Clinico-Pathological Profile of Oral Mucocele in a Tertiary Care Centre – A Comparative Study

Background: Oral mucocele are common non neoplastic lesions of the oral cavity that develop either as a result of damage to the duct or obstruction to the duct of minor salivary gland. Histopathologically oral mucoceles are divided into two categories: Extravasation mucoceles often seen in young individuals, the lower lip being the classic location. The second category includes retention mucoceles, which occurs most often in older patients usually located in the floor of the mouth and the inside the cheek. Objectives: This study aims to describe the demographic and histological characteristics of Oral mucocele along with com- parative study between Extravasation mucocele and Retention Mucocele. Method: A total of 32 cases of mucocele diagnosed in the Department of the Pathology, between 2012 and 2019 were re- viewed. The clinical data were recorded and histopathologic diagnosis was made. The study variables included were age, gen- der, type, site, color, etiology, symptoms and dimension of the lesion. Results: A total of 32 cases of oral mucocele cases were studied corresponding to a M:Fratio of 1.13:1. Peak incidence occurred in third decade followed by equally in the first and second decades of life. Extravasation Mucocele was the clinical diagnosis in 59.4% and Retention Mucocele in 40.6%. Most lesions were located in the lower lip (59.3%). Conclusion: This study provides an important insight into demographic and histological profile of oral mucocele lesion. It was concluded that oral mucocele predominantly presented in two histological forms, Extravasation Mucocele which was more common than other lesser common form Retention Mucocele. Although these lesion are easily diagnosed on the basis of clini- cal presentation but sometimes these swelling can mimic other benign mucosal lesion of these region, hence histopathologi- cal examination must be done in order to rule out these lesion and also to note any variation from its normal morphological findings.

Evaluation of Recent Updates Regarding Adherent Placenta, Diagnosis and Management

Background: The adherent placenta is a range of pathologic adherence of the placenta, including placentaincreta, placenta percreta, and placenta accreta. Villous invasion depth determines the severity of thecomplications, and the villi sometimes invade the surrounding pelvic organs. Therefore, any surgical procedurebecomes technically difficult, especially with excessive neovascularity. Objective: The prenatal diagnosis of theadherent placenta has become essential to its management and outcome. In this article, we aimed to review thepublished literature that discussed adherent placenta diagnosis and management. Method: A comprehensivesearch was done using biomedical databases including Medline, and PubMed to study the role of AdherentPlacenta. Keywords used in our search through the databases were “Adherent Placenta”, “Placenta Increta,Placenta Percreta, and Placenta Accreta”, and “Pathophysiology and Management”. Conclusion: The mainstayimaging technique in cases of placenta accreta is ultrasound. Pelvic ultrasound is highly reliable to diagnose orexclude the presence of placental adhesive disorders. However, when the ultrasound results are not conclusive,MRI is recommended, because it has a higher potential benefit. In general, the recommended management of anadherent placenta is planned cesarean hysterectomy with a hysterotomy that avoids the placenta. Appropriatecounseling can be conducted to consider alternative management strategies. A center with a multidisciplinaryteam experienced in the care of the condition should conduct the delivery in order to optimize the response toevery peri and intraoperative complication.

Augmentation of Insulin Secretion Induced by Rhizophora Mucronata and Avicennia ‎Marina Extracts in Streptozotocin-Induced Diabetic Rats

Background: Diabetes mellitus is a chronic metabolic disease and is considered as the third leading cause of death in the developedcountries. Objectives: The aim of this study was to assess the antidiabetic, antioxidant and insulin-enhancing potentials of the aqueous extractsof R. mucronata and A. marina or combination of them. Materials and methods: The effects of daily oral administration of aqueous extract fromthe leaves of R. mucronata, A. marina (400 mg/kg BW for each) and combination of both for 6 weeks on streptozotocin-induced diabetic ratswere evaluated considering the blood glucose and insulin levels in the serum. Oxidant/antioxidants status was assessed in the cardiac andmuscular tissues. Immunohistochemical expression of insulin in the pancreatic tissue was also assessed. Results: Oral administration of theplants extracts alleviated the diabetes-induced changes in serum glucose, insulin and antioxidants status in the heart and muscles compared tothe untreated rats. In addition, these plants enhanced insulin secretion by β-cells of Langerhans as evidence immunohistochemically andbiochemically through calculation of HOMA- β. Conclusion: The extract of R. mucronata exhibited a promising antidiabetic, antioxidant andinsulin-enhancing effects compared with A. marina extract alone or in combination with R. mucronata.

The Efficacy of Nasal Steroids in Treatment of Otitis Media with Effusion: A Comparative Study

Introduction Otitis media with effusion (OME) continues to be an important pediatric clinical problem, and more studies are needed to decide the proper treatment for it. Objective To assess the efficacy of nasal steroids in the management of OME by comparing its results with that of oral steroid and that of nasal saline spray as placebo. Methods This study was carried on 60 patients with OME who were divided into three groups: in group 1, 20 patients received mometasone furoate spray, one puff in each nostril daily, for 3 months; in group 2, 20 patients received oral prednisolone, 5 mg three times per day for the first 3 weeks; in group 3, 20 patients received nasal saline spray, one puff in each nostril daily for 3 months. Results A highly significant difference between systemic or topical (nasal spray) steroid therapy and saline nasal spray was detected (p < 0.001), and the difference between systemic and topical steroid was nonsignificant (p > 0.05). Conclusion Nasal steroid spray can be used as an effective treatment for OME, giving a significant result similar to systemic steroid. Further studies are needed to investigate its use for longer duration and in recurrent cases.(AU)

A Comparative Study of Cardiovascular Risk Factors in Cases of Smoked Nicotine and Chewed Nicotine Users.

Objective: To study the cardiovascular risk factors exposed to tobacco chewing and compare these findings with that of smokers and control subjects. Methods: This study was conducted at Jawaharlal Nehru Medical College, Aligarh. 180 subjects were included in this study. The subjects were divided in three groups. Group I (Tobacco chewers-chewed nicotine), Group II (Smokers-smoked nicotine) and Group III (control subjects). Each group consists of 60 subjects. Various anthropometric and cardiovascular parameters were recorded and compared among these three groups. Results: Significant difference was found for weight and body mass index (p<0.001) between smokers and control subjects. When compared to control subjects, tobacco chewers had significantly higher pulse rate (p<0.001), systolic blood pressure (p<0.011), diastolic blood pressure (p<0.004) and mean arterial pressure (p<0.001) but no significant difference was found between tobacco chewers and smokers.

Seroepidemiology of Toxoplasma infection in blood donors in Jahrom District, Southern Iran

Objective: To identify the anti-Toxoplasma antibodies from blood donors who referred to blood transfusion bases of Jahrom County, using ELISA method. Methods: Based on the prevalence and characteristics method, 400 serum samples were collected from blood donors referred to Jahrom blood transfusion bases, Southern Iran, during 2010–2011, designed at testing by ELISA. IgM and IgG antibodies against Toxoplasma gondii were tested using ELISA kits (Dia-Pro) on serums. The data were analysed by SPSS 19 software. Results: Review of 400 cases, 54 of them were IgG positive for parasites (13.5%) and 346 of those with negative IgG (86.5%). In IgM examination, 1.75%of them have been positive IgM (7 cases) and 98.25% of them were IgM negative (393 cases). By comparing the different group ages, 40–50 year age group had the highest prevalence of IgG positive (17.9%) and the age group of 30–40 years had the highest incidence of IgM negative (2.5%). Conclusions: Due to the serological infection rate of toxoplasmosis obtained from this study, toxoplasmosis should be considered as a significant transfusion risk factor in Jahrom and also in any region with similar situations.

[Does sensory-motor integration exercises affect on static and dynamic balance in children with trainable mental retardation?]

Objective: The purpose of this research was to investigate the effect of sensory- motor integration exercises on static and dynamic balance in children with trainable mental retardation

Materials and Methods:: In this semi experimental research, with Purposive sampling method 40 subjects from GOLHAYE BEHESHT rehabilitation and training center with the mean age 8.4 +/- 2.81 years and mean IQ 30.62 +/- 6.81 participated. All children were pre tested. Then According to both factors [IQ and pretest scores] subjects divided randomly in two [experimental and control] equal groups. Each group were consist of 10 boys and 10 girls .Balance evaluated by balance part of Bruininks - Ossietzky Test of Motor Proficiency were used .experimental group encounter to Sensory stimulation and perform physical exercises during 50 sessions, each session was 45 minutes and 6 times a week . Control group were using the class education programs. After 50 sessions both groups [experimental and control] were post tested

Results: Data analyzed by Uman vitny and observed a significant difference in posttest among experimental and control groups [P<0.05]

Conclusion: Experimental group gained more scores. This research indicated that sensory integration training improve balance [both static and dynamic balance]

Peripheral ulcerative keratitis our challenging experience

A 52 year old male presented with peripheral ulcerative keratitis in the right eye. Patient's history included retinitis pigmentosa, pseu-dophakia [right eye], cataract [left eye], bilateral partial deafness, ischemic heart disease, hypertension, type 1 diabetes mellitus, depression, hyperparathyroidism, hypertriglycemia and renal failure. The patient was on weekly hemodialysis. The peripheral corneal ulceration remained stable until he developed sudden and rapid thinning after eight months of regular follow up and management. Laboratory investigations including immunological studies were negative and we had to rely on treatment based on clinical signs, including the visual acuity, size, depth and staining of the ulcer and perilimbal, episcleral, scleral, corneal and anterior chamber reactions. The patient was treated with medical and conservative approaches and the eye was protected with a plastic shield to avoid injury. Despite our efforts, the patient perforated his eye due to a trivial trauma during sleep. He was managed successfully with cyanoacrylate glue and a bandage contact lens. The anterior chamber reformed after the perforation was sealed and the patient is on a regular follow up with a multidisciplinary approach

[In vitro evaluation of efficacy and toxicity of Amphotericin Bloaded nanocapsules]

Amphotericin B [AmB] is an ancient antifungal drug and proper for treatment of systemic fungal infection. Unfortunately, this antibiotic has shown some side effects such as nephrotoxicity. Therefore, recently new AmB formulated has been prepared for reduced toxicity and increased effectiveness. AmB nanocapsules prepared from polymers such as poly D, L-lactide-coglycolide by means of a solvent displacement technique. Then, the dried nanocapsules prepared by using SiO2 and entrapment efficacy of AmB was measured by spectrophotometry technique. The MICs of these nanocapsules to Candida albicans [ATCC 90028] was also determined by using microdilution method. Then, in vitro toxicity [haemolysis] of the AmB-loaded nanocapsules determined on human red blood cells. The data shows AmB entrapment efficacy for nanocapsules were 75% +/- 0.13.The MICs of AmB-loaded nanocapsules against C. albicans tested were significantly reduced compared to that of free antibiotic. Also, the AmB-loaded nanocapsules found to be 5.89 times less toxic than free AmB on human red blood cells. The results suggest that prepared AmB-loaded nanocapsules in this research may be an appropriate delivery system for AmB to be used in the treatment of fungal infections

Diagnostic accuracy of ultrasonography in traumatic meniscal injury

Ultrasonography is a feasible inexpensive and accurate method for evaluating musculoskeletal injuries, which can be used as the first complementary diagnostic method. US is more sensitive than radiology when evaluating cartilage damage. [Buchman and Fjaramillo 2004] The common cause of knee pain and disability are tears in medial and lateral menisci. To determine accuracy of US in diagnosis of meniscal tears in middle aged patients in relation to MRI. Forty patients [27males and 13 females] with traumatic knee injury after one month of trauma to the knee. were selected from outpatient clinic of rheumatology and physical medicine and rehabilitation department of Bab-Elshareya university hospital. They were subjected to history taking, clinical examination including local [inspection, palpation, range of motion] and special tests as McMurray and Appley tests. Also ultrasonographic examination of the knees was done to evaluate the menisci and magnetic resonance imaging of the affected knees was done as a gold standard. This study was done on forty patients [27 males and 13 females] with their age ranged from 15 and 40 with mean age was [26 +/- 5] years. They were evaluated within one month of injury. All patients were subjected to full history taking, clinical examination, and US and MRI examination of affected knees. Swelling was found in 27[68%] of patients, stiffness was present in 28 [70%] of patients, giving way was present in 25[62%], snapping in 26[65%] and locking was present in 9[22%]of patients. Signs include effusion in 27 [68%] tender medial meniscus [97%] tender lateral meniscus27 [68%] tender popliteal fossa 31[77%], limited flexion in 18[45%] and limited extension in 14 [35%] of patients. Appley test was positive in all patients while McMurray test was positive only in 37 [92%] of patients. MRI examination showed tears in medial menisci in 35 patients and tears in lateral menisci in 15 patients. Ultrasonography had shown tears in 33 of 35 MRI+ve patients with medial tears [94.3%]-ve in 2 [5.7%]menisci, in15 lateral meniscal tears, ultrasonography showed tears in 14[92.9%] and was incorrect in only one [7.12%] meniscus Sensitivity, specificity, positive and negative predictive value of ultrasonography for medial tears were 89%, 66%, 97%, and 66.6% respectively. Regarding lateral meniscus it was 93% 76%, 70%, and 95% respectively. Ultrasonography is an easy, feasible, real-time, and an accurate imaging modality for diagnosis of post traumatic meniscal tears, It has a good correlation with MRI results. This suggests that it can be a useful imaging modality for the diagnosis of traumatic meniscal injuries

Value of MRI and inflammatory markers in assessment of erosive osteoarthritis hand

To investigate the role of MRI and inflammatory markers [serum C reactive protein [CRP] as a marker of erosive osteoarthritis [EOA] of the hand. Thirty three patients, 22 with EOA and 11 with non-EOA of the hand, were included in the study and analysed for radiographic score [RS], number of erosions, and joint count [JC] at clinical observation and at MRI CRP was assayed in a serum sample by a highly sensitive immunonephelometric method. The median [interquartile range] CRP level was 5.2[2.7-7.2] mg/l in the EOA and 2.8 [0.7-5.2] mg/I in the non-EOA group [p = 0.001]. In all patients, CRP correlated with RS [p<0.001], and mainly with JC at clinical observation [p<0.001] and MRI [p<0.001]. The correlation of CRP with RS and JC was confirmed at clinical observation and at MRI in the EOA subgroup, but only with JC at clinical observation in the non-EOA subgroup. CRP levels are higher in EOA than in non-EoA patients. These levels probably reflect the disease activity of EOA, as suggested by correlations between CRP and JC at clinical observation and MRI. BMI, body mass index; CRP, C reactive protein; EOA, erosive osteoarthritis; ESR, erythrocyte sedimentation rate; hsCRP, high sensitivity CRP; MRI, Magnetic Resonance Imaging; IL, interleukin; JC, joint count; OA, osteoarthritis; RS, radiographic score

Clinical differentiation between resistant asthma and chronic bronchiolitis: testing a practical approach

Intractable asthma is a challenging clinical problem. This study was conducted to determine whether a subset of patients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Seventy six patients with Intractable asthma were re-treated with recommended maximal doses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol and ipratropium bromide for 30 days. Thirty five patients were considered as unresponsive and constituted the study group. They underwent high-resolution CT [HRCT] scan following which they were offered with video-assisted thoracoscopic surgical biopsy. Group 1 [n=27] refused biopsy and each was treated with macrolide therapy, while Group 2 [n=8] underwent biopsy, and then received macrolide therapy. The patients were treated and followed for three months. The study group consisted of 27 patients, with a mean age of 46.9 +/- 11.1 years. The mean duration of time between the onset of symptoms and the start of this study was 8.1 years. In group 2, no patient had pathologic findings of asthma, and 7/8 had a form of bronchiolitis. There was significant improvement in dyspnea, cough and pulmonary function indices at the end of the 3-month in both groups [p<0.001]. Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease

Risk factors of male osteoporosis

Osteoporosis [OP] is a growing health problem not only in women but also in men. Significant risk factors of OP include previous fragility fractures, hypogonadism, low calcium intake and use of bone resorbing medications amongst others. To find out risk factors in the induction of osteoporosis in apparently healthy Egyptian males. This study was carried out on one hundred apparently healthy men. Their age ranged from 30-65 years with a mean +/- SD of [44.65 +/- 8.3]. All of them were recruited from the workers of Assiut University Hospital during a period of one year. Complete clinical history included occupational history, smoking habits, physical activity and calcium intake. Complete clinical examination was performed. Laboratory investigations included serum calcium, phosphorus and osteocalcin. Bone Mineral Density [BMD] was measured with calcaneal ultrasound. Sixty three percent of participants were normal BMD, 37% had BMD, 26% were osteopenic and 11% were osteoporotic. Smoking was a strong predictor of BMD. A significant positive correlation was found between BMD and physical activity, body mass index, serum calcium and osteocalcin. Osteoporosis is not only a disease of females, but also it is a disease of males. Smoking, physical inactivity and low body index are significant risk factors. Low serum calcium, low serum osteocalcin and high serum phosphorus are biochemical risk factors of OP in males

Adrenocortical function relation to inflammatory markers in early untreated rheumatoid arthritis

To study adrenocortical function alterations in patients with early rheumatoid arthritis [RA]. 25 untreated patients with new onset RA were studied and compared with 25 age and sex-matched healthy subjects [controls]. All subjects were studied for plasma ACTH, cortisol, dehyroepiandrosterone sulfate [DHEAS], free and total testosterone, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor. No significant differences in the basal levels of ACTH, Cortisol, DHEAS, and total testosterone when comparing RA patients with controls were found, while there were statistically significant elevations in the inflammatory indices [ESR and CRP] and lower basal morning levels of free testosterone [Lower in males age >/= 45 years] in RA patients when compared with controls. From this study we concluded that adrenocortical function seem to be unaltered in early untreated RA patients

Relationship of disease severity to some biochemical markers of generalized osteoarthritis

To find out whether serum level of MMP-3, plasma level of TIMP-1 and urinary pyridinoline are specifically increased in generalized osteoarthritis [OA] or not. Also whether there is a relationship between those markers and the disease severity as detected clinically and radiologically. Thirty females suffering of generalized OA and 15 apparently healthy matched females as controls were studied. Serum MMP-3, plasma TIMP-1 and urinary pyridinoline were measured. The knee and hand joints were graded clinically [Steinbrocker] and radiologically [Kellgren and Lawrence]. Serum level of MMP-3, plasma level of TIM-1 and urinary pyridinoline were significantly higher in generalized OA patients than normal controls. The joint space width decreased with increasing Kellgren - Lawrence grade. All biochemical markers had negative correlations with the joint space width, but only urinary pyridinoline had a significant correlation. All biochemical markers had positive correlations with Steinbrocker grading. Some biochemical markers of OA may be of diagnostic value and a predictor for the severity of the disease in progressive generalized OA. The inhibition of their production and activity may decrease or delay the joint damage

Could serum hyaluronic acid and matrix metalloproteinase-2 preclude liver biopsy for assessment of hepatic fibrosis in chronic viral hepatitis?

The present study has aimed at evaluation of serum hyaluronic acid [HA], and matrix metdloproteinase-2 [MMP-2], as a possible markers of Liver fibrosis, and their association, if any, with other clinical parameters in patients with chronic viral hepatitis. The study included 60 patients with chronic viral hepatitis and 15 normal healthy subjects of matched age and sex as a control group. Detailed history taking, complete clinical examination as well as routine investigations including complete blood picture, liver function tests [serum albumin, bilirubin, AST , ALT, and prothrombin activity], serological tests for HBV, and HCV, serum creatinine, abdominal ultrasonography, and liver histology [so long as there was no contraindication, and after a written consent from those who accept the maneuver], in addition to serum hyaluronic acid [HA], and matrix metalloproteinase [MMP-2] were all undertaken. The study revealed that: both HA and MMP-2 levels were significantly higher in patients [non-cirrhotic or cirrhotic] than the control [P<0.001]. Moreover, their levels exhibited a linear increase with the grade of liver inflammation from the minimal t-o the moderate grade [P<0.001]. In addition, they showed a linear elevation with the progression of the stage of hepatic fibrosis [P<0.001]. Only serum MMP-2 levels were significantly elevated with the deterioration of the Child-Paugh class however, the differences between A and C and Band C were significant [P=0.004, 0.001 respectively]. Both HA and MMP-2 were positively correlated with each other and with serum bilirubin [P<0.001]. They were also negatively correlated with serum albumin [P<0.001] prothrombin and time [P<0.001], and platelet count [P>0.001]. However, they were not correlated with either SGOT or SGPT. It could be concluded that; serum HA and MMP-2 levels were found, not only to be elevated in chronic viral hepatitis than the control, but they became also markedly increased when cirrhosis supervenes. In addition, these markers exhibited a linear elevation with the progression of both the grade of inflammation and the stage of hepatic fibrosis. Thus, they might be considered as an alternative to liver biopsy for assessment of the extent of hepatic fibrosis especially if the biopsy is contraindicated

role of laryngeal electromyography in vocal fold immobility

Vocal fold paralysis could be caused by a wide variety of etiological factors that interfere with the nerve supply of the larynx. To assess the utility of laryngeal-EMG as a diagnostic method for patients with immobile vocal folds and to evaluate its possible role as a prognostic indicator in the management of those cases. The study included 35 patients with unilateral vocal fold immobility [VFI] in addition to 10 normal individuals who served as controls. All patients were subjected to full history taking and thorough clinical examination and radiological investigations. Laryngeal EMG was performed for all the patients and controls. None of the control group showed abnormal EMG data while abnormal EMG findings were detected in 23 out of 35 of the patients' group i.e. the specificity of EMG was [100%] while the sensitivity was [65.7%] in detecting VFI. On clinical follow up with indirect laryngoscopy, 6 months later revealed recovery in 10 of the 25 cases [40%]. None of the recovered patients showed abnormal EMG data at presentation while 13 out of 15 cases of non-recovered patients showed abnormal EMG data i.e. the specificity of EMG was 100% while the sensitivity was 86.6% in predicting recovery in patients with VFI. The quantitative analysis of the interference pattern was more sensitive [65.7% and 86.6%] than the conventional methods of analysis [60% and 80%] in detecting and predicting recovery in patients with immobile vocal folds respectively. The clinical use of L-EMG was shown to be an efficient and objective test in the study of patients with immobile vocal folds and in predicting recovery of those cases