Calcium Carbonate.

Calcium carbonate is a chemical compound with the formula CaCO3 formed by three main elements: carbon, oxygen, and calcium. It is a common substance found in rocks in all parts of the world (most notably as limestone), and is the main component of shells of marine organisms, snails, coal balls, pearls, and eggshells. CaCO3 exists in different polymorphs, each with specific stability that depends on a diversity of variables.

Transition from intravenous or subcutaneous prostacyclin therapy to inhaled treprostinil in patients with pulmonary arterial hypertension: a retrospective case series.

WHAT IS KNOWN AND OBJECTIVE: Inhaled treprostinil represents an attractive alternative to the other available prostacyclin formulations by obviating the use of continuous infusions and its associated risks. Published evidence describing the process of transition from infusion prostacyclin therapy to inhaled treprostinil is limited. The purpose of this report is to describe an inpatient protocol for transitioning patients with pulmonary arterial hypertension (PAH) from intravenous (IV) or subcutaneous (SQ) prostacyclin therapy to inhaled treprostinil. METHODS: A retrospective case cohort study was performed evaluating medical records of three patients undergoing transition from IV/SQ continuous infusion prostacyclin therapy to inhaled treprostinil. The transition protocol and clinical data were collected prospectively. RESULTS AND DISCUSSION: Haemodynamics, six-min walk distance (6MWD), World Health Organization (WHO) functional class, modified Borg Dyspnea Score and brain natriuretic peptide prior to and after transition remained similar. All patients were receiving concomitant oral PAH medications prior to and after conversion. Adverse effects during the change were mild. No patients discontinued inhaled treprostinil following transition. At long-term follow-up, functional class remained stable at WHO functional class II or better. Patient 1 and Patient 3 demonstrated stable to modest improvement in 6MWD, whereas Patient 2 had a slight decrease in 6MWD. The transition to inhaled treprostinil from IV/SQ infusion prostacyclin therapy appears to be safe in carefully selected patients. WHAT IS NEW AND CONCLUSION: Our report describes a standard method used to transition patients from IV/SQ infusion prostacyclin to inhaled treprostinil.

The incidence of hypoglycaemia in Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan: a randomised trial.

AIMS: To compare the incidence of symptomatic hypoglycaemia in fasting Muslim patients with type 2 diabetes treated with sitagliptin or a sulphonylurea during Ramadan. METHODS: Patients with type 2 diabetes (age ≥ 18 years) who were treated with a stable dose of a sulphonylurea with or without metformin for at least 3 months prior to screening, who had an HbA(1c) < 10% and who expressed their intention to daytime fast during Ramadan were eligible for this open-label study. Patients were randomised in a 1 : 1 ratio to either switch to sitagliptin 100 mg qd or to remain on their prestudy sulphonylurea. Patients completed daily diary cards to document information on hypoglycaemic symptoms and complications. The primary end-point was the overall incidence of symptomatic hypoglycaemia recorded during Ramadan. RESULTS: Of the 1066 patients randomised, 1021 (n = 507 for sitagliptin and n = 514 for sulphonylurea) returned at least one completed diary card and were included in the analysis. The proportion of patients who recorded one or more symptomatic hypoglycaemic events during Ramadan was lower in the sitagliptin group (6.7%) compared with the sulphonylurea group (13.2%). The risk of symptomatic hypoglycaemia was significantly decreased with sitagliptin relative to sulphonylurea treatment (Mantel-Haenszel relative risk ratio [95% CI] = 0.51 [0.34, 0.75]; p < 0.001). There were no reported events that required medical assistance (i.e. visits to physician or emergency room or hospitalisations) or were considered severe (i.e. events that caused loss of consciousness, seizure, coma or physical injury) during Ramadan. CONCLUSIONS: In Muslim patients with type 2 diabetes who observed the fast during Ramadan, switching to a sitagliptin-based regimen decreased the risk of hypoglycaemia compared with remaining on a sulphonylurea-based regimen. The incidence of hypoglycaemia was lower with gliclazide relative to the other sulphonylurea agents and similar to that observed with sitagliptin.

The association between periodontal disease, physical activity and healthy diet among adults in Jordan.

BACKGROUND AND OBJECTIVE: Physical inactivity and an unhealthy diet have been implicated as risk factors for several chronic diseases that are known to be associated with periodontitis, such as cardiovascular diseases, obesity and diabetes. Studies investigating the relationship between periodontitis and physical activity and diet are limited. Therefore, this study was conducted to determine the relationship between physical activity, healthy eating habits and periodontal health status. MATERIAL AND METHODS: A systematic random sample of 340 persons, 18-70 years of age, was selected from persons accompanying their relative patients who attended the outpatient clinics in the medical center of Jordan University of Science and Technology in north of Jordan. Data collected included socio-demographic and clinical characteristics, anthropometric measurements, physical activity level and dietary assessment. RESULTS: Individuals who were highly physically active had a significantly lower average plaque index, average gingival index, average clinical attachment loss (CAL) and percentage of sites with CAL ≥ 3 mm compared to individuals with a low level of physical activity and individuals with a moderate level of physical activity. Those who had a poor diet had a significantly higher average number of missing teeth and an average CAL compared with those who had a good diet. In the multivariate analysis, a low level of physical activity and a poor diet (diets with a healthy eating index score of < 50 points) were significantly associated with increased odds of periodontitis. CONCLUSIONS: A low physical activity level and a poor diet were significantly associated with increased odds of periodontal disease. Further studies are needed to understand this relationship in greater detail.

Plasma C-terminal pro-endothelin-1 is associated with left ventricular mass index and aortic root diameter in African-American adults with hypertension.

Endothelin-1 (ET-1), a circulating vasoactive peptide with potent vasoconstricting and mitogenic properties, may contribute to target-organ damage in hypertension. We investigated whether plasma levels of C-terminal pro-endothelin-1 (CT-pro-ET-1) are associated with left ventricular (LV) mass and aortic root diameter in African-American adults with hypertension. Plasma CT-pro-ET-1 was measured by an immunoluminometric assay in 1041 African Americans (65±9 years, 72% women) with hypertension. LV mass and aortic root diameter were measured according to the American Society of Echocardiography guidelines, and LV mass was indexed by height to the power 2.7 (LVMi). Multivariable regression analyses were used to assess whether plasma CT-pro-ET-1 was associated with LVMi and aortic root diameter, independent of potential confounding variables. Plasma CT-pro-ET-1 was modestly correlated with LVMi (r=0.21, P<0.0001) and aortic root diameter (r=0.09, P=0.004). In separate multivariable regression models that adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, smoking history, diabetes, history of myocardial infarction or stroke, and blood pressure-lowering medication and statin use, log CT-pro-ET-1 was significantly associated with greater LVMi (P=0.001) and larger aortic root diameter (P=0.006). CT-pro-ET-1 is independently associated with LVMi and aortic root diameter and may be a marker of target-organ damage in African-Americans adults with hypertension.

Shaping canals with ProFiles and K3 instruments: does operator experience matter?

OBJECTIVE: The aim of this study was to determine the influence of operator experience on the shaping ability of ProFile and K3 nickel-titanium rotary instruments in simulated root canals. STUDY DESIGN: One hundred sixty simulated canals consisting of 4 different shapes in terms of angle and position of curvature were prepared by experienced and inexperienced operators. One experienced operator prepared 80 canals and 2 inexperienced operators prepared 80 canals with a crown-down technique using either ProFile or K3 .06 taper instruments. Images of the canals were taken, using a camera attached to a computer with image analysis software, before surgery and after preparation to sizes 20, 25, and 30 to working length. Postoperative images were combined with the preoperative image to highlight the amount and position of material removed during preparation as well as the shape of the prepared canal. RESULTS: Overall, there was a highly statistically significant difference (P<.001) between the instruments for the time taken to prepare the canals, with K3 instruments taking a mean of 4.9 minutes and ProFile 6.0 minutes. Six instruments fractured (3 in each operator category); 4 were ProFile instruments. Four instruments deformed, all with the inexperienced operators; 3 were K3. No perforations or zips were observed; however, 1 danger zone (created by the experienced operator using K3 instruments) and 1 ledge (created by an inexperienced operator using K3 instruments) were created. Twelve outer widenings were created with a highly significant difference (P<.001) between the operator and instrument used. There was a highly significant difference by instrument (P<.001), and experience (P=.008) regarding absolute transportation at the beginning of the curve and a statistically significant difference (P=.031) for the instrument used regarding absolute transportation half way to the orifice. CONCLUSION: The experienced operator prepared canals more quickly and safely than the inexperienced operators when using K3 instruments; both used ProFile instruments quickly and safely. Inexperienced operators would be advised to train using less aggressive instruments and when confident could progress to other instrument designs.

Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis.

AIM: The aim of this study is to compare the hemodynamics and the morphology of the internal jugular veins using colour-Doppler and B-mode sonongraphy in multiple sclerosis patients (MS) and in controls. METHODS: The internal jugular veins of 25 MS patients and 25 controls were examined using colour Doppler and B-mode ultrasound in sitting and supine positions, recording the changes in hemodynamics and the presence or absence of morphological changes. The presence of at least two of the extracranial Zamboni criteria in the same individual was considered positive for evidence of chronic cerebrospinal venous insufficiency (CCSVI). RESULTS: According to the described criteria, 92% of the MS patients showed abnormal findings and 84% of them showed evidence of CCSVI, however; only 24% of controls showed abnormal findings, but none of them showed evidence of CCSVI (OR=7.25, 95% CI 2.92-18.01, P<0.0001). CONCLUSION: Hemodynamic abnormalities and morphological changes involving the internal jugular vein are strongly associated with MS. These findings can be demonstrated by a non-invasive, cost effective Doppler ultrasound criteria.

Smoking and caries experience in subjects with various form of periodontal diseases from a teaching hospital clinic.

OBJECTIVE: The aim of this study was to assess the relationships between aggressive periodontitis (AgP), caries and smoking. METHOD AND MATERIALS: A cross-sectional study was conducted among patients who were specifically referred to the Dental Teaching Clinic in Irbid, Jordan for periodontal treatment. Self-administered questionnaire related to socio-demographic data and smoking habits was completed. The oral hygiene, gingival status, periodontal health and dental status of the participants was determined by using the plaque index of Silness and Loe [Acta Odontol Scand, 22 (1964), 121], the gingival index of Loe and Silness [Acta Odontol Scand, 21 (1963), 233], clinical attachment level (CAL) and decayed, missing and filled teeth (DMFT) index respectively. RESULT: The prevalence of smoking was greater in chronic periodontitis (CP) group (44.2%) than in either chronic gingivitis (CG) (27.4%) or AgP (29.9%) group. Self-reported perio-diseases in the close family was more prevalent (77%) among subjects diagnosed with AgP. The mean plaque scores were significantly higher for smoker than non-smoker in AgP group only (P = 0.04), with significantly greater plaque and gingival scores in CG and CP groups than AgP group (P = 0.012, 0.004). A significantly greater mean gingival scores were noted among CG and CP groups than AgP group (P = 0.004). The mean CAL was higher in smokers than in non-smokers in the three groups, with statistically significant differences in CP and AgP groups (P = 0.04, 0.01 respectively).The mean number of DMFT was significantly higher in smoker than in non-smoker of all age groups (P = 0.016, 0.043 and 0.01). However, mean DMFT was significantly greater in CP and CG than AgP groups. CONCLUSION: It was concluded that (i) higher plaque and gingival index among smokers in all groups; (ii) significant difference in the CAL between smoker and non-smoke in CP and AgP groups; (iii) significant increase in caries risk among smokers in all groups; (iv) smokers and non-smokers of AgP group had significantly lower mean DMFT scores than those of CG or CP groups.

Dental arch morphological and dimensional characteristics in Jordanian children and young adults with beta-thalassaemia major.

OBJECTIVE: The aim of this study was to examine the arch dimensions of Jordanian patients with beta-thalassaemia major in comparison with an unaffected control group. METHODS: The sample consisted of 24 patients who suffered from beta-thalassaemia major (mean age = 13.9 +/- 3.1 years) and an unaffected control group (mean age = 13.5 +/- 2.9 years) matched for dental age, sex, and incisor and molar relationships. The unaffected control group was randomly selected from four public schools in the Governate of Irbid-Jordan. Alginate impressions were taken of the maxillary and mandibular dental arches of all participants. All measurements of the arch dimensions were made on the casts using an electronic digital sliding calliper. RESULTS: In the mandibular arch, when compared with the patients with thalassaemia, the unaffected control group subjects showed a (statistically) significantly larger incisor width, larger arch depth, and larger left and right anterior arch lengths (1.18, 2.58, and 1.85 and 1.12 mm, respectively). In the maxillary arch, there was a statistically significant difference in the mean incisor width (+/- 2.16 mm), arch depth (+/- 3.14 mm), inter-molar width (+/- 1.21 mm) and in the left anterior arch length (+/- 1.97 mm). The canine widths, premolar widths, left and right posterior arch length, and curve of Spee of both arches showed no statistically significant differences between the two groups. CONCLUSION: When compared to unaffected subjects, patients with beta-thalassaemia major exhibited: a narrower maxilla; a shorter maxilla and mandible; and smaller incisor widths for the maxillary and mandibular arches.

Determination of cetirizine dihydrochloride, related impurities and preservatives in oral solution and tablet dosage forms using HPLC.

An HPLC method was developed and validated for the determination of cetirizine dihydrochloride (CZ) as well as its related impurities in commercial oral solution and tablet formulations. Furthermore, two preservatives associated with the drug formulations, namely, propyl (PP) and butylparabens (BP) were successfully determined by this method. The chromatographic system used was equipped with a Hypersil BDS C18, 5 microm column (4.6 x 250 mm) and a detector set at 230 nm in conjunction with a mobile phase of 0.05 M dihydrogen phosphate:acetonitrile:methanol:tetrahydrofuran (12:5:2:1, v/v/v/v) at a pH of 5.5 and a flow rate of 1 ml min(-1). The calibration curves were linear within the target concentration ranges studied, namely, 2 x 10(2) - 8 x 10(2) microg ml(-1) and 1-4 microg ml(-1) for CZ, 20-100 microg ml(-1) for preservatives and 1-4 microg ml(-1) for CZ related impurities. The limits of detection (LOD) and quantitation (LOQ) for CZ were, respectively, 0.10 and 0.34 microg ml(-1) and for CZ related impurities were in the ranges of 0.08-0.26 microg ml(-1) and 0.28-0.86 microg ml(-1), respectively. The method proved to be specific, stability indicating, accurate, precise, robust and could be used as an alternative to the European pharmacopoeial method set for CZ and its related impurities.

Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan.

OBJECTIVES: The objective of this study was to evaluate radiographically the technical standard of root canal treatment performed by undergraduate dental students at the Dental Teaching Center in Jordan. METHODS: A random sample of 8500 records of dental patients was examined. A total of 542 endodontically treated teeth with 912 roots were evaluated. Periapical radiographs were used to assess the technical quality of the root canal filling. The length of each root canal filling was categorized as acceptable, short and overfilled based on their relationship with the radiographic apex. Density and taper of filling was evaluated based on the presence of voids and the uniform tapering of the filling, respectively. Chi-square analysis was used to determine statistically significant differences between adequacy of root canal filling in each group of teeth according to its location, position and curvature. RESULTS: Sixty-one percent of roots had fillings of acceptable length, while 34.5% were short and 4.2% were overfilled. The root canal fillings of 47.4% were found to be adequate. Adequate fillings were found more in maxillary than mandibular teeth (P < 0.005), anterior compared to posterior teeth (P < 0.05) and in straight canals compared to curved canals (P < 0.001). CONCLUSION: The technical quality of root canal treatment performed by undergraduate dental students using step-back preparation and lateral condensation was found to be less than 50%. Review of the endodontic curriculum requirements, specialized clinical supervision and increasing the time of training at the preclinical and clinical levels should improve this quality.

Amlodipine besylate-excipients interaction in solid dosage form.

This article studies the compatibility of amlodipine besylate in its solid formulations with various drug excipients. The various factors affecting amlodipine besylate stability were studied using high-performance liquid chromatography (HPLC). It has been found that binary 1:1 mixtures of amlodipine besylate and an excipient are stable at 65 degrees C and 40 degrees C/75% RH. Further investigations were conducted to study the stability of amlodipine besylate in multicomponent mixtures, including mixtures with actual formulations. The study reveals that mixtures of lactose, magnesium stearate, and water induce some instability on amlodipine besylate. The major degradation product confirmed by HPLC-mass spectrometry is amlodipine besylate glycosyl. This is in conformity with the well-known Maillard reaction between primary amines and lactose. Thus, lactose-free amlodipine formulations are recommended from the safety, quality, efficacy, and process cost points of view.

The effect of frequency of toothbrushing on oral health of 14-16 year olds.

The aim of the present study was to evaluate the impact of toothbrushing frequency on dental plaque, caries and periodontal condition in 14-16 year old students. A total of 2083 students selected from 20 schools enrolling 8th and 9th grades were investigated by a questionnaire and a clinical examination. All participants were examined for oral hygiene, dental caries and periodontal condition using Silness & Löe plaque index (Pl.l), decayed, missing and filled teeth/surfaces (DMFT/S) indices and Community Periodontal Index of Treatment Needs (CPITN), respectively. It was revealed that about 49 per cent of males and 89 per cent of the females reported to brush their teeth on a regular basis. Such differences in toothbrushing frequency between the sexes were statistically significant (P = 0.0001). The mean (Pl.l) scores were lower in those who brushed than those who did not brush their teeth, with a significantly lower scores in females than in males (P = 0.0001). There were slight but nonsignificant differences in caries experience (MFT/S) amongst males and females as related to toothbrushing frequency (P = 0.121, 0.208 respectively). While bleeding on probing (43.0 per cent) was most prevalent in students who did not brush. Calculus scores were similar in all groups. The occurrence of shallow and deep pockets in students who brushed or didn't brush their teeth were minimal (6.6-8.4 per cent). The oral health status among those who did not brush or brushed their teeth on regular or irregular basis was found to be poor and slightly varied. Therefore, more emphasis should be placed on proper oral hygiene. Also, implementation of school based oral health promotion and prevention programs is urgently needed.

Dental diseases in subjects with beta-thalassemia major.

OBJECTIVES: The aim of this study was to determine whether beta-thalassemia major is associated with an increase in the severity of periodontal disease and dental caries. METHODS: A total of 61 thalassemia patients and 63 healthy controls (age range = 6-18 years) were examined for plaque deposits, gingivitis, periodontitis and dental caries using Silness and Löe plaque index (Pl.I), Löe and Silness gingival index (GI), probing pocket depth (PPD) and DMFT, respectively. RESULTS: There were no significant differences in Pl.I, GI and PPD scores between both thalassemia patients and healthy control groups (P > 0.05). Dental caries was significantly higher in thalassemia patients group (P < 0.0001) compared to the healthy controls. CONCLUSION: Thalassemia is not associated with increased levels of gingivitis or periodontitis but is associated with higher dental caries experience.

Determination of terbutaline sulfate and its degradation products in pharmaceutical formulations using LC.

There is a lack of information concerning analysis of terbutaline sulfate and quantification of its related substances particularly in the liquid dosage forms. This work aimed at developing and validating an HPLC method for determination of terbutaline sulfate and its possible degradation products, namely, 3,5-dihydroxybenzoic acid, 3,5 dihydroxybenzaldehyde and 1-(3,5-dihydroxyphenyl)-2-[(1,1-dimethylethyl) amino]-ethanone that might appear as impurities in the starting material as well as in the solid and liquid formulations. The chromatographic system used consisted a Hypersil 100 C(18,) 150 x 4.6 mm (5 microm) column, a mobile phase of ammonium acetate (0.15 M) and glacial acetic acid (pH of 4.0, 96:4 v/v) with a flow rate of 2 ml min(-1) and a UV detector set at 270 nm. The degree of linearity and the characteristic statistical parameters of the calibration curves including the limit of detection (LOD) and limit of quantitation (LOQ) were estimated for terbutaline sulfate and its degradation products. The method was found to be specific, stability indicating, accurate, precise and robust.

Determination of sildenafil citrate and related substances in the commercial products and tablet dosage form using HPLC.

This study aimed at developing and validating an HPLC method for the assay of sildenafil citrate and its related substances that might coexist in the drug commercial products and in tablets' formulation as impurities that originate from synthesis processes or degradation. A chromatographic system comprising a microBondapak C(18) (10 microm) column, a mobile phase of ammonium acetate (pH 7.0, 0.2 M)-acetonitrile (1:1, v/v), a flow rate of 1 ml/min and a UV detector set at 240 nm has shown good chromatographic separation for sildenfil and the other related substances. The degree of linearity of the calibration curves, the percent recoveries of sildenafil and related substances, the limit of detection, LOD, and limit of quantitation, LOQ for the HPLC method have been determined. The HPLC method under study was found to be specific, precise, accurate, reproducible indicating stability and robust.

Effect of the drug-matrix on the stability of enalapril maleate in tablet formulations.

The chemical stability of enalapril maleate in tablet dosage forms consisting of different formulation excipients has been studied in this work. The influence of various parameters such as heat, moisture, light and the drug-matrix was investigated. The degradation of enalapril maleate has been followed by using an HPLC method, which was demonstrated to be specific, stability indicating, accurate and precise. The degradation kinetics of enalalpril maleate in phosphate buffer solutions of pH values in the range of 2.2-10.5 were observed to be psuedo first order throughout the whole pH range studied. Enalapril maleate alone showed high stability for temperature under dry and humid conditions, however it became unstable when mixed with the drug-matrix in its tablet formulations and exposed to the same conditions. The pathway of degradation of enalapril maleate was found to be pH dependent. The extent of degradation of two different enalapril maleate tablet formulations (product A of a basic drug-matrix and product B of an acidic drug-matrix) has been investigated. The degree of degradation of the product with acidic matrix was significantly less than that of the basic matrix under same temperature and humidity conditions. In fact, diketopiperazine and enalaprilat degradants were mainly associated with the degradation of the product with the acidic matrix and that with the basic matrix, respectively. Dry enalapril maleate powder showed some photolysis, which was more significant with daylight (3.3%) compared with that under UV light (0.2%). Although the product with the acidic matrix showed some photolysis but the effect was not pronounced and the % recovery of enalapril was almost complete and within the acceptable experimental errors. However, the product with the basic matrix showed almost no response for photolysis.

Gastric perforation. An unusual cause of ascites in a newborn baby.

We report a case of a low birth weight asymmetrical small for gestational age baby, who presented at the age of 20 hours with sudden abdominal distension. Since birth he has been breastfed and was kept with his mother. Absence of radiological findings of necrotizing enterocolitis or perforation at the time of presentation delayed the diagnosis for 48 hours. At laparotomy the baby was found to have perforation of the stomach with no evidence of other gastrointestinal disorder.

Clinical problems associated with unusual cases of talon cusp.

CASE REPORT: Talon cusp is an uncommon dental anomaly manifested as an accessory cusp-like structure on the crown of anterior teeth. This report describes two unusual cases of talon cusp. Case 1 showed bilateral anomalous cusps on the palatal aspects of maxillary supernumerary teeth, causing premature contact and tooth impaction. In case 2, a double-fused talon cusp was projected from the palatal surface of a large geminated central incisor. A talon cusp is not an innocuous defect, as it may provide a substantial diagnostic, treatment planning and procedural challenge. Early diagnosis and management are important to avoid complications.