Comparative studies of the anaesthetic efficacy of 4% articaine used as mandibular infiltration versus 2% lidocaine used as inferior dental nerve block in extraction and pulpotomy of mandibular primary molars

Global abstract: The research presented in this thesis is in several parts. Firstly, the aim of systematic review was to systematically review available evidence on the efficacy of two local anaesthetic solutions lidocaine and articaine used for dental treatment in children. The findings from this review served as a basis for the next phase of the project, which was to address the deficiencies identified from the systematic review. This took the form of a Randomised Controlled Trial, the aim of which was to carry out an equivalence parallel prospective, randomised, controlled study, in order to evaluate and compare the anaesthetic efficacy of mandibular infiltration using 4% articaine (1:100,000 epinephrine) with mandibular nerve block using 2% lidocaine (1:80,000 epinephrine) in the extraction and restoration of mandibular primary molars. The translational intention was to be able to recommend the most effective and acceptable method of achieving anaesthesia for dental treatment of mandibular primary molars in children. In addition, a mixed method research strategy was implemented, in order to assess and explore the child’s experience associated with dental injection, and compare the two different techniques that were used (buccal infiltration and inferior dental nerve block). This comparison was in terms of children acceptance as well as parent satisfaction of their child’s dental treatment under local anaesthesia and their perception of the impact of this treatment on their child. Methods: Systematic review: A systematic search was conducted on Cochrane CENTRAL Register of Controlled Trials, MEDLINE (OVID; 1950 to June 2013), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOhost; 1982 to June 2013), EMBASE (OVID; 1980 to June 2013), SCI-EXPANDED (ISI Web of Knowledge; 1900 to June 2013), key journals, and previous review bibliographies through June 2013. No restrictions were placed on years, language or publication status. Original research studies that compared articaine with lidocaine in children dental treatment were included and methodological quality assessment including assessment of risk of bias was carried out for each of the included studies. RCT: In total 98 children aged 5–9 years old were randomly assigned into two groups: one group (treatment group) received mandibular infiltration with 4% articaine with 1:100,000 epinephrine; the other group (control group) received an inferior alveolar nerve block with 2% lidocaine with 1:80,000 epinephrine. All local anaesthetic injections were given by a single operator, who had the role of assessing the presence/absence of pain as well as the child’s behaviour during the injection and treatment procedures (using W-BFRS, VAS and Frankl Behaviour Scale). Each child received one treatment for one tooth only. Qualitative sub-study: Concurrent mixed method data collection strategies were used. The qualitative and quantitative data were collected from the same participants as well as in the same timeframe. Thematic analysis was performed on the semi- structured interviews. Results: Systematic review: Electronic searching identified 520 publications. After the primary and secondary assessment process, only three studies were included in the final analysis. The RCTs included in this review investigated the efficacy of local anaesthetic solutions when given as a combination of both techniques, local infiltration as well as block anaesthesia. The data analyses showed superiority of articaine over that of lidocaine in terms of achieving anaesthetic success, although these results were not statistically significant. RCT: During the injection phase the absolute differences between the two anaesthetic techniques using W-BFRS VAS and behaviour scales was zero (no difference), 0.060 (95% CI -0.110 to 0.230) and -0.080 (95% CI -0.190 to 0.030) respectively. During the treatment phase, the absolute difference were -0.020 (95% CI -0.180 to 0.140), -0.040 (95% CI -0.220 to 0.150) and zero (no difference). The equivalence margin was set at ± 0.2 and all comparisons showed equivalence of the two treatments except for the comparison of VAS during injection and W-BFRS during treatment with the 95% confidence intervals exceeding the equivalence margin. Qualitative sub-study: A total of 42 (56%) participants in the qualitative part of the study, were in articaine group while 31 (41%) were in lidocaine group. Only two of the participants (3%) had received both local anaesthetics. Parent’s responses to the questionnaire reflected their opinion based on their observation of the dental treatment. Majority of the parents were happy about the treatment in general. The children’s responses were very positive as well. The questionnaire/interviews with the children, parents, along with the dentist’s comments, allowed the development of three major themes addressing the aims and purposes of the study. The three major themes emerged were: Firstly, “Experience of the anaesthetic procedures”. Second major theme “Ease vs difficulty of the dental treatment” and the third major theme was “Perception of the dentist approach during the treatment”. Conclusion: The quality of the included RCTs in the systematic review was generally inadequate. All the included studies had several limitations in reporting which indicated a need for a randomised clinical trial with standardised methodology to address these limitations. The findings of the systematic review indicated that, articaine and lidocaine presented similar efficacy when used as infiltration and blocks respectively for routine dental treatments. The effect of numbness of soft tissues was longer using articaine than lidocaine, and few adverse events were reported following the use of both solutions. The results from this review indicate that articaine injections can cause slightly more post injection pain in the area injected than lignocaine, the difference was not statistically significant. Overall, the results of the present RCT pointed out that it would be acceptable to carry out invasive dental treatment for mandibular molars with the administration of infiltration with buccal intrapapillary infiltration using 4% articaine instead of the traditional method of inferior dental block using lidocaine, which many children find difficult to cope with. Considering the findings from the survey, along with the results from the questionnaire/interview, it was established that, the reactions of the patients with both of the local anaesthetics were very similar. The interview findings added meaning and depth to the survey findings, in terms of explaining and clarifying the children’s responses and answers. Parents/children reported a high degree of satisfaction with the treatment outcomes. The satisfaction expressed by parents/children can have a positive impact on the children’s future dental treatment. Registration: SR Registration: PROSPERO registration: CRD42013004620. Trial registration: EudraCT number: 2011-004711-2

A founder CEP120 mutation in Jeune asphyxiating thoracic dystrophy expands the role of centriolar proteins in skeletal ciliopathies

Jeune asphyxiating thoracic dystrophy (JATD) is a skeletal dysplasia characterized by a small thoracic cage and a range of skeletal and extra-skeletal anomalies. JATD is genetically heterogeneous with at least nine genes identified, all encoding ciliary proteins, hence the classification of JATD as a skeletal ciliopathy. Consistent with the observation that the heterogeneous molecular basis of JATD has not been fully determined yet, we have identified two consanguineous Saudi families segregating JATD who share a single identical ancestral homozygous haplotype among the affected members. Whole-exome sequencing revealed a single novel variant within the disease haplotype in CEP120, which encodes a core centriolar protein. Subsequent targeted sequencing of CEP120 in Saudi and European JATD cohorts identified two additional families with the same missense mutation. Combining the four families in linkage analysis confirmed a significant genome-wide linkage signal at the CEP120 locus. This missense change alters a highly conserved amino acid within CEP120 (p.Ala199Pro). In addition, we show marked reduction of cilia and abnormal number of centrioles in fibroblasts from one affected individual. Inhibition of the CEP120 ortholog in zebrafish produced pleiotropic phenotypes characteristic of cilia defects including abnormal body curvature, hydrocephalus, otolith defects and abnormal renal, head and craniofacial development. We also demonstrate that in CEP120 morphants, cilia are shortened in the neural tube and disorganized in the pronephros. These results are consistent with aberrant CEP120 being implicated in the pathogenesis of JATD and expand the role of centriolar proteins in skeletal ciliopathie

Greenness assessment of chromatographic methods used for analysis of empagliflozin: a comparative study

The analytical chemistry community is attempting to incorporate green chemistry concepts in the development of analytical techniques to redefine analytical methods and dramatically modify the philosophy of analytical technique development. Each greenness assessment method has its own benefits and drawbacks, as well as its own procedures. The results of each greenness assessment method produce numerous deductions regarding the selection of a greenest chromatographic method on which the determination of a greenness assessment tool depends. The current study examined the greenness behavior of 26 reported chromatographic methods in the literature for the evaluation of the medicine empagliflozin using three evaluation methods: the national environmental methods index (NEMI), the eco-scale assessment (ESA), and the green analytical procedure index (GAPI). This comparative study discussed the value of using more than one greenness evaluation methods while evaluating. The findings showed that the NEMI was a less informative and misleading tool. However, the ESA provided reliable numerical assessments out of 100. Despite the GAPI being a complex assessment compared to the others, it provided a fully descriptive three-colored pictogram and a precise assessment. The findings recommended applying more than one greenness assessment tool to evaluate the greenness of methods prior to planning laboratory-based analytical methods to ensure an environment friendly process

Melatonin downregulates the increased hepatic alpha-fetoprotein expression and restores pancreatic beta cells in a streptozotocin-induced diabetic rat model: a clinical, biochemical, immunohistochemical, and descriptive histopathological study

BackgroundDiabetes mellitus (DM) is a chronic metabolic disorder. Hepatopathy is one of the serious effects of DM Melatonin (MT) is a potent endogenous antioxidant that can control insulin output. However, little information is available about the potential association between melatonin and hepatic alpha-fetoprotein expression in diabetes.ObjectiveThis study was conducted to assess the influence of MT on diabetes-related hepatic injuries and to determine how β-cells of the pancreas in diabetic rats respond to MT administration.Materials and methodsForty rats were assigned to four groups at random (ten animals per group). Group I served as a normal control group. Group II was induced with DM, and a single dose of freshly prepared streptozotocin (45 mg/kg body weight) was intraperitoneally injected. In Group III, rats received 10 mg/kg/day of intraperitoneal melatonin (IP MT) intraperitoneally over a period of 4 weeks. In Group IV (DM + MT), following the induction of diabetes, rats received MT (the same as in Group III). Fasting blood sugar, glycosylated hemoglobin (HbA1c), and serum insulin levels were assessed at the end of the experimental period. Serum liver function tests were performed. The pancreas and liver were examined histopathologically and immunohistochemically for insulin and alpha-fetoprotein (AFP) antibodies, respectively.ResultsMT was found to significantly modulate the raised blood glucose, HbA1c, and insulin levels induced by diabetes, as well as the decreased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Furthermore, MT attenuated diabetic degenerative changes in the pancreas and the hepatic histological structure, increased the β-cell percentage area, and decreased AFP expression in the liver tissue. It attenuated diabetes-induced hepatic injury by restoring pancreatic β-cells; its antioxidant effect also reduced hepatocyte injury.ConclusionCollectively, the present study confirmed the potential benefits of MT in downregulating the increased hepatic alpha-fetoprotein expression and in restoring pancreatic β-cells in a streptozotocin-induced diabetic rat model, suggesting its promising role in the treatment of diabetes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

QMMAC: Quorum-Based Multichannel MAC Protocol for Wireless Sensor Networks

In wireless sensor networks, energy conservation is a critical task. Thus, it is crucial to design an effective MAC protocol that minimizes energy consumption while guaranteeing high network throughput and low delay. In this article, we propose a quorum-based multichannel MAC protocol (QMMAC) for corona-based WSNs. QMMAC utilizes the multichannel communication feature and the quorum concept to greatly increase the throughput while conserving energy. The aim of this protocol is to allow each node and all its forwarders to wake up at the same time while avoiding collision and overhearing by separating their simultaneous communications using the multichannel feature. More precisely, the main idea of QMMAC is twofold. First, QMMAC wakeup scheduling is designed to minimize the end-to-end delay by allowing nodes to wake up at exactly the same time as their potential forwarders, whereas nodes that are not acting as forwarders for each other wake up at a completely different time, and thus overhearing, idle listening and collisions are avoided. Second, channel assignment, which also uses the concept of quorums, is used to share data channels so that there is no conflict or additional packet exchange required to negotiate the availability of channels. Thus, the end-to-end delay is further minimized as well as collisions between conflicting neighbors are avoided. Simulation results indicate that the network performance is improved by QMMAC in terms of energy efficiency, throughput and end-to-end delay

An atypical presentation of severe congenital contractures and lack of cerebellar involvement in a patient with a novel LAMA1 mutation

Background: LAMA1 gene is mutated in patients with Poretti-Boltshauser syndrome, which include mainly the characteristic neuroimaging findings of cerebellar dysplasia and cysts. Case Presentation: We present a novel homozygous LAMA1 variant that is predicted to cause atypical phenotype of severe arthrogryposis, feeding difficulties, developmental delay, retinopathy, and no cerebellar involvement. Conclusion: Our findings are suggestive of absence of cerebellar involvement in LAMA1 mutations in some cases and phenotype may include severe arthrogryposis. [JBCGenetics 2018; 1(1.000): 43-46

The Concordance between Myocardial Perfusion Imaging and Coronary Angiography in Detecting Coronary Artery Disease: A Retrospective Study in a Tertiary Cardiac Center at King Abdullah Medical City

Background. Coronary artery disease (CAD) is considered as the leading cause of the cardiovascular fatalities worldwide. CAD is diagnosed by many modalities of imaging such as myocardial perfusion imaging (MPI) and coronary angiography (CAG). Methods. A retrospective cross-sectional study was conducted that included all patients referred to the KAMC (King Abdullah Medical City) nuclear cardiology lab from its opening until the end of May 2014 (a period of 17 months). A total of 228 patient reports with a history of conducting either CAG or MPI or both were used in this study and statistically analyzed. Results. An analysis of the MPI results revealed that 78.5% of the samples were abnormal. On the other hand, 26.75% of the samples revealed that they were subjected to CAG and MPI. There was a significant and fair agreement between MPI and CAG by using all the agreement coefficients (kappa = 0.237, phi = 0.310, and value = 0.043). The sensitivity, specificity, and accuracy of MPI with reference to CAG were 97.8%, 20%, and 78.69%, respectively. In addition, positive predictive and negative predictive values were 78.95% and 75%, respectively. Conclusion. In a tertiary referral center, there was a significant agreement between MPI and CAG and a high accuracy of MPI. MPI was a noninvasive diagnostic test that could be used as a gatekeeper for CAG

Burst Channel Error Reduction Based on Interleaving for Efficient High-Speed Wireless Communication

Recently, the demand for reliable and high-speed wireless communication has rapidly increased. Orthogonal frequency division multiplexing (OFDM) is a modulation scheme that is the newest competitor against other modulation schemes used for this purpose. OFDM is mostly used for wireless data transfer, although it may also be used for cable and fiber optic connections. However, in many applications, OFDM suffers from burst errors and high bit error rates. This paper presents the utilization of a helical interleaver with OFDM systems to efficiently handle burst channel errors and allow for Bit Error Rate (BER) reduction. The paper also presents a new interleaver, FRF, the initial letters of the authors’ names, for the same purpose. This newly proposed interleaver summarizes our previous experience with many recent interleavers. Fast Fourier transform OFDM (FFT-OFDM) and Discrete Wavelet Transform OFDM (DWT-OFDM) systems are used to test the efficiency of the suggested scheme in terms of burst channel error removal and BER reduction. Finally, the general complexity of the FRF interleaver is different from that of the helical interleaver in terms of hardware requirements. The performance of the proposed scheme was studied over different channel models. The obtained simulation results show a noticeable performance improvement over the conventional FFT-OFDM and the FFT-OFDM systems with the helical interleaver. Finally, the disadvantage of the proposed FRF interleaver is that it is more complex than the helical interleaver