Accuracy of single and parallax film and digital periapical radiographs in diagnosing apical periodontitis - a cadaver study.

AIM: To compare the accuracy of film and digital periapical radiography (PR) in detecting apical periodontitis (AP) using histopathological findings as a reference standard. METHODOLOGY: Jaw sections containing 67 teeth (86 roots) were collected from nine fresh, unclaimed bodies that were due for cremation. Imaging was carried out to detect AP lesions using film and digital PR with a centred view (FP and DP groups); film and digital PR combining central with 10˚ mesially and distally angled (parallax) views (FPS and DPS groups). All specimens underwent histopathological examination to confirm the diagnosis of AP. Sensitivity, specificity and predictive values of PR were analysed using rater mean (n = 5). Receiver operating characteristics (ROC) analysis was carried out. RESULTS: Sensitivity was 0.16, 0.37, 0.27 and 0.38 for FP, FPS, DP and DPS, respectively. Both FP and FPS had specificity and positive predictive values of 1.0, whilst DP and DPS had specificity and positive predictive values of 0.99. Negative predictive value was 0.36, 0.43, 0.39 and 0.44 for FP, FPS, DP and DPS, respectively. Area under the curve (AUC) for the various imaging methods was 0.562 (FP), 0.629 (DP), 0.685 (FPS), 0.6880 (DPS). CONCLUSIONS: The diagnostic accuracy of single digital periapical radiography was significantly better than single film periapical radiography. The inclusion of two additional horizontal (parallax) angulated periapical radiograph images (mesial and distal horizontal angulations) significantly improved detection of apical periodontitis.

Comparison of the effect of zinc oxide nanoparticles and extract of Acorus calamus applied topically on surgical wounds inflicted on the skin of rabbits.

Antibiotics are used for postsurgical wound healing purposes but unfortunately, resistance against them demands some alternatives for quick recovery. Sepsis of wounds is a challenge for medical as well as veterinary professionals. Nanoparticles have significant advantages in wound treatment and drug resistance reversal. This study was conducted to appreciate emerging alternates of antibiotics like zinc oxide nanoparticles and plant extracts in topical application. Zinc oxide is considered a good wound healer and its nanoparticles are easy to access. So, the efficacies of zinc oxide nanoparticles and sweet flag plant extract ointments were tested to compare modern and traditional therapeutics as sweet flag is considered a pure medicinal plant. Rabbits were selected for this study due to the healing properties of their skin. Wounds were inflicted on the thoracolumbar region and treated for 29 days post-surgically daily with normal saline and the ointment of zinc oxide nanoparticles and sweet flag extract ointment, prepared in a hydrophilic solvent. Wound shrinkage was observed daily and histopathological analysis was made and results were compared. Zinc oxide nanoparticles ointment showed the most satisfactory results for every parameter included in the study. No side effects of its topical application were observed. Healing was normal without any complications. The preparations of zinc oxide nanoparticles may help in the era of antibiotic resistance as topical drugs in the future.

The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health.

BACKGROUND: Several factors can contribute to the development of postpartum depression (PPD) and negatively affect mothers' mental and physical well-being. The objective of this study was to determine the relationship between fatigue, sleep quality, resilience, and the risk of PPD development. METHODS: A cross-sectional study was conducted using an online questionnaire distributed to mothers during their postpartum period. The risk of PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), postpartum fatigue (PPF) was assessed using the Fatigue Severity Scale (FSS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and resilience was assessed using the Brief Resilience Scale (BRS). The Pearson correlation coefficient was calculated to determine the relationship between the study variables. Simple and multiple linear regression analyses were performed to explain the contributions of PPF, sleep quality, and resilience as independent predictors of PPD development. RESULTS: A total of 1409 postpartum women were included in the analysis, with 75% of the participants reporting a risk of PPD, 61% reporting PPF, 97% reporting having sleep problems, and 36% being in the "low resilience level" category. In terms of correlations, the scores of FSS and the PSQI showed moderate positive relationships with the EPDS scores (r = 0.344 and r = 0.447, respectively, p = .000). The BRS scores were negatively associated with the EPDS scores (r = -0.530, p = 0.000). Fatigue, sleep quality, and resilience were predictors of depressive symptoms (ß = 0.127, ß = 0.262, and ß = -0.393, respectively, R2 = 0.37, p = 0.000). The association remained significant in the regression model after adjusting for mother's age, mother's BMI, child's age, smoking status, full-term pregnancy, having a chronic disease, and taking anti-depressant. CONCLUSIONS: Mothers with higher levels of fatigue, poor sleep quality, and low resilience levels were at high risk of developing PPD. Healthcare providers should identify these factors and thus set better rehabilitation goals to improve overall maternal health.

Treatment of refractory melasma with combination of topical 5% magnesium ascorbyl phosphate and fluorescent pulsed light in Asian patients.

BACKGROUND: Melasma is an acquired disorder of hypermelanosis of great psychosocial concern. The treatments with various conventional therapies are often unsatisfactory. Lasers and light sources have been used to treat pigmented lesions, but in Asian skin with higher melanin content, such treatments may be challenging. OBJECTIVES: To determine the effectiveness of treating melasma with a combination of topical 5% magnesium ascorbyl phosphate (MAP) and fluorescent pulsed light (FPL). MATERIALS AND METHODS: Patients of skin types III-V with refractory melasma were treated for 12 weeks with topical application of 5% MAP and three sessions of FPL (570-950 nm) at 3, 6, and 9 weeks (fluence 12-14 J/cm(2) , pulse width 15 ms, and spot size 3 cm(2) ). They were followed up for another 12 weeks to assess the persistence of treatment benefit. Digital photographs of the patients were taken at each visit. Treatment efficacy was determined by calculating mean melasma area and severity index (MASI) at the beginning and then at weeks 6, 12, and 24. The subjective assessment was done by comparing pre-treatment and post-treatment photographs by an independent observer and self-assessment by patients using four-point scoring scale (1, poor, 2, fair, 3, good, and 4, excellent). RESULTS: Sixty-five patients completed the study. The baseline mean MASI score of 14.80 decreased to 4.53 at the 12th week (end of treatment) and 6.35 at the 24th week (end of follow-up). The overall regression of mean MASI at these end-points was 69.3% and 57% (P < 0.01). The pre- and post-treatment photographic evaluation by independent observer and patients' self-assessment at the 12th week showed good to excellent response (scores 3 and 4) in 52.3% and 44.6% cases, respectively. No significant adverse effects of treatment were noted. CONCLUSION: Combination of 5% MAP with FPL is effective, well tolerated, and safe in treating refractory melasma in Asian patients but for persistent improvement, maintenance treatments would be required.

Nanostructured donor-acceptor self assembly with improved photoconductivity.

Nanostructured supramolecular donor-acceptor assemblies were formed when an unsymmetrical N-substituted pyridine functionalized perylenebisimide (UPBI-Py) was complexed with oligo(p-phenylenevinylene) (OPVM-OH) complementarily functionalized with hydroxyl unit and polymerizable methacrylamide unit at the two termini. The resulting supramolecular complex [UPBI-Py (OPVM-OH)]1.0 upon polymerization by irradiation in the presence of photoinitiator formed well-defined supramolecular polymeric nanostructures. Self-assembly studies using fluorescence emission from thin film samples showed that subtle structural changes occurred on the OPV donor moiety following polymerization. The 1:1 supramolecular complex showed red-shifted aggregate emission from both OPV (∼500 nm) and PBI (∼640 nm) units, whereas the OPV aggregate emission was replaced by intense monomeric emission (∼430 nm) upon polymerizing the methacrylamide units on the OPVM-OH. The bulk structure was studied using wide-angle X-ray diffraction (WXRD). Complex formation resulted in distinct changes in the cell parameters of OPVM-OH. In contrast, a physical mixture of 1 mol each of OPVM-OH and UPBI-Py prepared by mixing the powdered solid samples together showed only a combination of reflections from both parent molecules. Thin film morphology of the 1:1 molecular complex as well as the supramolecular polymer complex showed uniform lamellar structures in the domain range <10 nm. The donor-acceptor supramolecular complex [UPBI-Py (OPVM-OH)]1.0 exhibited space charge limited current (SCLC) with a bulk mobility estimate of an order of magnitude higher accompanied by a higher photoconductivity yield compared to the pristine UPBI-Py. This is a very versatile method to obtain spatially defined organization of n and p-type semiconductor materials based on suitably functionalized donor and acceptor molecules resulting in improved photocurrent response using self-assembly.

The effect of motor vehicle airbag deployment on tooth surfaces.

Motor vehicle airbag technology is directed at the reduction of injury to drivers and passengers however a number of researchers have reported cases of injuries caused by airbags. Injuries to tooth surfaces, particularly tooth wear following the deployment of motor vehicle airbags, have never been studied. A review of the literature and clinical experience does not suggest tooth enamel abrasion to be a likely outcome following airbag deployment. This in vitro pilot study was conducted to assess the effect on tooth surfaces following the deployment of motor vehicle airbags, and in particular to attempt to reproduce the injuries claimed in a case report published in the Journal of Forensic Odonto- Stomatology in December 2007. A sample of extracted upper anterior teeth (n = 20) were analyzed using unaided visual observation, photographic and microscopic observation pre- and post- airbag deployment. Teeth were mounted on a fabricated head form (similar to those used in crash test dummies) using dental putty. The tests were performed using a modified airbag test rig with airbags deployed in 5 different positions relative to the head, with respect to distance and angulations. The result of the tests showed no changes to the teeth with unaided observation, macro photography or under the microscope. Tooth wear patterns described in the case report were not observed. Although accurate reproduction of an in vivo situation is not possible, this study has given some insight into the effects of motor vehicle airbag deployment, and suggests that significant tooth wear is an unlikely outcome from airbag deployment.

Mandibular metastatic hepatocellular carcinoma: a case involving severe postbiopsy hemorrhage.

PURPOSE: To highlight the hemorrhagic character of metastatic hepatocellular carcinoma. PATIENT AND METHOD: A case report of a patient with mandibular metastatic hepatocellular carcinoma, who had severe postbiopsy hemorrhagic episodes, and literature review is presented. CONCLUSIONS: Mandibular metastatic hepatocellular carcinoma is a hemorrhagic tumor because of its hypervascular nature. Any rapidly enlarging swelling with ill-defined mandibular destruction suggestive of malignancy should be considered for metastatic hepatocellular carcinoma. Only a needle biopsy should be attempted in view of the hemorrhagic nature of the tumor. Palliative radiotherapy can be useful for the control of local expansile symptoms of the tumor and because of its possible role in the prevention of hemorrhage.

Blindness associated with midfacial fractures.

PURPOSE: This study assessed the frequency of blindness associated with midfacial fractures and correlated this with the fracture pattern. PATIENTS AND METHODS: A retrospective analysis of 49 patients admitted with midfacial fractures from January 1995 to March 1997 was performed to determine the presence of posttraumatic blindness. The medical and radiological records of the patients with blindness were reviewed for age and sex, cause of the injury, type of facial fracture, type of ocular trauma, and probable cause of the blindness. RESULTS: Ten of the 49 patients lost vision in one eye (20% of all midfacial fractures and 22% of midface fractures involving the orbit). The possibility of blindness associated with facial fractures was directly related to the severity of injury. Road traffic accidents were the most common cause. Blindness was attributable to traumatic optic nerve injury in seven cases and a ruptured globe in three cases. CONCLUSIONS: The high frequency of blindness associated with midfacial fractures in this series was attributable to the predominance of road traffic accidents as the major cause and absence of an obligatory seat belt law. Early diagnosis of the exact nature of the ophthalmic injury and treatment are important, and involvement of the ophthalmologist is mandatory.

Patient satisfaction with primary health care services in Riyadh

To assess the level of patients satisfaction with primary health care PHC services in health centers affiliated to Riyadh Military Hospital RMH, Riyadh, Kingdom of Saudi Arabia. A cross-sectional study was conducted in 3 PHC centers, affiliated to Riyadh Military Hospital RMH, Riyadh, Kingdom of Saudi Arabia, over 2 months period in 2006, data was collected using a self-administered questionnaire to assess patients' overall satisfaction with PHC services and their level of satisfaction with 5 PHC domains: reception services, accessibility, continuity of care, communication, and enablement. Seven hundred questionnaires were distributed yielding 86.6% response rate, 39.6% of our patients were 20-30 years old, 51.5% of the respondents were females, 76.4% were married and 34.5% of them showed a medical visit frequency of a minimum of 8 times per year. The domains of PHC with the highest level of reported satisfaction was enablement 70.6%. The poorest level of satisfaction was at the continuity of care 56.3%. The mean score of satisfaction with reception was 70.0%, communication 69.2%, and accessibility to care was 62.4%. The overall satisfaction level was 64.2%. Patients of older age were more satisfied with PHC services than their younger counterparts p-value <0.001 and patients with lower education level were more satisfied p-value<0.001. Patients' satisfaction was inversely related to their average annual visit frequency to PHC centers p-value =0.015. There was no relation found between patients' satisfaction and their gender, marital status, occupational status, and their average monthly income. The level of satisfaction with PHC services in health centers affiliated to RMH is relatively low, results identified areas in which quality improvement is required, mainly accessibility and continuity of care