Association between helicobacter pylori infection and autoimmune hashimoto's thyroiditis

Background: Autoimmune thyroid diseases are multifactorial conditions that result from genetic predisposition in combination with environmental risk factors. Some bacteria and viruses are suspected of being able to mimic the antigenic profile on the thyroid membrane and play an important role in the onset of auto immune diseases

Object: The aim of this study was directed to investigate the association between helicobacter pylori infection and Hashimoto's thyroiditis

Methodology: The present study included 100 subjects divided into two groups: Patient group: this group included 70 patients, chosen from attending outpatient medical clinic patients and were newly diagnosed as having Hashimoto's thyroiditis guided by clinical diagnosis and detection of TSH, free T3, free T4, thyroperoxidase antibodies [TPOAbs] and Thyroglobulin antibodies [TgAbs] in serum samples. Control group: This group included 30 age- and sex-matched apparently healthy individuals with normal thyroid profile [TSH, freeT3 and freeT4]

Results: In the present work, there was abnormal elevation of TSH in 60 patients [85.7%], compared to just one subject [3.3%] of control group with statistically significant difference between groups. In the present work, there was significant and proportional [positive] correlation between HPIgG and each of TPO and ATG values

Conclusions:Our results showed significant association between Hashimoto's thyroiditis and HP infection. This association might be related to the disease severity, and might reflect the need of adding anti-HP medications as additional choice in management of Hashimoto's thyroiditis

Rotational tendencies and their influence on surveying and designing of removable partial denture: theoretical considerations with literature review

Rotational tendency is an important factor that determines the way in which all kinds of removable partial dentures [RPDs] behave during function. However, a literature review revealed lack of comprehensive quantitative presentation about the problem. The purpose of this article was to investigate this assumption and explain the importance of rotational tendency using diagrammatic as well as mathematical evidence. The presented diagrams and mathematical equations were used to explore different aspects related to the function of RPDs such as the way in which the guiding planes behave and interact with the tilt of the cast [decided path of insertion] to govern their retentive and stress breaking potential as well as other aspects related to RPD service. New evidence that supports considering zero tilt during RPD designing is also presented in the contest of this article. Rotational tendency is an important factor that influences the way in which RPDs function. The study approached the topic in a quantitative way and prescribed simple mathematical formulas that can be used in assessing different treatment plans. Accounting for this during RPD, surveying and designing steps should contribute to the quality improvement of this still applicable dental service. In addition, the quantitative approach carries the potential of increasing the predictability of the outcome when different factors related to RPD designing are manipulated. It is extremely important to consider the interactions that take place between the inclination of the desired path of insertion and the retention, stabilizing and stress breaking potential of the different RPD components

Accuracy of multidetector computed tomography coronary angiography in the diagnosis of coronary artery disease

The standard of reference diagnosis of CAD is the conventional coronary angiography. However its invasive nature necessitates a new non-invasive imaging modality. MSCT coronary, angiography is a new development non-invasive technique in the diagnosis of coronary disease. The aim of this study is to investigate the accuracy of 64-slice CT coronary angiography for assessing coronary artery disease in comparison with conventional coronary angiography. The study included 45 patients out of 50 patients with suspected coronary, artery disease underwent both MSCT coronary angiography and conventional coronary angiography. The total sensitivity and specificity of MSCT coronary, angiography were 99% and 94.5% respectively and the overall accuracy was 95.5%. The negative predictive value was 97.5% while the positive predictive value was 83.5%. Non-invasive CT angiography of the coronary arteries can diagnose and exclude hemodynamically significant coronary stenoses with high accuracy

Fundal placenta percreta: case report and review of literature

Placenta percreta is a very rare but serious complication of pregnancy. We report a case of fundal placenta percreta in a multiparous women during cesarean section that was managed by supra-vaginal hysterectomy. We review the incidence, diagnostic criteria and management options along with a review of similar reports in the literature

Pulmonary veins potential recording in paroxysmal, persistent atrial fibrillation: prevalence and technical aspects

The focal theory of atrial fibrillation [AF] has tempted the electrophysiologists to try radically curing AF via radiofrequency [RF] ablation. Interventional ablation depended on localizing and precisely recording pulmonary vein potentials [PVPs] from the origins of the 4 pulmonary veins [PVs] and less commonly from the ostia of the superior vena cava [SVC], and coronary sinus [CS]. The present study is intended to assess the prevalence and feasibility of recording PVPs in patients [pts] with paroxysmal and persistent AF. The study included 27 pts, [14M, 13F] of variable age groups [27-62 yrs], mean age 39.3 +/- 10 and highlysymptomatic paroxysmal and/or persistent AF. refractory to more than two antianhythmic drugs. all had normal thyroid functions. All pts were subjected to left atrial mapping after a trans-septal puncture and introduction of 2 catheters, one via an 8F femoral sheeth [the Lasso catheter] a special circumferential pulmonary vein catheter for recording, and the other was the ablation catheter. Pulmonary venography preceded the PV-mapping to localize the site and to delineate the size of PV and hence the diameter of the lasso catheter that will be used. A coronary sinus hexapolar catheter was placed distally in the coronary sinus. PV potentials were mapped in both sinus rhythm [for Rt. PVs] and with distal coronary sinus or left atrial appendicular [LAA] pacing [for left PVs]. An arrhythmogenic PV was defined on the basis of documented ectopy [single or multiple] with or without conduction to the LA. PV potentials can be described as sharp electrical activity superimposed on atrial activity, that can be separated by LAA pacing in the Left sided veins. or recorded without pacing from Rt sided veins. One hundred and four out of 108 PVs were mapped. Pulmonary venous potentials could be recorded in 25 out of 27 left superior PVs [92.6%], 21 out of 26 left inferior PV [80.8%], 20 out of 25-" right superior PVs [80%] and in 19 out of 26 right inferior PVs [73%]. Pts were arbitrarily divided according to age into 2 age groups; 14 below 40 and 13 above the age 40y. Compared to the younger age oup, those above 40 yrs. exhibited significant lower prevalence of PVP [3.6 +/- 0.6 Vs 2.6 +/- 1.3 respectively]. proximal CS and the former was superceded by pacing from LAA. PVPs cou1dnt be recorded in 2 out of 27 LSPVs, 5 out of 26 LIPVs, 5 out of 25 RSPVs. 7 out of 26 RIPVs, Four PVs were not mapped due to technical problems. Three cases were complicated with cardiac tamponade the first due to puncture of the LA appendage with the transieptal needle, the case due to extensive ablation and the 3 due to over anticoagulation. Two ps [7.4%] developed mild pericardial effusion that was asymptomatic and disappeared during follow-up and one developed TIA. No mortality was recorded. Pulmonary vein potential recording is an essential prerequiste for successful RE ablation of focal AF using Lasso technique. Our data point to the feasibility anti safety of recording in non rheumatic cases and stress the importance of the learning curve. Left superior, Left inferior, Rt superior, Rt inferior pulmonary veins in that order of frequency are arrhytbmogenic foci generating PV potentials. Left sided and superior PVs are more frequently a source of PVPs representing triggers that initiate AF than right sided and inferior PVs. The prevalence of PVPs recording progressively declines with aging possibly pointing to the increasing role of micro reentry in the genesis of AF and the diminishing of PV triggers. Identification of PVPs is highly important and could be easily detected without pacing in case of Rt sided PVs and with CS or LAA pacing for left sided PVs. Pacing from distal CS was noted to promote better separation of PVPs from the atrial activity than pacing from proximal CS and the former was superceded by pacing from LAA

effect of intraabdominal instillation of lidocaine during gynecological laparoscopic procedures

Although laparoscopic surgery is known to cause less postoperative pain when compared to laparotomy, some patients still suffer from excessive pain, especially during the first stages of recovery. The purpose of this study was to assess the effect of intraperitoneal instillation of lidocaine during gynecological laparoscopic procedures on postoperative pain. The study was a prospective, randomized, double-blinded, placebo-controlled trial. This study included 75 patients who underwent gynecological laparoscopic procedures at Women Hospital - Kusr Al-Aini. Patients were randomly assigned either to a study group that received 120mg of lidocaine intraperitonealy at the end of surgery [n=60] or to a control group that received normal saline [NS] in the same manner [n=15]. The fluid was injected with a sterile syringe through one of the laparoscopy ports at the end of surgery. All patients received the same anesthetic technique. Postoperative pain was evaluated according to postoperative analgesic requirements and by Wong-Baker FACES Pain Rating Scale [WBFS] at 15min, 1h, 2h, 4h, 12h and 24h postoperatively. The [WBFS] score was found to be lower for the study group 1h, 2h and 4h after surgery [p=0.023]. There was no difference in the [WBFS] scores at 15min [p=0.9], 12h [p=0.13] and 24h [p=0.11] after surgery. There was no difference in terms of fentanyl administration during surgery or analgesic consumption following surgery between the study and control groups. The results indicated that intraperitoneal installation of lidocaine was effective at reducing postoperative pain and the need for postoperative analgesics following gynecologic laparoscopic procedures

Conventional Vs non invasive ventilation in acute respiratory failure

Treatment of patients with acute respiratory failure [ARF] often involves mechanical ventilation via endotracheal intubation. Non-invasive positive pressure ventilation [NIV] using Bi-level positive airway pressure [BiPAP] can be a safe and effective means of improving gas exchange. 1] Assess non-invasive positive pressure ventilation [BiPAP] as an alternative way for ventilation in ARF, and to 2] Determine factors that can predict the successful use of BiPAP. Thirty patients with acute respiratory failure [both type I and II] were enrolled in the study and divided into two groups. Group I included 10 patients who were subjected to invasive mechanical ventilation. Group II included 20 patients were subjected to NIV using BiPAP. Both groups were compared regarding the following parameters: Arterial blood gases [ABG] on admission, 30 minutes after beginning of mechanical ventilation, 1[1/2] hour then once daily. Complications namely ventilator associated pneumonia [VAP], skin necrosis and CO[2] narcosis; static compliance and resistance were measured at day one and day two. Compared to group I, group II patients were associated with similar improvement in ABGs data at 30 minutes and at discontinuation of ventilation [Table A]. Group II patients showed significantly lower incidence in VAP [20% Vs 80%], shorter duration of mechanical ventilation [3 +/- 3 Vs 6 +/- 5 days, p=0.006], with shorter length of hospital stay [5.8 +/- 3.6 Vs 8.9 +/- 2.7 days, p=0.011] when compared to group I. Skin necrosis [50%] and CO[2] narcosis [20%] occurred in group II only. Group II patients showed significant difference change in compliance and change in resistance from day I to day II when compared to group I Table [B]. On univariate basis, parameters were analyzed to choose those who were associated with outcome in concern [successful NIV]. The following parameters were identified: Level of consciousness, pH [7.3 +/- 0.03 Vs 7.26 +/- 0.1, p=0.009] PCO[2] [69.16 +/- 13.14Vs 100.97 +/- 12.04] on admission, 1[1/2] hour after NIV, pH [7.37 +/- 0.03 Vs 7.31 +/- 0.17, p=0.005], PCO[2] [53.98 +/- 8.95 Vs 77.47 +/- 5.22, p=0.0001] in whom NIV succeeded and failed respectively. Then multivariate analysis utilizing two different techniques namely [multivariate logistic regression and discriminate analysis] was used. The variable identified was PCO[2] after 1[1/2] hour in the two models with specificity 100%. In patients with acute respiratory failure, non-invasive ventilation was as effective as conventional ventilation in improving gas exchange, associated with fewer serious complications and shorter stay in intensive care. One and half hour trial with NIV can predict success with BiPAP, as shown by an improvement in pH and PCO[2] and overall clinical picture. PCO[2] after 1[1/2] hour could be the sole predictor of successful NIV with 100% specificity

ACE gene polymorphism: a predictor of instent restenosis

Restenosis is the maladaptive response of the coronary artery to Restenosis occurs in 20-50% of patients [Pts] after balloon angioplasty and in 10-30% of patients receiving a stent. Neointimal proliferation is one distinct processes involved and the rennin-angiotensin system has been implicated in its pathogenesis. The level of plasma has been implicated in its pathogenesis. The level of plasma ACE is party under genetic control and the plasma and cellular levels pf ACE are associated with the insertion/deletion [I/D] polymorphism in the ACE gene where DD genotype bearers have higher levels of ACE than either ID or II genotype bearers. Aim: To assess the possible role of ACE gene polymorphism in the pathogenesis of instent restenosis [ISR]. We studies 136 patients having elective or emergency successful angioplasty and of a previously untreated native single coronary artery, including 117 males and 19 females, with a mean age of 52.5 +/- 9.8 years. Besides clinical evaluation, all pts were subjected to routine laboratory measurements, followed by DNA extraction for a peripheral venous sample using the QUIAmp Blood Kit. ACE gene was amplified by PCR-technique [30cycles], then were electrophoresed in agars gel and visualized directly with ethidium bromide staining under an ultraviolet light source to determine the ACE I/D genotypes. Clinical follow-up was performed on monthly basis up to six months for the occurrence of major adverse cardiac events. Angiographic follow-up was done in 93 patients at a mean of 6.17 +/- 2.3 months after PCI using edge detection and segment analysis by the Xcelera catch Philips Intruris QCA program to detect the minimal lumen diameter, reference vessel diameter and segment length before and after PCI and after 6 months follow up in the same views at baseline, to detect acute gain, late lumen loss and binary restenosis rate. ISR was expressed as >/= 50% diameter loss. Out of 136 pts, 93 were available for angiographic follow- up. Those were divided into two groups: 41 pts with angiographic evidence of restenosis [ISR], and 52pts without angiographic evidence of restenosis [NO-ISR]. The homozygous DD genotype was significantly more frequent in the ISR group compared to the NO-ISR group [51.2% vs 11.5%, p=0.005]. The heterozygous ID genotype was significantly more frequent in the NO-ISR group compared to the ISR group [76.9% vs 39%, p=0.005]. The homozygous II genotype was equal in both group [11.5% in ISR vs 9.8% in No ISR, p=0.79]. Compared to the heterozygous ID and the homozygous II, genotypes the homozygous DD genotype, of the ACE gene was more significantly associated with in-stent restenosis. This knowledge may help in the selection of subgroups of patients who will benefit form alternative therapeutic strategies such as CABG surgery or intensive preventive treatment or drug-eluting stent

Cryopreservation of human sperms may insure fertility before exposure to gonadotoxic agents.

A retrospective study was done on three hundred patients complaining of either azoospermia or severe oligospermia. Their ages ranged between nineteen to forty two with a mean of 29 +/- 1 [years]. There were thirty six patients with history of exposure to different gonadotoxic agents such as radiotherapy, chemotherapy as well as mumps infection. Also, there were high FSH level, hypospermatogenesis and complete absence of spermatogenesis. The study showed the marked effect of these gonadotoxic agents on fertility. So, the study recommend cryopreservation of sperms samples for any person who may be exposed to these agents or any surgical manoeuvre which may affect his fertility

results of treatment of spondylolysis and grade-1-spondylolisthesis by Buck's operation

The results of internal fixation and bone grafting of pars defect [Bucks's operation] in 8 adult patients having spondylolysis [4 cases] and Grade-1 spondylolisthesis [4 cases] with symptoms resistant to all forms of conservative treatment, were evaluated. Five patients were males and 3 were females. The average age was 26 years. The degree of slip was less than 4mm. in all cases except one in which the slip was 7mm. None of the cases had dengenerative disc disease. The results were satisfactory in 6 patients and unsatisfactory in 2. We concluded that Buck's operation is an excellent option for treatment of spondylolysis and Grade-1 spondylolisthesis in adults, when conservation fails provided that there is no associated degenerative disc disease and the slip is less than 4mm. With more forward slip the results of this method seems to be highly questionable