The effect of repair protocols and chewing simulation on the microtensile bond strength of two resin matrix ceramics to composite resin.

BACKGROUND: To assess the micro tensile bond strength (µTBS) of two resin matrix ceramic (RMC) blocks bonded to composite resin by using different repair protocols with and without chewing simulation (CS). MATERIALS AND METHODS: Two resin matrix ceramic blocks (Vita Enamic and Lava Ultimate) were divided into 4 groups according to the surface treatments: Bur grinding (control), Bur grinding + silane, 9.5% HF acid etching, and 9.5% HF acid etching + silane. The single bond universal adhesive was applied on all specimens after the surface treatments according to the manufacturer's instructions, it was administered actively on the treated surface for 20 s and then light cured for 10 s, followed by incremental packing of composite resin to the treated surface. Each group was further divided into 2 subgroups (with/without chewing simulation for 500,000 cycles). A micro tensile bond strength test was performed for each group (n = 15). The effect of surface treatments on the materials was examined by using a scanning electron microscope (SEM). The micro tensile bond strength (MPa) data were analyzed with a three-way ANOVA, the independent t-test, and one-way ANOVA followed by the Tukey post-hoc test. RESULTS: µTBS results were significantly higher for Lava Ultimate than Vita Enamic for all the surface treatment protocols with (p < 0.01). The chewing simulation significantly negatively affected the micro-tensile bond strength (p < 0.001). Bur grinding + saline exhibited the highest bond strength values for Lava Ultimate, both with and without chewing simulation. For Vita Enamic, bur grinding + saline and HF acid + saline showed significantly higher bond strength values compared to other surface treatments, both with and without chewing simulation (p ≤ 0.05). CONCLUSION: Bur grinding + silane could be recommended as a durable repair protocol for indirect resin matrix ceramics blocks with composite resin material.

Separation of the glanular part of the urethral plate, mobilization of the distal part of the neourethra, and creation of the glanular groove: a new modification of second-stage Thiersch-Duplay urethroplasty in proximal hypospadias repair.

PURPOSE: To evaluate the effect of separation of the glanular part of the urethral plate from the underlying glans penis with creation of a glanular groove for free accommodation of the neourethra as a new modification of Thiersch-Duplay urethroplasty in proximal hypospadias repair. PATIENTS AND METHODS: Between January 2016 and January 2022, 35 patients with proximal hypospadias underwent a modified Thiersch-Duplay two-stage procedure. The glanular portion of the urethral plate was either separated from the underlying glanular tissue or discarded if found scared with mobilization of the distal portion of the neourethra to reach the tip of the glans penis. In all patients, a few millimeter of glanular tissue is excised to create a glanular groove in which the neourethra is embedded freely. RESULTS: 35 patients were involved in this study. The patient's age at the time of operation ranged from 18 months to 10 years (median 3.7 years). The mean follow-up period was 15.7 months (ranging from 12 to 18 months). Two patients developed urethrocutaneous fistula; while, none of the patients had meatal stenosis, urethral stricture, or meatal retraction. All patients have a slit-like meatus at the tip of the penis and a good cosmetic conical shape glans appearance. CONCLUSION: We believe that in Thiersch-Duplay urethroplasty, separation of the urethral plat from the underlying glanular tissue and creation of good glandular groove to accommodate the neourethra is associated with adequate glanular closure and minimization of post-operative meatal stenosis, glanular dehiscence, and meatal retraction.

The Perceptions and Expectations of the Clinical Learning Environment in Saudi Arabia: a Multidisciplinary Study.

Background: The clinical learning environment is a fundamental component of healthcare education. In this setting, students can develop the skills and knowledge necessary to become competent and efficient healthcare practitioners. Due to the importance of clinically based education, it is crucial to have a valid and reliable tool to enable its evaluation. Objective: The aim of this study was to use the Clinical Learning Environment Inventory (CLEI) to examine the perceptions of Saudi undergraduate healthcare students regarding their actual and preferred clinical learning environment and explore the differences between the two viewpoints. Methods: A cross-sectional survey design was utilised with a cohort of Saudi undergraduate healthcare students. Data regarding perceptions of the 'actual' and 'preferred' clinical learning environments were gathered with the Clinical Learning Environment Inventory tool. Results: A total of 194 students participated and nine healthcare disciplines were represented. The highest mean score for both 'actual' and 'preferred' clinical learning environment was for the subscale Task Orientation. Significant differences between 'actual' and 'preferred' environments were demonstrated for Innovation and Individualization, with both subscales scoring higher for the 'preferred' environment. All five subscales-Individualization, Innovation, Involvement, Personalization, and Task Orientation-appear to be important aspects contributing to student satisfaction with their clinical learning environment. Conclusion: Saudi healthcare students demonstrate a preference for a clinical learning environment with the utilization of new and interesting experiences, as well as recognition and accommodation of student individuality. Additionally, student satisfaction appears to be multifactorial in origin. Therefore, there may be many avenues available to enhance the clinical experiences of healthcare students, which is vitally important for the optimization of clinical learning opportunities.

Management of neglected clubfoot in children using Ilizarov external fixator and minimal invasive surgery, Sub-Saharan Africa experience.

PURPOSE: To evaluate the outcomes of Ilizarov external fixator (IEF) and minimal invasive surgery (MIS) in correction of neglected club foot (NCF). METHODS: Thirty-seven feet in 24 child, between five and 15 years old were diagnosed as NCF. All were treated with Achilles tendon lengthening (ATL) and IEF for gradual correction. After IEF removal, cast was applied for six weeks to maintain correction of the deformity. RESULTS: There were 20 boys and four girls. Seven children had left (Lt), four children had right (Rt) while 13 children had bilateral foot deformity. The mean age at surgery was 10.3 (range 5-15) years with an average follow-up of 32.5 (range 24-96) months. All feet were graded as severe according to Pirani score. All feet were corrected after an average six weeks in IEF. After two years follow-up, 23 feet (16 patients) showed good results, five feet (3 patients) showed fair results and four feet (2 patients) had Rt side foot fair result while the Lt foot had good result in both patients. Five feet (3 patients) showed poor results. Eight patients had pin site infection. One case had infected skin and subcutaneous tissue and needed debridement. Two cases developed skin sloughing, changes in color and needed close follow-up. CONCLUSION: We recommend combined IEF and MIS as a suitable, efficient and successful salvage procedure in the management of severe idiopathic NCF in children especially in developing countries.

Release characterization and biological effect of Glass Ionomer Functionalized with two different chlorohexidine derivatives: an in vitro study

ABSTRACT Objective: To evaluate the effect of adding two different chlorohexidine derivatives; chlorhexidine hexametaphosphate and chlorhexidine digluconate to glass ionomer at three different concentrations (0.25%, 0.75%and 1.5%) regarding the antibacterial effect, chlorhexidine release and fluoride release. Methods: A total of 405 specimens were prepared and tested after 7 days, 3 months and 6 months of storage in distilled water (n=5).For testing antibacterial effect, chlorhexidine release and fluoride release, the mix was packed in a ready-made Split Teflon molds to obtain disc-shaped specimen with dimensions 10 mm in diameter and 2 mm thickness according to ISO standardizations. One-way ANOVA and One-way repeated measure ANOVA test were used for statistical analysis of data. Results: The incorporation of chlorhexidine into ChemFil Superior glass ionomer cement in both derivatives has high significance ability to provide a long-term antimicrobial effect on Streptococcus mutans and Lactobacillius acidophilus. The chlorhexidine release was increased by adding chlorhexidine in both derivatives to GIC than the unmodified Glass-ionomer cement for study duration. However, the fluoride release was decreased in the modified specimens than the original one. Conclusion: Addition of chlorhexidine enhanced the antibacterial effect of the glass ionomer and chlorhexidine release. However, fluoride release was reduced than original

Hypothyroidism in restless legs syndrome.

The diurnal nature of restless legs syndrome (RLS) and its response to dopamine hint that hormones are central in RLS pathophysiology. Hypothyroidism has been linked to RLS, but studies are limited. This study's objective is to determine whether RLS is more prevalent in persons with hypothyroidism and whether hypothyroidism is more prevalent in RLS sufferers. Persons with hypothyroidism and controls were recruited through an on-line registry of potential research participants. RLS was assessed using the Cambridge-Hopkins questionnaire. RLS persons and controls were recruited through RLS Foundation and on-line registry advertisements and assessed for hypothyroidism by self-report. The International RLS Study Group Severity Scale assessed RLS severity; 266 hypothyroid subjects and 321 controls were comparable in age (52.3 ± 13.4 versus 53.9 ± 11.7 years; p = .14) and gender (91.7% versus 91.3% women; p = .85), as were 354 RLS and 313 controls (59.1 ± 13.2 versus 58.2 ± 13.6 years; p = .41; 80.8% versus 78.3% women; p = .42). Hypothyroid participants versus controls had a significantly higher prevalence of RLS (14.3% versus 8.1%; p = .02). RLS participants versus controls had a significantly higher prevalence of hypothyroidism (22.3% versus. 13.8%; p = .005). RLS severity was similar in persons with and without hypothyroidism. Among 73 persons with RLS and hypothyroidism, 14 previously were hyperthyroid versus 0 of 37 persons with hypothyroidism alone (p = .004). RLS prevalence is increased in individuals with hypothyroidism; hypothyroidism prevalence is increased in individuals with RLS. Persons with hypothyroidism and RLS are significantly more likely than those with hypothyroidism alone to have had hyperthyroidism prior to hypothyroidism. Associations between RLS and thyroid disease may shed light on complex biological mechanisms underlying RLS.

Effect of heterogeneity on failure of natural rock samples.

A carbonate sample extracted from the depth of about 10 kft was subjected to uniaxial loading while the confining stress remained constant. Post-experiment inspection of the sample showed an inclined crack at an angle less than 20° to the horizontal. This subhorizontal crack orientation was contrary to the expected 45° inclination, the plane of the maximum shear stress. Coincidentally, as shown by CT-scan prior to loading, there was a boundary between two layers of different density inside the sample located almost exactly where the crack appeared. This density difference has arguably translated into the contrast in the elastic properties at the boundary. The hypothesis is that because of this elastic heterogeneity, an incipient crack developed at the boundary due to the unavoidable tensile stressing of the sample as it was brought to the benchtop from its original state of high confining stress at depth. Controlled uniaxial compression made the sample slip along this crack, which then developed into a prominent feature. This assumption was corroborated by a numerical experiment showing a strong von Mises stress concentration at the elastic contrast boundary during hydrostatic tensile loading. Another sample, from the same formation, but without strong density heterogeneity, exhibited a classic 45° crack after uniaxial loading. These results provide a novel and important insight into the mechanics, breakage, and strength of natural rock.

Assessment on CPR Knowledge and AED Availability in Saudi Malls by Security Personnel: Public Safety Perspective.

Security personnel are the first ones who attend the scene in the case of out-of-hospital cardiac arrest (OHCA) at malls. Cardiopulmonary resuscitation (CPR) is not enough for those patients; they need an automated external defibrillator (AED) to bring the heart to function normally. This study aimed to assess the current status of CPR and AED knowledge and availability in Saudi malls by security personnel. Using a descriptive design, a study was conducted at seven malls located in the Eastern Province of Saudi Arabia. Two hundred and fifty participants were surveyed using the American Heart Association (AHA) 2015 guidelines to assess CPR and AED knowledge and availability in Saudi malls. The sample mean age was 32.60 years (SD = 10.02), and 87% of participants were working as security personnel. The majority of the participants had not received training about CPR and AED (75.8% and 95.2%, respectively). Common misconceptions are fallen into all categories of CPR and AED knowledge. Correctly answered statements ranged from 7.2% in the compression rate to 24.2% in hand placement. The study results indicated a poor training knowledge of CPR and AED in public settings. Integrating high-quality CPR and AED knowledge within the school and college curricula is a vital need. However, in order to maximize the survival rate, it is important to set laws and legislation adopted by stakeholders and decision makers to advocate the people who try to help, mandate AED installation in crowded places, and mandate teaching hands-only CPR and AED together as a package.

Implications of the Gut Microbiome in Parkinson's Disease.

Parkinson's disease is a common neurodegenerative disorder that presents with nonmotor and motor symptoms. The nonmotor manifestations of Parkinson's disease often begin years before the motor symptoms. Autopsy studies, including both Parkinson's disease patients and matched controls, demonstrated that α-synuclein aggregates in Parkinson's disease patients can be found in both the substantia nigra and the enteric nervous system. Therefore, it has been hypothesized that the pathological process that leads eventually to Parkinson's disease might initially take place in the enteric nervous system years before the appearance of motor features. The gut microbiome plays essential roles in the development and maintenance of different body systems. Dysbiosis of the normal gut microbiome is thought to be associated with pathophysiologic changes not only in the gastrointestinal system itself but also in the enteric and central nervous systems. These changes are thought to ultimately cause loss of dopaminergic neurons via various mechanisms including the release of neurotoxins into the systemic circulation, decreased production of neuroprotective factors, and triggering inflammatory and autoimmune responses. In this review, we review the gut microbiome changes in Parkinson's disease and discuss the mechanisms by which gut microbiome dysbiosis may be a contributing factor to the pathophysiology of Parkinson's disease. © 2020 International Parkinson and Movement Disorder Society.

Toxicity of Fipronil and Emamectin Benzoate and Their Mixtures Against Cotton Leafworm, Spodoptera littoralis (Lepidoptera: Noctuidae) With Relation to GABA Content.

Fipronil and emamectin benzoate (EMB) are effective insecticides for controlling cotton leafworm, Spodoptera littoralis. Fipronil works by blocking gamma-amino butyric acid (GABA) gated chloride. In contrast, EMB is activating GABA transporters. The objectives of our study were to assess relative toxicity of the technical fipronil and EMB alone and in mixture against S. littoralis. In addition, the GABA content was simultaneously determined using HPLC. Technical fipronil and EMB and their mixtures were applied topically to the fourth-instar larvae, and their LD50 values were estimated after 48 h. Results demonstrated that the LD50 for EMB applied alone was 0.751 ng/larva which was much less than for fipronil 7.271 ng/larva. Each of the two insecticides alone showed a significant decrease in GABA content at LD10, LD25, and LD50 doses, while their mixtures induced GABA levels. The highest potentiation was observed when both insecticides were in a mixture at the ratio of LD10:LD10 which was associated with higher increase in GABA levels. Moreover, the weight of the alive larvae was less than that was in the untreated control. However, all mixtures exhibited potentiation effect, except for the mixture of fipronil at LD50 with EMB at LD10, LD25, and LD50 that had antagonistic effect correlated with the lowest decrease in GABA level. Results suggested that lower doses of both insecticides in a binary mixture had potentiation effect against S. littoralis. This mixture could be used in combination as field application for successful and effective control of S. littoralis and would also help in managing insecticide resistance.

Suicidal risk and demoralization in Parkinson disease.

OBJECTIVE: We aimed to determine suicide risk and lifetime suicidal ideation in Parkinson disease (PD) patients versus controls and how depression, demoralization, and insomnia are associated with suicidality. METHODS: In this case-control study, PD patients and matched controls were recruited from movement disorder clinics, Michael J. Fox Foundation, and Research Match websites. Suicide risk and suicidal ideation were assessed using the Suicidal Behavior Questionnaire-revised (SBQ-R) and Columbia-Suicide Severity Rating Scale. Lifetime depression was assessed using the Brief Lifetime Depression Scale, sleep using Insomnia Severity Index (ISI), demoralization using Diagnostic Criteria for Psychosomatic Research and Kissane Demoralization Scales, and non-motor symptoms using UPDRS Non-Motor Aspects of Experiences of Daily Living scale (nM-EDL). RESULTS: 186 PD participants and 177 controls were matched for age (64.2 ± 7.7 years), sex (48.8% female), and socioeconomics. PD participants were not more likely than controls to have high suicide risk (SBQ-R ≥ 7) (7.5% vs. 11.3%; p = 0.22) or to have had a lifetime suicide plan or attempt (2.7% vs. 5.1%; p = 0.24), but were less likely to have had lifetime suicidal ideation (23.1% vs. 35.0%; p = 0.01). PD participants were more likely than controls to have lifetime depression history (34.4% vs. 20.9%; p = 0.004), and demoralization (19.9% vs. 10.7%; p = 0.02), and had higher ISI scores (8.7 ± 5.8 vs. 5.1 ± 4.5; p < 0.0001). PD patients with high versus normal suicide risk had higher nM-EDL scores (16.5 ± 6.8 vs. 10.7 ± 5.9; p = 0.002), and more demoralization (71.4% vs. 21.5%; p < 0.0001). CONCLUSIONS: Suicide risk is not elevated and suicidal ideation is uncommon in PD, despite the high prevalence of depression and demoralization.

Procedures used for correction of isolated penile torsion: are they competitive or complementary?

OBJECTIVES: To report our experience in starting the correction of penile torsion, whatever its degree (moderate or severe) with one or more simple procedures either separately or complementary in the same session. PATIENTS AND METHODS: Between 2013 and 2018, 62 patients who have significant isolated penile torsion (> 45°) were involved in this study. Those patients were subjected to either simple degloving with skin reposition, degloving with skin overcorrection and/or dartos flap procedures. Those procedures were performed either separately or complementarily. All patients were examined postoperatively after 7 days and followed up at 3, 6, and 9 months postoperatively. RESULTS: 37 out of 62 patients had a moderate degree (45-90) of penile torsion; 21 of them were corrected using skin degloving-reattachment technique, 11 patients were corrected by degloving with skin overcorrection, and in the remaining 4 patients dartos flap technique was used for correction. In 25/62 patients who had severe degree (> 90°) of torsion; 9 patients were managed by degloving with skin overcorrection, while in 13 patients the procedure was shifted to dartos flap technique, and the remaining 3 patients, 2 of whom had 180° torsion, were managed by dartos flap with added skin overcorrection. CONCLUSION: Performing degloving and skin reattachment with or without skin overcorrection procedure and dartos flap procedure either separately or complementarily in the same patient whatever the degree of torsion (moderate or severe) is associated with good results and can protect some patients from exposure to more difficult and extensive procedures as corporopexy and corporeal plication.

Impact of Ultrasound-Guided Transvaginal Ovarian Needle Drilling Versus Laparoscopic Ovarian Drilling on Ovarian Reserve and Pregnancy Rate in Polycystic Ovary Syndrome: A Randomized Clinical Trial.

STUDY OBJECTIVE: To compare the impact of ultrasound-guided transvaginal ovarian needle drilling (TND) versus laparoscopic ovarian drilling (LOD) on ovarian reserve and pregnancy rate in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). DESIGN: A randomized clinical trial (Canadian Task Force classification I). SETTING: A university hospital. PATIENTS: Of 644 patients who presented at an infertility clinic, 246 with CC-resistant PCOS were randomized for treatment. INTERVENTIONS: Patients were randomly allocated to ultrasound-guided TND (n = 124) and LOD (n = 122). MEASUREMENTS AND MAIN RESULTS: Ovarian reserve parameters (serum antimüllerian hormone [AMH] and antral follicle count [AFC]) and pregnancy rate at 3 and 6 months were evaluated. At 3 months, patients in the LOD group experienced a significantly lower AMH (p < .001) and a higher ovulation rate (p < .05) with comparable AFC and pregnancy rate to patients in the TND group (p > .05) and a significant decrease in AMH and AFC within each individual group when compared with baseline (p < .001). At 6 months, patients in the LOD group experienced a significantly lower AMH (p < .001), lower AFC (p < .001), higher ovulation rate (p < .001) and higher pregnancy rate (p < .001) when compared with patients in the TND group. This effect started to diminish between the fourth and sixth month with an increase of AMH and AFC compared with baseline values (p < .05). CONCLUSIONS: Although TND is simple, safe, and less invasive than LOD, its effect on ovarian reserve appears to be transient and diminishes at 6 months. Multicenter studies are warranted to confirm efficacy as a second-line treatment in patients with CC-resistant PCOS.

Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial.

BACKGROUND AND AIM: Acute kidney injury (AKI) with liver transplantation (LT) is not uncommon. Impact of terlipressin infusion on AKI, hemodynamics, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) was studied. METHODS: Patients (n=50) were randomized (NCT02059460, USA) into two equal groups: terlipressin vs Controls. Terlipressin (1-4 µg/kg/h) was administrated for 5 days. Intraoperative transesophageal Doppler for hemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV), and hepatic artery resistive index (HARI) were recorded. Plasma NGAL (pNGAL) was measured baseline, 2 and 24 hours postreperfusion. RESULTS: Hepatitis C virus (HCV) was the main etiology. Age, sex, model of end-stage liver disease (MELD), and renal functions were comparable. Postoperative AKI incidence and NGAL concentrations were comparable (P>.05) between terlipressin and controls groups (44% vs 48% and 112.5±9 vs 93.1±8 ng/mL), respectively, but intraoperative NGAL in both groups increased significantly 2 hours postreperfusion (P<.05). The three NGAL readings were comparable (P>.05) between AKI (n=23) and non-AKI developers (n=27). Mean arterial blood pressure (MAP) was maintained in both groups with less systemic vascular resistance (SVR) fluctuations with terlipressin. Median norepinephrine consumption was lower in terlipressin vs controls (8 vs 12 mg; P=.04). The PPV and HARI were not affected by terlipressin at any stage (P>.05). CONCLUSION: Postliver transplant AKI was not prevented by terlipressin use nor predicted by NGAL levels.

Body mass index is linked to cervical length and duration of pregnancy: An observational study in low risk pregnancy.

In this prospective cohort study, one hundred participants were allocated into four groups according to their body mass indices. Vaginal ultrasound was performed at enrolment to measure cervical length. The shortest cervical measurement was recorded. Overweight and obese groups had significantly longer mean cervical length than women in the normal weight group when measured at 20-22 weeks of gestation (p < .001). Underweight women had the shortest mean cervical length. The incidence of preterm delivery was the highest in underweight women (RR; 1.5). The incidence of post-term delivery was 10% in total in overweight and obese women. Underweight women were more likely to have short cervical length and subsequent preterm delivery compared to overweight and obese women.

Radiopacity of Nonmetallic CAD/CAM Restorative Blocks.

PURPOSE: This study determined the radiopacity of a group of computer-aided design/computer-assisted manufacture blocks using digital radiography and pixel monitoring. MATERIALS AND METHODS: Specimens 2.0 ± 0.05-mm thick were cut from nine different blocks. Longitudinal sections of the same thickness were obtained from molar and premolar. Specimens were assigned to one of two groups, and each group was placed on a digital radiograph sensor together with an aluminum step wedge. Following standardized technique, the sensor was exposed and two images were obtained from each group. Images were analyzed using ImageJ software to determine the number of pixels at five different locations for each specimen. Means and standard deviations were calculated and the data statistically analyzed. Radiopacity values were expressed as equivalent of aluminum thickness. RESULTS: Analysis of variance revealed significant difference in mean pixels among the blocks (P < .001). CONCLUSION: The majority of blocks had radiopacity values that were higher than that of dentin.

A new one-pot synthesis of novel hetarylazo-heterocyclic colorants and study of their solvatochromic properties.

A simple synthetic strategy for synthesis of new series of hetarylazo-heterocycles is described. The effects of solvent on their electronic absorption spectra were analyzed using Kamlet-Taft equation. The results of fitting coefficients indicated that the solvatochromism of the studied compounds is mainly due to the solvent polarity rather than the solvent basicity and acidity.

The relationship between term pre-eclampsia and the risk of early childhood caries.

OBJECTIVE: To test the hypothesis that pre-eclampsia is associated with higher incidence of early childhood caries in children aged between 3 and 5 years old. DESIGN: An observational non concurrent cohort study. SETTING: Al-Hayat National Hospital, Khamees Mushyat, Saudi Arabic Kingdom. POPULATION: Two hundred children aged 3-5 years who fulfilled the inclusion criteria. METHOD: A detailed dental examination was carried out for all children enrolled. We obtained all relevant obstetric data from mothers' and pediatric's medical records. Thirty cases were excluded due to missing data and therefore, only 170 children were considered for the statistical analysis. Results were tabulated and statistically analyzed. MAIN OUTCOME MEASURE: Early childhood caries. RESULTS: Sixty-three children (37%) of the 170 were affected with early childhood caries; 6 were delivered to pre-eclamptic and 57 to non pre-eclamptic mothers. Using logistic regression curve, early childhood caries was significantly associated with low birthweight, low Apgar score at 1st min and with the pattern of infant feeding but not with pre-eclampsia. The relative risk for early childhood caries was 2.84 among low birthweight infants (95%CI: 1.47-5.49), 1.95 among non breast fed children (95% CI: 1.11-4.20) and 2.64 among those delivered with an Apgar score less than 5 at 1 minute (95%CI:1.46-4.77). CONCLUSION: Pre-ecalampsia may not be associated with early childhood caries. A larger study and/or a study addressing the relation between pre-eclampsia and caries inducing lesions may provide more significant results.

Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting.

OBJECTIVE: To determine the best time to administer prophylactic antibiotics at Cesarean delivery in order to reduce the postoperative maternal infectious morbidity in a low resource setting. MATERIAL AND METHODS: One hundred term primigravidae with singleton pregnancy were recruited and randomly allocated to two equal groups. Each woman received 2 g intravenous Cefazoline. Women in Group I received it prior to skin incision while those in Group II had it immediately after cord clamping. We measured the following outcome parameters: (1) Surgical site wound infection; (2) Endometritis and (3) Urinary tract infection. RESULTS: There was no significant difference in any of the patients' characteristics between both groups. In Group I, three cases developed surgical site infections but four in Group II (p > 0.05). In Group I, the infected cases had Cesarean because of malpresentations while in Group II, two cases had Cesarean because of patients' request, one because of maternal heart disease and one due to intra-uterine growth restriction. Seven and nine cases had urinary tract infection in Groups I and II, respectively, (p > 0.05). CONCLUSION: Prophylactic antibiotic administration either prior to surgery or after cord clamping is probably equally effective in reducing the postoperative infectious morbidity after Cesarean in low resource settings.

Abdominal electromyography in laboring and non-laboring pregnant women at term and its clinical implications.

OBJECTIVE: To determine the patterns of uterine action potentials in laboring and non-laboring women at term using the non-invasive abdominal electromyography technique. METHODS: One hundred pregnant women at term who fulfilled the inclusion criteria were enrolled in the study and equally divided into two groups. Group I consisted of 50 women in active labor, while group II included 50 women not in labor. After enrollment, the cardiotocograph was applied to all women. Abdominal electromyographic recording was started and for every burst of action potential, we measured the amplitude, frequency and duration of action potential. The results were tabulated and statistically analyzed. RESULTS: Both groups were comparable in demographic characteristics. Four patterns of EMG were detected. The amplitude of action potentials was significantly higher in laboring compared to non-laboring women (77.44 ± 11.25 vs 13.71 ± 8.57, P < 0.001). Similar significantly longer durations of electrical bursts were also noted in laboring women (45.94 ± 8.77 vs 7.11 ± 4.68 s, P < 0.001). Specific electromyographic changes were noted in women passing from the non-laboring to laboring state and in women who required oxytocin augmentation during labor. CONCLUSION: Abdominal electromyography may help to distinguish between women in true active labor from those who are not. It also may help to identify women who will enter into labor within 24-72 h and those who require augmentation of labor.