Influence of the Fiber Post Length on the Fracture Strength of Endodontically Treated Teeth.

Background and Objectives: Although fiber posts are widely used in the restoration of endodontically treated teeth (ETT), their ideal cementation depth into the root canal is still debated in literature. The aim of the present study was to evaluate whether the different intra-radicular insertion lengths of the fiber posts influence the fracture strength of ETT. Materials and Methods: A total of 10 permanent human lower incisors with straight roots of similar length and volume extracted for periodontal reason were sectioned 2 mm above the cement-enamel junction (CEJ) to a total length of 18 mm and endodontically treated in the same manner, then randomly divided into two groups of five each (Groups 1 and 2, n = 5). Two sound incisors, with no endodontic treatment, were used as the control group (Group 3, n = 2). After one week of storage in a humid environment, spaces for fiber post no. 1 (Reforpost, Angelus, Londrina, PR, Brazil) were prepared in the first two groups at a depth of 5 mm (Group 1) and 7 mm (Group 2), and the fiber posts were adhesively cemented using self-adhesive resin cement (Maxcem Elite, Kerr GmbH, Herzogenrath, Germany). After 7 days, the samples were vertically positioned and fixed in a self-curing transparent acrylic resin, up to 2 mm below the CEJ level, and mechanically tested in compression after another week of storage using a displacement-controlled testing machine up to each sample's fracture. The force-displacement curves were recorded for each sample, the means were calculated for each group and a statistical comparative analysis between groups was conducted. Results: Although no statistically significant differences between groups were observed, the highest mean fracture force (N) was recorded in Group 2 (1099.41 ± 481.89) in comparison to Group 1 (985.09 ± 330.28), even when compared to the sound, non-treated teeth (1045.69 ± 146.19). Conclusions: Within the limitations of this in vitro study, teeth where fiber posts were placed deeper into the root canal (7 mm) recorded slightly higher fracture forces in comparison with shorter lengths (5 mm). However, similar biomechanical performances obtained in the mechanical tests showed no statistical differences between the 7 mm and the 5 mm inserted posts.

Physiological Parameter Response to Variation of Mental Workload.

OBJECTIVE: To examine the relationship between experienced mental workload and physiological response by noninvasive monitoring of physiological parameters. BACKGROUND: Previous studies have examined how individual physiological measures respond to changes in mental demand and subjective reports of workload. This study explores the response of multiple physiological parameters and quantifies their added value when estimating the level of demand. METHOD: The study presented was conducted in laboratory conditions and required participants to perform a visual-motor task that imposed varying levels of demand. The data collected consisted of physiological measurements (heart interbeat intervals, breathing rate, pupil diameter, facial thermography), subjective ratings of workload (Instantaneous Self-Assessment Workload Scale [ISA] and NASA-Task Load Index), and the performance. RESULTS: Facial thermography and pupil diameter were demonstrated to be good candidates for noninvasive workload measurements: For seven out of 10 participants, pupil diameter showed a strong correlation ( R values between .61 and .79 at a significance value of .01) with mean ISA normalized values. Facial thermography measures added on average 47.7% to the amount of variability in task performance explained by a regression model. As with the ISA ratings, the relationship between the physiological measures and performance showed strong interparticipant differences, with some individuals demonstrating a much stronger relationship between workload and performance measures than others. CONCLUSION: The results presented in this paper demonstrate that physiological and pupil diameter can be used for noninvasive real-time measurement of workload. APPLICATION: The methods presented in this article, with current technological capabilities, are better suited for workplaces where the person is seated, offering the possibility of being applied to pilots and air traffic controllers.

Ocular involvement in highly treatment-experienced patients with HIV.

Introduction: Ocular involvement in human immunodeficiency virus (HIV) infected and treatment-experienced patients is a significant concern, despite the advancements in antiretroviral therapy (ART) medication. The extended life expectancy of HIV patients has altered the spectrum of HIV-associated ocular diseases, ranging from minor issues to severe vision impairment or blindness. Therefore, understanding these complications becomes crucial in providing comprehensive medical care and quality of life improvement. HIV patients on multiple ARTs can experience various ocular disorders due to the complexity of their treatment regimens, drug toxicities, immune reconstitution, and opportunistic infections. Most worthy to consider are: cytomegalovirus (CMV) retinitis, immune recovery uveitis (IRU), keratoconjunctivitis sicca (dry eye syndrome), and HIV-associated neuroretinal disorders. Materials and methods: A retrospective clinical investigation was conducted on HIV/AIDS-infected patients from January 1, 2013, to December 31, 2023. The study included 62 patients over 18 years, who tested HIV-positive via enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot (WB), with assessments of HIV plasma viral load (VL) and CD4+ T cell counts (CD4). Data collected included demographics, pathological histories, clinical characteristics, blood tests, assessments for opportunistic infections, patient staging, antiretroviral therapy initiation, and disease prognosis. Results: The study found that of most patients, 37 were aged 30-39 (59.7%), with 59.7% males and 40.3% females. Most had been living with HIV for 10-19 years (35.5%). Initial CD4 counts were < 200 cells/mm3 in 46.8% of patients, which improved to 19.3% when the study was done. CMV retinitis prevalence decreased from 46.8% initially to 35.5% despite ART. Other conditions included ocular toxoplasmosis (3.22%), tuberculosis-related uveitis (1,6%), keratoconjunctivitis sicca (19.3%), and HIV retinopathy (29%). Notably, 62.1% of CMV retinitis patients experienced significant visual acuity reduction. Oral valganciclovir was beneficial for patients with CMV disease affecting multiple sites and effective for both induction and maintenance therapy of CMV retinitis. Conclusions: Managing ocular complications in HIV-experienced patients requires a multidisciplinary approach with regular ophthalmologic evaluations, prompt treatment of infections, and continuous monitoring of ART effectiveness. Early detection and intervention are crucial for preserving vision and improving outcomes. The study highlighted the importance of constant monitoring even after viral suppression. Abbreviations: HIV = Human immunodeficiency virus, ART = antiretroviral therapy, CMV = cytomegalovirus, IRU = immune recovery uveitis, ELISA = enzyme-linked immunosorbent assay, WB = Western Blot, VL = viral load, CD4 = CD4+ T cells.

Miscellaneous ophthalmic conditions related to low CD4 cell count in HIV-positive patients.

Introduction: Management of patients living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (AIDS) (PLWHA) still represents a challenge for doctors in various medical fields. The presence of co-infections, with different degrees of immune system impairment, raises the need for a multi-disciplinary approach to the PLWHA. Methods: In this paper, we present three cases of PLWHA with various ophthalmological conditions, who were admitted to "Prof. Dr. Matei Balș" National Institute for Infectious Diseases (INBIMB). Three of them were late presenters, recently diagnosed with AIDS. All three were in immuno-virological failure. The ophthalmic conditions were either related to the HIV infection, or the result of other complications. Discussion: The diversity and complexity of ocular involvement in PLWHA were deeply linked to the patient's immunological status at the ophthalmological evaluation moment. Thus, antiretroviral therapy (ART) played an important immune status recovery role. Encountered ocular conditions vary, some being directly caused by the presence of the virus, and the others were the result of opportunistic infections (cytomegalovirus, Varicella virus) or other co-infections (Treponema pallidum). Neurological conditions disturbing the natural defense mechanism, prolonged hospital stay, and exposure to multiple antibiotic regimens are risk factors for difficult-to-treat eye infections with multidrug-resistant bacteria. Some ocular conditions can be the reason that leads to HIV infection diagnosis, while others can appear during the time, especially in patients with low ART adherence. The prognostic is conditioned by the early recognition and correct management of the disease and the immunological status recovery under ART. Conclusions: Correct and early diagnosis of HIV-related eye conditions is mandatory to establish the most appropriate medical management to obtain an increase in the quality of life of the patient. Abbreviations: HIV = Human Immunodeficiency Virus, AIDS = Acquired Immunodeficiency Syndrome, ART = Antiretroviral Therapy.

Occurrence of acute otitis and sinusitis in patients hospitalized for influenza.

Introduction: Acute otitis and sinusitis are common complications in patients with influenza and are responsible for increased hospitalization rates. Methods: A five-year retrospective study (2018-2023) was conducted including all patients hospitalized for influenza (etiologic diagnosis by RT-PCR) to identify the incidence and characteristics of cases complicated with otitis and/or sinusitis. Cases associated with other viral co-infections were excluded from the analysis. Results: We identified a cumulative rate of 20.6% (324 cases) of acute otitis (AO) and acute sinusitis (AS) among patients with influenza. Of these, 62.3% had AO, 28.1% AS, and 9.6% concomitant AO and AS. Cases of AO were predominant in the pediatric population (97.0%), while cases of AS were more common in adults (56.1%). Influenza A viruses were identified in 67.2% of patients. The infection with influenza B viruses increased the risk of acute congestive otitis media 2.1-fold (p=0.020), and influenza A viruses increased the risk of acute maxillary sinusitis 2.7-fold (p=0.029). Late presentation to the hospital, with a median of 4 days from the onset of influenza symptoms, was identified as a factor in the occurrence of AO and AS. Conclusions: The risk of AO and AS is increased in patients with influenza, especially in the pediatric population and in late hospital presentations. These findings highlight the importance of proper monitoring and management of patients with influenza to prevent the development of complications, as well as the need to better understand the mechanisms whereby influenza viruses contribute to these secondary conditions.

Hospitalizations for Acute Otitis and Sinusitis in Patients Living with HIV: A Retrospective Analysis of a Tertiary Center in Romania.

Background/Objectives: Acute or chronic ear, nose and throat (ENT) conditions in people living with HIV can lead to hospitalization and affect their quality of life. The aim of our study was to determine the frequency and characteristics of hospitalizations for acute sinusitis (AS) and acute otitis (AO) in people living with HIV. Methods: We performed a retrospective analysis over the course of six years (from January 2018 to December 2023), assessing all hospitalizations for AS and/or AO occurring in patients living with HIV, at the largest infectious diseases hospital in Romania. Results: We identified a total of 179 cases, among which 149 cases (83.2%) were attributed to AS and 41 cases (22.9%) were due to AO. Among cases of AS, maxillary sinuses were most frequently involved (n = 140/149, 94.0%), and among cases of AO, acute congestive otitis media (n = 14, 34.1%) and acute purulent otitis media (n = 13, 31.7%) were the most common forms. The underlying HIV infection was classified as stage C3 in 57.5% of cases. In 19.6% of cases, it was possible to identify either the trigger or the etiological agent, and the most frequent bacterial pathogens were Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. Conclusions: In conclusion, this study highlights that hospitalizations due to acute sinus and ear involvement are not isolated events in people living with HIV. A prospective follow-up is needed to gain a deeper and more dynamic understanding of how ENT health is affected in people with HIV infection. Furthermore, promoting prevention through vaccination may reduce to a certain extent the burden of ENT infections in this population.

Cardiovascular Risk Factors, Angiographical Features and Short-Term Prognosis of Acute Coronary Syndrome in People Living with Human Immunodeficiency Virus: Results of a Retrospective Observational Multicentric Romanian Study.

People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.

Omicron in Infants-Respiratory or Digestive Disease?

The Omicron variant of SARS-CoV-2 has caused a large number of cases and hospitalizations in the pediatric population. Infants due to their age are susceptible to viral infections that may have a worse prognosis. Therefore, the aim of the current study has been to characterize the clinical features and the outcome of infants hospitalized with confirmed SARS-CoV-2 infection during the Omicron wave. We conducted a retrospective study of all consecutive infants hospitalized with symptomatic COVID-19 and no other co-infections, from January to September 2022 in one of the largest infectious diseases hospitals from Bucharest, Romania. A total of 613 infants were included in the analysis. The median age was 5 months (IQR: 3, 8 months). The clinical features were dominated by fever (96.4%), cough (64.8%) and loss of appetite (63.3%), and overall, respiratory symptoms were the most numerous (76.0%). Infants between 1-3 months old had a 1.5-fold increased risk of elevated alanine aminotransferase (ALT) values, and a longer length of hospitalization as compared to older infants. Infants between 7-9 months of age had 1.5-fold higher odds of loss of appetite, 1.7-fold more frequent cough and 1.6-fold more frequent digestive symptoms compared to infants in other age groups. The presence of digestive symptoms increased the probability of hepatic cytolysis (increased ALT) by 1.9-fold. Continued monitoring of COVID-19 among infants is very necessary, given the progressive character of SARS-CoV-2, in order to take correct and rapid therapeutic measures and to adapt to clinical changes driven by viral variant change.

En-face optical coherence tomography analysis of gold and silver nanoparticles in endodontic irrigating solutions: An in vitro study.

Optical coherence tomography (OCT) is a non-invasive, non-radioactive optical diagnostic method based on low-coherence interferometry, which achieves images with different orientation. In dentistry, its major advantage is represented by the localization and characterization of the smallest defects in hard dental tissues, dental materials and of the smallest details in dental anatomy (supplementary canals, recesses, isthmuses, or intra-radicular connections). The aim of the present in vitro study was to evaluate using c-scan en-face optical coherence tomography, the optical opacity, and the distribution inside the root canal lumen of several extracted human teeth of silver and gold nanoparticles from special irrigating solutions used in endodontic treatment. Twelve root canals from 5 human teeth were instrumented using the ProTaper Universal system after initial negotiation with hand K-files ISO no. 10 and rotary nickel-titanium PathFile instruments. An initial c-scan OCT analysis was performed for each sample to confirm that the root canal lumen was empty from radiopaque materials (Group 1). Teeth were first irrigated with NanoCare Plus (Group 2) and then with NanoCare Gold (Group 3) and C-scans were repeated after each irrigation method. The OCT investigation started at the tooth apex, at a depth of 1 mm from its tip. Subsequently, 100 slices of 10 microns were obtained from each root canal. Images were captured and then analyzed with ImageJ software to calculate the level of grey inside the root canal lumen. The highest values of grey were obtained in the samples irrigated with NanoCare Gold after NanoCare Plus (Group 3). The present study proved that both nanoparticles inserted in root canal irrigants were evidenced through OCT imagistic analysis due to their optical opacity, which allowed their highlighting in an empty root canal lumen, after the endodontic treatment was performed and the root canal was cleaned and shaped using specific protocols.

Geographical origin identification of Romanian wines by ICP-MS elemental analysis.

Trace elemental analysis, besides its ability to determine stable isotopes ratios, represents a possible complementary tool useful to differentiate wines based on their regional origins. Wines and their provenance soils from two major wine producing areas in Southeast Romania ('Valea Calugareasca' and 'Murfatlar'), and also wine from the region of Moldova (Eastern Romania) were analyzed by inductively coupled plasma mass spectrometry (ICP-MS), and statistical data of elemental composition was used to differentiate these wines according to grape type and geographical origin. Moreover, this study gathers relevant elemental trace composition of wines produced in most important Romanian vineyards, thus offering a useful wine differentiation tool by their production district. The results show that the differentiation of Romanian wines according to their provenance is based on the following main elements: Ni, Ag, Cr, Sr, Zn, and Cu for Valea Calugareasca, Rb, Zn, and Mn for Murfatlar, and Pb, Co, and V for Moldova.