Effect of cementation,cement type and vent holes on fit of zirconia copings

Objectives

To investigate the effect of cementation, cement type and vent-holes on the marginal and internal fit of Zirconia (Zr) Copings.

Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience

Purpose

We report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.

Materials and Methods

Since January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.

Results

Technical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.

Conclusion

Sharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.

     

Epidemiology of football injuries in Asia: A prospective study in Qatar

ObjectivesTo investigate the incidence, characteristics and patterns of football injuries at club level in Qatar.DesignProspective cohort study.MethodsData were prospectively collected from the first division football league clubs in Qatar, in accordance with the international consensus statement on football injury epidemiology. An injury was defined as any physical complaint sustained during football activity resulting in the inability to participate fully in the next training or match. Individual injuries and exposure of each player were recorded by the medical staff of each team over one season.ResultsA total of 217 injuries were recorded, with an injury rate during matches of 14.5/1000 h (95% CI: 11.6–18.0) compared with 4.4/1000 h during training sessions (95% CI: 3.7–5.2). More than one third of all injuries were muscle strains (36.4%). Hamstring strains (54.4% of all muscle strains) exhibited a higher incidence than all other injury types (p < 0.001). The thigh was the most frequent injury location (41.9%, p < 0.001). Reinjuries (15% of total injuries) were mainly comprised of muscle strains associated with a higher severity compared with new injuries.ConclusionsDespite the different environmental, social and cultural setting, our findings are comparable with previous data from European club football, confirming the previous finding at national team level that there are no regional peculiarities of football injuries in this part of the Asiatic continent.The relatively high overuse injury incidence rate and the high recurrence rate for (severe) thigh muscle strains, especially during games, warrants prevention strategies.     

Outcomes of patients with multiple sclerosis at a neurorehabilitation unit in Saudi Arabia

Objectives:To assess the impact of inpatient multidisciplinary rehabilitation on a Saudi Arabian population of patients with multiple sclerosis (MS).Methods:We retrospectively analyzed the data of patients with MS who underwent inpatient rehabilitation between 2009 and 2015 at King Fahad Medical City (KFMC). Differences in Functional Independence Measure (FIM) scores (used in rehabilitation settings to assess the functional independence of patients) and length of stay (LOS) were measured between patients of different ages, sexes, and types of MS and analyzed using the independent t-test. The Pearson correlation coefficient was used to investigate the correlation between FIM, LOS, and other variables.Results:In total, 24 patients were identified, with an average age of 36 years. The average age at disease onset was 31 years. Disease duration ranged from 1-20 years, with a mean of 7 years. The most common type of MS was relapsing-remitting (45.8%). The mean FIM score at admission was 77.5 and at discharge 97.25. Functional independence measure gain ranged from 2-51, with a mean of 18.58. Functional independence measure efficiency (FIM gain divided by LOS) ranged between 0.09-0.95. The length of stay ranged between 21-95 days, with a mean of 37.79 days. There was a significant association between age and FIM efficiency (p=0.043).Conclusions:Inpatient rehabilitation is an important intervention that improves the functional independence of patients with chronic MS.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating autoimmune disease with a female preponderance and an estimated prevalence of 30-190 cases per 100,000 people in Europe.1 Because of its early onset, progressive course, and long survival time, MS can lead to long-term disability with a significant negative impact on personal and social life.2,3 Among neurologic diseases, it is the third most common cause of disability, with 50% of patients requiring a walking aid and 10% requiring a wheelchair within 15 years of onset; within 25 years of onset, more than 90% of patients experience significant functional impairments.4,5 Life expectancy in patients with MS is reduced by about 5-10 years compared with age-matched individuals without MS.6 Around 2 million people worldwide are affected by MS.7 In young adults, this disabling neurodegenerative disease of the central nervous system is considered the leading cause of non-traumatic disability.8 In the Middle East, the risk of MS has recently been reported to be moderate to high.9 The Kurtzke classification places the Middle East in a low-risk zone for MS; however, a moderate-to-high prevalence in areas within the region (31-55 cases per 100,000 individuals), especially among women, has recently been reported.10,11 Thus, MS represents a considerable burden to Middle Eastern countries. In the Kingdom of Saudi Arabia, the prevalence of MS is poorly documented. Reviews of epidemiologic studies have suggested that it is underdiagnosed and that its prevalence is increasing.10,11 A few studies have reported an increase in the prevalence of MS in the Kingdom of Saudi Arabia to 40/100,000 in 2008 from 25/100,000 in 1998.9,12 Likewise, there are no data on the effects of inpatient rehabilitation in the Arabian Peninsula. In the literature, common treatment strategies are based on a combination of pharmacotherapy and rehabilitation. In daily practice, multidisciplinary rehabilitation (MDR) is often recommended to patients with MS. However, the evidence regarding the outcomes of MDR is contradictory. Some trials have reported improvements in impairment and in the mental component of a health-related quality of life measure, but others have shown that MDR improves the experience of people with MS in terms of activity and participation without changing the level of impairment.13,14-16 The overall evidence on the efficacy of MDR is limited by variation in the clinical presentation of MS and problems associated with study methodology.13 In this study, we assessed the impact of short-term inpatient MDR in a Saudi-Arabian population of patients with MS to identify the clinical predictors of effective rehabilitation treatment. At KFMC, both inpatient and outpatient services are included in the neurorehabilitation program. King Fahad Medical City treats patients from all regions of the country, including those internally transferred from the National Neuroscience Institute within KFMC. The integrated neurorehabilitation program was deemed to meet the standards of the Commission on Accreditation of Rehabilitation Facilities.17     

Caffeine prevents sleep loss‐induced deficits in long‐term potentiation and related signaling molecules in the dentate gyrus

We have previously reported that caffeine prevented sleep deprivation‐induced impairment of long‐term potentiation (LTP) of area CA1 as well as hippocampus‐dependent learning and memory performance in the radial arm water maze. In this report we examined the impact of long‐term (4‐week) caffeine consumption (0.3 g/L in drinking water) on synaptic plasticity ( Alhaider et al., 2010 ) deficit in the dentate gyrus (DG) area of acutely sleep‐deprived rats. The sleep deprivation and caffeine/sleep deprivation groups were sleep‐deprived for 24 h by using the columns‐in‐water technique. We tested the effect of caffeine and/or sleep deprivation on LTP and measured the basal levels as well as stimulated levels of LTP‐related molecules in the DG. The results showed that chronic caffeine administration prevented the impairment of early‐phase LTP (E‐LTP) in the DG of sleep‐deprived rats. Additionally, chronic caffeine treatment prevented the sleep deprivation‐associated decreases in the basal levels of the phosphorylated calcium/calmodulin‐dependent protein kinase II (P‐CaMKII) and brain derived neurotrophic factor (BDNF) as well as in the stimulated levels of P‐CaMKII in the DG area. The results suggest that chronic use of caffeine prevented anomalous changes in the basal levels of P‐CaMKII and BDNF associated with sleep deprivation and as a result contributes to the revival of LTP in the DG region.     

Occupational health in Saudi Arabia

The Kingdom of Saudi Arabia is rapidly industrializing, and the economy is now less dependent on oil. The future of industrial growth is very bright. Two industrial complexes (at the Arabian Gulf and the Red Sea coasts) of eight provide the basis for the Kingdom s programs to develop hydrocarbon-based and energy-intensive industries. Expatriates form the driving workforce in industry. Today, more Saudis are being recruited and trained to man the factories. Occupation-related disorders in industry vary from minor irritations to injuries and cancers. However, the risk of massive releases of toxic chemicals is not great. The national Occupational Health Service directorate is based at the Ministry of Health. Together with the Ministry of Labor, it assumes the overall supervision of industrial health and safety. However, there are constraints the most important of which is the lack of enough qualified Saudis in this field.     

Thoratec ventricular assist devices in pediatric patients: update on clinical results

Particularly in pediatric patients, mechanical circulatory support remains a clinical challenge. We analyzed the Stanford experience with use of the Thoratec ventricular assist device (VAD) in children and adolescents and data from the company's voluntary database. Through January 2005, 209 patients up to 18 years of age have been supported with the Thoratec VAD worldwide. Mean age was 14.5 years (range 5-18 years), mean weight was 57 kg (range 17-118 kg), and mean body surface area was 1.6 m2 (range 0.7-2.3 m2). The majority of patients were supported for cardiomyopathies (55%) and acute myocarditis (25%). A minority (6%) was treated for end-stage congenital heart disease. Average duration of support was 44 days (0-434 days). Overall survival to transplantation or weaning off the device was 68%. Survival rates were higher for patients with cardiomyopathies (74%) and acute myocarditis (86%) compared with patients with congenital heart disease (27%). We performed a subanalysis in small children with a body surface area of less 1.3 m2. This subgroup had a higher incidence of congenital heart disease and a slightly lower survival (52%). Aspects of the particular risks and device management in these small patients are discussed.