Assessment of Efficiency of Bioactive Glass, Self-Assembling Peptide, and Ozone Remineralising Agents on Artificial Carious Lesion

ABSTRACT Objective: To assess the efficacy of bioactive glass, self-assembling peptide, and ozone-remineralizing agents on the artificial carious lesion. Material and Methods: On the extracted 60 premolar teeth, an artificial carious lesion/demineralization was created. Later, the remineralization of demineralized teeth was done with respective remineralizing agents (Group A: Calcium sodium phosphosilicate (bioactive glass), Group B: Self-assembling peptide, Group C: Ozone remineralizing agents and Group D (Control): De ionized water. The degree of demineralization and remineralization were evaluated using the Vickers Hardness Number. Results: There was a decrease in microhardness from baseline to demineralization in all the groups, and this reduction was found to be statistically considerable. After the remineralization of demineralized samples with respective remineralizing agents, there was an increase in microhardness of 312.38, 276.67, and 254.42 in groups A, B, and C, respectively. In contrast, in Group D, there were no changes. Conclusion: Bioactive glass and self-assembling peptides had higher remineralizing capacities, which can be used to treat early carious lesions.

Frequency and Severity of Temporomandibular Disorders Among Weightlifters at Fitness Centers in a Subset Population of Saudi Arabia: A Cross-Sectional Observational Study.

Background Teeth clenching in weightlifters is a common finding that may result in temporomandibular disorders (TMDs). This study aimed to evaluate the severity and frequency of TMDs among weightlifters at fitness centers in Saudi Arabia. Methods A cross-sectional study was designed to collect data from weightlifters at fitness centers. A non-probability convenient sampling technique was applied using a valid and reliable Fonseca's questionnaire on a Google Sheet (Google, Mountain View, CA) to collect participant data. The survey was conducted from November 2022 to April 2023. Epi Info software (CDC, Atlanta, Georgia) was used to calculate the sample size, and a minimum sample of 278 was required. The data underwent analysis using SPSS version 20 (IBM Corp., Armonk, NY). Results Data analyzed from 375 participants revealed that 192 (51.2%) had mild signs of TMD, whereas 128 (34.13%) of the respondents had no symptoms of TMD. A significant difference was observed among female participants in all the temporomandibular joint severity categories. A statistically significant difference was observed between both genders concerning frequent headaches, earache, and nervousness. Conclusion The prevalence of TMD is high worldwide. Unsupervised athletic activity may result in the occurrence of TMD. Fonseca's questionnaire findings reveal a mild prevalence of TMD in weightlifters.

Effect of Root Canal Taper on the Ability of Endodontically Treated Teeth using the TruNatomy and Protaper Next File Systems to Resist Fracture.

Objectives: This research was done to evaluate how the root canal taper affects the Endodontically Treated Teeth (ETT) prepared with the TruNatomy and Protaper Next file systems in terms of fracture resistance. Materials and Method: Forty recently extracted mandibular premolar teeth were used in this research, which was classified into four groups at random. Groups 1a and 1b used TruNatomy 4% and 6%, respectively, while groups 2a and 2b used the Protaper Next 4% and 6% file systems, respectively. The root canals were cleaned, shaped, and sealed using cold lateral compaction. The root canals were then fixed in standardized autopolymerizing acrylic resin blocks and tested for vertical root fracture using a universal testing machine. Newtons were used to measure the forces needed to cause fractures. Data were statistically analyzed. Results: In comparison with other groups, group 1a (TruNatomy 4%) displayed greater fracture resistance (423.322.43 Newtons), and group 2b (Protaper Next 6%) displayed the least fracture resistance (264.512.76 Newtons). Conclusion: Protaper Next file system had lower fracture resistance than TruNatomy file system. With the use of greater taper instruments, a notable decrease in the fracture resistance of ETT was observed.

Endodontic Management of Mandibular Second Premolar with Vertucci Root Canal Configuration Type V.

The diversity of root canal anatomy in permanent dentition is quite common. Understanding the basic anatomy of the root canal morphology and its variations is particularly important for successful root canal treatment. Mandibular second premolar usually consists of a single root with a single root canal. The presence of split roots in the apical third of the root with two separate root canals is quite rare. The major cause of endodontic failure in missed canals is that it harbors bacteria and other microorganisms. Careful radiographic interpretation and clinical examination of the pulp chamber will be helpful in locating canal orifices. The mandibular premolars with Vertucci type V canal configuration pose a challenge in clinical management. Identifying them early is important to aid appropriate modification in treatment protocol. In this case report, important modifications of clinical steps and application of magnification for successful management with access chamber modification are explained.

Effect of the COVID-19 pandemic on dental interns in Saudi Arabia.

BACKGROUND: The coronavirus disease (COVID-19) has emerged as a global pandemic recognized by the World Health Organization. It has a significant impact on Saudi Arabia's educational process, resulting in several universities suspending on-campus teaching, exams, and training. OBJECTIVE: The study aimed to evaluate the effect of COVID-19 on dental students' examination, internship placement, and subsequent impact on preparedness and confidence. METHODS: A cross-sectional study was conducted to gather data from dental interns in Saudi Arabia using a pre-tested online questionnaire. Convenient sampling was applied to collect data from 5th September to 15th September 2020. Data were analyzed using SPSS version 23. Descriptive data were presented as frequency and percentages. The Chi-square test was used to evaluate the relationship between variables. RESULTS: Data of 409 dental interns from 8 dental schools reported that 209 (51%) participants' exams were affected as the format was changed to online examination. 130 (31.8%) dental interns strongly agreed that assistance in hospitals during the outbreak of COVID-19 would complement their learning opportunities. Whereas 115(28.1%) respondents strongly agreed that dental schools' measures to modify their curriculum were necessary.The impact of COVID-19 on dental intern preparedness discovered that the affected exams had a significant effect on final year students' readiness to begin the internship (p = 0.042). Considering students' confidence in starting the training earlier than expected, the student course had a statistically significant impact on their confidence (p = 0.002). CONCLUSION: The current study demonstrates that COVID-19 had disrupted dental interns' preparedness towards clinical rotation and decreased their confidence performing in the clinical setup. Due to being unprepared and having low confidence, most dental interns were not ready to start working in the hospital on time.

Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals.

There are an estimated 1.8 billion Muslims worldwide, with the majority of them choosing to fast during the month of Ramadan. Fasting, which requires abstinence from food and drink from dawn to sunset can be up to 20 h per day during the summer months in temperate regions. Fasting can be especially challenging in patients on haemodialysis and peritoneal dialysis. Moreover, there is concern that those with chronic kidney disease (CKD) can experience electrolyte imbalance and worsening of renal function. In this article, current literature is reviewed and a decision-making management tool has been developed to assist clinicians in discussing the risks of fasting in patients with CKD, with consideration also given to circumstances such as the coronavirus disease 2019 pandemic. Our review highlights that patients with CKD wishing to fast should undergo a thorough risk assessment ideally within a month before Ramadan, as they may require medication changes and a plan for regular monitoring of renal function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low-moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the very high risk and high risk categories should be encouraged to explore alternative options to fasting, while those in the low-moderate category may be able to fast safely with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules and instructions on when to terminate their fast or abstain from fasting.

ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study.

BACKGROUND: Small studies suggest an association between ANCA-associated vasculitis (AAV) incidence and rurality, seasonality and socioeconomic deprivation. We examined the incidence of kidney biopsy-proven AAV and its relationship with these factors in the adult Scottish population. METHODS: Using the Scottish Renal Biopsy Registry, all adult native kidney biopsies performed between 2014 and 2018 with a diagnosis of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) were identified. The Scottish Government Urban Rural Classification was used for rurality analysis. Seasons were defined as autumn (September-November), winter (December-February), spring (March-May) and summer (June-August). Patients were separated into quintiles of socioeconomic deprivation using the validated Scottish Index of Multiple Deprivation and incidence standardised to age. Estimated glomerular filtration rate and urine protein:creatinine ratio at time of biopsy were used to assess disease severity. RESULTS: 339 cases of renal AAV were identified, of which 62% had MPA and 38% had GPA diagnosis. AAV incidence was 15.1 per million population per year (pmp/year). Mean age was 66 years and 54% were female. Incidence of GPA (but not MPA) was positively associated with rurality (5.2, 8.4 and 9.1 pmp/year in 'urban', 'accessible remote' and 'rural remote' areas, respectively; p=0.04). The age-standardised incidence ratio was similar across all quintiles of deprivation (p=ns). CONCLUSIONS: Seasonality and disease severity did not vary across AAV study groups. In this complete national cohort study, we observed a positive association between kidney biopsy-proven GPA and rurality.

A National Registry Study of Patient and Renal Survival in Adult Nephrotic Syndrome.

INTRODUCTION: We aimed to determine the mortality rate, cause of death, and rate of end-stage kidney disease (ESKD) in adults with nephrotic syndrome (NS). METHODS: We conducted a national registry-based study, including all 522 adults who had a kidney biopsy for NS in Scotland in 2014-2017. We linked the Scottish Renal Registry to death certificate data. We performed survival and Cox proportional hazards analyses, accounting for competing risks of death and ESKD. We compared mortality rates with those in the age- and sex-matched general population. RESULTS: A total of 372 patients had primary NS; 150 had secondary NS. Over a median follow-up of 866 days, 110 patients (21%) died. In patients with primary NS, observed versus population 3-year mortality was 2.1% (95% CI 0.0%-4.6%) versus 0.9% (0.8%-1.0%) in patients aged <60 years and 24.9% (18.4%-30.8%) versus 9.4% (8.3%-10.5%) in those aged ≥60 years. In secondary NS, this discrepancy was 17.1% (5.6%-27.2%) versus 1.1% (0.9%-1.2%) in <60-year-olds and 49.4% (36.6%-59.7%) versus 8.1% (6.6%-9.6%) in ≥60-year-olds. In primary NS, cardiovascular causes accounted for 28% of deaths, compared with 18% in the general population. Eighty patients (15%) progressed to ESKD. Incidence of ESKD by 3 years was 8.4% (95% CI 4.9%-11.7%) in primary and 35.1% (24.3%-44.5%) in secondary NS. Early remission of proteinuria and the absence of early acute kidney injury (AKI) were associated with lower rates of death and ESKD. CONCLUSIONS: Adults with NS have high rates of death and ESKD. Cardiovascular causes account for excess mortality in primary NS.

The International Continence Society (ICS) report on the terminology for male lower urinary tract surgery.

INTRODUCTION: In the development of terminology of the lower urinary tract (LUT), due to its increasing complexity, the terminology for male LUT surgery needs to be updated using a male-specific approach and via a clinically-based consensus report. METHODS: This report combines the input of members of the Standardization Committee of the International Continence Society in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 14 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for male LUT and pelvic floor surgery, encompassing 149 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in male LUT surgery. Figures have not been included to avoid any preference or bias towards a specific procedure. CONCLUSIONS: A consensus-based Terminology Report for male LUT surgery has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Transgenic Analysis Reveals 5' Abbreviated OsRGLP2 Promoter(s) as Responsive to Abiotic Stresses.

Germins and germin-like proteins are ubiquitous, expressed at various developmental stages and in response to various abiotic and biotic stresses. In this study, to functionally validate the OsRGLP2 promoter, 5' deletion analysis of the promoter sequences was performed and the deletion fragments fused with the ß-glucuronidase (GUS) and green fluorescent protein reporter genes were used for transient expression in tobacco as well as for generating stable transgenic Arabidopsis plants. Very high level of GUS activity was observed in agroinfiltrated tobacco leaves by the construct carrying the P-1063 and P-565 when subjected to abiotic stresses. Histochemical analysis of transgenic Arabidopsis plants revealed expression of reporter gene in root, leaf and stem sections of plants harboring P-1063 and P-565. Real-time qPCR analysis of transiently expressed tobacco leaves and transgenic Arabidopsis plants subjected to several abiotic stresses supported histochemical data and showed that P-565 responded to all the stresses to which the full-length promoter was responsive. The data suggest that P-565 may be a good alternative to full-length promoter region that harbors the necessary cis-elements in providing stable and high level of expression in response to wound, salt and temperature stresses.

Spontaneous rupture of the bladder during vomiting.

A 46-year-old woman with no urological history or comorbidities presented with an acute abdomen with haematuria after a spell of protracted vomiting. The initial cystogram was negative; however, CT imaging highly suggested an intraperitoneal bladder perforation, which was confirmed during laparotomy and subsequently repaired. Cystoscopic evaluation prior to laparotomy revealed no concurrent bladder pathology, and the ureteric orifices were intact. A cystogram 2 weeks after repair demonstrated no leaks, and her catheters were removed. She recovered well, with expectant postoperative pain and lower urinary tract symptoms settling on 3-month review. Spontaneous bladder rupture is a rare entity, with very few reports in the literature.

Intraurethral bulking agents for the management of female stress urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: The object of this review was to assess the efficacy and safety of urethral bulking agents (UBA), principally Macroplastique and Bulkamid, in the treatment of female stress urinary incontinence (SUI). METHODS: MEDLINE® and EMBASE® databases were systematically searched up to June 2016. Year of publication, study type, outcome measures, urodynamics before and after the procedure, number of participants, procedure complications, proportion requiring repeat injections or surgical procedures, frequency of follow-up, and results were analysed. RESULTS: The use of Bulkamid and Macroplastique for the treatment of female SUI was described in 26 studies. Studies used modalities including the visual analogue scale, Likert scale, International Consultation on Incontinence Modular Questionnaire (ICIQ), Patient Global Improvement Questionnaire (PGIQ) and Incontinence Impact Questionnaire (IIQ) and showed success rates ranging from 66% to 89.7% at 12 months follow-up. Objective improvements in patient symptoms were measured using urodynamics, 24-h pad tests, cough tests and voiding diaries. Studies showed variable objective success rates ranging from 25.4% to 73.3%. Objective findings for UBAs remain less well documented than those for the midurethral sling procedure. CONCLUSIONS: There are a range of complications associated with UBAs, the most common being urinary tract infection. However, it remains a very well tolerated procedure in the majority of patients. UBAs should be considered as an alternative in patients unsuitable for more invasive procedures and those willing to accept the need for repeat injections. The majority of the literature focuses on subjective improvement measures rather than objective improvement measures. Further randomized controlled trials directly comparing UBAs are required to indicate the most effective agent.

Multiplex PCR assay for identification of commonly used disarmed Agrobacterium tumefaciens strains.

The success of Agrobacterium mediated plant transformation depends to a certain extent on appropriate selection of the A. tumefaciens strain for a particular plant species. Many stages in a plant transformation procedure are prone to bacterial contamination with similar antibiotic resistance that may compromise the identity of the A. tumefaciens strain used, in turn adversely affecting success of a transformation experiment. Different primer sets were designed to exploit genetic differences among different strains of A. tumefaciens which are commonly used for plant genetic transformation, to identity confirmation as well as to distinguish them from one another. The primer sets Ach5FtsZ-F/R specific for Ach5 and C58GlyA-F/R specific for C58 were designed on chromosomal DNA while primer sets pTiBo542-F/R and nptI-F/R specific for plasmid pTiBo542 are capable to identify and distinguish these strains from one another. These primer sets when used simultaneously in multiplex PCR, produce a pattern which uniquely identifies all these strains and distinguishes them except for GV3101 and C58C1, which can further be distinguished from each other by rifampicin screening. The multiplex PCR assay and primers being reported here serve as a valuable tool in determining the identity of A. tumefaciens strains at any stage of plant transformation procedure.

Touch not the cat bot a glove*: ANCA-positive pauci-immune necrotizing glomerulonephritis secondary to Bartonella henselae.

A 36-year-old male presented with a secondary, but anti-neutrophil cytoplasmic antibody (ANCA) (proteinase-3) positive, vasculitis with renal insufficiency due to a pauci-immune necrotizing glomerulonephritis. An infective process was initially excluded by blood cultures and an echocardiogram prior to immunosuppression. The patient's condition failed to improve and re-evaluation confirmed infective endocarditis requiring valve replacement. Subsequent tissue cultures identified Bartonella henselae. Antibiotic treatment led to full resolution of physical, biochemical and immunological markers. This is the first case of B. henselae endocarditis-associated ANCA positivity with a pauci-immune glomerulonephritis. It demonstrates the importance of revisiting standard investigations in patients not improving expectantly on conventional therapy.

Evidence of recombination in the Banana bunchy top virus genome.

Viruses serve as good model for evolutionary studies, owing to their short generation times and small genomes. Banana bunchy top virus (BBTV) is a significant subject being multicomponent circular single stranded DNA virus. BBTV belongs to family Nanoviridae and contains DNA-R, -U3, -S, -M, -C, and -N as integral genomic components. Evolutionary studies have shown genetic re-assortment of components among its isolates and revealed a concerted type evolution in non-coding regions of its genome. The DNA U3 having been shown as the most diverse component in our previous studies, was subjected to sequencing from some Pakistani isolates for the first time. Sequence analysis revealed intergenomic recombination in DNA-U3 among the isolates of two sub-groups and a very rare intragenomic recombination in Pakistani BBTV population. This indicates that like other evolutionary processes including intergenomic recombination, intragenomic recombination among the genomic components of the same isolate may also have a significant contribution in the evolution of BBTV genome. Intragenomic recombination therefore appears to be a unique way to generate genetic diversity in the multicomponent ssDNA viruses.

Effectiveness of submucosal dexamethasone to control postoperative pain & swelling in apicectomy of maxillary anterior teeth.

PURPOSE: The purpose of this study was to evaluate the effect of submucosal dexamethasone injection to control postoperative pain and swelling in apicectomy of maxillary anterior teeth. METHODS: A randomized, controlled trial comprising 60 adult patients (68.3% male, 31.7% female) with no local or systemic problems was conducted. Patients were randomly divided into two groups: Group A was given 4mg dexamethasone injection perioperatively. Group B (control group) was treated conventionally without any steroid injection. Postoperative pain and swelling was evaluated using a visual analog scale (VAS). Objective measurements of facial pain and swelling were performed daily up to six days postoperatively. RESULTS: Dexamethasone group showed significant reduction in pain and swelling postoperatively compared with the control. CONCLUSION: Submucosal dexamethasone 4mg injection is an effective therapeutic strategy for swift and comfortable improvement after surgical procedure and has a significant effect on reducing postoperative pain and swelling. The treatment offers a simple, safe, painless, noninvasive and cost effective therapeutic option for moderate and severe cases.

Robotic-assisted radical cystectomy.

OBJECTIVE: To evaluate the emerging role of robotic-assisted radical cystectomy (RARC) in the management of bladder cancer. METHODS: Review of the published literature on robotic-assisted radical cystectomy, including data from our cystectomy series of 30 patients. RESULTS: Nearly 150 procedures have been performed worldwide. The benefits of robotic-assisted operations are similar to those of laparoscopically-performed procedures. RARC appears to be technically safe, oncologically and functionally equivalent to open (ORC) and laparoscopic radical cystectomy (LRC). However, RARC offers superior ergonomics and better vision. These benefits come at extra initial capital expenditure and subsequent higher maintenance costs. CONCLUSION: With the rapid spread of robotics, it is likely that RARC will become the standard of care in units with access to the technology.