Parental willingness of HPV vaccination in Mainland China: A meta-analysis

This meta-analysis aimed to systematically review and analyze parental awareness of human papillomavirus (HPV) and its vaccine, as well as parental willingness of the HPV vaccine in China. The literature search selected studies that met the following criteria: study published between 2009 and 2023, study design involving parents with at least one child aged ≤ 18 years, sample sizes exceeding 300, availability of data on parental willingness of the HPV vaccine or sufficient information to calculate effect sizes, and studies published in either English or Chinese. Studies that did not meet one of the above points were excluded. From an initial pool of 660 papers, 33 studies were included, encompassing a total sample size of 92,802. The analysis revealed that the pooled awareness rates of HPV and the HPV vaccine among Chinese parents were 45.0% (95% CI: 36.1-54.0%) and 41.4% (95%CI: 30.7-52.5%), respectively. The overall parental willingness for vaccinating children against HPV was 61.0% (95% CI: 53.5-68.3%). Both parental awareness and willingness of the HPV vaccine in China were found to remain low when compared to other countries.

Positioning implementation science in national immunization programmes to improve coverage equity and advance progress toward Immunization Agenda 2030: An urgent global health imperative

Despite the availability of effective vaccines for preventing common childhood infectious diseases, there is still significant disparities in access and utilization across many low- and middle-income countries (LMIC). The factors that drive these disparities are often multilevel, originating from individuals, health facilities, health systems and communities, and also multifaceted. Implementation science has emerged as a field to help address "know-do" gaps in health systems, and can play a significant role in strengthening immunization systems to understand and solve implementation barriers that limit access and uptake within their contexts. This article presents a reflexive perspective on how to position implementation research in immunization programmes to improve coverage equity. Furthermore, key points of synergy between implementation research and vaccination are highlighted, and some potential practice changes that can be applied within specific contexts were proposed. Using a human rights lens, it was concluded that the cost that is associated with implementation failure in immunization programmes is significant and unjust, and future directions for implementation research to optimize its application in practice settings have been recommended.

Health-related quality of life among adult patients with cancer in Uganda - a cross-sectional study

OBJECTIVES

The study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda.

METHODS

This cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue.

RESULTS

The mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life.

CONCLUSION

Improvement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.

Application of one-piece endodontic crowns fabricated with CAD-CAM system to molars

Computer-aided design-computer-aided manufacturing (CAD-CAM) systems have been widely used as a fabrication method for restorations because of their high efficiency and accuracy, which significantly reduces fabrication time. However, molars with insufficient clearance or short clinical crown lengths require retention holes or grooves on the preparation, making it difficult to replicate the shapes with the CAM milling system. In these cases, restorations using the lost-wax method are selected. This article focuses on one-piece endodontic crowns (endocrowns) fabricated with a CAD-CAM system (CAD-CAM endocrowns), in which their posts and crowns are integrated. Articles from July 2012 to August 2023 were searched in PubMed with the keyword "endocrown". This review discusses the application of CAD-CAM endocrowns to molars from the viewpoint of model experiment (fracture resistance, adaptation) and clinical research. This technique, which allows margins and internal gaps to be set within the clinically acceptable range, is reported to be an effective way of restoring molars with high survival rates in clinical research.

Effect of social support on fetal movement self-monitoring behavior in Chinese women: a moderated mediation model of health beliefs

OBJECTIVE

Strengthening the management of women's self-monitoring during pregnancy is important to reduce fetal death in utero and improve maternal and infant outcomes. However, due to the lack of awareness among pregnant women about the importance of self-monitoring fetal movement, resulting in low behavioral compliance, adverse pregnancy outcomes remain common in China. This study aimed to investigate the relationship between social support and health beliefs and the self-monitoring behavior of fetal movement. In addition, we examined the moderating and mediating effects of health beliefs on fetal movement self-monitoring.

METHODS

This cross-sectional study was conducted on 200 postpartum mothers in a tertiary hospital in China. The mothers were asked to complete a socio-demographic questionnaire, the fetal movement self-monitoring behavior questionnaire, the fetal movement self-monitoring health beliefs questionnaire, and the social support rating scale. Data from the questionnaires were analyzed and compared using SPSS 24.0 and PROCESS 3.2.

RESULTS

The results of this study showed that the total scores of social supports, health beliefs, fetal movement self-monitoring were 42.98 ± 11.65, 78.605 ± 13.73, and 11.635 ± 2.86, respectively. The study found that when social support and health beliefs were included in the regression equation, both social support and health beliefs showed a positive correlation with fetal movement self-monitoring. Health beliefs partially mediated the effect of social support on fetal movement self-monitoring, accounting for 37.5% of the total effect.

CONCLUSION

Social support and health beliefs play a crucial role in influencing the self-monitoring behavior of fetal movements. Therefore, strengthening social support and health beliefs during pregnancy has the potential to improve compliance with fetal movement self-monitoring behaviors for pregnant women.

Compare the safety and efficacy of endoscopic third ventriculostomy and ventriculoperitoneal shunt placement in infants and children with hydrocephalus: a systematic review and meta-analysis

PURPOSE

Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt placement are two surgical options used for treatment of non-communicating hydrocephalus. The purpose of this study was to compare the efficiency and safety of these techniques in pediatric patients.

MATERIALS AND METHODS

An extensive literature review regarding the clinical outcome, safety and efficiency of ETV and shunting in treatment of hydrocephalus was conducted in Medline, PubMed, Cochrane and Google Scholar databases up to 27 November 2015. Patient demographics, ETV and shunting success and failure rates were extracted.

RESULTS

A total of seven two-arm studies were included for quantitative analysis and 25 single-arm studies were included for systematic review. The two-arm studies recruited a total of 6995 patients: 1046 in the ETV group and 5949 in the shunt group. The pooled results showed that the 1 year success rate of ETV and shunt-placement procedure were similar (pooled RR = 0.870, 95% CI = 0.680-1.112, P = 0.266). The failure rate in the ETV treatment group was 0.9 times higher than in the shunt group; however, the results did not reach statistical significance (pooled RR = 0.893, 95% CI = 0.576-1.383, P = 0.611).

CONCLUSIONS

Both ETV and shunts are associated with similar 1 year success and failure rates. Therefore, there are no current indications to recommend one mode of treatment over the other. Future studies designed to assess the effectiveness of ETV and shunt procedures depending on patient's age and etiology are warranted.

The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review

BACKGROUND

Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies.

AIMS AND OBJECTIVES

We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed.

METHODS

Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms.

RESULTS

Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized.

CONCLUSIONS

This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.

Clinical Issues - May 2024

Wearing shoe covers in the perioperative setting Key words: shoe covers, shoes, contamination, transmission, bacteria. Wearing eyelash extensions in the perioperative setting Key words: eyelash extensions, sterile field, bonding agent, eye infection, cosmetic products. Promoting health in the workplace Key words: health-promotion program, injury-prevention program, musculoskeletal, mindfulness, stretching. Releasing amputated limbs Key words: amputated limb release, specimen management, burial, cultural, religious.

Impact of Two Urethral Stent Types on Complications after One-Stage Hypospadias Repair Using the Duckett Procedure

BACKGROUND

The authors evaluated whether the new nickel-titanium alloy stent (NTAS) is superior to the traditional silicone stent used in hypospadias repair surgery in preventing complications such as urinary fistula.

METHODS

This retrospective cohort study included 576 patients with hypospadias who underwent NTAS or traditional silicone stent placement after hypospadias surgery between March of 2002 and August of 2019. The primary outcome was the rate of urinary fistula occurrence at 4 weeks (stent removal time), and the secondary outcomes were the rate of other complications, such as urethral stricture, urethral diverticulum, infection, and so on. The occurrence of complications in both groups was compared, and the important contributing factors of urinary fistula and urethral stricture were determined.

RESULTS

Among 576 patients, 398 were assigned to the NTAS group, and 178 were assigned to the silicone group. Thirty-five patients in the NTAS group and 30 in the silicone group developed urinary fistula, with a rate of 8.8% and 16.9%, respectively ( P = 0.005). Subgroup analysis showed that the differences were mainly in preschool patients (6 years or younger) ( P = 0.004) and those with the penile type of hypospadias ( P = 0.008). In addition, urethral stricture complicated five patients in the NTAS group and two in the silicone group, with a rate of 1.3% and 1.1%, respectively ( P = 1.000). Logistic regression showed that hypospadias type ( P = 0.001) and stent type ( P = 0.001) are the important risk factors for urethral fistula.

CONCLUSION

The NTAS reduced the occurrence of urinary fistula complications after hypospadias repair in preschool patients, and can be presented as a better choice for hypospadias surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Kidney transplantation in low- and middle-income countries: the Transplant Links experience

Paediatric kidney failure is a global problem responsible for significant childhood morbidity and mortality. The gold-standard treatment is kidney transplantation. However, the availability of kidney transplantation remains limited in some low- and middle-income countries (LMICs). Transplant Links Community (TLC) is a UK-based charity that mentors units in LMICs wishing to start kidney transplantation; the ultimate goal is for these units to become self-sufficient. TLC provides this support through in-person training visits and skill transfer, plus direct mentorship from the UK that is maintained over many years. From such mentoring programmes, it is evident that there are numerous challenges in the initial establishment and long-term maintenance of kidney transplant services, with specific and unique barriers applying to setting up paediatric transplant programmes compared to their adult counterparts. This review summarises TLC's first-hand experience of developing paediatric kidney transplantation services in LMICs over the past 15 years, the challenges encountered, and the major ongoing barriers that must be addressed to facilitate further progress in delivering transplantation services to children globally.

Association of Blood Manganese and Preeclampsia: A Systematic Review and Meta-analysis

A systematic review and meta-analysis was performed to comprehensively evaluate the association between manganese (Mn) level and preeclampsia (PE) during pregnancy. Relevant observational studies were retrieved by searching Medline, Web of Science, Embase, and Cochrane Library from database inception to May 25, 2023. Pooling results was performed using a random-effects model incorporating heterogeneity. This meta-analysis incorporated 18 observational studies, which included 1113 women with PE and 5480 normotensive pregnant women. Pooled results showed that compared to normotensive control, women with PE had significantly lower blood Mn concentration (standardized mean difference: -0.36, 95% confidence interval: -0.50 to -0.22, p < 0.001; I2 = 67%). Subgroup analysis showed that the results were not significantly affected by study country (African, Asian, or Western), timing of blood sampling (before, at, or after the diagnosis of PE), mean blood Mn level of controls, or numbers of confounding factors adjusted (p for subgroup analysis all > 0.05), while methods for measuring blood Mn levels might affect the results (p for subgroup difference < 0.001). Finally, pooled results of three studies showed that a high level of blood Mn was related to a low risk of PE with blood Mn analyzed in continuous (risk ratio [RR]: 0.71, 95% CI: 0.59 to 0.85, p < 0.001; I2 = 0%) and categorized variables (RR: 0.50, 95% CI: 0.30 to 0.82, p = 0.006; I2 = 32%). In conclusion, a low blood level of Mn may be associated with PE in pregnant women.

Knowledge of cervical cancer, human papillomavirus (HPV), and acceptance of the HPV vaccine among parents of daughters in Riyadh, Saudi Arabia

BACKGROUND

Cervical cancer is the eighth most prevalent cancer among women nationwide, with 358 new cases reported annually. One of the strategies to prevent it is getting vaccinated against the human papillomavirus (HPV), the leading cause of this cancer.

METHODS

A survey-based cross-sectional study was conducted in Riyadh, Saudi Arabia, to evaluate the acceptance of the HPV vaccine among parents of daughters and their knowledge of three domains: cervical cancer, HPV, and the HPV vaccine.

RESULTS

390 parents participated in the study, with 88.2% female, 39.74% of the participants aged between 36-62 years old, and 62.56% holding a bachelor's degree or above. Parents were more aware of cervical cancer (78.97%), followed by HPV (50%) and the HPV vaccine (41.28%). Awareness levels about cervical cancer were significantly different among males and females, while awareness of HPV and the HPV vaccine was significantly associated with parents' education levels. For instance, parents with a bachelor's degree or higher (54.9%) demonstrated greater awareness of HPV compared to parents with a high school diploma (41.9%) or a middle school diploma or less (41.5%). The overall participants' knowledge scores in all three domains were poor, with an average below 50%. 60% of parents believed their daughters should receive the HPV vaccine.

CONCLUSION

More than half of the study participants are willing to vaccinate their daughters with the HPV vaccine despite their poor knowledge of the assessed domains. Awareness levels of HPV and the HPV vaccine are associated with education levels. We believe raising awareness among parents is necessary to improve the acceptance level of the HPV vaccine.

Predictors of postpartum depression and its association with sleep quality among mothers in Qassim, Saudi Arabia: A descriptive cross-sectional study

OBJECTIVE

This cross-sectional study aims to examine the prevalence of postpartum depression (PPD) and sleep problems, their relationship, and the characteristics associated with depression/insomnia in Qassim, Saudi Arabia.

METHODS

An online survey was administered to a convenience sample of 395 mothers who had given birth within the preceding year. The survey comprised demographic characteristics, pregnancy and childbirth characteristics, depression (via the Edinburgh Postnatal Depression Scale; EPDS), and sleep quality (via the Pittsburgh Sleep Quality Index; PSQI).

RESULTS

Nearly two-thirds of respondents (62.3%) had PPD, while 92.2% experienced poor sleep quality. Both scales demonstrated a statistically significant positive correlation. Participants with previous PPD, peripartum depression, a personal or family history of other depression, those bottle-feeding their infants, or who had a change in sleep pattern scored significantly higher on the EPDS and had poorer PSQI scores. Respondents with a history of mental illness, pregnancy or delivery complications, those who lacked support, or gave birth to unhealthy newborns also had significantly higher EPDS scores.

CONCLUSIONS

PPD and poor sleep quality were highly prevalent among mothers living in the Qassim region of Saudi Arabia. Not surprisingly, PPD was strongly correlated with poor sleep quality. Postpartum counseling for mothers during the first year after delivery is necessary to decrease the risk of developing depressive symptoms and poor sleep quality. Screening for sleep-related difficulties and depression in prenatal and postnatal programs may help prevent the development of depressive disorder among postpartum women in this region of Saudi Arabia (or other areas of the Middle East).

Prevalence and correlates of sexual dysfunction among patients with schizophrenia spectrum disorder on antipsyhotic medications in Maiduguri, Northeastern Nigeria

OBJECTIVES

Despite the importance of a satisfying sexual life, most patients with schizophrenia spectrum disorders do not discuss sexual issue with their clinicians. The current study seeks to determine the prevalence and socio-clinical correlates of sexual dysfunction among patients with schizophrenia spectrum disorders receiving typical and atypical antipsychotic medications. The second objective is to determine the frequency and correlates of specific sexual dysfunction (desire, arousal, erection/lubrication and orgasm) by gender and drug type using the Arizona Sexual Experience Scale.

METHODOLOGY

This cross-sectional study used standardized structured interviewer based survey to assess sexual dysfunction among patients with schizophrenia that are both sexually active and inactive at a tertiary hospital in Maiduguri from December 2020 to April 2021. Participants were also assayed for prolactin using ELISA Kit for a possible association with sexual dysfunction.

RESULTS

The overall prevalence of sexual dysfunction among patients with schizophrenia spectrum disorder receiving antipsychotics was 34% with patients on typical and atypical antipsychotics reporting rates of 36.8% and 24.6%, respectively. Among the typical and atypical antipsychotics, patients receiving haloperidol (40.3%) and risperidone (37.5%) reported a relatively higher frequency of sexual dysfunction compared to those receiving clozapine (18.2%). Independent correlates of sexual dysfunction were: female gender (OR = 1.89, 95% CI = 1.17-3.06; P = .010), being unmarried (OR = 1.51, 95% CI = 1.17-1.96; P = .001), pseudoparkinsonism (OR = 1.66, 95% CI = 1.02-2.69; P = .008), prolactin (OR = 2.15, 95% CI = 1.34-3.43; P = .001) and severity of illness (OR = 1.34, 95% CI = 1.03-1.75; P = .030).

CONCLUSION

Sexual dysfunction is prevalent among patients with schizophrenia spectrum disorder receiving either typical or atypical antipsychotics.

Application of artificial intelligence in dental implant prognosis: A scoping review

OBJECTIVES

The purpose of this scoping review was to evaluate the performance of artificial intelligence (AI) in the prognosis of dental implants.

DATA

Studies that analyzed the performance of AI models in the prediction of implant prognosis based on medical records or radiographic images. Quality assessment was conducted using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies.

SOURCES

This scoping review included studies published in English up to October 2023 in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus. A manual search was also performed.

STUDY SELECTION

Of 892 studies, full-text analysis was conducted in 36 studies. Twelve studies met the inclusion criteria. Eight used deep learning models, 3 applied traditional machine learning algorithms, and 1 study combined both types. The performance was quantified using accuracy, sensitivity, specificity, precision, F1 score, and receiver operating characteristic area under curves (ROC AUC). The prognostic accuracy was analyzed and ranged from 70 % to 96.13 %.

CONCLUSIONS

AI is a promising tool in evaluating implant prognosis, but further enhancements are required. Additional radiographic and clinical data are needed to improve AI performance in implant prognosis.

CLINICAL SIGNIFICANCE

AI can predict the prognosis of dental implants based on radiographic images or medical records. As a result, clinicians can receive predicted implant prognosis with the assistance of AI before implant placement and make informed decisions.

Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study

OBJECTIVES

The recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri‑implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis.

METHODS

This retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation.

RESULTS

The incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively.

CONCLUSION

This study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease.

CLINICAL SIGNIFICANCE

This study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

OBJECTIVE

To investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases.

STUDY DESIGN

One-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05).

RESULTS

There was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05).

CONCLUSION

Maxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it.

CLINICAL RELEVANCE

There is an association between dental implants' perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

The fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth

INTRODUCTION

Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core.

MATERIALS AND METHODS

Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture.

RESULTS

Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength.

CONCLUSION

No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

Seroma formation after mastectomy: A systematic review and network meta-analysis of different flap fixation techniques

Flap fixation is the most promising solution to prevent seroma formation after mastectomy. In this systematic review with network meta-analysis (NMA), three different techniques were compared. The NMA included 25 articles, comprising 3423 patients, and revealed that sutures are superior to tissue glue in preventing clinically significant seroma. In addition, running sutures seemed to be superior to interrupted sutures. An RCT comparing these suture techniques seems necessary, given the quality and nature of existing literature.

Time to initiate complementary feeding and its predictors among primipara mothers who have infants aged 6-12 months in the Awi zone, northwest Ethiopia

Introduction

The timely initiation of complementary feeding is essential to reduce infant mortality. In Ethiopia, 37.5 % of mothers did not initiate complementary feeding to their infants in time. However, previous studies could not identify the time to initiate complementary feeding among primipara mothers. Therefore, this study aims to identify the time to initiate complementary feeding and its predictors among primipara mothers with infants aged 6-12 months in the Awi zone, northwest Ethiopia.

Methods

A community-based retrospective follow-up study was conducted among 732 primipara mothers who had infants aged 6-12 months from January 1, 2022, to December 30, 2022. A multistage sampling technique was used to select study participants through questionnaires administered by interviewers. Data were entered into EPI-data 3.1 and exported to STATA 17 for further analysis. The Kaplan-Meier survival curve together with the log-rank test was used to assess the survival experience of the infant at specific times and to compare the survival of the infant in it between different categorical independent variables. Bivariable and multivariable Cox proportional hazard regression models were used to identify significant predictors. Model fitness was also assessed using the Schoenfield residual and the Cox-Snell global residual test. Statistical significance was declared at the p-value <0.05.

Result

The median time to initiate complementary feeding among primipara mother-infant pairs was 6 ± 2 months. The overall incidence rate of complementary feeding initiation before, at and after 6 months of age of the infant was 7.28 (95%CI: 6.44, 8.25), 41.41 (95%CI: 36.05, 47.56), and 42.97 (95%CI: 36.89, 50.05) per 100 person-month observations, respectively. Among those mothers who initiated complementary feeding for their infants, 249, 200, and 165 initiated complementary feeding before, at and after 6 months of age of the infants. Furthermore, the age (15-24 years) of mothers (AHR: 1.63, 95%CI: 1.16, 2.29), rich wealth (AHR: 1.35, 95%CI: 1.05, 1.75), and richest wealth (AHR: 1.43, 95%CI: 1.10, 1.84) were identified as statistically significant predictors of the time to initiate complementary feeding.

Conclusions

The median time to initiate complementary feeding among primipara mother-infant pairs was 6 months. The age of the mother and the wealth status of the household were found to be statistically independent predictors of the time to initiate complementary feeding. Therefore, community health professionals are better able to work on when to initiate complementary feeding to infants of rich and richest young primipara mothers.

Too Little, Not Enough: Impact of Safety Nets on Food Security Among Households with Disabled Members in Nigeria

This study assessed the impact of safety nets on food insecurity in households with people with disabilities (PWD) in Nigeria. Using data from the 2019 Nigeria General Household Survey, we assessed the risk of experiencing food insecurity among households and the moderating role of safety nets using households without PWDs as a reference. PWD households were three times more likely to experience severe food insecurity compared to households without PWDs. The impact of the safety net program on the risk of food insecurity showed that receiving social benefits had little effect among households with disabled members experiencing severe food insecurity.

Disaster literacy in disaster emergency response: a national qualitative study among nurses

BACKGROUND

As the largest group of healthcare professionals, nurses play an indispensable and crucial role in disaster response. The enhancement of nurses' disaster literacy is imperative for effective disaster emergency management. However, there is currently a lack of knowledge regarding nurses' disaster literacy. This study represents the first attempt to explore the key components and characteristics of disaster literacy among nurses.

METHODS

A qualitative descriptive design was employed, and the reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (refer to File S1). The purposive sampling method was utilized. Thirty-one rescue nurses from 31 medical institutions across 25 provinces and regions in China were recruited to participate in the study. The respondents were requested to share their experiences and insights regarding disaster rescue operations. Inductive content analysis was employed for data examination.

RESULTS

The results indicated that rescue nurses universally recognized that there was a pressing need to enhance the level of disaster literacy among nurses. The disaster literacy of nurses encompasses nine dimensions: physical and mental quality, disaster rescue general knowledge, professional and technical competence, professional ethics, teamwork, emotional ability, information literacy, leadership, and knowledge transformation.

CONCLUSIONS

To ensure national sustainability, government departments, healthcare organizations, and hospital administrators can accurately evaluate the disaster literacy of individual clinical nurses, groups, and the workforce as a whole through nine dimensions, which also can provide evidence to support the development of precision strategies to strengthen the disaster literacy of nurses.

The effect of extracorporeal shock-wave therapy on pain in patients with various tendinopathies: a systematic review and meta-analysis of randomized control trials

OBJECTIVES

Tendinopathy is a common condition that affects the body's tendon structures, causing discomfort, restricted movement, and reduced functionality. In this study, we looked at how extracorporeal shock wave therapy (ESWT) affected pain levels in individuals with various forms of tendinopathy around the world.

DESIGN

This study is a comprehensive review and meta-analysis of previously published randomized controlled trials. To gather relevant data, the researchers performed keyword searches in international databases, including PubMed (Medline), Scopus, Web of Sciences, Cochrane Central Register of Controlled Trials (CENTRAL), Research Registers of ongoing trials (ClinicalTrials.gov), as well as Embase. The search was conducted up until March 2023. The quality of the selected articles was assessed using the Cochrane risk-of-bias method for randomized trials (RoB2).

RESULTS

Based on the results of the meta-analysis, which included 45 clinical studies, the use of ESWT was found to have a significant impact on reducing pain in various conditions. The standardized mean difference (SMD) in patients with plantar fasciitis (PF) was reduced by 1.63 (SMD: -1.63, 95% CI: -3.04, -0.21; I2: 77.36%; P heterogeneity: 0.0001). For lateral epicondylitis (LE), the SMD was 0.63 (SMD: -0.63, 95% CI: -1.11, -0.16; I2: 67.50%; P heterogeneity: 0.003). In the case of chronic Achilles tendinopathy, the SMD was 1.38 (SMD: -1.38, 95% CI: -1.66, -1.10; I2: 96.44%; P heterogeneity: 0.0001). Additionally, in individuals with rotator cuff tendinopathy, the SMD for pain reduction was 2.37 units (SMD: -2.37, 95% CI: -3.58, -1.15; I2: 98.46%; P heterogeneity: 0.0001).

CONCLUSION

This study suggests that ESWT can be a highly effective therapy option for relieving pain in people with tendinopathy. Nonetheless, it is encouraged to make additional recommendations based on high-quality clinical research and more accurate information in order to define the optimal therapeutic options for each type of tendinopathy.

Cytogenetic and epidemiological profile of chronic myeloid leukemia in Morocco

Chronic myeloid leukemia (CML) is a neoplastic disease of genetic origin resulting from clonal proliferation of hematopoietic stem cells (HSCs). The reciprocal translocation t(9;22)(q34;q11) is the main chromosomal abnormality involved in this pathology, usually detected by conventional cytogenetics. This article aims to investigate the epidemiological, cytogenetic, therapeutic, and clinical characteristics of Moroccan patients with CML. This research represents the first large-scale study of CML patients in Morocco and was carried out at Institut Pasteur of Morocco. Bone marrow samples were processed for cytogenetic analysis, and karyotypes were described according to an international system of human cytogenetic nomenclature (ISCN 2016). Patients were studied according to their epidemiological characteristics, clinical information and cytogenetic results. For statistical calculations, R version 4.3.1 was used to analyze the data and calculate the statistical parameters. RStudio and Power BI were used for data visualization. The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) method of incidence estimation was used to calculate our incidence. We received 826 patients (from 1992 to 2023) who were referred for suspected CML or who were undergoing treatment. Only 650 patients with confirmed CML were included in the study, all of whom underwent their first cytogenetic test. The median age of our patients was 45 years and the sex ratio was 1.03. At the time of diagnosis, 147 (30%) of the patients had clinical manifestations. Most patients were diagnosed in the chronic phase (94.5%). Nineteen complex variant translocations of the Philadelphia (Ph) chromosome were detected. At the time of diagnosis, 55 (11.5%) patients had ACAs, of which 30 (54.5%) were high-risk ACAs. Based on data from 174 patients treated with imatinib, the median time to complete cytogenetic response (CCyR) was 11 months, and at the last cytogenetic follow-up, 81 patients (46.6%) achieved CCyR, while 64 patients (36.8%) showed no response to treatment. Regarding adherence to European LeukemiaNet (ELN) guidelines, 58 patients (33%) were followed according to these guidelines, with optimal treatment in 8.6%, suboptimal treatment in 7% and treatment failure in 18%. The estimated incidence of chronic myeloid leukemia calculated is 0.6 cases per 100,000 in the Casablanca region. This study provides a detailed overview of CML in Morocco, highlighting important clinical, cytogenetic and therapeutic aspects despite some limitations. It also highlights the need to deepen our understanding of this complex disease for disease management in our specific context.

Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study

BACKGROUND

Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme.

OBJECTIVE

We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh.

METHODS

A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed.

RESULTS

We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services.

CONCLUSIONS

More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review

BACKGROUND

Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.

RESULTS

A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).

CONCLUSION

PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

Galactagogue activity of poly-herbal decoction from Indonesia: a randomized open label controlled trial

OBJECTIVES

Indonesia have several herbs empirically used as galactagogue. However there are limited clinical evidence regarding the efficacy and safety of this herbs especially poly-herb. The aim of this study was to assess the efficacy and safety of polyherbal galactagogue (PHG) consist of katuk leaves, torbangun leaves and papaya leaves compared to commercial galactagogue capsules (CGC) that contain a single plant extract, katuk leaves.

METHODS

This study was an open label randomized controlled trial with 120 subjects that randomly assigned into two groups, PHG and CGC. This study was conducted at the herbal medicine research house (Rumah Riset Jamu/RRJ) Hortus Medicus and 30 subsites in Central Java and Jogjakarta provinces from July to November 2018. Duration of intervention 28 days. Parameter of efficacy breast milk volume, baby weight, prolactin level and parameter of safety ALT, AST, Urea, Creatinin were performed at baseline, day 14 and 28. The symptom of side effects also recorded every week.

RESULTS

Breast milk volume and infant's weight increased at day-14 and 28 in both groups. However, prolactin level in both groups decreased. There were no significant differences of efficacy parameters at baseline in both groups. At three times measurement of ALT, AST, Urea and Ceratinin average levels were within the normal range. About 3-5% mothers experience higher ALT, AST and nausea that can tolerated well. No side effect was found in infants.

CONCLUSIONS

PHG and CGC have the equal efficacy and safety as a galactagogue. The optimal used is for 14 days.

The impact of digital storytelling for children during paediatric day surgery on anxiety and negative emotional behaviors: Randomized controlled trial

PURPOSE

The aim of the study was to examine the effectiveness of digital storytelling as a therapeutic care intervention in paediatric day surgery.

DESIGN AND METHODS

his study was conducted in a randomized controlled experimental design. Seventy-two voluntary children who were scheduled for day surgery and met the inclusion criteria for the study were included. Research data were collected using the Child's Descriptive Information Form, the Children's Emotional Manifestation Scale, and the State Anxiety Inventory for Children. The study group used digital storytelling to prepare for day surgery.

RESULTS

State anxiety scores decreased over time in the study group. The digital storytelling intervention was found to be effective in reducing anxiety scores. In the control group, state anxiety scores were highest on the day of the surgery. Children in the control group experienced higher levels of anxiety on the day of the surgery compared to those in the study group. The high anxiety levels in the control group continued at a higher level even two weeks after surgery. Children in the control group exhibited more negative emotional behaviors on the day of the surgery.

CONCLUSION

The digital storytelling intervention implemented in this research was found to be effective in reducing children's anxiety and negative emotional behaviors.

PRACTICE IMPLICATIONS

Digital storytelling should be applied and adapted to various other areas of paediatric surgery. Its utilization is significant for nurses working in the field of day surgery.

Environmental Justice and Health in Nigeria

PURPOSE OF REVIEW

The United Nations Sustainable Development Goals (SDGs) identified 17 goals to achieve by the year 2030, with many of these goals directly or indirectly linked to environmental justice. Health outcomes remain poor in Nigeria; the country ranks low in environmental quality despite supporting environmental treaties and laws. The burden of diseases in the country is in part related to poor environmental quality and is linked to environmental justice issues, such as mining, energy exploration, transport emission, poor waste management, and proliferation of slum settlement.

RECENT FINDINGS

Previous studies found that living in proximity to mines and environmental degradation of land and water disrupts means of livelihood and causes poor health outcomes among children and adults. Specifically, health issues like respiratory illness, malaria, kidney disease, and high blood pressure are likely consequences of proximity to mine waste. Few published studies are available for a developing country like Nigeria, although the link between environmental justice and health in Nigeria is clear enough to require action on the part of the government and polluting industries. This paper reviewed the concept and coverage of environmental justice in the Nigerian context and its impact on health. Addressing environmental injustices related to mining and other environmental issues can accelerate health gains through conscious and concerted efforts towards preserving the environment. Also, the right of everyone to a sustainable city regardless of socioeconomic class and geographical location can only be secured through environmental justice.

Tunneled Paranasal Augmentation Using Diced Autologous Costal Cartilage in Asian Rhinoplasty: A Comparative Study

Due to the prevalence of anterior maxilla dysplasia in Asian population, paranasal concavity is a common accompaniment to low nose, but its impact on facial harmonization is often underestimated. A retrospective comparative study was conducted on patients diagnosed as low nose with paranasal concavity between June 2017 and June 2021, with a total of 56 patients followed up successfully. The control and observation groups were established according to whether the paranasal augmentation was performed. Demographic data were collected. Cosmetic enhancement was quantitatively evaluated by sagittal planimetry, establishing related anatomical landmarks and measuring columella base prominence (CBP) and alar base prominence (ABP). Subjective evaluation concluded the patient-reported satisfaction (FACE-Q-Rhinoplasty Module and Facial Appearance Module) and the third-party physician assessment (Global Aesthetic Improvement Scale, GAIS).Significant improvements in CBP and ABP were reported both in the control and the observation group (p < 0.01). In postoperative intergroup comparisons, the observation group was superior to the control group regarding ABP values (2.5 ± 0.75 degrees, p < 0.01), FACE-Q-Facial scores (7.49 ± 3.70, p < 0.05), and GAIS scores (p < 0.05). However, no statistical difference was found in CBP values and FACE-Q-Rhinoplasty scores. Paranasal augmentation-related complications included asymmetry of alar bases (6.9%) and facial or intraoral foreign body sensation (34.5%). This study affirmed that paranasal augmentation using diced costal cartilage in rhinoplasty is a safe procedure effective in remedying paranasal concavity and improving facial satisfaction. LEVEL OF EVIDENCE::  IV.

Non-cigarette Tobacco Use and Stroke Among West Africans: Evidence From the SIREN Study

INTRODUCTION

Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans.

METHODS

A total of 7617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigative Research and Educational Network (SIREN) study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial computed tomography/magnetic resonance imaging. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship of NCT with stroke at a two-sided p < .05.

RESULTS

Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-NCT users (62.8 ± 15.7 vs. 57.7 ± 14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95% CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95% CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95% CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates.

CONCLUSIONS

NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans.

IMPLICATIONS

A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance and evidence-based recommendations for public health prevention and management of stroke on the African continent.

Trivial trauma to the cheek: significant complications in the chest

A man in his 30s presented to the emergency department with a history of injury to the face with a crowbar. He was discharged from the department, in the absence of any facial bone fractures and given normal examination findings, except for a puncture wound on the mentum. The patient then re-presented within 24 hours with extensive cervical emphysema extending into the mediastinal cavity.He was referred to ear, nose and throat team for further management. CT scan of the chest and neck showed extensive surgical emphysema and a pneumomediastinum. The patient was managed conservatively and recovered well with no significant sequelae.Even in the absence of facial bone fractures, it is imperative to understand the force of impact which should prompt a consideration of imaging of the chest. Appropriate advice regarding avoidance of Valsalva manoeuvres will help prevent extensive propagation of air through the fascial planes that can result in a pneumomediastinum.

Sexual and reproductive health information needs; an inquiry from the lens of in-school adolescents in Ebonyi State, Southeast Nigeria

BACKGROUND

It is important to understand the sexual and reproductive health (SRH) needs of adolescents from the adolescents themselves to address their needs properly. Hence, this paper provides new knowledge on the information needs on SRH among adolescent boys and girls in selected secondary schools in Ebonyi state, southeast Nigeria.

METHOD

A comparative assessment was conducted among adolescent boys and girls in public secondary schools that received a specific school-based SRH intervention (group A) and those that did not receive the intervention (group B). These schools were spread across six urban and rural local government areas in Ebonyi state, southeast Nigeria. A structured interviewer-administered questionnaire was used to collect data from 514 adolescents aged 13 to 18 on their stated needs for SRH information and services. Categorical variables were compared using the Chi-square test, and predictors were determined using logistic regression analysis. The statistical significance was determined at p < 0.05.

RESULT

Majority of the adolescents (82% of intervention group and 92% of non-intervention group) identified puberty and pubertal changes as perceived SRH information need for adolescents (χ2 = 7.94; p-value = 0.01). Adolescents who received SRH intervention have 3.13 (p < 0.001) times the odds of perceiving the need for adolescents to be provided with SRH information than adolescents who did not receive SRH intervention. The odds of perceiving the need for adolescents to be provided with SRH information for adolescents who reside in urban communities are 0.31 (p < 0.001) times the odds for adolescents who resides in rural communities. That is, the perception odds are higher adolescents who reside in rural communities. Multivariate regression of specific SRH information showed the location of residence as a strong predictor of adolescents' perceived need for information on 'puberty and pubertal changes' (OR = 0.30; p = 0.001), 'safe sex and sexual relations' (OR = 0.33; p < 0.001) and 'prevention of pregnancy and use of contraceptives' (OR = 0.28; p < 0.001). Adolescents in senior secondary school have 2.21 (p = 0.002) times the odds of perceiving the need for adolescents to be provided with specific SRH information than adolescents who are in junior secondary school.

CONCLUSION

Adolescents' age, location of residence, and study group were found to be strong predictors of SRH information needs. This suggests the need for in-school adolescents to be provided with substantial and continuous SRH information for healthy living and making informed SRH choices. In developing SRH interventions that will achieve optimal effectiveness in the lives of adolescents in school, different demographic factors should be considered for context-specific and appropriate strategies.

Examination of quality of life and psychiatric symptoms in childhood Graves' disease

OBJECTIVES

The aim of our study is to examine the emotional, behavioral problems, and psychiatric symptoms of children diagnosed with Graves' disease (GD), to assess their quality of life, and to compare with control group.

METHODS

The research was planned as a cross-sectional study and included 16 patients with GD (13 female and three male) and 29 healthy children for control group (19 female and 10 male). Sociodemographic form, Pediatric Quality of Life Inventory, Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV), Strengths and Difficulties Questionnaire (SDQ), Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S), and Affective Reactivity Index scale were applied to the children and their families.

RESULTS

Eighty one percent of GD group (GG) (n=13, mean age 15.1 ± 2.2) and 66 % of control group (CG) (n=19, 14.6 ± 2.2) were girls. No significant difference was found between GG and CG in terms of quality of life, anxiety, and depression scores. GG had higher scores in affective reactivity index, SDQ-P total score, and T-DSM-IV-S total scores (p values 0.039; 0.009; 0.023, respectively). While no significant difference was detected in the T-DSM-IV-S-inattention and hyperactivity scores, significantly higher scores were detected in oppositional defiance and conduct disorder scores (p values 0.172; 0.294; 0.019; 0.027, respectively).

CONCLUSIONS

In children with GD, irritability, oppositional defiant, and conduct disorder symptoms have been detected. Children with these mental health symptoms experience behavioral and emotional difficulties in their daily lives. It is important to follow up children with GD for possible comorbid psychiatric disorders.

A web-based dynamic predictive model for postoperative nausea and vomiting in patient receiving gynecological laparoscopic surgery

OBJECTIVE

The aim of this study was to develop a web-based dynamic prediction model for postoperative nausea and vomiting (PONV) in patients undergoing gynecologic laparoscopic surgery.

METHODS

The patients (N = 647) undergoing gynecologic laparoscopic surgery were included in this observational study. The candidate risk-factors related to PONV were included through literature search. Lasso regression was utilized to screen candidate risk-factors, and the variables with statistical significance were selected in multivariable logistic model building. The web-based dynamic Nomogram was used for model exhibition. Accuracy and validity of the experimental model (EM) were evaluated by generating receiver operating characteristic (ROC) curves and calibration curves. Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Decision curve analysis (DCA) was used to evaluate the clinical practicability of the risk prediction model.

RESULTS

Ultimately, a total of five predictors including patient-controlled analgesia (odds ratio [OR], 4.78; 95% confidence interval [CI], 1.98-12.44), motion sickness (OR, 4.80; 95% CI, 2.71-8.65), variation of blood pressure (OR, 4.30; 95% CI, 2.41-7.91), pregnancy vomiting history (OR, 2.21; 95% CI, 1.44-3.43), and pain response (OR, 1.64; 95% CI, 1.48-1.83) were selected in model building. Assessment of the model indicates the discriminating power of EM was adequate (ROC-areas under the curve, 93.0%; 95% CI, 90.7%-95.3%). EM showed better accuracy and goodness of fit based on the results of the calibration curve. The DCA curve of EM showed favorable clinical benefits.

CONCLUSIONS

This dynamic prediction model can determine the PONV risk in patients undergoing gynecologic laparoscopic surgery.

Intravenous Iron for Acute and Chronic Heart Failure with Reduced Ejection Fraction (HFrEF) Patients with Iron Deficiency: An Updated Systematic Review and Meta-Analysis

Patients with heart failure (HF) and iron deficiency are at increased risk of adverse clinical outcomes. We searched databases for randomized controlled trials that compared IV iron to placebo, in patients with HF with reduced ejection fraction (HFrEF). A total of 7813 participants, all having HFrEF with 3998 receiving IV iron therapy, and 3815 control recipients were included. There was a significant improvement in Kansas City Cardiomyopathy Questionnaire favouring IV iron with MD 7.39, 95% CI [3.55, 11.22], p=0.0002. Subgroup analysis, based on acute and chronic HF, has displayed a sustained statistical significance. Additionally, a significant increase in the left ventricular ejection fraction % was observed, with MD 3.76, 95% CI [2.32, 5.21], p<0.00001. A significant improvement in 6-minute walk test was noted, with MD 34.87, 95% CI [20.02, 49.72], p<0.00001. Furthermore, IV iron showed significant improvement in NYHA class, peak VO2, serum ferritin, and haemoglobin levels. Finally, despite the lack of difference in terms of all-cause hospitalisation and HF-related death, IV iron was associated with a significant reduction in HF-related, any cardiovascular reason hospitalisations, and all-cause death; which supports the need for implementation of IV iron as a standard of care in patients with HF and iron deficiency.

The effect of refined psychological pain nursing combined with IMB nursing on the pain, sleep and quality of life of patients after cervical cancer surgery

To explore the effect of refined psychological pain nursing combined with information-motivation-behavioral (IMB) care model on the pain, sleep and quality of life of patients after cervical cancer surgery, so as to provide reference and basis for the nursing of patients after cervical cancer surgery. The clinical data of 798 postoperative cervical cancer patients who were nursing in our hospital from January 2018 to December 2022 were included in this retrospective study and divided into the control group (n = 382) and observation group (n = 416) according to the different care methods. The control group used refined psychological pain nursing, and on this basis, the observation group used IMB nursing to observe and compare the differences in pain, sleep and quality of life between the 2 groups. There was no significant difference in pain between the 2 groups before nursing (P > .05). After nursing, the pain of both groups was significantly improved. The scores of NRS, VAS, and PSEQ of the observation group were significantly better than those of the control group (P < .001). After nursing, the quality of life scores such as emotion, cognition, society, and overall health were significantly higher in the observation group than those of the control group, while physical, fatigue, nausea, vomiting, and pain were significantly lower than those of the control group (P < .05). The negative emotion score of the observation group was significantly lower than that of the control group (P < .001). The residual urine volume and urinary tract infection rate of the observation group were significantly lower than those of the control group (P < .05). The bladder function was significantly better than that of the control group (P < .05). The analgesic effect of refined psychological pain nursing combined with IMB nursing on patients after cervical cancer surgery is better than that of refined psychological pain nursing alone, which can promote pain recovery and further improve the quality of life and sleep quality of patients.

Switching to the aflibercept (3 mg) therapy for treatment-resistant wet age-related macular degeneration: 1-year outcomes

This study aimed to elucidate 1-year outcomes following switching to the aflibercept (3 mg) therapy for treatment-resistant wet age-related macular degeneration (wAMD). In this prospective, open-label, non-controlled clinical trial, 18 patients with wAMD who had multiple recurrences or persistent exudation despite intravitreal injections of anti-vascular endothelial growth factor agents (except aflibercept) received a 3-mg intravitreal aflibercept injection every 4 weeks. Each patient received 3 to 8 injections. The central retinal thickness and fibrovascular pigment epithelial detachment height decreased significantly at 1 month after initiation of the aflibercept injection, and the values were 146 and 163.2 μm, respectively, at the final visit. The morphological improvement was sustained. The intraretinal and subretinal fluid was completely absorbed at the end of the follow-up. The logMAR vision increased from baseline 0.68 to 0.59 (P < .05). No ocular or systemic adverse events occurred. The intravitreal injection of 3-mg aflibercept seems to be feasible in the treatment of wAMD unresponsive to other anti-vascular endothelial growth factor agents.

Impact of various aging treatments on the microhardness and surface roughness of CAD-CAM monolithic restorative materials

PURPOSE

Dental ceramics deteriorate as a result of thermal aging and exposure to acidic solutions, which change their microhardness and surface roughness. This study assessed the resistance of several computer-aided design and computer-aided manufacturing (CAD-CAM) restorative dental materials in terms of surface roughness and microhardness following exposure to acidic solutions and thermal aging.

MATERIALS AND METHODS

Five different monolithic CAD-CAM restorative materials, two leucite-reinforced glass ceramics (G-Ceram and CEREC Blocs), a zirconia-infiltrated lithium silicate (Celtra Duo), a resin nanoceramic (Grandio), and monolithic zirconia (inCoris TZI), were used to create 2-mm-thick rectangular specimens (n = 100). After being immersed in either acidic saliva (pH = 4.0) (ST) or gastric juice (pH = 1.2) (GT), each material was subjected to 10,000 cycles of thermal aging. The Vickers microhardness and average surface roughness of the specimens were assessed at baseline, following thermal aging and exposure to either gastric juice or acidic saliva. The surface properties were examined using an atomic force microscope. The Mann‒Whitney U test with Bonferroni correction and the Wilcoxon signed-rank test was used for statistical analysis (a = 0.05).

RESULTS

The surface roughness of two leucite-reinforced glass ceramics (G-ceram and CEREC) significantly decreased with ST (p = 0.027 and p = 0.044). Only the CEREC was affected when the aging protocols were compared, and the ST group had a significant reduction in roughness (p = 0.009). The microhardness values significantly decreased after both aging protocols in all groups except for the ST subgroup of G-Ceram. Only inCoris was affected when the aging protocols were compared, and the GT group exhibited a significant reduction in microhardness (p = 0.002).

CONCLUSION

The surface roughness of the tested materials was not affected by the GT. Only leucite ceramics exhibited a decrease in surface roughness in the ST stage. Both aging processes produced a significant decrease in the microhardness of the tested ceramics. Leucite-reinforced glass-ceramic materials may be advantageous for patients with gastroesophageal reflux disease and those with a diet high in acidic foods due to their lower values for changes in microhardness and surface roughness compared to those of other CAD-CAM materials.

Genetic Variants Associated with the Risk of Stroke in Sickle Cell Anemia: Systematic Review and Meta-Analysis

Sickle cell anemia (SCA) is the most common cause of stroke in children. As it is a rare disease, studies investigating the association with complications like stroke in SCD have small sample sizes. Here, we performed a systematic review and meta-analysis of the studies exploring an association of genetic variants with stroke to get a better indication of their association with stroke. PubMed and Google Scholar were searched to identify studies that had performed an association analysis of genetic variants for the risk of stroke in SCA patients. After screening of eligible studies, summary statistics of association analysis with stroke and other general information were extracted. Meta-analysis was performed using the fixed effect method on the tool METAL and forest plots were plotted using the R program. The random effect model was performed as a sensitivity analysis for loci where significant heterogeneity was observed. 407 studies were identified using the search term and after screening 37 studies that cumulatively analyzed 11,373 SCA patients were included. These 37 studies included a total of 2,222 SCA patients with stroke, predominantly included individuals of African ancestry (N = 16). Three of these studies performed whole exome sequencing while 35 performed single nucleotide-based genotyping. Though the studies reported association with 132 loci, meta-analyses could be performed only for 12 loci that had data from two or more studies. After meta-analysis we observed that four loci were significantly associated with risk for stroke: -α3.7 kb Alpha-thalassemia deletion (P = 0.00000027), rs489347-TEK (P = 0.00081), rs2238432-ADCY9 (P = 0.00085), rs11853426-ANXA2 (P = 0.0034), and rs1800629-TNF (P = 0.0003396). Ethnic representation of regions with a high prevalence of SCD like the Mediterranean basin and India needs to be improved for genetic studies on associated complications like stroke. Larger genome-wide collaborative studies on SCD and associated complications including stroke need to be performed.

Role and knowledge of nurses in the management of non-communicable diseases in Africa: A scoping review

BACKGROUND

31.4 million people in low- and middle-income countries die from chronic diseases annually, particularly in Africa. To address this, strategies such as task-shifting from doctors to nurses have been proposed and have been endorsed by the World Health Organization as a potential solution; however, no comprehensive review exists describing the extent of nurse-led chronic disease management in Africa.

AIMS

This study aimed to provide a thorough description of the current roles of nurses in managing chronic diseases in Africa, identify their levels of knowledge, the challenges, and gaps they encounter in this endeavor.

METHODS

We performed a scoping review following the key points of the Cochrane Handbook, and two researchers independently realized each step. Searches were conducted using five databases: MEDLINE, PyscINFO, CINAHL, Web of Science, and Embase, between October 2021 and April 2023. A descriptive analysis of the included studies was conducted, and the quality of the studies was assessed using the Downs and Black Scale.

RESULTS

Our scoping review included 111 studies from 20 African countries, with South Africa, Nigeria, and Ghana being the most represented. Findings from the included studies revealed varying levels of knowledge. Nurses were found to be actively involved in managing common chronic diseases from diagnosis to treatment. Facilitating factors included comprehensive training, close supervision by physicians, utilization of decision trees, and mentorship. However, several barriers were identified, such as a shortage of nurses, lack of essential materials, and inadequate initial training.

CONCLUSION

There is significant potential for nurses to enhance the screening, diagnosis, and treatment of chronic diseases in Africa. Achieving this requires a combination of rigorous training and effective supervision, supported by robust policies. To address varying levels of knowledge, tailored training programs should be devised. Further research is warranted to establish the effectiveness of nurse-led interventions on population health outcomes.

Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review

PHENOMENON

Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof.

APPROACH

A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives.

FINDINGS

Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues.

INSIGHTS

Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.

Sexual dysfunction among Nigerian women living with HIV infection

INTRODUCTION

Sexual dysfunction in women with HIV is a necessary but understudied aspect of HIV complications in women living with HIV. This study reports the prevalence, pattern, and risk factors for sexual dysfunction in women living with HIV in southwest Nigeria.

METHODS

A validated Female Sexual Function Index was used to determine sexual dysfunction in a cross-sectional study design involving 2926 adult women living with HIV in a large, publicly funded tertiary HIV treatment centre in Lagos, Nigeria. A score of less than 26.5 indicated sexual dysfunction. Multivariate logistic regression analysis was performed to identify risk factors for sexual dysfunction. P<0.05 was considered statistically significant at a 95% confidence interval (CI).

RESULTS

The prevalence of sexual dysfunction was 71.4%. The types of dysfunctions detected included disorder of desire (76.8%), sexual arousal (66.0%), orgasm (50.0%), pain (47.2%), lubrication (47.2%), and satisfaction (38.8%). Multivariate analysis showed that menopause (aOR: 2.0; 1.4-4.1), PHQ score of 10 and above (aOR: 2.3; 1.7-3.2), co-morbid medical conditions (aOR: 1.8; 1.4-2.7), use of protease inhibitor-based antiretroviral therapy (aOR: 1.3; 1.2-2.1) and non-disclosure of HIV status (aOR: 0.7; 0.6-0.8) were factors associated with sexual dysfunction.

CONCLUSIONS

Sexual dysfunction is common among Nigerian women living with HIV. Menopause, use of protease inhibitor-based regimens, PHQ score of at least 10, co-morbid medical condition, and non-disclosure of HIV status were associated with sexual dysfunction. National HIV programmes, in addition to incorporating screening and management of sexual dysfunction in the guidelines, should sensitise and train health workers on the detection and treatment of sexual dysfunction.

Prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

This review aimed to estimate the pooled prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia.

DATA SOURCES

Primary studies were searched from PubMed, Scopus, HINARI, and Google Scholar from January 1, 2010 to December 10, 2023. In addition, we have used citation tracking.

STUDY SELECTIONS

Observational studies (cross sectional, case control, and cohort) conducted among asthmatic patients ≥15 years old in Ethiopia, published in English language were included. After screening, the studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q-statistics and I2.

RESULTS

The review was performed among 13 institution-based studies with a total of 2901 participants with asthma. About 1058 participants had comorbid disease and 354 were cigarette smokers. The pooled prevalence of adherence to medications among patients with asthma was 40.50% (95% CI: 28.05, 52.96; p value < 0.001) with high heterogeneity (I2 = 98.25%, p < 0.001). Getting health education about asthma and having comorbid disease were predictors of medication adherence among adolescents and adults with asthma in Ethiopia.

CONCLUSIONS

The pooled prevalence of medication adherence among adolescents and adults with asthma in Ethiopia is low and indicated that three out of five adolescents and adults with asthma were non-adherent to medications. This implies the Ministry of Health should develop different strategies to improve medication adherence including patient education and strengthening the health care system. Multicenter longitudinal studies should be further conducted by using objective methods of adherence measurement and large sample size.

Prevalence and patterns of third molar impaction among Ethiopians in Addis Ababa: a retrospective pilot study

Tooth impaction is a condition in which a tooth does not reach its normal position and is often observed in the third mandibular molar due to inadequate space. This study aimed to investigate the prevalence and configuration of the impacted third molars with an emphasis on angular orientations in a sample of the Ethiopian population. This cross-sectional study included a retrospective analysis of 291 patient records and orthopantomography data from the archives of a private dental clinic in Addis Ababa, during the study period from December 2020 to November 2022. Demographic details and data on the position and level of the impacted third molars were evaluated using the Winter classification. Data were analyzed for frequency distribution. The prevalence of impacted third molars was 22% (n = 64), with a greater incidence on the right side (60.9%) and a higher frequency in the mandible (67.2%). Vertical angulation (32.8%), followed by mesioangular angulation (31.2%), was the most common impaction pattern. The results highlight the need for improved treatment protocols for third molar impaction, emphasizing the prevalence in the mandible and the importance of addressing vertical impaction. Regular dental check-ups are essential for assessing third molar impaction and planning appropriate management. These data can inform policymaking and treatment considerations for impacted third molars in the Ethiopian population.

Histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center, Jimma, Southwest Ethiopia: A two-year cross-sectional study

BACKGROUND

The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal.

OBJECTIVE

This study aimed to determine the histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center from September 12, 2017, to September 12, 2019.

METHODS

A 2-year facility-based cross-sectional study was conducted from May 1 to June 30, 2020.

RESULT

In this study, cervical cancer was the most common (71%) cause of cervical lesions. Squamous cell carcinoma was the most frequent cervical cancer diagnosed during the study, accounting for 96.4% of 331 cancerous cases, followed by adenocarcinoma (3.3%). High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous lesions, accounting for 68.4% of cases. Endocervical polyps were the most commonly diagnosed benign lesions, accounting for 59.3% of cases.

CONCLUSION

The maximum age distribution of cervical lesions was in the 41-50-year age range. Squamous cell carcinoma was the most frequent type of cervical cancer. High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous cervical lesions. The most common benign cervical lesions were endocervical polyps.

RECOMMENDATION

We recommend educating the community to improve health-seeking behavior and on possible preventive strategies for cervical cancer.

Stigma in vitiligo: associated factors and severity strata of the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) score

BACKGROUND

Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed.

OBJECTIVES

To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) for patients with vitiligo.

METHODS

We conducted a cross-sectional study in ComPaRe Vitiligo, an e-cohort of adult patients with vitiligo. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata for the PUSH-D.

RESULTS

In total, 318 patients participated (mean age 49.7 years; 73.9% women). Fitzpatrick skin phototype IV-VI, severe facial involvement (high Self-Assessment Vitiligo Extent Score of the face) and depression (high Patient Health Questionnaire-9 score) were positively -associated with a higher stigmatization score, although this association was weak [r = 0.24 (P < 0.001) and r = 0.30 (P < 0.001), respectively]. PUSH-D cutoff values that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23 (κ = 0.622, 95% confidence interval 0.53-0.71).

CONCLUSIONS

Our study is the first to use a skin-specific stigmatization tool to assess stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.

Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review

Background: Fournier gangrene (FG) is a form of necrotizing fasciitis involving the perineal, peri-anal, and genital structures, and has exceptionally high mortality rates. To help in early detection of high-risk patients, we aimed to systematically review factors associated with mortality from FG. Patients and Methods: Searches were conducted in PubMed, Embase and Scopus. In our review, a minimum of five patients were required and this was to exclude studies with exceedingly small sample sizes, such as case reports and small case series, with minimal relevance in comparison to larger scale studies. Patient characteristics, causative microbes, anatomic areas of infection, presence of comorbidities, severity scores, causes of FG, and complications were extracted and compared to identify factors related to mortality. Results: A total of 57 studies were included in the review. Across 3,646 study participants, the mortality rate of FG was 20.41%. The mean age of non-survivors was 61.27 years. There were more total male deaths, however, the mortality rate was higher in females. Diabetes mellitus was the most common comorbidity in those who died, but the highest mortality rate was seen in HIV patients (54.17%). Mortality rates did not differ widely among antibiotic agents. Regarding causative organisms, fungal infections had the highest rates of mortality (68.18%) and the most common microbe leading to death was Escherichia coli. Conclusions: Female gender, comorbidities, anatomic distribution, development of sepsis, and fungal infection all increased risk for mortality. Early identification of risk factors, and provision of appropriate treatment are crucial in reducing mortality rates of high-risk patients with FG.

The internal and marginal adaptation of lithium disilicate endocrowns fabricated using intra and extraoral scanners: An in-vitro study

OBJECTIVES

The impression technique highly influences the adaptation of ceramic restorations. Not enough information is available to compare the marginal (MF) and internal fit (IF) of endocrowns fabricated with various digitization techniques. Therefore, this in-vitro study aimed to compare the MF and IF of lithium disilicate (LDS) endocrowns fabricated through direct and indirect digital scanning methods.

MATERIALS AND METHODS

One extracted maxillary molar was used to fabricate endocrowns. The digitization of the model was performed with (G1) direct scanning (n = 10) utilizing an intraoral scanner (IOS), (G2) indirectly scanning the conventional impression taken from the model using the same IOS (n = 10), (G3) indirectly digitalizing the obtained impression using an extraoral scanner (EOS) (n = 10), and (G4) scanning the poured cast using the same EOS (n = 10). The MF and IF of the endocrowns were measured using the replica method and a digital stereomicroscope. The Kruskal-Wallis test was used to analyze data.

RESULTS

The studied groups differed significantly (p<0.001). G2 (130.31±7.87 μm) and G3 (48.43±19.14 μm) showed the largest and smallest mean vertical marginal gap, respectively. G2 and G3 led to the highest and lowest internal gaps in all regions, respectively. With significant differences among the internal regions (p<0.001), the pulpal area demonstrated the most considerable misfit in all groups.

CONCLUSIONS

Scanning the impression using an extraoral scanner showed smaller marginal and internal gaps.

Flexural strength of repaired denture base materials manufactured for the CAD-CAM technique

PURPOSE

To evaluate the flexural properties of repaired poly(methylmethacrylate) (PMMA) denture base materials for computer-aided design/computer-aided manufacturing (CAD-CAM) and to compare them with heat-activated polymerized PMMA.

METHODS

A total of 288 specimens (65 × 10 × 2.5 mm) were prepared using both CAD-CAM and conventional blocks and repaired using autopolymerizing and visible-light polymerizing (VLC) materials. Microwave energy, water storage and hydroflask polymerization were applied as additional post-polymerization cycles after the repair process. The flexural strength (FS) of the specimens was evaluated using the three-point bending test. Data were evaluated statistically using 2-way ANOVA followed by Bonferroni's correction to determine the significance of differences between the groups (P ≤ 0.05).

RESULTS

The FS of the denture base materials for CAD-CAM was significantly higher than that for the heat-activated group (P ≤ 0.05). The FS was significantly highest when microwave energy was used for the post-polymerization cycle. The FS values for all groups repaired with VLC resin were significantly lower than for the autopolymerization group (P ≤ 0.05).

CONCLUSION

The flexural properties of denture base materials for CAD-CAM repaired using autopolymerizing acrylic resins can recover by 50-70%. Additional post-polymerization cycles for autopolymerizing repair resin can be suggested to improve the clinical service properties of repaired dentures.