DIODE LASER TREATMENT OF ORTHODONTICALLY INDUCED GINGIVAL HYPERPLASIA. A RANDOMIZED CONTROLLED CLINICAL TRIAL

Gingival hyperplasia becomes a relatively frequent pathologic condition during orthodontic treatment. The aim of this study was to evaluate the effectiveness of diode laser gingivectomy as an adjunct to nonsurgical periodontal treatment in the management of gingival hyperplasia in orthodontic patients. Materials and Methods: Thirty eight orthodontic patients with gingival enlargement due to fixed appliances were divided randomly into two groups. The test group received diode laser (810-nm) gingivectomy as an adjunct to nonsurgical periodontal treatment. The control group received nonsurgical periodontal treatment only. For all patients, clinical periodontal parameters were assessed at baseline, 6weeks, and 12 weeks: Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, and Gingival Overgrowth Index. Intra- and intergroup variations in the periodontal parameters were determined at time intervals versus baseline measurements. Results: Both groups showed statistically significant improvements in clinical periodontal parameters over the study period (P < .05). However, significant improvements in periodontal health were evident earlier in the test group as the extent of improvement in periodontal health compared to baseline was greater in the test group than in the control group for most of the clinical parameters. (P< .05)Conclusion: The adjunct use of diode laser gingivectomy combined with meticulous oral hygiene can produce quicker and greater improvement in gingival health, suggesting its beneficial use for orthodontic patients with gingival overgrowt

Diode Laser Ablation Versus Surgical Scalpel Technique For Gingival Depigmentation: A Randomized Controlled Clinical Trial

The aim of this study is to evaluate and compare the clinical efficiency of gingival depigmentation procedure with conventional scalpel and diode laser techniques. Materials and methods: This study was carried out as a randomized controlled clinical trial, split mouth design, in which fifteen patients having diffuse continuous physiologic pigmentation of the gingiva involving facial aspect of maxillary right to left premolar area were selected. The maxilla was divided into two halves and randomly allotted for “study site” for depigmentation with diode laser technique, and “control site” for depigmentation with scalpel technique. The studied variables were the degree of pain, bleeding, duration of the procedure, wound healing, and level of melanin repigmentation. The follow-up period was twelve months. For statistical analysis, Wilcoxon signed-rank test were conducted. Results: The diode laser technique showed better results regarding pain during the first three days, duration of the procedure, and bleeding. There was no significant difference between diode laser technique and scalpel technique regarding the wound healing and pain experienced by the patient after one week of surgery. Both sites showed recurrence of pigmentation, yet it was after a shorter period on the scalpel site. Conclusion: The findings of the present study suggest that gingival depigmentation was effective with both scalpel and laser techniques. However, the laser treated sites showed reduced pain experienced by the patient and better operator comfort. Melanin repigmentation was observed on sites treated with scalpel and diode laser, yet faster on the scalpel technique sites

Evaluation of Guided Bone Regeneration Using Xenograft/APRF Mixture in Atrophic Posterior Mandible (Clinical and Radiographic study)

Introduction: The rehabilitation of posterior mandible with dental implants represents today a hard challenge for clinicians due to the lack of supporting bone. Different surgical techniques are currently being used to augment the posterior mandible where GBR is considered most commonly used. Materials and Methods: Fifteen patients were selected to treat mandibular alveolar ridge resorption with guided bone regeneration using titanium reinforced membrane and a filling mixture of xenograft bovine bone/PRF. The membrane was fixed using meisinger pin control kit and profix 3mm microscrews. A PRF membrane was used to cover the Ti d-ptfe. Results: Using the mixture of PRF/xenograft as well as PRF membranes showed promising results in term of primary wound healing, whereas a significant bone quantity with a mean bone volume of 5.78 ± 0.81 was reported. The primary implant stability recorded high values and significantly increased at a period of 6 months post insertion p=0.037 Conclusion: It could be concluded that PFR/ xenograft mixture can be promising when used with the titanium reinforced d-ptfe membrane in 3D ridge reconstruction of atrophic posterior mandible, moreover using PRF membrane to cover the TI- d-ptfe membrane could enhance soft tissue healing as well as it can prevent soft tissue dehiscence due to the concentration of the growth factors that can be released during primary wound healing.  Xenograft/PRf mixture can be consistent to be utilized for creation of new bone in severely atrophic ridges if used in GBR. The high ISQ at primary implant placement and at a period of 6 months post insertion according to Osstell can explain the successful application of this mixture in 3D bone augmentation of atrophic posterior mandible

Evaluation of Guided Bone Regeneration Using Xenograft/APRF Mixture in Atrophic Posterior Mandible (Clinical and Radiographic Study)

Introduction: The rehabilitation of the posterior mandible with dental implants represents a hard challenge for clinicians today due to the lack of supporting bone. Different surgical techniques are currently being used to augment the posterior mandible, where GBR is considered the most commonly used. Materials and Methods: Fifteen patients were selected to treat mandibular alveolar ridge resorption with guided bone regeneration using a titanium-reinforced membrane and a filling mixture of xenograft bovine bone and PRF. The membrane was fixed using a Meisinger pin control kit and Profix 3mm microscrews. A PRF membrane was used to cover the Ti-d-ptfe. Results: Swelling, pain, and numbness were evaluated using the mixture of PRF/xenograft as well as PRF membranes. The results showed promising results in terms of primary wound healing, whereas a significant bone quantity with a mean bone volume of 5.78 ± 0.81 was reported after 6 months. The primary implant stability recorded high values and significantly increased at a period of 6 months post-insertion (p = 0.037). Conclusion: It could be concluded that the PFR/xenograft mixture can be promising when used with the titanium-reinforced d-ptfe membrane in 3D ridge reconstruction of the atrophic posterior mandible; moreover, using the PRF membrane to cover the TI-d-ptfe membrane could enhance soft tissue healing as well as prevent soft tissue dehiscence due to the concentration of growth factors that can be released during primary wound healing. The xenograft/PRf mixture can be consistently utilized for the creation of new bone in severely atrophic ridges if used in GBR. The high ISQ at primary implant placement and at a period of 6 months post-insertion, according to Osstell, can explain the successful application of this mixture in 3D bone augmentation of the atrophic posterior mandible

Evaluation of Guided Bone Regeneration Using Xenograft/APRF Mixture in Atrophic Posterior Mandible (Clinical and Radiographic study)

Introduction: The rehabilitation of posterior mandible with dental implants represents today a hard challenge for clinicians due to the lack of supporting bone. Different surgical techniques are currently being used to augment the posterior mandible where GBR is considered most commonly used. Materials and Methods: Fifteen patients were selected to treat mandibular alveolar ridge resorption with guided bone regeneration using titanium reinforced membrane and a filling mixture of xenograft bovine bone/PRF. The membrane was fixed using meisinger pin control kit and profix 3mm microscrews. A PRF membrane was used to cover the Ti d-ptfe. Results: Using the mixture of PRF/xenograft as well as PRF membranes showed promising results in term of primary wound healing, whereas a significant bone quantity with a mean bone volume of 5.78 ± 0.81 was reported. The primary implant stability recorded high values and significantly increased at a period of 6 months post insertion p=0.037 Conclusion: It could be concluded that PFR/ xenograft mixture can be promising when used with the titanium reinforced d-ptfe membrane in 3D ridge reconstruction of atrophic posterior mandible, moreover using PRF membrane to cover the TI- d-ptfe membrane could enhance soft tissue healing as well as it can prevent soft tissue dehiscence due to the concentration of the growth factors that can be released during primary wound healing.  Xenograft/PRf mixture can be consistent to be utilized for creation of new bone in severely atrophic ridges if used in GBR. The high ISQ at primary implant placement and at a period of 6 months post insertion according to Osstell can explain the successful application of this mixture in 3D bone augmentation of atrophic posterior mandible

Detection of A2142G, A2142C and A2143G clarithromycin mutations in Helicobacter pylori in Alexandria University Pediatric Hospital

Background: Helicobacter pylori (H. pylori)colonizes the stomach and affect almost 50% of the world’s population. Clarithromycin is considered a cornerstone for H. pylori treatment. Emergence of clarithromycin resistance (CLR-R) has played a major role in failure of H. pylori eradication both in adults and children.  Clarithromycin resistance is mostly due to mutations in 23S rRNA gene: A2142G, A2142C, and A2143G. The aim of the current study is to determine the prevalence of CLR-R among H. pylori infected children with prior clarithromycin treatment. Materials and Methods: Multiple endoscopic gastric biopsies were collected from 50 H. pylori infected children after cessation of clarithromycin-based treatment. Samples were subjected to histopathological examinations, rapid urease test (RUT) and simultaneous molecular detection of H. pylori infection as well as CLR-R by multiplex Real-Time polymerase chain reaction (PCR). Results: Histopathological examinations and RUT revealed H. pylori in 74% and 92% of samples respectively. Molecular detection of CLR-R showed that 62.5% positive H. pylori cases were not harboring any of the tested mutations, while 25% harbored 2143A-G single mutation. Double mutations (2142A-C and 2143A-G) were detected in only 4 cases. Statistical significant correlation existed between both RUT and PCR results as well as between histopathological findings and PCR test results. Conclusions: A combination of histopathogy, RUT and multiplex PCR procedures offers a real benefit in the simultaneous diagnosis of H. pylori infection along with clarithromycin resistance status. Other mechanisms of clarithromycin resistance need to be investigated to explain treatment failure in absence of the previously detected mutations

Suction circuit flushing with chlorhexidine decreases ventilator-associated pneumonia: a quasi-experimental study

BackgroundEndotracheal suctioning of mechanically ventilated patients differs across the world. In many low and middle-income countries, endotracheal suctioning is often performed with a sterile suctioning catheter that is used for 12 h or during the length of one nursing shift. The effect of flushing multiple used endotracheal suction system with chlorhexidine after suctioning to reduce ventilator associated pneumonia (VAP) remains unclear.AimThe aim of the study is to assess the effectiveness of flushing multiple-used open endotracheal suction catheters and suctioning system with chlorhexidine gluconate 0.2% to reduce VAP in mechanically ventilated patients in a resource-limited Intensive Care Unit (ICU).MethodsDue to the difficulty of blinding the intervention for nurses who perform endo-tracheal suction procedures, we adopted a quasi-experimental method with a randomized controlled trial design. A sample of 136 ICU patients were allocated to the intervention (n = 68) or control group (n = 68) between May and November 2020. The intervention was flushing the multiple-used suction catheter and suction system with 40ml chlorhexidine gluconate 0.2% and in the control group we used normal saline to flush the catheter and suction system. The primary outcome was incidence of VAP and the cost of the flushing solutions was the secondary outcome measure.ResultsPatients in the intervention group had a lower incidence of VAP compared to patients in the control group; 15 (22.1%) vs 29 (42.6%), p = 0.01. The incidence of late-onset VAP was 26.2% in the intervention group and 49% in the control group (p = 0.026) and the early-onset VAP was 13.2% in the intervention group and 25% in the control group (p = 0.081). Chlorhexidine gluconate 0.2% reduced the cost of suction system flushing (median: 78.4 vs 300 EGP, p < 0.001).ConclusionUsing chlorhexidine gluconate 0.2% to flush multiple-used suctioning catheters after every endo-tracheal suction procedure might reduce the incidence of VAP in mechanically ventilated patients. Chlorhexidine gluconate 0.2% can be a cost-effective solution for flushing the suction circuit. Nurses working in resource-limited ICUs and using suctioning catheters multiple times might consider using chlorhexidine gluconate 0.2% instead of normal saline or distilled water when flushing the suction system.Clinical trial registrationClinicalTrials.gov, identifier NCT05206721

Assessment of hepatic fibrosis, portal hemodynamic changes, and disease severity in patients with HCV-related liver cirrhosis after sustained virologic response to direct-acting antiviral drugs (DAAs)

Abstract Background Regression of fibrosis and improvement of portal hemodynamics after achievement of sustained viral response (SVR) in patients with chronic hepatitis C (HCV) is a subject of debate in different studies. Some studies reported improvement in the degree of fibrosis, while others did not find significant changes. Objective We aimed to evaluate changes in liver fibrosis, portal hemodynamics and clinical outcomes in patients with chronic HCV-related liver cirrhosis after the achievement of SVR with direct-acting antiviral drugs (DAAs). Patients and methods In our prospective longitudinal study, a total of 100 patients with chronic HCV infection-related liver cirrhosis were recruited, received DAAs, and completed the follow-up period. Clinical evaluation for assessment of liver disease severity using MELD and Child–Pugh class and scores were done. A noninvasive assessment of liver fibrosis using serum biomarkers (APRI index & FIB4 score) and share wave elastography (SWE) was done. Portal hemodynamic evaluation using Doppler ultrasound was done. All were done at baseline and 3 and 12 months after the end of therapy. Results A significant reduction in the degree of fibrosis was observed. Share wave elastography (SWE) readings showed 19.79% and 30.45% reduction 3 and 12 months after the end of therapy respectively (P < 0.001). Regarding the FIB4 score, the percentage of score reduction was 19.8% and 26.46% 3 and 12 months after the end of therapy, respectively (P < 0.01). APRI scores showed 22.6% and 41.09% reduction 3 and 12 months after the end of therapy respectively (P < 0.001). Significant improvement in Child–Pugh scores 3 and 12 months after the end of treatment was observed. Doppler ultrasound showed a significant increase in portal vein flow velocity, a significant decrease in time average mean velocity, and cross-section area 12 months after the end of treatment. Conclusion There was a considerable degree of reduction of liver fibrosis, improvement of portal hemodynamics, and Child–Pugh score in cirrhotic HCV patients who achieved SVR after DAAs. Trial registration ClinicalTrials.gov, ID: NCT03241823 . Registered on 08 May 2017

Protective and Therapeutic Efficacy of Hesperidin versus Cisplatin against Ehrlich Ascites Carcinoma-Induced Renal Damage in Mice

This study evaluates the antitumor efficacy of hesperidin (Hesp) versus cisplatin (Cis) in Ehrlich ascites carcinoma (EAC)-bearing mice, as well as its protective effect against Cis-triggered nephrotoxicity. Seventy female mice were allocated into control, Hesp, EAC, Hesp-protected, Hesp-treated, Cis-treated, and Cis+Hesp-treated groups. The inoculation of mice with EAC cells significantly reduced the mean survival time, while significantly increased the body weight, abdominal circumference, ascitic fluid volume, viable tumor cell count, and serum carcinoembryonic antigen, urea and creatinine levels, besides various hematological changes. Additionally, kidney tissue of EAC-bearing mice showed a significant increase in the malondialdehyde level, significant decreases in the reduced glutathione content and catalase activity, marked pathological alterations, and a strong Ki-67 expression with a weak caspase-3 expression in neoplastic cells infiltrating the renal capsule. Conversely, the administration of Hesp and/or Cis to the EAC-bearing mice induced, to various degrees, antitumor responses and alleviated the cytotoxic effects of EAC. In addition to the potent antitumor effect of the concomitant administration of Hesp and Cis, Hesp minimized the renal adverse side effects of Cis. In conclusion, Hesp may open new avenues for safe and effective cancer therapy and could be valuable for enhancing the antitumor potency and minimizing the renal adverse side effects of chemotherapeutic drugs

New perspectives for fascioliasis in Upper Egypt’s new endemic region: Sociodemographic characteristics and phylogenetic analysis of Fasciola in humans, animals, and lymnaeid vectors

Background Fascioliasis is a significant vector-borne disease that has emerged in numerous tropical and subtropical countries causing severe health problems. Egypt is one of the fascioliasis endemic regions; however, the current situation in Upper Egypt is understudied, with only sporadic human cases or outbreaks. This study aims to highlight the sociodemographic characteristics of human fascioliasis in a newly emerged endemic area in Upper Egypt, along with risk factors analysis and the molecular characteristics of the fasciolid population in humans, animals, and lymnaeid snails. Methodology/Principal findings The study reported Fasciola infection in patients and their close relatives by analyzing the risk of human infection. Morphological and molecular characterization was performed on lymnaeid snails. Multigene sequencing was also used to characterize fasciolids from human cases, cattle, and pooled snail samples. The study identified asymptomatic Fasciola infection among family members and identified the presence of peridomestic animals as a significant risk factor for infection. This is the first genetic evidence that Radix auricularia exists as the snail intermediate host in Egypt. Conclusions/Significance This study revealed that Assiut Governorate in Upper Egypt is a high-risk area for human fascioliasis that requires additional control measures. Fasciola hepatica was the main causative agent infecting humans and snail vectors in this newly emerged endemic area. In addition, this is the first report of R. auricularia as the snail intermediate host transmitting fascioliasis in Upper Egypt. Further research is required to clarify the widespread distribution of Fasciola in Egypt’s various animal hosts. This provides insight into the mode of transmission, epidemiological criteria, and genetic diversity of fasciolid populations in Upper Egypt.\ Author summary Human fascioliasis is a freshwater snail-transmitted disease that is widely distributed in many tropical and subtropical countries including Egypt. Recently, Upper Egypt reported sporadic cases of human fascioliasis and a few outbreaks establishing a new endemic area. This study was conducted to get information on the sociodemographic characteristics of the infected patients and possible risk factors of infection in this recently emerged endemic region. Further, this study tried to describe lymnaeid intermediate host snails involved in infection transmission morphologically and by molecular analysis. Analysis of the phylogenetic relationships between natural fasciolid populations was performed in humans, animals, and snail isolates by multilocus sequencing. Results indicated that asymptomatic fascioliasis should be screened in areas at risk of infection. Also, younger age groups and the presence of peri domestic animals were significantly associated with an increased risk of infection. This is the first molecular proof of the existence of Radix auricularia snails causing fascioliasis in Egypt. Results showed that Upper Egypt may be an area at risk for human fascioliasis that needs additional control measures