Two-year sealant survival in a high caries cohort at a graduate pedodontic clinic

Objectives: To assess the efficacy of resin sealants in children aged 6-12 years referred to one graduate pedodontic program located in the Middle East (2009-2010). Study Design: Data from a cohort of 110 patients with at least 2 erupted first permanent molars were included in this study. Dental health status was evaluated using the DMFs/t index. UltraSeal XT® Plus sealants (n=253 applications) were performed in presence of rubber dam isolation and survival carefully inspected and scored at 1 and 2 years. Cross-sectional examination of descriptives and bi/multivariate analysis followed. Results: Majority (63%) were males. Caries were diagnosed in 77.9% of children with only 1% deemed caries-free. Hence, mean DMFs/t was 9.3±6.1/7.2±5.1, respectively. At 2 years, 66% of sealants were completely retained and 11% completely lost. Analysis revealed higher sealant survival in mandibular teeth. Conclusions: Fluoride-releasing resin sealant is an effectual preventive tool especially in such a high carious population

Intra-Articular Interleukin-1 Receptor Antagonist (IL1-ra) Microspheres for Posttraumatic Osteoarthritis: In Vitro Biological Activity and in Vivo Disease Modifying Effect

Background: Interleukin-1 receptor antagonist (IL-1 ra) can be disease-modifying in posttraumatic osteoarthritis (PTOA). One limitation is its short joint residence time. We hypothesized that IL-1 ra encapsulation in poly (lactide-co-glycolide) (PLGA) microspheres reduces IL-1 ra systemic absorption and provides an enhanced anti-PTOA effect. Methods: IL-1 ra release kinetics and biological activity: IL-1 ra encapsulation into PLGA microsphere was performed using double emulsion solvent extraction. Lyophilized PLGA IL-1 ra microspheres were resuspended in PBS and supernatant IL-1 ra concentrations were assayed. The biological activity of IL-1 ra from PLGA IL-1 ra microspheres was performed using IL-1 induced lymphocyte proliferation and bovine articular cartilage degradation assays. Systemic absorption of IL-1 ra following intra-articular (IA) injection of PLGA IL-1 ra or IL-1 ra: At 1, 3, 6, 12 and 24 h following injection of 50 μl PLGA IL-1 ra (n = 6) or IL-1 ra (n = 6), serum samples were collected and IL-1 ra concentrations were determined. Anterior cruciate ligament transection (ACLT) and IA dosing: ACLT was performed in 8–10 week old male Lewis rats (n = 42). PBS (50 μl; n = 9), IL-1 ra (50 μl; 5 mg/ml; n=13), PLGA IL-1 ra (50 μl; equivalent to 5 mg/ml IL-1 ra; n = 14) or PLGA particles (50 μl; n = 6) treatments were performed on days 7, 14, 21 and 28 following ACLT. Cartilage and synovial histopathology: On day 35, animal ACLT joints were harvested and tibial cartilage and synovial histopathology scoring was performed. Results: Percent IL-1 ra content in the supernatant at 6 h was 13.44 ± 9.27 % compared to 34.16 ± 12.04 %, 47.89 ± 12. 71 %, 57.14 ± 11.71 %, and 93.90 ± 8.50 % at 12, 24, 48 and 72 h, respectively. PLGA IL-1 ra inhibited lymphocyte proliferation and cartilage degradation similar to IL-1 ra. Serum IL-1 ra levels were significantly lower at 1, 3, and 6 h following PLGA IL-1 ra injection compared to IL-1 ra. Cartilage and synovial histopathology scores were significantly lower in the PLGA IL-1 ra group compared to PBS and PLGA groups (p \u3c 0.001). Conclusions: IL-1 ra encapsulation in PLGA microspheres is feasible with no alteration to IL-1 ra biological activity. PLGA IL-1 ra exhibited an enhanced disease-modifying effect in a PTOA model compared to similarly dosed IL-1 ra

Modified Mamdani-fuzzy inference system for predicting the cost overrun of construction projects

Cost overruns are a common worldwide problem in the construction industry; improved proactive risk management and cost control are much needed. Several models have been proposed, but all have weaknesses, particularly in data demands and the severity of critical risks or uncertainties associated with expert judgment. In response, this study develops a new 3-part model based on the Mamdani-type fuzzy inference system (FIS) to predict the cost overrun of construction projects. The first part assesses the weight of each expert, evaluating the severity of cost overrun factors. The second part contains a list of 40 in-built cost overrun factors and their degree of severity, while the third part establishes the relationships of every factor's occurrence probability and severity to predict the cost overrun of a specific project. The severity of each factor is assessed based on a survey of 31 randomly selected experts in the Saudi Arabian construction industry. The model is demonstrated on two completed projects in Saudi Arabia. For each project, this involves a group of project-based experts rating the probability of occurrence of each factor on that project and applying this to the factor severity list to obtain a predicted cost overrun (PCO) for the whole project. The model is validated for robustness by sensitivity analysis comparing the predicted and actual whole project cost overrun and shown to be of practical value in assessing critical risks and predicting the likely amount of cost overrun. The model is equally applicable in the early project stages.</p

Temporal trends in incidence rates of lower extremity amputation and associated risk factors among patients using Veterans Health Administration services from 2008 to 2018

Importance: Lower extremity amputation (LEA) is associated with significant morbidity and mortality. However, national temporal trends of LEA incidence rates among US veterans and associated factors have not been well characterized. Objective: To describe the temporal trends of LEA, characterize associated risk factors, and decompose the associations of these risk factors with changes in temporal trends of LEA among US veterans using Department of Veteran Affairs (VA) services between 2008 and 2018. Design, Setting, and Participants: This cohort study used VA data from 2008 to 2018 to estimate incidence rates of LEA among veterans using VA services. Cox regression models were used to identify risk factors associated with LEA. Decomposition analyses estimated the associations of changes in prevalence of risk factors with changes in LEA rates. Data were analyzed from October 1, 2007, to September 30, 2018. Main Outcomes and Measures: Toe, transmetatarsal, below-knee, or above-knee LEA. Results: A total of 6 493 141 veterans were included (median [interquartile range] age, 64 [54-76] years; 6 060 390 [93.4%] men). Veterans were studied for a median (interquartile range) of 10.9 (5.6-11.0) years. Between 2008 and 2018, rates of LEA increased from 12.89 (95% CI, 12.53-13.25) LEA per 10 000 persons to 18.12 (95% CI, 17.70-18.54) LEA per 10 000 persons, representing a net increase of 5.23 (95% CI, 4.68-5.78) LEA per 10 000 persons. Between 2008 and 2018, toe amputation rates increased by 3.24 (2.89-3.59) amputations per 10 000 persons, accounting for 62.0% of the total increase in LEA rates. Transmetatarsal amputations increased by 1.54 (95% CI, 1.27-1.81) amputations per 10 000 persons; below-knee amputation rates increased by 0.81 (95% CI, 0.56-1.05) amputations per 10 000 persons; and above-knee amputation rates decreased by 0.37 (95% CI, 0.14-0.59) amputations per 10 000 persons. Compared with men, women had decreased risk of any LEA (hazard ratio [HR], 0.34 [95% CI, 0.31-0.37]). Factors associated with increased risk of any LEA included Black race (HR, 1.25 [95% CI, 1.21-1.28]) or another non-White race (ie, Asian, Latino, or other; HR, 2.36 [95% CI, 2.30-2.42]), obesity (HR, 1.59 [95% CI, 1.55-1.63]), diabetes (HR, 6.38 [95% CI, 6.22-6.54]), chronic kidney disease (CKD; eg, CKD stage 5: HR, 3.94 [95% CI, 3.22-4.83]), and smoking status (eg, current smoking: HR, 1.97 [95% CI, 1.92-2.03]). Decomposition analyses suggested that while changes in demographic composition, primarily driven by increased proportion of women veterans, associated with a decrease of 0.18 (95% CI, 0.14-0.22) LEA per 10 000 persons, and decreases in smoking rates, associated with a decrease of 0.88 (95% CI, 0.79-0.97) LEA per 10 000 persons. However, these were overwhelmed by increased rates of diabetes, associated with an increase of 1.86 (95% CI, 1.72-1.99) LEA per 10 000 persons; peripheral arterial disease, associated with an increase of 1.53 (95% CI, 1.41-1.65) LEA per 10 000 persons; CKD, associated with an increase of 1.45 (95% CI, 1.33-1.57) LEA per 10 000 persons; and other clinical factors, including body mass index, cancer, cardiovascular disease, cerebrovascular disease, chronic lung disease, dementia, and hypertension, associated with an increase of 1.45 (95% CI, 1.33-1.57) LEA per 10 000 persons. Conclusions and Relevance: This cohort study found that incidence rates of LEA among veterans using VA services increased between 2008 and 2018. Efforts aimed at reducing burden of LEA should target the reduction of diabetes, peripheral arterial disease, and CKD at the individual and population levels

Perventricular device closure of muscular ventricular septal defects on the beating heart: technique and results

AbstractObjectiveBoth surgical management and percutaneous device closure of muscular ventricular septal defects have drawbacks and limitations. This report describes our initial experience with intraoperative device closure of muscular ventricular septal defects without cardiopulmonary bypass in 6 consecutive patients.MethodsA median sternotomy or a subxiphoid minimally invasive incision was performed. Under continuous transesophageal echocardiographic guidance, the right ventricle free wall was punctured, and a wire was introduced across the largest defect. The Amplatzer (AGA Medical Corporation, Golden Valley, Minn) muscular ventricular septal defect occluding device (a self-expandable double-disk device) was used. An introducer sheath was fed over the wire, with the sheath tip positioned in the left ventricle cavity. The device was then advanced inside the sheath and deployed by retracting the sheath. Associated cardiac lesions, if any, can then be repaired during cardiopulmonary bypass. A similar technique can also be applied for periatrial closure of complex atrial septal defects.ResultsThe initial 6 patients are presented. Cardiopulmonary bypass was not needed in any patient for placement of the device and needed in 4 patients for repair of concomitant malformations only (double-outlet right ventricle, aortic arch hypoplasia, pulmonary artery band removal). No complications from using this technique occurred. Discharge echocardiograms showed no significant shunting across the ventricular septum.ConclusionsPerventricular closure of multiple muscular ventricular septal defects is safe and effective. We believe that this could become the treatment of choice for any infant with muscular ventricular septal defects or any child with muscular ventricular septal defect and associated cardiac defects

The prevalence and the clinical characteristics of metabolic syndrome patients admitted to the cardiac care unit

AbstractObjectivesMetabolic syndrome (MetS) is a group of multiple cardiovascular risk factors, including dysglycemia, central obesity, high cholesterol, and hypertension. Cardiovascular disease is one of the most common complications of MetS. Recent studies showed that prevalence of MetS among patients admitted with acute coronary syndrome was as high as 46%.DesignWe conducted a cross-sectional study of 203 patients at the two main hospitals in Ta’if, Saudi Arabia. Patients older than 18years who were admitted to the Cardiac Care Unit (CCU) between the months of August 2013 and June 2014 were asked to participate. MetS diagnosis was made based on the International Diabetes Federation definition.ResultsA total of 203 patients participated, with 59.1% male and 40.9% were female. The mean age was 60.9 years with a mean body mass index of 28.97kg/m2 and a mean waist circumference of 95.45cm. The prevalence of MetS was 47.8%, primarily among obese female patients who reported sedentary lifestyles. Additionally, MetS patients were more likely to be admitted with heart failure (p<0.05) and more likely to have moderate-to-severe left-ventricular hypertrophy (LVH; p<0.05) relative to non-MetS patients.ConclusionOf the patients admitted to the CCU, 47.8% had MetS, with those patients likely to be female and obese. Furthermore, MetS patients were more likely to be admitted with heart failure and suffer from moderate-to-severe LVH

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

Over the past two decades, treatment of multiple myeloma (MM) has advanced dramatically. However, despite the introduction of several lines of novel therapeutics, autologous hematopoietic stem cell transplantation (HSCT) followed by maintenance therapy is the current standard of care in transplant eligible patients. Autologous HSCT can be performed with or without cryopreservation with equivalent short-term and long-term outcomes. In patients with MM, performance of autologous HSCT at outpatient setting is safe, feasible and has a number of advantages such as saving hospital beds and reducing treatment costs. Autologous HSCT can be safely performed in patients with MM having renal dysfunction or failure although particular attention should be made to the timing of administering medications and stem cells with respect to hemodialysis and dose reduction of specific medications according to creatinine clearance. Tandem autologous HSCT is of value in younger patients with adverse cytogenetics and extramedullary disease. Allogeneic HSCT is the only potentially curative therapeutic modality in MM, but it can only be performed in a small fraction of highly selected patients due to the relatively high treatment-related morbidity and mortality. Despite its valuable role in the treatment of MM, autologous HSCT has its own short-term as well as long-term complications

Practice of wound closure techniques among emergency physicians and surgeons in Makkah City Hospitals in Saudi Arabia

Background: Wound suturing is a procedure performed by medical and surgical specialists. While there are many different suturing techniques and materials used to treat patients, the choice of which to employ depends on different variables that affect the outcome of the procedure.Design and Methods: This is a cross-sectional study conducted to provide descriptive data regarding the practice of wound closure techniques, and to develop an awareness of scar formation factors. A total of 172 general surgery (GS) surgeons and emergency (EM) physicians in Makkah city hospitals in Saudi Arabia participated in the study.Results: More than 50% of the practitioners favored the simple interrupted technique for the treatment of all types of studied wounds. The other most common techniques among participants were the subcuticular and vertical mattress methods, respectively, while the use of a stapler was limited to certain wound types. Regarding suturing material, polyglycolic acid was the most frequent material used by 50.1% of participants, whereas only 22% of the participants selected nylon material for wound suturing. However, this study showed a good level of awareness among participants, with significant p-values (p&lt;0.05) of strongly agree and agree regarding the essential factors affecting wound healing and scar formation.Conclusions: The result provides insight into the most common suture techniques and materials used in wound closure. There are wide variations in selecting these techniques and materials among the participants. Also, we found that there is good awareness among participants about factors that lead to scar formation

Potensi Biji Labu Kuning sebagai Agen Fitoestrogen pada Wanita Post Menstrual

Osteoporosis and hypercholesterolemia are prevalent condition in menopausal women. The common therapy to prevent the estrogen degrading condition is Hormone Replacement Therapy (HRT). However, HRT possessed various risks. Curcubita pepo L. seed (pumpkin seed) contains lignan secoisolariciresinol and lariciresinol which exhibit estrogenic effect. The aim of this study is to determine the estrogenic effect of Ethanolic Extract of Pumpkin Seeds (EEPS) through in silico and in vivo study. In silico study were conducted by molecular docking of lignan which is secoisolariciresinol and lariciresinol with Estrogen Receptor (ERα and Erβ). In vivo study conducted by using ovariectomized Sprague dawley female rats as a model of postmenopausal women. Blood lipid profile, bone density, and uterine weight were assayed after thirty days. Molecular docking score of secoisolariciresinol and lariciresinol were similar to estradiol. In vivo study found that EEPS increase bone density and uterine weight percentage while also improve the blood profile. In conclusion, these result showed that EEPS is potential to be developed as an osteoporosis and hypercholesterolemia prevention agent