ABSTRACT
Asthma is a continuous significant health problem. Strategies for treating exacerbations are best adapted and implemented at a local level. Severe exacerbations are potentially life threatening, and their treatment requires close supervision. The severity of the exacerbation determines the treatment administered. Indices of severity, particularly peak expiratory flow [PEF], pulse rate, respiratory rate, and pulse oximetry should be monitored during treatment. The aim of this work was to assess the effect of the implementation of the Global Initiative for Asthma [GINA] guidelines in the prognosis and the outcome of asthma exacerbation in the emergency department. The study was conducted on one hundred asthmatic patients. All patients were informed about the study and gave their consents. Patients were subjected to full history taking and clinical evaluation. Investigations were done in the form of peak flow rate [PFR] measurement, pulse oximetry assessment, ABG analysis [for only 17 patients], chest X-ray [it is not routinely recommended] and complete blood count [if needed]. Then patients were classified according to their attacks. All patients were managed according to GINA guidelines. Older patients were significantly suffering from severe to life threatening attacks than younger patients. We found that 12% of patients had occupational related asthma in relation to 88% of patients had non-occupational related asthma. There were no statistical significant differences between classification of severity of current attack and previous emergency department [ED] visits/year. There were no statistical significant differences between the studied groups regarding temperature. Systolic and diastolic blood pressure had statistically significant lower values in patients with severe to life threatening attacks than those with mild to moderate attacks. Severe to life threatening group had respiratory rate higher than mild to moderate group. Mild to moderate group had PEF and SaO2% higher than severe to life threatening group. PEF was statistically higher post treatment than pre treatment. Three patients of 17 had PaCo2 >45 mmHg with hypoxemia and respiratory acidosis and they admitted to the intensive care unit [ICU]. All patients in ED were assisted to determine the severity of asthma concomitant with administration of initial treatment [plan A], which is oxygen to achieve O2 saturation >/= 92%, inhaled B2 adrenergic bronchodilator and an oral or intravenous dose of corticosteroids. Five patients met a good response so they enter in [plan C1]. Seventy-five patients met with the criteria of moderate episode they go to plan B1, 68 patients of them [about 90%] had a good response within 2 h so go to plan C1 and the rest 7 patients [10%] had an incomplete response go to plan C2. Twenty patients met with criteria of severe episode, 17 of them [85%] with incomplete response move to plan C2, and the rest 3 patients [15%] had a poor response and moved to plan C3, no improvement noticed so they were admitted to the ICU. Hospitalization was done to 11 patients who met a poor response [plan C2], 86 patients were discharged from the ED [73 patients from plan C1 and 13 patients from plan C2]. Severe to life threatening group stayed in ED longer than mild to moderate group. All patients presenting in the emergency department with asthma exacerbations should be evaluated and triaged immediately and must be treated according to their severity of classification using GINA guidelines. Measurements of airflow obstruction, using peak expiratory flow, can help to guide therapy for acute asthma. Continuous monitoring of oxyhaemoglobin saturation by pulse oximetry should be undertaken for all patients with acute exacerbation of asthma. We must; educate patients in ED about the nature of asthma and its therapy, educate patients how to use inhalers, encourage patients to use spirometer at home and discharge each patient with ED-asthma discharge plan
Subject(s)
Humans , Male , Female , Clinical Protocols/standards , Patient Care/methods , Patient Care Planning/statistics & numerical data , Emergency Service, Hospital/statistics & numerical dataABSTRACT
Background: Streptococcus agalactiae or group B streptococcus [GBS] is a normal flora of the vagina of healthy women. It emerged as the leading cause of neonatal invasive infections
The purpose of this study was to detect the magnitude of GBS neonatal infection and colonization and to compare between invasive and colonizing strains as regard antibiotic susceptibility patterns, serotypes and virulence factors
Methods: A total of 145 neonatal blood samples and 95 vaginal swabs from pregnant women were collected in the present study. Invasive GBS were isolated from neonates by blood cultures. Colonizing GBS isolates were identified by vaginal swabbing of pregnant women using Todd-Hewitt selective broth medium, supplemented with gentamicin [8microg/mL] and nalidixic acid [15microg/mL]. Antibiotic sensitivities and serotyping by latex agglutination were done. GBS virulence factors were studied including detection of beta-haemolysin production, CAMP test on blood agar plates, C5a peptidase production encoded by scpB gene and presence of highly virulent GBS ST-17 clone
Results: GBS were isolated from 11.7% of neonates [17/145] and from 18.9% [18/95] of vaginal swabs. Resistance patterns of isolated invasive GBS were 29.4 %, and 17.6% for erythromycin and clindamycin respectively. Among invasive and colonizing GBS isolates, serotype III was the most common. GBS neonatal sepsis was significantly associated with respiratory distress, pneumonia, use of mechanical ventilation and use of nasal continuous positive airway pressure. All of GBS isolates were CAMP test positive. Hemolytic GBS were 91.4% [32/35] of isolates. The scpB gene was detected in 88.2% and 88.9% of invasive and colonizing GBS isolates respectively while presence of ST-17 clone was significantly associated with invasive GBS isolates with P value of 0.002
ABSTRACT
Background and Objectives: adenovirus causes a variety of diseases such as acute respiratory, gastrointestinal, and conjunctiva infections. In this study we aimed to compare the performance of conventional virus isolation on cell culture and rapid diagnostic methods by direct fluorescent assay [DFA] and enzyme immune assay [EIA] for diagnosis of adenoviral infections
Materials and methods: one hundred and twenty six patients were included in the present study from September 2008 till April 2010 at Mansoura University Children Hospital [MUCH] and Ophthalmic Center Mansoura University, they were 68 males and 58 females with a mean age of 27.8+/- [30.19 SD]months, 153 samples were collected from them. The patients were categorized into 3 groups Group I: twenty four patients with acute conjunctivitis, group 2: sixty four patients with upper respiratory tract infection [URTJ] and group 3: sixty five patients with acute diarrhea and 25 healthy controls. Conjunctiva/ and throat swabs were subjected to study by culture on the HEp-2 cell line and DF A, while stool specimens were subjected to study by culture on the HEp-2 and EIA
Results: adenovirus was detected by cell culture in 8/24 [33.3%], 8/64 [12.5%] and 3165 [4.6%] from conjunctiva/ swabs, throat swabs and stool specimens respectively. By DFA, adenovirus was detected in 7/24 [29.2%] and 7/64 [10.9%] from conjunctiva! Swabs and throat swabs. Regarding EIA adenovirus was identified in patient with acute diarrhea in 3165 [4.6%] of cases and 1125 [4%] of control. The overall sensitivity [SENS], specificity [SPEC], accuracy [ACC], positive predictive value [PPV] and negative predictive value [NPV] of DFA in conjunctivitis were 75%, 94% 88%, 86% and 88%, and in patients with URT/ were 50%, 95%, 89%, 57% and 93%, respectively . On comparing EIA with culture in patient with acute diarrhea, SENS, SPEC, ACC, PPV and NPV we,-e I 00%, 98%, 98%, 75% and 100%
Conclusion: from the present study cell culture was the gold standard for diagnosis of adenovirus and detect active replicating viruses but it is costly and time consuming requires viable organism. DF A and E1A are rapid, easy to perform sensitive and accurate methods for adenovirus diagnosis
ABSTRACT
Background: implementation of MRSA decolonization programs is increasing and the emergence of mupirocin resistance among MRSA isolates has been a well-defined phenomenon in many parts of the world two mupirocin resistance phenotypes; low-level [LR-Mup] and high-level [HR-Mup] mupirocin resistance. Are defined in staphylococci. High-level mupirocin resistance cannot be eradicated with mupirocin
Aim of the Work: to assess the prevalence of the Mup A [ileS-2] gene encoding high-level mupirocin resistance among MRSA isolates and to study risk factors and predictors of mupirocin resistance in Mansoura University Hospitals [MUHs] supporting an efficient control of MRSA colonization
Materials and Methods: This study was carried out on 1200 nasal swab, MRSA isolates were detected by growth on Mueller-Hinton agar supplemented with 4% NaCl and oxacillin [6mglml] and confirmed by cefoxitin disc 'diffusion test [DDT]. Mupirocin resistance was detected by DDT and agar dilution test [ADT]. The presence of mup A [ileS-2] gene was tested by PCR for all mupirocin resistant MRSA isolates
Results: out of the 396 MRSA isolates, 76 mupirocin resistant strains were detected. Of them 59 [77.6%] were LR-Mup and 17 isolates [22.4%] were HR-Mup Significant risk factors included; previous ICU stay, previous treatment with mupirocin, other antibiotics and previous pseudomonas infection
Conclusion: mupirocin resistance is an emerging problem in MUHs. In our study HR- Mup mupirocin resistance was detected in 22.4% of MRSA isolates. The finding that the ileS2 gene was detected in all HR-Mup MRSA represents an alarming sign as this gene allow the fast spread of resistance among both MRSA, methicillin sensitive S. aureus [MSSA] and coagulase negative staphylococci [CoNS]. Thus we recommend a strict policy on mupirocin use. in MUHs including proper dose and duratio:1 as prolonged use has led to the development of a rapidly transmissible resistance
ABSTRACT
Background: Peritoneal tuberculosis [PTB] is an unusual cause of ascites in developed countries but it is a considerable problem in developing countries. The advance and validation of new diagnostic strategies are precedence for tuberculosis control programs
Objective: To probe the effectiveness of adenosine deaminase [ADA] activity and QuantiFERON TB Gold In-tube [IT] for diagnosis of PTB
Materials and Methods: Forty one patients were enrolled from Feb. 2007 to Jan. 2010 with a presumptive diagnosis of tuberculous peritonitis with ascites at Mansoura University Hospitals. The ascitic fluid was examined biochemically [protein content], cytologically [WBCs count] and microbiologically [ZN stain and TB culture on Lowenestien-Jensen media]. The level of ADA was determined in ascetic fluid samples. Interferon [IFN] - gamma of whole blood was assayed by QuantiFERON TB Gold [IT] ELISA test
Results: Fourteen [34.14%] patients were diagnosed as TB peritonitis according to pre-determined definition criteria. Three [21.4%] cases were positive for acid-fast bacilli [AFB] smear with 21.4% detection sensitivity and 100% specificity. Mycobacterium tuberculosis [MTB] cultures were positive in 8 patients with a detection sensitivity of 57.1% and 100% specificity. Using Receiver operating characteristics [ROC] curve, a cut-off level of 35 IU/L for the diagnosis of TB peritonitis by ADA was found to have the best results with corresponding sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of 100%, 92.6%, 87.5% and 100% respectively. Thirteen [92.85%] out of 14 TB peritonitis patients were positive for QuantiFERON-TB Gold [IT] assay. The only negative case was TB culture positive and AFB-smear negative. The sensitivity and specificity of PPV and NPV assay were 92.9%, 100%, 100% and 96.4% respectively
In conclusion: the use of these rapid tests with enough discriminatory power gives a chance for initiation of treatment while waiting for the results of MTB culture
ABSTRACT
The objective of the present study was to assess the distribution of malocclusion traits in a selected sample of Saudi adolescent and adult females seeking orthodontic treatment in the Eastern Region of Saudi Arabia. The sample consisted of 330 females divided into two age groups; adolescents [12-17 years] and adults [18-35 years]. Each patient was clinically examined and the type of malocclusion was recorded including Angle's classification, overjet, over bite, open bite, crossbite, scissors bite, crowding and spacing. The collected data were statistically analyzed for percentage distribution of different malocclusion traits for both the age groups. The study revealed that adolescents constituted the larger proportion of subjects seeking orthodontic treatment in the Eastern Region of Saudi Arabia. Angle's Class I malocclusion was the most prevalent type, followed by Class III and Class II malocclusion. Crowding and spacing were the most frequent space discrepancies in all malocclusion traits
Subject(s)
Humans , Female , Adolescent , Orthodontics , Malocclusion, Angle Class I , Malocclusion, Angle Class II , Malocclusion, Angle Class IIIABSTRACT
Background: pityriasis rosea [PR] is a common papulosquamous skin disease in which infective agent may be implicated. Reactivation of human herpes virus 7 [HHV-7] and, in some cases human herpes virus 6 [HHV-6] was suggested to occur in PR
Objective: we aimed to study the involvement of HHV-6 and HHV-7 in the aetiology of PR by nested polymerase chain reaction of both serum and skin lesions
Subjects and methods: this work was achieved through the study of 22 patients with PR [9 males, 13 females, age ranged from 14 to 42 years], 13 age and sex matched patients with other dermatological diseases [4 psoriasis vulgaris, 3 lichen planus, 3 alopecia areata and 3 acne vulgaris] and 8 age and sex matched healthy control. Serum samples were taken from all patients and control. Punch biopsies were taken from lesional skin of both patient groups and from non lesional skin of PR patients. All samples were tested by nested PCR for both HHV-6 and HHV-7 specific DNA sequences
Results: HHV-6 DNA was detected in 7/22 [31.82%] lesional skin, in 5/22 [22.73%] of non lesional skin and in 5/22 [22.73%] of serum samples in PR patients. In the group of other dermatologic diseases HHV-6 DNA was detected in 1/13 [7.69%] of lesional skin and 1/13 [7.69%] of serum samples of one case of psoriasis vulgaris. HHV-7 DNA was found in 10/22 [45.45%] of lesional skin, 6/22 [27.27%] of non-lesional skin and 7/22 [31.81%] of serum samples in PR patients. HHV-7 was detected in only one 1/8 [12.5%] serum sample of the healthy control
Conclusion: HHV-6 and HHV-7 may be implicated in the etiology and pathogenesis of PR in some patients
ABSTRACT
Background: psoriasis is T cell mediated disorder in which the cytokine network is extremely complex, involving the actions and interactions of multiple cytokines. Psoriasis vulgaris was reported to be associated with T helper cell type 1 [Th1] upregulation and T helper cell type 2 [Th2] downregulation
Objective: this cross section study was aimed to evaluate the changes in serum levels of IFN-gamma and IL4 in psoriasis vulgaris patients and correlate these parameters with psoriasis area severity index score [PASI]
Subjects and methods: this work was achieved through the study of 24 psoriasis vulgaris patients [16 males, 8 females, age ranged from 24 to 62 years] and 12 age and sex matched healthy controls. They were subjected to thorough history taking, general and dermatological examination for patients and controls. PASI score was calculated for every one of psoriatic patients. IFN-gamma and IL4 serum levels were assessed for patients and control by quantitative sandwich enzyme immuneo-assay technique. The patients were classified into three groups according the duration of the disease, a group with duration up to 5 years [6 patients], a group with duration from 5 to 10 years [10 patients] and the third one with duration more than 10 years [8 patients], according to PASI score into two groups a group with PASI score up to 15 [14 patients] and a group with PASI score more than 15 [10 patients]
Results: the serum level of IFN-gamma was significantly higher in psoriasis vulgaris patients compared to controls and serum level of Il-4 was significantly lower in psoriasis vulgaris patients compared to controls. There was highly significant positive correlation between serum level of IFN-gamma and PASI score. There were significant inverse correlation between serum level of IL4 and each of PASI score and serum IFN-gamma. There was significant difference in the serum levels of IFN-gamma and IL4 between groups of psoriatic patients with different PASI scores, while the difference between groups with different duration of the disease was non-significant
Conclusion: psoriasis vulgaris is associated with high serum level of IFN-gamma indicating Th1 upregulation and low serum level of IL-4 indicating Th2 down regulation. These changes in IFN-gamma and IL-4 serum levels were significantly correlated to PASI score
ABSTRACT
Background and objectives: staphylococcus aureus [S. aureus] is a very successful hospital and community-acquired pathogen. Methicillin-resistant S. aureus [MRSA] is a major cause of hospital acquired infection worldwide. The number of MRSA strains isolated from community-acquired infections [CA-MRSA] has increased. Most of CA-MRSA strains carry the Panton-Valentine leukocidin [PVL] gene at a high level of incidence. We aimed to determine the prevalence of PVL genes among S. aureus isolates, association with various types of staphylococcal disease and determine the characters of PVL-positive isolates from hospital and community setting
Materials and methods: 386 S. aureus isolates, 182 community-acquired and 204 nosocomial S. aureus isolates were enrolled in the present study. Antimicrobial susceptibility for all isolates was done and methicillin resistance was confirmed by 1[micro]g oxacillin and 30[micro]g cefoxitin disk diffusion. All isolates were tested for the presence of PVL genes [lukS-PV and lukF-PV] using specific primer sequences and polymerase chain reaction amplification
Results: twenty three [5.95%] S. aureus isolates were positive for carrying the PVL genes. The majority of them 16/182[8.79%] community acquired isolates were from skin and soft tissue infections [abscesses [n = 8], cellulitis [n =3], skin lesions [n = 2], and boils [n = 3]]. Among 182 communities acquired S. aureus, 53 isolates were CA MRSA, 7[13.20%] of them were PVL-positive and 129 CA-MSSA, 9[6.97%] of them were PVL positive. On the other hand, only 7/204[3.43%] hospital acquired isolates were from other sites of infection [pneumonia [n = 3], wound [n = 2], septicemia [n = 2]]. Five [3.06%] PVL positive isolates were cured from 163 hospital associated MRSA [HA-MRSA] and 2[4.87%] out of 41 HAMSSA. Antimicrobial susceptibility patterns differed among the PVL-positive isolates. Twelve [52.17%] were resistant to methicillin and oxacillin. Several of the isolates were resistant to penicillin and ampicillin 19[82.60%], gentamicin 13[56.52%], fusidic acid and trimethoprim 10[43.47%], tetracycline 9[39.13%], erythromycin 6[26.08%], cefotaxime 5[21.74%], chloramphenicol 4[17.39%], and while resistance to ciprofloxacin, was rare 1[4.34%]. All isolates were susceptible to vancomycin
Conclusion: the PVL genes are carried by a relatively low number of S. aureus isolates. These isolates were associated mostly with necrotic infections of the skin and soft tissue. We recommend test MRSAs for susceptibility to ciprofloxacin as a marker of putative CA-MRSA since the majority of HA-MRSA are resistant to ciprofloxacin
ABSTRACT
Background and objectives: acinetobacter baumannii [A. baumannii] septicemia is an important cause of morbidity and mortality in neonates hospitalized in neonatal intensive care units [NICUs]. The difficulty of treating A. baumannii nosocomial infection is associated with the high resistance to a wide range of antimicrobial agents. We aimed to find the role of A. baumannii as a nosocomial pathogen causing neonatal septicemia with special concern on risk factors for their acquisition and metallobetalactamases [MBLs] production, aiming to implement infection control program and treat infections
Material and Methods: this study was conducted over 22 month period and included 272 neonates with suspected septicemia admitted to NICU, Mansoura University Children's Hospital. Blood samples were cultured from all cases. A. baumannii identification, susceptibility testing and MBL production using double-disc synergy test [DDST] and combined-disc test [CDT] were performed. Multiplex polymerase chain reaction [PCR] assay was done to detect and differentiate the five families of acquired MBL genes IMP, VIM, SPM, GIM and SIM in a single reaction
Results: A. baumannii was detected in 23/272 [8.45%]. Associated risk factors included low birth weight, the use of central venous catheters, mechanical ventilation and prior antibiotics use. Case fatality rate was 6/23[26.1%]. Resistance to imipenem was 8/23 [34.78%]. Resistance to other antimicrobials was 7[30.4%] meropenem, 12[52.17%] piperacillintazobactam, 11[47.8%] tobramycin, 18[78.26%] ceftazidime and 13[56.52%] ciprofloxacin. Of 8 imipenem-resistant isolated clinical strains 3[37.5%] and 2 [25%] were positive for MBL production by DDST and CDT respectively. PCR analysis revealed the presence of blaVIM gene in 1 [12.5%] isolate and blaIMP gene in 3 [37.5%] isolates. No imipenem-resistant A. baumannii isolates that harbored bla SPM, SIM or bla GIM were detected. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for DDST were 75% , 100% , 88% , 100% and 80% respectively and for CDT, they were 50% , 100% , 75% , 100% and 66.7% respectively. Interestingly, 1 [6.7%] imipenem sensitive isolate was positive MBL producer as harboring blaIMP gene by PCR
Conclusion: MBL producing A. baumannii prevalence is considerable and alarming in NICU and is associated with significant infant fatality. We recommend the consistent and constant surveillance of such strains for the amendment of empirical antimicrobial therapy and probably the reduction of mortality rates for neonates infected with MBL- producing isolates and avoiding the intra-hospital dissemination of such strains
ABSTRACT
Bacterial vaginosis [BV] is the most common cause of abnormal vaginal discharge among women in childbearing period. It develops when vaginal lactobacilli are replaced by an overgrowth of Gardnerella vaginalis, anaerobes, and mycoplasma. BV is associated with subclinical endometritis and may be correlated with recurrent miscarriages. Miscarriage refers to the loss a pregnancy before 24 weeks. It was reported that there is a relation between IL-6 and IL-8 in cervical and amniotic fluid and microbial invasion of chorioamniotic membranes. Our aim is to determine the value of genital tract levels of IL-6 and IL-8 in women with recurrent miscarriages in the presence or absence of BV. The present study included 94 women, 54 of them had history of recurrent miscarriage [patients group] and 40 females with normal pregnancy [control group]. Samples were collected by vaginal swabs and cervicovaginal lavages [CVL] and examined physically, microscopically and were graded by Gram stain for BV, cytokine levels measured by ELISA kits. There was an increase in frequency of miscarriage with age. BV was detected in 37% of patients group and in 20% of control group. Gardnerella vaginalis was found in 33% and 15% of patients and control group respectively. When comparing patients group versus control group both cytokines levels were elevated, the mean [+/- SD] of IL-6 was 66.88+/-60.00 vs 11.14 +/-13.69 pg/ml and that of IL-8 was 2265.47 +/-3328.92 vs 195.12 +/-203.59 pg/ml, P-value was highly significant
ABSTRACT
Background: Human papillomaviruses [HPVs] are small epitheliotropic DNA viruses that can induce cutaneous and mucosal lesions and appear to be closely linked to skin cancers. A broad variety of HPV types which have been referred to as epidermodysplasia verruciformis [EV] HPVs. It was found that patients with psoriasis revealed high prevalence of EV-associated HPV, suggesting that EV-HPV can act as putative antigen contributing to the pathogenesis of psoriasis. In particular, some viral genotypes HPV-5 and HPV-36 have been associated with psoriasis
Objective: To assess the presence of HPV-5 DNA in skin of psoriatic patients, its relation to disease severity by using PASI score and correlation with phototherapy treatment. Design: Screening for the presence of HPV-5 DNA sequences in skin biopsies and scrapings from psoriatic patients without treatment [group A], with history of Psoralen-ultraviolet A [PUVA] treatment [group B], with narrow band ultraviolet B [NB-UVB] [group C] and skin biopsies from control [group D]
Patients and methods: Samples were taken from 54 patients with plaque type psoriasis [39 men and 15 women, mean age 52.8 years] including 25 patients in group A, 15 patients in group B [mean number of PUVA exposure 140], 14 patients in group C [mean number of NB UVB exposure 60] and 15 subjects in group D. DNA was isolated from skin samples and analyzed by polymerase chain reaction with the use of 2 nested primer systems specific for HPV type 5
Results: The rate of HPV DNA positivity was significantly higher in patient groups than control group with a percentage of 24% [6/25] in group A, 33.33% [5/15] in group B, 28.5% [4/14] in group C and 6.6% [1/15] in group D [P=0.003 and X[2]=25.9]. There was a significant difference between lesional and non-lesional areas of psoriatic patients regarding HPV-DNA positivity with P < 0.0001 and X[2]= 16.98. PASI score was highly significant P < 0.001 between HPV-5 DNA negative, positive and double positive psoriatic patients
Conclusion: Skin of psoriatic patients was a reservoir for HPV-5. The prevalence was high in lesional than non-lesional areas, while HPV-5 negative subjects seemed to have a less severe disease. PUVA and NB UVB treatment for psoriasis in optimum doses are not associated with increasing HPV-5 in psoriatic patients
ABSTRACT
The purpose of the present study was to assess the timing and frequency of various pubertal growth spurt stages related to maturation of middle phalanx of the third finger [MP3 stages]. A cross-sectional study on hand-wrist radiographs of 173 Egyptian subjects; ninety females and eighty three males was carried out along a period of two years. The age ranged from 8-18 years old. All radiographs were examined and five MP3 stages were identified. Stage MP3 F represents the onset of the pubertal growth spurt, MP3 FG occurs at the accelerative growth spurt period, MP3 G coincides with the peak growth velocity, while MP3 H and MP3 I stages are attained at the decelerative period and end of the pubertal growth spurt. The chronological age correspondent to each identified stage was recorded. Statistical analysis of the collected data was analyzed for descriptive statistics to calculate the mean age at which each stage was manifested. Student t-test was performed to reveal the significance of sex difference for timing of each stage. A significant sex difference was recorded for all the MP3 stages with the highest difference addressed for the MP3 G stage. Females showed earlier manifestation of all stages compared to males. Moreover, the frequency of occurrence of each stage at different age intervals, as well as at each specified age was calculated. The MP3 F stage showed the highest percent of occurrence at the age interval of 8-11 years for females and 11-15 years for males. MP3 FG and MP3 G stages manifested greatest frequency at 11-15 years for both females and males. The MP3 H and MP3 I stages prevailed at 15-18 years old interval for males while in females these two stages showed highest percent of occurrence at 11-15 years and 15-18 years respectively. Calculating the frequency of each MP3 stage at the different specified ages of the included sample showed results of special interest where 11 11% of the females aged 8 years old manifested existence of MP3 FG stage; accelerative pubertal growth period, while 8.33% of the females at age 12 years showed early manifestation of decelerative and end periods of the pubertal growth spurt; MP3 H and MP3 I stages. Thus representing a sample of early female maturers. On the other hand, 16.66% of the males aged 18 years old were still in the peak growth velocity period, assigned by stage MP3 C, thereby considered an example of late male maturers. Consequently, maturational levels of adolescent subjects seeking orthodontic treatment must be considered during different modalities of growth modification
ABSTRACT
The purpose of this study was to investigate the presence of a relationship between pharyngeal morphology and the related skeletal structures in skeletal class I, II and III malocclusions. A sample of forty lateral cephalometric radiographic views was collected for children aged 7-12 years old. The cephalograms were traced and divided into three groups according to the value of the ANB angle. Group I, consisted of ten skeletal Class I cases [control group] Group II, comprised 15 skeletal class II cases and Group III, included 15 skeletal Class III cases. The pharyngeal landmarks related to the naso and oropharyngeal areas were identified and different sagittal and vertical pharyngeal measurements were recorded. The collected data was statistically analyzed using ANOVA test to reveal the significance of difference of pharyngeal measurements among the three groups; skeletal class I, II and III. Moreover, Correlation analysis between different pharyngeal and skeletal parameters was performed. Results of the study revealed that the majority of the pharyngeal measurements showed no significant difference among the three groups except two parameters' the posterior airway space and the vertical airway length. The posterior airway space [tb-ppwb] significantly differed in class II than in both class I and III. Moreover, the vertical airway length [Val] in class III was significantly different than in Class I and Class II. Regarding the correlation coefficient a significant negative correlation was evident between anteroposterior mandibular position [SNB] and tb-ppwb in skeletal class II, while in Class III cases a significant negative correlation was found between palatal plane angle [PP/SN] and depth of the nasopharynx [PPW-PNS]
ABSTRACT
The aim of the present study was to evaluate the effect of bite opening using a fixed flat anterior bite plane oil rotation based on a non- numeric lateral cephalographic analysis: Centrographic analysis. A sample of seven female subjects aged 12-14 years old, presented with deep overbite was selected. Subjects manifesting Angle's class I or class II malocclusions with horizontal growth pattern were included. Diagnosis of the subjects was based on non-numeric Centrographic analysis of the pretreatment lateral cephalographs against conventional numeric cephalometric analysis. After a six month study period treatment changes were analyzed graphically by the Centrographic approach against statistical analysis of the numeric data collected from the conventional cephalometric approach. Results drawn through both lateral cephalograhic analyses confirmed the efficiency of fixed anterior bite plane in improving the mandibular rotation, thus inducing more vertical facial harmony. Such, the synchronization of the results produced from both analyses ascertained the validity of the Centrographic analysis in evaluating orthodontic treatment changes on individualized basis during our daily clinical practice