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Objectives This study aimed to describe the incidence and spectrum of postoperative complications in infants who underwent their first cardiac surgery for the repair of congenital heart diseases. Methods This is a single-center retrospective study. Data of infants admitted to King Faisal Specialist Hospital & Research Center; Jeddah; Saudi Arabia, from January 2015 to December 2019 who underwent the first cardiac procedure for congenital heart disease at an age of less than 3 months, were analyzed. The primary outcome is the prevalence and spectrum of postoperative complications during hospitalization. Data were analyzed by using descriptive and analytical statistics using SAS software version 9.4. Results Data of 130 procedures were analyzed. The most frequent procedure performed was the Norwood procedure (31.5%), aortic coarctation repair (13.8%), arterial switch operation (13%), and Blalock-Taussig and central shunts (10%). The overall postprocedural complications were reported in 96 (73.8%) of the procedures. The most frequent complications were prolonged postoperative mechanical ventilation (27%), pleural effusion (21%), excessive bleeding (19%), cardiac arrest (18%), and systemic infections (18%). Conclusion Cardiac surgery for congenital heart disease in young infants has a substantial risk for postoperative complications. The high incidence of these complications in these cases makes necessary attention to prove the outcomes in the cardiac centers.

Occupational health and safety (OHS) is an essential area that is concerned with the protection, health, and safety plus the welfare of individuals involved in any kind of occupation. This study aimed at assessing the occupational health and safety awareness and practices among the healthcare workers in the pediatric hospital in Benghazi city, Libya. The study adopted descriptive survey research in the Benghazi pediatric hospital. The study randomly selected 246 healthcare workers and the response rate was 96%. A questionnaire was used as the main data collection instrument. The data were coded and analyzed using descriptive statistics; frequencies and percentages and inferential analysis of correlation. Around 50% of the participants reported a lower level of awareness regarding occupational health and safety (OHS). The study proposes that the ministry of health should conduct specialist training in occupational health and safety for their staff, they also should confirm provisions of this policy and technical guidelines apply to all health institutions and administrative units within the health sector. Further hospital risk management should put in place a regular monitoring team who will certify that workers notice in firm terms safety measures put in place to avoid any accidents/injuries. Lastly, the study recommends that further research on the factors determining the implementation of occupational health and safety awareness and practices at public health care facilities in Libya.&nbsp

Background: GIST is a common mesenchymal tumor of the Gastrointestinal Tract. The stomach is the most frequently affected site. In this study, we focus on the relation between tumor site and survival.Materials and methods: our retrospective study included 47 patients diagnosed with GIST at Sohag University Hospital, Sohag Cancer Center, and Sohag Health Insurance Hospitals during the period between 2012 -2017. The collected data were extracted from patient's files. Missed data in the files were obtained via phone communication with the patients or their relatives. Results: 47 cases with gastrointestinal tumors were selected. All tumors were stained positive for c-kit. 48.9% (23/47) of the tumors were located in the stomach, 40.4% (19/47) in the small intestine, and 10.6% (5/47) in the large intestine. The mean progression-free survival (PFS) was 20.75 months ranging between 7months and 39 months. On analyzing the impact of tumor site on PFS we found that There was a significant relationship between the gastric site of the tumor and improved PFS (log-rank P = 0.010). The mean overall survival (OS) was 35.26 months ranging between 1 month and 108 months, on analyzing the impact of tumor site on OS we found no relation. Conclusion: Gastric origin of GIST is associated with more benign behavior and improved PFS in comparison with the intestinal origin.Keywords: GIST, gastric GIST, survival.

Background: Telocytes (Tc) are newly discovered histological cells that are scattered within most of the tissues and organsincluding the musculoskeletal system. They are a peculiar type of interstitial cells with very long prolongations termedtelopodes (Tp). They have also been isolated and cultured from tissues in vitro.Some recent researches have been done handling the possible physiological function of these cells and the pathophysiologicalrole in some musculoskeletal diseases. In any case, future functional studies of telocytes in vivo will help to understand themechanism by which telocytes contribute to tissue homeostasis in health and disease.Aim: We are in need to highlight on these cells to widen the scope of research about the potential hidden roles of telocytes inthe pathogenesis of some rheumatic diseases.Conclusion: Hence this review focuses on the latest progresses regarding Tc in the pathogenesis and/or repair and regenerationof different tissues like skeletal muscle, synovium and peripheral nerves.

Pulmonary mucormycosis is a relatively rare pulmonary fungal disease, which is difficult to diagnose early and lacks effective treatment. It is seen in patients with hematological malignancies, diabetes mellitus, and immunocompromised states. The diagnosis depends primarily on the detection of fungi in lung tissue. Here, we present a case of a 52-year-old male who has type 2 diabetes mellitus and a past history of treated pulmonary tuberculosis. Clinical diagnosis is difficult in pulmonary mucormycosis, and early diagnosis is needed for this life-threatening infection. Histopathological examination of a resected cavity confirmed the diagnosis of pulmonary mucormycosis. This report highlights the difficulty of diagnosis and the importance of histological examination in detecting mucormycosis which will help for early management.

Potassium bromate (KBrO3) is a potent nephrotoxic agent that leads to a significant decrease in the activities of renal antioxidant capacity, antioxidant loss and restoration of the renal dysfunction. Several measurements are used to examine the kidney status, including the base width of the foot, the slit pore diameter, and the glomerular basement membrane thickness of the kidney. In this work, morphometric analysis based on image processing is carried out to assess the filtration barrier integrity parameters, which indicates the degree of recovery against the nephrotoxic effect of the KBrO3 on the renal cortex of adult male albino rat and assesses the capability of the renal cortex to recover after its cessation. The morphometric methods based proposed image analysis system enabled the identification of the renal status of different groups, namely the control, potassium bromate affected, and the recovered groups, according to the variation of the measured parameters is a powerful tool. The proposed image analysis system provided a radical geometric morphometrics, which includes morphological operations and structuring element processes in order to identify the glomerular filtration barrier and the feet for further measurements in each case study. The results established that the average lengths of the feet in the histological microscopic images are 465.2397 nm, 278.189 nm, and 393.2347 nm for the control, KBrO3 affected rats and the recovered rats; respectively.

Lower back pain (LBP) is recognized as a cause of morbidity in developed nations in different occupational situations. Health care workers (HCWs), in particular nurses, are especially vulnerable to LBP. About 60–80% of the general people suffer from LBP at some time during their lives. However, there is not enough care about workplace health and safety problems facing the health care workforce in developing nations, such as Libya. Thus, this study aimed to find out the status of low back pain and factors affecting pain among the nurses in Benghazi Medical Centre (BMC), Libya. Cross-sectional study was conducted on BMC in 2018. The data was collected by a self-administered questionnaire. Chi-square was used to determine the association between associated risk factors and LBP prevalence (p

That the main purpose of the training is to achieve the best numerical achievement for swimmer, and the 50 meters butterfly race considered one of important speed racing, which requires training for the development of both strokes length and stroke rate of arms, The arm rate is also an important indicator of both the tempo and timing of the butterfly swim. The very low stroke rate is a sign of slow movement of the arms and indicates that there is an instantaneous stopover during performance that effects on race time negatively Research aim. This research aims to improve the numerical level of 50 meters butterfly swim by using Tempo Trainer tool. Research hypotheses: 1- There are statistically significant differences between the pre and post measurements in the numerical level of 50 m butterfly swim for the benefit of post measurements.

Background Symplastic hemangioma is a benign superficial abnormal buildup of blood vessels, with morphological features which can mimic a pseudo malignancy. A few cases have been reported in the literature. We report here, a unique case of calvarial symplastic hemangioma, which is the first case in the calvarial region. Case presentation A 29-year-old male patient, with a left occipital calvarial mass since childhood, that gradually increased in size with age, was associated with recurrent epileptic fits controlled by Levetiracetam (Keppra), with no history of trauma. He presented to the emergency room with a recent headache, vomiting, frequent epileptic fits and a decrease in the level of consciousness 1 day prior to admission. A CT scan showed three diploic, expansile, variable sized lytic lesions with a sunburst appearance; two that were biparietal, and one that was left occipital, which were all suggestive of calvarial hemangiomas. However, the large intracranial soft tissue content, within the hemorrhage of the occipital lesion was concerning. The patient had refused surgery over the years; however, after the last severe presentation, he finally agreed to treatment. The two adjacent, left parietal and occipital lesions were treated satisfactorily using preoperative embolization, surgical resection, and cranioplasty. Histopathology revealed cavernous hemangiomas, in addition to symplastic hemangioma (pseudo malignancy features) on top at the occipital lesion. The right parietal lesion was not within the surgical field; therefore, it was left untouched for follow-up. Conclusions Histopathology and radiology examinations confirmed the diagnosis as symplastic hemangioma, on top of a pre-existing cavernous hemangioma. To the best of our knowledge, this is the first case of a calvarial symplastic hemangioma, which we report here.

Background: We investigated if staggering sugammadex would reduce postoperative complications(with special regards to cough), compared to single dose of sugammadex or standard neostigmine in patients undergoing thyroidectomy surgery.Methods: A 36 adult patients aged 21-60 years old, ASA I and II undergoing thyroidectomy surgery, were randomized into 3 groups; (S group) that received 2 mg/kg sugammadex as single bolus, (SS group) that received sugammadex 2 mg/kg in a staggered dose of 1 mg/kg prior to extubation and another 1 mg/kg immediately after extubation and (N group) that received 0.05 mg/kg neostigmine combined with 0.02 mg/kg atropine.Results: Cough was absent in (SS) group. The percent of cough was 33% in S group and about 67 % in N group.Patients of (SS) and (S) groups had significant shorter recovery time and extubation time. Patients of (N) group showed significant increase in HR and SBP at 5 min after reversal compared to both (SS) and (S) groups, but no significant difference in DBP between all groups. There was no significant difference between all groups regarding postoperative complications other than cough.Conclusion: Staggered sugammadex reduces significantly risks for cough on emergence when compared to 2mg single bolus sugammadex .In addition, staggered sugammadex-as well as bolus sugammadex-has better recovery and more stable hemodynamics when compared to neostigmine.Keywords: Sugammadex, Staggered, Reversal, Cough, Postoperative

Background : The use of continuous spinal anesthesia (CSA) has been slow because the high risk of post dural puncture headache (PDPH). However, recent researches suggest significant reduction in PDPH when intrathecal catheters are used. This study aimed to compare between (CSA) & continuous epidural anesthesia (CEA) in lower limb surgeries.Patients & Methods : A comparative randomized prospective clinical study to compare onset, effect & side effects between (CSA) & (CEA) in LL surgeries. 46 patients, 21 - 60 years of age who were scheduled for elective LL surgeries, expected to last from 2 - 6 hours, were included in this study & divided into two groups of 23 each. Group S (CSA) & Group E (CEA). All patients were assessed for : hemodynamics , technical implementation period , sensory & motor onset , quality of the block , technical problems , post operative visual analogue scale (VAS) & any complications.Results : Regarding sensory & motor onset time & technical implementation period all were shorter in group S than group E. There was no significant difference as regard hemodynamics, duration of sensory recession & number of top up doses in both groups. There were no neurological sequelae nor (PDPH) in any patient in both groups.Conclusion : (CSA) using a 20 G catheter is an easy technique, better onset & quality, ↓ risk of systemic toxicity & no ↑ risk of (PDPH) when compared to (CEA).Key Words : Continuous , Anesthesia , Spinal , Epidural.

Background: Accuracy of implant placement using computer designed surgical guides ascompared to conventional laboratory-processed guides has been investigated by many researchers.However there are no published articles on the effect of placing dental implants using computerdesignedguides on bone height changes around the implants as compared to those placed usingconventional guides.Purpose: The aim of this study was to compare between bone height changes around dentalimplants placed using stereolithographic surgical guides versus conventional guides in completelyedentulous patients rehabilitated with 2-implant supported mandibular overdentures opposed byconventional maxillary complete dentures.Methods: This parallel randomized controlled trial (RCT) included 14 participants (age rangingfrom 50-60) with a mean age of 56.7 years who were selected based on specific inclusion criteria.Conventional maxillary and mandibular compete dentures were constructed for all participants whowere then randomly divided into two equal groups (7 participants in each). All participants receivedtwo implants, 3.5 mm in width and 10 mm in length, in the mandibular inter-foraminal areas(canine region). However implants in Group I (Control) were placed using a conventional surgicalguide while implants in Group II (Experimental Group) were placed using a stereolithographicsurgical guide. After implants’ osseointegration, all participants received ball attachment- retainedmandibular overdentures. Bone height changes around the installed implants were evaluated withthe aid of cone beam computed tomography (CBCT) scans. Measurements were recorded threetimes at 0 months, 6 months and 12 months after overdenture insertion and the changes werecalculated and statistically analysed. Statistical significance was set at 5 %.Results: All participants attended all follow up visits with no drop outs. None of the implantswas lost presenting a 100% survival rate for both groups. After 6 months post-insertion, the meanbone loss was 0.32mm and 0.31mm for groups I and II respectively. After 12 months post- insertion,mean bone loss reached 0.61mm and 0.49mm for groups I and II respectively. There were nostatistically significant differences between the two groups at both (6 and 12 months) follow-upperiods.Conclusion: Bone height changes around implants placed with stereolithographic surgicalguides versus conventional guides were statistically insignificant with no relevant superiority ofone guide over the other. Both surgical guides provided clinically successful implant treatment witha 100% survival rate for both groups during the one-year follow-up period.

Background: Occlusal balance in complete dentures is usually achieved by eliminating occlusal discrepancies through selective grinding. The main challenge lies in the accurate detection of the premature contacts to be able to achieve true and proper occlusal balance. There are several ways to detect occlusal errors and premature contacts including the intra-oral clinical assessment methods and remounting procedures. Purpose: Dental literature lacks studies that objectively investigated the accuracy of occlusal adjustment after clinical remounting procedures as compared with that done only by intra-oral assessment using articulating paper. The aim of this study was to quantitatively and objectively assess the influence of clinical remounting on occlusion (OT) and disocclusion (DT) times, as objective indicators of occlusal balance, using computerized occlusal analysis. Methods: This clinical study included 20 completely edentulous patients, 11 males and 9 females (aged 51 to 64, with an average of 57.6 years). Two sets of conventional complete dentures were constructed for each patient with a total of 40 dentures. Occlusal adjustment of 20 denture sets was done based on intra-oral assessment using articulating paper (control group) while occlusal adjustment of the other 20 denture sets was done based on clinical remounting procedures (experimental group). Occlusal parameters including OT, DT during right excursion (DT-Right) and DT during left excursion (DT-Left) were recorded for each set of dentures. Paired t-test was used to statistically analyze and compare the OT, DT-Right and DT-Left values between the two denture groups. A probability value of less than 0.05 was considered statistically significant. Results: The mean recorded OT was 0.48 seconds in the intra-oral method (articulating paper) group and decreased to 0.32 seconds in the clinical remounting group. This decrease was statistically significant. The mean recorded DT was 0.6 and 0.62 seconds for DT-Right and DT-Left respectively in the intra-oral method group. However they decreased to 0.36 and 0.37 seconds in the clinical remounting group. Again this decrease was statistically significant for both right and left lateral excursions. Conclusion: Occlusal adjustment based on clinical remounting procedures is more accurate and achieves more occlusal balance, as represented by shorter occlusion and disocclusion times, when compared to the intra-oral adjustment method using an articulating paper.

Overcrowding in Emergency Department usually results in serious consequences such as delay in facilities, medical errors and medical complications as well. This occurs because delay in transfer of the patients from ED to inpatient departments. We conducted this study to know patients’ and their attendants preferences to stay in ED or to be shifted to in-patient units. Data was collected via Arabic translated questioner. A total of 316 applicants included in the study (after inclusion / exclusion criteria), 144 patients with 157 patient attendants. 75 (52.1%) were male, while 69 (47.9%) were females. The preferred area for boarding was ED curtained space for 77.8% of patients and 79% of patient watcher as compared to 11.8% patients and 15.3% attendants who accepted the admission to inpatient hallway (p- value 0.253). Regarding the comparison of boarding time (8 hours and 24 hours), 55.5% of patients preferred in ED with 8 hours scenario versus 29.9% who preferred inpatient hallway (p=0.0897). When 24 hours scenario was compared, it was found that 59% patients preferred ED while 49.7% preferred inpatient hallway (p= 0.252). Current study proves that collectively patients prefer to stay in ED (either curtained space or hallway); this is because the patients received quick facilities and attention from the staff. However, with 24 hours scenario, more patients now preferred to stay in in-patient hallway; this is because of delay in transfer of the patients from ED, and delay or lack in facilities which usually occur during overcrowding. We concluded that patient and their preferences differ in different settings. However, overcrowding in ED should be dealt seriously with transfer of patients to in-patient departments / wards as soon as possible to avoid medical errors and complications.

IntroductionNon-small-cell lung cancer (NSCLC) is a common fatal malignancy worldwide and has a high mortality rate and poor prognosis.AimThe aim was to study the potential prognostic role of markers of cancer stem cells in NSCLC.Materials and methodsThe associations between the expression of CD44

Background: Computer-aided design and computer-aided manufacturing (CAD/CAM) technology has expanded to embrace implant, maxillofacial and removable prosthodontics including the fabrication of complete dentures. However, despite that the implementation of computer-aided technology with edentulous patients seemed to improve and simplify complete denture treatment as it significantly reduced the number of patient visits, yet still a limited number of reports described its use for complete denture fabricationObjective: This literature review will cast light on digital technology and its implementation in complete denture prosthodontics including its advantages, limitations, techniques and will present the articles that reported or investigated this topic and their outcomes including clinical or patient-based outcomesMaterials and methods: An independent electronic search of the English language literature was conducted by 2 investigators (authors), in bibliographic database MEDLINE, EMBASE, the Cochrane Library and Google up to March 2017 using certain key words. The electronic search was conducted in 3 stages in a systematic order. Stage 1, involved acquiring a record of titles from the electronic databases, which was then independently analysed by each investigator to extract relevant titles based on the predetermined inclusion criteria. The investigators independently applied the exclusion criteria, and any inconsistency was resolved by discussion. In uncertainty situations, the disputed article was included in the second (abstract) stage for contemplation. Stage 2 involved screening the abstracts of all selected titles by both investigators separately. Once more, any disagreement between the investigators was discussed, and, in uncertain situations, the abstract was included in the third and last stage of full-text analysis. At stage 3, all full text articles that were included were studied by the two investigators. This was followed by applying the final exclusion criteria and reviewing the final list of articles thoroughly and in depth to extract all relevant qualitative and quantitative data. Results: The review included a total of 20 articles. 2 studies described techniques for digital arrangement of denture teeth, 13 studies described techniques for digital fabrication of digital complete dentures either using rapid prototyping technology or computerized numerical control milling. The other 5 articles were clinical studies that assessed the clinical and patient-based outcomes of digitally-fabricated dentures.Conclusions: Digitally fabricated dentures can be an effective and time-efficient option for completely edentulous patients with favourable clinical and patient-centered outcomes. They are preferred by clinicians and patients as they significantly reduced clinical time and number of appointments, improved retention as well as digital archivability and hence reproducibility. However, dental literature lacks short-term and long term prospective clinical studies in this field to be able to reach definitive conclusions.

Choroid plexus papilloma (CPP) is a rare benign tumor of the central nervous system that is usually confined to the cerebral ventricles. According to the World Health Organization, CPP corresponds to a grade I atypical CPP (a-CPP); however, it can become more aggressive and reach grade II, which can rarely undergo malignant transformation into a choroid plexus carcinoma (grade III). To the best of our knowledge, identification of these tumors mutations by next generation DNA sequencing (NGS) has not been yet reported. In the present study, NGS analysis of an a-CPP case was performed. Data were analyzed using Advaita Bioinformatics i-VariantGuide and Ion Reporter 5.6 programs. The results from NGS identified 12 novel missense mutations in the following genes: NOTCH1, ATM, STK36, MAGI1, DST, RECQL4, NUMA1, THBS1, MYH11, MALT1, SMARCA4 and CDH20. The PolyPhen score of six variants viz., DST, RECQL4, NUMA1, THBS1, MYHI1 and SMARCA4 were high, which suggested these variants represents pathogenic variants. Two novel insertions that caused frameshift were also found. Furthermore, two novel nonsense mutations and 14 novel intronic variants were identified in this tumor. The novel missense mutation detected in ATM gene was situated in c.5808A>T; p. (Leu1936Phe) in exon 39, and a known ATM mutation was in c.5948A>G; p. (Asn1983Ser). These novel mutations had not been reported in previous database. Subsequently, the quality statistics of these variants, including allele coverage, allele ratio, P-value, Phred quality score, sequencing coverage, PolyPhen score and alleles frequency was performed. For all variants, P-value was highly significant and the Phred quality score was high. In addition, the results from sequencing coverage demonstrated that 97.02% reads were on target and that 97.88% amplicons had at least 500 reads. These findings may serve at determining new strategies to distinguish the types of choroid plexus tumor, and at developing novel targeted therapies. Development of NGS technologies in the Kingdom of Saudi Arabia may be used in molecular pathology laboratories.

Beta-ketothiolase (BKT) deficiency is a disorder of ketone body metabolism and isoleucine catabolism. Patients with BKT deficiency have intermittent ketoacidosis attacks. In this report, we describe an unusual case that mimicked type 1 diabetes presentation. The patient is a 1-year-old boy who presented with clinical and biochemical evidence of diabetes ketoacidosis (DKA). After the resolution of DKA, he was commenced on subcutaneous insulin regimen. Insulin requirements decline over few weeks to 0.3 U/kg/day, and due to normalization of blood glucose coupled with frequent hypoglycemic episodes, insulin was stopped for few months. Later, he developed two additional DKA episodes with intermittent period of no insulin requirement. At 2 years of age, he presented with ketoacidosis and hypoglycemia. The unusual presentation of ketoacidosis accompanied with hypoglycemia prompted genetic testing. Genetic testing revealed a novel homozygous mutation in the ACAT1 gene. The patient was advised to avoid prolonged fasting and started on a low-protein diet. Since then, he had developed mild episodes of ketosis with illness required intravenous hydration. In conclusion, the pediatrician should maintain a high index of clinical suspicion when dealing with children presenting with unusual diabetic ketoacidosis. Delayed diagnosis of BKT, failure of management of acute crisis, and the unnecessary use of insulin can lead to high morbidity and mortality.

How to Obtain Contact Hours by Reading This Article Instructions 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf . To obtain contact hours you must: 1. Read the article, “Proton Pump Inhibitors and the Prescribing Cascade” found on pages 23–31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until March 31, 2019. Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Activity Objectives 1. Describe the prescribing cascade of proton pump inhibitors (PPI) in nursing home residents. 2. Identify the statistically significant factors related to the use of PPI and H 2 receptor blockers. Disclosure Statement Neither the planners nor the authors have any conflicts of interest to disclose. The current study examined the use of proton pump inhibitor (PPI) drugs in 248 nursing home residents and factors associated with being prescribed a PPI. Ninety-three percent of residents taking a PPI had done so for longer than recommended durations. As anticholinergic burden, vitamin/supplement use, and number of oral products taken daily increased, residents were more likely to be taking a PPI. Higher anticholinergic burden ( p = 0.031) and number of oral products taken daily ( p = 0.04) were two statistically significant predictors in the final logistic regression model. Significant predictors of PPI use in the current study may be explained by the association between polypharmacy and dyspepsia and the lowering of esophageal sphincter pressure by anticholinergic drugs. High use of PPIs in nursing home residents may represent a prescribing cascade. [ Journal of Gerontological Nursing , 42 (4), 23–31.]

The effectiveness of adhesives in enhancing several functional aspects of complete denture performance has been well established. The direct influence of adhesives on occlusal contact simultaneity has not yet been investigated.The purpose of this crossover clinical trial was to evaluate quantitatively the influence of adhesives on occlusal balance by recording timed occlusal contacts; namely occlusion time (OT) and disocclusion time during right (DT-right) and left (DT-left) excursions by using computerized occlusal analysis.A crossover clinical trial was adopted. Assessments were carried out while participants (n=49) wore their dentures first without then with adhesives. Computerized occlusal analysis using the T-Scan III system was conducted to perform baseline computer-guided occlusal adjustment for conventionally fabricated dentures. Retention and stability assessment using the modified Kapur index and recording of OT and DT-right and DT-left values using the T-Scan III were subsequently carried out for all dentures, first without adhesives and then after application of adhesive. All T-Scan procedures were carried out by the same clinician. Wilcoxon signed-rank test was used to analyze the Kapur index scores and occlusal parameters (α=.05).Stability and retention of conventional dentures ranged initially from good to very good. However, adhesive application resulted in significant improvement (P.001) in stability and retention and a significant decrease in duration of all occlusal parameters (OT [P=.003], DT-right [P=.003], and DT-left [P=.008]).Adhesives significantly decreased OT and DT durations in initially well-fitting complete dentures with fairly well balanced occlusion, and further enhanced denture stability and occlusal contact simultaneity.

Numerous parasitic infections can cause inflammation of the appendix and can mimic appendicitis clinically. The diagnosis is generally achieved only after surgery. However early diagnosis through stool examination may prevent life-threatening complications. This study investigated the presence of parasitic infections in surgically removed appendices as an etiology of acute appendicitis. A retrospective study included patients who had undergone surgery for acute appendicitis over a period of three years from Jan 2012 to Dec 2014. Demographic data, laboratory investigations, operative data and pathological findings, presence and type of parasites were retrieved. The results showed that out of 1536 patients with appendectomy done, 938 (61.1%) were males and 598 (38.9%) were females. Parasitic infection was demonstrated only in 0.4% (6 patients). Mean average age of these patients was 12 years. Enterobius vennicularis was present in 4 patients (66% of the parasitic affection) and Schistosoma mansoni in 2 patients (34% of the parasitic affection). Other etiologies were acute suppurative appendicitis (94.1%), chronic appendicitis (3.1%), tumors (0.3%), tuberculosis (0.2%) and actinomycosis (0.1%). Appendix was found normal in 2% of patients underwent appendectomy.

Background: Multiple Myeloma (MM) is currently incurable despite many novel therapies. Tumour Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL) is a potential anti-tumour agent although the effects as a single agent are limited. This investigation determined whether the Histone Deacetylase (HDAC) inhibitor SAHA, or inhibitors of the histone methyltransferases G9a and EZH2 (BIX 01294 and GSK343) and Nuclear export inhibitor (NEI) LMB, enhance TRAIL-induced apoptosis and overcome TRAIL resistance in both suspension culture, and 3D cell culture as a model of solid disseminated MM lesions that form in bone.\ud Methods: The effects of TRAIL sensitizers and/or TRAIL treatment were investigated in both suspension cultures and in an alginate-based 3D culture model. Apoptosis was detected by assessment of nuclear morphology using Hoechst 33342/PI staining. TRAIL-resistant cells were generated by acute exposure of TRAIL sensitive cells to TRAIL followed by the selection of TRAIL-resistant cells (TRAILR). Apoptotic effects in quiescent cells (labelled as PKH26Hi) were also determined. Subsequently, an investigation was undertaken to identify potential mechanisms of action of these agents when used alone and in combination with TRAIL.\ud Results: TRAIL significantly induced apoptosis in a dose-dependent manner in OPM2, RPMI 8226, NCI-H 929, U266, JJN3 human MM cell lines and ADC-1 plasma cell leukaemia cells. All epigenetic modifiers and NEI synergistically enhanced TRAIL responses in several lines and responses were potentiated in 3D culture. Interestingly, TRAILR cells were sensitive to BIX 01294 and LMB; however, TRAIL responses in cells that had been selected for TRAILR were not further enhanced by SAHA and GSK343. Quiescent PKH26Hi cells were resistant to dual therapy. Mechanistically, TRAIL and TRAIL sensitizers induced apoptosis via both extrinsic and intrinsic pathways in addition to decreasing the expression of oxidative enzyme catalase.\ud Conclusions: Inhibitors of HDAC, EZH2 and G9a and NEI are potent sensitisers of TRAIL responses both in suspension, and crucially in 3D cell culture, which may mimic physiological aspects of bone metastases. These agents may be a therapeutic option in combination with TRAIL and may increase TRAIL sensitivity in insensitive cells, but not in cells that have specifically been selected for acquired TRAIL-resistance, and not in quiescent cells.

Recurrent pregnancy loss (RPL) is loss of three or more consecutive pregnancies during first trimester of pregnancy. The etiology in most of the recurrent miscarriages is unknown. The main cause of recurrent miscarriage is the abnormal karyotype. Apart from this, number of factors are responsible like defects in maternal endometrium, placenta, and autoimmune malfunctions. Additionally exaggerated immune response by the cytokines seems to play a crucial role in the termination of pregnancies. Analysis of serum cytokines in women with recurrent pregnancy loss would add to better and clear understanding of the role of cytokines in miscarriage. The study enrolled 60 pregnant women aged 26-48 y; the RPL group comprised of 30 women with first trimester miscarriage and the control group included 30 women with first trimester successful pregnancy with no history of miscarriage. Serum cytokines were measured by Milliplex Luminex with XMAP (Multianalyte profiling) technology. Cytokines like tumor necrosis factor-α, interferon-γ, interleukin-8 increased and interleukin-6 decreased significantly (p

Statement of problem The effect of the neutral zone (NZ) technique on different functional aspects (masticatory performance, speech, and muscle activity) has been studied objectively. Subjectively, some studies reported that their participants felt that NZ dentures were more stable, retentive, and comfortable than conventionally fabricated dentures. These studies, however, lacked a measurable assessment scale or a specifically designed questionnaire. Purpose The purpose of this within-subject, crossover clinical trial was to investigate patient satisfaction levels in edentulous patients after rehabilitation with dentures fabricated using the NZ concept as compared with conventional dentures using a specific, question-oriented patient satisfaction questionnaire. Material and methods The clinical trial included 52 participants. Each received one set of conventional dentures and another fabricated based on the NZ concept with a 1-month wash-out period. Participants randomly chose 1 of 2 closed opaque envelopes with 2 denture sequences, either conventional then NZ or NZ then conventional. Hence, participants were blinded to the dentures they wore. Patient satisfaction with each denture type was assessed 6 weeks after insertion by a blinded staff member using a 5-scale questionnaire developed for the most important functional aspects (esthetics, masticatory ability, retention, stability, speech, and comfort). The Wilcoxon Signed Rank test was used to compare the satisfaction scores of the 2 denture types (α=.05). Results Patient satisfaction scores were significantly higher with the NZ dentures than with the conventional dentures in all aspects; P=.001 for question 2 (opinion of denture appearance) and P Conclusions NZ dentures offer significantly higher levels of patient satisfaction than conventional dentures in all functional aspects (retention, stability, masticatory ability, and speech) as well as in comfort and appearance.

Objective The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis with laboratory findings of human leukocyte antigen-B27 (HLA-B27), conventional radiography, and clinical assessment. Participants and methods Sixty patients with spondyloarthropathy (group II) with duration of illness less than 2 years and 20 healthy controls (group I) were included in this study. Both groups were subjected to assessment of history, clinical examination, and laboratory investigations (erythrocyte sedimentation rate, C-reactive protein titer, rheumatoid factor, HLA-B27). Conventional radiography and MRI of the sacroiliac joints were performed. Spondyloarthropathic patients were divided according to MRI as follows: group IIA, which included patients with sacroiliitis, and group IIB, which included patients without sacroiliitis. Results In our study, ankylosing spondylitis was diagnosed in 22 (36.6%) patients, followed by undifferentiated spondyloarthropathy in 12 (20%) patients, reactive arthritis in 10 (16.7%) patients, psoriatic arthropathy in 10 (16.7%) patients, and enteropathic arthropathy in six (10%) patients. Evidence of sacroiliitis was found in 66.6% (40/60) of patients by MRI, which was higher than the result obtained by plain radiography 20% (12/60). HLA-B27 positivity found in 53.3% (32/60) of patients. There was a significant difference between the two groups in HLA-B27 and radiological sacroiliitis; there was no sacroiliitis in the control group. MRI showed sacroiliitis even in patients with no inflammatory back pain. There was a highly statistically significant difference between patient subgroups in disease duration (P = 0.001) and primary complaints and clinical sacroiliitis (P = 0.001). Conclusion MRI is the preferred modality in the detection of early sacroiliitis in spondyloarthropathy and HLA-B27 positivity is a highly useful predictor of early sacroiliitis

Strongyloides stercoralis is an intestinal nematode with a complex life cycle. It is usually asymptomatic in healthy host however it may be a life threatening condition in immunocompromised patients when hyperinfection is associated with disseminated disease. However, reports of gastric involvement are rare. This is a case report of fatal gastrointestinal hemorrhage due to hyperinfection with S. stercoralis in a Burmawi male patient after brief corticosteroid therapy.

This study investigated changes in oral health-related quality of life (OHRQoL) in partially edentulous patients treated with removable dental prostheses (RDPs), fixed dental prostheses (FDPs), fixed-removable (combined) restorations (COMBs), and implant-supported fixed prostheses (ISFPs).A total of 200 patients (30 to 50 years old) were enrolled: 45 received RDPs, 32 received FDPs, 66 received COMBs, and 57 received ISFPs. OHRQoL was measured using the shortened version of the Oral Health Impact Profile (OHIP-14) before treatment and 6 weeks and 6 months after treatment. Treatment groups were sex-neutral; however, significant differences were found relative to age and Kennedy classification. A general linear model was used to explore the interaction of age and Kennedy classification with treatment modality.Pretreatment analysis revealed that the psychologic discomfort domain showed the greatest negative impact on OHRQoL, while functional limitation had the smallest effect. Within-group comparison revealed a significant decrease in OHIP scores throughout the study in all groups except the younger age group treated with RDPs after 6 weeks. Between-group comparison revealed significant differences among the treatment groups. The least amount of OHRQoL improvement was recorded for RDPs for both age groups at 6 weeks and for the younger age group at 6 months. There were no significant differences between FDPs and ISFPs.All treatments produced significant improvement in OHRQoL. The least amount of improvement was observed in patients with RDPs. OHRQoL changes in patients treated with FDPs and ISFPs were comparable. The same treatment can have different impacts on the OHRQoL of partially edentulous individuals depending on their age and Kennedy classification.

BACKGROUND:The Na-H exchanger [NHE] performs an electroneutral uptake of NaCl and water from the lumen of the gastrointestinal tract. There are several distinct NHE isoforms, some of which show an altered expression in the inflammatory bowel diseases (IBD). In this study, we examined a role of NHE-2 in experimental colitis. METHODS:Colitis was induced in male Sprague-Dawley rats by intra-rectal administration of trinitrobenzenesulphonic acid (TNBS). On day 6 post-TNBS, the animals were sacrificed, colonic and ileal segments were taken out, cleaned with phosphate buffered saline and used in this study. RESULTS:There was a significant decrease in the level of NHE-2 protein as measured by ECL western blot analysis and confocal immunofluorescence microscopy. The levels of NHE-2 mRNA and heteronuclear RNA measured by an end-point RT-PCR and a real time PCR were also decreased significantly in the inflamed colon. However, there was no change in the level of NHE-2 protein in response to in vitro TNF-α treatment of uninflamed rat colonic segment. These changes were selective and localized to the colon as actin, an internal control, remained unchanged. Confocal immunofluorescence microscopy revealed co-localization of NHE-2 and NHE-3 in the brush borders of colonic epithelial cells. Inflamed colon showed a significant increase in myeloperoxidase activity and colon hypertrophy. In addition, there was a significant decrease in body weight and goblet cells' mucin staining in the TNBS treated colon. These changes were not conspicuous in the non-inflamed ileum. CONCLUSIONS:These findings demonstrate suppression of NHE-2 expression on the brush borders in the colonic epithelial cells which is regulated transcriptionally. However a role of TNF-α in the regulation of NHE-2 is discounted in the present model of colitis. This decrease in the NHE-2 expression will lead to a loss of electrolyte and water uptake thus contributing to the symptoms associated with IBD.

Minor Salivary Gland tumours are rare, representing 2% of the head and neck tumours and less than 1% of hypopharyngeal cancers. The most common subtype of minor salivary gland tumours is adenoid cystic carcinoma. Although there are several case reports discussed it, there are only two reports discussing hypopharyngeal presentation in the literature, and they were treated by surgical resection. Despite that, our case report still to be unique as it presents a case of irresectable locally advanced tumour subjected to a trial of induction therapy.

Rheumatoid arthritis (RA) is a common, systemic autoimmune disease characterized by persistent symmetric polyarthritis (synovitis). Anxiety and depression are common among patients with RA, compared to the general population and have been associated with increased pain, fatigue, physical disability and health care costs, and an overall reduced health-related quality of life. The aim of the present study was to assess the relation between psychological factors (anxiety and depression) and disease activity (and severity) parameters in RA patients. This national, single-center, cross-sectional study recruited over 6 months 25 patients with RA diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria, and 25 healthy control individuals. All participants were subjected to the clinical and laboratory evaluation of disease activity and psychological assessment according to the International Classification of Mental and Behavioral Disorders tenth revision. Significance and regression analyses were performed to determine disease activity and severity predictors. 80% of RA patients had depression and 52% anxiety symptoms, while only 8% of healthy controls reported mild depression (P

Background/Objective: The role of sucrose and/or non-nutritive sucking (NNS) has been evaluated for relieving procedural pain in newborn infants with satisfactory results however there was a controversy regarding the synergestic effect of their combination.}Methods: This quasi-experimental study was conducted in the neonatal intensive care unit in Assiut University Children Hospital including 120 preterm neonates who were divided into 4 groups (20 neonates each). Control group received routine hospital care; sucrose group received oral sucrose solution (OS); pacifier group received pacifier; and last group received oral sucrose solution and pacifier during painful procedures. All were assessed regarding socio-demographic and clinical data in addition to application of Premature Infant Pain Profile (PIPP) scale to assess the levels of pain and mean pain scores pre and post-intervention.Results: The 4 groups were similar regarding soci-demographic and clinical data. The application of the OS and/or pacifier, led to significant improvement of the levels of pain and reduction of the mean score of pain among preterm neonates during painful procedures. In addition, combined pacifier and OS was superior to OS alone and comparable to pacifier alone regarding their effect on the reduction of pain level and mean score of pain.Conclusions: OS and pacifier are effective as pain reliever during painful procedures among preterm neonates. Combined OS and pacifier is superior to OS and pacifier alone.

Background: Shivering is an undesirable, unpleasant experience after spinal anesthesia. Injecting cold bupivacaine has been incriminated as a contributory factor. Aims and Objective: In this prospective study we evaluated the efficacy of warming the heavy bupivacaine to body temperature for prevention of shivering and if it influences analgesic quality of spinal anesthesia. Materials and Methods: In this double blind, randomized controlled study, 100 patients aged 20-35 years of American Society of Anesthesiologist physical status I and II undergoing elective or emergency Caesarean sections were included and allocated to either Room temperature group (RT Group, n= 50), or Body temperature group (BT group, n = 50). A standard spinal anesthetic of 2ml of 0.5 % heavy bupivacaine plus 20 microgram of fentanyl was administered using 25G pencil point spinal needle in the sitting position. Besides the incidence and intensity of shivering and effect on intraoperative analgesia, effect on hemodynamics, nausea, vomiting, blood loss, pruritis and Apgar scores were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 22.0 software (International Business Machines Corporation, Armonk, New York, USA). P < 0.05 was considered significant. Results: The patients were comparable in terms of demographic variables. Shivering was present in 31 (62%) and 7 (14%) patients respectively in RT and BT Groups, which was statistically significant (P = 0.0001). Intensity of shivering ≥3 was observed in 15 (30%) patients of RT group and 5 (10%) patient in BT group. We did not note any difference in the analgesic status intraoperatively nor any difference in the duration of analgesia. Surprisingly, the incidence of pruritis was significantly reduced in the BT group as compared to RT group (P = 0.037). Conclusions: Warming the heavy bupivacaine to body temperature is effective in preventing shivering and reducing pruritis secondary to spinal anesthesia without affecting analgesia.

Aim: Preeclampsia is characterized by development of high blood pressure and proteinuria. It affects 5%u20138% of all pregnancies and is a major contributor to maternal and fetal morbidity and mortality. There is no single test that fulfills all the criteria for a good predictor of preeclampsia and associated hepatic dysfunction. The present study was therefore undertaken to assess the role of liver enzymes as marker in prediction of preeclampsia. Material and Method: The study comprised of 120 pregnant women divided into three groups: normal pregnant women, women with high risk of preeclampsia and women with preeclampsia. Serum levels of AST, ALT, ALP and LDH were analyzed and comparison of clinical characteristics and biochemical parameters of cases with control was performed by t-test followed by one way ANOVA. Results: There was significant increase (p

Dental research is rich with articles that investigated the influence of host-site variables, some implant-related variables (implant length, diameter, taper, design, location, and surface topography), different loading protocols or surgical procedures, and measurement methodology on dental implant stability. However, the number of implants and its effect on implant stability remain unclear.The purpose of this randomized clinical trial was to investigate the influence of implant number on implant stability by comparing 2 versus 4 implants in mandibular implant overdentures.The trial included 20 participants with edentulous mandibular ridges. Participants were randomly assigned to 2 equal groups, a 4-implant (experimental) group consisting of 4 implants installed in lateral-canine and premolar regions; and a 2-implant (control) group, consisting of 2 implants in lateral-canine regions. Implant stability was measured using resonance frequency analysis at implant placement and then at 1, 3, 6, 9, and 12 months. The Student t test was used to compare the implant stability quotient (ISQ) values of the anterior implants in the 4-implant and 2-implant groups. One-way ANOVA followed by the post hoc Bonferroni test was used to compare ISQ values among the different follow-up periods within each group (α=.05).Mean ISQ values for anterior implants in the 4-implant group were slightly higher than those recorded for the 2-implant group at all follow-up periods. However, these differences were not statistically significant (P.05). Within-group comparison revealed an initial decrease in implant stability for all implants. This decrease was statistically significant for the 2-implant group (P.001) and for posterior implants in the 4-implant group (P.001). This was then followed by a gradual increase in ISQ values for all implants in both groups.Increasing the number of implants from 2 to 4 in mandibular implant overdentures did not have a significant influence on implant stability.

BACKGROUND: People with poorly controlled diabetes are likely to have shortened life, diabetes related complications and also reduced quality of life. WHO-EMRO region is considered to be the highest prevalence region accounted 43 million people. Among GCC countries, Oman has reported increased number of cases in recent years. OBJECTIVE: To identify the prevalence and risk factors associated with uncontrolled diabetes (Type 2) in a diabetic setting of Al Buraimi Polyclinic, AL Buraimi Governorate, Oman. METHODOLOGY: This Cross sectional retrospective study was conducted in diabetic clinic of Al Buraimi Polyclinic of primary health care, Al Buraimi Governorate Oman between January-April 2015. This study enrolled all diabetic patients type 2 (N=1164) who were registered during the period 2010-2014 in the polyclinic. Data was retrieved from the electronic diabetic register and patient’s electronic records in a diabetic setting at Al Buraimi Polyclinic. Descriptive statistics were applied to analyze the data. Differences between the groups were analyzed by using Chi-square test in SPSS 16 with p value ≤ 0.05 significance level. RESULTS: Prevalence of Uncontrolled Diabetes Mellitus Type 2 was found to be 623 (54%) among 1164 registered patients. 1108 (95%) were Omani nationals and 56 (5%) were non-Omani nationals with mean age 51±12 and male predominance 632 (54%) with higher significance (p-value=0.009). A significant association was found between treatment and glycemic control (p-value = 0.000) with 926 (80%) were on oral hypoglycemic agents. Moreover, HbA1c was significantly associated with total cholesterol, Low density lipoprotein and Triglyceride with (p-value=0 .000). 629 (54%). Diabetic patients were having family history as a common risk factor. CONCLUSION: Uncontrolled diabetes mellitus with prevalence >50% implies an alarming challenge to health care system. An intervention should be focused on patient’s education, emphasizing on life modification strategies. Furthermore, multidisciplinary approach is needed for the effective care of diabetes in primary health care.

BACKGROUND: Due to existence of highly infectious materials, the biomedical waste can be a probable source for transmission of diseases as well as occupational hazards among health care workers if not adequately managed. Objective: To assess the knowledge, attitude and practices of biomedical waste management among health care personnel in a secondary hospital of Al Buraimi Governorate, Sultanate Oman.METHODOLOGY: A Cross sectional descriptive self-administered questionnaire based study was conducted among 207 subjects from 30th September 2015 to 30th March 2016 in Al-Buraimi hospital, Oman. Stratified random sampling comprised of four strata (100 nurses, 65 doctors, 22 housekeeping staff and 20 laboratory technicians).Chi-Square test was applied using SPSS version 21 with significance level ≤ 0.05. Confidentiality was maintained with ethical approval from research committee and informed formal consent was taken from the participants. RESULT: Overall response rate was 125 (60.3%) from total 207, mean age 36.14±8.9 and age ranges from 20 to 58 years with mean age (doctors 42.5, nurses 29.8, laboratory technician 29.2 and housekeeping staff 36). Female proportion of 82 (65.6%) was higher as compare to males 43 (34.4%). The study was analyzed on the basis of “satisfactory” and “unsatisfactory” scores using “cut-off point” tools. Nurses had better satisfactory knowledge (90.9%), attitude (94.5%) and practice (80%) scores as compare to other participants. The overall “satisfactory” knowledge, attitude and practice scores were found to be statistically insignificant (P=0.100, P=0.346, P=0.364 respectively). No significant relationship established between dichotomized variables of knowledge and practice (P = 0.264) as well as attitude and practice (P = 0.147).CONCLUSION: The “satisfactory” scores of knowledge, attitude and practice were found to be higher among nurses as compared to other participants, which may be due to intensive patient care and more involvement in biomedical waste management as well as greater responsibility allocated by hospital administration.