Effect of Different Implant Materials on Stresses Transmitted to Peri-Implant Areas of Implant-Retained Mandibular Overdenture

Aim this in vitro study was conducted to evaluate the effect of mechanical loading on different implant materials on supporting structures materials and methods: a total of three implant retained overdentures were used in this study, retained by two implants each (Titanium, polyetheretherketon and zirconia) were placed in epoxy resin casts at the canine area using a surgical guide. Soft liner material was used at the distal extension area to mimic the soft tissues. Two linear strain gauges were bonded buccal and lingual to each implant to measure the peri-implant strains during unilateral and bilateral loading. Results: during bilateral loading the highest strain values were recorded with the PEEK implants, while the lowest strain values were recorded with the zirconia implants. During unilateral loading, the highest strain values in the loading side were also demonstrated with the PEEK implants, and the lowest strain values were observed with the zirconia implants.Conclusion: within the limitations of this in vitro study, PEEK implants were found to transmit more occlusal stresses at the marginal bone area than titanium and zirconia implants, thus PEEK implants avoid stress shielding phenomenon and its subsequent disuse atrophy of bon

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The Aesthetics Of The Combining Between The Enamel And The Semi-Precious Stones And Their Role In Enriching The Surface Of Metal Crafts

Applying enamel on the surface of the metal artwork is one of the techniques of a great importance, regarding metal formulation, due to its colors and textures provided enriching the surface. Moreover, the color is an important atheistic factor affecting the artwork; it enriches the plastic and expressive value of metal artworks, in case of matching the color of the background. Consequently, it aids the artist to achieve the desired aesthetic value, as Enamel is the process of emerging layers of glass on the surface of the metal.The semiprecious stones have been included in the ancient Egyptian jewels, which increases its glamour. The ancient Egyptians had been aware of colorful stones and including them in their jewels resulting in producing pieces of artworks astonishing the whole world of its beauty, since the time pre-families.The semiprecious stones are the stones that might belong to a metal non-metallic or organic origin, which can be either zoological or botanical, and all have various features. Man has reached various treatments for precious and semiprecious stones, in order to improve their qualities, of which, there is treatment with heat.Treatment with heat may affect the surface of the metal artwork, as it is possible to combine enamel and semiprecious stones. The process results in color and texture on the surface of the metal enriching the plastic value of the artwork. This combination can treat the cracks of the semiprecious stones, along with the formulation troubles. It is considered one of the means of permanent combination of metals, as well as, it either assures or changes the color in some stones, while in others, it results in diaphaneity.Combining between enamel and semiprecious stones of metal surface can result in enriching the artwork, through the variety of plastic and expressive values. The variety is produced by the heat in combining the two elements in different formulations, upon which the issue of the research is; how to enrich metal artworks expressing the aesthetics of combining between enamel and semiprecious stones

Evaluation of Incorporating Bracing Arm in Precision Attachment Unilateral Removable Partial Denture

ABSTRACT Purpose: This Randomized Control Trial study aimed to compare between two designs of Precision Attachment Unilateral Removable Partial Denture, one conventional design and the other modified with bracing arm and mesial rest. Materials and Methods: twenty male patients having Kennedy Class II mandibular edentulous ridges received the two designs in a split mouth study for a follow-up period of eighteen months. Probing Pocket Depth around abutment was measured. A standardized radiographic technique was used to evaluate bone height changes. Results: The results showed insignificant pocket depth and bone height changes in the two groups. Conclusion: Precision Attachment Unilateral Removable Partial Denture proved to be a viable treatment therapy in treating unilateral edentulous ridges

Effectiveness of using deep eutectic solvents as an alternative to conventional solvents in enzymatic biodiesel production from waste oils

Ionic liquids (ILs) have been proposed as a more benign replacement to toxic and volatile organic solvents in enzymatic biodiesel production, used to minimize methanol inhibition effect and enhance the stability of immobilized enzyme. Despite their several advantages, ILs are expensive, which renders the overall process unfeasible. In this work, the use of low-cost deep eutectic solvents (DESs) has been investigated as a new reaction medium for enzymatic biodiesel production from waste oils. A DES composed of chlorine-chloride and glycerol (ChCl:Gly) was tested and its effectiveness was compared to 1-butyl-3-methylimidazolium hexafluorophosphate, [bmim][PF6], which has shown positive results. To decrease the viscosity of ChCl:Gly DES, ternary ChCl:Gly:water DESs with different water contents were prepared and tested. Despite lower cost compared to ILs, without successful repeated reuse of the DES-immobilized lipase system, their advantages remain theoretical. Therefore, the reusability of the DES-Novozym®435 system in consecutive cycles was examined. It was shown that 34% biodiesel production yield could be achieved in ChCl:Gly at 1:2 molar ratio, compared to 23% when [bmim][PF6] was used. The yield increased further, when the ternary DES of ChCl:Gly:water (1:2) with 3 wt% water was used, reaching 44%. By removing the by-product glycerol, the reusability of the DES-immobilized system was improved, with better results achieved using 1-butanol compared to using ethylene glycol. Keywords: Biodiesel, Deep eutectic solvent, Ionic liquids, Immobilized lipase, Reusabilit

Retention Loss of Locator Attachment System Different Retention Caps for Two Implant Retained Mandibular Overdenture.

Abstract Purpose. The objective of this invitro study was to evaluate gradual loss of retention at different time intervals between four different colour coded retentive caps of locator R-TX attachment system through 3000 cycles resembling 3years of attachment usage. Material and Methods. According to prosthetically driven implant placement, two implants were digitally planned and placed by 3D printed surgical stent in an epoxy model. Forty-eight mandibular complete dentures divided into four groups (12 dentures for each group) were constructed to compare Loss of retention between (12 pairs of locator R-TX each retention cap: zero retention, low retention, medium retention and regular retention), each was subjected to insertion and removal cycles resembling 3years of patient usage. Retention values at zero, one, two, three years were recorded using universal testing machine. Results. Locator R-TX medium &low retention showed no statistically significant retention values through three years while locator R-TX regular retention cap showed better retention values at zero, first, second year of use. Conclusion. Locator R-TX attachment systems low, medium, regular retention cap had no statistically significant different retention values at the end of third year of use while there were only statistically significant primary retention values. Clinical Implications. The importance of difference retention caps appears only in the start of over denture treatment until complete patient adaptation to over denture treatment

Effect of fractional carbon dioxide (CO2) laser on improving minoxidil delivery for treatment of androgenetic alopecia

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment.Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment.Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin &amp; thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness.Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA

Effect of adding trunk core training exercise to conventional therapy on patients with chronic mechanical neck pain

Background: One of the most frequent causes of musculoskeletal pain in the general population is cervicalgia, sometimes known as neck pain. Its estimated prevalence ranges from 16.7% to 71.5 percent, and it should be noted that up to 50% of these cases may develop into chronic conditions. In this study, patients with persistent mechanical neck pain were examined to determine the effectiveness of trunk core training exercises on pain, range of motion, functional impairment, and muscle activity. Purpose: The goal of the study was to determine the impact of adding core training to patients' existing conventional treatments for chronic mechanical neck pain. Methods: Twenty male and twenty female patients with persistent mechanical neck pain, ranging in age from 18 to 40, participated in this study. The cases were classified into two equal groups randomly (A and B). Group A has got standard physiotherapy program (Passive stretching of the upper fibers of trapezius, sternocleidomastoid, and scalene muscles, Isometric strengthening exercises of neck muscles, hot pack). Group B has obtained standard physiotherapy program in addition to trunk core training program.&nbsp