Effect of phytic acid on bond strength and interfacial integrity of universal adhesive to deep dentin

Abstract This study investigated the effect of phytic acid (IP6) in different concentrations and application times on microtensile bond strength (µTBS) and interfacial integrity of universal adhesive to deep dentin. Flat deep dentin surfaces of 48 human molars were either etched with 37% phosphoric acid (PA) for 15 sec (control); or received no acid treatment and universal adhesive was applied directly in a self-etch mode (SE); or divided according to IP6 concentration (C) into two main groups: C1, 0.5%, and C2, 1%. Specimens of IP6 groups were further subdivided into three subgroups according to application time of IP6 (T) where; T1, 15 sec; T2, 30 sec and T3, 60 sec. Single Bond Universal Adhesive was then applied and resin composite blocks were built-up. Forty Specimens were then sectioned to produce resin/dentin beams that were used for µTBS testing using a universal testing machine. The remaining eight specimens were sectioned into slabs that were immersed into ammonical silver nitrate solution and nanoleakage was observed using a field emission scanning electron microscope (FE-SEM). The results showed that the application of IP6 in 0.5% and 1% produced significantly higher µTBS and less nanoleakage compared to PA and SE groups. Also, the application of IP6 for 60 sec recorded the highest µTBS and the lowest nanoleakage followed by 30 sec, and 15 sec respectively. Therefore, conditioning of deep dentin with IP6 enhances µTBS and interfacial integrity of universal adhesive to deep dentin in comparison to PA etching or using the universal adhesive in SE mode.

Resumo Este estudo investigou o efeito do ácido fítico (IP6) em diferentes concentrações e tempos de aplicação na resistência da ligação microtensiva (µTBS) e na integridade interfacial do adesivo universal à dentina profunda. As superfícies planas de dentina profunda de 48 molares humanos foram preparadas com ácido fosfórico (PA) a 37% durante 15 seg. (controlo); ou não receberam tratamento ácido e o adesivo universal foi aplicado diretamente em modo de auto-adesivo (SE); ou dividido de acordo com a concentração de IP6 (C) em dois grupos principais: C1, 0,5%, e C2, 1%. Os espécimes dos grupos IP6 foram ainda subdivididos em três subgrupos de acordo com o tempo de aplicação do IP6 (T) em que; T1, 15 seg; T2, 30 seg e T3, 60 seg. Aplicou-se então Single Bond Universal Adhesive e construíram-se blocos compostos de resina. Quarenta espécimes foram então seccionados para produzir feixes de resina/dentina que foram usados para testes µTBS usando uma máquina de testes universal. Os restantes oito espécimes foram seccionados em placas que foram imersas em solução amoniacal de nitrato de prata e observou-se uma nano-infiltração utilizando um microscópio eletrônico de varrimento de emissões de campo (FE-SEM). Os resultados mostraram que a aplicação de IP6 em 0,5% e 1% produziu µTBS significativamente mais elevado e menos nano-infiltração em comparação com os grupos PA e SE. Além disso, a aplicação de IP6 durante 60 seg registou o µTBS mais alto e o mais baixo de nano-infiltração seguido de 30 seg, e 15 seg respectivamente. Portanto, o condicionamento da dentina profunda com IP6 melhora o µTBS e a integridade interfacial do adesivo universal à dentina profunda em comparação com a gravação de PA ou utilizando o adesivo universal no modo SE.

Computed tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale for symptomatic improvement in rhinoplasty / Avaliação do ângulo e da área da válvula nasal interna por tomografia computadorizada e sua correlação com a escala NOSE na melhora sintomática pós rinoplastia

Abstract Introduction: Nasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. Objective: We aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. Methods: A prospective observational study was conducted between March 2017-May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. Results: Twenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. Conclusion: Reformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.

Resumo Introdução: A obstrução nasal é uma das queixas otorrinolaringológicas mais comuns, e o colapso ou obstrução da válvula nasal interna é a principal causa da obstrução das vias aéreas nasais. Objetivo: Objetivamos avaliar a válvula nasal interna pré, e 3 meses pós-rinoplastia utilizandotomografias computadorizadas reformatadas e avaliar sua correlação com a melhora do sintoma obstrutivo utilizando a escala NOSE, do Inglês Nasal Obstruction Symptom Evaluation. Método: Um estudo observacional prospectivo foi realizado entre março de 2017 e maio de 2018 em um centro de otorrinolaringologia de atenção terciária. Foram incluídos pacientes que apresentavam obstrução nasal secundário a colapso da valva nasal interna e deformidade nasal. Pacientes com sinusite, polipose nasal e tumores nasais foram excluídos. Resultados: Vinte pacientes consecutivos, a maioria do sexo masculino (n = 14; 70%) com média de idade de 22,2 ± 2,8 anos, foram submetidos a rinoplastia eincluídos no estudo. Não houve correlação significante entre as avaliações tomográficas pré / pós cirúrgicas do ângulo/área da valva nasal interna e os escores NOSE. Foi detectada uma diferençã altamente significante entre os escores médios da escala NOSE entre o pré e pós-operatório (p < 0,0001), mas não nos resultados da avaliação por tomografia computadorizada. Conclusão: As medidas reformatadas de tomografias computadorizadas da área e ângulo da valva nasal interna pré e pós cirúrgicas não tiveram valor. Entretanto, os escores da escala NOSE pré e pós-rinoplastia mostraram uma diferença significante ao determinar o grau de melhora do sintoma obstrutivo.

Comparative study between fibro-test and egy-score as non-invasive markers for assessment of hepatic fibrosis in chronic hepatitis c

Backgound: Liver fibrosis [LF] occurs in response to almost all causes of chronic liver injury. Assessing LF is important for both predicting disease progression and monitoring efficacy of therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of discriminating between ginsignificanth, [F0-F1] by METAVIR and clinically gsignificanth fibrosis [. F2] by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated chronic liver disease. Both these aims are clinically the most relevant

Aim: We aimed to compare the diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a prospectively enrolled cohort of Egyptian patients with chronic hepatitis C

Patients and Methodlogy: Twenty patients, treatment naive chronic hepatitis C patients were enrolled. They were 16 males [80%] and 4 females [20%] mean age of these patients was 53.55 +14.3 [rang 18_73 years]. The study was carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar University during the period between March 2016 and March 2018

Results: Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters [total bilirubin, albumin, platelet count] in addition to age and 2 non routine tests [CA 19-9 and Alpha-2-Macroglobulin]. Although this panel needs to be done in validated laboratories, the cost of our score is much cheaper than other well-known and patented tests such as FibroTest and the net results of both methods nearly the same

Conclusion: Egy-Score can be applied easily in clinical practice to exclude severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are reluctant to do it. Egy-score would need further valida-tion to be regarded as an alternative to liver biopsy

Recommendations: Physician should be careful when interpreting elevated levels of tu-mor markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may give false positive results for our scores which give Limitations to our study

Intersexual variation in tail length, venom composition, toxicity, and anticancer activity of cerastes cerastes [viperidae]

Background: The medically important desert-horned or Egyptian sand viper [Cerastes cerastes] is one of the most familiar snakes of the great deserts of North Africa and the Middle East. It is a poisonous and widely distributed snake in Africa and inhabits the sandy deserts of Egypt. Male and female specimens of C. cerastes have been compared from different aspects

Results: Morphologically, tail length relative to snout-vent length was compared. Males significantly showed longer tails than do females. From the venom aspect, males showed a significant [p<0.005] higher concentration of protein in the venom [133mg/ml] compared to females [106 mg/ml]. Female venom was significantly more toxic than male, with a median lethal dose [LD[50]] in mice of 0.6microg venom protein/gm body weight whereas LD[50] for males was 0.7 microg/gm. Protein analyses by means of electrophoretic technique revealed differences in venom composition between males and females. We have detected individual variability and highlighted sex-specific protein similarities and differences among snake venoms. SDS-polyacrylamide gel electrophoresis showed protein bands of 42 and 39 kDa specific to male venoms while bands of 46 and 44 kDa are specific to female venoms. Moreover, we evaluated the antitumor efficacy of male and female snake venoms in liver [HEPG-2], breast [MCF-7], colon [HTC-116] and normal cell lines and IC50 was calculated. Interestingly, both male and female venoms had anti proliferative effects on the tumor cell lines with different potency. Female venom had a higher cytotoxicity against colon cells [IC[50]=0.006 microg/ml] than male venom [IC[50]= 0.019microg /ml]. In contrast, male venom had a higher cytotoxicity against breast cells [IC[50]=0.005 microg/ml] than female venom [IC[50]=0.024microg /ml]. These results indicate that males and females of C. cerastes produce venoms with different composition and activity, which may have epidemiological implications

effects of nitric oxide donors on uterine artery and sub-endometrial blood flow in patients with unexplained recurrent abortion

Nitric oxide plays a major role in increasing uterine blood flow during the luteal phase and early pregnancy. This study was done to compare uterine artery and sub-endometrial blood flow indices during the luteal phase between patients with unexplained recurrent abortion and fertile women and also to evaluate the effects of nitric oxide donors on blood flow indices in the abortion group. The study included a control group of 30 primiparae who had normal vaginal delivery and no history of abortion and an abortion group of 30 nulliparous women with history of two or more unexplained recurrent abortions. Transvaginal three-dimensional pulsed color Doppler ultrasound was done on days 21-23 of the cycle to measure uterine artery resistance and pulsation indices and the subendometrial vascular, flow and vascular-flow indices. Isosorbide mononitrate 20 mg tablet was administered vaginally in the abortion group and blood flow indices were measured again after two hours. The Student t-test and the paired t-test were used for analysis of results and a p-value of

Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile Saudi patients

The study meant to define the prognostic factors that help in prescribing intrauterine insemination [IUI] for infertility treatment which remains an area of continuous improvements. The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates [PRs] were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months [January 2010 till August 2011], and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant. The highest PR, 18.87%, of the polycystic ovarian syndrome [PCOS]-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, [p=0.011, compared to all other groups combined]. The second highest PR, 14.0%, of the tubal factor [TF]-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56%, respectively. However, a group of some hormonal-imbalance based indications had the least PR [0.0% to 2.70%]. Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR [8.33% to 11.11%]. There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances

Effect of various media and supplements on laccase activity and its application in dyes decolorization

Aims: Marine-derived fungi are a potential for the search of new compounds with relevant features. Among these, the ligninolytic enzymes have potential applications in a large number of fields, including the environmental and industrial sectors. This work aimed to evaluate the laccase activity of the marine-derived fungus Alternaria alternata, under various cultivation conditions and its application in synthetic dyes decolorization. Methodology and results: Wheat bran prepared with 40 mL sea water proportion was the most suitable substrate for laccase production (114.06±2.24 U/mL) by A. alternata, after 14 days of incubation in submerged fermentation. Laccase production in static cultivation was superior to that in agitated cultures. The simple Boyd and Kohlmeyer medium with supplementation of 2 mM CuSO4·5H2O on day 6, at an incubation period of 14 days and incubation temperature of 28±2°C under static conditions, yielded amounts of laccase (36.13±0.34 U/mL) less than that obtained with submerged fermentation of wheat bran as unique substrate. Furthermore, A. alternata has high decolorization capability toward azo dyes in the absence of redox mediators, 75.47% of the reactive black at 0.01% concentration, was removed after 30 days of incubation. Also has good ability to decolorize the triphenylmethane dye crystal violet, at 0.01% concentration, about 69.35% of the dye was removed after 30 days. Conclusion, significance and impact of study: These unusual properties demonstrate that the marine-derived fungus Alternaria alternata has potentials in specific industrial or environmental applications.

Assessment of the effect of implementation of global initiatives for asthma [GINA] guidelines in the outcome of asthma exacerbation in the Emergency Department

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

Preemptive peritonsillar ketamine infiltration: postoperative analgesic efficacy versus meperidine

The current study was planned to assess post-tonsillectomy analgesic efficacy of pre-emptive peritonsillar ketamine infiltration with or without bupivacaine in comparison to meperidine alone or in combination with bupivacaine. The study included 100 patients with mean age of 10. 5 +/- 2. 3 years assigned for adenotonsillectomy. Patients were randomly allocated into 4 groups [n=25]: Group K1: received peritonsillar infiltration of ketamine [0. 5 mg/kg], Group M1: received peritonsillar infiltration ofmeperidine [1 mg/kg], and groups K2 and M2 received either ketamine [0. 5 mg/kg] or meperidine [1 mg/kg] in combination with bupivacaine [5 mg/ml]. All medications were prepared as 2 ml in volume and were applied as 1 ml per tonsil 3 min prior to tonsillectomy. On admission to the post-anesthesia care unit [PACU] pain was assessed using the objective pain scale [OPS] score which evaluates 5 parameters each was scored from 0 to 2 for a collective score ranged from 0=best to 10=worst. OPS score was assessed at time of admission to PACU and every 15 min for one hour and every 30 minutes till patients were ready for discharge from PACU at an Aldrete score of 9. Rescue analgesia with morphine 0.05 mg/kg i. v. was administered, after operation; for OPS score>or=5 and time elapsed till first request of rescue analgesia was determined. Upon patient discharge, parents were asked to rate their satisfaction with patient analgesia on 7-point scale; 1=extremely dissatisfied and 7=extremely satisfied. All enrolled patients passed smooth intraoperative course without complication. Mean duration ofPACU stay was significantly shorter in group K2 compared to the other 3 groups and in group K1 compared to groups M1 and M2. Moreover, total hospital stay was significantly shorter in group K2 compared to groups M1 and M2 but was non-significantly shorter compared to group K1. Both duration of PACU and hospital stay showed a non-significant difference between groups M1 and M2. In group K1 number of patients who had short hospital stay was significantly higher compared to groups M1 and M2. Number of patients in group K2 and had short hospital stay was significantly higher compared to groups M1 and M2. Mean recorded OPS scores showed progressive increase in all patients reaching a peak at 90-min after PACU admission in groups K1, M1 and M2 and at 120-min in K2 group. At 60-and 90-minutes after admission to PACU patients enrolled in group K2 had a significantly lower OPS scores compared to groups K1 and M1 but non-significantly lower scores compared to group M2. Mean parents' satisfaction scores reported in group K2 were significantly higher compared to groups K1 and M1 and were non-significantly higher compared to group M2 with non-significant difference among the other three groups despite being in favor of group M2. Peritonsillar injection of a combination of bupivacaine and ketamine provided efficient postoperative analgesia after adenotonsillectomy and achieved higher parents' satisfaction for the outcome of surgery. The used drugs' combination and volume could be recommended as a routine preemptive analgesic policy for children assigned for adenotonsillectomy

Elevated serum PSA and abnormal prostatic echo pattern. Is prostate cancer a must?

To evaluate the distribution of malignant and non-malignant conditions in patients undergoing prostate needle biopsies and correlate the presence of malignancy to their sonographic pattern and PSA level. Over 3 years period from June 2006 till June 2009. 152 patients were included prospectively in the study. Their ages ranged between 57 years to 81 years with a mean age of 68.94 years +/- 8.41 years. Inclusion criteria for suspecting prostate cancer include abnormal digital rectal examination, increased total serum PSA level or abnormal suspicious sonographic echopattern. The prostate was evaluated with a high resolution 5-9 MHZ endorectal probe and TRUS guided core biopsies were taken. A total of 12 cores were sampled for every patient plus any suspicious lesion seen on TRUS examination. The presence of prostate cancer was correlated with the echo pattern of the biopsied areas and the PSA level. Statistical analysis was done. In our 152 cases, the serum PSA range was between 1.5 and 100 ng/ml with a median of 27.2 ng/ml. Prostate cancer was detected in 12 cases [28.57%] out of 42 cases with hypoechoic lesions while it was detected in 2 cases out of 16 cases with isoechoic lesions [37.53]. The difference between both groups was statistically significant [X2 = 16.48. P value < 0.001]. The pathological results of TRUS guided biopsies [n=152] showed adenocarcinoma in 18 cases [11.8%], benign prostatic hyperplasia [BPH] in 103 cases [67.8%]. BPH and prostatitis in 27 cases [17.8%]. BPH and high grade PIN in 4 cases [2.6%]. Any suspicious echo pattern lesion should undergo 12 core biopsy. The majority of pathology on biopsy in patients with suspected prostate cancer is nonmalignant with BPH being the most common [67%] followed by BPH and prostatitis [17.8%]. The higher the PSA above 10 ng/ml the higher the probability of prostate cancer

Total cystopericystectomy versus traditional cyst evacuation for treatment of hydatid cysts of the liver

Echinococcosis is a zoonotic disease that occurs throughout the world. Surgery is the recommended treatment for hepatic hydatid cysts. The purpose of this study is to evaluate the technique of cystopericystectomy for treatment of hydatid cysts of the liver comparing it with the traditional surgical technique of cyst evacuation. Twenty six patients [26] admitted with hydatid disease of the liver in Assiut University Hospital from January 2004 to April 2007. All patients were randomized into two groups, group I [13 patients] were managed by total cystopericystestomy and group II [13 patients] managed by conservative technique of cyst evacuation. History, clinical examination chest X-ray abdominal ultrasonography and computed tomography were performed. All patients were treated with oral albendazole dose for two months after surgery. Blood transfusion hospital stay, post-operative complications, and any evidence of hydatid recurrence were recorded. Surgery was performed on 26 patients with liver hydatid disease [14 men and 12 women] with a mean age of 40.2 years [range 21-73 years]. The mean diameter of the cyst was 6.6cm [range 5-11cm]. Blood transfusion was required in 5 patients in the group of cystopericystectomy and in 2 patients of traditional technique of cyst evacuation. The mean hospital stay was 6.1 days in cystopericystectomy group and 8.2 days in the traditional technique of cyst evacuation. During the follow up period which extended up two years postoperatively, no mortality was verified, the incidence of postoperative complications was 7.6% in the group randomized to cystopericystectomy and it was 23.07% in the group randomized to cyst evacuation. Recurrence of hydatid disease was observed in one patient 7.6% in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy group. Surgical treatment of hepatic hydatid disease by total cystopericystectomy combined with medical therapy with albendazole is a valuable alternative to the more conservative technique of cyst evacuation with a lower incidence of morbidity and recurrence

Program for improving psychosocial state of patients with end stage renal disease

Recently, number of patients with chronic renal failure in Egypt has considerably increased. As a life-threatening and potentially disabling disease, End Stage Renal Disease and its treatment cause stress as well as other psychosocial problems for patients and their families. The researchers used the following measurements: Scale for Emotional status, Scale for psycho-social adaptation; and to measure the cognitive status the researcher used Primary Mental Abilities Test and Memory Processes Scale. The above mentioned measurements were applied to a sample consists of 80 units, including 40 patients with chronic renal failure, 40 healthy persons as a control sample, this experimental study was carried out in Fayoum governorate, a verbal consent had been taken before doing the study to uncover the effect of chronic renal failure on the emotional status, social and psychological adaptation, and the cognitive status of patients. The results of the study showed that there are statistically significant differences between patients and controls concerning their response using the scales of emotional/cognitive status and the psycho-social adaptation in favor of healthy sample. The results of the study also revealed that there are statistically significant differences concerning the response using the scales of emotional/cognitive status and the psycho-social adaptation before and after the application of the program for improving psycho-social state of the patients. This study supports the effectiveness of an intervention program to decrease cognitive and mental impairment of patients receiving dialysis

Survey for hearing loss in El Minia governorate

Hearing impairment has a significant impact on societies; Egypt is not excluded. Moreover, there is no database about the magnitude and distribution of the problems. Our study was started by survey was a household survey, which targeted the El Minia Governorate populations in its different Districts. El minia population is around 3,670389. The sample was chosen based on the multistage stratified clustering technique. The screening was done by the impedance Tympanometery studying the middle ear function and the otoacoustic emission [OAEI as a first phase for the hearing function integrity. Those who failed the screening were then tested by formal conventional pure tone audiometery [PTA] and auditory brainstem response audiometery [ABRI in children below 4 years as a second phase. Results showed that failure rate [hearing loss] in the first phase was 17.06% of the tested sample. The second phase hearing loss was 13.79%

clinical and histological effects of topical bleomycin on leukoplakia of the oral mucosa

Fourteen male patients [aged 45-65 years] complaining of large white keratotic lesions [Leukoplakia] of the buccal mucosa were enrolled in this study. All patients underwent a biopsy before entering into this trial to confirm the diagnosis of leukoplakia and after trial for pathologic comparison. Patients with the histological presence of dysplasia, or evidence of infectious or inflammatory lesions such as lichen planus were excluded. Before entering the study, all suspected local factors were eliminated and also all the patients were asked to stop smoking. Patients were divided into two groups, each consisting of 7 patients. Group I [control group] received 2.5% Miconazole gel 3 times/day for 2 weeks. Group II [study group] received 2.5% Miconazole gel 3 times/ day and 2% bleomycin sulphate mouth rinse one time daily for 2 weeks. The lesions were evaluated clinically for the size of the total area [lesions were assessed 4 times [re-treatment, at 2, 4, 8 weeks and compared statistically], presence of erythema, and presence of atrophy of the other mucosa as a reaction to the topical application of bleomycin. To evaluate the possible hematologic toxicity of the absorbed bleomycin sulphate, baseline and follow-up complete blood counts were obtained weekly during trial. It has been found that the lesions of all cases did not resolve completely either by topical antifungal drug alone or by a combination of topic antifungal drug and bleomycin. However, the reduction in size of the lesions after 8 weeks in group two is significantly different from group one [P<0.05] when compared to the pretreatment size. Pathologically, all the specimens of the lesions did not show dysplasia either before or after trial. There was a measurable decrease in the thickness of the hyperkeratosis, rete pegs elongation, and inflammatory cells infiltration in specimens of the patients of group two after 8 weeks when compared with their specimens which were taken before the treatment. Topical administration of bleomycin usually reduces lesion size and has little toxic side effects. It is beneficial to use bleomycin adjuvant with the surgical procedure for extensive leukoplakia to decrease the size of lesion before surgery. This helps to avoid grafting after removal of the lesion and prevent the dysplastic change of benign form of lesion

Comparative study of generalanesthesia with mini-dose lidocainespinal anesthesia for outpatientknee arthroscopy

We compared general anesthesia [GA] with spinal anesthesia [SA] foroutpatient knee arthroscopy. Fifty patients were randomized to receive either sevoflurane in a mixture of nitrous oxide [60%] in oxygen with laryngeal mask, or 30 mg of lidocaine 1% spinal anesthesia. All patients received premedication with intravenous [iv] lornoxicam 8 mg and at theend of the operation; patient's knee joint was injected with 1 ug/kg cloni-dine diluted in 20 ml of 0.25% bupivacaine. Postoperatively, iv fentanyl was given if visual pain scale [VAS] at rest exceed 4 and on discharge from the hospital, patients were instructed to take lornoxicam 8 mg tablet every 12 hour [h] as needed for pain. Perioperative vital signs, intraoperative time intervals, duration in the recovery and discharge times were re-corded. Postoperatively, we also evaluated pain and sedation scores, to-tal analgesic requirements, patient satisfaction, and incidence of complications [nausea, vomiting, pruritus, positional headache, backache,difficulty voiding, and dizziness]. We found that in the recovery, no patients in either group asked for analgesia. VAS pain scores were very low in both groups [2.6 +/-0.8 in GA group versus 2.4 +/-1.0 in SA group after60 min postoperatively]. There were no significant differences between both groups as regards total analgesic consumption during 72h postoperatively, and sedation scores. Patients in SA group had longer time of operating room [OR] entry until starting skin preparation [13 +/-4.5 versus 5.2+/-3.1 min] and also, from OR entry until skin incision [16 +/-5.2 versus 10.9 +/-4.7 min] in comparison with patients in GA group. However, the total duration inside OR was not different between both groups. Patients received SA had met the criteria for home readiness earlier than those received GA [68.3 +/-44 versus 95.2 +/-33 min respectively]. Patients in GA group suffered more nausea than in SA [24% vs 8% respectively]. The incidences of other side effects were comparable in both groups and there were no differences in patients' satisfaction scores between groups. We concluded that the two techniques with the multimodal analgesia given had provided comparable patient satisfaction and efficiencies both intra-operatively and postoperatively with low incidence of complications

Injectable bioactive cement in treating selected distal radial fractures

Between 2003 to 2006, twenty eight selected distal radial fractures in 27 patients operated in the division of emergency surgery, department of orthopedics and traumatology, Al Azhar university and other specialized centers were followed clinically and radiologically. Injectable bioactive calcium phosphate cement was used in conjunction with osteosynthesis or external fixation to correct metaphyseal bone defects experienced after reduction due to comminution. Fracture fixation/fragment stabilization was individualized according to every case. Percutaneous pins were used in 10 [35.7%] fractures, small fragment plate and screws in 3[10.7%] supplemental removable external splint immobilization for 4-6 weeks was used when indicated. External fixator helped with K-wires if necessary was used in 12[42.9%] fractures and Plaster-of-Paris splint or cast support in the remaining 3[10.7%]. Of the 27 patients, 23 [85.2%] were males and 4[14.8%] were females. Mean age at surgery was 33 years [range 21 to 59 years]. There were 17 [63%] right, 9[33.3%] left and 1 [3.7%] bilateral cases. Fractures were classified into three AO groups, accordingly, cases were graded; A [21.4%], B[17.9%] and C[60.6%]. Standard X-rays were used for radiological evaluation in all patients. Wrist scoring system developed by Cooney, et al., was employed for clinical assessment [9]. At a mean follow up 9.6 months [range 11-29 months], the overall results were: 17[60.7%] excellent,6 [21.4%] good, 2 [7.1%] fair and 3[10.7%] poor. In conclusion, calcium phosphate cement represent a good spacer biologically and biomcchanically, resulted in improved treatment outcomes for patients with comminuted fractures of the distal radius

Alignment and soft tissue balance of severe varus knee in total knee replacement

Twenty-nine cases of severe arthritic knee with various degrees of varus deformity [15°-20°] were treated by total knee replacement. Twenty-one [72.4%] of cases were due to osteo-arthritis of knee while the rest [27.6%] were due to rheumatoid arthritis; bilateral affection was reported in 2 patients. There were 20 males and 7 females whose age ranged from 60 to 74 years. The deformity was partially correctable in nine [31%] cases and fixed in twenty [69%] cases. The aim of surgery was to achieve normal alignment of the limb and joint line and to balance the soft tissue structures on both sides of the joint. This required augmentation of medial compartment in 3 [10.3%] cases by bone graft and fixation by cancellous screws. Normal limb alignment was achieved in twenty-five [86.2%] cases. Four [13.8%] cases had residual varus deformity that ranged from [3°- 5° varus]. In three [10.3%] cases lateral laxity was sill present despite the soft tissue surgery

Shoulder arthroscopy: part I Is it justifiable after acute first-time anterior shoulder dislocation?

We reported on 34 young labor men, mean age 31.4 years with high physical demands who sustained first-time anterior dislocation of the shoulder. All were treated initially with closed reduction and immobilization, followed by shoulder therapy programs. Despite this, patients still suffered episodes of pain, discomfort and/or insecurity and feelings of joint being out on performing a particular activity. MRI was done for all cases, then, arrangement was made for arthroscopic evaluation some weeks to few months after primary treatment. The pathologic findings at arthroscopy divided the cases into 5 groups: capsular tears only in 5 patients; 4 [11.8%] of them [G1] the tear was defined at the glenoid attachment - in the rest one [2.9%] it was at the humeral insertion [G2]. Capsular tears associated with partial labral detachment [G3] in 9 [26.5%], capsular tears and complete labral detachment [G4] in 17 [50.0%], and complex injury [G5] in the remaining [8.8%] shoulders that demonstrated full labral detachment from the glenoid, frank tearing and fraying of the capsular structure which was seen as well avulsed from the labrum. No bony Bankart lesions, or mid-capsular tears were defined. The decision, based on the literature review [1-4-5-8-12-13-14-15-17-18-32] was to continue conservative treatment and observation for the 5 patients suffered capsular tears, but, an arthroscopic repair was an option in our mind for the 4 shoulders with glenoid capsular detachment, and an open surgery for the humeral avulsion of the glenohumeral ligament. While the option for the fifth group of cases was open shoulder stabilization procedures. The third, and fourth groups of cases including 26 shoulders were considered as an ideal candidates for arthroscopic treatment. This study emphasizes that a systemic arthroscopic examination of the glenohumeral joint is not only more confirmatory, defining the exact pathologic anatomy associated with first-time anterior shoulder dislocation, but as well how best in patient selection, and decision making

Shoulder arthroscopy: part II arthroscopic Bankart repair for anterior shoulder instability using suture anchor reconstruction technique

Suture anchor reconstruction technique was used in 19 shoulders over the last 2.7 years in 19 patients in an attempt to restore anterior stability. All the patients had traumatic anterior instability diagnosed on physical examination and at arthroscopy. Discrete Bankart lesion and well formed glenohumeral ligaments, with or without capsular laxity was the evidence consistent with instability in all patients, and each underwent a standardized procedure, however, the number of anchors were different for every patient, range 1-to-3 according to the size of the lesion. Additional capsulorraphy procedures were done to reduce excess capsular volume including; plication sutures in 8 shoulders, and thermal shrinkage in 7. All patients were young active men with high physical demands, the average age at the time of operation was 25.2 years. All were right handed, the dominant side was affected in 11 patients. None of the patients had prior instability operations. The follow-up averaging 18 months, range 9-to-3 1 months. None of the patients developed redislocation, subluxation, or positive apprehension during the follow-up period. No major intra-operative, or pen-operative complications were reported during this study. 75%-to-full range of motion of the shoulder joint as compared with the opposite asymptomatic side was preserved 21 in most patients. Using the shoulder evaluation scale advocated by Rowe; and Zarins, 1981 1421, the patients had excellent-to-good results with an overall average score of 85.82 points; but 5 patients had episodes of moderate pain with activity, and 7 had moderate limitation in overhead work. It would appear that arthroscopic repair of pathologic Bankart lesion in a carefully selected patients using suture anchor technique is a favorable answer restoring stability to the shoulder better than non-operative treatment of first-time dislocation and to surgical treatment of recurrent shoulder dislocation

Shoulder arthroscopy: part III arthroscopic versus open anterior shoulder stabilization

To evaluate the efficacy of a particular line of treatment, criteria based on functional basis and complication rate must be considered. This work was carried out because of the authors' conviction that any new operative procedure must be critically assessed, on this basis, comparison with other procedures must be included. Forty one shoulders were allocated to an arthroscopic repair group [19 shoulders], and an open repair group [22 shoulders]. The two groups were generally comparable in terms of age [a mean of 25.2 years in the arthroscopic group and 27.3 years in the open group], gender [all patients in either group were males], mechanism of injury and etiology of instability [all patients related a history of a traumatic event], dominant extremity [the right and the dominant side was the most vulnerable], duration of symptoms [a mean of 13 months and 19 months for the arthroscopic and open groups respectively], level of daily activities and effort demand [all were young active with high physical demand]. Three variations were existed: [1] pre-selection and pre-conditioning was the strategy in the arthroscopic repair group, so that, procedural option was determined on the basis of the pathological findings, only at the time of surgery, modification of treatment was possible. [2] the arthroscopic procedure involved an anatomic repair of the avulsed anterior capsule and labrum to the glenoid lip using standardized suture anchor technique and an incorporation of capsulorraphy in most shoulders. While in the open repair group, different operative modalities were employed using familiar techniques including: 2 soft tissue reconstructions; Magnuson - Stack [4 shoulders] and Putti-Platt [6 shoulders]. In addition, coracoid tip with its attached muscles transfer [Bristow operation in 9 shoulders] and rerouting [Boytchev operation in 3 shoulders]. [3] the duration of the follow-up, which considered short-to-mid term [averaging 18 months] and long-term [averaging 71 months] in the arthroscopic and open groups respectively. The treatment outcomes for each group were determined according to the recurrence rate, the presence or absence of -pain, the range of motion, the strength and the return to pre-injury activity. Analysis of the measured parameters for both approaches; open and arthroscopic showed no significant differences, both yielded comparable results