Purpose: To evaluate the effect of different wax pattern fabrication techniques on the fit of customized pressed lithium disilicate implant abutments on titanium inserts before and after pressing. The marginal fit results of pressed lithium disilicate implant abutments were then compared with those of milled lithium disilicate abutments. Materials and Methods: After scanning the titanium inserts and designing an implant abutment, wax patterns were fabricated with three techniques (n = 15 each): computeraided design/computer-aided manufacturing (CAD/CAM) milling, 3D printing and conventional layering. The marginal fit (µm) was measured using a stereomicroscope for all the wax patterns before pressing them into the lithium disilicate abutments. The pressed implant abutments were measured again for marginal fit, and the results were compared to those of the milled lithium disilicate abutments. One-way analysis of variance (ANOVA) was used to assess different wax pattern fabrication techniques in each stage before and after pressing. One-way ANOVA was also used to compare the groups of pressed and milled lithium disilicate abutments. Multiple pairwise comparisons were performed using the Tukey post hoc test in each stage. Results: There were statistically significant differences between the marginal fit of the three wax patterns groups (p < 0.001; f = 123.33), wherein the mean marginal fit was the highest for conventionally layered wax patterns (30 ± 13.09) µm. Furthermore, after pressing, there were statistically significant differences between the marginal fit of the three pressed abutments groups (p < 0.001; f = 518.62), wherein the mean marginal fit was the highest for pressed e.max abutments fabricated from conventionally layered wax patterns (25.26 ± 3.9) µm. There was no statistically significant difference between the mean marginal fit of the pressed abutments fabricated from conventional layered wax patterns and that of the milled CAD/CAM abutments. However, the mean marginal fit of the milled CAD/CAM abutments was higher than that of the pressed abutments fabricated from both CAD/CAM wax and 3D printed wax. Conclusion: All the tested fabrication methods provided degrees of accuracy that lie well within accepted limits. The use of pressed lithium disilicate abutments fabricated from conventional layering wax pattern technique should provide a more consistent better marginal fit between the titanium insert and the abutment and may therefore be the preferable fabrication method.
PurposeThe purpose of this study is to compare the efficacy of intratunnel cross-linking combined with intrastromal corneal ring segment (ICRS) implantation versus combined epithelium-off (epi-off) cross-linking and ICRS implantation for the management of keratoconus.MethodsOur study included 20 eyes of 12 patients with moderate-to-severe keratoconus. Group A included 10 eyes that underwent simultaneous ICRS implantation with intratunnel cross-linking. Group B included 10 eyes that underwent simultaneous ICRS implantation with epi-off cross-linking. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere and cylinder, mean and maximum keratometric readings, corneal thickness at pachy apex and thinnest location, as well as corneal hysteresis (CH) and corneal resistance factor (CRF) were compared preoperatively and at 6 months postoperatively.ResultsThe mean UDVA and CDVA improved significantly in both groups with a statistically nonsignificant difference between the groups (P=0.798 and 0.126, respectively). The manifest cylinder decreased significantly in both groups, while the manifest sphere decreased significantly in Group A but nonsignificantly in Group B with a statistically nonsignificant difference between the groups (P=0.773 and 0.111, respectively). Both techniques led to significant flattening of the cornea and a significant decrease of Km and Kmax with a statistically nonsignificant difference between the groups (P=0.312 and 0.857, respectively). There was a statistically significant decrease in CH in both groups postoperatively; however, there was a statistically nonsignificant increase in CRF after both techniques with a statistically nonsignificant difference between the groups in the mean change of CH and CRF (P=0.633 and 0.313, respectively). No intraoperative or postoperative complications were observed in both groups.ConclusionBoth techniques improved the visual and refractive outcomes in cases of moderate and severe keratoconus with no statistically significant difference between the groups; however, simultaneous intratunnel cross-linking and ICRS implantation showed early visual rehabilitation due to the absence of epithelial defect.
The COVID-19 pandemic has had a great impact on chronic diseases, including epilepsy. The imbalance of antiepileptic drugs in case of intercurrent infection with COVID-19 leads to worsening seizures.
A 71-year-old man, followed for post-traumatic epilepsy for 30 years, was stabilized with phenobarbital and topiramate. He presented generalized tonic-clonic epileptic seizures without meningitis. He improved well on midazolam combined with the usual treatment before the diagnosis and worsening of the covid-19. The severity of the lung damage led to hypoxia, recurrence of seizures, and poor prognosis.
The association between covid-19 and epilepsy remains pejorative despite management.
An epileptic seizure should always be considered as a possible manifestation of COVID-19. The article aimed to establish the relationship between covid-19 and the risk of worsening seizures and to demonstrate the severity of the association between covid-19 and epilepsy in elderly patients.
This work was carried out to study the effect of some diets as pollen substitutes on the biological activities and morphological measurements of caged worker bees at different ages. The obtained results indicated that the mean longest life length of caged bees (32 days) was recorded by the liquid yeast (diet A) (Candida tropicalis) at 25% conc. which represented 133.33% of the control (D) (24 days) fed on sugar syrup (1:1). On the other hand, the least life length (21.00 days) which represented 87.50% of the control (D) of caged bees was recorded by the diets; B (400 ml. liquid yeast + 200 gm. soya bean (lipid free) + 300 gm. bran + 100 gm. corn flour + 1000 gm. sugar ) and C (200 gm. dried brewer's yeast (Saccharomyces sp.) at 25% concentration + 400 gm. soya bean (lipid free) + 400 gm. barley (apical + roots) +1000 gm. sugar). Feeding caged bees on liquid yeast (diet A) at 25% conc. resulted in the longest LT 50% (day) (23 days) represented 143.75% in comparison with the control (D) (16 days) fed on sugar syrup (1:1) .While the diets B, C and the control (D) recorded the lowest LT 50% (day) (16 days for each).
The COVID-19 pandemic and its impact on health systems had a significant effect on the management of inflammatory diseases in the long term and myopathies could be signs of COVID-19, making it difficult to diagnose the cause and effect relationship.
An unvaccinated 62-year-old female patient followed for polymyositis was tested positive for COVID-19 on polymerase chain reaction (PCR) of nasopharyngeal swab revealed by dyspnea and rhinorrhea with fever and pulmonary involvement of 75%. She had an enlarged left ventricle with complete left branch block, inaugural diabetes mellitus with ketosis, kidney dysfunction, and inflammatory syndrome. Despite the early initiation of invasive ventilation in combination with the national protocol against covid-19, the patient died on day 4 of care. The best management should anticipate comorbidities and the evolutionary profile would guide the continuation of the treatment. Polymyositis like other rheumatic diseases was associated with a very high risk of developing a severe form of COVID-19. The combination of elder age and comorbidities led to a severe form of COVID-19 and therefore to a poor prognosis. The article aimed to show the severity of the association of covid-19 with polymyositis at the comorbid stage.
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