Measuring Accuracy of Dolphin Imaging Software in predicting upper jaw soft tissue profile changes in Class II Adult Patients treated with Extraction versus Non-Extraction.

Abstract Objective: To assess the accuracy of Dolphin Imaging software in predicting upper jaw profile changes in class II patients treated by extraction and non-extraction. Methods: The records of 60 Class II div 1 patients were selected; 30 patients treated by extraction of upper first premolar and 30 patients treated by non-extraction. The Pre- and post-treatment lateral cephalometric x-rays of each patient were traced using Dolphin software. The actual hard tissue changes due to treatment were calculated and installed into the prediction module to generate the predicted profile. The soft tissue measurements of the actual post-treatment and predicted profiles were compared using the Dolphin measurement function. The accuracy of the software-generated prediction was analysed using Dahlberg’s formula (RDE), Bland & Altman methodand Lin’s Concordance Coefficient (CCC). Results: RDE of the measured variables were significantly lower for non-extraction group (P = 0.05). Regarding the extraction cases, prediction of the upper lip position relative to E line was not reliable (RDE = 19.1%). Mean difference (predicted-actual) of the upper lip thickness (+ 0.8 mm), upper lip length (+ 0.633 mm), and nasolabial angle (- 4.09) showed a high Bland & Altman range. Regarding the extraction group, upper lip position and nasolabial angle showed poor agreement between the actual and predicted measurements (CCC= 0.505 & 0.38). Conclusions: Dolphin software prediction for soft tissue changes is more accurate in non-extraction treatments for class II div 1 cases. The software tends to underestimate the upper lip retractive response due to extraction

The preparation and characterization of chitosan/poly (vinyl alcohol) blended films : mechanical, thermal and surface investigations

In this study, blends of chitosan (CS) and polyvinyl alcohol (PVA) (CS/PVA) having various proportions were prepared and characterized by universal mechanical tester, the differential scanning calorimetry (DSC) and contact angle measurements. Studying the mechanical properties of the films showed that blending improved the tensile strength, which increased with increasing PVA content up to 40% while the elongation% at break of the blends was decreased compared to that of the pure components. The obtained results of DSC suggested that some interaction between chitosan and PVA mostly took place. Static water contact angle measurements showed an improvement in the wettability of the obtained films

Preparation and Properties of Non-Crosslinked and Ionically Crosslinked Chitosan/Agar Blended Hydrogel Films

Hydrogel films of chitosan (Cs) and agar blends of various proportions were prepared using physical solution blending. Some of the obtained films were ionically cross-linked by treatment with calcium chloride solution. The obtained films were characterized by Fourier transform infrared (FTIR) spectroscopy, thermogravimetry analysis (TGA), differential scanning calorimetery (DSC) and universal mechanical tester. The non-crosslinked Cs/agar blended films showed lower water swelling, melting temperature, stiffer and less elastic properties than that of pure Cs films and higher than pure agar films. Crosslinked blended films displayed further reduction in the swelling and melting temperature while maintained more hydrogel stability

Rheological and morphological studies of chitosan/agar/ poly (vinyl alcohol) blends

In this study, a number of ternary mixture aqueous solutions of chitosan/agar/poly vinyl alcohol (CS/AG/PVA) at different proportions (considering chitosan as the main component) were prepared. The effects of temperature, shear rate, shearing time and storage time on the rheological properties, i.e., the apparent viscosity and the shear stress as a function of shear rate were investigated for the ternary system. Results showed that a Newtonian behavior was observed at temperatures from 40 o C to 55 o C for the ratios 90/05/05 and 80/10/10. The mixture solutions become pseudoplastic (shear thinning) when the concentrations of agar and PVA were higher than 10 % each. It was also found that all the blend solutions obeyed the Arrhenius equation. In addition, the effect of the shearing time on the shearing viscosity did not show any significant change at all shearing times applied for lower concentrations than 15% of each of agar and PVA in this study. However, at higher concentrations of agar and PVA, a rheopectic behavior was observed. Furthermore, different behaviors were observed for the blend solutions when the period of storage was extended to three weeks. The observations obtained from the rheological measurement suggested the existence of interaction between the three polymers. Finally, the morphology of the blended films confirmed the interaction between the functional groups of the blend components

Preparation and characterization of chitosan/agar blends: rheological and thermal studies

In this work, a number of mixture aqueous solutions of chitosan/agar (CS/AG) at different ratios (considering chitosan as the main component) were prepared. The rheological properties i.e. shearing viscosity and shear stress of the blend solutions as a function of shear rate as well as the thermal properties of the blend films were investigated. Among the parameters studied were temperature, shearing time and storage time. Results showed that almost Newtonian behavior was observed at temperatures from 40°C to 55°C for the ratios 100/0, 90/10, 80/20 and 70/30. However, the proportions 60/40 and 50/50 showed a clear shear thinning behavior (pseudoplastic non-Newtonian behavior). It was also found that all the blend solutions obeyed the Arrhenius equation. In addition, the effect of shearing time on the shearing viscosity of all blends did not show any significant differences at all shearing times applied in this study except the proportion 50/50 wherein decreasing in shearing viscosity and shear stress was observed as the shearing time increased. Furthermore, different behaviors were observed for the blend solutions when the period of storage was extended to three weeks. The FTIR results and the differential scanning calorimetery (DSC) curves showed that the interaction between chitosan and agar can occur

Preparation and Characterization of Chitosan/Agar Blended Films: Part 2. Thermal, Mechanical, and Surface Properties

Chitosan/agar (CS/AG) films were prepared by blending different proportions of chitosan and agar (considering chitosan as the major component) in solution forms. The thermal stability of the blended films was studied using thermal gravimetric analysis (TGA). It was revealed that chitosan and agar form a compatible blend. Studying the mechanical properties of the films showed a decrease in the tensile strength and elongation at break with increasing agar content. Blending of agar with chitosan at all proportions was found to form hydrogel films with enhanced swelling compared to the pure chitosan one. Static water contact angle measurements confirmed the increasing affinity of the blended films towards water suggesting that blending of agar with chitosan improves the wettability of the obtained films

Mechanical, thermal and surface investigations of chitosan/agar/PVA Ternary blended films

The mechanical and thermal properties of chitosan/agar/poly vinyl alcohol (CS/AG/PVA) ternary blended films having various proportions considering chitosan as the main component were investigated. The various variables static water contact angle such as contact angle, drop base area, drop volume and drop height was also studied in correlation with the variation of time. Results obtained from mechanical measurements showed a noticeable increase in the tensile strength (TS) coincided with a sharp decrease in elongation percent at break (E%) of blended films with increasing agar and PVA contents. The DSC results prevailed the development of an interaction between chitosan individual components: agar and PVA. Moreover, an enhancement of the wettability of the blends was obtained with increasing agar and PVA contents. It was also found that the pure CS film and the blended films with 90/05/05 and 80/10/10 compositions were more affected by time than blended films with other compositions when the contact angle, the drop height and the drop length were studied as a function of time. In addition, when the drop is initially placed on the substrate, the drop area and the drop volume of all films remained almost constant up to a certain time after which they showed a slight difference with the elapse of time

Comparison of Anthropometric Measurements of Infants Born to Bahraini Mothers with and Without Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus is a major cause of morbidity and mortality to both mother and fetus. It is defined as the development of hyperglycemia during pregnancy in women who were not previously diagnosed with Diabetes Mellitus (DM) (1). Diagnosis usually occurs during the 24th to 28th weeks of gestation (1). The prevalence of GDM varies worldwide and was reported to be in Bahrain in 2012 at 10.1% of pregnancies, which was increased from 7.2% in 2002 (6). For this study, a total sample of 10,865 patients was used, dating from May 2016 to January 2020. The sample size is set in King Hamad University Hospital (KHUH), Kingdom of Bahrain. They were chosen based on inclusion and exclusion criteria. The data collected included the GDM status of the mother (GDM or Non-GDM), gestational age of the fetus (weeks), birth weight (grams) of the fetus, length (centimeters) of the fetus, head circumference (centimeters) of the fetus and placental weight (grams) upon delivery. In our study, the results showed an increase in anthropometric measurements in infants born to GDM mothers. 10 out of 200 (5%) neonates had a macrocosmic birth weight in GDM infants. However, when comparing to the birth weight, p= 0.940 was found, showing a non-significant difference between both groups. There was a faster acceleration in head circumference in neonates born to mothers with GDM, and there was no significant difference in average head circumference between both groups. Moreover, 153 out of 200 (76%) of the GDM group had a placental weight of more than 500 grams, whereas 179 out of 200 (89.5%) of the non-GDM group had a placental weight of more than 500 grams. GDM is a common yet serious complication encountered throughout pregnancy, most commonly via routine screening. One of the commonly observed outcomes of GDM in pregnancy is increased fetal growth through various mechanisms, which can result in an increased risk of neonatal morbidity and mortality. This study helps to reaffirm that routine screening of GDM is required, and perhaps placental weight is another factor to be taken into consideration after further study as an indicator of fetal growth and GDM progression

Incidence of Necrotizing Enterocolitis and an Assessment of Related Risk Factors and Outcomes

Necrotizing Enterocolitis (NEC), defined as inflammation of the intestines most commonly due to a bacterial cause, is a relatively rare condition widely encountered in premature infants. Established risk factors for developing NEC include low gestational age, extremely low birth weight, sepsis, and hypotension. However, studies have investigated other causes that may alter the gut microbiome, such as blood transfusions, antibiotic use, and co-morbid conditions. The study design is a retrospective cohort study, and patient data were collected from King Hamad University Hospital (KHUH) after receiving the necessary approvals. Patients included in this study were from 2012 to 2020. The variables assessed included gestational age, birth weight, hemoglobin and hematocrit levels, prenatal and postnatal antibiotic use, blood transfusions, other transfusion products the patients received, and blood culture results. A total of 16 patients were identified as having NEC after thoroughly reviewing their files, and the data were analyzed at the KHUH Research Department. Although a small sample size was involved in this study, antibiotic use was a significant factor in the development of NEC as antibiotics such as ampicillin, gentamicin, and cefotaxime have been shown to alter the gut microbiome, which can predispose a patient to the development of NEC, as was reflected in our study. We also observed a 10.4-time relative risk for developing NEC in patients who had received blood transfusions. The use of antibiotics in patients with NEC has been shown to increase the likelihood of developing the condition, especially with the predominance of Enterobacteriaceae. Although controversial, blood transfusions have also been associated with the development of NEC. Due to the fragile vascular system in patients with NEC, constant phlebotomies and the introduction of packed red blood cells can alter the levels of nitric oxide present, predisposing premature infants to hypoxic conditions and, therefore, the development of NEC

Incidence of Trauma during Birth to Neonates Born to Mothers with Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance that occurs during pregnancy. The incidence of GDM has been on the rise and is a significant cause of various consequences for both the mother and infant. Such consequences include birth trauma. Factors such as shoulder dystocia and fetal macrosomia can increase the incidence of birth trauma. Additionally, GDM is a major cause of fetal macrosomia, influencing the intrapartum delivery method. This study aims to investigate the incidence of birth trauma in mothers with and without GDM. A total of 10,865 patients from King Hamad University Hospital (KHUH) were included, and their files were then further stratified only to include neonates with evidence of birth trauma. A total of 64 patients were found to fit the inclusion criteria. The study looked at GDM status, gestational age, birth weight, length, head circumference, mode of delivery, presentation of the baby before delivery, assistance during delivery, and maternal/neonatal trauma. Maternal trauma rates were found to be statistically significant within the population of the Kingdom of Bahrain. An increased incidence of maternal trauma was observed in the non-GDM group, with 56.3% of the patients requiring an episiotomy or having a complication of a vaginal laceration. Regarding the incidence of birth traumas in the GDM group, they presented most commonly with cephalohematoma or Erb’s palsy, whereas the non-GDM group most commonly presented with cephalohematoma. The incidence of birth trauma due to GDM has seldom been researched in the existing literature. However, it has been noted that factors such as macrosomia can increase the likelihood of birth trauma. The general incidence of neonatal birth trauma has been reported to be 2.7%, which is reassuring; however, it is essential to investigate further the effect of GDM on the rates of birth trauma using large population cohorts