Antimicrobial activity of Er, Cr: YSGG and Ultrasonic on E. faecalisbiofilm in the mesial root canal systems of lower molars / Atividade antimicrobiana de Er, Cr: YSGG e Ultrassônico no biofilme de E. faecalis nos sistemas de canais radiculares mesiais de molares inferiores

The internal topography of the root canal is complex, especially for the permanent molar's mesial root. In response to such issues, improved irrigation techniques have been created, which use laser pulses to agitate fluids and improve microbial deposit removal. Objective: To assess the effectiveness of the Er,Cr:YSGG laser with a wavelength of 2,780 nm via photon-induced photoacoustic streaming (PIPS) protocol which agitated of 2% chlorohexidine (CHX) in removing mature Enterococcus faecalis (E. faecalis) biofilm in root canal systems of lower molars. Material and Methods: The mesial roots of lower first and second molars were separated and inoculated with E. faecalis bacterial suspension for 30 days. The roots were irrigated with CHX, some of them were agitated with a passive ultrasonic device (PUI), while the other roots were agitated by an Er,Cr:YSGG laser in PIPS at 60 µs/pulse, 5 Hz, (0.25, 0.5, 0.75, and 1) W. An atomic force microscope (AFM) was used as a new method to get the results in the isthmus area; the obtained results from each group were compared with each other. Results: Based on the AFM and SEM analyses, laser and ultrasonic activation groups showed higher antimicrobial efficacy than the conventional syringe irrigation group (P<0.05). Conclusion: Based on the investigation's findings, the activation of 2% CHX solution by Er,Cr:YSGG laser in PIPS and PUI offers better mature bacterial biofilm removal in the mesial root of lower human molars than the same irrigant with the SI technique (AU)

A topografia interna do canal radicular é complexa, especialmente para a raiz mesial do molar permanente. Em resposta a esses problemas, foram criadas técnicas aprimoradas de irrigação, que utilizam pulsos de laser para agitar fluidos e melhorar a remoção de depósitos microbianos. Objetivo: Avaliar a eficácia do laser Er,Cr:YSGG com comprimento de onda de 2.780 nm via protocolo de streaming fotoacústico induzido por fótons (PIPS) que agitou clorohexidina a 2% (CHX) na remoção de Enterococcus faecalis maduro (E. faecalis) biofilme em sistemas de canais radiculares de molares inferiores. Material e Métodos: As raízes mesiais de 28 primeiros e segundos molares inferiores foram separadas e inoculadas com suspensão bacteriana de E. faecalis por 30 dias. As raízes foram irrigadas com CHX, sendo algumas delas agitadas com aparelho ultrassônico passivo (PUI), enquanto as demais raízes foram agitadas com laser Er,Cr:YSGG em PIPS a 60 µs/pulso, 5 Hz (0,25, 0,5, 0,75 e 1) W. Um microscópio de força atômica (AFM) foi utilizado como um novo método para obter os resultados na área do istmo; os resultados obtidos de cada grupo foram comparados entre si. Resultados: Com base nas análises de AFM e SEM, os grupos de ativação por laser e ultrassom apresentaram maior eficácia antimicrobiana do que o grupo de irrigação com seringa convencional (P<0.05). Conclusão: Com base nos achados da investigação, a ativação da solução de CHX a 2% pelo laser Er,Cr:YSGG em PIPS a (60 µs/pulso, 5 Hz, 0,75 W) oferece melhor remoção de biofilme (AU)

Un estudio de prevalencia de error de refracción en niños entrecerrados (6-12 años) asistiendo al Hospital Dr. Aso-Eye Shahed / A study of Prevalence of Refractive Error in Squinted children (6-12 years) attending shahed Dr. Aso-Eye Hospital

Determinar la prevalencia del error de refracción (RE) como causa en los ojos en los niños en niños de esta edad (6-12 años) en la ciudad de Sulaimania. El estudio de tasa de prevalencia entre los pacientes que asisten al Shahed Dr. Aso Eye Hospital para el período del 1 de octubre de 2008 al 1 de junio de 2009. Un total de 116 niños (6-12 años) asisten al departamento de entrecerrares durante aproximadamente 8 meses. El estudio incluyó ambos sexos, eran niños de 55 años y niñas 61. Se sometieron a un examen ocular completo. Encontramos que (72) pacientes (62.02 %) tenían un error de refracción, incluyen: 33 pacientes (45.9 %) = hipermetropia (H); 22 pacientes (29.16%) = miopía [m]; 18 pacientes (24.3%) astigmatismo (AST.); 4 mixtos; 6 h-as. y 8 m-as. En conclusiones, la causa más frecuente del entrecerrar de la infancia a este ancho [6-12 años) es el error refractivo, mientras que las otras causas en su conjunto constituyen solo 1/3 de las causas, y el error de refracción más común es la hipermetropía

To determine the prevalence of refractive error (RE) as a cause in squinted in children in this aged (6-12 years) in Sulaimania city. The prevalence rate study among patient attending Shahed Dr. Aso eye hospital for the period from 1st October 2008 - 1st June 2009. A total of 116 children ( 6-12 years) attending squint department for about 8 months. The study included both sexes, were boys 55 and girls 61. Underwent full ocular examination. We found that (72) patients (62.02%) had refractive error, include: 33 patients (45.9 %) = Hypermetropia (H); 22 patients (29.16%) = Myopia [M]; 18 patients (24.3%) Astigmatism (Ast.); 4 mixed; 6 H-Ast. and 8 M-Ast. In conclusions, the most prevalent cause of childhood squint at this aged [6-12 years) is refractive error while the other causes as a whole constitute only 1/3 of the causes, and most common refractive error is hypermetropia

Seropositividad de H. pylori y Fiebre Tifoidea en Pacientes iraquíes con dispesia / Seropositivity of H. pylori and Typhoid Fever in Dyspesia Iraqi Patients

Background: There are many studies highlight the association between Helicobacter pylori seropositivity with typhoid fever in human populations and there is no study in Iraq. Aim: Our study designed to estimate the correlation between seroprevelace of H. pylori and Typhoid fever in clinically examined patients as dyspeptic and typhoid fever infected. Methods: From May (2016) to February (2018), a total of 213 patients (134 females and 79 male) attending an enterology outpatient clinic in AL-Najaf province, Iraq. The patients with age range from 10 to 90 years and with symptoms of dyspepsia and typhoid fever (as fever, diarrhea, headache), were referred to serologic diagnosis of antibodies against H. pylori (IgG) and Typhoid (IgG and/or IgM), using the Rapid Tests Cassette. Results: Of a total of 213 clinically examined as dyspeptic and typhoid fever infected patients,134 (63.0%) were females and 79 (37.0%) were males.In this study, 82 (38.5 %) of 213 patients were seropositive for typhoid fever and 131 patients were seronegative. Moreover, 128 (60.1 %) of 213 patients were seropositive for H.pylori IgG (51 case,39.8%, typhoid seropositive, and 77 case,60.2%, typhoid seronegative) and 82 were seronegative. The serologic co-infection diagnosed in 51 (24.0%) patients. The seropositivity of typhoid fever was higher in H. pylori seropositive patients, co-infections (62.2 %), than H. pylori seronegative patients (37.8%). The co-infection was more in female (64.7%) than male (35.3%). In respect of age H. pylori seropositivity was more prevelance (25.8%) in 30s age group where as co-infection was more prevalence in 40s age group (29.4%). But the statistical analysis showed insignificant association of H. pylori with typhoid fever (P value = 0.6203), gender (P value = 0.4770) and age groups (P value = 0.0745). Conclusion: Our study indicates that H. pylori seropositive dyspepsia more susceptiple to typhoid fever particularly in female and 40s ages and suggest there was insignificant relationship amongst seropositivity of H. pylori and typhoid fever within dyspepsia patient

Uterine sparing approaches in management of placenta accreta: a summarized review

Placenta accreta is a potentially life-threatening obstetric condition that required multidisciplinary approach to management. Placenta accreta occurs in complete absence of the decidua basalis. Women with previous cesarean section delivery or placenta previa are known to be at greater risk of placenta accreta. A previous study reported that 24%& 67% increase in the incidence of placenta accreta in women 1 versus 3 or more previous cesarean deliveries respectively. Antenatal diagnosis of placental invasion has the potential to improve maternal and fetal outcomes. In practice, incomplete non-separation of the placenta at delivery leads to massive obstetric hemorrhage resulting in maternal morbidities such as massive blood transfusion, DIC, injury to the bladder and intestines and the need for hysterectomy. Sonographic examination with gray scale and color doppler imaging is the recommended first line modality for diagnosis of morbidly adherent placenta. Techniques developed for conservative management are techniques developed to preserve uterus and future fertility which is crucially linked to societal status and self-esteem.

Relationship between liver iron concentration determined by R2-MRI, serum ferritin, and liver enzymes in patients with thalassemia intermedia

BACKGROUND: Iron overload is a risk factor affecting all patients with thalassemia intermedia (TI). We aimed to determine whether there is a relationship of serum ferritin (SF) and alanine aminotransferase (ALT) with liver iron concentration (LIC) determined by R2 magnetic resonance imaging (R2-MRI), to estimate the most relevant degree of iron overload and best time to chelate in patients with TI. METHODS: In this cross-sectional study, 119 patients with TI (mean age years) were randomly selected and compared with 120 patients who had a diagnosis of thalassemia major (TM). Correlations of LIC, as determined by R2-MRI, with SF and ALT levels, were assessed in all participants. A P-value 5 mg Fe/g dry weight (P < 0.0001). A significant relationship was also found for patients with TI who had elevated ALT level (63.5 U/L), of 3.15 times the upper normal laboratory limit, using a cut-off for LIC ≥5 mg Fe/g dry weight. CONCLUSION: We determined the cut-off values for ALT and SF indicating the best time to start iron chelation therapy in patients with TI, and found significant correlations among iron overload, SF, and ALT.

Comparação da satisfação, motivação, flexibilidade e dor muscular tardia entre método Pilates moderno e método Pilates instável / Comparación de la satisfacción, motivación, flexibilidad y dolor muscular tardío entre el método Pilates moderno y el método Pilates inestable / Comparison of satisfaction, motivation, flexibility and delayed onset muscle soreness between modern Pilates method and unstable Pilates method

RESUMO O objetivo deste estudo foi comparar a satisfação e motivação para a prática de exercício físico, flexibilidade e dor muscular tardia (DMT) em participantes saudáveis após exercícios de duas modalidades do método Pilates. Para isso, cinquenta participantes saudáveis realizaram uma sessão de exercícios do Pilates moderno e outra do Pilates instável. Foram avaliados os desfechos satisfação e motivação após as sessões, flexibilidade posterior do tronco e membros inferiores (banco de Wells) antes e após cada sessão, e DMT 24, 48 e 72 horas após cada sessão (Escala Numérica de Dor). Os resultados mostraram que não houve diferença estatisticamente significante entre as duas modalidades do Pilates para satisfação e motivação, flexibilidade e DMT 72 horas após a sessão (p>0,05). Para a DMT foi observada diferença estatisticamente significante entre as duas modalidades 24 horas (diferença entre as médias: -0,7; IC a 95%: -1,5 a 0,0) e 48 horas (diferença entre as médias: -0,8; IC a 95%: -1,4 a -0,2) após a sessão, com maior dor no Pilates instável. Como conclusão, as duas modalidades do Pilates apresentaram o mesmo nível de satisfação e motivação e ganho similar de flexibilidade. No entanto, o Pilates instável causou mais DMT após 24 e 48 horas, mas essa diferença não foi clinicamente relevante.

RESUMEN El objetivo de este estudio ha sido comparar la satisfacción y motivación para la práctica de ejercicio físico, flexibilidad y dolor muscular tardío (DMT) en participantes sanos después de ejercicios de dos modalidades del método Pilates. Para ello, cincuenta participantes sanos realizaron una sesión de ejercicios del Pilates moderno y otra del Pilates inestable. Se evaluaron los resultados de satisfacción y motivación después de las sesiones, flexibilidad posterior del tronco y miembros inferiores (banco de Wells) antes y después de cada sesión, y DMT 24, 48 y 72 horas después de cada sesión (Escala Numérica de Dolor). Los resultados mostraron que no hubo diferencia estadísticamente significativa entre las dos modalidades del Pilates para satisfacción y motivación, flexibilidad y DMT 72 horas después de la sesión (p>0.05). Para la DMT se observó diferencia estadísticamente significativa entre las dos modalidades 24 horas (diferencia entre las medias: -0.7, IC a 95%: -1.5 a 0.0) y 48 horas (diferencia entre las medias: -0.8, IC a 95%: -1.4 a -0.2) después de la sesión, con mayor dolor en el Pilates inestable. Como conclusión, las dos modalidades del Pilates presentaron el mismo nivel de satisfacción y motivación y benificio similar de flexibilidad. Sin embargo, el Pilates inestable causó más DMT después de 24 y 48 horas, pero esa diferencia no ha sido clínicamente relevante.

ABSTRACT The aim of our study was to compare the satisfaction and motivation for the practice of exercise, flexibility and delayed onset muscle soreness (DOMS) in healthy participants after exercises in two types of the Pilates method. For this, 50 healthy participants performed a session of exercises of modern Pilates and other of unstable Pilates. We evaluated the outcomes for satisfaction and motivation after sessions, posterior flexibility of the torso and lower extremities (sit-and-reach box) before and after each session, and DOMS 24, 48 and 72 hours after each session (Numeric Pain Rating Scale). Results showed no statistically significant difference between both types of Pilates for satisfaction and motivation, flexibility and DOMS 72 hours after the session (p>0.05). Regarding the DOMS we observed statistically significant difference between the two types 24 hours (difference between the means: -0.7; 95%CI: -1.5 to 0.0) and 48 hours (difference between means: -0.8; 95%CI: -1.4 to -0.2) after the session, with greater pain in unstable Pilates. As a conclusion, both categories of Pilates showed the same level of satisfaction and motivation and similar flexibility gain. However, unstable Pilates caused more DOMS after 24 and 48 hours, but this difference was not clinically relevant.

Caracterização do complexo Candida glabrata em isolados de hemocultura e avaliação da sensibilidade a antifúngicos / Characterization of the complex Candida glabrata in blood culture isolates and evaluation of sensitivity to antifungals

Candida glabrata assumiu grande importância na clínica médica, desde que, sua resistência adquirida ao fluconazol foi descrita. Além disso, estudos mostraram a fraca atividade in vitro de outros fármacos azólicos contra isolados dessa espécie. C. glabrata é agente de infecções invasivas e o monitoramento da eficácia de antifúngicos usados na prática médica frente a isolados dessa espécie tem relevância clinica. C. bracarensis e C. nivariensis são espécies relacionadas, fenotipicamente, à C. glabrata para as quais há necessidade de métodos moleculares para sua identificação. Na América Latina, a ocorrência de infecções em corrente sanguínea por C. glabrata e espécies correlatas não é tão alta quanto na América do Norte e, por isso, pouco é conhecido sobre sua distribuição e perfil de suscetibilidade a antifúngicos nessa região. Neste estudo, foram analisados 75 isolados com características morfológicas e bioquímicas de C. glabrata, obtidos da corrente sanguínea de pacientes atendidos em hospitais do estado de São Paulo, entre 2007 e 2013. As concentrações inibitórias mínimas (CIM) de cinco fármacos antifúngicos: anfotericina B, caspofungina, voriconazol, fluconazol e itraconazol, foram determinadas pela metodologia de microdiluição de referencia M27-A3 do Clinical and Laboratory Standards Institute (CLSI). A ação fungicida de anfotericina B foi avaliada por método de curva de morte. A pesquisa das duas espécies correlatas foi realizada com metodologia de reação em cadeia da polimerase (PCR) em todos os isolados. Nenhum isolado de C. bracarensis e C. nivariensis foi encontrado neste estudo. Resistência a itraconazol foi encontrada em 18,6 % (14) das cepas de C. glabrata. Altos valores de CIM de voriconazol (> 0,5 mg/L), de acordo com cutoff (ponto de corte) epidemiológico, foram observados para duas cepas...

Candida glabrata has assumed great importance in clinical medicine, since acquired resistance to fluconazole had been described. Furthermore, studies have shown the weak in vitro activity of other azole drugs against isolates of this species. Since C. glabrata is an agent of invasive infections, monitoring the effectiveness of antifungal agents used in medical practice against isolates of this species has become of great importance. C. bracarensis and C. nivariensis are phenotypically related species to C. glabrata and so it is necessary molecular methods to identify properly these members. In Latin America, the occurrence of bloodstream infections in C. glabrata and related species is not as high as in North America, and little is known about their distribution and antifungal susceptibility profile in this region. In this study, we analyzed 75 isolates with morphological and biochemical features of C. glabrata obtained from the bloodstream of patients treated in hospitals in the state of São Paulo, between 2007-2013. The minimum inhibitory concentrations (MIC) of five antifungal drugs, namely: amphotericin B, caspofungin, voriconazole, fluconazole and itraconazole were determined by microdilution reference method M27-A3 from the Clinical and Laboratory Standards Institute (CLSI). The fungicidal action of amphotericin B was evaluated by the method of time-kill curves. The investigation of the two related species was performed with polymerase chain reaction (PCR) in all isolates. No isolate of C. bracarensis and C. nivariensis was found in this study. Resistance to itraconazole was found in 18.6% (14) strains of C. glabrata. High MIC values of voriconazole (> 0.5 mg/L), according to epidemiological cut-off were observed for two strains. The fluconzole-MICs ranged from 4mg/L to 16mg/L, caspofungin-MIC were between 0.03 mg/L and 0.5 mg/L, and amphotericin B-MIC were between 0.12 mg/L and 1 mg/L...

Health systems and tuberculosis - a comparison between Iraq and Romania

Tuberculosis continues to be one of the important public health challenges of this century. After 6 years of STOP TB Strategy, countries like Iraq and Romania, still struggle to decrease the impact of this disease. This paper looks at the TB epidemic in the context of the health systems in the two countries. The findings show that Iraq ranks third in the Eastern Mediterranean Region regarding incidence, prevalence and death rates, ranks second in treatment success rate, but has one of the lowest case detection rate; Romania ranks first in the European Region regarding incidence and prevalence, second regarding mortality rates and treatment success rates and has the lowest case detection rate in its region. There is a need for specific interventions to control TB in both countries, more so as funding seems to be available

[Subclinical lymph nodes metastasis in laryngeal [T3,T4] SCC for irradiation and none irradiation patients in al moassat university hospital]

Late - stage laryngeal carcinoma [T3-T4] has a high incidence of cervical metastasis. The incidence of subclinical metastasis is not well described in none irradiation and irradiation patients initially clinically [T3,T4] with negative nodes of the neck, and the treatment of these patients is contraversal. Identify the incidence of subclinical metastatic disease in [T3,T4] with negative nodes of the neck undergoing functional neck dissections with laryngectomy. And identify the incidence of subclinical metastatic disease in those patients who faild radiotherapy. Are there any benefits of Cts in those patients? And what is the most aproprait therapy? 48 [T3,T4] with negative nodes of the neck patients underwent laryngectomy with neck dissection in Al Mowasat Hospital between 1/1/2010-1/1/2012. Pathologic study of the neck dissection specimens as undertaken. The male to female ratio was 9/1, with a mean age of 62 years [range, 47 to 92 years]. Presence of subclinical metastatic disease in the neck according to stage was as follows: T3; 4 out of 27 [14.82%], T4; 6 out of 21 [28.6%]. And according to radiation was 5 out of 27 [18%], none radiation patients 5 out of 21 [24%]. The incidence of positive node on Cts was 6 out of 10 [37%] in none radiatin patients, subclinical metastasis was 3 out of 16 [18.75%]. The incidence of positive node on Cts was 7 out of 7 in radiation patients, subclinical metastasis was 5 out of 7 [71.44%]. Subclinical cervical metastasis present in T3,T4 with negative nodes of the neck laryngeal SCC patients consequantly, [14.82%-28.6%]. Radiation has small affect on the incedanse subclinical cervical metastasis to be less. The aproprait therapy of patients who failed radiotherapy and there is node on Cts. The functional neck dissection should be done. The apropriat therapy of those patients is laryngectomy with functional neck dissection because there are subclinical cervical metastasis

Intraoperative albumin plus crystalloid solution versus crystalloid alone in renal transplant surgery

Chronic renal failure is defined as an irreversible deterioration in renal function which classically develops over a period of months or years. renal transplantation is the treatment of choice for end stage renal failure and during surgery the maintenance and restoration of intravascular volume are essential tasks to achieve sufficient organ function in renal transplants. To study the comparison between normal saline 0.9% with glucose 5% and normal saline 0.9%, glucose 5% with albumin in renal transplantation. The study data from 50 patients 47 patients underwent living donor kidney transplants three were excluded because they are diabetics.twenty three patients received normal saline 0.9%, glucose saline 5%,and twenty four received normal saline 0.9 with glucose 5% and albumin 100 milliliter. There was no statistical difference between the two groups in the primary measurement of outcome measure in the urine output in the 1[st] day and the serum creatinine in the 1[st] and 3[rd] day. Although statistically there was no difference in the two groups, it might be its useful to combine a colloid with a crystalloid in the fluid management regimen to improve microcirculation, oxygen perfusion and to ovoid large volumes of crystalloid

Detection of antisperm antibodies by elisa system in the cervical mucus of women with unexplained infertility

Unexplained infertility occurs in many couples of childbear-ing age, immune mechanisms have been postulated in this disorder for the last few decades. Circulating antibodies against spermatozoa present in serum and seminal plasma have been especially implicated. This autoimmunity against spermatozoa has been investigated in males, while the isoimmunity [in the females] has got low attention. Fifty women with unexplained infertility and twenty fertile women were involved in this case-control study. ELISA system was prepared and used to detect antisperm antibody [ASA] in cervical mucus [CM] and serum specimens of both groups of women. CM was collected at mid-cycle period and dissolved mechanically [not by bromeline]. Thirty percent of infertile women have IgG-ASA in their serum and 20% have IgA-ASA in the CM, while 22% of fertile women have IgG-ASA in their serum and no fertile women have any titer of IgA-ASA in their CM specimens. Only CM-lgA-ASA of infertile women $howed significant statistical correlation with cellular property of CM, which was scored according to Insler score. It is concluded that ELISA test is sensitive and specific test for detection of serum ana secreted ASA. Also, secretory IgA-ASA are more indicative and have potential role in immunological infertility as iso-immunity than IgG-ASA. Therefore, it is strongly recommended that immunological infertility should be considered as an important cause of infertility and to be having a special interest by clinicians

Effectiveness of zinc protoporphyrin and hemoglobin concentrations in identifying iron deficiency in a group of fewer than five-aged children

Iron deficiency anemia is known to impair cognitive and psychomotor development. Hemoglobin and zinc protoporphyrin [ZPP] tests are commonly used to screen for iron deficiency. However, little research has been done to systematically evaluate the sensitivity and specificity of these 2 tests. The aim of this study is evaluating the effectiveness of ZPP test in Identifying iron deficiency anemia in under five-year old children. These studies were approved by Nutrition Research Institute, Ministry of Health. The subjects, 195 children [62% males and 38% females], were seen in pediatric clinic during the period from April 2006 to April 2007. The children were all between 1 and 5 years of age. Iron status of the subjects was evaluated as a routine part of patient care at the clinic. Whole blood hemoglobin concentration, hematocrit ratio, and the ZPP/H [Heme] ratio were measured. The ZPP/H ratio was then evaluated as a single indicator of iron status. Ethylene diamine tetra acetic acid-anticoagulant blood had been obtained used to perform the ZPP/H test. The mean Hemoglobin concentration for the study sample size [195] was [9.9 mg/dl] and Hb test was used as the reference test to compare the effectiveness of ZPP in detecting Iron deficiency anemia, with a sensitivity of [80.6%] and a specificity of [93.1%], positive predictive value [93.5%], negative predictive value [79.4%], the ZPP appears to be an excellent test in detecting anemia. ZPP/H ratio measurement alone can detect iron anemic deficiency better than other individual tests. Because the ZPP/H ratio is a functional indicator of long-term iron status, it is an attractive screen test for deficiency. The ZPP/H ratio is a cost-effective test that is performed using as little as one drop of capillary blood

Early oral feeding following total laryngectomy

Pharyngocutaneous fistula is a serious complication after total laryngectomy. The reported incidence varies from 1% to 50%. There is still no agreement regarding when to begin oral feeding after total laryngectomy. The aim of this study was to demonstrate the safety of early oral feeding after total laryngectomy. Materials and In a prospective study, patients who underwent total laryngectomy were randomly divided into either the oral feeding or the nasogastric tube [NGT] groups. For patients in the oral feeding group, feeding was initiated orally with a clear liquid diet on the third postoperative day, whereas patients in the nasogastric tube group were fed through NGT and received nothing orally until the seventh postoperative day. Between September 2002 and October 2006, 25 patients were studied in this trial. There were 13 patients [52%] in the oral feeding group and 12 patients [48%] in the NGT group. Their ages ranged from 49 to 77 years [mean 66.07 +/- 7.22 and 63.83 +/- 7.58 years in oral feeding and NGT groups, respectively]. Mann-Whitney U and Chi-square tests showed that differences between the two groups were not statistically significant with regard to age, tumor location and tumor stage. One case of fistula occurred in each group. Our results indicate that in a selected group of patients, it is possible to initiate oral feeding much earlier in the postoperative period than what was formerly thought

Pentosidine - a biochemical marker in diabetic retinopathy

This study was done to evaluate the role of Pentosidine in predicting the progression of diabetic retinopathy. This study included 30 subjects with insulin dependent diabetes mellitus [Type 1] and 10 healthy control individuals. A case control study was done. Full ophthalmological examination together with laboratory investigations [blood glucose level, HbA[1]C and blood Pentosidine level corrected to blood total protein values were measured] were done in all subjects included in this study. The level of Pentosidine was correlated with the duration of diabetes and the stage of retinopathy. All data were analyzed and reported. Significant elevation of Pentosidine was found in patients during the earliest detectable phase of diabetic retinopathy [early non-proliferative diabetic retinopathy] and more elevation at the pre-proliferative stage of retinopathy, returning to lower levels at the proliferative stage of diabetic retinopathy. Pentosidine can be used as a biochemical marker for early occurrence of diabetic retinopathy and as an alarming factor in the pre-proliferative stage of diabetic retinopathy, thus help to decrease ocular complications

Growth delay in steroid sensitive nephrotic patients

Growth in patients with idiopathic nephrotic syndrome [INS] is influenced by several factors, they suffer the influence of the disease itself as long as there is proteinuria, caused by the increase of the glomerular permeability and leading to hypoproteinemia. The effects of the glucocorticoid treatment, which alters growth by a direct action on the growth cartilage, or via disturbances of growth factors. In this study we assess the effect of nephrotic syndrome, it's relapse rate and it's treatment [i.e. steroid], in the statural growth of steroid sensitive nephrotic patients. A Prospective study of 110 steroid responsive nephrotic patients collected from AL- Kadhemia Teaching Hospital, Central Child Teaching Hospital, Child Wellfaire Teaching Hospital and AL-Karama Teaching Hospital. The study started from first of June 2005 to first of June 2006. Data collected as following: age, sex, date of first diagnosis, duration of disease, number of relapses per year, measurement of the height, weight and body mass index and sign of steroid toxicity. Total number of our patients were 110, 74[67.3%] were males and 36[32.7%] were females, with male to female ratio of 2: 1. The age of our patients range from 2-18 years with a mean of 7.9+3.8 years. Thirtyone [28.2%] of them were with height below 3[rd] percentile for their age, 24[77.4%] were males and 7[22.6%] were females. Twenty- five [22.7%] patients were at pubertal age. Eighteen [72%] were males and 7[28%] were females, and 17[68%] of them have height below 3rd percentile. Seventy - six [69%] patients have their onset of the disease at age between 2 and 6 years. Forty-six [41.8%] of patients have disease duration of less than 3 years, 3 [6.5%] of them were have height below 3[rd] percentile, 46[41.8%] with duration of 3-6years, 14[30.4%] them were have height below 3rd percentile and 18[16.4%] with duration of more than 6 years, 14[77.8%] of them have height below 3rd percentile. Fifty-five [50%] patients had frequent relapses, twenty-seven [49.1%] of them have height below 3[rd] percentile, compared to 4[7.3%] of those with infrequent relapse had height below 3rd percentile. Forty-seven [42.7%] patients show sign of steroid toxicity[cushigoid facial appearance with or with out hypertention, obesity, hirsutism..etc] 25[53.2%] of them have height below 3[rd] percentile, compared to 6[9.5%] of those who have no sign of toxicity. Nephrotic syndrome is a potentially chronic disease with patients suffering a relapsing course and being at risk of frequent courses of prednisolone therapy with increase the risk of growth delay especially in patients reaching pubertal age and still taking steroid therapy

effect of immersion in water on cardiopulmonary responses

This study was carried out on 146 normal healthy volunteers in order to study the effect of postural changes and immersion in water to the level of diaphragm and to the level of the neck on cardiopulmonary reflexes by using non invasive technique. mercury sphygmomanometer for measuring the blood pressure, vitalograph spirometer to measure forced vital capacity [FVC] and forced expiratory volume in one second [FEV 1] and water tank is used for immersing the subjects. Measurement of blood pressure [BP], heart rate [HR], FVC, and FEV 1 was done in supine position, standing position, immersion in water up to the level of diaphragm and to the level of the neck. The volunteers are divided in two age groups, from 20-40 years [80subjects, 50 males and 30 females] and from 41-60 years [66 subjects, 50 males and 16 females]. Comparison between standing and supine, position indicate that. there was a significant increase in heart rate [HR]-diastolic blood pressure. [DBP], mean blood pressure [MBP] FEV1 and FVC, and significant decrease in systolic blood pressure [SBP] in standing position. During immersion in water [WI] to the level of diaphragm it was found that there was no significant changes in HR, SBP, DBP, MBP, FEV1 and FVC on comparison with supine position in both age groups, but during immersion in water [WI] to the level of neck, there was a significant increase in SBP, DBP 'and MBP, but a significant decrease in HR, FEV1 and FVC on comparison with supine position. It was found that the results of cardiopulmonary reflexes to the immersion in water up to the level of diaphragm, is significantly different from that in standing. position because WI act as an antagonist to the effect of gravity on cardiopulmonary reflexes when compared with standing position

Laparoscopic versus open cholecystecystectomy for acute calculous cholecystitis; which is better?

Laparoscopic cholecystectomy [LC] has become the treatment of choice for elective cholecystectomy, but controversy persists over use of this approach in the treatment of acute calculous cholecystitis. To assess the feasibility, safety, and outcome of laparoscopy in management of patients with acute calculous cholecystitis and to determine whether it is a boon or bust in comparison with open cholecystectomy [OC]. This study included 84 patients [38 males and 46 females] who met criteria for acute calculous cholecystitis. Their age ranged from 19 to 65 year with average of 47 years. They were randomized to be treated by LC [40 patients] or OC [44 patients]. Operation time, postoperative pain, length of hospital stay, intraoperative and postoperative complications were the main outcome measures used to compare the two studied groups. In LC group, the rate and reasons for conversion to OC were also studied. The two randomized groups were similar in demographic, physical, and clinical characteristics. There was no significant difference in the operation time between LC and OC [89.9 min +/- 19.9 vs.83.9 min- +/- 8.2, P: 0.2]. Postoperative analgesia was better in the LC than in the OC with median score [VAS] of 2 points vs.4 points in the two groups respectively and the mean analgesic requirements was 160mg +/- 40 vs.240mg +/- 60 in the two groups respectively [P: 0.0004]. The length of hospital stay for patients who underwent successful LC was significantly shorter than the open group [2.2 days +/- 0.82 vs.6.4 daysfl. +/- 1.6, P: 0.0001]. Operative complications were higher in the LC group than in the OC group. By far the commonest was gallbladder perforation with spillage of bile and or stones [25%]. Bleeding occurred in five patients in the LC group [12.5%] and in two patients in the OC group [4.5%]. There were no deaths or bile duct injuries in either group. Postoperative complications were higher in the OCR than in the LC. By far the commonest were wound related complications [11.4%]. Wound sepsis occurred in five cases in OC group [11.4%] and in two cases in LC group [7.7°%]. Incisional hernia and intestinal obstruction each occurred in one case in the OC [2.3%]. In LC group, 14 patients required conversion to OC [35%], in 10 of them [71%] the cause was obscure anatomy and dense adhesions of inflammation. Male gender represents the majority of converted cases [64%]. LC is feasible and safe method for treatment of patients with acute calculous cholecystitis,. However it is not without risks and might not be suitable for every patient

Effect of experimentaly induced diabetes on the rat's heart: influence of tocopherol as antioxidant [a morphological and a morphometric study]

The present work aimed to study the effect of vitamin E supplementation on diabetic cardiomyopathy. This was achieved by comparing the normal control group [group I], alloxan induced diabetic group [group II] versus vitamin E-treated diabetic group III. This was clarified by studying these groups as regards cardiomyocytes, connective tissue matrix and blood vessels [coronary arteries and capillaries] in an attempt to find out if this vitamin could protect against diabetic cardiomyopathy. The following parameters were measured for all groups: non fasting blood glucose levels; plasma tocopherol concentrations, body and heart weight. For histological study of the myocardium, all animals were subjected to the following techniques: morphometric study for the myofiber diameters and the numerical densities of blood capillaries/ mm[2] of the examined tissues, paraffin sections stained with HX and E, Masson's trichrome and PAS, cryostate sections stained with succinic dehydrogenase, and alkaline phosphatase, and ultrastructural study. There was a significant increase in non fasting blood glucose levels [370 +/- 55mg/dL] in group II animals if compared with that [100 +/- 20 mg/dL] of group 1 healthy animals. While in alloxan diabetic /vitamin E treated group III the non fasting blood glucose levels were [180 +/- 30 mg/dl] not too higher than that in group I. Plasma tocopherol concentrations for group III animals [12.7 +/- 0.5 mg/dl] were significantly increased of about 66 +/- 0.14 percent more than that [8.4 +/- 0.4 mg/dl] in the control group I. This means that the concentration of Eocopherol in the plasma was significantly influenced by feeding the animals a vitamin E-enriched diet for 16 weeks starting soon after inducing diabetes. This vitamin E- enriched diet used for group III animals nearly preserved both body and heart weights, which were significantly reduced in diabetic animals fed on the standard diet. Morphometric study showed a significant decrease in myofiber diameter observed in focal areas of the myocardium of alloxan diabetic rats. The cause of this result could be attributed to focal structural alterations affecting the cardiomyocytes. These structural changes included disorganization of the myofibrils at the Z lines, transverse tearing and distortion of intercalated discs and presence of contraction bands. There were also deterioration and fragmentation of myofilaments leading to loss of cross and longitudinal striations, crestolysis of mitochondria and cytoplasmic vacuolation. The intramural coronary arteries had thickened basement membranes and thickened walls due to deposition of more collagen fibers in their adventitia, and these changes might impair their elasticity and elastic recoil. These stressed blood vessels often lead to myocardial ischemia due to impairment of blood flow. The interstitial blood capillaries in the myocardium of diabetic group II showed an increase in their numerical densities /mm[2][CD[s]]. This increase was about 5 +/- 0.06 percent more than that in the control group I. This increase in CDs could be owed to the need to maintain good microvascularity, even in diabetic state, to protect the myocardium from ischemic damage. Many, not all of these capillaries appeared partially collapsed with thickened basement membranes. This was due to increase in the amount of connective tissue fibers especially collagen in the precapillary locations. These collapsed capillaries were observed to retain blood in their lumena, and this indicated that these capillaries impeded the influx of blood. The endothelial cells lining these capillaries appeared swollen and rich in biosynthetic organelles e.g. rER, ribosomes, mitochondria and Golgi bodies with the associated vesicles. This explains the effort exerted by these cells to synthesize new fibers added to their basement membranes in an attempt to compensate the degenerative changes associated with diabetes. Tocopherol acetate-enriched diet used instead of the standard diet to feed diabetic animals of group III was cardio protective and largely prevented severe alterations of myocardial structure typically observed after an alloxan diabetes duration of 16 weeks [group II]. Deterioration and fragmentation of myofilaments were seen less, the areas of degeneration and of contraction bands were clearly reduced, the abundant collagen fiber deposits especially at precapillary locations and in the wall of coronaries were significantly reduced. It could be concluded that the oxidative stress plays a significant role in the disturbances of cardiac structure in diabetes. Antioxidants such as alpha tocopherol are able to prevent these adverse effects despite the elevated blood glucose levels. It seems likely that adjuvant treatment with antioxidants is needed to maintain a healthy balance in diabetic patients with multiple complications. Therefore it would seem wise to supplement all diabetics with vitamin E either from natural or medicinal sources to retard or even prevent the occurrence of complications especially cardiomyopathy

Inhibition of posterior capsule opacification after extracapsular cataract extraction by 5-fluorouracil in rabbits

This work was designed to study the effect of 5-fluorouracil on prevention of posterior capsule opacification after extra-capsular cataract extraction as well as it's effect. On the corneal endothelium and uveal tissue. The study was done on 30 eyes of 15 pigmented rabbits with the left eye as a control, while the right eyes were irrigated with three different concentrations of 5-fluorouracil dividing them into 3 groups. The first group was irrigated with 50 mg/15-fluorouracil, the second group was irrigated with 40 mg/15-fluorouracil and the third group was irrigated with 30 mg/15-fluorouracil [5 -FU]. Postoperative follow up was done for 2 month and the study revealed a statistically significant reduction of the posterior opacification. Also the ocular complications were least with the lowest concentration of 5-fluorouracil