Effect of Abutments Design on Wear of Locator Attachments in Implant Retained Mandibular Overdenture.

Purpose: The aim of this study is to compare the effect of abutments design on wear behavior of Locator attachments in implant-retained mandibular overdenture. Materials and Methods: Two epoxy models representing an edentulous mandible were used, two implants were placed in each model. Twenty-four locator attachments were used (twelve in each study group). Cycles of Insertion and removal were performed using a universal testing machine resembling 3 years of clinical use, then each abutment was scanned by scanning electron microscope (SEM) before and after insertion and removal cycles. Data were compared qualitatively using a specialized computer software Results: There was a statistically significant difference in wear between the two studied locator groups P=0000*. Locator F-TX showed 29±1.704 % of surface change. PEEKLOC. Locator showed 21±2.090 %of surface change. Conclusions: PEEKLoc. abutment design showed more wear resistance than the recently introduced Locator F-TX

Comparison Between Combined Sensory Index Test and Diagnostic Ultrasonography (Inlet Outlet Ratio) in Suspected or Early Cases of Carpal Tunnel Syndrome

Background: The combined sensory index (CSI) test is more precise in diagnosing carpal tunnel syndrome (CTS) early cases. Another useful tool for early detection of CTS is the diagnostic ultrasonography. Objective: The present study was conducted to compare between the CSI test and its sensitivity with diagnostic ultrasonography IOR (inlet outlet ratio) in suspected or early cases of carpal tunnel syndrome (CTS).Patients and methods: The present case-control study involved 20 subjects with signs and symptoms suggestive of early cases of CTS with duration less than 6 months, in addition to 20 apparently healthy subjects who were clinically examined and underwent EDX and US evaluation. We excluded patients with severe CTS, proximal cervical lesion, or other neurological diseases.Results: By comparison, CSI shows a higher sensitivity than IOR. Combining both tests induced elevated substantial differences between patients as well as controls (P <0.01), besides elevating the sensitivity to 100%.Conclusion: It could be concluded that the sensitivity and accuracy of CSI is higher than diagnostic ultrasonography IOR on the median nerve. On the contrary, diagnostic ultrasonography can detect the anatomical abnormalities of the median nerve while the physiological abnormalities of the median nerve and their level can be examined by nerve conduction studies (NCS). They are complementary tests for CTS diagnosi

Seawater Polluted with Highly Concentrated Polycyclic Aromatic Hydrocarbons Suppresses Osteoblastic Activity in the Scales of Goldfish, Carassius auratus

We have developed an original in vitro bioassay using teleost scale, that has osteoclasts, osteoblasts, and bone matrix as each marker: alkaline phosphatase (ALP) for osteoblasts and tartrate-resistant acid phosphatase (TRAP) for osteoclasts. Using this scale in vitro bioassay, we examined the effects of seawater polluted with highly concentrated polycyclic aromatic hydrocarbons (PAHs) and nitro-polycyclic aromatic hydrocarbons (NPAHs) on osteoblastic and osteoclastic activities in the present study. Polluted seawater was collected from two sites (the Alexandria site on the Mediterranean Sea and the Suez Canal site on the Red Sea). Total levels of PAHs in the seawater from the Alexandria and Suez Canal sites were 1364.59 and 992.56 ng/l, respectively. We were able to detect NPAHs in both seawater samples. Total levels of NPAHs were detected in the seawater of the Alexandria site (12.749 ng/l) and the Suez Canal site (3.914 ng/l). Each sample of polluted seawater was added to culture medium at dilution rates of 50, 100, and 500, and incubated with the goldfish scales for 6 hrs. Thereafter, ALP and TRAP activities were measured. ALP activity was significantly suppressed by both polluted seawater samples diluted at least 500 times, but TRAP activity did not change. In addition, mRNA expressions of osteoblastic markers (ALP, osteocalcin, and the receptor activator of the NF-κB ligand) decreased significantly, as did the ALP enzyme activity. In fact, ALP activity decreased on treatment with PAHs and NPAHs. We conclude that seawater polluted with highly concentrated PAHs and NPAHs influences bone metabolism in teleosts. © 2016 Zoological Society of Japan.Embargo Period 12 month

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

Patient satisfaction of tooth supported overdentures utilizing ball attachments

Statement of problem: Teeth retained overdenture therapy is an alternative treatment rarely used in cases with few remaining teeth. Purpose: The aim of this study was to evaluate the patient satisfaction associated with teeth retained maxillary and mandibular overdentures utilizing ready made ball attachment. Materials and methods: Thirty patients treated with teeth retained overdenture utilizing ready made ball attachment. Participants completed a series of questionnaires (OHIP-14 questionnaire) after tooth supported overdenture wearing by one month (base line), then after one month and 12 months of wearing the attachment retained overdenture. Results: Statistically insignificant difference between gender, and for upper and lower arch overdentures, before attachment placement, one month and one year post attachments placement. Statistically significant difference in patient satisfaction was recorded with different intervals of the questioner. Conclusion: Tooth retained overdentures using ball attachments achieve greater satisfaction scores than those conventional tooth supported overdentures

Bacterial leakage of different internal implant/ abutment connection

Objectives: This research was carried out to evaluate the bacterial leakage of two different internal implant abutment connections in vitro. Materials and Methods: Twenty dental implants divided into two equal groups were compared; Group 1 fixtures with an internal hexagonal geometry; Group 2 fixtures with a tri-lobe internal connection. A bacterial suspension of Staphylococcus aureus was prepared to obtain a density of 0.5 McFarland standards. All implant abutment assemblies were submerged in sterile tubes containing 4mL of S. aureus broth culture and were incubated at 37C for 14 days. The specimens were disassembled and the inner surfaces of the implants were sampled by sterile paper points. Then the paper points were immersed in test tubes containing sterile BHI broth. From the broth, culture was done on blood agar plates and incubated at 37 C for 24 h. The resulting colonies were identified by Gram\u27s stain and biochemical reactions. Results: Internal hexagon implants showed statistically significant higher mean Log10 CFU than Tri-lobe implants. Conclusion: Bacterial leakage seems to be inevitable but fixture abutment interface geometry plays an important role in the amount of leakage

Evaluation of ridge changes in immediate implant placement in split crest technique

Objectives: This research was carried out to evaluate crestal bone level changes around dental implants immediately installed after split-crest technique in mandible. Materials and Methods: Ten patients receiving 20 dental implants with inadequate mandibular buccolingual dimension, 23 mm of crestal width; and sufficient height from the tip of the alveolar ridge to the inferior alveolar canal were evaluated in this retrospective study. All the patients underwent split-crest technique with immediate implant insertion. Implant placement was conducted through a conventional two- step procedure. After 4 months the patients received a mandibular (partial or complete) overdenture retained by ball and socket attachments. Crestal bone level changes around dental implants were assessed using cone beam computed tomography.Results: Using the split ridge technique showed high rate of success and minimal ridge height changes