Evaluation of the accuracy of direct intraoral scanner impressions for digital post and core in various post lengths: An in-vitro study.

STATEMENT OF PROBLEM: Despite the growing utilization of direct intraoral scanners (IOSs) in dentistry, there is a scarcity of research investigating their accuracy, specifically in post and core. Few studies have conducted comprehensive three-dimensional assessments and comparisons of IOSs with the conventional impression technique, particularly in different post space lengths. PURPOSE: The purpose of this in vitro study was to digitally assess the accuracy of direct intraoral scanner (IOS) impressions for different post space lengths, specifically 6, 8, and 10 mm. MATERIALS AND METHODS: A total of 45 typodont teeth (maxillary central incisors) were selected for this study. The teeth underwent endodontic treatment and were divided into three subgroups, each with 15 teeth, based on the desired post space lengths: 6, 8, and 10 mm. Intraoral scans of all specimens were acquired directly using the CEREC Primescan intraoral scanners by two trained examiners. The obtained scan data were compared with conventional impressions obtained using light and heavy bodies of polyvinyl siloxane (PVS). As a control, the conventional impressions were subsequently scanned using an inEos X5a lab scanner. The accuracy of the digital scans was evaluated in the coronal, middle, and apical thirds using the Geomagic Control X software. Statistical analysis was performed using Bonferroni Post-hoc and One-way ANOVA tests to analyze the data. RESULTS: The overall mean root mean square (RMS) deviations for the different post lengths across the three thirds groups were 58, 81, and 101 µm for the 6, 8, and 10 mm subgroups, respectively. There were no statistically significant differences in the accuracy of the coronal and middle thirds among all subgroups (p > 0.5). However, in the apical third, the 10 mm subgroup exhibited a significantly lower accuracy (163 µm) compared to the 6 mm (96 µm) and 8 mm (131 µm) subgroups (p < 0.05). These results suggest that while the accuracy of intraoral scans using direct IOS impressions was consistent in the coronal and middle thirds regardless of the post length, there was a noticeable decrease in accuracy in the apical third, particularly with longer post lengths. CONCLUSION: Considering the limitations of this in vitro study, chairside direct IOS impressions offer a viable and clinically acceptable alternative to the conventional impression technique for post space lengths of 6 and 8 mm. However, as the post space length preparation increases, the accuracy of IOS decreases. CLINICAL SIGNIFICANCE: The Chairside direct IOS enables expedited and efficient digital impression capture within the root canal, ensuring acceptable accuracy for intracanal post length preparation of up to 8 mm.

Effect of ten different biomarkers in the gingival crevicular fluid of obese and non-obese undergoing fixed orthodontic treatment.

OBJECTIVE: The aim of this study is to evaluate the effect of ten proinflammatory cytokines in GCF of participants with raised body mass index (BMI) compared to non-obese subjects undergoing fixed orthodontic treatment. PATIENTS AND METHODS: In the cross-sectional cohort, subjects were shortlisted through the purposive sampling method with the same age and gender and similar characteristics (cohort). For inclusion and exclusion, predefined criteria were followed. In all included participants obese and non-obese collection of GCF was made from mandibular canine to canine. Identification of inflammatory mediators (MPO and CRP) leptin, adiponectin, and resistin (pg/mL). Bone remodeling biomarkers RANKL (pg/mL) and tissue remodeling biomarkers MMP8, MMP9, TIMP1, and MMP8/TIMP1, MMP9/TIMP1 ratio were collected and blinded by the investigator. Normal distribution of data i.e., age, BMI, the flow rate of GCF, indices plaque and gingival, and uWMS were compared using a t-test. Non-normality biomarker data were evaluated using Mann-Whitney U-test. To assess the relationship between the concentration of GCF biomarkers and plaque and gingival indices Pearson and Spearman correlation coefficients were used. RESULTS: The total number of participants included was 44. In the obese and non-obese groups, the male/female ratio was the same i.e., (n=11 each). The mean age of participants in the obese group was (25.7±1.55 years), whereas the non-obese group was (26.1±1.29 years). In obese the mean BMI was (33.6±2.1 kg/m2) whereas in non-obese (22.9±1.9 kg/m2) (p<0.02). Among the levels of biomarkers adiponectin (p<0.006) and leptin (p<0.028) demonstrated a significant difference between obese and non-obese participants. Also, a significant difference was noted between obese and non-obese in tissue remodeling biomarker MMP9 (p<0.03). CONCLUSIONS: A surge in the level of the biomarkers, i.e., MMP9, leptin, and adiponectin in the gingival crevicular fluid is found in obese undergoing fixed orthodontic treatment.

Efficient inactivation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in human apheresis platelet concentrates with amotosalen and ultraviolet A light.

OBJECTIVES: The detection of SARS-CoV-2 RNA in blood and platelet concentrates from asymptomatic donors, and the detection of viral particles on the surface and inside platelets during in vitro experiments, raised concerns over the potential risk for transfusion-transmitted-infection (TTI). The objective of this study was to assess the efficacy of the amotosalen/UVA pathogen reduction technology for SARS-CoV-2 in human platelet concentrates to mitigate such potential risk. MATERIAL AND METHODS: Five apheresis platelet units in 100% plasma were spiked with a clinical SARS-CoV-2 isolate followed by treatment with amotosalen/UVA (INTERCEPT Blood System), pre- and posttreatment samples were collected as well as untreated positive and negative controls. The infectious viral titer was assessed by plaque assay and the genomic titer by quantitative RT-PCR. To exclude the presence of infectious particles post-pathogen reduction treatment below the limit of detection, three consecutive rounds of passaging on permissive cell lines were conducted. RESULTS: SARS-CoV-2 in platelet concentrates was inactivated with amotosalen/UVA below the limit of detection with a mean log reduction of>3.31±0.23. During three consecutive rounds of passaging, no viral replication was detected. Pathogen reduction treatment also inhibited nucleic acid detection with a log reduction of>4.46±0.51 PFU equivalents. CONCLUSION: SARS-CoV-2 was efficiently inactivated in platelet concentrates by amotosalen/UVA treatment. These results are in line with previous inactivation data for SARS-CoV-2 in plasma as well as MERS-CoV and SARS-CoV-1 in platelets and plasma, demonstrating efficient inactivation of human coronaviruses.

Willingness of Hemodialysis Patient's Family Members Toward Kidney Donation: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: There is a significant shortage of kidneys available for donation. Family members of hemodialysis (HD) patients are experiencing the suffering of their close relatives, which can be a factor toward better acceptance to kidney donation. Knowledge is also an important factor that might affect willingness. In this study, we aimed to estimate the rate of willingness to donate kidneys as live donors (LD) and identify related potential barriers among family members of HD patients. METHODS: This was a cross-sectional observational study involving family members of adult HD patients from King Abdulaziz Medical City and the King Abdullah International Foundation dialysis project in Jeddah, Saudi Arabia. Participants were interviewed through phone calls using a pretested questionnaire. Calculated sample size was 385. RESULTS: A total of 370 family members of HD patients were included. Median age was 37 (interquartile range: 33-44) years and 64% were male. All participants were first-degree relatives to HD Patients. The majority reported willingness to donate kidneys as LD (n = 300, 81%), a proportion 0.81% with 95% confidence interval (CI; 0.77-0.85). Only 42 (11%) graded their knowledge about kidney transplantation as high or very high. On multivariable analysis, less willingness was shown with age >40 years (adjusted odds ratio [AOR] 0.459; 95% CI 0.266-0.792; P = .005), and female gender (AOR 0.496; 95% CI 0.287-0.856; P = .012). CONCLUSION: The majority of family members of HD patients were willing to donate kidneys. The willingness rate was lower among participants 40 years of age and older, as well as among women. The majority of patients graded their knowledge about kidney transplantation as average or lower. Therefore, education targeting of relatives of HD patients may help optimize knowledge and hence improve acceptance of kidney donation.

Rising prevalence of multiple sclerosis in Saudi Arabia, a descriptive study.

BACKGROUND: In 2015, the first nationwide, multicenter Multiple Sclerosis (MS) registry was initiated in the Kingdom of Saudi Arabia (KSA) mainly with an objective to describe current epidemiology, disease patterns, and clinical characteristics of MS in Saudi Arabia. This article aimed to report initial findings of the registry and regional prevalence of MS. METHOD: In 2015, a national MS registry was launched in KSA to register all MS patient with confirmed diagnosis according to the 2010 McDonald Criteria. The registry aimed to identify and recruit all healthcare facilities treating MS patients in the Kingdom, and collect data such as demographics, clinical characteristics (disease onset, diagnosis, presentation of symptoms at onset, disease course, relapse rate, and disability measures), family history, and treatments. All the included sites have obtained IRB/EC approvals for participating in the registry. Currently, the registry includes 20 hospitals from different regions across the Kingdom. The Projected prevalence was calculated based on the assumption that the number of diagnosed MS cases in participating hospitals (in each region) is similar to the number of cases in remaining nonparticipant hospitals in the same region. RESULTS: As of September 2018, the registry has included 20 hospitals from the different regions across the Kingdom and has collected comprehensive data on 2516 patients from those hospitals, with median age 32 (Range: 11-63) and 66.5% being females. The reported prevalence of MS for those hospitals was estimated to be 7.70/100,000 population and 11.80/100,000 Saudi nationals. Based on the assumption made earlier, we projected the prevalence for each region and for the country as a whole. The overall prevalence of MS at the country level was reported to be 40.40/100,000 total population and 61.95/100,000 Saudi nationals. Around 3 out of every 4 patients (77.5%) were 40 years of age or younger. Female to male ratio was 2:1. The prevalence was higher among females, young and educated individuals across all five regions of Saudi Arabia. CONCLUSION: The prevalence of MS has significantly increased in Saudi Arabia but is still much lower than that in the western and other neighboring countries like Kuwait, Qatar, and the UAE. However, compared to the past rates, Saudi Arabia's projected prevalence of MS through this national study is 40.40/100,000 population, putting the Kingdom above the low risk zone as per Kurtzke classification. The projected prevalence was estimated to be much higher among Saudi nationals (61.95/100,000 Saudi-nationals). The prevalence was higher among female, younger and educated individuals. Further studies are needed to assess the risk factors associated with increased prevalence in Saudi Arabia.

Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia.

BACKGROUND: Few data are available about the rate of short-term remission and its impact on the long-term outcomes of proliferative lupus nephritis in the Middle East. METHODS: An observational study was carried out involving 96 adult patients with biopsy-proven focal or diffuse proliferative lupus nephritis (PLN) from four different hospitals. Data on induction, remission and long-term outcomes were collected and analyzed. RESULTS: Among the 96 patients with biopsy-proven PLN (median age 27 (IQR: 21,34) years, 85% women and median duration of systemic lupus erythematosus (SLE) prior to diagnosis 27 (IQR: 11, 55) months), 67% developed remission at 6 months (proportion 0.67; 95% CI 0.57, 0.76). Mycophenolate mofetil (MMF) was used in 45/96 (47%), CYC in 41/95 (43%) and other agents in 10/96 (10%). The choice of MMF as induction agent has increased in recent years. Among baseline characteristics, only histologic activity was found to have a significant association with remission, with active lesions more likely to remit than active/chronic and chronic lesions (AOR 6.5, 95% CI 1.44-29.39, p = 0.015). Based on Kaplan-Meier analysis, the 5-year renal survival rate without doubling serum creatinine was 73.8%. Compared to patients with complete remission, lower long-term renal survival rates were observed in patients with no remission (89.7 versus 43%, p = 0.001) and partial remission (89.7 versus 77.6%, p = 0.256). The cumulative rate of doubling serum creatinine, dialysis, relapse and death was 23%, 11%, 10% and 5%, respectively, at 48-month median follow up. CONCLUSION: Approximately two-thirds of patients with PLN develop remission in response to standard induction therapy. Remission was negatively associated with the presence of chronic changes in renal biopsy. Overall, MMF is the most commonly used agent to induce remission; however, with more severe disease CYC, is used more frequently. PLN is associated with significant long-term renal outcomes including a 26% cumulative rate of doubling of serum creatinine at 5 years. Initial remission predicts this long-term renal survival.

ICSI outcome in patients with high DNA fragmentation: Testicular versus ejaculated spermatozoa.

Sperm DNA fragmentation (SDF) has emerged as an important biomarker in the assessment of male fertility potential with contradictory results regarding its effect on ICSI. The aim of this study was to evaluate intracytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular versus ejaculated spermatozoa. This is a prospective study on 36 men with high-SDF levels who had a previous ICSI cycle from their ejaculates. A subsequent ICSI cycle was performed using spermatozoa retrieved through testicular sperm aspiration. Results of the prior ejaculate ICSI were compared with those of the TESA-ICSI. The mean (SD) SDF level was 56.36% (15.3%). Overall, there was no difference in the fertilization rate and embryo grading using ejaculate and testicular spermatozoa (46.4% vs. 47.8%, 50.2% vs. 53.4% respectively). However, clinical pregnancy was significantly higher in TESA group compared to ejaculated group (38.89% [14 of 36] vs. 13.8% [five of 36]). Moreover, 17 live births were documented in TESA group, and only three live births were documented in ejaculate group (p < .0001). We concluded that the use of testicular spermatozoa for ICSI significantly increases clinical pregnancy rate as well as live-birth rate in patients with high SDF.

Hemodialysis Patients' Willingness to Undergo Kidney Transplantation: An Observational Study.

BACKGROUND: The number of dialysis patients is increasing, with only 20% undergoing kidney transplantation. In Saudi Arabia, no studies had examined transplantation barriers from the patients' perspectives. We aimed in this study to estimate hemodialysis (HD) patients' willingness to undergo kidney transplantation and to explore its underlying determinants. METHODS: In an observational cross-sectional study involving adult HD patients from King Abdulaziz Medical City and King Abdullah Dialysis Center-Jeddah, patients were interviewed through a pre-tested questionnaire. Calculated sample size was 243. RESULTS: Among the 252 HD patients (mean age, 55 years [standard deviation = 15.21]; 59% men; median duration on HD, 24 months [interquartile range, 11.1, 60]), 61% described their knowledge about kidney transplantation as "poor" or "very poor." Only 69% chose "willingness to undergo kidney transplantation" (proportion, 0.69; 95% confidence interval [CI], 0.64-0.75). The main reported reasons against willingness were being too old for transplantation (61%) and fear of surgical complications (26%). Less willingness was shown with age ≥60 years (adjusted odds ratio [AOR], 0.2; 95% CI, 0.11-0.36; P < .001), duration on HD ≥5 years (AOR, 0.47; 95% CI, 0.25-0.89; P = .021), and being non-married (AOR, 0.47; 95% CI, 0.24-0.93; P = .03). CONCLUSIONS: Approximately one third of the respondents did not choose "willingness to undergo kidney transplantation." Willingness was negatively associated with older age, lack of spouse, and longer duration on HD. The majority of HD patients reported poor knowledge about kidney transplantation. Therefore, structured education may optimize the knowledge, perceptions, and attitudes of HD patients toward kidney transplantation and hence improve their transplantation willingness.

Portal vein ligation versus portal vein embolization for induction of hypertrophy of the future liver remnant: A systematic review and meta-analysis.

An important risk of major hepatic resection is postoperative liver failure, which is directly related to insufficient future liver remnant (FLR). Portal vein embolization (PVE) and portal vein ligation (PVL) can minimize this risk by inducing hypertrophy of the FLR. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of PVE and PVL for FLR hypertrophy. A systematic search was conducted on the17th of January 2017. The methodological quality of the studies was assessed using the Oxford Critical Appraisal Skills Program for cohort studies. The primary endpoint was the relative rate of hypertrophy of the FLR. Number of cancelled hepatic resection and postoperative morbidity and mortality were secondary endpoints. For meta-analysis, the pooled hypertrophy rate was calculated for each intervention. The literature search identified 21 eligible studies with 1953 PVE and 123 PVL patients. All studies were included in the meta-analysis. No significant differences were found regarding the rate of FLR hypertrophy (PVE 43.2%, PVL 38.5%, p = 0.39). The number of cancelled hepatic resections due to inadequate hypertrophy was significantly lower after PVL (p = 0.002). No differences were found in post-intervention mortality and morbidity. This meta-analysis demonstrated no significant differences in safety and rate of FLR hypertrophy between PVE and PVL. PVE should be considered as the preferred strategy, since it is a minimally invasive procedure. However, during a two-stage procedure, PVL can be performed with expected comparable outcome as PVE.

Renal Allograft Aspergillus Infection Presenting With Obstructive Uropathy: A Case Report.

BACKGROUND: Isolated renal allograft aspergillosis is rare and usually presents with fever and decreased glomerular filtration rate. Presentation with obstructive uropathy caused by aspergillus fungal balls is much less common. We report a young male patient who presented with obstructive uropathy secondary to isolated renal allograft aspergillus infection 6 weeks after transplant. He was treated with nephrectomy and antifungal medications. CASE PRESENTATION: A 29-year-old Saudi male patient had a recent living non-related kidney transplantation in Pakistan. Early Post-transplant course was complicated by acute cellular rejection (Banff Class IB) which was managed successfully with pulse steroid and anti-thymocyte globulin. The patient presented again to our emergency room on fortieth day post-transplant with a complaint of decreased urine output and passing white particles in his urine. This presentation was three Three weeks after treatment for cellular rejection, the urine fungal culture showed growth of Aspergillus fumigatus, and ultrasound imaging of the allograft kidney revealed mild to moderate hydronephrosis with echogenic materials within the renal pelvis. Biopsy of the transplanted kidney showed severe necrotizing granulomatous inflammation and fungal elements consistent with aspergillus species. The patient was given voriconazole as an antifungal agent and was weaned from immunosuppressive medication. The patient eventually required intermittent hemodialysis and underwent surgical allograft nephrectomy. CONCLUSION: Suboptimal environmental and infection prevention and control precautions can explain this type of infection. It is important for clinicians to have a high index of suspicion and to investigate for fungal infection as a rare cause of obstructive uropathy in high-risk patients.

Mini-incision microdissection testicular sperm extraction: a useful technique for men with cryptozoospermia.

Microdissection testicular sperm extraction (micro-TESE) was developed to minimize the testicular injury associated with multiple open TESEs. We sought to evaluate a mini-incision micro-TESE in men with cryptozoospermia and non-obstructive azoospermia (NOA). We conducted a retrospective study of 26 consecutive men with NOA and cryptozoospermia who underwent a primary (first) micro-TESE between March 2015 and August 2015. Final assessment of sperm recovery (reported on the day of intra-cytoplasmic sperm injection (ICSI)) was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a mini-incision micro-TESE (with limited unilateral micro-dissection) or standard/extensive (with unilateral or bilateral micro-dissection) was guided by the intra-operative identification of sperm recovery (≥5 spermatozoa) from the first testicle. Overall, sperm recovery was successful in 77% (20/26) of the men. In 37% of the men (8/26), the mini-incision micro-TESE was successful (positive sperm recovery). The remaining 18 men required a standard (extensive) microdissection: 61% (11/18) underwent a unilateral and 39% (7/18) a bilateral micro-TESE. We found that 90% (9/10) of the men with cryptozoospermia and 63% (10/16) of the men with NOA underwent a unilateral (mini or standard micro-TESE). The mini-incision micro-TESE allowed for successful sperm recovery in 60% (6/10) of the men with cryptozoospermia and 13% (2/16) of the men with NOA. The data demonstrate that a mini-incision micro-TESE together with rapid intra-operative assessment and identification of spermatozoa recovery can be useful in men undergoing microTESE, particularly, men with cryptozoospermia.

Outcome of microsurgical testicular sperm extraction in familial idiopathic nonobstructive azoospermia.

The aim of the study was to evaluate the sperm retrieval rate by microsurgical testicular sperm extraction (TESE) in familial idiopathic nonobstructive azoospermia (NOA). One hundred and nineteen patients with idiopathic NOA who underwent microsurgical TESE over the past 5 years were included. Patients were then divided into two groups; Group 'A' with familial idiopathic NOA (11 families with two brothers in each family, 22 patients) and Group 'B' with nonfamilial idiopathic NOA (97 patients). Clinical data as well as data of microsurgical TESE were recorded. In Group 'A', the sperm retrieval rate was 9.1% (2/22 patients) compared to 45.4% in Group 'B' (44/97 patients) (P ≤ 0.05). The two patients in Group 'A' with successful sperm retrieval belonged to one family. The histopathological diagnosis was the same in the brothers in each family. It can be concluded that the testicular sperm retrieval rate in familial idiopathic NOA is significantly lower than in nonfamilial idiopathic NOA.

Biochemical modulation of cell energy by 2-deoxyglucose and malonate in 7,12-dimethylbenz(a)anthracene-induced carcinogenesis in rats.

The goal of this study was to explore the impact of 2-deoxglucose or malonate individually or in combination on the level of cell energy (adenosine-5'-triphosphate) and oxidative stress in 7,12-dimethylbenz(a)anthracene (DMBA)-induced mammary proliferation in rats. A total of 60 adult female Sprague Dawley rats were randomly divided into five groups (12 rats each): group I serves as the control group. Rats in groups (II-V) were administrated intragastrically a single dose of 50 mg/kg body weight (bw) of DMBA. A day after DMBA administration, rats in group III were injected intraperitoneally (ip) with 100 mg 2-deoxyglucose (2-DG)/kg bw daily. Rats in group IV were injected ip with 10 mg sodium malonate/kg bw daily. Rats in group V were injected ip with 100 mg 2-DG/kg bw and 10 mg sodium malonate/kg bw (treatment for 90 days). The results obtained showed that DMBA induced oxidative stress by decreasing the activities of glutathione reductase (GRase) and superoxide dismutase (SOD), glutathione peroxidase (GPx) and elevating the levels of malondialdehyde (MDA) and nitric oxide (NO) in mammary tissues when compared with control. The combined treatment protected against the previous deleterious changes by a significant elevation in the activities of GRase and SOD, GPx and lowering the levels of MDA and NO more potentially when compared with individual treatment. Apoptosis, as indicated by a significant release of cytochrome c from mitochondria into the cytosol, observed in DMBA-injected rats was positively significantly correlated with the elevation of the level of NO. These data explained the possible additive effect of 2-DG and malonate by depleting the cell energy by their protective effects against the earlier stages of carcinogenesis.

DNA barcoding of Oryx leucoryx using the mitochondrial cytochrome C oxidase gene.

The massive destruction and deterioration of the habitat of Oryx leucoryx and illegal hunting have decimated Oryx populations significantly, and now these animals are almost extinct in the wild. Molecular analyses can significantly contribute to captive breeding and reintroduction strategies for the conservation of this endangered animal. A representative 32 identical sequences used for species identification through BOLD and GenBank/NCBI showed maximum homology 96.06% with O. dammah, which is a species of Oryx from Northern Africa, the next closest species 94.33% was O. gazella, the African antelope. DNA barcode sequences of the mitochondrial cytochrome C oxidase (COI) gene were determined for O. leucoryx; identification through BOLD could only recognize the genus correctly, whereas the species could not be identified. This was due to a lack of sequence data for O. leucoryx on BOLD. Similarly, BLAST analysis of the NCBI data base also revealed no COI sequence data for the genus Oryx.