Antimicrobial photodynamic therapy using chloro-aluminum phthalocyanine for treating advanced stage-III periodontitis in smoking patients.

PURPOSE: To evaluate the bacterial, clinical, and cytokine profile of adjunctive photodynamic therapy using chloro-aluminum phthalocyanine (CAP/aPDT) with root surface debridement (RSD) versus RSD alone in cigarette smokers (CS) and never-smokers (NS) during the period of 6 months. METHODS: Twenty-nine patients [CS - 14 and NS - 15] were recruited for the trial having stage-III periodontitis. All candidates from the study groups were subjected to a split-mouth treatment technique receiving CAP/aPDT + RSD and RSD alone. Periodontal parameters including plaque levels (PL), bleeding on probing (BP), probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. Polymerase chain reaction (qPCR) assay was used to analyze the copy numbers of Porphyromonas gingivalis (Pg) and Tannerella forsythia (Tf). Levels of tumor necrosis factor-alpha (TNF-α) interleukin (IL)-6 in the crevicular fluid were evaluated by enzyme-linked immunosorbent assay (ELISA). RESULTS: CAP/aPDT+RSD decreased BP in smokers after 6 months (p < .05). Probing depth and CAL reported statistically significant reductions within both CAP/aPDT+RSD and RSD groups and also within the NS and CS (p < .05). Pg and Tf stayed elevated in smokers at the 6-month evaluation period (p < .01). Only CAP/aPDT+RSD significantly decreased Pg and Tf at 3- and 6-month follow-up in smokers (p < .05). CAP/aPDT+RSD showed decreased IL-6 levels in the NS during the 6-month follow-up (p < .01). TNF-α levels were significantly reduced in the CS group with CAP/aPDT+RSD and RSD alone until 6 months (p < .01). CONCLUSION: CAP-mediated aPDT along with nonsurgical periodontal therapy helped to improve the bacteriological outcomes among smokers and never-smokers with stage-III CP patients.

Chloro-aluminum phthalocyanine-mediated photodynamic therapy in the treatment of stage-II chronic periodontitis among smokers.

PURPOSE: To assess the clinical periodontal, bacterial, and immunological outcomes of chloro-aluminum phthalocyanine-mediated photodynamic therapy (PDT) as an adjunct to dental scaling (DS) versus DS alone among cigarette smokers (CS) and never-smokers (NS). METHODS: A total of 26 patients (13 CS and 13 NS) with clinical and radiographic diagnosis of stage-II chronic periodontitis were recruited. Each patient from both groups were subjected with two parallel therapies (split-mouth): PDT + DS (test side) and DS alone (control side). Periodontal parameters were investigated by evaluating plaque scores (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL). Subgingival plaque was collected to detect and quantify Porphyromonas gingivalis and Tannerella forsythia using real-time quantitative polymerase chain reaction (RT-qPCR) assay. Gingival crevicular fluid was sampled for the quantification of interleukin (IL)-1ß and tumor necrosis factor-alpha (TNF-α) using enzyme linked immunosorbent assay. All assessments were performed at baseline, 3 months, and 6 months. RESULTS: Bleeding on probing was significantly reduced at 6 months after PDT + DS in CS groups (p < .05). Mean PD and CAL significantly reduced after both PDT + DS and DS subgroups and among NS and CS groups (p < .05). At 6 months follow-up, the copy number of both P. gingivalis and T. forsythia remained significantly high in CS group (p < .01). Only PDT + DS subgroup in CS significantly reduced the counts of P. gingivalis and T. forsythia at 3 months and 6 months (p < .05). Only at 6 months did PDT + DS showed statistically significantly reduced IL-1ß levels in the NS group (p < .01). TNF-α levels significantly reduced in CS group with PDT + DS and DS alone at both 3 months and 6 months follow-up (p < .01). CONCLUSION: Chloro-aluminum phthalocyanine-mediated PDT helped to improve the non-surgical periodontal therapy outcomes among stage-II chronic periodontitis patients among smokers and never-smokers.

Role of Riboflavin; Curcumin photosensitizers and Ozone when used as canal disinfectant on push-out bond strength of glass fiber post to radicular dentin.

AIM: To assess the efficacy of photosensitizers (CP, riboflavin) and gaseous ozone in comparison to the conventional radicular dentin disinfectant (NaOCl) on push-out bond strength (PBS) of PFRC post cemented to radicular dentin. MATERIAL AND METHOD: Human single-rooted teeth were collected, steriled implanted in polyvinyl pipes up to a cement-o-enamel junction and de coronated. Cleaning and shaping of the canal were performed using the crown down technique followed by obturation of the canal space. Canal space was prepared using peso reamers and samples were divided into four groups based on types of canal disinfectant protocols. Group 1: Riboflavin+ 17%EDTA; group 2: Curcumin Photosensitizer + 17% EDTA; group 3: Gaseous Ozone disinfection (O3) +17% EDTA and group 4 control 2.5% NaOCl +17% EDTA. Within the canal space, fiber post was cemented and cured, and thermocycled. PBS was evaluated using a Universal testing machine (UTM) and failure modes using a stereomicroscope at 40x magnification. One-way analysis of variance (ANOVA) was used to determine the mean and standard deviation of push-out bond strength (PBS). The Tukey multiple comparison tests (p = 0.05) was used to compare the means of PBS. RESULTS: The highest PBS was displayed in group 2 CP+ 17% EDTA at all three root levels, coronal (8.81±0.61), middle (7.77±0.55), and apical (5.25±0.61). The lowest PBS was revealed in group 4, disinfected with 2.5% NaOCl +17% EDTA (control) at coronal (6.12±0.54), middle (5.46±0.84), and apical (3.00±1.88) levels. The most prevailed fracture mode was an adhesive failure (cement-dentin interface). CONCLUSION: Radicular dentin disinfected with PDT using CP, riboflavin, and O3 displayed similar PBS at all root segments. NaOCl is a convenient, traditional, and commonly used disinfectant, and it's effects on PBS is still controversial.

Measuring the appropriateness of carbamazepine and valproic acid prescribing and utilization using a newly implemented online system in the Tabuk Region of Saudi Arabia.

Epilepsy is a common neurologic disorder, which is efficiently treated with carbamazepine and valproic acid. Moreover, Saudi Ministry of Health implemented a new E-system for Poison Control Centers called Awtar to enhance technology utilization in ensuring patients' satisfaction and to improve treatment outcomes. Therefore, we conducted this study to assess appropriateness of indication of requests and therapeutic levels of carbamazepine and valproic acid in Tabuk area, North West Saudi Arabia. This is a retrospective observational study conducted in Poison Control & Forensic Chemistry Center, Tabuk, Saudi Arabia. Patients' data were obtained for years 2018 and 2019. The blood levels of carbamazepine and valproic acid were measured by Therapeutic Drug Monitoring (TDM) Unit. We selected patients treated with either valproic acid or carbamazepine alone without any history of drug allergy. Data of 264 patients were extracted from Awtar E-system. Serum carbamazepine levels were within therapeutic range in 114 patients (75.50%), above-therapeutic range in 13 patients (8.61%) and sub-therapeutic levels in 24 patients (15.89%). Regarding serum valproic acid, it is within therapeutic range in 62 patients (54.87%), above-therapeutic range in 11 patients (9.73%) and sub-therapeutic levels in 40 patients (35.40%). In conclusion, this study gives information about partial appropriateness of usage of carbamazepine and low level of appropriateness of valproic acid. However, more efforts are needed to improve results of appropriateness of indication of antiepileptic drugs.

Bond assessment of resin modified glass ionomer cement to dentin conditioned with photosensitizers, laser and conventional regimes.

AIM: To assess different conditioning regimes on shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC) bonded to dentin MATERIAL AND METHODS: Fifty non carious intact maxillary molars were cleaned, isolated and randomly divided into five groups (n = 10). Before randomization, dentin surface was exposed and finished. Samples in group 1 were conditioned with methylene blue photosensitizer (MBP) 50 mg/l and activated by photodynamic therapy (PDT), Group 2: surface treated with Er,Cr:YSGG (ECL), Group 3: surface conditioned with polyacrylic acid (PAA) (control), Group 4: surface conditioned with 17 % Ethylenediaminetetraacetic acid (EDTA), Group 5: surface conditioned with total etch (Optibond solo Plus). For SBS testing the samples were placed in universal testing machine. Fracture analysis of debonded surfaces were evaluated using stereomicroscope at 40x magnification. Means and standard deviations were calculated using analysis of variance (ANOVA) and Tukey's post hoc test at a significance level of (p < 0.05). RESULTS: The maximum bond strength was found in group 5 conditioned with Optibond solo plus total etch (23.15 ±â€¯3.21 MPa). Whereas, the lowest bond values were observed in group 1 treated with MBP (15.25 ±â€¯1.54 MPa). Moreover, samples in group 2, group 3 and group 4 resulted in comparable bond strength (p > 0.05). CONCLUSION: MBP at 50 mg/l is not recommended to condition dentin prior to RMGIC application. Moreover, ECL has a potential to be suggested for dentin conditioning compared to PAA.

Polymer matrix of fiber-reinforced composites: Changes in the semi-interpenetrating polymer network during the shelf life.

This laboratory study was aimed to characterize semi-interpenetrating polymer network (semi-IPN) of fiber-reinforced composite (FRC) prepregs that had been stored for up to two years before curing. Resin impregnated prepregs of everStick C&B (StickTech-GC, Turku, Finland) glass FRC were stored at 4°C for various lengths of time, i.e., two-weeks, 6-months and 2-years. Five samples from each time group were prepared with a light initiated free radical polymerization method, which were embedded to its long axis in self-curing acrylic. The nanoindentation readings on the top surface toward the core of the sample were made for five test groups, which were named as "stage 1-5". To evaluate the nanohardness and modulus of elasticity of the polymer matrix, a total of 4 slices (100µm each) were cut from stage 1 to stage 5. Differences in nanohardness values were evaluated with analysis of variance (ANOVA), and regression model was used to develop contributing effect of the material's different stages to the total variability in the nanomechanical properties. Additional chemical and thermal characterization of the polymer matrix structure of FRC was carried out. It was hypothesized that time of storage may have an influence on the semi-IPN polymer structure of the cured FRC. The two-way ANOVA test revealed that the storage time had no significant effect on the nanohardness of FRC (p = 0.374). However, a highly significant difference in nanohardness values was observed between the different stages of FRC (P<0.001). The regression coefficient suggests nanohardness increased on average by 0.039GPa for every storage group. The increased nanohardness values in the core region of 6-months and 2-years stored prepregs might be due to phase-segregation of components of semi-IPN structure of FRC prepregs before their use. This may have an influence to the surface bonding properties of the cured FRC.

Prevalence and pattern of lipid disorders in Saudi patients with angiographically documented coronary artery disease.

OBJECTIVE: The aim of the study was to assess the prevalence and patterns of dyslipidemia in Saudi patients with angiographically documented coronary artery disease (CAD). MATERIALS AND METHODS: This is a cross-sectional, hospital-based study, which was conducted on all Saudi patients who underwent coronary angiography under the author's personal care and were found to have > 50% coronary stenosis. Fasting lipid profile was measured in all patients during the admission for the coronary angiography. RESULTS: Two hundred and ninety-five patients were included in the study. The mean age (±Standard deviation) was 55.1 ± 11, ranging from 17 to 86 years. The majority of patients were males: 229 (77.6%). Mean total cholesterol was 175.6 ± 47.6 mg/dl, mean low-density lipoprotein cholesterol (LDL-C) was 111.3 ± 40.3 mg/dl, mean high density lipoprotein cholesterol (HDL-C) was 38.27 ± 9.5 mg/dl and mean triglyceride level was 141.8 ± 74.8 mg/dl. 21 (7.1%) patients had normal coronary arteries, 107 (36.3%) had one vessel disease, 78 (26.4%) had two vessel disease and 89 (30.2%) had three vessel disease. There was a significant correlation between the extent of CAD and age (P = 0.003), sex (P = 0.0002), total cholesterol (P = 0.02) and low HDL-C (P < 0.001. 21 (7.1%) patients were asymptomatic, 110 (37.3%) had stable angina, 127 (43.1%) had none ST elevation acute coronary syndrome, 20 (6.8%) had ST elevation myocardial infarction and 17 (5.7%) had heart failure. There was also a significant correlation between age (P = 0.03), sex (P < 0.001), LDL-C (P = 0.005) and low HDL-C (P < 0.001) and the severity of CAD. CONCLUSION: Dyslipidemia is a very prevalent risk factor in Saudi patients with CAD. Low HDL-C was the most frequent lipid abnormality, which significantly impacts on the extent of the CAD.

Right ventricular function during one-lung ventilation: effects of pressure-controlled and volume-controlled ventilation.

OBJECTIVES: To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function. DESIGN: A prospective, randomized, double-blind, controlled, crossover study. SETTING: A single university hospital. PARTICIPANTS: Fourteen pairs of consecutive patients scheduled for elective thoracotomy. INTERVENTIONS: Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia. MEASUREMENTS AND MAIN RESULTS: Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (p<0.001) and compliance and lower ESV, EDV and airway pressures (p<0.05) than during the use of VCV. Oxygenation indices were similar during the use of VCV and PCV. CONCLUSIONS: The use of PCV offers more improved RV function than the use of VCV during OLV for open thoracotomy. These results apply specifically to younger patients with good ventricular and pulmonary functions.