Showing papers in "Open Access Macedonian Journal of Medical Sciences in 2018"

Contemporary Dental Ceramic Materials, A Review: Chemical Composition, Physical and Mechanical Properties, Indications for Use.

Abstract: BACKGROUND: The high esthetic expectations from the prosthodontic restorations have directed the qualitative development of the materials towards the all-ceramic materials that are capable of replacing porcelain-fused-to-metal systems. AIM: This article reviews the literature covering the contemporary all-ceramic materials and systems with a focus on the chemical composition and materials’ properties; also it provides clinical recommendations for their use. RESULTS: The glass-matrix ceramics and polycrystalline ceramics are presented, as well as recently introduced machinable materials, all-zirconia and resin-matrix ceramics. The specific properties of zirconia, such as transformation toughening, stabilisation of the crystallographic structure, low-temperature degradation and factors affecting the zirconia’s ageing, are emphasised. CONCLUSION: The favourable properties of the resin-matrix ceramics, such as modulus of elasticity similar to dentin, shock-absorbing characteristics and high resilience and fracture resistance, are also covered in this article.

The Role of TNF-α induced MSCs on Suppressive Inflammation by Increasing TGF-β and IL-10

Abstract: BACKGROUND: Mesenchymal stem cells (MSCs) may serve as immunoregulators by producing various anti-inflammatory molecules. Under sufficient level of TNF-I±, MSCs become activated and adopt immune-suppressive phenotype (MSCs type-2) by releasing various anti-inflammatory molecule including TGF-I² and IL-10. However, the ability of MSC itself to produce IL-10 under TNF-I± stimulation and the correlation of TGF-I² production of MSCs to IL-10 level remains to be elucidated. AIM: In this study, MSCs were activated with various TNF-I± doses to determine the increase of IL-10 and TGF-I² level as well as its correlation. MATERIAL AND METHODS: This study used post-test only control group design, by using 3 study groups, consist of 1 control (C) and 2 treatments (T) (TNF-I± = 5 and 10 ng/mL) with triplicate induced in MSC for 24 hours, then the levels of IL-10 and TGF-I² were measured by using ELISA assay. RESULTS: The results of this study showed a significant increase of TGF-I² and IL-10 levels (p < 0.05) at TNF-I± 5 and 10 ng/mL dose of TNF-I±. Moreover, there was a significant negative correlation between TGF-I² and IL-10 level on 5 and 10 ng/mL dose TNF-I± treatment. CONCLUSION: Based on our study, we conclude that the 5 ng/mL dose of TNF-I± is a sufficient dose for MSCs to suppress the inflammatory milieu. The higher increase of TGF beta is due to the controlled inflammation by IL-10.

Presentation of the Molecular Subtypes of Breast Cancer Detected By Immunohistochemistry in Surgically Treated Patients.

Abstract: INTRODUCTION: The detection of estrogen, progesterone and HER-2 neu receptors on the surface of the tumour cell is a significant prognostic factor, alone or in combination. The presence or absence of receptors on the surface of the tumour cell is associated with the conditional gene expression in the tumour cell itself. Based on these genetically determined expressions of the tumour cell, five molecular subtypes of breast cancer have been classified on the St. Gallen International Expert Consensus in 2011 that can be immunohistochemically detected, with each subtype manifesting certain prognosis and aggression.AIM: Analyzing the presentation of molecular subtypes of breast cancer that are immunohistochemically detected in surgically treated patients at the Clinic for Thoracic and Vascular Surgery.MATERIAL AND METHODS: We used the international classification on molecular subtypes of breast cancer which divides them into: Luminal A (ER+ and/or PR+, HER-2 negative, Ki-67 < 14%), Luminal B with HER-2 negative (ER+ and/or PR+, HER-2 negative, Ki-67 ≥ 14%), Luminal B with HER-2 positive (ER+ and/or PR+, HER-2+, any Ki-67), HER-2 enriched (ER-, PR-, HER-2+), and basal-like (triple negative) (ER-, PR-, HER-2 negative, CK5/6+ and/or EGFR+). A total of 290 patients, surgically treated for breast cancer, were analysed during 2014.RESULTS: In our analysis, we found that Luminal A was present in 77 (26.55%) patients, Luminal B HER-2 negative was present in 91 (31.38%) patients, Luminal B HER-2 positive was present in 70 (24.14%) patients, HER-2 enriched was present in 25 (8.62%) patients and basal-like (or triple negative) was present in 27 (9.31%) patients.CONCLUSION: Detecting the subtype of breast cancer is important for evaluating the prognosis of the disease, but also for determining and providing an adequate therapy. Therefore, determining the subtype of breast cancer is necessary for the routine histopathological assay.

The burden of Diabetes, Its Oral Complications and Their Prevention and Management.

Abstract: BACKGROUND: Diabetes mellitus (DM), chronic disease, is a public health problem that affects 8.5% adult population worldwide. The number of adults with DM has risen sharply from 108 million in 1980 to 422 million in 2014. In 2012, 1.5 million individuals died because of DM and an additional 2.2 million deaths occurred because of high blood glucose level resulting in cardiovascular and other systemic diseases. DM brings huge economic loss to patients, their families, and healthcare systems. Globally, the cost of DM was US$1•31 trillion in 2015.AIM: This review article utilised the prevalence data of diabetes mellitus from the World Health Organization and International Diabetes Federation to provide a comprehensive picture of the disease in different parts of the world.METHODS: Electronic databases such as Google Scholar, Medline via PubMed, Scopus, and Web of Science were used to search the literature. The library resources of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia were used to retrieve studies on the topics of the present review.RESULTS: Systemic complications of DM include heart attack, kidney disease, limb loss, blindness, and peripheral nerve damage. More than 90% of diabetic patients were found to have oral manifestations. It is known that DM severely damages oral tissues causing periodontal disease, tooth loss, xerostomia, caries, burning mouth disorder, taste and salivary gland dysfunction, delayed wound healing, lichen planus, geographic tongue, and candidiasis. The evidence is mounting about a strong bidirectional relationship between DM and periodontal disease. Unfortunately, many diabetic patients are unaware of the association between DM and oral health, and only a small percentage of them visit the dentist for routine dental check-ups. Changes in lifestyles (control of blood glucose levels and self-care practices), regular dental check-ups with emphasis on periodontal assessment, and reinforcement of oral health instructions can effectively prevent oral complications of DM. Scaling and root planning are effective in improving glycemic control among diabetic patients.CONCLUSION: Dental professionals should be part of the multidisciplinary team that helps individuals with diabetes.

Advantages of CAD/CAM versus Conventional Complete Dentures - A Review.

Abstract: BACKGROUND: The introduction and evolution of CAD/CAM technology into complete dentures fabrication brought high expectations in improving disadvantages associated with conventional methods.AIM: The purpose of this review was to analyse the existing literature on computer-engineered complete dentures and to determine their advantages over the conventional dentures.MATERIAL AND METHODS: An electronic search of the English literature from January 1994 to March 2018 was performed in PubMed/MEDLINE, using the following keywords: CAD/CAM complete dentures, computer-engineered complete dentures, complete digital dentures, complete milled dentures, and rapid prototyping dentures.RESULTS: A total of 179 English language titles were obtained from the database, and 14 were relevant to fulfil the purpose of this review. A review of 7 articles is summarized in 2 tables for presenting a comparison between CAD/CAM and conventional dentures in clinical and laboratory studies.CONCLUSION: Following the review of articles that discussed the comparison between CAD/CAM and conventional complete dentures in clinical studies, it can be concluded that the main advantages of CAD/CAM dentures are the reduced clinical chair time and the number of visits, digital archiving, significantly higher retention, and more favorable clinical and patient-centered outcomes. As a result of the review of laboratory studies, superior mechanical and physical properties in CAD/CAM dentures were revealed, concerning enhanced accuracy of fit of milled denture bases, less denture tooth movement and increased toughness, ultimate flexural strength, and higher elastic modulus.

Can Health Belief Model Predict Breast Cancer Screening Behaviors

Abstract: BACKGROUND: Breast cancer is the second cause of cancer-related death among women. Prevention programs insist on the early diagnosis and screening to reduce the mortality rate.AIM: The study was conducted to determine the predictors of breast cancer screening behaviours based on the health belief model.MATERIAL AND METHODS: The present cross-sectional study was conducted by involving 304 women ranging from 20 to 65 years of age, living in East Guilan cities, the North of Iran, in 2015 using two-stage cluster sampling. The research instrument was Champion's Health Belief Model Scale. The data were analysed based on Regression test by using SPSS software version 18.RESULTS: The results showed perceived benefits (ExpB = 1.118, p = 0.009), self-efficacy (ExpB = 1.122, p = 0.001) and the perceived barriers (ExpB = 0.851, p = 0.001) as the predictors of breast self-examination. In addition, the study revealed that the two components of perceived benefits (ExpB = 1.202), and the perceived barriers were the predictors of mammography (ExpB = 0.864) (p = 0.001). None of the health belief model components showed a role to predict clinical breast examination (P > 0.05).CONCLUSION: The present study highlights the need for educational programs, which should focus on increasing breast self-exam skills and understanding the benefits of healthy behaviours and eliminating their barriers.

Probiotics Improve Urogenital Health In Women

Abstract: BACKGROUND: Urogenital recurrent infections represent a global medical issue in the world, affecting millions of women because of dramatic shifts in bacterial composition and concentrations in response to numerous endogenous and exogenous factors. Urogenital microbiota forms a mutually beneficial relationship with their host and has a major impact on health and disease. AIM: This study aimed to compare probiotic therapy versus placebo in Oxidative Stress Values (OSVs) and histological features in urogenital infections in female patients. METHODS: Forty (n = 40) patients diagnosed with recurrent urogenital infections were recruited to be treated as test group (n = 20), receiving Probiotics, and a control group (n = 20), receiving looking similar placebo, both for 90 days. Both the groups were assessed for total oxidant capacity (d-ROMs test) and biological antioxidant potential as iron-reducing activity (BAP test) at baseline, after 1 and 3 months. Histological changes on inner vaginal mucosa were also investigated, during the entire study. RESULTS: d-ROM assay clearly showed that the values of the test group were significantly different, thus leading the general health conditions from a state of high oxidative stress to low oxidative stress levels. Increasing of BAP values were more significant, and clinically relevant, in probiotic test group over time. CONCLUSION: Our pilot study gave interesting and promising elements to confirm the safety and effectiveness of oral probiotics in preventing/reducing the recurrent urogenital infections by an overall modification of inner vaginal microbiota.

Assessment of Photodynamic Therapy and Nanoparticles Effects on Caries Models

Abstract: AIM: To assess the antibacterial competence of 650 nm diode laser, Methylene Blue (MB) and Silver Nano-Particles (Ag NPs) on Streptococcus mutans in biofilm-induced caries models.MATERIAL AND METHODS: One hundred eighty specimens were prepared and equally divided into 6 groups. One group was untreated (control), and the others were subjected to either MB, laser, Ag NPs, the combination of MB and Laser or MB, laser and Ag NPs.RESULTS: Comparison of the log10 mean Colony Forming Units per millilitre (CFU/ml) values of each of the treated 5 groups and the control group was found statistically significant (P-value < 0.05).The combination of MB, laser and Ag NPs recorded the greatest reduction (95.28%). MB alone represented the least capable (74.09%). The efficiency differences among the Ag NPs treated group; the Laser treated group and the combined MB/Laser treated group were found statistically insignificant.CONCLUSION: The combination of MB, 650 nm diode laser and Ag NPs may be among the highly effective modern antimicrobial therapeutics in dentistry.

Hydrofluoric Acid: Burns and Systemic Toxicity, Protective Measures, Immediate and Hospital Medical Treatment.

Abstract: BACKGROUND: Hydrofluoric acid is a commonly used chemical in many industrial branches, but it can also be found as an ingredient in household products such as cleaning agents. Possessing high corrosive potential, HF acid causes burns and tissue necrosis, while when absorbed and distributed through the bloodstream, its extremely high toxic potential is expressed. Acute symptoms are often followed by pain, particularly in the case of skin burns, which intensiveness does not often correlate with the expressiveness of the clinical findings. Even exposure to low-concentrated solutions or gasses, or low-doses of high-concentrated acid, may provoke delayed systemic disorder which may eventually have a lethal outcome. AIM: Therefore, having information regarding the possible hazardous effects of hydrofluoric acid usage, a variety of symptoms, as well as a treatment approach, is of great importance in the case of HF exposure. METHODS: Available scientific articles published in literature databases, scientific reports and governmental recommendations from the internet websites, written in English, using the following search terms “Hydrofluoric acid, skin burns, eye injury, ingestion, inhalation, systemic toxicity, decontamination, antidote, medical treatment” have been reviewed. RESULTS: This review is useful not only for physicians but for everyone who may come in contact with a person exposed to HF acid. CONCLUSION: It highlights the mechanism of action, presents the acute and chronic symptoms, personal and general protective measures and devices that should be used, as well as decontamination procedures, immediate, antidote and hospital medical treatment.

Acid Etching as Surface Treatment Method for Luting of Glass-Ceramic Restorations, part 1: Acids, Application Protocol and Etching Effectiveness.

Abstract: AIM: The purpose of this review is to represent acids that can be used as surface etchant before adhesive luting of ceramic restorations, placement of orthodontic brackets or repair of chipped porcelain restorations. Chemical reactions, application protocol, and etching effect are presented as well.STUDY SELECTION: Available scientific articles published in PubMed and Scopus literature databases, scientific reports and manufacturers' instructions and product information from internet websites, written in English, using following search terms: “acid etching, ceramic surface treatment, hydrofluoric acid, acidulated phosphate fluoride, ammonium hydrogen bifluoride”, have been reviewed.RESULTS: There are several acids with fluoride ion in their composition that can be used as ceramic surface etchants. The etching effect depends on the acid type and its concentration, etching time, as well as ceramic type. The most effective etching pattern is achieved when using hydrofluoric acid; the numerous micropores and channels of different sizes, honeycomb-like appearance, extruded crystals or scattered irregular ceramic particles, depending on the ceramic type, have been detected on the etched surfaces.CONCLUSION: Acid etching of the bonding surface of glass - ceramic restorations is considered as the most effective treatment method that provides a reliable bond with composite cement. Selective removing of the glassy matrix of silicate ceramics results in a micromorphological three-dimensional porous surface that allows micromechanical interlocking of the luting composite.

The Success of Dental Veneers According To Preparation Design and Material Type

Abstract: BACKGROUND: Due to their high aesthetic outcome and long-term predictability, laminate veneers have become a common restorative procedure for anterior teeth. However, because of the variety in the preparation designs and the material types, the clinician faces a dilemma of which approach to use. AIM: To compare the survival rate of dental veneers according to different preparation designs and different material types. The sub-aim is to reach a favourable preparation design and material based on scientific evidence. METHODS: Comprehensive electronic search of the dental literature via PUBMED, MEDLINE and Scopus databases was performed using the following keywords: “porcelain veneers”, “composite veneers”, “all-ceramic veneers”, “success of porcelain veneers”, “preparation design”, “preparation geometry”, “patient’s satisfaction”. Additionally, references from the selected studies and reviews were searched for more information. RESULTS: Under the limitations of the available literature, the clinician preference is the decisive factor for choosing the preparation design. Nonetheless, incisal overlap preparation seems to have the most predictable outcome from all the preparation designs. CONCLUSION: Porcelain veneers show excellent aesthetic results and predictable longevity of the treatment, while composite veneers can be considered as a good conservative option, but with less durability.

The Relationship between Nurse's Job Stress and Patient Safety.

Abstract: BACKGROUND: Patient safety is a key element of the quality of health services. Nurses are the largest group that care for patients, observing safe in nursing care would reduce injuries, disability, morbidity and mortality. However, high stress can lead to a decline in the quality of nursing care. AIM: This study aimed to investigate the relationship between job stress of the nurses and patient safety in a teaching hospital of Hamadan in 2017. MATERIAL AND METHODS: This is a cross-sectional study. The data was gathered by a questionnaire of Nurse’s job stress prepared by the researcher that after confirming the validity and reliability was completed by 198 nurses of three teaching hospitals of Hamadan city that were selected by simple random sampling and the checklist of patient safety that was collected by the researcher. Data analysis was done in the two levels of descriptive and analysis statistics. RESULTS: The results showed that the job stress of the nurses and patient safety (mean = 1.75 and SD = 0.114) have been at an average level. There was no statistically significant relationship between Nurse’s job stress and patient safety because the Spearman correlation coefficient showed that r = 0.007 and p = 0.919. Among the demographic factors, there was only a significant relationship between marital status and Nurse’s job stress (p < 0.05). CONCLUSION: Because of nursing job stress is affected by different working conditions, further studies in the many hospitals are needed. Moderate levels of patient safety are not acceptable; Therefore, heath’s policymakers should focus on providing the safety of all patients at the optimal level, with more effort to reduce the stress of their nurses at the lowest level. e optimal level, with more effort to reduce stress of their nurses at the lowest level.

Epidermoid Cysts - A Wide Spectrum of Clinical Presentation and Successful Treatment by Surgery: A Retrospective 10-Year Analysis and Literature Review.

Abstract: Epidermoid cysts are common benign lesions of hair-bearing, and less often glabrous skin. They can also occur in oral mucosa and internal organs. In case of cutaneous lesions, an epidermal punctum is a clinical diagnostic hallmark. The clinical presentation is variable leading to some differential diagnoses. Diagnosis of epidermoid cysts needs histopathological confirmation – not only of the potential of malignant transformation. The treatment of choice is surgery. We report a retrospective analysis of 2159 epidermoid cysts treated surgically. Most of the cases can be performed under local anaesthesia. The complication rate of 2.2% is low. To avoid relapses, the cyst wall has to be removed completely. Rare genetic disorders with multiple cysts are Gardner and Lowe syndrome.

Ameliorative Effect of Silymarin on Scopolamine-induced Dementia in Rats.

Abstract: AIM: This study aims to elucidate the possible ameliorative effect of silymarin on scopolamine-induced dementia using the object recognition test (ORT) in rats.METHODS: The study was extended to demonstrate the role of cholinergic activity, oxidative stress, neuroinflammation, brain neurotransmitters and histopathological changes in the anti-amnestic effect of silymarin in demented rats. Wistar rats were pre-treated with silymarin (200, 400, 800 mg/kg) or donepezil (10 mg/kg) orally for 14 consecutive days. Dementia was induced after the last drug administration by a single intraperitoneal dose of scopolamine (16 mg/kg). Then behavioural, biochemical, histopathological, and immunohistochemical analyses were then performed.RESULTS: Rats pre-treated with silymarin counteracted scopolamine-induced non-spatial working memory impairment in the ORT and decreased acetylcholinesterase (AChE) activity, reduced malondialdehyde (MDA), elevated reduced glutathione (GSH), restored gamma-aminobutyric acid (GABA) and dopamine (DA) contents in the cortical and hippocampal brain homogenates. Silymarin reversed scopolamine-induced histopathological changes. Immunohistochemical analysis showed that silymarin mitigated protein expression of the glial fibrillary acidic protein (GFAP) and nuclear factor kappa-B (NF-IoB) in the brain cortex and hippocampus. All these effects of silymarin were similar to that of the standard anti-amnestic drug, donepezil.CONCLUSION: This study reveals that the ameliorative effect of silymarin on scopolamine-induced dementia in rats using the ORT maybe in part mediated by, enhancement of cholinergic activity, anti-oxidant and anti-inflammatory activities as well as mitigation in brain neurotransmitters and histopathological changes.

Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran.

Abstract: BACKGROUND: Neonatal jaundice is one of the main causes of the patient's admission in the neonatal period and is potentially linked to morbidity.AIM: This study aimed to determine the possible risk factors for neonatal jaundice.METHODS: We investigated the case of infants who were admitted to the neonatal department of Ziyaeian hospital and Imam Khomeini Hospital for jaundice. Simple random sampling was used to evaluate variables related to maternal and neonatal predisposing factors based on the medical records and clinical profiles. All variables in this study were analysed using SPSS software.RESULTS: In this study, about 200 mothers and neonates were examined. Our findings depicted that mother's WBC, Hb, PLT, and gestational age were associated with jaundice (P < 0.05). Furthermore, there were significant relationships between different degrees of bilirubin with TSH, T4 levels and G6PD (P < 0.05). In fact, TSH, T4 levels and G6PD were found to be linked to neonatal hyperbilirubinemia. The risk factors for jaundice in our study population comprise some predisposing factors such as WBC, Hb, PLT, gestational age, TSH, and T4 levels, as well as G6PD. Neonates at risk of jaundice are linked to some maternal and neonatal factors that can provide necessary interventions to reduce the burden of the disease. Therefore, identification of associated factors can facilitate early diagnosis, and reduce subsequent complications.CONCLUSION: Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in newborns and high-risk mothers.

Determinants of Exclusive Breastfeeding in a Sample of Egyptian Infants.

Abstract: BACKGROUND: Breastfeeding is an optimum, healthy, and economical mode of feeding an infant. However, many preventable obstacles hinder exclusive breastfeeding in the first six months of life. AIM: We aimed to assess the social-, maternal- and infant-related factors disturbing exclusive breastfeeding in the first six months of life. METHODS: It is a retrospective study included 827 dyads of mothers and infants older than 6 months (411 exclusively breastfed, 311 artificially-fed and 105 mixed feds). Mothers were interviewed to obtain sociodemographic information, maternal medical history and perinatal history and a detailed history of infant feeding. RSULTS: Many factors were found to support the decision for artificial feeding rather than exclusive breastfeeding, including maternal age 3rd (OR = 2.436), being a primi-para (OR = 1.878), single marital status (OR = 2.762), preterm infant (OR = 3.287) and complicated labor (OR = 1.841). Factors in favor of mixed feeding included cesarean section (OR = 2.004) and admission to the Neonatal Intensive Care Unit (OR = 1.925). CONCLUSIONS: Although it isn’t a community-based study and its results can’t be generalised, plans to improve health and development of children are preferable to include the following: health education and awareness programs about the importance of exclusive breastfeeding should be directed for young and first-time mothers. Improved antenatal care to reduce perinatal and neonatal problems; and training, monitoring, and supervising community health care workers to recognise labour complications and provide support and knowledge to lactating mothers.

Use of Curcumin in Psoriasis.

Abstract: Curcumin is a polyphenol derived from the golden spice turmeric, which is widely used for different purposes, such as culinary spice and alimentary addictive, make - up and, finally, as a natural product for the treatment of different diseases, especially for the chronic inflammatory ones Recently, curcumin has been proposed as a valid and safe therapeutic option for psoriasis

Stress Factors among Nurses at the Primary and Secondary Level of Public Sector Health Care: The Case of Slovenia.

Abstract: BACKGROUND: Working in nursing is mentally and physically demanding and is one of the most stressful professions.AIM: To determine the basic causes of stress and examine the symptoms of stress among healthcare professionals at the primary and secondary level of health care.MATERIAL AND METHODS: The research was based on the descriptive and causal non-experimental method of empirical research. The independent samples t-test was used.RESULTS: The survey results have shown that those employed in nursing are exposed to stressful situations on a daily basis, most often involving psychological or physical violence in the workplace (M = 4.2), dealing with death (M = 3.9), lack of personnel (M = 3.9) and a high frequency of patients (M = 3.8). The following stress factors cause women greater stress than they do men: relationships among co-workers (t = 2.745; p = 0.006), psychological or physical violence in the workplace (t = 3.492; p = 0.001), and working with difficult patients (t = 2.427; p = 0.017).CONCLUSION: To manage risks, employees and employers must work together and establish a suitable safety and organisational culture, which would enable them to manage and reduce stress.

Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis; Extensive Review of Reports of Drug-Induced Etiologies, and Possible Therapeutic Modalities.

Abstract: Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis are adverse hypersensitivity reactions that affect the skin and mucous membranes. They are characterised by erythematous macules and hemorrhagic erosions of the mucous membranes. Epidermal detachments of varying degrees of severity also occur in these conditions. Various aetiologies are associated with these conditions, with adverse drug reaction being the most common. Though the worldwide incidence of these conditions is recorded as low, diverse types of medication are being observed to lead to these conditions. This review compiles information on the details of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis, the pathophysiology, therapeutic management, and largely considers the drug-induced etiologies associated with these conditions.

Dynapenia and Sarcopenia as a Risk Factor for Disability in a Falls and Fractures Clinic in Older Persons.

Abstract: BACKGROUND: The role of sarcopenia and dynapenia in disability in older persons from falls and bone health clinics remain unknown.AIM: This study aims to compare the association of sarcopenia and dynapenia with physical and instrumental disability in a population of older persons attending a falls and fractures clinic.METHODS: This is a cross-sectional study in Manizales, Andes Mountains, Colombia. 534 subjects (mean age = 74, 75% female) Sarcopenia was measured according to the European Working Group on Sarcopenia in Older People (EWGSOP) including an index of skeletal mass, muscle strength, and gait speed. Dynapenia was defined as a handgrip force ≤ 30 kg for men and ≤ 20 kg for women.RESULTS: Dynapenia and sarcopenia were present in 84.6% and 71.2% respectively. Both were more prevalent in older subjects and women than men. While sarcopenia was associated with body mass index and hypertension, dynapenia was associated with hypothyroidism and visual impairment. After controlling for all covariates, sarcopenia was associated with low IADL and mobility disability.CONCLUSIONS: Sarcopenia was associated with mobility, ADL and IADL disability. Dynapenia was not associated with disability in this high - risk population. Systematic assessment of sarcopenia should be implemented in falls and fractures clinics to identify sarcopenia and develop interventions to prevent functional decline among elderly individuals.

Sugar Substitutes: Mechanism, Availability, Current Use and Safety Concerns-An Update

Abstract: BACKGROUND: Dental caries has continued to be the major oral disease in the past, as well as the present scenario. Cariogenic sugars in the presence of specific bacteria Streptococcus mutans over a period have been attributed as the major etiologic agent for dental caries. The association between sugar consumption and dental caries has been well documented. AIM: Hence, the dental profession shares an interest in the search for safe, palatable sugar substitutes. METHODS: Therefore, the use of a suitable sugar substitute can help in combating dental caries. RESULTS: Out of the various sugar substitutes available, xylitol is the most widely used. It is available in various forms. It decreases the plaque formation, bacterial adherence and inhibits the growth of Mutans Streptococci. CONCLUSION: This article provides a comprehensive review of the sugar substitutes, present-day availability, role in the prevention of dental caries and their safety concerns.

Maternal and Neonatal Outcomes in Pregnant Women with Gestational Diabetes Mellitus Treated with Diet, Metformin or Insulin.

Abstract: AIM: Aim of the study was to compare outcomes of pregnancy in gestational diabetes mellitus (GDM) treated with metformin, insulin, or diet.MATERIAL AND METHODS: The study included 48 women with GDM treated with metformin, 101 with insulin, and 200 women on a diet from the Outpatient Department of Endocrinology and University Clinic of Obstetrics and Gynecology in Skopje.RESULTS: The groups were comparable in age, smoking cigarettes and positive family history of diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week, mean fasting, postprandial glycaemia, and gestational age at delivery were lower in diet and metformin than insulin group. No differences in mode of delivery were observed between the metformin and insulin group. Women in metformin group had a significantly lower incidence of LGA newborns than diet and insulin groups. The percent of SGA new-borns was higher in insulin group than diet and metformin groups. The incidence of neonatal hypoglycemia was statistically significantly higher in the insulin group than in the metformin and diet group.CONCLUSION: Metformin in women with GDM can improve maternal and neonatal outcomes compared with those treated with diet or insulin.

The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis

Abstract: Introduction: The impact of resiliency on professional burnout in nurses has been evaluated in several studies. This meta-analysis was conducted to examine the effect of resiliency on different aspects of nurses' professional burnout. Materials and Methods: Publications were identified through targeted literature review in national and international databases between 1980 – 2017, in Persian and English. Two independent coders assessed and extracted articles. Data analysis was done by random effects model. Study heterogeneity was measured by I2 test. The data were analyzed by STATA software v. 14. Results: Initially, 227 articles were extracted. After titles and abstract screening, 108 articles were selected for full text review. Only five of them had the necessary inclusion criteria for analysis. The meta-analysis performed on these observational studies showed that correlation between resiliency and burnout was -0.57 with a 95% confidence interval of -0.354 to -0.726. Conclusion: Regarding the inverse relationship between resiliency and burnout, it is recommended to plan for the interventions that can improve the resilience of nurses against burnout. Conducting interventional and resilient training courses for nurses in nursing education can be considered.

Metabolic Profiles in Obese Children and Adolescents with Insulin Resistance.

Abstract: BACKGROUND: In the past several decades, the increasing frequency of overweight and obese children and adolescents in the world has become a public health problem. It has contributed significantly to the already high tide of diabetes, cardiovascular and cerebrovascular diseases.AIM: To investigate the frequency of insulin resistance and to evaluate the metabolic profile of insulin resistant and non-insulin resistant obese children and adolescents.SUBJECTS AND METHODS: The study included 96 (45 boys, 51 girls) obese children and adolescents aged     4-17 years old (10.50 ± 2.87 years). Only participants with Body Mass Index ≥ 95 percentile were included. We analysed sera for fasting insulin levels (FI), fasting serum triglycerides (TG), total serum cholesterol (TC), fasting plasma glucose (FPG) and plasma glucose 2 hours after the performance of the oral glucose tolerance test        (2-h G). Homeostatic model assessment for insulin resistance (HOMA-IR) index was calculated as fasting insulin concentration (microunits per millilitre) x fasting glucose concentration (millimolar)/22.5. The value of HOMA-IR above 3.16 was used as a cut-off value for both genders.RESULTS: Insulin resistance was determined in 58.33% of study participants. Insulin resistant participants had significantly higher level of 2-h G (p = 0.02), FI level (p = 0.000) as well as TG levels (p = 0.01), compared to non-insulin resistant group. Strikingly, 70.73% of the pubertal adolescents were insulin resistant in comparison to 49.09% of the preadolescents (p = 0.03). Significantly higher percentage of insulin-resistant participants were girls (p = 0.009). Moreover, a higher percentage of the girls (70.59%) than boys (44.44%) had HOMA-IR above 3.16 and had elevated FI levels (70.59% vs 48.89%). The difference in the frequency of insulin resistance among obese versus severely obese children and adolescents was not significant (p = 0.73, p > 0.05). Our study results also showed positive, but weak, correlation of HOMA-IR with age, FPG, TG and BMI of the participants (p < 0.05).CONCLUSION: Higher percentage of insulin-resistant participants was of female gender and was adolescents. In general, insulin resistant obese children and adolescents tend to have a worse metabolic profile in comparison to individuals without insulin resistance. It is of note that the highest insulin resistance was also linked with the highest concentrations of triglycerides.

Early Regenerative Modifications of Human Postmenopausal Atrophic Vaginal Mucosa Following Fractional CO2 Laser Treatment.

Abstract: BACKGROUND: Postmenopausal women experience undesired symptoms that adversely affect their quality of life In the recent years, a specific 12 - week fractional CO2 laser treatment has been introduced, with highly significant relief of symptomsAIM: The aim of this paper is the identification of the early modifications of structural components of atrophic vaginal mucosa induced by laser irradiation, which is responsible for the restorative processesMATERIAL AND METHODS: We investigated by microscopical, ultrastructural and biochemical methods the modifications of the structural components of postmenopausal atrophic vaginal mucosa tissues after 1 hour following a single fractional laser CO2 applicationRESULTS: In one hour, the mucosal epithelium thickens, with the maturation of epithelial cells and desquamation at the epithelial surface In the connective tissue, new papillae indenting the epithelium with newly formed vessels penetrating them, new thin fibrils of collagen III are also formed in a renewed turnover of components due to the increase of metalloproteinase - 2 Specific features of fibroblasts support stimulation of their activity responsible of the renewal of the extracellular matrix, with an increase of mechanical support as connective tissue and stimulation of growth and maturation to epithelium thanks to new vessels and related factors deliveredCONCLUSION: We found the activation of regenerative mechanisms expressed both in the connective tissue - with the formation of new vessels, new papillae, and new collagen - and in the epithelium with the associated thickening and desquamation of cells at the mucosal surface

Exploring the Gingival Recession Surgical Treatment Modalities: A Literature Review.

Abstract: Gingival recessions present complex soft tissue pathology, with a multiple aetiology and a high prevalence which increases with age. They are defined as an exposure of the root surface of the teeth as a result of the apical migration of the gingival margin beyond the cementum-enamel junction, causing functional and aesthetic disturbances to the affected individuals. Aiming to ensure complete root coverage and satisfying aesthetic outcomes, a wide range of surgical techniques have been proposed through the decades for the treatment of the gingival recessions. The following literature review attempts to provide a comprehensive, structured and up-to-date summary of the relevant literature regarding these surgical techniques, aiming to emphasise for each technique its indications, its long-term success and predictability, its advantages and disadvantages about each other.

Detection of Biofilm Producing Staphylococci among Different Clinical Isolates and Its Relation to Methicillin Susceptibility.

Abstract: AIMS: To evaluate three in vitro phenotypic methods; tissue culture plate, tube method, and Congo red agar for detection of biofilm formation in staphylococci and assess the relation of biofilm formation with methicillin resistance and anti-microbial resistance. METHODS: The study included 150 staphylococcal isolates. Biofilm detection in staphylococci was performed using tissue culture plate, tube method, and Congo red agar. RESULTS: Tissue culture plate, tube method, and Congo red agar detected 74%, 42.7%, and 1.3% biofilm producing staphylococci respectively. S. aureus isolates were more common biofilm producers (53.2%) than CONS (46.8%). Biofilm production in CONS species was highest in S. hemolyticus (57.7%). Tube method was 51.4% sensitive, 82.1% specific. As for Congo red agar, sensitivity was very low (0.9%), but specificity was 97.4%. Biofilm producers were mostly; isolated from blood specimens (82.6%) and detected in methicillin-resistant strains 96/111 (86.5%). They were resistant to most antibiotics except vancomycin and linezolid. CONCLUSIONS: Tissue culture plate is a more quantitative and reliable method for detection of biofilm producing staphylococci compared to tube method and Congo red agar. Hence, it can still be used as a screening method for biofilm detection. Vancomycin and Linezolid are the most sensitive antibiotics among biofilm producing staphylococci.

Male Infertility and Sperm DNA Fragmentation.

Abstract: BACKGROUND: One of the main factors affecting male infertility is DNA fragmentation in sperm. Male infertility is a heterogeneous group of disorders, known causes account for only 30-50%, and unknown cause (idiopathic) constitute the rest. Infertility involves nearly 15% of couples in the reproductive age, and only the male problem involves about 40% of the problems.AIM: We have studied our DNA damage to sperm cells of a group of infertile males (113 patients) with abnormal sperm parameters (oligoasthenospermia and oligospermia) and a group of male patients (80 patients) with normal semen parameters (normospermia) to document whether the Sperm Chromatin Dispersion (SCD) analysis could increase the information obtained from the sperm routine analysis to explain the causes of infertility.MATERIALS: A group of 193 patients were analysed, 113 patients in the working group and 80 patients in the control group were screened. The ejaculate samples were taken by the patient to whom the reason for the analysis was explained. All patients were from the Republic of Kosovo. Samples are collected from 2014/2018. Sperm Chromatin Dispersion (SCD) analyses in the ejaculate were analysed by the Biolab Zafi laboratory in Peja.RESULTS: Clinical data were compared between the two groups by one-way ANOVA, mean ± SD, student's t-test. A p-value of less than P < 0.05% was considered statistically significant. Outcomes: In our study, we have gained significant (P < 0.05) results in the workgroup and the control group across all hormonal parameters, sperm parameters, and fragmented DNA in the sperm.CONCLUSION: Based on our obtained results we can conclude that DNA fragmentation in spermatozoa is useful in the selection of unsuitable DNA sperm for use in ART methods. We conclude that our DNA fragmentation analysis results are encouraging and can be used for diagnostic purposes in determining male infertility.

Quality of Life in Children with Asthma versus Healthy Children

Abstract: BACKGROUND: Asthma is the most prevalent chronic disease in the pediatric age group. The disease affects different aspects of the children's lives, such as physical, emotional, social and educational aspects. Thus, more focus has been on the quality of life in these patients rather than the duration of their illness in recent years.AIM: This study examined the different aspects of quality of life in asthmatic children for the first time in this geographic area.METHODS: The study was cross-sectional conducted in 2015-2016. The asthmatic group was 100 patients aged 8 to 12 admitted to the Asthma and Allergy Clinic of Ghaem Hospital (as) in Mashhad with the control group composed of 100 healthy children of the same age and gender. The standard questionnaire pedsQLTM was used for comparing the quality of life of children in the two groups. Statistical analysis was SPSS23 with P-value less than 0.05, which was statistically significant.RESULTS: In each group, 58 patients were boys, and 42 were girls. In a comparison of the quality of life of children, the asthma group with a mean total score of Peds QL 20.99 ± 12.54 compared to the healthy children with a mean total score of Peds QL of 8.8 ± 5.41 had a lower quality of life (P < 0.001). Moreover, regarding various aspects of quality of life asthma group had a lower quality of life in physical performance, emotional performance and performance in school (P < 0.001). Nonetheless, there was no significant difference between the two groups considering social function (P = 0.267). Examining the relationship between Peds QL score of patients with asthma with various variables was indicative of the fact that Peds QL scores were significantly correlated with the gender of the patients, showing better quality of life in the girls (P = 0.001).CONCLUSION: The results indicated that children with asthma have a significantly lower quality of life compared with healthy children of the same age. Also, in examining the different aspects of quality of life, these children had a lower quality of life in physical performance, emotional performance, and performance at school, and were at the level as that of healthy children only in social performance.

Effect of Exposure to Cement Dust among the Workers: An Evaluation of Health Related Complications.

Abstract: BACKGROUND: Cement contains various types of chemicals in addition to lime and silica, and such chemicals cause different health complications and pathogenesis in addition to respiratory disorders. The most important occupational hazards for cement workers are allergy and complication related to respiratory system.AIM: The current study was performed by analysing the questionnaire distributed among the workers and also by the sputum collected from them to study the general health conditions and other life activities.METHODS: Sputum samples were assayed for cytological analysis by Hematoxylin and Eosin staining.RESULTS: In this study, it was observed that majority of these workers suffered from different types of respiratory complications, such as a cough, asthma and lung infections. In addition to this, few subjects showed allergy and other complication like hypertension, diabetes and backache. Moreover, cytological analysis of the sputum was made, and it was observed that majority of the subjects showed severe inflammation.CONCLUSION: Based on these finding, we concluded that long-term cement dust exposure and inhalation causes respiratory complications due to epithelial tissue damage and that can lead to secondary complications as well.