meta-analysis for optimum selection of attachment system.

Aim: This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system. Settings and Design: This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines. Materials and Methods: A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies. Statistical Analysis Used: The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020. Results: Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10). Conclusion: It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.

Clinical success between tilted and axial implants in edentulous maxilla: A systematic review and meta-analysis.

Aim: This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss. Setting and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). Materials and Methods: The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool. Statistical Analysis Used: Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software. Results: Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69). Conclusion: In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.

Endodontic management of maxillary second molar with two palatal roots: a report of two cases.

Endodontic treatment may sometimes fail because morphological features of the tooth adversely affect the treatment protocol. Maxillary second molars are recognized as usually having a single palatal root with a single palatal canal. The incidence of second palatal root in the maxillary second molar is very rare. Two cases are presented in this paper describing the endodontic management of a four-rooted maxillary second molar with two distinct palatal roots and canals and two distinct buccal roots and canals. Clinical examination and radiographs showed the presence of two palatal roots during the root canal procedure. The canals were biomechanically prepared with crown-down technique and obturated using lateral condensation technique with AH-Plus sealer.