An investigated organic and inorganic reinforcement as an effective economical filler of poly (methyl methacrylate) nanocomposites.

Polymer matrix composites have garnered the interest of the dentistry sector. Nano-fillers are frequently used as reinforcements in these composites to enhance their characteristics. Poly (methyl methacrylate) was filled with date seed nanoparticles (DSNP) and titanium oxide nanoparticles (TiO2NP). In this work, two nanofillers (DSNP and TiO2NP) were analyzed using Fourier-transform infrared spectroscopy (FTIR). In addition, the features of the PMMA-nanofiller composite were experimentally evaluated via compression, micro-hardness, wear rate (WR), and coefficients of friction (µ) testing. Utilizing a scanning electron microscope (SEM), the microstructure of the PMMA-DSNP composite was examined. The results of the experiments on the nanocomposites demonstrated that the elastic modulus, microhardness, wear resistance, and friction resistance increased with an increase in DSNP content to 1.2 wt, in comparison to TiO2NP at the same concentration. Finally, according to the guidelines, the ideal weight was determined to be 1.2 wt%, filler in the form of DSNP, at a normal load of 10 N.

Does detrusor underactivity affect the results of transurethral resection of prostate?

PURPOSE: We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have weak detrusor contractility by urodynamic study. METHODS: A prospective study of 32 male patients had BPH candidate for TURP diagnosed to have impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome after TURP regarding international prostate symptoms score (IPSS), maximum flow rate (Qmax), post-voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) after 6 month follow-up. RESULTS: Twenty-one cases presented with urethral catheter because of chronic or refractory retention. Twenty patients voided preoperatively during PFS with mean detrusor pressure (Pdet) at Qmax 23.97 ± 25.54 cmH2O and the mean BCI was 51.04 ± 23.86, while twelve patients did not void with mean maximum Pdet 21.75 ± 7.34. After 6 month follow-up, there was significant improvement in IPSS, Qmax, and detrusor contractility (Pdet at Qmax and BCI) postoperatively in all patients, and there was no significant postoperative improvement of post-voiding residual urine (p value 0.92). Finally, 11 patients voided normally without RU, 7 patients needed timed triple voiding with crede maneuver and small RU, and 14 patients needed CIC. CONCLUSIONS: There were significant improvements in IPSS, detrusor contractility, and urine flow after TURP in patients with BPH and weak bladder contractility, although the risk of postoperative urine retention in approximately 43% of cases and needed CIC.

Impact of allergy on children with attention deficit hyperactivity disorder.

Summary: Background. Attention deficit hyperactivity disorder (ADHD) is commonly present worldwide, causing serious problems to those affected. ADHD was suggested to be secondary to allergic disorder or its medication. Both ADHD and allergy depend on complex environmental and genetic interaction, and they meet the hypersensitivity criteria. Objective. Detect the percentage of allergy in ADHD children, the common allergic disorders and allergens, and the effect of allergy on symptom and severity of ADHD. Material and methods. 100 children with ADHD were subjected to psychiatric assessment for ADHD type and severity, history of allergy, skin prick test to common environmental allergens, serum total IgE levels and open food challenge. Co-morbid neuropsychiatric disorders, below average intelligence quotient (IQ), and chronic illnesses were excluded. A control of 60 healthy children was chosen to compare the results of skin prick test and serum total IgE levels. Results. 35 ADHD children (35%) were allergic. Most cases had combined allergic rhinitis and bronchial asthma (25%). Common allergens were hay dust (43%) followed by different pollens (37.5%). There were statistical significant differences between coexistence of allergy, type of ADHD, early onset and severity of symptoms. Conclusion. Children with ADHD had an increased prevalence of allergic diseases. Evaluation of allergy in ADHD is mandatory, to decrease the burden of the condition.

Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt.

Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy. Many studies have shown strong correlation between HD dose and clinical outcome. The cross-sectional study was conducted on 100 patients in Hemodialysis Unit at Tanta University Hospital, Egypt. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. The results revealed inadequate HD dose among 60% of the study population. The results also showed that increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings showed a positive correlation between dialysis dose and hemoglobin, serum albumin, normalized protein catabolic rate, and physical health. A great percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of dialysis session, patients' complaints, and well-functioning vascular access.

Caesarean section surgical techniques: 3 year follow-up of the CORONIS fractional, factorial, unmasked, randomised controlled trial.

BACKGROUND: The CORONIS trial reported differences in short-term maternal morbidity when comparing five pairs of alternative surgical techniques for caesarean section. Here we report outcomes at 3 years follow-up. METHODS: The CORONIS trial was a pragmatic international 2 × 2 × 2 × 2× 2 non-regular fractional, factorial, unmasked, randomised controlled trial done at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. In this follow-up study, we compared outcomes at 3 years following blunt versus sharp abdominal entry, exteriorisation of the uterus for repair versus intra-abdominal repair, single versus double layer closure of the uterus, closure versus non-closure of the peritoneum, and chromic catgut versus polyglactin-910 for uterine repair. Outcomes included pelvic pain; deep dyspareunia; hysterectomy and outcomes of subsequent pregnancies. Outcomes were assessed masked to the original trial allocation. This trial is registered with the Current Controlled Trials registry, number ISRCTN31089967. FINDINGS: Between Sept 1, 2011, and Sept 30, 2014, 13,153 (84%) women were followed-up for a mean duration of 3·8 years (SD 0·86). For blunt versus sharp abdominal entry there was no evidence of a difference in risk of abdominal hernias (adjusted RR 0·66; 95% CI 0·39-1·11). We also recorded no evidence of a difference in risk of death or serious morbidity of the children born at the time of trial entry (0·99, 0·83-1·17). For exteriorisation of the uterus versus intra-abdominal repair there was no evidence of a difference in risk of infertility (0·91, 0·71-1·18) or of ectopic pregnancy (0·50, 0·15-1·66). For single versus double layer closure of the uterus there was no evidence of a difference in maternal death (0·78, 0·46-1·32) or a composite of pregnancy complications (1·20, 0·75-1·90). For closure versus non-closure of the peritoneum there was no evidence of a difference in any outcomes relating to symptoms associated with pelvic adhesions such as infertility (0·80, 0·61-1·06). For chromic catgut versus polyglactin-910 sutures there was no evidence of a difference in the main comparisons for adverse pregnancy outcomes in a subsequent pregnancy, such as uterine rupture (3·05, 0·32-29·29). Overall, severe adverse outcomes were uncommon in these settings. INTERPRETATION: Although our study was not powered to detect modest differences in rare but serious events, there was no evidence to favour one technique over another. Other considerations will probably affect clinical practice, such as the time and cost saving of different approaches. FUNDING: UK Medical Research Council and the Department for International Development.

Synthesis, characterization, release kinetics and toxicity profile of drug-loaded starch nanoparticles.

The current research work focuses on the medical application of the cost-effective cross-linked starch nanoparticles, for the transdermal delivery using Diclofenac sodium (DS) as a model drug. The prepared DS-cross-linked starch nanoparticles were synthesized using nanoprecipitation technique at different concentrations of sodium tripolyphosphate (STPP) in the presence of Tween 80 as a surfactant. The resultant cross-linked starch nanoparticles loaded with DS were characterized using world-class facilities such as TEM, DLS, FT-IR, XRD, and DSc. The efficiency of DS loading was also evaluated via entrapment efficiency as well as in vitro release and histopathological study on rat skin. The optimum nanoparticles formulation selected by the JMP(®) software was the formula that composed of 5% maize starch, 57.7mg DS and 0.5% STPP and 0.4% Tween 80, with particle diameter of about 21.04nm, polydispersity index of 0.2 and zeta potential of -35.3mV. It is also worth noting that this selected formula shows an average entrapment efficiency of 95.01 and sustained DS release up to 6h. The histophathological studies using the best formula on rat skin advocate the use of designed transdermal DS loaded cross-linked starch nanoparticles as it is safe and non-irritant to rat skin. The overall results indicate that, the starch nanoparticles could be considered as a good carrier for DS drug regarding the enhancement in its controlled release and successful permeation, thus, offering a promising nanoparticulate system for the transdermal delivery non-steroidal anti-inflammatory drug (NSAID).

A novel photosynthesis of carboxymethyl starch-stabilized silver nanoparticles.

The water soluble photoinitiator (PI) 4-(trimethyl ammonium methyl) benzophenone chloride is used for the first time in the synthesis of silver nanoparticles (AgNPs). A new green synthesis method involves using PI/UV system, carboxymethyl starch (CMS), silver nitrate, and water. A mechanism of the reduction of silver ions to AgNPs by PI/UV system as well as by the newly born aldehydic groups was proposed. The synthesis process was assessed by UV-vis spectra and TEM of AgNPs colloidal solution. The highest absorbance was obtained using CMS, PI and AgNO3 concentrations of 10 g/L, 1 g/L, and 1 g/L, respectively; 40 °C; 60 min; pH 7; and a material : liquor ratio 1 : 20. AgNPs so-obtained were stable in aqueous solution over a period of three weeks at room temperature (~25 °C) and have round shape morphology. The sizes of synthesized AgNPs were in the range of 1-21 nm and the highest counts % of these particles were for particles of 6-10 and 1-3 nm, respectively.

Antimicrobial wound dressing and anti-inflammatory efficacy of silver nanoparticles.

Powdered silver nanoparticles (AgNPs) were successfully prepared through addition of AgNO3 to alkali dissolved starch followed by precipitation with ethanol. AgNPs aqueous suspensions were prepared from powder AgNPs by dispersion and dilution with water. Wound dressings were obtained by treating cotton fabrics with different concentrations of AgNPs aqueous suspensions (60, 125 and 250 ppm). The as prepared AgNPs were characterized using UV-vis spectroscopy, transmission electron microscopy (TEM), particle size analyzer, polydispersity index (PdI), zeta potential. The prepared AgNPs powder had particle size value (22 nm), polydispersity index (0.163) and zeta potential (-28 mV) indicating the formed AgNPs had small and well stabilized particles. The treated cotton fabrics were characterized by making use of SEM-EDX. Cotton fabrics containing 250 ppm AgNPs were more effective against different species of organisms than those containing 60 and 125 ppm. The results of potent healing using fabrics treated with 250 ppm AgNPs indicate that it leads to similar results compared with that of the Dermazin cream. Moreover, the anti-inflammatory effect AgNPs is nearly similar to 20 ml dose of the reference indomethacin drug.

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial.

BACKGROUND: Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies. METHODS: CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined five elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the five intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intra-abdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967. FINDINGS: Between May 20, 2007, and Dec 31, 2010, 15 935 women were recruited. There were no statistically significant differences within any of the intervention pairs for the primary outcome: blunt versus sharp entry risk ratio 1·03 (95% CI 0·91-1·17), exterior versus intra-abdominal repair 0·96 (0·84-1·08), single-layer versus double-layer closure 0·96 (0·85-1·08), closure versus non-closure 1·06 (0·94-1·20), and chromic catgut versus polyglactin-910 0·90 (0·78-1·04). 144 serious adverse events were reported, of which 26 were possibly related to the intervention. Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section. INTERPRETATION: These findings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects. FUNDING: UK Medical Research Council and WHO.

Effect of extracorporeal shock wave lithotripsy on kidney growth in children.

PURPOSE: We investigated whether shock wave lithotripsy affects kidney growth in children. MATERIALS AND METHODS: This prospective controlled study included 150 children with renal stones who presented for shock wave lithotripsy between March 2005 and February 2010 (group A). The control arm included 100 children without any urological problems who were enrolled in the study after obtaining written maternal consent (group B). All children in both groups underwent abdominal ultrasound to assess renal size (bipolar renal length), which was repeated after 6 months for group A and after 1 year for both groups. RESULTS: Bipolar renal size in group A increased significantly at 6 months and 1 year after shock wave lithotripsy. Renal growth did not differ based on patient age at shock wave lithotripsy (p = 0.472), number of shock wave lithotripsy sessions (p = 0.65) or number of stones (p = 0.405). There was no significant difference between the rate of kidney growth in children who underwent shock wave lithotripsy during the year of the study and normal controls. CONCLUSIONS: Shock wave lithotripsy has no deleterious effect on the normal rate of renal growth in children. This outcome is not affected by either the number of stones or the age of the child at shock wave lithotripsy.

Evaluation of renal function in children undergoing extracorporeal shock wave lithotripsy.

PURPOSE: The effect of extracorporeal shock wave lithotripsy on the growing kidneys of young children has always been a concern. We determined whether shock wave lithotripsy causes renal parenchymal scarring or affects glomerular filtration rate in children. MATERIALS AND METHODS: This prospective study included 100 children with renal stones who presented to the shock wave lithotripsy unit at our institution between March 2005 and March 2008. A total of 28 children had multiple stones in the same kidney. All children with bilateral renal stones had 1 kidney cleared of stones by percutaneous nephrolithotomy before undergoing shock wave lithotripsy. A total of 138 stones were subjected to shock wave lithotripsy. All children underwent radionuclide scan of the renal parenchyma using dimercapto-succinic acid, and glomerular filtration rate was estimated using diethylenetriamine pentaacetic acid before extracorporeal shock wave lithotripsy and 6 months afterward. Children with renal scarring due to previous surgery or vesicoureteral reflux were excluded from the study. The number of shock wave lithotripsy sessions to achieve stone-free status and the dose of shock waves used were recorded for each patient. RESULTS: No patient demonstrated renal parenchymal scarring on dimercapto-succinic acid scan or any statistically significant change in glomerular filtration rate on diethylenetriamine pentaacetic acid scan up to 6 months after shock wave lithotripsy. CONCLUSIONS: Shock wave lithotripsy is a safe modality for treating renal calculous disease in children up to 16 years old, with no impact on long-term kidney function.

Intercanthal Distance of a Sudanese Population Sample as a Reference for Selection of Maxillary Anterior Teeth Size

Background: The choice of the size of artificial teeth takes an important place in the removable prosthodontic treatment. However; the standards or proportions commonly used as a guide have been developed mainly on Caucasian populations. Objectives: to investigate the relationship between intercanthal distance and the anterior maxillary teeth size in Sudanese population. Methods: This is a descriptive cross sectional study conducted in 114 subjects; (45 males - 69 females); from Khartoum and Juba Universities. The age range was from 18-46 years. The intercanthal distance (I.C.D) was the measurement taken between the median angles of the palpabral fissure. Maxillary intercanine distance was obtained by measuring a line from the tip of the canine on one side; to the canine on the other side. An electronic digital caliper (Narex - Czechoslovakia) was used for all measurements. Data were analyzed using Person chi-square test. Results: a significant correlation is found between intercanthal distance and maxillary intercanine distance in all subjects (P-value 0.015); and in females who had a (P-value of 0.006).Maxillary intercanine distance may be estimated by dividing I.C.D by factor 0.9. Conclusion: These results could be used as a helpful guide for selection of anterior teeth width in the Sudanese population

Pediatric and adolescent transperineal anastomotic urethroplasty.

PURPOSE: Pediatric urethral stricture disease represents a significant surgical challenge because of smaller pelvic confines, decreased caliber and increased tissue fragility. Operative series of pediatric urethral reconstruction usually involve small numbers. In this study, we examined the outcome of open reconstructive techniques for pediatric and adolescent patients with posterior urethral distraction injuries. PATIENTS AND METHODS: Between February 2002 and September 2005, 15 patients from Kasr ElAini hospital presenting with posterior urethral distraction defects due to motor vehicle accidents were included in our study. Their age ranged between 5 and 17 years (mean 12.5). We used the progressive perineal approach to achieve a tension-free spatulated anastomosis. RESULTS: Mean follow-up was 28.4 months. Initial and ultimate success rates were 80 and 86.6%, respectively. Other than re-stricture, one child had a bladder stone treated by cystolithotomy 6 months after surgery. No penile curvature, shortening or urethral diverticulae were noted during follow-up. CONCLUSION: Using the appropriate modern guidelines of urethroplasty, consistent success can be achieved in pediatric and adolescent patients with posterior urethral injuries. Open urethral reconstruction of adolescent and pediatric strictures provides excellent long-term results with minimal morbidity. Urethral reconstruction is strongly recommended as the primary treatment option, especially in the pediatric urethral stricture population, because of the repair durability.

Parental drinking problems and children's adjustment: vagal regulation and emotional reactivity as pathways and moderators of risk.

Children's emotional regulation (as indexed by vagal suppression) and children's emotional reactivity during an argument were examined as moderators and mediators of parental problem drinking and children's adjustment in a sample of 6- to 12-year-olds. Cardiac vagal tone was assessed during both a baseline condition and exposure to an audiotaped argument. Vagal suppression was calculated by subtracting vagal tone during the baseline from that recorded during the argument, with a higher number representing increased suppression of vagal tone during the argument. Emotional reactivity was based on both observations of overt behaviors of children and their reported feelings during the argument. A higher level of vagal suppression was a protective factor against children's externalizing, internalizing, and social problems associated with exposure to parental problem drinking. Emotional reactivity was a vulnerability factor, and children's increased anger and fear, and to a lesser degree sadness, each moderated and exacerbated the effects of parental problem drinking on child outcomes.

Appraisals of marital conflict and children's adjustment, health, and physiological reactivity.

Children's appraisals of marital conflict were examined as moderators and mediators of conflict and children's adjustment, physical health, and physiological reactivity. Mothers completed measures of marital conflict and children's adjustment and physical health, and elementary school children provided information on their parents' marital conflict, appraisals of perceived threat and self-blame in relation to parents' conflicts, and their internalizing symptomatology. Children's heart rate, systolic and diastolic blood pressure, and skin conductance response and level were examined during both a baseline and an interadult argument. Higher levels of both self-blame and perceived threat functioned as robust vulnerability factors for children exposed to higher levels of marital conflict in relation to internalizing behaviors, health problems, and higher levels of cardiovascular reactivity to the argument. Further, a higher level of perceived threat was a vulnerability factor for externalizing problems associated with exposure to marital conflict.

Parental problem drinking and children's adjustment: family conflict and parental depression as mediators and moderators of risk.

We examined marital conflict, parent-child conflict, and maternal and paternal depression symptoms as mediators and moderators in the associations between fathers' and mothers' problem drinking and children's adjustment. A community sample of 6-12-year-old boys and girls and their mothers, fathers, and teachers participated. Marital conflict, parent-child conflict, and maternal depression symptomatology each functioned as a mediator of the association between father's problem drinking and children's externalizing and internalizing problems, and maternal depression symptoms accounted partially for the link between father's problem drinking and children's social problems. For mother's problem drinking, marital conflict, parent-child conflict, and maternal depression symptoms each mediated the association with children's externalizing problems. Further, parent-child conflict explained partially the link between mother's problem drinking and internalizing problems, and marital conflict accounted for the association between mother's problem drinking and social problems. When the mediators were simultaneously examined, parent-child conflict was the most robust mediator of the association between parental problem drinking and externalizing problems, and maternal depression symptomatology was the most consistent mediator of the relation between parental problem drinking and internalizing problems. Further, parent-child conflict and paternal and maternal depression symptoms each interacted with parental problem drinking to moderate some domains of children's adjustment. The significant moderation effects indicate that parent-child conflict is a robust vulnerability factor for internalizing problems.