Comparative Evaluation of N-Butyl Cyanoacrylate and Silk Sutures on Healing of Periodontal Flaps: A Clinico Histological Evaluation.

Background The periodontal flap is one of the most frequently employed procedures. Closure of reflected flap is important step in flap surgery. Black silk sutures are most often used material in routine surgical procedures. These suture materials demand more time and effort and expertise from the surgeon. Tissue adhesives have been developed as alternatives to overcome these problems such as cyanoacrylates. Objective The present study is an attempt to compare effectiveness of the black silk suture with cyanoacrylate adhesives in closing reflected periodontal flap. Method Thirty systemically healthy patients who underwent bilateral flap surgery were given 3-0 black silk sutures on one side and N-butyl cyanoacrylate adhesive on the other side to close a surgical incision. All the participants in the study were recalled on the seventh, 21st, 42nd day. Participants were evaluated for healing and plaque accumulation by assessing the gingival index, plaque index, wound healing index. Biopsy specimens were obtained on seventh and 42nd postoperative day. Result The amount of inflammation was less during the first week of healing when cyanoacrylate was compared with silk. However, over a period of 21 days to 42 days, the sites treated with both the materials showed similar healing patterns without any significant difference in the evaluated parameter. Conclusion The result of the study showed that the use of cyanoacrylate for the closure of periodontal flaps results in better initial post-operative healing as compared to closure with silk suture and that this method of closure can be advocated in a routine surgical periodontal practice.

Genetic association between the HLA-G 14-bp insertion/deletion polymorphism and the recurrent spontaneous abortions in Saudi Arabian women.

The non-classical class I human leukocyte antigen (HLA)-G molecule was found to be predominately expressed in the extravillous cytotrophoblasts at the fetal-maternal interface during pregnancy. This molecule is critically important for successful implantation during human pregnancy. The polymorphic insertion-deletion (indel) 14-base pair (bp) site localized at the 3' untranslated region was associated with HLA-G mRNA stability and isoform alternative splicing patterns, and thus may influence HLA-G function during pregnancy. We studied the association between the 14-bp indel polymorphism (rs16375) at the 3' untranslated region with recurrent spontaneous abortions in a Saudi population living in Riyadh. A group of 64 women with 2-11 successive abortions were included in this study. The control group included 62 women without reported abortions and at least 2 pregnancies, all visiting the King Khaled Hospital in Riyadh. The 14-bp indel was genotyped in the case and control groups. The frequency of the genotype +14/+14 was slightly higher in women with recurrent spontaneous abortions, but no significant differences were observed in the distribution of alleles and genotypes.

Malvidin attenuates behavioral and inhibits the TNF-α/Caspase-3/Nrf-2 expression in rotenone-induced Parkinson's disease in rats: insights from molecular docking.

OBJECTIVE: Malvidin is a natural, biologically active polyphenol found in several fruits. It exhibits several therapeutic benefits; however, limited studies are available on its effects on neurodegenerative clinical conditions, including Parkinson's disease. The study aimed to investigate the therapeutic properties of malvidin on rotenone-triggered Parkinson's disease in an animal model. MATERIALS AND METHODS: To determine the effects of malvidin, rotenone (1.5 mg/kg) was injected subcutaneously into Wistar rats for 21 days, followed by a dose of malvidin (200 and 100 mg/kg). Behavioral tests were performed on the experimental animals before sacrifice. On the 22nd day of the experiment, biochemical tests were performed, including superoxide dismutase (SOD), glutathione (GSH), malondialdehyde (MDA), and catalase (CAT). The activity of neurotransmitters and their metabolites, including acetylcholine (ACh), acetylcholinesterase (AChE), dopamine (DA), norepinephrine (NE), serotonin (5-HT), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA) along with neuroinflammatory markers including interleukin-6 (IL-6), interleukin-1ß (IL-1ß), tumor necrosis factor- α (TNF-α), and nuclear factor erythroid 2-related factor 2 (Nrf-2) were estimated. Moreover, the level of the apoptotic marker, caspase-3, was also estimated. In addition, molecular docking was performed. RESULTS: The administration of rotenone resulted in oxidative stress, cholinergic imbalances, dopaminergic alternations, and increased expression of inflammatory compounds. The docking analysis revealed that malvidin displayed a favorable binding affinity for AChE, showcasing a binding energy of -9.329 Kcal/mol. CONCLUSIONS: The investigation concludes that malvidin exhibits neuroprotective effects due to its curative effects against inflammation and oxidative stress. These findings suggest that malvidin possesses therapeutic potential against rotenone-triggered behavioral, oxidative, and inflammatory abnormalities in rodents.

[Endoscopic treatment of renal diverticular stone (Single Centre Study of 45 cases)]. / Traitement endoscopique des calculs caliciels intradiverticulaires : à propos d'une série monocentrique de 45 patients.

OBJECTIVE: We aim to evaluate the outcome of flexible ureterorenoscopy (F-URS) with holmium laser in treating renal diverticular stone as a minimal invasive option. PATIENTS AND METHODS: We reviewed retrospectively the records of 45 patients who underwent F-URS using holmium laser from 2004 to 2011 for symptomatic renal diverticular stone. The presenting symptoms were renal colic, urinary tract infection or hematuria. The F-URS used after the Shock Wave Lithotripsy (SWL) failure in 30 (66.7 %) patients. The repeated treatment by F-URS was carried out twice for four patients; in three patients, it was correlated to the size of the stone and it was because of failure to identify the diverticulum in one patient. The follow up visit range were between 4 to 6 weeks with plain radiograph (KUB) and renal ultrasound or non-contrast CT scan (NCCT). RESULTS: Of our data, there were 45 patients, 22 women and 23 men (mean age of 46.3 years, range 18-72). We found 28 patients (62.2 %) who had stone free (SF), 10 patients (22.2 %) with clinically insignificant residual fragments (less than 3mm in size) and residual fragments (RF) in seven patients (15.6 %). Success rate was considered as stone free or insignificant residual fragment, which was obtained in 38 patients (84.4 %). The symptom-free was in 42 patients (93.3 %). CONCLUSION: In our experience, F-URS using holmium laser was very effective minimally-invasive technique that could be the best option for the treatment of renal diverticular stone especially for those who resist the treatment with the SWL. It showed an excellent stone clearance rate, minimal morbidity rate and brief hospital stay.

Diabetes is associated with impairment of uterine contractility and high Caesarean section rate.

AIMS/HYPOTHESIS: The prevalence of births worldwide complicated by diabetes mellitus is increasing. In the UK, for example, <25% of diabetic women have a non-instrumental vaginal delivery. Strikingly, more than half the Caesarean sections (CS) in these patients are non-elective, but the reasons for this are not understood. We have tested the hypothesis that poor myometrial contractility as a consequence of the disease contributes to this high CS rate. METHODS: We compared spontaneous, high K depolarisation and oxytocin-induced contractions from diabetic and matched control patients having an elective CS. To investigate the mechanism of any differences we measured intracellular Ca, and performed western blotting and compared the tissues histologically. RESULTS: There was significantly decreased contraction amplitude and duration in uteri from diabetic compared with control patients, even when possible confounders such as BMI were analysed. Reduced intracellular calcium signals and expression of calcium entry channels were found in uteruses from diabetic patients, which, along with a reduction in muscle content found on histological examination, could explain the reduced force. Myometrium from diabetic patients was responsive to oxytocin, but still did not reach the levels found in non-diabetic patients. CONCLUSIONS/INTERPRETATIONS: These are the first data investigating myometrium in diabetic patients and they support the hypothesis that there is poorer contractility even in the presence of oxytocin. The underlying mechanism is related to reduced Ca channel expression and intracellular calcium signals and a decrease in muscle mass. We conclude that these factors significantly contribute to the increased emergency CS rate in diabetic patients.

Plant diversity in Sabkha ecosystems of arid region: spatial and environmental drivers.

This study investigated the effects of spatial and environmental factors and their interactions on plant species composition in salt marsh (Sabkha) ecosystem located in arid region (Saudi Arabia). The plant species and environmental variables were investigated in 38 sites located in three regions. A total of 15 environmental variables were measured in each site and the geographical coordinates were used to extract spatial variables (using PCNM). A total of 81plant species were reported from 38 sites. The three regions showed patterns of homogeneity of multivariate dispersions (i.e. beta diversity). The PCNM analysis extracted 18 PCNM vectors and only 3 vectors were retained after forward selection. The spatial variables (selected PCNM vectors) explained only 3.21% of the variation in species composition of plants (using variation partitioning technique). However, eight environmental variables were selected after forward selection (Lead, Copper, total organic matter, Potassium, Magnesium, pH, Zinc and Iron, F= 4.72, P<0.05) and explained 19.61% of the total variation in the species composition. In conclusion, the plant communities in Sabkhas were not spatially structured due to the low percentage of variation explained by the spatial variables (PCNM vectors). The environmental variables were corresponded to the high fraction of variation explained. On the other hand, Sabkhas in Saudi Arabia are considered a hot spot for diversity not only for plants but for other animals (birds, vertebrates and invertebrates). Therefore, immediate conservation plans should be implemented to reduce the adverse effect of urbanization, industrialization as well as other anthropogenic activities.

[Horseshoe kidney stones: benefit of flexible ureterorenoscopy with holmium laser]. / Calculs urinaires et rein en fer à cheval: place de l'urétérorénoscopie souple-laser.

OBJECTIVES: We aim to assess the outcome of the flexible ureterorenoscopy (F-URS) with holmium laser in treating horseshoe kidney (HSK) stones. PATIENTS AND METHODS: We reviewed retrospectively the records of 18 patients with HSK stone (18 renal units) who underwent F-URS using holmium laser from December 2004 to October 2009. The mean age was 37.7±6.9 years. The F-URS used after the extracorporeal shock wave lithotripsy (ESWL) failure in eight patients (44.4%) and four patients (22.2%) had PCNL failure. The follow up visit range were between 4 and 6 weeks with plain radiograph (KUB) and renal ultrasound or non contrast computed tomography scan (NCCT). Success rate was defined as stone free or residual fragment less than 3 mm. Use of auxiliary procedures like ESWL were considered as treatment failure. RESULTS: Eighteen patients, three females and 15 males with mean age was 37.7±6.9 years with HSK calculi underwent ureteroscopic management. The presenting symptoms were renal colic, urinary tract infection or hematuria. We found different HSK stone location (11 mixed calyceal, three mixed pelvic and calyceal and four pelvic). The average stone burden was 15.5±7.3 mm and the mean operative time was 112±9.4 minutes. All over procedures were 27, with mean average of 1.5 procedures per patient. The success rate was 89%. CONCLUSION: The F-URS with holmium laser is an efficient minimal invasive procedure in treating HSK stones.

[Narrow band imaging: description of the technique and initial experience with upper urinary tract carcinomas]. / Narrow Band Imaging (NBI) : mise au point sur la technique et expérience initiale pour les tumeurs de la voie excrétrice urinaire supérieure.

PURPOSE: Endoscopic treatment of upper urinary tract carcinomas (UUTC) is becoming more and more prevalent compared to non-conservative surgery. Our goal was to determine if NBI technology could improve tumour detection. MATERIAL: Twenty-seven patients with known or suspected UUTC were prospectively enrolled and treated using the Olympus URF-V flexible ureteroscope. We report 13 new cases (48%) and 14 known cases as follow up (52%). White light and NBI were subsequently performed to examine the upper urinary tract. Visual aspect of the lesions could be compared using both types of light. Biopsies were taken for all apparent lesions prior to vaporization by Holmium laser. RESULTS: Forty-three lesions were detected in 21 patients. Five lesions (14.2%) in four patients were detected through NBI light only among the 35 lesions containing UUTC. Two out of four of these patients were new cases and would not have been diagnosed with white light alone. Three UUTC-treated (8.5%) had extended margins in NBI. Thirteen biopsies (26%) were not valid. Altogether, the tumour detection rate improved by 22.7% in seven patients (25.9%) by using the NBI method. CONCLUSION: Upper urinary tract endoscopy with NBI light is a new technology that improves visualization of UUCT and enables diagnosis of lesions non visible in white light. This procedure cannot yet be recommended for daily practice and further validation of the technique is required.

Effect of Pfizer/BioNTech and Oxford/AstraZeneca vaccines against COVID-19 morbidity and mortality in real-world settings at countrywide vaccination campaign in Saudi Arabia.

OBJECTIVE: Vaccinations are highly essential to control infectious diseases and epidemics. Presently, the entire world faces a challenging crisis of "Severe Acute Respiratory Diseases Coronavirus 2 (SARS-CoV-2), also known as the COVID-19 pandemic". The impact of vaccines at national levels to reduce the SARS-CoV-2 cases and deaths are unclear, and people have concerns about the effectiveness of vaccines in real-world settings. This study's objective was to examine the effect of the "Pfizer/BioNTech and Oxford/AstraZeneca" vaccines to prevent SARS-CoV-2 cases and deaths in Saudi Arabia. MATERIALS AND METHODS: In this retrospective cohort study, we collected data on SARS-CoV-2 cases and deaths from the date of the first case of SARS-CoV-2 in Saudi Arabia March 2, 2020, to the date of launching the vaccination campaign on December 14, 2020; and from December 15, 2020, to September 8, 2021. We recorded the World Health Organization data and Ministry of Health of Saudi Arabia to evaluate the impact of the "Pfizer/BioNTech, (BNT162b2 mRNA) and Oxford/AstraZeneca (AZD1222)" vaccine against SARS-CoV-2 cases and deaths before and after the vaccination campaign in Saudi Arabia. RESULTS: Saudi Arabia launched the "Pfizer/BioNTech and Oxford/AstraZeneca" vaccination campaign against SARS-CoV-2 on December 14, 2020. In Saudi Arabia, before the vaccination campaign from March 2, 2020, to December 14, 2020, the mean daily SARS-CoV-2 cases were 1235.60, daily deaths were 22.70, that significantly reduced (p=0.0001) compared to the period after the vaccination campaign from December 15, 2020, to September 8, 2021, in which the daily cases fell to 692.08, and daily deaths fell to 9.48 (p=0.0001). CONCLUSIONS: In Saudi Arabia, Pfizer/BioNTech and Oxford/AstraZeneca vaccinations significantly reduced the number of SARS-CoV-2 cases and deaths after the vaccination compared to the period before the vaccination campaign at country levels. The study findings demonstrate that vaccination and adherence to nonpharmaceutical intervention can better control the COVID-19 pandemic.

End-of-life practices in a tertiary intensive care unit in Saudi Arabia.

Our aim was to evaluate end-of-life practices in a tertiary intensive care unit in Saudi Arabia. A prospective observational study was conducted in the medical-surgical intensive care unit of a teaching hospital in Riyadh, Saudi Arabia. Over the course of the one-year study period, 176 patients died and 77% of these deaths were preceded by end-of-life decisions. Of these, 66% made do-not-resuscitate decisions, 30% decided to withhold life support and 4% withdrew life support. These decisions were made after a median time of four days (Q1 to Q3: 1 to 9) and at least one day before death (Q1 to Q3: 1 to 4). The patients' families or surrogates were informed for 88% of the decisions and all decisions were documented in the patients' medical records. Despite religious and cultural values, more than three-quarters of the patients whose deaths were preceded by end-of-life decisions gave do-not-resuscitate decisions before death. These decisions should be made early in the patients' stay in the intensive care unit.

Acetabular fractures before and after the introduction of seatbelt legislation.

OBJECTIVES: To compare the incidence and severity of acetabular fractures and associated injuries before and after seatbelt legislation. DESIGN: A retrospective study. SETTING: Two major trauma centres, which are teaching hospitals. PATIENTS: Three hundred and ninety-three patients who sustained acetabular fractures during the 5 years before and 5 years after seatbelt legislation was enacted. Of these, the fractures in 198 patients (50.4%) resulted from a motor vehicle accident. MAIN OUTCOME MEASURES: The number and severity of acetabular fractures and associated injuries. RESULTS: There has been a significant reduction in the number of acetabular fractures (p = 0.005) since seatbelt use became mandatory, and the complexity of the fractures has decreased. There has also been a marked reduction in associated injuries, such as fractures of other bones, and head, chest and abdominal injuries (p < 0.001). CONCLUSION: The seatbelt law has been a useful preventive measure, resulting in a reduction in the incidence of acetabular fractures and associated injuries.