Urban Quality of Life in Nasr City: An Assessment of the Reformation Project of the Built Environment

Large-scale urban renewal initiatives are undertaken by governments in cities under pressure to improve residents' quality of life (QoL) and mitigate economic and environmental issues. In 2019, as a part of the Egypt 2030 vision, the government initiated a road network reformation project to solve mobility issues in the districts linking the east and west of Cairo, including Nasr City District. To investigate if the built environment of Nasr City District is still resident-friendly, this research is being undertaken to examine residents' satisfaction with the reformation project, which had an impact on their QoL

Internal fit of lithium disilicate and resin nano-ceramic endocrowns with different preparation designs

Purpose: Investigation of different central cavity designs on internal fit of endocrowns fabricated from two materials. Materials and methods: Forty maxillary premolars were endodontically treated and divided into 8 groups [n ¼ 5]: LS10, LS6, LD10, LD6, ES10, ES6, ED10 and ED6 (“L” restored with Lava™ Ultimate [resin nano ceramic], “E” restored with IPS e.max® CAD [lithium disilicate], “S” shallow depth [3 mm], “D” extended depth [5 mm], “6”-degree and “10”-degree axial wall divergence). All restorations were fabricated using CEREC CAD/CAM system. Samples were tested for internal fit using CBCT imaging (Next Generation i-CAT scanner) before and after adaptation. Data was tabulated and statistically analyzed. Results: Lava™ Ultimate showed significant better internal fit compared to IPS e.max® CAD endocrowns both before and after adaptation [p ¼ 0.007 and 0.003, respectively]. Samples with 6-degree axial wall divergence showed significant better internal fit compared to those with 10-degree axial wall divergence before adaptation [p ¼ 0.041]. Before adaptation, group LS6 showed the best internal fit [403.00 ± 115.30 mm] followed by LD6, LD10, ES6, ES10, ED10, LS10 and ED6. After adaptation, group LS10 showed the best internal fit [394.80 ± 21.17 mm], followed by LS6, LD10, ED6, LD6, ES6, ED10, and ES10. Conclusion: Resin nano-ceramic endocrowns presented better internal adaptation compared to lithium disilicate endocrowns, regardless of the preparation design

Evaluation of Color Difference and Translucency of Modified PEEK Restorations Veneered with Different Veneering Materials Before and After Thermal Cycling

Objective: The aim of this study was to investigate the effect of different PEEK veneering materials, as well as thermocycling on the color difference (ΔE) and the translucency parameter (TP) of modified PEEK veneered restorations. Materials and Methods: Thirty disc shaped specimens of veneered BioHPP (1.5 mm X 12 mm) were randomly divided into three groups (n=10) based on the type of the veneering material. Group (A): Discs veneered with CAD milled Lithium Disilicate, group (B): Discs veneered with pre-cured milled composite, and group (C): Discs veneered with conventional light cured composite. CIELab values were calculated for all specimens over white and black backgrounds using a laboratory spectrophotometer and then (ΔE) and (TP) were calculated. Specimens were subjected to thermal cycling, after which the same procedure for calculating (ΔE) and (TP) was repeated. Results: Repeated measures ANOVA showed that both the veneering material, and thermocycling had a statistically significant effect on mean ΔE, and on (TP) (P-value Conclusions: All veneering techniques rendered an amount of color difference that was clinically unacceptable, as well as displaying much lower translucency levels than that of natural enamel and dentine

The Effect of Thickness And Accelerated Aging on Opalescence of Different Ceramic Materials

Purpose: The objective of the study was to evaluate the effect of ceramic material type and thickness on opalescence before and after accelerated aging. Materials and methods: 180 all-ceramic slices were divided into three groups (n=60) according to the ceramic material (InCoris TZI, Empress CAD HT, and Empress CAD LT). Each group was further subdivided into four subgroups (n = 15) according to their thickness (0.5 mm, 0.8 mm, 1 mm and 1.2 mm).). CIE Lab coordinates were measured for each slice against black and white backgrounds using intraoral spectrophotometer and OP was calculated. All specimens were subjected to accelerated aging using autoclave (134 ºC, 0.2 MPa for 5 h) and OP was calculated after accelerated aging. Repeated ANOVA combined with a Tukey-post hoc test were used to analyze the data obtained (P ≤ 0.05). Results: The results showed that ceramic material type and thickness have significant effect on opalescence with OP values (from 4.4±1.2 to 7.1±1.7) for InCoris TZI, (from 4.1±0.28 to 5.7±0.36) for CAD HT, and (from 5.9±0.7 to 8.7±4.6) for CAD LT, while the effect of accelerated aging was not statistically significant. Conclusion: The dental ceramic type affected the opalescence with Empress CAD HT showing the highest OP values. Increasing the thickness caused an increase in the opalescence of leucite reinforced glass ceramic, while it decreased the opalescence of zirconia. Therefore, manufactures should develop all-ceramic materials that can simulate the opalescence of natural teeth especially in esthetic ceramic restoration with lower thickness

Evaluation of colour reproduction of CAD/CAM Lithuim-disilicate veneers of different thicknesses and translucency

Background: With the increasing patients’ demand for a perfect smile, the call for highly aesthetic and yet minimally invasive veneers has surmounted. Objective: The aim of this study was to evaluate the colour of CAD/CAM lithium disilicate veneers fabricated in different thicknesses and different translucencies of the lithium disilicate blocks. Materials and Methods: Forty discs of lithium disilicate glass-ceramic (IPS e.max CAD) of shade A1 of both high and low translucency (HT, LT) were tested for their colour reproduction. HT and low LT blocks were cut in the form of plates of dimensions (12 x 14 mm) and of different thicknesses (0.3 mm, 0.5 mm, 0.7 mm, and 0.9 mm). Twenty specimens of each translucency were classified into three sub-groups according to thickness (n=5). Colour reproduction (∆E) was determined using VITA Easyshade Advance against a foundation block and compared with A1 shade tab. Data was collected for statistical analysis. Analysis of Variance (ANOVA), and pair-wise comparison tests were used. Significance level was set to PResults: Two-way ANOVA test showed that the change in both thickness and translucency a well as the interaction between them had a significant effect over (∆E) values. One-way ANOVA and Bonferroni’s tests showed that the low translucency samples showed a statistically significant difference in (∆E) values between all thickness groups except between the 0.3 mm and 0.7 mm as well as between the 0.5 mm and 0.9 mm thickness specimens. High translucency specimens showed a significant difference between all thicknesses. Conclusions: The final colour of laminate veneers could be highly affected by both the thickness and translucency of the ceramic material used. LT specimens produced much better color reproduction with better masking ability than the HT specimens

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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 &lt; 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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe