Effect of anodized titanium abutment collars on peri-implant soft tissue: A split-mouth clinical study.

STATEMENT OF PROBLEM: Anodic oxidation of titanium implant abutment collars has been used to mask their unesthetic grayish color. However, the effect of anodic oxidation on the health and appearance of peri-implant soft tissues is unclear. PURPOSE: The purpose of this split-mouth clinical study was to investigate the effect of anodized titanium on the health and esthetics of peri-implant soft tissues. MATERIAL AND METHODS: A total of 60 osseointegrated implants placed in 30 participants were included in the present study. Each participant received 2 randomly allocated abutments, one with a pink anodized collar and the other with an unanodized one to form 2 groups: unanodized group (control group) and anodized group (experimental group). All implants were restored with lithium disilicate restorations. Evaluations of the peri-implant soft tissues were performed at the time of definitive restoration insertion (baseline) and after 3, 6, 12, and 18 months: peri-implant probing depth, soft tissue recession, modified sulcus bleeding index, modified plaque index, and modified gingival index. The esthetics of peri-implant soft tissues were evaluated by using the modified pink esthetic score. The paired t test or Wilcoxon signed-rank test was used for comparing the 2 study groups at each point of time depending on the normality of the variables (α=.05). To compare each variable at different time points within each group separately, repeated measures ANOVA or Friedman tests were used according to the normality of the variables, followed by post hoc pairwise comparisons by using the Bonferroni adjusted significance (α=.05). RESULTS: Five peri-implant soft tissue indices were followed up throughout the study. No statistically significant differences were found among the mean values of the tested indices in the anodized and unanodized groups throughout the evaluation periods (P>.05). The collective mean values of the modified pink esthetic score also showed no statistically significant differences between the groups (P>.05). CONCLUSIONS: Based on this split-mouth clinical study, pink anodized titanium abutment collars do not produce a clinically significant effect on the health or esthetics of peri-implant soft tissues.

Evaluation of the dislodgement force of splinted restorations with engaging conical abutments over multiple nonparallel implants (in-vitro study).

BACKGROUND: Splinted multiunit cement-retained restorations with screw access channels over engaging abutments are viable implant prosthetic options. However, information regarding the maximum degree of divergence between multiple implants is lacking. The purpose of this in vitro study was to determine the maximum degree of divergence between 2 adjacent implants with conical connections that allows insertion and removal of splinted restorations with engaging preparable abutments or titanium base abutments. METHODS: Two implants were aligned in a stone base, one straight and the other at an angle ranging from 0 to 20 degrees. The implants represented an implant system that had an internal conical connection and a hexed abutment engaging the base of the connection. Two straight preparable engaging cement retained abutments were screwed onto the implants and splinted together using acrylic resin. A total of 11 angles were tested, with 7 specimens for every angle. Evaluation of dislodging force was performed by pulling out the splinted abutments after unscrewing them. This was performed subjectively by 3 blinded investigators who applied a tactile pulling force. A scale of 0-10 was used to estimate the pulling force. Objectively the dislodging force was measured in Newtons using a universal testing machine. A statistical correlation was made between the subjective and objective dislodging force values using Spearman's rank correlation coefficient. RESULTS: The mean subjective values increased gradually from 0 to 16 degrees. A sudden rise was noticed at 18 degrees (9.71 ± 0.23) and, at 20 degrees, the investigators were not able to remove the splinted abutments from the implants. The mean objective dislodgement force values increased gradually from 0 to16 degrees and abruptly from 16 degrees (13.57 ± 0.45 N) to 18 degrees (25.40 ± 0.66 N) and 20 degrees (35.22 ± 0.64). The correlation between the subjective and the objective evaluations assessed using the Spearman's rank correlation coefficient was 0.98 indicating a statistically significant correlation (P < .001). As the objective dislodging force increased, the subjective dislodgement difficulty increased. CONCLUSIONS: Splinting cement retained restorations with screw access channels on engaging abutments is possible when multiple implants with conical connections having an internal flare angle of 8 degrees are used, with implant divergence of up to 16 degrees.

Effect of yellow anodization of titanium on the shade of lithium disilicate ceramic with different thicknesses.

STATEMENT OF PROBLEM: The color of the titanium abutment can affect the shade of the definitive restoration. Methods such as anodic oxidation, which changes the gray color of implant abutment to yellow, have been advocated to mask the unesthetic gray color of the abutment. However, whether a yellow anodized titanium abutment can prevent discoloration of translucent ceramic restorations is uncertain. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the yellow anodization of titanium on the shade of lithium disilicate ceramic with different thicknesses by using CIEDE 2000 formulas. MATERIAL AND METHODS: Sixty grade V titanium backgrounds were fabricated and divided into 2 test groups (n=30): group A was anodized to a yellow color, and group U was unanodized. Each group was subdivided into 3 subgroups (n=10) according to the thickness of the lithium disilicate ceramic cemented over it: subgroup 1 with 1-mm-thick lithium disilicate, subgroup 1.5 with 1.5-mm-thick lithium disilicate, and subgroup 2 with 2-mm-thick lithium disilicate. Each titanium background was cemented to its corresponding lithium disilicate block by using translucent resin cement. For the control group, 5-mm-thick lithium disilicate specimens were fabricated. Color measurements of the specimens were made with a spectrophotometer, and differences were calculated by using CIEDE 2000 formulas (ΔE00). Comparisons between the 2 study groups were done by using independent samples t test. Two-way ANOVA was used to assess the effect of anodization and thickness on ΔE00 with calculation of adjusted means and 95% confidence intervals (α=.05). RESULTS: Statistically significant differences were found among the mean values between yellow anodized and unanodized groups in all ceramic thicknesses (P<.001 for 1 mm, P<.001 for 1.5 mm, and P<.046 for 2 mm). Yellow anodization of titanium and increasing the ceramic thickness from 1 to 2 mm decreased the ΔE00 values. CONCLUSIONS: The restoration shade appeared to be improved by titanium anodization to a yellow color and by increasing the thickness of the machinable high-translucent lithium disilicate.

Oncological outcomes and complication rates after laparoscopic-assisted cryoablation: a European Registry for Renal Cryoablation (EuRECA) multi-institutional study.

OBJECTIVE: To assess complication rates and intermediate oncological outcomes of laparoscopic-assisted cryoablation (LCA) in patients with small renal masses (SRMs). PATIENTS AND METHODS: A retrospective review of 808 patients treated with LCA for T1a SRMs from 2005 to 2015 at eight European institutions. Complications were analysed according to the Clavien-Dindo classification. Kaplan-Meier analyses were used to estimate 5- and 10-year disease-free survival (DFS) and overall survival (OS). RESULTS: The median [interquartile (IQR)] age was 67 (58-74) years. The median (IQR) tumour size was 25 (19-30) mm. The transperitoneal approach was used in 77.7% of the patients. The median postoperative hospital stay was 2 days. In all, 514 patients with a biopsy-confirmed renal cell carcinoma (RCC) were available for survival analyses. The median (IQR) follow-up for the RCC-cohort was 36 (14-56) months. A total of 32 patients (6.2%) were diagnosed with treatment failure. The 5-/10-year DFS was 90.4%/80.0% and 5-/10-year OS was 83.2%/64.4%, respectively. A total of 134 postoperative complications (16.6%) were reported, with severe complications (grade ≥III) in 26 patients (3.2%). An American Society of Anesthesiologists score of 3 was associated with an increased risk of overall complications (odds ratio 2.85, 95% confidence interval 1.32-6.20; P = 0.005). CONCLUSIONS: This large series of LCA demonstrates satisfactory long-term oncological outcomes for SRMs. However, although LCA is considered a minimally invasive procedure, risk of complications should be considered when counselling patients.

Predictors for Severity of SARS-CoV-2 Infection Among Healthcare Workers.

BACKGROUND: Healthcare workers (HCWs) are still at higher risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections than the general population. Identifying risk factors associated with severe SARS-CoV-2 infections is of paramount importance to protect HCWs and the non-infected patients attending different healthcare facilities. PURPOSE: To recognize the predictors for severity of SARS-CoV2 infection among HCWs working in either COVID-19 or non-COVID-19 healthcare settings. Also, to assess compliance of HCW to standard precautions of infection control and explore the possible risk factors for SARS-CoV-2 infection among HCWs. METHODS: A cross-sectional study was conducted among HCWs with suspected or confirmed SARS-CoV-2 infection, from different Egyptian governorates. They were asked to fill in a web-based self-reporting questionnaire. The questionnaire assessed the demographic and socio-economic characteristics of participants, compliance of HCWs to standard precautions of infection control and COVID-19 presentation. RESULTS: Our study enrolled 204 HCWs (52.3% physicians). Infection of SARS-CoV-2 was confirmed in 61.3% by RT- PCR; 35.8% were admitted to hospital, and of these, 3.9% were admitted to the intensive care unit. While 30.4% had mild disease, 48.5% had moderate disease, 17.2% had severe disease and 3.9% had critical disease. Regression analysis for variables predicting COVID-19 severity among study healthcare workers showed that associated chronic diseases and management at home were the main independent variables predicting severity of their SARS-COV-2 infection, while the variables age, sex, residence, occupation or drug history of immunosuppressives had no role in severity prediction. CONCLUSION: Associated chronic diseases and management at home were the main independent variables predicting severity of SARS-COV-2 infection among HCWs. So, HCWs with chronic diseases should not work in COVID-19 designated hospitals, and there should be a screening strategy for their infection with SARS-COV-2. HCWs must not be negligent in adhering to strict precautions of infection control. HCWs infected with SARS-COV-2 must be managed in hospital not at home.

Efficacy and safety of 7 days versus 10 days triple therapy based on levofloxacin-dexlansoprazole for eradication of Helicobacter pylori: A pilot randomized trial.

BACKGROUND: Levofloxacin-based triple therapies are considered the standard regimen for eradication of Helicobacter pylori (H. pylori) due to decreased sensitivity to clarithromycin and the optimal duration of therapy is still controversial. Besides, there is no complete evidence about dexlansoprazole efficacy in the eradication of H. pylori. AIM: Our study aimed to determine the effectiveness of triple therapy based on levofloxacin-dexlansoprazole as a standard treatment for H. pylori infection and estimate the effect of H. pylori on lipid profile and hemoglobin (Hb). MATERIALS AND METHODS: A pilot prospective randomized trial of a triple therapy based on levofloxacin-dexlansoprazole for H. pylori eradication was conducted at Damanhour Medical National Institute, Egypt; 66 participants with H. pylori infection received levofloxacin (500 mg/day) plus amoxicillin (1 g/12 h) plus dexlansoprazole (60 mg/day). All medications administrated orally for either 7 days or 10 days. Four weeks after treatment, the eradication was assessed by the stool antigen test. RESULTS: The rate of eradication was 63.6% in levofloxacin, amoxicillin, and dexlansoprazole (LAD) 7-day group, and 90.9% in LAD 10-day group. In addition, laboratory test results showed a significant difference in Hb, low-density lipoprotein, high-density lipoprotein, triglyceride, and total cholesterol levels before and after treatment (P < 0.05). CONCLUSION: LAD 10 days is the least duration that provides maximum efficacy for H. pylori in Egyptian participants. In addition, successful treatment of H. pylori infection may reduce the risk of anemia and dyslipidemia. Furthermore, all members of the patient's family should be screened for H. pylori to prevent recurrent infection.

Blood count profile in chronic active hepatitis (C) Egyptian patients.

Hepatitis C virus (HCV) is one of the most important causes of chronic hepatitis globally, and particularly in Egypt. Abnormal blood counts have been noted in clinics among patients with HCV infection. The present work is a case control study conducted in Damanhour Medical National Institute (DMNI) to evaluate the frequency and severity of peripheral blood cell abnormalities in HCV- infected Egyptian patients. Two groups of individuals were randomly selected, group 1 comprised 100 patients suffering from chronic active hepatitis C with positive RNA PCR, and group 2 comprised 100 healthy persons and represented the control group. Low neutrophil and platelet counts, but not anemia were noticed in the first group and were significantly different when compared to the control group (<2.1x10(9)/L in 27% of patients versus 10% of controls and <175x10(9)/L in patients versus 11% of controls respectively at p<0.01). Obesity, advanced age and anti HCV seropositivity were independently associated with neutropenia, while advanced age and female gender and anti HCV seropositivity were associated with thrombocytopenia among HCV infected patients.

Ramadan fasting: relation to atherogenic risk among obese Muslims.

Increased platelet aggregation as well as changes in coagulation factors have an important effect on the occurrence of atherogenicity and cardiovascular diseases. Fasting in general has been used in medicine for medical purposes when other measures fail. Since Ramadan fasting is different from total fasting, the present work was conducted to study the effect of Ramadan fasting on lipid pattern, some blood coagulation parameters, blood pressure and body mass index (BMI)--as atherosclerotic risk factors--in one hundred and three apparently healthy obese volunteers (15 men and 88 women) aged 15-52 years. The study comprised an initial visit for assessment V1 (before Ramadan) and three other follow up visits: V2 (at the end of Ramadan), V3 (4 weeks after Ramadan) and V4 (8 weeks after Ramadan), Targets were subjected to an interview questionnaire, complete physical and clinical examination, anthropometric measurements, dietary profile, and laboratory assay of complete blood picture (CBC), fasting serum glucose level (FSG), serum lipid pattern: total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL-c) and low density lipoprotein (LDL-c), lipoprotein a Lp (a), apolipoprotein A1 (APA), and apolipoprotein B (APB) levels; bleeding (BT) and clotting time (CT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen and plasma factor VII activity. Statistical analysis was performed using Chi squared, Fisher exact, Student t test, paired t test and Pearson's correlation coefficient. Statistical significance was defined at P < 0.05. The study showed that by the end of Ramadan fasting, there was a significant improvement in the mean levels of hemoglobin (Hb), TC, TG, HDL-c, LDL-c, TC/HDL, LDL/HDL, Lp (a), APA, APB, PT and systolic (SBP) and diastolic blood pressure (DBP) that persisted for four weeks after fasting (P < 0.05). Ramadan fasting has not adversely affected leucocytic count or coagulation parameters (P > 0.05). There was also a significant association between dietary intake, SBP, DBP, weight, BMI, percent body fat and waist, fibrinogen and factor VII activity and TC, TG, HDL-c, LDL-c, LDL/HDL, Lp (a) and APB (P < 0.05). The model of Ramadan fasting could be followed as a behavior modification program to control or prevent atherogenicity because of its positive impact on the lipid pattern, blood count and coagulation parameters.