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

Missing teeth and prosthetic treatment in patients treated at College of Dentistry, University of Dammam

Abstract The percentage of completely and partially edentulous patients and their prosthetic treatment at the Department of Substitutive Dental Sciences (SDS), College of Dentistry, University of Dammam, were investigated. Panoramic radiographs and medical records of adult patients (𝑛 = 479, mean age 45.9 years, and range 25–96 years) treated in 2011–2014 were examined. 6% of the patients were completely edentulous, 8% had single jaw edentulousness, and 74% were partially edentulous. Edentulousness was significantly correlated with age and the number of missing teeth was significantly higher among males (𝑝 &lt; 0.026). Diabetes was significantly associated with complete edentulousness, single edentulous jaw (𝑝 value 0.015), and partial edentulousness (𝑝 value 0.023). Kennedy class III was the most frequent class of partial edentulousness in single and/or both jaws (𝑝 = 0.000). Patients having class I and/or class II were treated most often with removable partial dentures (RPD) (𝑝 = 0.000), while patients having class III were treated with fixed partial dentures (FPD). It was found that complete edentulousness increases in older age and the number of missing teeth was significantly higher among males. Kennedy class III was most common in both upper and lower jaw and was treated more often with FPD than with RPD

Frequency of root canal treatment among patients attending a teaching dental hospital in Dammam, Saudi Arabia

Objective: The purpose of the study was to evaluate the frequency and status of root canal-treated teeth in patients treated at the College of Dentistry, University of Dammam in the Eastern Province of Saudi Arabia. Materials and Methods: A total of 3701 patients visited the clinics during the study period. Through the use of radiographs, 161 patients were initially selected who had endodontically treated teeth. However, after applying the inclusion criteria, the total number of eligible cases was reduced to 155. Patients were divided into three groups according to age (children 1–12 years, adults 13–65 years and geriatrics >65 years). Results: On average, each patient had 2.28 ± 1.88 root canal-treated teeth and 24.02 ± 5.03 teeth without root canal treatment. The average number of endodontically treated teeth increased with an increase in age. The adult group showed the highest number of root-filled teeth 314 (93.4%). Of the 336 endodontically treated teeth, only 75 (22.3%) teeth exhibited periapical radiolucency. First molars (28.43–36.36%) and second premolars (20.1–27.27%) were the most frequently root-filled teeth in both jaws, followed by the first maxillary premolars (11.76%). Periapical lesions showed an almost similar pattern with the highest number of radiolucencies found in the first molars in both jaws (29.3–33.3%) followed by the second premolars in the mandible (30.6%) and first premolars in both jaws (20.8–25%). Conclusion: The first molars and second premolars were the most frequently root-filled teeth in both jaws, followed by maxillary first premolars. Periapical lesions showed an almost similar pattern among teeth with a higher number of radiolucencies found in the first molars in both jaws, followed by the second premolars in the mandible and the first premolars in both jaws

Students&rsquo; Awareness of the Role of Phonetics in Construction of Removable Dental Prostheses: A Questionnaire-Based Cross-Sectional Study

Phonetics plays a major role in the fabrication of prostheses. This study aimed to assess the knowledge of students regarding the role of phonetics in denture fabrication and to improve the educational process and the clinical application. The study was conducted at the College of Dentistry, Imam Abdulrahman Bin Faisal University, and involved a survey of 344 dental students and interns. The questionnaire contained 20 questions and was divided into three sections: general knowledge, clinical correlations, and clinical evaluations. The data were collected and analyzed statistically using independent t-tests, one-way ANOVA, and Tukey&rsquo;s post hoc tests. The response rate was 100%. Male and female students only differed significantly in terms of their scores for answers to general knowledge questions, with females achieving better results (p = 0.023). General knowledge varied significantly between fourth-year students and all other levels (p &lt; 0.001), and fifth-year students and interns (p = 0.027). The clinical correlations varied significantly between fourth-year students and interns (p = 0.01), whereas the clinical evaluations varied between all the academic years and interns (fourth-year, p &lt; 0.001; fifth-year, p = 0.003; and sixth-year, p = 0.017). The interns obtained the highest scores in all sections. There was a lack of awareness among dental students of some aspects of the role of phonetics in denture fabrication. The study highlights the deficiencies that need to be addressed and the need for adjustments to the curriculum related to removable prosthodontics in order to improve the knowledge of students regarding the role of speech in denture fabrication

Comparative Evaluation of TiO₂ Nanoparticle Addition and Postcuring Time on the Flexural Properties and Hardness of Additively Fabricated Denture Base Resins

Three-dimensionally (3D)-printed fabricated denture bases have shown inferior strength to conventional and subtractively fabricated ones. Several factors could significantly improve the strength of 3D-printed denture base resin, including the addition of nanoparticles and post-curing factors. This study evaluated the effect of TiO2 nanoparticle (TNP) addition and the post-curing time (PCT) on the flexural properties and hardness of three-dimensionally (3D)-printed denture base resins. A total of 360 specimens were fabricated, with 180 specimens from each type of resin. For evaluating the flexural properties, bar-shaped specimens measuring 64 × 10 × 3.3 mm were used, while, for the hardness testing, disc-shaped specimens measuring 15 × 2 mm were employed. The two 3D-printed resins utilized in this study were Asiga (DentaBASE) and NextDent (Vertex Dental B.V). Each resin was modified by adding TNPs at 1% and 2% concentrations, forming two groups and an additional unmodified group. Each group was divided into three subgroups according to the PCT (15, 60, and 90 min). All the specimens were subjected to artificial aging (5000 cycles), followed by testing of the flexural strength and elastic modulus using a universal testing machine, and the hardness using the Vickers hardness test. A three-way ANOVA was used for the data analysis, and a post hoc Tukey’s test was used for the pairwise comparisons (α = 0.05). Scanning electron microscopy (SEM) was used for the fracture surface analysis. The addition of the TNPs increased the flexural strength in comparison to the unmodified groups (p p p p < 0.001). Both concentrations of the TNPs increased the flexural strength, while the 2% TNP concentration decreased the elastic modulus and hardness of the 3D-printed nanocomposites. The flexural strength and hardness increased as the PCT increased. The material type, TNP concentration, and PCT are important factors that affect the strength of 3D-printed nanocomposites and could improve their mechanical performance

Color Stability and Surface Properties of PMMA/ZrO2 Nanocomposite Denture Base Material after Using Denture Cleanser

Statement of Problem. Novel polymethyl methacrylate (PMMA) containing zirconium dioxide nanoparticles (nano-ZrO2) was suggested as a denture base material but there is a lack of information regarding denture cleanser effects. Objectives. This study aimed to evaluate denture cleanser effects on color stability, surface roughness, and hardness of PMMA denture base resin reinforced with nano-ZrO2. Materials and Methods. A total of 420 specimens were fabricated of unreinforced and nano-ZrO2 reinforced acrylic resin at 2.5% and 5%, resulting in 3 main groups. These groups were further subdivided (n = 10) according to immersion solution (distilled water, Corega, sodium hypochlorite, and Renew) and immersion duration. Surface roughness, hardness, and color were measured at baseline (2 days-T0) in distilled water and then after 180 and 365 days of immersion (T1 & T2) in water or denture cleansing solutions. Data was collected and analyzed using two-way ANOVA followed by Bonferroni post hoc test (α = 0.05). Results. Surface roughness increased significantly after denture cleanser immersion of unmodified and nano-ZrO2-modified PMMA materials while hardness decreased (P<0.001). The denture cleansers significantly affected the color of both PMMA denture bases (P<0.001). The immersion time in denture cleansers significantly affected all tested properties (P<0.001). Within denture cleansers, NaOCl showed the highest adverse effects (P<0.05) while Renew showed the least adverse effects. Conclusion. Denture cleansers can significantly result in color change and alter the surface roughness and hardness of denture base resin even with ZrO2 nanoparticles addition. Therefore, they should be carefully used

Comparative Evaluation of Surface Roughness and Hardness of 3D Printed Resins

The effect of printing parameters on the surface characteristics of three-dimensional (3D)-printed denture base resins (DBRs) is neglected. Therefore, this study investigated the effect of printing orientation and post-curing time on the surface roughness and hardness. One conventional heat-polymerized (HP) resin and two 3D-printing resins (NextDent (ND) and ASIGA (AS)) were used to fabricate a total of 250-disc (10 &times; 2.5 mm) specimens. ND and AS specimens were printed with different orientations (0-, 45-, and 90-degree) and each orientation group was subjected to four post-curing times (30, 60, 90, 120 min). Printed specimens were thermo-cycled (10,000 cycles) followed by the measuring of surface roughness (Profilometer (Ra)) and hardness (a Vickers hardness (VH)). ANOVA and post hoc tests were used for data analysis (&alpha; = 0.05) at significant levels. AS and ND showed no significant changes in Ra when compared with HP (p &#707; 0.05), except the 45-degree orientation (AS/90 min and AS/120 min) significantly increased surface roughness (p &#706; 0.001). There was no significant difference in Ra with different orientations and post-curing time for both materials AS and ND (p &#707; 0.05). Compared with HP, 3D-printed DBRs showed low VH values (p &#706; 0.001). For AS, 90-degree orientation showed a significant decrease in VH at 60, 90, and 120 min when compared with 0- and 45-degree orientation (p &#706; 0.001), while ND showed no significant difference in VH with different printing orientations (p &#707; 0.05). The VH of AS and ND improved when increasing post-curing time to 120 min (p &#706; 0.001), and the printing orientations and post-curing time did not affect the Ra of 3D-printed DBRs