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Abstract Prostatic abscess (PA) is an uncommon disorder that mainly affects diabetic and immunocompromised patients. It requires a high index of suspicion for diagnosis since it can clinically mimic acute prostatitis. Historically, transurethral drainage along with antimicrobial therapy has been the gold standard therapy. However, advances in imaging modalities have shifted the management of PA to less invasive approaches. Here, we present a case of a large PA drained by the percutaneous transgluteal approach. This access route is a safe, effective, and well tolerated alternative for PA drainage, done under local anesthesia and providing a relatively cleaner approach than transrectal or transperineal drainage, allowing easier and better catheter fixation as well. This article illustrates the different steps of the procedure and reviews the literature on PA management.

The cost of healthcare is a burden in most developing countries, and this is exponentially increasing in the context of population growth, pandemics, and rapidly evolving medical necessities. A customized healthcare typology should rely on data collection and architectural requirements, before moving to aesthetically compelling designs, so hospitals in low-resource or developing countries will not mimic their Western counterparts. The greatest bearing that improves the patient’s outcome and well-being would engage a productive interaction between the hospital designers and the medical practitioners, this will also allow for evidence-based hospital planning. As the author of this short report, I use the best of my experience as a physician and healthcare planner to translate a successful interaction with multinational designers building hospitals in Rivers State, Nigeria.

Abstract Objectives To examine ridge dimensional changes and histologic parameters of healing when ridge preservation (RP) was performed at molar sites using dense polytetrafluoroethylene (dPTFE) membrane alone, without a bone graft. Material and Methods Eighteen patients had molar extraction and RP using dPTFE membrane alone. Ridge dimensions were measured using two standardized cone beam computerized tomography (CBCT) scans taken within 72 h and 3 months following extraction. Following a 3‐month healing period, an implant osteotomy was prepared using a trephine drill and bone cores were collected for histological analysis. Four‐arm analyses were performed using data from three previously published study arms of the same research group. Results There was a significant change in the buccal ridge height between the four groups at all aspects of the socket. Alveolar ridge width reduction at 3 mm from crest for all aspects (mesial, midpoint, distal) of the socket showed statistically significant difference for dPTFE alone group compared to the other three groups. Percentage of vital bone formation (62.10%) was significantly greater in dPTFE alone group compared to the other groups. Conclusions RP using dPTFE membrane alone in molar sites with intact socket walls showed successful outcomes in maintaining ridge dimensions and in histologic wound healing.

Introduction: This review revisits clinical use of antibiotics for most common acute oro-dental conditions; we aim to provide evidence governing antibiotics use when access to oral healthcare is not available, as during the ongoing outbreak of the severe acute respiratory syndrome coronavirus 2. Materials and methods: In this rapid review, articles were retrieved after conducting a search on PubMed and Google Scholar. Relevant publications were selected and analyzed. Most recent systematic reviews with/without meta-analyses and societal guidelines were selected. Data were extracted, grouped, and synthesized according to the respective subtopic analysis. Results and discussion: There was evidence supporting the use of antibiotics in common oro-dental conditions as temporary measure when immediate care is not accessible, such as in case of localized oral swellings as well as to prevent post-extraction complications. No sufficient evidence could be found in support of antibiotic use for pain resulting from pulpal origin. Conclusion: Antibiotic use may be justified to defer treatment temporarily or reduce risk of complications in case of localized infection and tooth extraction, when no access to immediate dental care is possible. Graphical abstract:

Abstract Background Dentists are at high risk of exposure to occupational Coronavirus Disease 2019 (COVID-19). Since vaccination is crucial to control COVID-19 pandemic, we aimed to assess COVID-19 vaccination acceptance and its determinants among Lebanese practicing dentists. Methods A cross-sectional online study was conducted between February 15 and 22, 2021, among dentists practicing in Lebanon. Prevalence of COVID-19 vaccine acceptance was estimated. A multivariable modified Poisson regression model was used to explore determinants of COVID-19 vaccine acceptance. Results In total, 86% of participants were willing to receive or have already received a COVID-19 vaccine. Having received the influenza vaccine during the COVID-19 pandemic was linked to a 12% increase in the COVID-19 vaccination acceptance rate. In addition, participants having moderate and high COVID-19 vaccination knowledge levels were more likely to accept receiving the vaccine, and participants whose fear of COVID-19 level was high were more likely to accept receiving the vaccine compared to those having a low fear level. Contrarily, those who visit the medical doctor only when needed and once a year were less likely to accept COVID-19 vaccine compared to participants who routinely visit the medical doctor. Conclusions Our study showed a high level of acceptance of COVID-19 vaccination among Lebanese practicing dentists. And since knowledge about COVID-19 vaccination was associated with the vaccine acceptance, it should be improved and updated to further increase the acceptance rate. High acceptability of COVID-19 vaccination among dentists is expected to have a positive impact among the population in terms of increasing awareness and vaccine uptake.

The article is aimed at studying the theoretical bases and practical aspects of organization of the staff motivation system in the network of grocery stores «ATB-market». It is defined that in order to improve the system of motivation of the «ATB-market» staff it is necessary to combine the theoretical provisions of substantive and procedural theories of motivation. The substantive theories of motivation are based on human needs, that is, a feeling of lack of what is difficult for a person to live without, or through which a person feels a certain discomfort. The procedural motivational theories analyze how a person distributes its efforts to carry out different tasks and chooses a particular type of behavior. Two research methods were chosen: interviews and questionnaires, which were to provide the most effective information during the study. The purposes of interviewing and questionnairing is to understand the motivation of workers in the food trade; identify strategic ideas to motivate workers; understanding which remuneration systems should be prevalent. It is defined that the high motivation and comprehensive professional development of the staff of the «ATB-market» grocery stores chain is a huge asset. The main factors that attract and support an employee in the organization include: regular pay increases; availability of a commission; recognition from the leadership; contact with experienced managers; good sociability among the staff; high prospects for promotion through the ranks. Analysis of the carried out interviews and questionnaires allows to conclude that the basic needs of a lower level need to be met before one moves on to meeting the higher-level growth needs.

The western conifer seed bug, Leptoglossus occidentalis, is an alien invasive species of North American origin. Leptoglossus occidentalis was recorded for the first time in Arsoun-Metn, Lebanon in 2015. Adults and nymphs of L. occidentalis were collected by the authors from various locations in Lebanon and observed on two species of pine, Pinus pinea and Pinus brutia, on Juniperus excelsa and even on Cedrus libani. This could indicate its successful integration in the country and its presence on many coniferous tree species. Studies to investigate the behaviour and the economic impact of this alien insect species in Lebanon are recommended.

Limited maxillary defects are commonly grafted with bone blocks harvested from the symphysis or the ramus; harvesting a second surgical site in the mandible increases both operative time and patient’s postoperative morbidity. To overcome these disadvantages, the zygomatic buttress (ZB) was suggested as an alternative maxillary source of autogenous bone. This intraoral donor site has a natural convex shape and can be accessed along with the recipient site through the same flap design. We report a case series describing this uncommon technique of bone harvesting from the zygomatic buttress to reconstruct limited alveolar defects in the maxilla.

Bone augmentation techniques have increasingly been indicated for re-creating adequate bone height and volume suitable for dental implant sites. This is particularly applicable in the severely atrophic posterior maxilla where sinus perforation (ruptured Schneiderian membrane) is a very common complication and sinus floor elevation or lift is frequently considered a standard procedure. The augmentation of the maxillary sinus can be performed with or without grafting biomaterials. Herein, numerous biomaterials and bone substitutes have been proposed, primarily to sustain the lifted space. In addition, cytokines and growth factors have been used to stimulate angiogenesis, enhance bone formation as well as improve healing and recovery period, either as the sole filling material or in combination with bone substitute materials. Within such, is the family of autologous blood extracts, so-called platelet concentrates, which are simply the “product” resulting from the simple centrifugation of collected whole blood samples of the patient, immediately pre-surgery. Platelet-Rich Fibrin (PRF), a sub-family of platelet concentrates, is a three-dimensional (3-D) autogenous biomaterial obtained, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents during the centrifugation process. Today, it is safe to say that, in implant dentistry and oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-classes) are receiving the most attention, essentially due to their simplicity, rapidness, user-friendliness/malleability, and cost-effectiveness. Whether used as the sole “bioactive” filling/additive material or combined with bone substitutes, the revolutionary second-generation PRFs have been very often associated with promising clinical results. Hence, this review aims to provide a 10-years update on the clinical effectiveness of L-PRF when applied/used as the “sole” biomaterial in maxillary sinus augmentation procedures. An electronic search using specific keywords for L-PRF and maxillary sinus augmentation was conducted in three main databases (PubMed-MEDLINE database, Google Scholar and Cochrane library) for the period between January 2009–February 2020. The quest yielded a total of 468 articles. Based on the pre-established strict inclusion/exclusion criteria, only seven articles were deemed eligible and included in the analysis. Surprisingly, of the 5 studies which used de-proteinized bovine bone mineral (DBBM) in combination with L-PRF, 60% acclaimed no significant effects and only 40% declared positive effects. Of the two articles which had used allogenous bone graft, 50% declared no significant effects and 50% acclaimed positive effects. Only one study had used L-PRF as the sole grafting material and reported a positive effect. Likewise, positive effects were reported in one other study using L-PRF in combination with a collagen membrane. Due to the heterogeneity of the included studies, this review is limited by the inability to perform a proper systematic meta-analysis. Overall, most of the published studies reported impressive results of L-PRF application as a grafting material (sole or adjuvant) in maxillary sinus augmentation and dental implant restorative procedures. Yet, distinct technical processing for L-PRF preparation was noted. Hence, studies should be approached with caution. Here in, in sinus lift and treatment of Schneider membrane, the formation of mature bone remains inconclusive. More studies are eagerly awaited in order to prove the beneficial or detrimental effects of PRFs, in general and L-PRFs, in specific; especially in their tissue regenerative potential pertaining to the promotion of angiogenesis, enhancing of cell proliferation, stimulation of cell migration and autocrine/paracrine secretion of growth factors, as well as to reach a consensus or a conclusive and distinct determination of the effect of leukocytes (and their inclusion) on inflammation or edema and pain; a call for standardization in PRFs and L-PRFs composition reporting and regimenting the preparation protocols.

Abstract Background Metabolic alkalosis is common in patients with respiratory failure and may delay weaning in mechanically ventilated patients. Carbonic anhydrase inhibitors block renal bicarbonate reabsorption, and thus reverse metabolic alkalosis. The objective of this systematic review is to assess the benefits and harms of carbonic anhydrase inhibitor therapy in patients with respiratory failure and metabolic alkalosis. Methods We searched the following electronic sources from inception to August 2017: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and SCOPUS. Randomized clinical trials were included if they assessed at least one of the following outcomes: mortality, duration of hospital stay, duration of mechanical ventilation, adverse events, and blood gas parameters. Teams of two review authors worked in an independent and duplicate manner to select eligible trials, extract data, and assess risk of bias of the included trials. We used meta-analysis to synthesize statistical data and then assessed the certainty of evidence using the GRADE methodology. Results Six eligible studies were identified with a total of 564 participants. The synthesized data did not exclude a reduction or an increase in mortality (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.57 to 1.56) or in duration of hospital stay (mean difference (MD) 0.42 days, 95% CI −4.82 to 5.66) with the use of carbonic anhydrase inhibitors. Carbonic anhydrase inhibitor therapy resulted in a decrease in the duration of mechanical ventilation of 27 h (95% CI −50 to −4). Also, it resulted in an increase in PaO2 (MD 11.37 mmHg, 95% CI 4.18 to 18.56) and a decrease in PaCO2 (MD −4.98 mmHg, 95% CI −9.66, −0.3), serum bicarbonate (MD −5.03 meq/L, 95% CI −6.52 to −3.54), and pH (MD −0.04, 95% CI −0.07 to −0.01). There was an increased risk of adverse events in the carbonic anhydrase inhibitor group (RR 1.71, 95% CI 0.98 to 2.99). Certainty of evidence was judged to be low for most outcomes. Conclusion In patients with respiratory failure and metabolic alkalosis, carbonic anhydrase inhibitor therapy may have favorable effects on blood gas parameters. In mechanically ventilated patients, carbonic anhydrase inhibitor therapy may decrease the duration of mechanical ventilation. A major limitation of this finding was that only two trials assessed this clinically important outcome.

Emphysematous pyelonephritis (EPN) is a gas-producing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. It is a life-threatening condition that requires a high index of suspicion, an early diagnosis and an aggressive treatment. Rapid progression to septic shock may occur. We report, to the best of our knowledge, the first case of obstructive EPN caused by a giant fecaloma. The patient was successfully treated with percutaneous drainage and broad-spectrum antibiotics, in addition to fecaloma evacuation using fleet enemas and oral laxatives. This shows how fecal impaction, a common pathology in routine clinical practice, can cause some serious complications if left untreated, including extrinsic ureteral compression.

The cedar forests of Lebanon have been threatened by the outbreak caused by climate change of a web-spinning sawfly, Cephalcia tannourinensis (Hymenoptera: Pamphiliidae), which negatively impacted the survival of one of the oldest tree species on earth. In this study, we investigated the occurrence of naturally soil-inhabiting entomopathogenic fungi for their role in containing the massive outbreak of this insect. We used a combination of fungal bioexploration methods, including insect bait and selective media. Morphological features and multilocus phylogeny—based on Sanger sequencing of the transcripts encoding the translation elongation factor 1-alpha (TEF-α), RNA polymerase II second largest subunit (RBP2), and the nuclear intergenic region (Bloc) were used for species identification. The occurrence rate of entomopathogenic fungi (EPF) varied with location, soil structure, forest structure, and isolation method. From 15 soil samples positive for fungal occurrence, a total of 249 isolates was obtained from all locations using different isolation methods. The phylogenetic analysis confirmed the existence of two novel indigenous species: Beauveria tannourinensis sp. nov. and Beauveria ehdenensis sp. nov. In conclusion, the present survey was successful (1) in optimizing the isolation methods for EPF, (2) investigating the natural occurrence of Beauveria spp. in outbreak areas of C. tannourinensis, and (3) in characterizing the presence of new Beauveria species in Lebanese cedar forest soil.

Aim. This paper revisits Papillon-Lefèvre syndrome (PLS), addresses its diagnostic update and dental management, and reports a case of a 5-year-old Lebanese patient with consanguineously married parents. Background. PLS, also known as “keratoris palmoplantaris with periodontopathia” and “hyperkeratosis palmoplantaris with periodontosis,” is an extremely rare autosomal-recessive trait that combines a diffuse palmoplantar hyperkeratosis and a severe generalized, progressive prepubertal form of a precocious form of juvenile, aggressive periodontitis. Case Description. We are reporting a 5-year-old boy that sustained a spontaneous loss of all his primary teeth. At consultation, he was under treatment for hyperkeratosis of his palms and soles. Detailed family history of the child revealed that the patient’s parents, grandparents, and relatives were consanguineously married and two of his cousins displayed similar clinical signs (palmoplantar hyperkeratosis and premature loss of deciduous and most of the permanent teeth). Conclusion. PLS is an extremely rare disorder that usually becomes apparent from approximately 1-5 years of age. Genetic counseling should always be suggested to parents of affected children, informing them of chances of their offspring having the inherited disease.

Odontogenic cysts are usually treated by enucleation (cystectomy). Limited cysts (less than 5 cm) are usually managed by primary excision (total cystectomy), whereas larger ones (exceeding 5 cm) are often decompressed or marsupialized. Because it consists only of opening a much smaller surgical window, decompression is regarded as a more conservative method of treatment: this method associates the creation of an opening (window) into the cystic cavity with the suturing of a decompressing device (plastic tube or stent) at the periphery of the cyst. Apart from releasing intraluminal pressure in the pathological cavity, this procedure helps the lesion to progressively decrease in volume “with a gradual increase in bone apposition” and preserves pulp vitality and periodontal integrity of the adjacent teeth. We are reporting a case of a mandibular radicular cyst that was treated by decompression, followed by enucleation, bone reconstruction, and restoration with two osseointegrated dental implants. The cystic cavity progressively decreased in volume and increased in bone density.

Introduction: Environmental factors, including ambient light, play an important role in caries detection. Dental private practices and dental school clinics are exposed to extraneous light from fluorescent fixtures, operative unit lights and/or windows. In previous studies, visual fatigue and impaired diagnostic accuracy are found to be associated with the viewing conditions. Aim: The study aims to evaluate and compare dental students’ performance at detecting proximal caries on intraoral digital radiographs, under different ambient light conditions. Materials and Methods: Eight randomly chosen senior dental students and a dentist evaluated intraoral digital images of 32 extracted teeth mounted in 12 quadrants. Almost half of the teeth were carious as confirmed by histology. The illuminance measuring unit (Lux) was used to measure the light conditions at luminous flux per unit area. Raters viewed the images in ambient light conditions i.e., dim light settings (Less than 50 Lux) and in bright light settings (more than 800 Lux). Images were viewed with the same calibrated monitor. All other viewing conditions were controlled. Raters stated their certainty of caries presence on a 5-point scale. Sensitivity, specificity and Receiver Operating Characteristic (ROC) curve was calculated for all observations and for both light settings. Results: Raters performed at a higher specificity under dim light conditions (p

Objectives: Artifacts due to the Gutta-percha may result in an incorrect diagnosis when using cone-beam computed tomography (CBCT) only. Compare CBCT scans with photostimulable phosphor (PSP) plates using one angulation and PSP plates using two different angulations in detecting root fractures (RFs) in endodontically treated teeth. Materials and Methods: Sixty-six roots were collected and treated endodontically using gutta-percha. One-half of the roots were randomly selected and fractured. 8 cm × 8 cm fields of view (FOV) were acquired with a CBCT machine. Periapical radiographs (using intra-oral PSP plates) were also acquired using one and two angulations. Results: The area under the receiver operating characteristic curve and sensitivity were significantly greater using CBCT than using one or two PSP plate angulations. There were no significant differences between one or two PSP plate angulations. Conclusion: The accuracy of RF depiction in endodontically treated teeth using 8 cm × 8 cm FOV CBCT was greater than that obtained using one or two PSP plate angulations.

Introduction: Detection of root fracture is challenging both clinically and radiographically. Root fractures occur in different planes with unpredictable presentations. Aim: The aim of the study was to evaluate the diagnostic accuracy of selected digital image enhancement tools in the detection of horizontal Root Fracture (RF). Materials and Methods: Fifty three roots, of single and multirooted teeth, in eight dentate human cadaver mandibles were selected for this study. Following minimally traumatic extraction of the teeth, horizontal fractures were induced in 23 roots and remounted in the empty sockets of their respective human dry mandibles. The remaining teeth with no fractures were used as the control group. Twenty two periapical radiographs were obtained by using the paralleling technique and using Complementary Metal Oxide Semiconductor (CMOS). Image J software was used to enhance the original images with the Inversion (IN), Histogram-Equalization (EQ) and Polynomial (Poly) tools. A total of 88 periapical images (original and three enhanced images) were reviewed independently by three Oral and Maxillofacial Radiologists and two Endodontists. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the accuracy of fracture detection and the kappa statistic was used to assess agreement among reviewers. Results: The diagnostic accuracy for one of the observers was significantly different in detection of RF with only EQ enhancement tool. Sensitivity and specificity were not significantly different. Interobserver agreement showed no significant difference between imaging methods. Intra-observer agreement was high to moderate. Conclusion: There was no significant difference between the different imaging modalities. No statistical difference for the agreement was found among or between the endodontists and radiologists in this study.

A case report of a 45-year-old male who presented with a deep defect in the alveolar crest at the buccal side of the upper right 1 st molar strongly suggesting a perforation of the floor of the maxillary sinus and an oro-antral communication. Clinical signs and symptoms supported this diagnosis. After radiographic evaluation with Cone Beam Computed Tomography (CBCT), the diagnosis was shifting away from oro-antral communication. The diagnosis of a residual cyst was established after surgical exploration and removal, and histopathologic evaluation. The maxillary sinus membrane was intact.

Purpose: This in vitro study assessed the artifact production related to titanium and zirconia implants in cone beam computed tomography (CBCT) and compared the effect of different protocol settings on image quality for both materials. Materials and Methods: A titanium implant and a zirconia implant were placed in a dry mandible. CBCT scans were obtained separately for each implant using the ProMax 3D (Planmeca) unit; 20 protocols were tested with varying kilovoltage (70 to 90 kVp) and resolution (high and low), and with and without a metal artifact reduction tool. Standard deviation and contrast-noise ratio were calculated in regions of interest adjacent and distant to the implant. Results: The zirconia produced more artifacts and its images were more affected by the different protocols than titanium. High kVps and an activated metal artifact reduction tool decreased the standard deviation values related to both implants. Activation of the metal artifact reduction tool also increased contrast-noise ratio values for both implants, whereas increasing kVp improved them only on titanium images. The standard deviation and contrast-noise ratio were not affected by resolution. Conclusion: The zirconia implant generated more image artifacts than the titanium implant. Increasing kVp and the metal artifact reduction tool are efficient in decreasing the CBCT artifacts for both implants, whereas resolution does not affect their production. [ABSTRACT FROM AUTHOR]

Purpose: Ridge preservation limits dimensional changes after tooth extraction. However, it is still unclear if using a membrane may be advantageous over a collagen wound dressing. Therefore, the goal of this report was to evaluate the outcomes of ridge preservation using freeze-dried bone allograft with a collagen wound dressing. Materials and Methods: This study included 21 patients who had one molar extracted, and the site received ridge preservation using freeze-dried bone allograft and a collagen wound dressing (test 2 group). Patients had two standardized cone beam computed tomography (CBCT) scans, taken within 72 hours and 3 months after extraction, to measure changes in ridge height and width, and buccal and lingual plate thicknesses. Changes in keratinized tissue width were recorded. Three-arm analyses were performed using historic data from a previous randomized controlled trial by the same study group, in which 20 molar sites received a collagen wound dressing alone (control) and 20 received ridge preservation with freezedried bone allograft and a dense polytetrafluoroethylene membrane (test 1) using the same methodology. Results: There was a statistically significant difference in mean buccal ridge height changes between the control group (2.6 ± 2.06 mm) and test 2 group (1.55 ± 0.93 mm) but no difference in ridge and keratinized tissue width changes between groups. No correlation was found between buccal plate thickness and ridge width change. Conclusion: Freeze-dried bone allograft with collagen wound dressing as a barrier was used successfully for ridge preservation in intact molar extraction sites (< 50% bone loss) and can be considered as a treatment alternative to freeze-dried bone allograft with a dense polytetrafluoroethylene membrane. [ABSTRACT FROM AUTHOR]