Posterior Fossa Decompression with Duraplasty in Chiari-1 Malformations

Objective: To evaluate the symptomatic outcome after PFD [Posterior Fossa Decompression] with duraplasty in Chiari-1 malformations. Study Design: Case series. Place and Duration of Study: Department of Neurosurgery, JPMC, Karachi, from July 2008 to September 2012. Methodology: This included 21 patients of Chiari 1 malformations admitted in department through OPD with clinical features of headache, neck pain, numbness, neurological deficit, and syringomyelia. Diagnosis was confirmed by MRI. PFD followed by C1 laminectomy with duraplasty was done in all cases and symptomatic outcome was assessed in follow-up clinic. Results: Among 21 patients, 13 were females and 8 were males. Age ranged from 18 to 40 years. All the patients had neck pain and numbness in h and s. Only 3 patients had weakness of all four limbs and 12 with weakness of h and s. Symptoms evolved over a mean of 12 months. Syringomyelia was present in all cases. All patients underwent posterior fossa decompression with duraplasty with an additional C1 laminectomy and in 2 cases C2 laminectomy was done. Syringo-subarachnoid shunt was placed in one patient and ventriculo-peritoneal shunt was placed in 2 patients. Pain was relieved in all cases. Weakness was improved in all cases and numbness was improved in 19 cases. Syringomyelia was improved in all cases. Postoperative complications included CSF leak in 2 patients and wound infection in one patient. However, there was no mortality. Conclusion: Posterior fossa decompression with duraplasty is the best treatment option for Chiari-1 malformations because of symptomatic improvement and less chances of complications. Key Words: Chiari-1 malformation. Posterior fossa decompression. Duraplasty.

Colonoscopy at the National center for early detection of cancer: Evaluating indications and diagnostic yieald

Colonpscopic procedure is an accepted modality for the evaluation of colonic disease and an accurate procedure in the workup and screening of patients with lower gastrointestinal symptoms. The clinical spectrum and dignostic yield depend upon the indications for the procedure. To identify the yield of the major indications for the procedure, and the pattern of colon pathology in study population.A retrospective study was conducted over a period of 6 months extending from 18th November 2011 to 18th May 2012 at the national center for early Detection of cancer by reviewing the records of 224 colonoscopy examinations were done in the center between january 2010 and december 2012. The patients comprised 66 females[29.4%] and 158 males[70.6%] and their mean ages was [46.6] years. There were 114 patients [50.9%] who were aged less than 50 years. Complete examination to the caecum was possible in 114 cases [50.9%]. Pathological findings were identified in 127 patients [56.7%]. Thae diagnostic yield of patients referred for lower abdominal pain and alternation in bowel habit was low, of [29.72%] and [46.66%], respectively.The yield was high for those with lower gastrointestinal bleeding [71.15%] diarrhea [61.9%], category others [65%]. The diagnostic pattern showed that non-specific colitis and double colonic lesions were identified in [29.13%] and [16.53%] respectively. Colonic caner was diagnosed in 19 patients[14.96%] ulcerative colitis in 9 patients[7.08%], polyps were detected in 13 patients[10.23%], and internal hemorhhids in 17 patients[13.38%]. The highest diagnostic yield of colonoscopy procedure was for lower gastrointestinal bleeding and diarrhea and the main pattern of colonic pathology was nonspecific colitis and double colonic lesions

Serological investigation of salmonellosis among some wild birds and human contacts

A total of 311 serum samples were collected from wild birds and their human contacts [211 from wild birds including gray heron, wild ducks, wild fowl, wild quail and wild captive birds and 100 from their human contacts]. All collected samples were subjected of serological response to Salmonella Typhimurium [ST] and Salmonella Entritidis [SE] by using the Widal and Felix test kits [ST antigen TMH code 63542] and [SE antigen ENH code 63272] supplied by Bio-Rad Laboratories. It was found that the overall percentage of Salmonella antibodies of wild birds was 13.7% [8.5 and 5.2% for ST and SE respectively]. On the other side, the overall seropositive percentage of human salmonellosis in examined serum samples of the human contacts was 10% and SE was most prevalent serotype affecting human contacts with wild birds. The effect of some epidemiological factors including sex and seasons of the year on the occurrence of salmonellosis in both wild birds and their human contacts were studied. The obtained results clarified that salmonellosis incidence was increased in males than in females with highest seasonal incidence occurring in winter season in both wild birds and human. The public health importance of Salmonellosis was discussed

Premenopausal women life style as factor leading to osteoporosis

This is an descriptive study aimed at evaluate premenopausal women life style as factor leading to osteoporosis It was conducted at the bone density out patient clinic at Ain Shams University Hospital. It started in 24 December 2009 and was completed by 24 June 2010. The sample was consisted of [245] premenopausal woman using purposive sample technique according to the following criteria; age less than 45 years, still menstruate and have different religion, educational level and social standard and agreed to participate in the study. Two types of tools were used for data collection and conduction of the study. These consisted of woman's knowledge regard osteoporosis structured interviewing Arabic questionnaire sheet. And supportive material in the form of an educational Arabic booklet about life style for osteoporosis among premenopausal women. Results revealed that two-thirds of study sample [64.1%] in the age group 40-<45 years. They all lived in rural residence, and almost all of them were married [97.1%]. Slightly more than one third of the women were illiterate [34.7%], and about two-fifth were working [41.6%].Regarding total knowledge about the menopause and osteoporosis among women in the study sample ,results displayed that only slightly more than one-tenth of them [10.6%] had total satisfactory knowledge. Concerning dietary life style practices related to osteoporosis the results revealed that 83.7% of them reported taking calcium-rich food; only about half of them [53.1%] reported drinking milk. Also, only about one-third [33.5%] reported regularly eating dairy products. As for risky habits, only one woman [0.4%] reported smoking, and 70.6% reported regularly drinking soda. The vitamin D and calcium supplements were reported to be taken by only 1.2% and 5.3%, respectively. the present study draw attention to a critical point that that premenopausal women in the study sample have a marked deficiency in their knowledge regarding menopausal changes and osteoporosis. This is associated with a lack of adequate life style practices for minimizing osteoporosis. Therefore, the researchers recommend conduction of awareness women educational programs in different stage should concentrate on proper lifestyle as physical exercise, sun exposure and proper diet as well as faulty dietary habits and soda drinking that may protect them from the risk of osteoporosis

Bolton tooth-size discrepancies among University of Malaya's dental students

The objective of this retrospective study was to investigate what percentage of the dental students in the University of Malaya has a tooth size discrepancy. The sample comprised 40 good quality pre-treatment study models with fully erupted and complete permanent dentitions from first molar to first molar, which were selected from the dental students of the University of Malaya. The mesiodistal diameter tooth sizes were randomly measured manually from first molar to first molar using digital calliper (Mitutoyu) accurate to 0.01 mm, and the Bolton analyses for anterior and overall ratios were calculated by scientific calculator. Reproducibility analysis for intra- and interexaminer calibrations was assessed by measuring 10 study models twice, a week apart. A paired sample t-test and the correlation coefficient were used to evaluate the systematic and random errors of the measurements using Statistical Package for Social Sciences (SPSS) version 12.0. The reproducibility of the intra and inter-examiners for the sum of upper and lower mesiodistal tooth size were high (average mean difference = 0.62, r = 0.82). This study found 47.5% of the samples had anterior, and about 10% had overall· tooth width ratios greater than 2 standard deviations from Bolton's mean. Large percentage of the dental students of the University of Malaya has tooth size discrepancies outside of Bolton 2 standard deviations. It would seem prudent to routinely perform the tooth size analysis and include the findings into orthodontic treatment planning.

Indoor pollution and its effect on the pregnancy outcome in cluster and non cluster areas

Indoor pollution is one of the causes of death and disease in the world's poorest countries. Indoor pollution remains a silent and unreported killer, women and children are the most at risk. Smoke rising from stoves and fires inside homes is associated with million deaths per year in developing countries. Indoor air pollution is caused by poor water/ sanitation/ hygiene/ ventilation/ housing conditions. This study was aiming to evaluate the effect of indoor pollution on the pregnancy outcome in cluster and non cluster areas. The study aim was achieved through assessing the pregnant women socio-demographic characteristics, Assessing indoor environment and assessing the pregnant women [pre and postnatal] as well as the newborn. The study was conducted at Ain shames maternity university hospital the MCH Center at EL Dowika Maternal and Child Health Center, Manshiat Naser Maternal and Child Health Center [cluster areas] and El Daher Maternal and Child health Center [non cluster area] and at homes through home visits, started in November 2006 and was completed by Feb. 2008 study design: a descriptive comparative study, Sample type: a purposeful sampling. The selected sample included 200 pregnant women in the 3rd trimester, 100 in each group,. The study revealed an increased level of exposure to indoor pollution, increased level of CO and blood lead of the pregnant women in the cluster area more than the non cluster area. Increased complications during pregnancy, labor and increased adverse newborn outcomes as prematurity, stillbirth, SIDS, congenital malformation were more frequent in cluster areas than non- cluster areas. There were correlations between exposure to indoor pollution and adverse effect on women and newborn outcomes in both cluster and non cluster areas. The study recommended educational programs for the pregnancy women in MCH centers about indoor pollution and its effect on health

Humoral immune IgG response to Plasmodium falciparum in adults: the role of subclass-IgG in clinical immunity to cerebral Malaria

Although antibodies are essential mediators of immunity, high levels of IgG antibodies against a wide range of blood-stage antigens of P. falciparum are poor predictors of clinical protection. It is the qualitative and the functional specificity of the antibodies to malaria antigens that predict the development of a clinically potent protective immunity. The objective of this work is to study the pattern of IgG sub-class in healthy and malaria-infected adults resident in a malaria-endemic area in Sudan. Total plasma IgG and IgG subclasses [IgG1, 2, 3 and 4] against the C-terminal region of the MSA-1[19] antigen of Plasmodium falciparum were measured by a quantitative enzyme-linked immunosorbent assay [ELISA] in 30 adult patients presenting to the emergency department with cerebral malaria [CM]. The levels of IgG antibody profile in CM patients were compared with those in patients with uncomplicated acute malaria [n=20] and in clinically healthy asymptomatic volunteers [n=20]. Total plasma IgG level was significantly higher in CM patients. The level of the sub-class IgG1 antibody against MSA-119 was significantly lower in patients infected with P. falciparum; the lowest values being observed in CM patients and the highest values in the clinically healthy volunteers. Our data suggest that acquisition of IgG1 antibody to MS A-1[19] is associated with a clinically protective immunity and that low production or defective IgG1 response may be associated with severe form of malaria in adults

Elevated cerebrospinal fluid beta-2 microglobulin as a tumor marker in a patient with myeloma of the central nervous system

Myeloma involvement of the nervous system is rare. Extensive literature review revealed only a few cases reported from different parts of the world. The presence of CNS symptoms and detection of plasma cells in the CSF is the usual basis of diagnosis. In addition, immunoelectrophoresis and immunofixation for detection of monoclonal protein confirm the diagnosis in some cases, while some authors used flow cytometry and cytogenetic studies on CSF. Reports of multiple myeloma also include unfavorable cytogenetic abnormalities of chromosome 13. We report a case with relapsed CNS multiple myeloma with the detection of elevated b-2 microglobulin [b2M] as a tumor marker in the CSF

Elevated cerebrospinal fluid beta-2 microglobulin as a tumor marker in a patient with myeloma of the central nervous system

Myeloma involvement of the nervous system is rare. Extensive literature review revealed only a few cases reported from different parts of the world. The presence of CNS symptoms and detection of plasma cells in the CSF is the usual basis of diagnosis. In addition, immunoelectrophoresis and immunofixation for detection of monoclonal protein confirm the diagnosis in some cases, while some authors used flow cytometry and cytogenetic studies on CSF. Reports of multiple myeloma also include unfavorable cytogenetic abnormalities of chromosome 13. We report a case with relapsed CNS multiple myeloma with the detection of elevated beta-2 microglobulin [beta2M] as a tumor marker in the CSF

Effect of acute antioxidant overdose on blood hemostasis: experimental study

The current study was carried out to investigate the effects of the excessive use of large doses of the most widely used antioxidants, d-alpha-tocopherol [vitamin E], retinol acetate [vitamin A], and l-ascorbic acid [vitamin C], on the blood hemostasis. 140 albino rats were divided into 4 experimental groups of 40 animals each as follows: Group I: A control group [negative and positive]; Group II: Each animal of this group received a daily oral dose of 24 mg of d-alpha-tocopherol; Group III: Each animal of this group received a daily oral dose of 1mg of Trans-retinol acetate, and; Group IV: Each animal of this group received a daily oral dose of 20 mg of l-ascorbic acid. The results of the current study have revealed that both d-alpha-tocopherol and retinol acetate produced a significant prolongation of prothrombin time [PT] and activated partial thromboplastine time [PTT] with a significant reduction of factor X activity. On the contrary, l-ascorbic acid produced no significant effect on these parameters. Histopathological examination of liver, kidney, and brain specimens of the different treated animal groups revealed the presence of significant hemorrhages in most samples of both d-alpha-tocopherol- and retinol acetate-treated animals, while the specimens of l-ascorbic acid-treated animals showed no hemorrhage in nearly all samples. These histopathological changes were confirmatory to the biochemical ones. It could be concluded that the excessive use of large doses both d-alpha-tocopherol and retinol acetate alters the blood hemostasis with increased bleeding tendencies, while l-ascorbic acid doesn't. In fact, l-ascorbic acid could be considered a safe drug even in excessive doses for long periods

Hirschsprung's disease in adolescents and adults

Hirschsprung's disease [HD] is rare in the adolescent and adult. It is often misdiagnosed cause of life-long refractory constipation. This study was undertaken to find out the best management strategy for HD in this specific age group. This retrospective study included 6 adolescent and 7 adult patients [10 males and 3 females] with proven tissue diagnosis of HD. These patients were treated between 1996 and 2005 at Tanta University Hospital and affiliated hospitals. The clinical data, diagnostic tools, details of surgical treatment and outcome were analyzed. The patient's ages ranged from 13-27 years [mean 21 +/- 3 years]. The aganglionic segments were confined to the rectum in nine patients and included the distal part of sigmoid in four. All patients presented with chronic constipation requiring enemas, cathartics, and multiple hospital admissions for management. The diagnosis was confirmed by barium enema and full-thickness rectal biopsy. Four patients had anorectal manometry. The definitive procedures were: two-stage endorectal pull through [ERPT] [n=5], primary ERPT [n=2], primary transanal ERPT [n=2], ERPT after failed anorectal myectomy [n=2 patients], Duhamel after failed myectomy [n=1], and low anterior resection and myectomy [n=l]. These operations were complicated with anastomotic leak in 2 patients [15.4%], anal stricture [n=1] and cuff abscess [n=1]. Three patients [23.1%] have partial incontinence, while the other 10 patients have good functional results. 1. The diagnosis of HD should always be suspected in the context of chronic constipation in adolescents and adults; 2. although primary pull through is feasible after prolonged bowel preparation, a two -stage approach is more technically easier and safer; 3. Despite a relative higher incidence of complications, the functional results after surgery in adult patients is comparable to those achieved in children

Fixed anterior bite raising appliance [FABRA]

Deep overbite problem may result either from upward and forward rotation of the mandible or over-eruption of lower incisors teeth. Correction of this problem can be achieved by various methods. A fixed anterior bite-raising appliance was introduced. However, this appliance can be modified to overcome other problems. Such an appliance can be of great value to the orthodontist since it is considered as a multi-disciplinary appliance

Measurements of facial points during growth utilizing centroids

The aim of the present study was to Investigate the movement of facial cephalometric points during growth In a vertical and horizontal direction. A sample of 36 lateral skull radiographs were selected from a bigger sample. Half of the radiographs were taken at aged 9 years +/- 2 months and the other 18 radiographs were taken at 16 years +/- 2 months. The sample was traced and digitized. The computer was able to produce a line joining the centres of the skull, cranium and face CFC [Cranio Facial Centroid line]. Fifteen [15] cephalometric points were located for each subject and measured to a horizontal and a vertical line, based on the centre of the cranium and oriented 450 to the CFC. Millimetric measurements were used to calculate ratios. The data were subjected to descriptive statistics and student t-test. The greatest percentage change for the pooled sample was 11.75% upward movement for Nasion [SD +/- 17.90] and 11.46% downward movement for Gonion [SD +/- 3.25]. Horizontally, the greatest forward movement was for point A, maxillary and mandibular central Incisors, point B, pogonion, Menton, Gnathion and Gonion. There was significant difference between girls and boys in the vertical direction for point B, pogonion, Gnathion and Menton. While in the horizontal direction, significant differences were found for ANS, point A, Apex and tip upper and lower incisor, point B, pogonion, Gnathion Menton, and condylion

Non-surgical treatment approach of severe anterior open bite of an adult: a case report

Case report of an adult female demonstrating severe anterior open bite with skeletal class III malocclusion. The patient was treated non-surgically. The treatment mechanics and results are discussed

Intermaxillary tooth width ratio in a Saudi sample with different malocclusions

The intermaxillary tooth width ratio was investigated in Saudi subjects aged 13 to 20 years. Measurements of permanent teeth from central incisors through first molars in all four quadrants were performed in 40 pairs of pretreatment dental casts. The Bolton s formulae were used to examine the relationship between the maxillary and mandibular teeth. The results showed that the mean and standard deviation of mesiodistal tooth width for the over-all ratio was 91.4 and 1.72, and for the anterior ratio was 76.7 and 1.18 respectively. Further, the present study confirmed previous reports that the Bolton ratio is not affected by the different types of occlusion. When these values were compared with some mentioned in the literature it would appear that Saudis belong to the Caucasoid race

Hypothyroidism followed by hyperthyroidism in a patient with I131 treated Graves disease Parallel changes in the properties of TSH-receptor antibodies

The serum of a patient with Graves disease was found to contain TSH receptor antibodies with TSH antagonist activity 1 year after 1131 therapy and at this time the patient was subclinically hypothyroid. One year later the patient was once again hyperthyroid and this was associated with a change in the serum TSH receptor antibody activity from blocking to stimulating. It is now well established that hyperthyroidism in Graves disease is caused by autoantibodies which bind to the TSH receptor and mimic the actions of TSR. TSH receptor antibodies with thyroid stimulating [TSH agonist] activity are detected in more than 90% of hyperthyroid Graves patients [1]. Occasionally TSH receptor antibodies fail to stimulate the thyroid and in some cases these types of antibody appear to behave as TSR antagonists, such antibodies have been described in Hashimoto's disease and primary myxoedema and have been associated with transient neonatal hypothyroidism[2]. TSR receptor antibodies with TSH antagonist properties have also been reported in two patients who had received 1131 therapy for Graves' disease[3]. We report a case of Graves' disease in which induced hypothyroidism was associated with TSR receptor antibodies with TSH antagonist properties and was followed by recurrent hyperthyroidism associated with TSH receptor antibodies with thyroid stimulating properties