Bone regeneration and graft material resorption in extraction sockets grafted with bioactive silica-calcium phosphate composite versus non-grafted sockets: clinical, radiographic, and histological findings

Purpose@#The purpose of the present study was to evaluate the effect of silica-calcium phosphate composite (SCPC) granules on bone regeneration in extraction sockets. @*Methods@#Ten patients were selected for a split-model study. In each patient, bone healing in SCPC-grafted and control ungrafted sockets was analyzed through clinical, radiographic, histomorphometric, and immunohistochemical assessments 6 months postoperatively. @*Results@#A radiographic assessment using cone-beam computed tomography showed minimal ridge dimension changes in SCPC-grafted sockets, with 0.39 mm and 1.79 mm decreases in height and width, respectively. Core bone biopsy samples were obtained 6 months post-extraction during implant placement and analyzed. The average percent areas occupied by mature bone, woven bone, and remnant particles in the SCPC-grafted sockets were 41.3%±12%, 20.1%±9.5%, and 5.3%±4.4%, respectively. The percent areas of mature bone and woven bone formed in the control ungrafted sockets at the same time point were 31%±14% and 24.1%±9.4%, respectively. Histochemical and immunohistochemical analyses showed dense mineralized bundles of type I collagen with high osteopontin expression intensity in the grafted sockets. The newly formed bone was well vascularized, with numerous active osteoblasts, Haversian systems, and osteocytes indicating maturation.In contrast, the new bone in the control ungrafted sockets was immature, rich in type III collagen, and had a low osteocyte density. @*Conclusions@#The resorption of SCPC granules in 6 months was coordinated with better new bone formation than was observed in untreated sockets. SCPC is a resorbable bone graft material that enhances bone formation and maturation through its stimulatory effect on bone cell function.Trial Registration: ClinicalTrials.gov Identifier: NCT03897010

Bone regeneration and graft material resorption in extraction sockets grafted with bioactive silica-calcium phosphate composite versus non-grafted sockets: clinical, radiographic, and histological findings

Purpose@#The purpose of the present study was to evaluate the effect of silica-calcium phosphate composite (SCPC) granules on bone regeneration in extraction sockets. @*Methods@#Ten patients were selected for a split-model study. In each patient, bone healing in SCPC-grafted and control ungrafted sockets was analyzed through clinical, radiographic, histomorphometric, and immunohistochemical assessments 6 months postoperatively. @*Results@#A radiographic assessment using cone-beam computed tomography showed minimal ridge dimension changes in SCPC-grafted sockets, with 0.39 mm and 1.79 mm decreases in height and width, respectively. Core bone biopsy samples were obtained 6 months post-extraction during implant placement and analyzed. The average percent areas occupied by mature bone, woven bone, and remnant particles in the SCPC-grafted sockets were 41.3%±12%, 20.1%±9.5%, and 5.3%±4.4%, respectively. The percent areas of mature bone and woven bone formed in the control ungrafted sockets at the same time point were 31%±14% and 24.1%±9.4%, respectively. Histochemical and immunohistochemical analyses showed dense mineralized bundles of type I collagen with high osteopontin expression intensity in the grafted sockets. The newly formed bone was well vascularized, with numerous active osteoblasts, Haversian systems, and osteocytes indicating maturation.In contrast, the new bone in the control ungrafted sockets was immature, rich in type III collagen, and had a low osteocyte density. @*Conclusions@#The resorption of SCPC granules in 6 months was coordinated with better new bone formation than was observed in untreated sockets. SCPC is a resorbable bone graft material that enhances bone formation and maturation through its stimulatory effect on bone cell function.Trial Registration: ClinicalTrials.gov Identifier: NCT03897010

Burden of pediatric influenza A virus infection post swine-flu H1N1 pandemic in Egypt

OBJECTIVE@#To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection - post swine flu pandemic era - using rapid influenza diagnostic tests.@*METHODS@#During two years (2010 & 2011), 1 200 children with influenza like illness or acute respiratory tract infections (according to World Health Organization criteria) were recruited. Their ages ranged from 2-60 months. Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test.@*RESULTS@#Influenza A virus rapid test was positive in 47.5% of the children; the majority (89.6%) were presented with lower respiratory tract infections. Respiratory rate and temperature were significantly higher among positive rapid influenza test patients.@*CONCLUSIONS@#Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children. It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic.

multi dimensional grading system for assessment and follow up of COPD

Recently, the BODE [body mass index, airflow obstruction, dyspnea and exercise capacity] index, a multidimensional grading system was shown to be better than FEV1 in predicting the risk of hospitalization and death among patients with COPD. Evaluation of BODE [body mass index, air flow obstruction, dyspnea and exercise capacity] index as better predictor of hospitalization in COPD patients than FEV1 alone. Design: Randomized, double blind, prospective study. Methods: This study was conducted on 50 patients, with wide range of severity of COPD their age range was from age 32 - 81 years, including 49 males and 1 female, with smoking index 897.115 +/- 53.75, all patients provided written informed consent. They were from the outpatient clinic and others were admitted as inpatient in Ain Shams University hospital. All patients were subjected to the following: Complete history taking, Careful physical examination, Chest x-ray Routine investigation [CBC, ESR, kidney function, liver function and ECG], Arterial blood gas of admitted patients and O2 saturation for outpatient clinic, Measurement of spirometric lung function tests, The BODE index [body mass index, air flow obstruction, dyspnea and exercise capacity] was calculated for each patient, for calculation of the BODE index, we used suggestive model. Patient was followed up for 6 months after doing the test to know number of hospitalization and mortality during this period. Comparison was done between COPD staging as defined by GOLD and BODE index as a predictor of hospitalization during follow up period. In this study using FEV1 [as defined by GOLD] alone as a single prediction of hospitalization of COPD patients the results were statistically significant as shown the incidence of hospitalization in stage 1 was 0%, Stage II was 31%, in stage III was 66% and stage IV was 75%, and by using BODE index as a predictor of risk of hospitalization in COPD patients the results were statistically highly significant as shown the incidence of hospitalization in Quartile BODE index 1 [0-2] was 0%, in quartile 2 [3-4] was 30%, in quartile 3 [5-6] was 58% and quartile 4 [7-10] was 80%. It is noticed that there were statistically differences between two systems as prediction of hospitalization using BODE index was highly statistically significant. from the present study we conclude that the BODE staging system, which includes in addition to FEV1 other physiologic and clinical variables, helps to better predict hospitalization in patients with COPD. The BODE index is simple to calculate and requires no special equipment. This makes it a practical tool of potentially widespread applicability

Does addition of endobronchial ultrasound improves the classification of suspicious lesions detected by autofluorescence bronchoscopy?

Autofluorescence bronchoscopy [AFB] may improve sensitivity at the cost of specificity when it is used to identify suspicious bronchial mucosal lesions not seen by conventional white light bronchoscopy. Thus, it seems useful to study these lesions additionally with endobronchial ultrasound [EBUS] for further classification of dignity of suspicious lesions aiming in improving the positive predictive value [PPV] of AFB. This study aims to answer the following question: Does addition of EBUS improves the classification of suspicious lesions detected by AFB? Fifty five subjects with suspected lung cancer referred for AFB examination for different indications were recruited for this study. Rigid and Fiberoptic bronchoscopic examination were done followed by AFB then EBUS and finally samples from suspicious sites were taken for histopathological examination. The addition of EBUS to AFB improves PPV from 72.7% in AFB alone to 100% in AFB+EBUS in case of benign suspicious lesions detected by AFB with a negative predicted value [NPV] of 60% and with a sensitivity and specificity of 75% and 100% respectively for AFB+EBUS. While EBUS addition to AFB improves PPV from 60.6% in AFB alone to 95.2% in AFB+EBUS in case of malignant suspicious lesions detected by AFB with a NPV of 100% and with a sensitivity and specificity of 100% and 92% respectively for AFB+EBUS. Thus, the addition of EBUS improves the classification of suspicious lesions detected by AFB with its great implication on further patient management and combining AFB [for tumor localization] to EBUS [for depth estimation] may provide a reliable method of staging and choice of treatment modality of lung cancer

Study of gastro esophageal reflux disease in COPD patients

This study included 30 COPD inpatients in chest and internal medicine departments in Ain Shams University Hospital, 15 of them with moderate COPD and 15 of them with severe COPD [by Gold 2007], [1] 25 were males and 5 were females [active or passive smokers]. The aim of the work was to study the prevalence of GERD in COPD patients and its effect on the number of exacerbations of COPD. Both groups were subjected to history taking, full clinical examination, full laboratory investigations, radiography, spirometry, arterial blood gases and upper GIT endoscopy and biopsy. Results revealed that the prevalence of GERD in COPD patients was 53.3% in the moderate group, 73.3 in the severe group [total= 63.3%] by endoscopy and was 66.6% in the moderate group, 93.3% in the severe group [[total= 80%] by biopsy being more prevalent in the severe group of COPD. GERD severity increases as the degree of COPD increases [there were more patients with advanced grades among severe COPD than the moderate group]. GERD increases with increase in the smoking [pack/year] both in moderate and in the severe groups. Moreover, there was increase in the frequency of exacerbations of COPD in GERD patients both in moderate and in the severe groups. From this study we conclude that GERD is common in COPD patients being more among severe COPD. Also GERD increases the number of exacerbations of COPD

Interventional bronchoscopy: ain Shams University Hospital experience

Bronchoscopy has evolved considerably in our hospital. During recent years, we implemented the concept of interventional bronchoscopy [IB] for the first time in Egypt. IB is defined as a diagnostic and invasive therapeutic interventions that extend beyond routine Flexible bronchoscopy. In this article, we will review our clinical experience with IB during the last five years as regards methodology requirements, available equipments, clinical applications and presentation of selected research outcomes. We retrospectively reviewed all available reports of therapeutic IB performed in our bronchoscopy unit to determine the indications, application sites, methods of disobliteration and complications of therapeutic IB. In addition, recent interesting research work done on endobronchial ultrasound, autofluorescence bronchoscopy, Nd: YAG laser bronchoscopy and endobronchial electrocautery was reviewed. In order to perform an interventional procedure, well-equipped facilities, trained personnel, preprocedure evaluation, and monitoring are mandatory. More than 500 invasive therapeutic interventions were performed in the past 5 years. The results and analysis of these IB were reviewed. We concluded from the presented data that IB has quickly gained recognition and drawn interest with its promising results. Much effort is needed to overcome challenges facing IB awareness, financial concerns, training and verification of competency in our country

Health effects due to exposure to flour dust in some Egyptian governorates

Background: Exposure to flour dust occurs across a range of food industries such as grain mills, flour mills and baking factories

Subjects and Methods: Two flour mills were randomly selected, they located in South Cairo [Ezz El-Din Mills] and in Giza [El-Haram Mills] were investigated in the present study. Sixty exposed male workers, comprising the work force at the flour mills [occupationally exposed], sixty exposed males living nearby the mills [environmentally exposed] and one hundred unexposed controls were examined. Six samples were taken from each unit making a total of 12 samples from both mills. Twelve samples were taken from the external environment about 200 meters from the mill in a windward position and from control areas to determine the concentrations of inhalable flour dust. Air samples for microbiological analysis were taken. All subjects completed a questionnaire on respiratory symptoms. Pulmonary function tests including, Forced Vital Capacity [FVC], Forced Expiratory Volume in one second [FEV1] and their percent of predicted values were estimated. Skin testing was done to persons exposed to flour dust either occupationally or environmentally and also to the control group

Results: aerial microbial contamination differed greatly in the various areas of the mill; the mean values of contamination by total bacteria were significantly different at the points analyzed. The filling area [41.11 CFU/ m[3]] was greater than the following grain processing areas [milling area 5.15 CFU/m[3] sieving unit 4.63 CFU/m[3], cleaning area 3.68 CFU/m[3], storage area 4.33 CFU/M[-3] and the nearby external environment 3.06 CFU/m[3], [P< 0.001]. The highest levels of Aspergillus were found in the filling and bran- collecting areas. Similarly, Botrytis, Cladosporium and Penicillium were found in high concentration in the same areas. The differences in mean values for moulds at different sampling points were statistically significant [P<0.001]. Mean flour dust concentrations above 10mg/m[3] were observed in all areas of the mill and the highest concentrations were found in filling areas [19.27 mg/m[3]]. The mean values of dust concentrations differed significantly at the point analyzed [P<0.001]. Analysis by symptoms showed a statistically significant greater prevalence of asthma and wheezing in environmentally exposed persons to flour dust compared to controls [P<0.05], while in the occupationally exposed workers, there was a statistically significant greater prevalence of chronic bronchitis, chronic cough or phlegm, asthma, wheezing, running nose and eczema than in control group [P<0.05]. FVC%, FEV1%, FEV1/FVC% values were significantly decreased in flour exposed subjects [occupationally or environmentally] compared to control subjects [P<0.001]. A positive skin test to wheat flour antigen was found in 18 out of 60 environmentally exposed subjects [30%], in 35 out of 60 flour exposed workers [58.3%] and in 4 out of 100 controls [4%], this difference was highly significant [P<0.001]. Subjects with skin test positive to flour antigen were found to have significantly lower values of baseline pulmonary function parameters than subjects with negative skin test to flour antigen among flour-exposed workers, environmentally exposed individuals and controls [P<0.05]

Conclusions: Subjects exposed to flour dust are at greater risk of developing respiratory symptoms, asthma and chronic bronchitis

Recommendations: Critical evaluation of indoor air quality in different environments especially residential settings and qualitative assessment of microbiological pollutants is mandatory to establish indoor air quality standards