Evaluation of efficacy of non-resorbable membranes compared to resorbable membranes in patients undergoing guided bone regeneration

Background

Replacement of missing teeth in patients with prolonged edentulism poses a challenge for clinicians. An extended period of edentulism results in severe atrophy of alveolar ridges rendering them unsatisfactory for rehabilitation using an implant-supported prosthesis. To overcome this difficulty, Guided Bone Regeneration (GBR) was introduced and constructed upon the principles of Guided Tissue Regeneration (GTR) procedures. Evidence suggests that GBR has proven to be a predictable treatment modality for treating vertical and horizontal ridge deficiencies.

Objective

The present systematic review aimed to evaluate the efficacy of non-resorbable (N-RES) membranes compared to resorbable (RES) membranes in patients undergoing GBR.

Methods

An electronic search of three databases, including PubMed, Web of Science, and Scopus, was conducted for articles published until March 2022. A supplementary manual search of references from these articles was performed to include any articles that may have been overlooked in the electronic search. Articles that evaluated the efficacy of RES membranes and N-RES membranes in GBR were included. Case reports, case series, commentaries, letters to the editor, narrative or systematic reviews were excluded. Articles in languages other than English were also excluded. The articles were assessed against risk of bias 2 tool for Randomized Control Trials (RCTs) and ROBINS-I tool for Non-Randomized Clinical Trials (N-RCTs). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment was followed based on the Cochrane Handbook for quality assessment. A summary of findings table was used to present the results.

Results

One hundred and fifty one articles were identified in an electronic search. Eight articles met the inclusion criteria and were included in the present systematic review. The studies were conducted on partially or completely edentulous patients with alveolar ridge deficiencies undergoing vertical or horizontal bone for subsequent implant placement. The majority of the studies reported similar results for bone gain in both RES and N-RES membrane groups.

Conclusion

The available evidence suggests that RES and N-RES membranes are equally effective in GBR. However, the evidence must be interpreted with caution due to its 'low quality' GRADE assessment.

Clinical implications

Further research focusing on human clinical trials with well-matched subjects with homogeneity in the type and method of GBR and method of assessment of new bone formation will derive conclusive results on the efficacy of RES and N-RES membranes in achieving new bone formation.

Apigenin protects from hepatorenal damage caused by lead acetate in rats

Exposure to lead (Pb) is associated with serious health problems including hepatorenal toxicity. Apigenin is a natural-sourced flavonoid with promising antioxidant and anti-inflammatory effects. In this research, we investigated the potential protective role of apigenin against lead acetate (PbAc)-induced hepatorenal damage. Thus, this experiment studied the exposure of male Wistar Albino rats to apigenin and/or PbAc and their effects in comparison to the control rats. Apigenin administration decreased the levels of Pb and prevented the histopathological deformations in liver and kidney tissues following PbAc exposure. This was confirmed by the normalized levels of liver and kidney function markers. Additionally, apigenin inhibited significantly oxidative reactions through upregulating Nrf2 and HO-1, and activating their downstreamed antioxidants accompanied by a marked depletion of pro-oxidants. Moreover, apigenin decreased the elevated pro-inflammatory cytokines and inhibited cell loss in liver and kidney tissues in response to PbAc intoxication in both tissues. The obtained results demonstrated that apigenin could be used to attenuate the molecular, biochemical, and histological alterations associated with Pb exposure due to its potent antioxidant, anti-inflammatory, and antiapoptotic effects.

Role of Toothbrushes as Gene Expression Profiling Tool for Oral Cancer Screening in Tobacco and Alcohol Users

AIM

The use of toothbrushes was investigated as a potential RNA source and gene expression profiling tool for oral cancer screening in tobacco and alcohol users.

METHODOLOGY

A total of 20 subjects were selected on the basis of inclusion and exclusion criteria. They were divided into two groups: group I-healthy controls (n = 6); group II-individuals who consume tobacco and alcohol (n = 14). After the volunteers brushed their teeth using a soft-bristle toothbrush with ~0.5 gm of toothpaste, the toothbrushes were collected, and the gene expression of BAX, BCL2, CDK4, CKDN2A, GNB3, and TCF7L2 was assessed.

RESULTS

The gene expression of BAX decreased significantly in alcoholics and smokers (0.13867 ± 0.12014), while the gene expression of BCL2 increased in alcoholics and smokers (1.91001 ± 0.90425) in comparison with healthy controls (p = 0.0054 and p = 0.0055). Although there was increased expression of CDK4, CKDN2A, and TCF7L2 and decreased expression of GNB3 in smokers and alcoholics, the results were not significant.

CONCLUSIONS

A toothbrush is a good source of RNA, and gene expression analysis can be performed using the genetic material retrieved from toothbrushes, which can aid in the early diagnosis of oral squamous cell carcinoma among tobacco and alcohol users. Further studies with a larger sample size and different durations of toothbrush use should be conducted to explore the role of toothbrushes as a noninvasive tool for disease diagnosis.

Empirical treatment of uncomplicated urinary tract infection by community pharmacist in the Eastern province of Saudi Arabia

OBJECTIVE

It is a well known phenomenon in the Kingdom of Saudi Arabia that prescription drugs are dispensed over the counter in the community pharmacies. The aim of this study is to document the attitude of community pharmacists to fulfill the concept of pharmaceutical care and to evaluate how they manage a case of acute uncomplicated lower urinary tract infection.

METHODS

Eighty-eight community pharmacists in the Eastern province of Saudi Arabia were presented with a patient claiming urinary tract infection and seeking medical treatment.

RESULTS

Only one attendant pharmacist refused to dispense medications without prescription. Fifteen others (17%) dispensed urinary antiseptic only and 72 (82%) gave antibacterial agents. Fluoroquinolones were the most commonly dispensed (69%) as first choice and 87% as an alternative) followed by co-trimoxazole, penicillins, cephalosporins and tetracyclines. The number of drugs dispensed ranged from a single agent at 52 (59%), 2 drugs at 31 (35%) and 3 drugs at 4 (4.5%) pharmacies. The average cost was Saudi Riyal (SR) 45.8 ($12.2) for first choice drugs and SR 31.5 ($ 8.4) for the alternatives.

CONCLUSION

The heavy dispensing of fluoroquinolones over the counter could eventually lead to increased resistance of the pathogenic bacteria to these drugs. However, despite the lack of pharmacist's adherence to the pharmaceutical law, this study does not indicate that they had abused their patients. It is rather demonstrating the urgent needs for successful implementation of the pharmaceutical law taking into consideration better integration between governmental health providers and the private retail pharmacies. In addition, it supports calls to educate pharmacists to perform basic clinical assessment in the community pharmacy, as a vital tool to effectively manage their patients' health status. The Ministry of health should credit such educational activity for the renewal of pharmacist's license in the Kingdom.

The anti-inflammatory, analgesic and antipyretic activity of Nigella sativa

The aqueous extract of Nigella sativa (N. sativa) was investigated for anti-inflammatory, analgesic and antipyretic activities in animal models. The extract has an anti-inflammatory effect demonstrated by its inhibitory effects on Carrageenan induced paw edema. It also produced significant increase in the hot plate reaction time in mice indicating analgesic effect. However, N. sativa crude suspension had no effect on yeast induced pyrexia. This study therefore, supports its use in folk medicine both as analgesic and anti-inflammatory agent and calls for further investigations to elucidate its mechanism of action.

Evidence of a functional role in lung inflation for the buccal pump in the agamid lizard, Uromastyx aegyptius microlepis

This study has demonstrated that the agamid desert lizard Uromastyx aegyptius microlepis ventilates its lungs both with a triphasic, thoracic aspiratory pump and by gulping air, using a buccal pump. These two mechanisms never occur simultaneously because bouts of buccal pumping are always initiated after the passive expiration that terminates a thoracic breath. Lung inflation arising from thoracic and buccal ventilation was confirmed by direct recording of volume changes using a whole-body plethysmograph. This observation was further confirmed by mechanical separation of the inflationary pressures associated with these two breathing mechanisms, enabling the effects of lung inflation on buccal breathing to be observed. This revealed that the buccal pump is influenced by a powerful Hering-Breuer-type reflex, further confirming its role in lung inflation. Bilateral thoracic vagotomy tended to increase the variance of the amplitude and duration of the breaths associated with the aspiration pump and abolished the effects of lung inflation on the buccal pump. Uromastyx has vagal afferents from pulmonary receptors that respond to changes in lung volume and appear not to be sensitive to CO(2). This study describes two lung-inflation mechanisms (an amphibian-like buccal pump and a mammalian-like aspiration pump) in a single extant amniote, both of which are subject to vagal feedback control.

Use of norfloxacin in poultry production in the eastern province of Saudi Arabia and its possible impact on public health

Samples of market-ready chicken muscle and liver from 32 local broiler farms were first screened for antibiotic residues by microbiological assay. The antibiotic-residue-positive muscles and livers from 22 farms were further analysed for norfloxacin (NFX) residues by high performance liquid chromatography. NFX was detected in 35.0% and 56.7% of raw antibiotic-residue-positive muscles and livers, respectively. The NFX-positive muscles and livers were respectively obtained from 11 (50.0%) and 14 (63.6%) of the 22 antibiotic-residue-positive farms. Since the maximum residue limit (MRL) for NFX has not yet been fixed, the MRL for enrofloxacin was used in the study. All NFX-positive farms had mean raw tissue levels, which were 2.7- to 34.3-fold higher than the MRL. Although cooking markedly reduced NFX tissue concentrations, mean detectable levels remained above MRL in large proportions of NFX-positive samples and farms. Susceptibility patterns of Enterobacteriaceae isolates from chicken and human patients to NFX showed alarmingly high rates of resistance in chicken isolates especially among Escherichia coli (45.9%) and Pseudomonas spp. (70.6%) compared with patients' isolates (10.5% and 18.2%, respectively). The study reveals widespread misuse of NFX in the local poultry industry, which may pose a major risk to public health including possible stimulation of bacterial resistance and hypersensitivity reactions to fluoroquinolones. More prudent use of fluoroquinolones in food-producing animals is therefore recommended. Further, there is a need to establish MRL values for NFX.

Residues of tetracycline compounds in poultry products in the eastern province of Saudi Arabia

Chicken muscle, liver and egg samples were collected from 33 broiler and 5 layer farms in the eastern province of Saudi Arabia over a period of two years starting from January 1996. Antibiotic-residue positive samples were identified in the products of 23 (69.7%) broiler and 3 (60%) layer poultry farms. 87% and 100.0% of the antibiotic-residue positive broiler farms were positive for at least one tetracycline compound in raw muscle and liver respectively, while 73.9% and 95.5% were positive for 2 or more tetracyclines in these two tissues, respectively. Furthermore, 82.6% and 95.5% of the antibiotic-residue-positive farms had mean concentrations of at least one tetracycline compound in excess of the permissible maximum residue limit (MRL) in raw muscle and liver, respectively. These compounds also remained chemically detectable after cooking. Tetracycline levels exceeded MRL in 14.4% of antibiotic-positive raw eggs but the overall mean tetracycline concentration in each farm was below MRL. This study confirmed widespread misuse of tetracycline agents including multiple use of drugs belonging to the same pharmacological group and lack of implementation of recommended withdrawal times. This may be contributing to the high resistance rates to tetracyclines in both chicken and human microbial isolates observed in the region. This study, therefore, stresses the need for stricter regulations for the use of antimicrobial drugs in the poultry industry as well as the inspection of chicken for drug residues prior to marketing.

Patterns of resistance to antibiotics at king fahd hospital of the university

INTRODUCTION AND AIM

A sharp worldwide rise in bacterial resistance to antimicrobial agents in both nosocomial and community acquired pathogens has recently been observed. This may complicate treatment of infectious disease or increase the cost of its management. It is, therefore, important to regularly investigate the patterns of resistance to antimicrobial agents at both local and national levels.

METHODS

The antibiograms of organisms isolated over a one-year period in King Fahd Hospital of the University were analyzed.

RESULTS

Of the 3679 microbial isolates of 35 types of organisms identified, the most common were Streptococcous spp (25.5%), S. aureus (16.1%), E. Coli (12.7%), Psueudomonas spp (9.3%) and Klebsiella spp (7%) High resistance rates (>50%) to ampicillin and to amoxycillin + clavulanate (AMX+CLV) were encountered in Enterobacter spp., and H. influenzae while in E. coli, the resistance was higher to ampicillin (60.0%) than to AMX+CLV (38.1%). With regard to S. aureus, 98.3%, 91.1% and 25.5% of isolates were resistant to penicillin, AMX+CLV and methicillin respectively but all were sensitive to vancomycin. High resistance (53% of 2830 isolates) to tetracycline was also observed especially in H. influenzae (80.5%), Streptococcous spp (72.9%) and E. Coli (54.5%). The same organisms were also highly resistant to trimethoprim/sulphamethoxazole with rates of 75.5%, 80.4% and 48.1% respectively. Moderate resistance (26% of 1567 isolates) to gentamicin was noted but the drug remained very effective against most tested gram-negative organisms. In addition, multiple resistance to gentamicin and AMX+CLV was also detected in 24.3% of 839 isolates.

CONCLUSIONS AND RECOMMENDATIONS

It is concluded that the alarmingly high pattern of bacterial resistance to antibiotics may reflect the extent of use of each antibiotic in the eastern province of Saudi Arabia. It is recommended that hospital antibiotic policies (purchasing, prescribing and dispensing) be based on, and regularly reviewed in accordance with hospital antibiogram results. A center for infectious disease control should also be established in each region of the Kingdom to disseminate information and coordinate antibiotic policies among hospitals.

Antibiotic resistance of Escherichia coli isolated from poultry workers, patients and chicken in the eastern province of Saudi Arabia

The prevalence of antibiotic-resistant Escherichia coli isolates from faecal samples from 117 poultry industry workers, 100 patients and119 healthy chicken were compared. Resistance of E. coli chicken isolates to ampicillin, chloramphenicol, gentamicin, spectinomycin, tetracycline and trimethoprim + sulphamethoxazole (TMP + SMX) (range 57% - 99.1%) were significantly higher than those isolated from patients (range 21.9% - 71.4%) and workers (range 35% - 71.8%). However, for drugs not used in poultry, such as amoxicillin + cluvalanate (AMX + CLV), ceftazidime and nitrofurantoin, resistance rates of chicken isolates (range 0% - 2.6%) were significantly lower than those of patient isolates (range 8.7% - 30%). Resistance to spectinomycin reached 96% in E. coli chicken isolates and 71% in organisms isolated from humans. Use of this drug in Saudi Arabia is mostly limited to veterinary purposes. Multidrug resistance is alarmingly high in all groups but was highest in chicken isolates (77.4%). Serotyping of E. coli isolates showed that 27% of the organisms isolated from patients were overlapping with 10.9% of the chicken isolates, indicating the possibility of chicken being a source of the resistance pool for humans. We therefore call for the banning of antibiotics in the poultry industry as growth promoters and recommend that their use be restricted to treating infections.

Utilization of digoxin and theophylline assays in the eastern province

The utilization of therapeutic drug monitoring (TDM) for serum digoxin and theophylline was assessed with respect to the indication, time of sample collection and contribution to patient care. A total of 585 serum drug level determinations of digoxin (275) and theophylline (328) were done in a four month period. Reasons for requests were subtherapeutic response (27.5%), suspected toxicity (3.8%), baseline data (26.7%), patients at risk for toxicity (7.7%), and for the remaining 34.4% of orders, no reason was stated. The highest number of requests 246 (42.1%) were from the inpatient ward (INP), followed by emergency room (ER) 32.6%, outpatient department (OPD) 13% and intensive care unit (ICU) 12.3%. Repeated assays accounted for 363 determinations of which 55.9% had levels similar to the previous ones. In this study, we found a high incidence of inappropriateness in patient selection (34.4%), time of serum sample collection (28.4%), and dosage adjustment (46.8%). However, when these audit criteria were analyzed together, the overall appropriateness was as low as 33.5%. This indicated that serum drug monitoring was poorly utilized and did not contribute much to the patient's care. This results in an estimated financial loss per year (for inappropriate use of digoxin and theophylline levels) of about 37,344 Saudi Riyals (US $9,956.00). Corrective educational programs for the staff, based on standard guidelines for TDM, have been initiated and this study is a baseline for future prospective audits.