Relationship between premature ventricular complexes and stroke mortality in the general population.

OBJECTIVES: Predictors for increased stroke mortality identify those who may need closer monitoring and better hospital care. While the link between premature ventricular complexes (PVCs) and incident ischemic stroke has been reported, studies on the association with fatal stroke are non-existent. MATERIALS AND METHODS: We examined the association of PVCs with stroke mortality in 8047 participants (56.5 ± 0.39 years, 53% women, 80.9% Non-Hispanic Whites) without prior history of stroke from the Third National Health and Nutrition Examination Survey. National Death Index was used to identify the date and cause of death. PVCs were detected from 12­lead standard electrocardiograms. Cox proportional hazard analysis was used to examine the association between any PVC with stroke mortality. RESULTS: Approximately 2.1% (n = 134) participants had PVCs at baseline. Over a median follow-up of 22 years, 337 fatal strokes occurred. More strokes occurred in participants with baseline PVCs compared to those without (unadjusted cumulative incidence of stroke 9.5% vs. 2.5% respectively, p-value 0.001). In a multivariable-adjusted model, the presence of PVC was associated with an increased risk of stroke mortality (HR (95%CI): 2.50 (1.15-5.43). This association was stronger in participants with coronary heart disease (CHD) than those without it (HR (95%CI): 5.98 (2.2-16.2) vs. 1.97 (0.75-5.1) respectively; interaction-p = 0.008). CONCLUSIONS: PVCs are associated with an increased risk of stroke mortality, especially among individuals with CHD. Whether improved hospital care or modifying PVCs could change outcomes should be examined in prospective studies.

Perception of Minimum Interventional Dentistry among Dental Undergraduate Students and Interns.

Background: The philosophy of minimum interventional dentistry (MID) is to integrate prevention, remineralization, and minimal intervention for the placement and replacement of restorations. All branches of dentistry play an important role in practicing MID, and their primary goal is to realize that any restoration is of less biological significance than the healthy original tissue Objectives: The objective of this study was to assess the perception of MID among dental undergraduate students and interns in terms of knowledge, attitude, and practice at the College of Dentistry. Materials and Methods: This cross-sectional study was conducted among undergraduate students and interns at the College of Dentistry, Qassim University, Saudi Arabia. A self-administered questionnaire was distributed, which included basic demographic profiles and questions about the knowledge, attitude, and practices toward MID. The data were tabulated in MS Excel, and all statistical analyses were performed using SPSS version 21. Results: A total of 163 dental students were recruited, with senior students comprising 73% and interns comprising 27%. Male students were slightly more prevalent (50.9%) than female students (49.1%). About 37.6% of participants received training about MID during educational courses, while 10.3% received it during their internship. A statistical test revealed that the prevalence of interns who were trained in performing MID was significantly higher (p < 0.001). Conclusions: The majority of the participants demonstrated proper knowledge, attitude, and practice in different aspects of MID. Interns reported a higher rate of knowledge, attitude, and practice in MID compared to undergraduate students. However, more education and hands-on training about MID concepts during the college curriculum are necessary to attain better knowledge, attitude, and practices that could be useful for more conservative clinical practice.

Novel PCR detection of CRISPR/Cas systems in Pseudomonas aeruginosa and its correlation with antibiotic resistance.

CRISPR (clustered regularly interspaced short palindromic repeats)-Cas (CRISPR-associated proteins) systems are considered as acquired immune mechanisms in Gram-positive and Gram-negative bacteria and also in archaea. They provide resistance/immunity to attacking bacteriophages or mobile genetic elements as integrative conjugative elements (ICE) as well as plasmid transformation. As an opportunistic pathogen, Pseudomonas aeruginosa has been held responsible for serious infections especially in hospitalized and immunocompromised patients. Three subtypes of type I CRISPR system (I-C, I-E, & I-F1) have been detected in P. aeruginosa genomes. In this work, P. aeruginosa isolates were collected from different clinical sources, and the three CRISPR/Cas subtypes (I-C, I-E, & I-F1) were detected via singleplex and multiplex PCR techniques using novel universal primers that were designed specifically in this study. CRISPR subtypes I-C, I-E, and I-F1 were detected in 10, 9, and 13 isolates, respectively. Furthermore, antimicrobial susceptibility of CRISPR/Cas-positive and negative isolates to different antibiotics and the capacity of biofilm formation were detected using disc diffusion method and tissue culture plate method, respectively. There was a significant correlation between the presence/absence of CRISPR/Cas system and both antimicrobial susceptibility to some antibiotics and biofilm-forming capacity among P. aeruginosa clinical isolates. KEY POINTS: • A novel multiplex-PCR for detection of CRISPR/Cas-positive strains of P. aeruginosa. • Understand the correlation between CRISPR/Cas systems and other characters of P. aeruginosa. • Correlation between antimicrobial susceptibility and CRISPR systems in P. aeruginosa.

Electrocardiographic myocardial injury and stroke mortality in the general population.

BACKGROUND: Recent evidence suggests a link between myocardial infarction and stroke risk, but it is unclear whether such risk exists with electrocardiographic myocardial injury in otherwise healthy individuals. Therefore, we explored the association of myocardial injury with stroke mortality in participants free of cardiovascular disease. METHODS: This analysis included 6017 participants (58.4 ± 13.4 years, 54.1% women, 50.3% white) from the Third National Health and Nutrition Examination Survey. Cardiac infarction/injury score (CIIS), a weighted scoring system composed of several electrocardiographic waveform components related to myocardial injury and ischemia, was used to define myocardial injury. Stroke mortality was ascertained using the National Death Index during follow-up. Multivariable adjusted Cox proportional hazard analysis was used to examine the association between baseline myocardial injury and risk of stroke mortality. RESULTS: Over a median follow-up of 14 years, 152 stroke deaths occurred. Stroke mortality was more common in those with than those without myocardial injury (3.8% vs. 2.1%, respectively; p = 0.0003). In a model adjusted for potential confounders, the myocardial injury was associated with a 44% increased risk of stroke mortality (HR (95%CI):1.44(1.02-2.03)). In a similar model, each 1 CIIS score point increase was associated with a 2% increase in the risk of stroke mortality (HR (95%CI):1.02 (1.00-1.04), p = 0.01). CONCLUSIONS: Electrocardiographic myocardial injury in cardiovascular disease-free adults is associated with an increased risk of stroke mortality suggesting a potential link between asymptomatic myocardial injury and risk of cardiac thromboembolism. Whether screening and management of myocardial injury would reduce such risk requires further investigation.

Association between Atherogenic Dyslipidemia and Subclinical Myocardial Injury in the General Population.

Background: Subclinical myocardial injury (SCMI) is associated with an increased risk of poor cardiovascular disease (CVD) outcomes. Understanding the underlying risk factors for SCMI is crucial for the prevention and management of CVD. We hypothesized that atherogenic dyslipidemia, a combination of high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C), is associated with an increased risk of SCMI. Methods: This analysis from the third National Health and Nutrition Examination Survey (NHANES-III) included 7093 participants (age 59.3 ± 13.4 years, 52.8% women, and 49.4% White) free of CVD. Atherogenic dyslipidemia was defined as TG ≥ 150 mg/dL and HDL-C < 40 mg/dL in men or <50 mg/dL in women. A validated electrocardiographic-based cardiac infarction injury score (CIIS) ≥ 10 was considered positive for SCMI. Multivariable logistic regression analysis was used to examine the association of different combinations of TG and HDL-C groups, including atherogenic dyslipidemia with SCMI. Results: About 22.5% (n = 1594) of participants had atherogenic dyslipidemia, and 26.3% (n = 1862) had SCMI. Compared to participants with normal TG and normal HDL-C, those with atherogenic dyslipidemia had a higher prevalence of SCMI (31.2% vs. 23.9%, p-value < 0.001). In a multivariable logistic regression model, atherogenic dyslipidemia was associated with the highest odds of SCMI followed by high TG/normal HDL-C, then low HDL-C/normal TG [OR (95% CI): 131 (1.14, 1.52), 1.13 (0.97, 1.33), and 1.01 (0.86, 1.20), respectively). Conclusions: Atherogenic dyslipidemia is associated with a higher risk of SCMI, which highlights the role of nontraditional risk factors in the development of subclinical CVD.

Association between blood pressure levels and premature atrial contractions in patients with hypertension.

BACKGROUND: High blood pressure (BP) induces left atrial structural and functional remodeling that increases susceptibility to atrial arrhythmia. We hypothesized that lower systolic BP (SBP) levels are associated with a lower prevalence of premature atrial contractions (PACs) in patients with hypertension. METHODS: This analysis included 4,697 participants (mean age 62±13.1 years, 50% women, 25.6% blacks) with hypertension from the Third National Health and Nutrition Examination Survey who did not have a prior history of cardiovascular disease (CVD). Multivariable logistic regression was used to examine the cross-sectional association between SBP and prevalence of PACs ascertained from 12-lead resting electrocardiograms. Multivariable Cox proportional hazard analysis was used to examine the association between baseline PACs and CVD mortality. RESULTS: Approximately 1.6% (n=74) of participants had baseline PACs. Patients with SBP ≤140 mmHg had a lower prevalence of PACs than those with SBP ≥140 mmHg (1.1% vs. 1.9%, p-value=0.01). In a multivariable logistic regression model, each 10 mmHg decrease in SBP was associated with a 12% lower odds of PACs (OR (95%CI): 0.88 (0.77-0.99)). During 14 years of follow-up, 645 CVD deaths occurred. In a multivariable-adjusted Cox model, presence of PACs was associated with a 78% increased risk of CVD mortality (HR (95%CI): 1.78 (1.23-2.60)). CONCLUSIONS: In patients with hypertension, lower SBP levels are associated with a lower prevalence of PACs, and presence of PACs is associated with a higher risk of CVD mortality risk. These findings highlight the potential role of BP lowering in the management of cardiac arrhythmias.

Racial differences in prevalence and impact of electrocardiographic subclinical myocardial injury risk factors.

BACKGROUND: We explored whether the reported racial differences in subclinical myocardial injury (SCMI) are due to variations in the prevalence or differential impact of the SCMI risk factors. METHODS: This analysis included 3074 Whites, 1337 Blacks, and 1441 Mexican Americans from the Third National Health and Nutrition Examination Survey who were free of cardiovascular disease. SCMI was defined from standard electrocardiograms as a cardiac infarction/injury score ≥ 10 points. Multivariable logistic regression analysis was used to assess the association of SCMI with its risk factors stratified by race. Multiplicative interaction between each risk factor and race was also examined. RESULTS: Overall prevalence of SCMI was 20.3%, with Mexican Americans exhibiting a lower prevalence than Whites and Blacks (16.5%, 20.4%, and 20.7%, respectively). Whites had more prevalence of dyslipidemia and smoking. Mexican Americans had more diabetes, while Blacks had more hypertension, obesity, and left ventricular hypertrophy. Significant risk factors for SCMI were older age, lower income (<20 K), smoking, diabetes, and no regular exercise. The association of SCMI with age was more pronounced in Mexican Americans (p-value for interaction 0.03), whereas the associations of SCMI with smoking, no-regular exercise, and diabetes were stronger in Whites (p-value for interaction 0.04, 0.001, 0.007, respectively). CONCLUSIONS: Heterogeneity in the racial differences in the prevalence of SCMI risk factors exists, but they do not explain racial differences in SCMI. The stronger associations of smoking, diabetes, and no regular exercise with SCMI partially explain the higher prevalence of SCMI in Whites.

Association between Blood Lead Levels and Silent Myocardial Infarction in the General Population.

Background: Although the link between lead exposure and patterns of cardiovascular disease (CVD) has been reported, its association with silent myocardial infarction (SMI) remains unexplored. We aimed to assess the association between blood lead levels (BLLs) and SMI risk. Methods: We included 7283 (mean age 56.1 ± 2.52 years, 52.5% women) participants free of CVD from the Third National Health and Nutrition Examination Survey. BLL was measured using graphite-furnace atomic absorption spectrophotometry. SMI was defined as ECG evidence of myocardial infarction (MI) without history of MI. The association between SMI and BLLs was examined using multivariable logistic regression. Results: SMI was detected in 120 participants with an unweighted prevalence of 1.65%. Higher BLL correlated with higher SMI prevalence across BLL tertiles. In multivariable-adjusted models, participants in the third BLL tertile had more than double the odds of SMI (OR: 3.42, 95%CI: 1.76-6.63) compared to the first tertile. Each 1 µg/dL increase in BLL was linked to a 9% increase in SMI risk. This association was consistent across age, sex, and race subgroups. Conclusions: Higher BLLs are associated with higher odds of SMI in the general population. These results underscore the significance of the ongoing efforts to mitigate lead exposure and implement screening strategies for SMI in high-risk populations.

Perception of dental appearance and aesthetic analysis among patients, laypersons and dentists.

BACKGROUND: Current concepts of beauty are increasingly subjective, influenced by the viewpoints of others. The aim of the study was to evaluate divergences in the perception of dental appearance and smile esthetics among patients, laypersons and dental practitioners. The study goals were to evaluate the influence of age, sex, education and dental specialty on the participants' judgment and to identify the values of different esthetic criteria. Patients sample included 50 patients who responded to a dental appearance questionnaire (DAQ). Two frontal photographs were taken, one during a smile and one with retracted lips. Laypersons and dentists were asked to evaluate both photographs using a Linear Scale from (0-10), where 0 represent (absolutely unaesthetic) and 10 represent (absolutely aesthetic). One-way analysis of variance (ANOVA) and t-test analysis were measured for each group. Most patients in the sample expressed satisfaction with most aspects of their smiles and dental appearance. Among laypersons (including 488 participants), 47 pictures "with lips" out of 50 had higher mean aesthetic scores compared to pictures "without lips". Among the dentist sample, 90 dentists' perception towards the esthetic smile and dental appearance for photos "with lips" and "without lips" were the same for 23 out of 50 patients. Perception of smile aesthetics differed between patients, laypersons and dentists. Several factors can contribute to shape the perception of smile aesthetic. AIM: To compare the perception of dental aesthetic among patients, laypersons, and professional dentists, to evaluate the impact of age, sex, educational background, and income on the judgments made by laypersons, to assess the variations in experience, specialty, age, and sex on professional dentists' judgment, and to evaluate the role of lips, skin shade and tooth shade in different participants' judgments. METHODS: Patients sample included 50 patients who responded to DAQ. Two frontal photographs were taken: one during a smile and one with retracted lips. Laypersons and dentists were asked to evaluate both photographs using a Linear Scale from (0-10), where 0 represent (absolutely unaesthetic) and 10 represent (absolutely aesthetic). One-way ANOVA and t-test analysis were measured for each group. RESULTS: Most patients in the sample expressed satisfaction with most aspects of their smiles and dental appearance. Among laypersons (including 488 participants), 47 pictures "with lips" out of 50 had higher mean aesthetic scores compared to pictures "without lips". Whereas among the dentist sample, 90 dentists' perception towards the esthetic smile and dental appearance for photos "with lips" and "without lips" were the same for 23 out of 50 patients. Perception of smile aesthetics differed between patients, laypersons and dentists. CONCLUSION: Several factors can contribute to shape the perception of smile aesthetic.

Evaluation of the Dentinal Shear Bond Strength and Resin Interface in Primary Molars after Pre-Treatment with Various Dentin Bio-Modifiers: An In Vitro Study.

Dentine adhesives have demonstrated great success with permanent teeth. Though the results in primary teeth are not well documented, some studies have demonstrated lower values of bond strength in primary teeth than those found in permanent teeth. The aim of this study was to compare and evaluate the effect of grape seed extract (6.5%) (Herbal Bio Solutions, Delhi, India), glutaraldehyde (5%) (Loba Chemie PVT. LTD., Mumbai), hesperidin (0.5%) (Herbal Bio Solutions, Delhi, India), and casein phosphopeptide-amorphous calcium phosphate (tooth mousse) (GC Corporation, Alsip, IL, USA) on the shear bond strength of dentine of primary teeth and to evaluate the resin tags at the resin tooth interface. Seventy-five caries-free human primary molars were collected, and their occlusal surfaces were ground flat. Dentin surfaces were etched using phosphoric acid. Then teeth were randomly assigned in sequential order to five groups according to the dentinal treatment method: Group I (Control group) (no treatment), Group II (5% glutaraldehyde), Group III (6.5% grape seed extract), Group IV (0.5% hesperidin), and Group V (CPP-ACP). Ten teeth from each group were assigned for Shear Bond Strength and five for SEM analysis. ANOVA and a post hoc least significant difference test (p < 0.05) were used for statistical analysis of the collected data. The grape seed extract group showed significantly increased shear bond strength than the control group (p < 0.05), and the mean length of resin tags in different dentine bio modifiers groups was also statistically significant (p < 0.05). The use of dentin bio modifiers such as 5% glutaraldehyde, 6.5% grape seed extract, 0.5% hesperidin, and CPP-ACP in the bonding process for primary teeth did not improve the dentinal bond strength.

Joint Association of Albuminuria and Left Ventricular Hypertrophy with Incident Heart Failure in High-Risk Adults with Hypertension: a SPRINT substudy.

Background: Albuminuria and left ventricular hypertrophy (LVH) are independent predictors of heart failure (HF), however their combined effect on risk of HF has not been explored previously. Objectives: To examine the joint associations of albuminuria and electrocardiographic (ECG) LVH with incident acute decompensated HF (ADHF), and whether albuminuria/LVH combinations modified the effects of blood pressure control strategy in reducing the risk of ADHF. Methods: 8,511 participants from the SPRINT (Systolic Blood Pressure Intervention Trial) were included. ECG-LVH was present if any of the following criteria: Cornell voltage, Cornell voltage product, or Sokolow Lyon were present. Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥30 mg/g. ADHF was defined as hospitalization or emergency visit for ADHF. Cox proportional hazard models were used to examine the association of neither LVH, nor albuminuria (reference), either LVH or albuminuria, and both (LVH + albuminuria) with incident ADHF. Results: Over a median follow-up of 3.2 years, 182 cases of ADHF occurred. In adjusted models, concomitant albuminuria and LVH were associated with higher risk of ADHF than either albuminuria or LVH in isolation (HR (95% CI): 4.95 (3.22-7.62), 2.04 (1.39-3.00), and 1.47 (0.93-2.32), respectively (additive interaction p=0.01). The effect of intensive blood pressure in decreasing ADHF attenuated among participants with co-existing albuminuria and LVH without any interaction between treatment group assignment and albuminuria/LVH categories (interaction p-value= 0.26). Conclusions: Albuminuria and LVH are additive predictors of ADHF. The effect of intensive blood pressure control in decreasing ADHF risk did not vary significantly across albuminuria/LVH combinations.

Joint Association of Albuminuria and Left Ventricular Hypertrophy With Incident Heart Failure in Adults at High Risk With Hypertension: A Systolic Blood Pressure Intervention Trial Substudy.

Albuminuria and left ventricular hypertrophy (LVH) are independent predictors of heart failure (HF); however, to the best of our knowledge, their combined effect on the risk of HF has not yet been explored. Therefore, we examined the joint associations of albuminuria and electrocardiographic-LVH with incident acute decompensated HF (ADHF), and whether albuminuria/LVH combinations modified the effects of blood pressure control strategy in reducing the risk of ADHF. A total of 8,511 participants from the Systolic Blood Pressure Intervention Trial (SPRINT) were included. Electrocardiographic-LVH was present if any of the following criteria were present: Cornell voltage, Cornell voltage product, or Sokolow-Lyon. Albuminuria was defined as urine albumin/creatinine ratio ≥30 mg/g. ADHF was defined as hospitalization or emergency department visit for ADHF. Cox proportional hazard models were used to examine the association of neither LVH nor albuminuria (reference), either LVH or albuminuria, and both (LVH + albuminuria) with incident ADHF. Over a median follow-up of 3.2 years, 182 cases of ADHF occurred. In adjusted models, concomitant albuminuria and LVH were associated with greater risk of ADHF than either albuminuria or LVH in isolation (hazard ratio [95% confidence interval]: 4.95 [3.22 to 7.62], 2.04 [1.39 to 3.00], and 1.47 [0.93 to 2.32], respectively, additive interaction p = 0.01). The effect of intensive blood pressure in reducing ADHF was attenuated in participants with coexisting albuminuria and LVH without any interaction between treatment group assignment and albuminuria/LVH categories (interaction p = 0.26). In conclusion, albuminuria and LVH are additive predictors of ADHF. The effect of intensive blood pressure control in reducing ADHF risk did not vary significantly across albuminuria/LVH combinations.

Lactoferrin decorated bilosomes for the oral delivery of quercetin in type 2 diabetes: In vitro and in vivo appraisal.

Despite its tremendous potential for type 2 diabetes management, quercetin (QRC) suffers poor gastric stability, poor bioavailability, and extensive first pass metabolism. Drug encapsulation into bilosomes (BSL) has proven enhanced properties in-vitro and in-vivo. Herein, this work endeavoured to evaluate efficacy of QRC-encapsulated bilosomes capped with lactoferrin (LF); a milk protein with antidiabetic potential, for type 2 diabetes oral treatment. The optimized formulation (LF-QRC-BSL) was evaluated in-vitro on α-amylase enzyme inhibition and insulin resistant HepG2 cell model and in vivo on streptozocin/high fat diet induced diabetes in rats. LF-QRC-BSL showed a small size (68.1 nm), a narrow PDI (0.18) and a -25.5 mV zeta potential. A high entrapment efficiency (94 %) with sustained release were also observed. LF-QRC-BSL displayed 100 % permeation through excised diabetic rat intestines after 6 h, 70.2 % inhibition of α-amylase enzyme in-vitro and an augmented recovery of glucose uptake in insulin resistant cells. In diabetic rats, LF-QRC-BSL resulted in significant decrease in blood glucose level, improved lipid profile and tissue injury markers with reduced oxidative stress and inflammatory markers. Further, histopathological examination of the kidneys, liver and pancreas revealed an almost restored normal condition comparable to the negative control. Overall, LF-QRC-BSL have proven to be a promising therapy for type 2 diabetes.

Disinfection Efficacy of Laser Activation on Different Forms and Concentrations of Sodium Hypochlorite Root Canal Irrigant against Enterococcus faecalis in Primary Teeth.

Photoactivated disinfection with sodium hypochlorite (NaOCl) has improved primary root canal treatment outcomes. This in vitro study aims to assess and compare the disinfecting efficacy of 2.5% sodium hypochlorite solution and 5.25% sodium hypochlorite gel, without laser activation and accompanied by laser activation, on Enterococcus faecalis-contaminated primary teeth root canals. After one month of incubating extracted teeth specimens with E. faecalis, 36 specimens were randomly divided into two groups: Group A (conventional method without laser-activated irrigation) and Group B (with laser-activated irrigation). Each group was further divided into three subgroups, with six samples in each subgroup. Subgroup 1 received irrigation with normal saline, Subgroup 2 with 2.5% sodium hypochlorite solution, and Subgroup 3 with 5.25% sodium hypochlorite gel. Diode laser activation at 810 nm was used in Group B. Bacterial colony counts were measured before and after the intervention. Student's t-test and one-way analysis of variance (ANOVA) with Tukey's post hoc test were used for statistical analysis. The significance level was set at p < 0.05. Microbial analysis revealed no bacterial growth in samples irrigated with 5.25% sodium hypochlorite gel activated with the laser. Activation with the laser significantly (p = 0.02) improved the disinfection ability of the irrigant compared to the non-activation group. The disinfection ability of sodium hypochlorite gel was better than that of saline (p = 0.02); however, it was comparable to that of sodium hypochlorite solution (p = 0.67). Conclusion: Root canal irrigation with 5.25% sodium hypochlorite gel activated with an 810 nm diode laser resulted in complete eradication of Enterococcus faecalis, indicating its effectiveness as an endodontic disinfection treatment modality.

Comparison of Retention between Conventional and Nanofilled Resin Sealants in a Paediatric Population: A Randomized Clinical Trial.

Background: This study compared conventional-resin-sealant versus nanofilled-sealant retention at different intervals. Methods: A double-blinded split-mouth randomized control trial was performed on sixty-two children aged from six to nine years. Participants with one pair of contralateral permanent first molars with deep fissures or noncavitated carious lesions were randomly selected for sealant application. Conventional resin sealant was applied on one molar and nanofilled sealant on the contralateral molar. Evaluations were performed at one, three, six, twelve and eighteen months to check for retention. The chi-squared test, McNemar test, Wilcoxon signed-rank test and Friedman test were used for statistical analysis. Results: Conventional resin sealant showed complete retention in 91.4%, 86.2%, 74.1%, 62.1% and 55.2% of the teeth, and nanofilled sealant showed complete retention in 89.7%, 81%, 77.6%, 69% and 67.2% of the teeth, at the end of 1 month, 3 months, 6 months, 12 months and 18 months evaluation, respectively. Each sealant exhibited a statistically significant change (p < 0.05) in the retention rate during the evaluation period. However, when both the sealants were compared with each other, there was no statistically significant difference in any phase. At the end of 18 months, caries development was observed in 13.8% of the teeth sealed with conventional sealant, and in 10.3% of the teeth sealed with nanofilled sealant. Conclusion: At eighteen months, the nanofilled resin sealant exhibited complete retention in 12% more teeth than the conventional sealant. However, the difference was not statistically significant. The nanofilled resin sealant yielded an acceptable performance in sealing the occlusal pits and fissures of mandibular permanent first molars, compared to conventional pit-and-fissure sealants.

Is there a role of viral infection in cystic fibrosis exacerbation in children?

BACKGROUND: Cystic fibrosis (CF) is a degenerative disease distinguished by progressive epithelial secretory gland dysfunction associated with recurrent respiratory tract infections. Despite that bacteria have previously been studied as the main cause of CF airway damage, a strong effect of respiratory viral infections is also now recognized. We aimed to detect the relationship between viral infection and exacerbation in children with cystic fibrosis. METHODS: This is a cross sectional observational study recruiting 60 patients diagnosed as CF following in Cystic Fibrosis Clinic, Children`s Hospital, Cairo University, throughout a period of 7 months. Their age ranged from 6 months to 13 years. Patients had nasal swabs and sputum samples obtained when they developed respiratory exacerbations. Multiplex PCR (polymerase chain reaction) technique was used to detect respiratory viruses from nasal swabs. RESULTS: We detected viruses in 48 patients during exacerbation (80%), the most common virus was rhinovirus in 43.4% of patients, followed by bocavirus in 20%, adenovirus in 13.3%, enterovirus in 10% and human metapneumovirus in 6.7%. Co-infection with double viruses was detected in 10 patients. Bacterial infection was present in 56.7% of patients; the most common organism was Pseudomonas in 20% of patients, followed by Staphylococcus aureus, methicillin resistant Staphylococcus aureus, Klebsiella and Haemophilus influenzae. CRP was positive in 53.3% of patients. There was a significant relationship between sputum positive bacterial culture and each of influenza A virus, enterovirus and human metapneumovirus. CONCLUSIONS: This study demonstrated that exacerbation in cystic fibrosis may be exaggerated by viral infections such as influenza A and enterovirus necessitating hospitalization which shows the important protective role of vaccination. Also, a strong relationship was detected between some viruses such as enterovirus, human metapneumovirus and influenza and between bacterial infection.

Assessment of the Proximity of the Inferior Alveolar Canal with the Mandibular Root Apices and Cortical Plates-A Retrospective Cone Beam Computed Tomographic Analysis.

Various endodontic interventions often lead to iatrogenic damage to the inferior alveolar nerve present in the inferior alveolar canal (IAC). The purpose of the present study was to analyze the relationships of IAC with the root apices of mandibular teeth and with the mandibular cortical plates. MATERIALS: 116 cone beam computed tomography (CBCT) scans were examined and the shortest distance of IAC with the root apices of mandibular canines, premolars and molars, and with cortical plates was analyzed. The data were statistically analyzed using SPSS. RESULTS: The shortest mean distance between IAC and lingual cortical plate (LCP) was found in the third molar area, and between IAC and buccal cortical plate (BCP) in the second premolar area. A high incidence of 60% direct communication (DC) was present in mandibular second molars; 38% in mandibular third molars; 13% in mandibular second premolars; 12% in mandibular first molars; and 1% in mandibular first premolars. CONCLUSION: Anteriorly, IAC was found to be significantly present in close approximation to the roots of mandibular canines. Posteriorly, IAC was found to be in significant proximity to the distal roots of mandibular second molars.

Impact of Ceramic Material and Preparation Design on Marginal Fit of Endocrown Restorations.

Background: The aim of this study is to investigate the impact of ceramic material and preparation design on the marginal fit of endocrown restorations. Methods: Forty endocrown restorations were CAD/CAM-fabricated for forty extracted maxillary first premolar teeth. Samples were divided into two groups (n = 20) according to the ceramic materials used: Celtra Duo and Vita Enamic. Each group was divided into two subgroups (n = 10) according to the preparation design: with no intraradicular extension and with 3 mm intraradicular extension. The marginal gap was examined using a digital microscope. Results: Celtra Duo without intraradicular extension recorded the least mean marginal gap (7.74 ± 1.55 µm), while Group Celtra Duo with 3 mm intraradicular extension recorded the highest mean marginal gap (29.54 ± 6.32 µm). Group Vita Enamic recorded a lesser marginal gap (18.03 ± 12.11 µm) than group CD (Celtra Duo) (18.64 ± 12.05 µm). There is a statistically non-significant difference between the two groups of materials (p = 0.873). There is a statistically significant difference between the two tested preparation designs (p < 0.001). Conclusion: All groups recorded a marginal gap within clinically accepted values. Material selection may influence the fitting of restorations. Intraradicular extension for endocrown restorations adversely affects the marginal fit, however, the marginal gap is still within the clinically accepted range.

Influence of Open Apex on Working Length Determination Using Cone-Beam Computed Tomography and Apex Locators: A Comparative In Vitro Study.

Objectives: The aim of this study is to assess the effect of open apex on working length (WL) determination with aid of cone-beam computed tomography (CBCT) and electronic apex locators (EALs). Methods: Thirty-two extracted human mandibular premolars were selected, and apical 5 mm was removed. Root canals were prepared from the apical to the coronal direction of the canal using peeso reamers up to size 5 (retrograde) to simulate open apex. The samples were analyzed by CBCT, and WL was established (CWL) by a radiologist. An endodontist prepared the access cavities, and visual working length (VWL) was recorded. The samples were embedded in a freshly mixed alginate mould up to cementoenamel junction. Each root canal length was measured with two different EALs-Root ZX mini and i Root. The measurements were repeated 3 times by using a digital caliper, and the mean was recorded by the endodontist who was blinded to the results of the CWL. The recorded data was statistically analyzed using the SPSS software. Results: The results of this study showed statistically significant difference between VWL and i Root, CWL and i Root, and Root ZX mini and i Root (p < 0.05). Amongst EALs, a superior accuracy was noted for Root ZX mini than as compared to i Root. However, no statistically significant difference was seen between Root ZX mini and CWL (p > 0.05). Conclusion: The present study showed that CWL is as accurate and reliable as VWL which is the gold standard. Amongst EALs, Root ZX mini performed more accurately than i Root. Preexisting CBCT scans should be used as an advantage in determining WL.

Mechanical and antibacterial efficacy of photo-sonodynamic therapy via methylene blue-loaded nanoparticles over dental implants for treating peri-implantitis.

AIM: This study aimed to evaluate the mechanical (i.e., flexural modulus [FM], flexural strength [FS], and surface roughness [Ra]) and antibacterial efficacy of photo-sonodynamic therapy via methylene blue-loaded poly(D,L-lactide-co-glycolide) nanoparticles (MB-loaded PLGA NPs) over dental implants for potential treatment of peri-implantitis. METHODS: PLGA NPs were synthesized via a solvent displacement method. After the synthesis and confirmation of MB-loaded PLGA NPs via physical (Scanning Electron Microscope [SEM]) and chemical characterization (Fourier transform infrared spectroscopy [FTIR]), the mature dental biofilm of Porphyromonas gingivalis was produced over the surfaces of dental implants. Then, the bacterial viability assessment of the following five study groups was performed: group-I (diode laser treatment); group-II (PDT/MB-loaded PLGA NPs treatment; group-III (ultrasound treatment); group-IV (ultrasound/PLGA NPs-MB treatment); and group-V: control group included the samples without any treatment. Finally, the FS, FM, and Ra of the samples was assessed. RESULTS: Under the SEM, the NPs were spherical homogeneous particles having round morphology ranging approximately 100 nm in size without aggregation. The FTIR spectra of PLGA NPs and MB-loaded PLGA NPs demonstrated absorption peaks at approximately 1000 cm-1 to 1200 cm-1 and around 1500 cm-1 to 1750 cm-1. The greatest level of P. gingivalis killing was exhibited by ultrasound/MB-loaded PLGA-NPs-treated samples. The FS was statistically significantly greater for control group samples than any other group (i.e., 100.28 MPa; p<0.05). The FM and Ra ranged between 3.31 and 3.58 GPa and between 0.18 and 0.20 µm without any statistically significant difference between the control and experimental groups (p>0.05), respectively. CONCLUSION: Within the limitations of this study, the application of photo-sonodynamic therapy via MB-loaded PLGA NPs demonstrated the greatest antibacterial activity against P. gingivalis without deteriorating the surfaces and compromising the mechanical properties of dental implants.