Complement-Mediated Thrombotic Microangiopathy and Spontaneous Splenic Rupture Associated With Cytomegalovirus Infection.

This is a case report of a previously healthy female patient with complement-mediated thrombotic microangiopathy (TMA) caused by a systemic cytomegalovirus infection that was successfully treated with plasmapheresis, steroids, and parenteral valganciclovir. Complement-mediated TMA is the result of various genetic mutations leading to complement abnormalities with overactivation of alternate complement pathway in response to a triggering infection. She also had splenic rupture without splenomegaly and was managed successfully without splenectomy.

Comparison of the elastic recovery and strain-in-compression of commercial and novel vinyl polysiloxane impression materials incorporating a novel crosslinking agent and a surfactant.

This study aims to formulate experimental vinylpolysiloxane (VPS) impression materials and compare their elastic recovery and strain-in-compressions with three commercial VPS materials (Aquasil, Elite, and Extrude). Five experimental materials (Exp), two hydrophobic (Exp-I and II) and three hydrophilic (Exp-III, IV and V) were developed. Exp 1 contained vinyl-terminated poly-dimethyl siloxane and a conventional cross-linking agent (poly methylhydrosiloxane), while Exp- II contained a novel cross-linking agent that is tetra-functional dimethyl-silyl-ortho-silicate (TFDMSOS). Exp III-V (hydrophilic materials) were formulated by incorporating different concentrations of non-ionic surfactant (Rhodasurf CET-2) into Exp II formulation. Measurement of elastic recovery and strain-in-compression for commercial and experimental materials were performed according to ISO4823 standard using the calibrated mechanical testing machine (Tinius Olsen). One-way analysis of variance (one-way ANOVA) and Tukey's post-hoc (HSD) test were used for statistical analysis and a p-value of ≤ 0.05 was considered significant. Exp-I has statistically similar values to commercial VPS. The Exp-II showed the highest elastic recovery, while % elastic recovery was reduced with the addition of the non-ionic surfactant (Rhodasurf CET-2). The % reduction was directly related to the concentration of Rhodasurf CET-2. In addition, Exp II had significantly higher strain-in-compression values compared to Exp-I and commercial materials. These values were further increased with the addition of a non-ionic surfactant (Rhodasurf CET-2) was added (Exp-III, IV and V).

Capsule endoscopy in gastrointestinal disease: Evaluation, diagnosis, and treatment.

Capsule endoscopy, also known as wireless capsule endoscopy or video capsule endoscopy, is a noninvasive procedure that uses a swallowed capsule-shaped miniature camera for direct visual and diagnostic evaluation of gastrointestinal (GI) disease. Although originally intended as a tool to examine the small intestine, which is mostly beyond the reach of conventional endoscopy, capsule endoscopy is now also being used to examine the entire length of the GI tract.

Validation and Reliability Testing of the Child Oral Impacts on Daily Performances (C-OIDP): Cross-Cultural Adaptation and Psychometric Properties in Pakistani School-Going Children.

Background: This study aimed to develop an Urdu version of Child-Oral Impact on Daily Performance (C-OIDP) and assess its reliability and validity for children's oral health-related quality of life (OHRQoL) assessment in Pakistan. Methods: A total of 200 school-going children aged 11−14 were recruited from two public schools. For the adaptation process, the original English version of C-OIDP was translated into Urdu, reviewed by an expert committee, back-translated into Urdu, and then reviewed again by the same expert committee and pilot tested on 10 children. A clinical examination was carried out to record dental and gingival status followed by a face-to-face interview to measure oral health-related quality of life in children using C-OIDP-U. Reliability, internal consistency, construct and discriminant validity were assessed. Results: The Cronbach's alpha for C-OIDP-U was 0.69, the mean C-OIDP-U score was 10.2 ± 8.1 and 77.3% of the children reported at least one oral impact. Eating (40.3%) and difficulty in cleaning mouth (38.7%) were the two most impacted daily performances. For construct validity, the associations were significant between the C-OIDP-U score and all subjective oral health measures (p < 0.001). For discriminant validity, a significant association was observed between the C-OIDP-U score and clinical oral variables, children with DMFT + dmft ≥ 1, Gingival index > 1 and having malocclusion reported a higher C-OIDP-U score when compared to their counterparts. Conclusion: This study showed that C-OIDP is a valid, reliable and efficient instrument of OHRQoL for use in Pakistani children.

Dimensional changes of commercial and novel polyvinyl siloxane impression materials following sodium hypochlorite disinfection.

BACKGROUND: Dental impressions are used to record anatomy of teeth and surrounding oral structures. Impression materials become contaminated with saliva and blood requiring disinfection, which may have negative impact on dimensional stability of materials. OBJECTIVE: Comparatively evaluate linear dimensional changes of synthesized Tetra-functional (dimethylsilyl) orthosilicate (TFDMOS) containing Polyvinylsiloxane (PVS) impressions following sodium hypochlorite disinfection. METHODS: Percentage dimensional changes of three commercial PVS (Elite HD Monophase, Extrude and Aquasil Ultra Monophase) and five experimental PVS impression materials were measured. Experimental material contained novel cross-linking agent (TFDMOS) and a non-ionic surfactant (Rhodasurf CET-2) that is Exp-A (without TFDMOS), Exp-B (with TFDMOS), Exp-C (TFDMOS+ 2% Rhodasurf CET-2), Exp-D (TFDMOS+ 2.5% Rhodasurf CET-2) Exp-E (TFDMOS+ 3% Rhodasurf CET-2). Samples were made using rectangular stainless-steel molds (40 × 10 × 3 mm3) and linear dimensional changes were measured using a calibrated travelling microscope at 10× magnification after immersion in distilled water (D.W) and 1% Sodium Hypochlorite solution at two different time intervals i.e., 30 min and 24 h. RESULTS: Samples immersed in 1% NaOCl showed significant (p < 0.05) dimensional changes after 30 min of immersion. Exp-E showed significantly greater dimensional changes than their control (Exp-A and Exp-B). In distilled water, there were no significant difference among the tested materials. Aquasil exhibited highest expansion (0.06%) in both solutions. At 24 h, among the commercial materials, Extrude had the greatest expansion followed by Aquasil and Elite in DW while Aquasil showed the greatest expansion followed by Extrude and Elite in NaOCl. CONCLUSION: Experimental PVS had linear dimensional changes within the ISO 4823; 2015 recommended range. However, extended immersion can negatively affect the linear dimensions.

Comparison of the Hardness of Novel Experimental Vinyl Poly Siloxane (VPS) Impression Materials with Commercially Available Ones.

PURPOSE: To determine the hardness and Young's moduli of both commercial and experimental vinyl poly siloxane (VPS). METHODS: The purpose of this study was to develop a medium-bodied experimental (Exp-I, II, III, IV, and V) VPS impression materials and to analyse their effects on hardness and Young's modulus and compare them with three commercial VPS materials (Aquasil, Elite, and Extrude) using Shore A hardness tester. Measurements were recorded after 1, 24, 72, and 168 hours of mixing. The results were analysed with one-way ANOVA and post hoc Tukey's test using the SPSS PASW statistical 22 software. RESULTS: Commercial and experimental vinyl polysiloxane exhibited higher Shore A hardness values with time (i.e., 1 hour after mixing, 24 hours after mixing, 72 hours after mixing, and 1 week after mixing). All Comml and Exp VPS demonstrated a significant increase (ANOVA, p < 0.05) in hardness at increasing time points. Generally, all commercial VPS exhibited significantly higher values for Shore A hardness compared to all Exp formulations. For commercial products, Elt M presented significantly highest values at all-time points followed by Aq M then Extr M. Exp-I was significantly harder than all other Exp VPS at all-time points. Young's modulus values were directly related to Shore A hardness; materials with higher Shore A hardness values had higher Young's moduli. CONCLUSION: Continued polymerisation of elastomeric impression materials results in increased hardness over time. Hardness, Young's moduli, and rigidity of the set commercial and experimental VPS materials were within the required limits. Shore A hardness and Young's moduli were directly proportional to each other, and commercial and experimental materials had enough rigidity to contain the stone during pouring.

Physico-Mechanical Properties of Commercially Available Tissue Conditioner Modified with Synthesized Chitosan Oligosaccharide.

This study aims to compare the hardness, sorption and solubility of commercially available tissue conditioner [TC] modified with chitosan [CS] and synthesized chitosan oligosaccharide [COS] in antifungal concentration. COS was synthesized by acid hydrolysis and characterized by FTIR and XRD. Experimental materials were formulated by incorporating each per gram of TC powder with effective antifungal concentration of chitosan 1.02 mg (Group 1: TC-CS) and 0.51 mg COS (Group 2: TC-COS). A commercially available TC was used as control (Group 0: CTC). Shore A hardness test was performed according to ASTM D 2240-05 (2010) standards on samples stored in dry environment, distilled water (DW) and artificial saliva (AS) at 37 °C (n = 5 per group). Percent weight changes (n = 5 per group) after storage in DW and AS was used to record sorption and solubility. One-way Anova with post hoc Tukey's test was applied. FTIR and XRD confirmed low molecular weight and amorphous nature of COS. Experimental groups had higher Shore A hardness values; however, these changes were not significant. Greatest variations in durometer values (p ≤ 0.05) were observed during the first 24 h. Experimental groups had higher (p ≤ 0.05) percentage sorption and solubility. Samples stored in DW had significantly higher (p = 0.019) sorption, whereas material had higher (p = 0.005) solubility in AS. Mean solubility values in both immersion mediums was highest for Group 2, followed by group 1 and group 0. In addition, significant (p ≤ 0.05) increase in solubility upon aging was noted for each material. Experimental tissue conditioner had higher hardness, sorption and solubility. However, these changes are not substantial to interfere with their tissue healing property. Therefore, these materials may be considered and explored further as potential antimicrobial drug delivery agent for denture stomatitis patients.

Teledentistry awareness, its usefulness, and challenges among dental professionals in Pakistan and Saudi Arabia.

Objectives: This study aims to describe the perception of dental professionals in Pakistan and Saudi Arabia (SA) towards the practice of teledentistry, its usefulness and challenges. Methods: A cross-sectional study was carried out among 190 dentists from January 2021 to April 2021. The participants were included in the study using snowball sampling method. A 26-item adopted questionnaire was distributed using different social media channels. Chi-square test was used for analysis. Results: Out of 190 participants, 46.3% were from Pakistan and 53.7% were from SA. The majority of participants in both countries agreed that teledentistry would enhance guidelines and advice (74.2%), improve peer-to-peer interaction (79.5%) and make patient's referrals more efficient (75.8%). For the usefulness, most participants agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), avoid unnecessary travel (76.8%), helps monitoring (71.6%), and benefits patients in remote areas (74.7%); however, more Pakistani participants perceived that time spent with the patient would increase compared to SA participants (p < 0.001) and a higher proportion of SA participants believe that it helps in communication and monitoring of patients (p < 0.001) than Pakistani participants. Regarding the challenges in the use of teledentistry, few participants think that it violates the patient's privacy (22.6%) or is difficult to use (14.7%) or have distrust towards the teledentistry equipment (24.2%). Conclusion: The results indicated a high awareness and a positive attitude towards teledentistry, and its adaptation in their dental practice in both countries. However, limited infrastructure, set-up cost, and information technology (IT) literacy are the main challenges in integrating teledentistry which can be overcome by strategic government initiatives, policies, and programs.

Improved water absorption behaviour of experimental hydrophilic vinyl polysiloxane (VPS) impression materials incorporating a crosslinking agent and a novel surfactant.

OBJECTIVES: To study the effects of incorporating a further crosslinking agent and a novel surfactant on the water absorption behaviour of experimental VPS impression materials. METHODS: Part 1: The water uptake behaviour of Aquasil-Ultra-Monophase (AqM) was studied gravimetrically in three media (DW, 1%NaOCl and Perform ID), at 23 °C and 37 °C, over a period of one and four-months (n = 5) to gain information on long-term immersion. Part 2: Five experimental materials were formulated: Exp-I and II as hydrophobic and Exp-III-V as hydrophilic, containing an additional cross-linking agent (TFDMSOS) and Rhodasurf CET-2 surfactant. Their water uptake and desorption (both at 23 °C) properties (gravemetrically), solubility, pH and diffusion coefficient (DC) data were compared with three commercial, hydrophilic VPS impression materials, over seven days (n = 5). The results were analysed statistically. RESULTS: Part 1: Significant differences in water absorbed by AqM were observed in the three media at 23 °C. Aq M had a significantly higher uptake in 2% Perform ID, than in DW and NaOCl. At 37 °C, over four-months the uptake profiles were more enhanced and differed. Part 2: All Exp and commercial materials significantly increased in weight in both media (DW and 1% NaOCl at 23 °C), with differing uptake profiles and non-reached equilibrium. Exp-VPS absorbed significantly less water than commercial-VPS. Desorption of all VPS from both parts was faster than absorption, followed Fickian diffusion kinetics and reached equilibrium within 1-3 days. Desorption DCs for Exp-VPS were higher than commercial materials (10-10 versus 10-11 m2 s-1). The solubility was higher in 1% NaOCl compared to DW. The pH of DW after immersion of samples significantly increased compared to 1% NaOCl. SIGNIFICANCE: The incorporation of novel cross-linking agent, TFDMSOS and non-ionic surfactant, Rhodasurf CET-2, (ethoxylated-cetyl-oleyl alcohol) improved the dimensional stability of hydrophilic Exp-VPS in DW and 1% NaOCl. These materials merit further research in producing accurate casts of the patient's anatomy following disinfection.

Comparison of effect of locally available brands of clopidogrel on platelet aggregation in patients with coronary artery disease.

BACKGROUND: Anticoagulant effect of clopidogrel is of utmost importance in coronary artery disease, especially in prevention of coronary stent thrombosis. Recently, many new local brands of clopidogrel have been launched, with unknown efficacy. This study was conducted with the aim to compare two locally prepared clopidogrel brands, in terms of the effect of a loading dose of 600 mg on inhibition of platelet aggregation in patients with coronary artery disease. METHODS: This was a double blind randomised study. Sample population consisting of 35 patients, were admitted at Lady Reading Hospital, Peshawar, for the management of coronary artery disease. Baseline platelet aggregation of all these patients was measured. These patients were divided in two groups randomly. Group-A consisting of 18 patients was given brand 'A' clopidogrel 600 mg, while Group-B consisting of 17 patients was give brand 'B' of clopidogrel 600 mg. The platelet aggregation of both groups was then measured at baseline, and at 2, 4, and 6 hours after taking the loading dose of 600 mg. RESULTS: Platelet aggregation time at baseline in Group-A was 2.61 +/- 2.28 sec. and in Group-B it was 2.24 +/- 1.52 sec. (p = 0.57). After 2 hours of clopidogrel administration in Group-A the platelet aggregation time was 1.44 +/- 1.58 sec. and in Group-B it was 1.53 +/- 1.107 sec. (p = 0.85). Platelet aggregation time after 4 hours in Group-A was 0.28 +/- 0.57 sec. and in Group-B 1.06 +/- 1.03 sec. (p = 0.009), and after 6 hours it was 0.00 +/- 0.00 sec. in Group-A and in Group-B it was 0.59 +/- 0.71 sec. (p = 0.001). CONCLUSION: The two brands of clopidogrel had a significant difference in their effect on inhibition of platelet aggregation. Different brands of clopidogrel may not be equally effective.

Pattern of coronary artery disease with no risk factors under age 35 years.

BACKGROUND: Coronary artery disease (CAD) is no more deemed to be an ailment of the 4th or 5th decade; rather an earlier age incidence is not infrequently encountered in our population. However, there are a few data regarding CAD in young adults, and much about its underlying pathology still remains undetermined. The objective of this study was to delineate the coronary arterial disease pattern in adults under the age of 35 years, but having no known coronary risk factors. METHODS: This prospective study was conducted at the Cardiology Departments of all 3 public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After having excluded the traditional risk factors for CAD, patients under the age of 35 years with objective evidence of CAD were subjected to percutaneous coronary angiography. RESULTS: Out of a total of 104 patients, 85 (81.73%) patients were men, and 19 (18.27%) were women. The mean age of the whole group was 32.66 +/- 3.237 (22-35) years. Significant CAD (> 50% diameter narrowing of at least one major coronary artery) was found in 87 (83.7%) patients while 17 (16.3%) patients had non-atherosclerotic coronary artery disease, including 12 (11.53%) patients having normal coronary arteries, 1 (1%) patient had anomalous origin of right coronary artery (RCA), 1 (1%) patient had coronary arteritis, 2 (1.92%) patients had coronary artery ectasia, and 1 (1%) patient had a myocardial bridge over left anterior descending artery (LAD). Among the patients with significant CAD, the prevalence rate of one, two and three vessel disease was 54 (51.9%), 22 (21.2%) and 11 (10.6%) respectively. Almost 50% of the lesions occurred in LAD followed by 25% in RCA and 20% in circumflex, while only one patient (1%) had isolated significant CAD of left main coronary artery. Osteal segments were involved in 10%, proximal in 61%, mid in 21% and distal segments in 7% of the lesions. CONCLUSION: In the younger age group, CAD is mostly a disease of men, single vessel CAD predominates with LAD involvement mostly, predominant osteal to proximal segment involvement of vessels, and a much higher incidence of normal coronaries and non-obstructive CAD is met with.

The effects of cross-linking agent and surfactant on the tear strength of novel vinyl polysiloxane impression materials.

OBJECTIVES: To formulate experimental hydrophobic and hydrophilic vinyl polysiloxane (VPS) impression materials ab initio, comprising a novel cross-linking agent, tetra-functional (dimethylsilyl) orthosilicate (TFDMSOS), and a non-ionic surfactant, Rhodasurf CET-2 (ethoxylatedcetyl-oleyl alcohol), and to investigate their effects on tear strength (TS). METHODS: Five experimental formulations (Exp I-V) were prepared and compared with three medium bodied commercial VPS impression materials (Aq M, Elt M, Extr M). Tear test was performed on trouser test specimens (n=12 per material), at four time points (immediately, 24, 72 and 168 hours after setting). FTIR spectroscopy was used for identifying functional bonds and cross-linking. The results were analysed with one-way ANOVA, two-way ANOVA and post hoc Tukey's test using the SPSS PASW statistical 22 software. RESULTS: The material with novel cross-linking agent (Exp II) had significantly higher TSs at all-time points compared to Exp I (control; p˂0.05). Materials incorporating both TFDMSOS and surfactant (Exp III, IV and V), had further significantly increased TS at all-time points, which were concentration dependent. Extr M had a significantly lower TS (immediately after setting and at 24 hours) compared to all Exp and other commercial materials, with the exception of Elt M (difference not significant). The TSs of Exp II-V, after 72 and 168 hours, were significantly higher for than all commercial products and Exp I. FTIR spectra showed the consumption of Si-H groups indicating crosslinking had taken place with the addition of TFDMSOS and surfactant which contributed to an increase in the TS. SIGNIFICANCE: TFDMSOS cross-linking agent increased the TS of Exp II significantly at all-time points compared to the control. Novel surfactant further significantly increased TS, and it was also concentration dependent. Exp VPS with improved TS have been developed, addressing one of the drawbacks of commercial VPS materials.

Experimental hydrophilic vinyl polysiloxane (VPS) impression materials incorporating a novel surfactant compared with commercial VPS.

OBJECTIVES: To formulate experimental hydrophilic (Exp) VPS impression materials incorporating a novel surfactant (Rhodasurf CET-2), and to compare their contact angles (CAs) with commercial materials, before/after disinfection. METHODS: CAs were measured immediately after setting and after disinfection (1% NaOCl; 30min and 24h), together with their change whilst a droplet remained on the materials surface (over 10, 20, 30 60 and 120s), on three commercial (Aquasil Ultra-Monophase [Aq M], Elite HD-Monophase [Elt M], Extrude Medium-bodied [Extr M]) and four experimental (Exp I-IV) materials, using the Drop Shape Analysis 100 technique. The results were compared statistically. RESULTS: CAs of all experimental materials were within the range of those obtained for the commercial materials, with the exception of Exp-IV, which presented with the lowest CAs at the three time points. The control Exp-I was hydrophobic at all three time points (CAs ∼100+), as was Elite. Immediately after setting, Aq M had low CAs but these increased significantly after 30min of disinfection. After twenty four hours' disinfection CAs of all Exp/commercial VPS increased significantly compared to immediately after setting. The CAs of droplets left on the material (120s) decreased with time, even after disinfection, except for Exp-I. SIGNIFICANCE: The novel surfactant Rhodasurf CET-2 in Exp-III and IV, is an effective surfactant, retaining a low CA after disinfection, compared with Igepal CO-530 in Aq M. Disinfecting VPS impression materials for more than 30min increases their surface CAs, and therefore prolonged disinfection periods should be avoided.

Chemical and morphological characteristics of mineral trioxide aggregate and Portland cements.

The purpose of this study was to investigate the chemical composition and particle morphology of white mineral trioxide aggregate (WMTA) and two white Portland cements (CEM 1 and CEM 2). Compositional analysis was performed by energy dispersive X-ray spectroscopy, X-ray fluorescence spectrometry and X-ray diffraction whereas, morphological characteristics were analyzed by scanning electron microscope and Laser scattering particle size distribution analyzer. The elemental composition of WMTA, CEM 1 and CEM 2 were similar except for the presence of higher amounts of bismuth in WMTA. Calcium oxide and silicon oxide constitute the major portion of the three materials whereas, tricalcium silicate was detected as the major mineral phase. The particle size distribution and morphology of WMTA was finer compared to CEM 1 and CEM 2. The three tested materials had relatively similar chemical composition and irregular particle morphologies.