Diagnostic Use of Serum Ferritin as a Predictor of Hospital Outcome at Admission in Patients with Infective Endocarditis

Background: Infective endocarditis (IE) is characterised by a concentration of infection inside the heart; it is caused by a bacterial or fungal infection of the endocardial surface of the heart; and it is linked with substantial morbidity and death.The aim of this research was to assess serum ferritin as an admission predictor of in-hospital prognosis in subjects with IE. Methods: This case control researchincluded60subjects diagnosed with IEon the basis of the modified duke's criteria.Subjects were allocated equally into two groups: group I: IE subjects who were further subdivided into two groups based on presence or absence of major adverse cardiovascular events (subgroup A: 19 patients who showed IE complications or major adverse cardiac events during hospitalization and subgroup B: 11 patients who showed a smooth course during hospitalization without major adverse cardiac events or IE complications) and IE subjects as well as age and sex matched 30 healthy subjects. Results: serum ferritin level were significantly increased in group I than group II (P value<0.05). Serum ferritin level was significantly increased in subgroup A than subgroup B (P value<0.001). serum ferritin can significantly predict bad outcome (P value<0.001) with AUC of 0.964 (95% CI: 0.881 – 0.995). At cut off >1200, serum ferritin can significantly predict bad outcome with 94.44% sensitivity, 92.86% specificity, 85% PPV and 97.5% NPV. Conclusions: Serum ferritin was significantly increased in IE subjects who experiencedproblems on admission as compared to IE subjects who didn’t.

Protective Effects of Ginger Extract against the Toxicity of Cyclophosphamide on Testes: An Experimental Laboratory-Based Study

Background: Cyclophosphamide (CP) is a widely used medication in chemotherapy and can cause oxidative stress. Oxidative stress can affect testicular functions by reducing the sperm motility and concentration, changing the sperm morphology, and increasing DNA fragmentation in sperm. Ginger is one of the most widely used spices in various foods and is used as an herbal medicine in many countries due to its antioxidant effects. We aim to study the protective effects of ginger against CP-induced testicular toxicity in rats. Objectives: This study was conducted to investigate the role of ginger in preventing cyclophosphamide-induced adverse effects on the testicular histology of CP-treated male rats. Methods: The study was performed on 30 male albino rats with body weights of 300-350 g. The animals were divided into the following three groups (10/cage): Group 1 (control, untreated group), Group 2 (CP group, received a single dose of CP at 100 mg/kg-1 BW intraperitoneally), and Group 3 (CP+ginger, received ginger extract orally at 500 mg/kg for 35 days after CP injection). The morphological and histological structures of the testes were compared in the different groups of rats. Results: The CP-treated group showed a disorganized germinal epithelium compared with those of the controls. The CP+ginger-treated group showed a significant recovery of the organization of the germinal epithelium and the cellular attachments. Caspase-3-positive cells were significantly higher in the CP group and had remarkably lower levels in the CP+ginger-treated group. A reduction in the diameter of the seminiferous tubules and the destruction of connective tissue were observed in the CP-treated group; these changes were improved in the CP+ginger-treated group. Conclusion: Ginger extract can protect reproductive functions against CP-induced toxicity in rats.

Liver abscess: demographic, clinical, biochemical, imaging and microbial spectrum

Background: Liver abscesses are localized suppurative destruction of liver tissue due to infections of either bacterial (Pyogenic) or protozoa (Amoebic). Historically; pyogenic liver abscess has been described since the time of hippocrates (400 BC). Despite the more aggressive approach to treatment, the mortality rate remained at 60-80%.Methods: This Cross-sectional analytical study carried out at Department of Medicine, Al-Tibri Medical College Hospital, Karachi, from June 2017 to December 2018. All participants of either gender with diagnosis of liver abscess were included in this prospective study. Patients with co morbidities like malignancy, autoimmune disease or on immunosuppressive treatment for any reason were excluded from the study. Following confirmation of the diagnosis; different characteristics of either type of liver abscess like demographic, clinical features, biochemical and imaging findings were evaluated.Results: Data of 73 subjects, 65(89.0%) males and 08(11.0%) females were analyzed with mean age was 45.42±14.518 years. Fifty-four (73.97%) patients had pyogenic liver abscess while amoebic liver abscess was found in 19(26.03%) subjects. Clinically, the most common symptom was abdominal pain, found in 66(90.4%) subjects, followed by fever in 61(83.6%), hepatomegaly in 47(64.4%), jaundice in 18(24.7%) and vomiting in 10(13.7%) cases. Demographics and clinical features are shown in (Table 1).Conclusions: Local trends have been changing and majority of liver abscess were of pyogenic liver abscesses. Clinically, clear differentiation between two types of abscesses is not possible always but few manifestations like typical symptoms, raised alkaline phosphatase and leucocytosis may be helpful.

The response of microbial community in aerobic rice rhizosphere that affected by various plant growth stages and soil types

Aims@#Aerobic rice is a potential crop introduced to encourage water conservation in rice planting. However, a decline of aerobic rice yield has been reported and thus this study was initiated with the aim to observe the response of microbial community in this environment which are exposed to various plant growth stage and soil types. @*Methodology and results@#To determine the effect of soil types such as peat and sandy clay loam on microbial community. A total of four growth stages were tested namely vegetative, reproductive, ripening and maturing. To determine the influence of growth stages and soil types towards microbial community in aerobic rice, Biolog Ecoplate™ technique was used to quantify the response of microbial community through microbial functional diversity and carbon source utilization. The abundance of culturable aerobic bacteria, fungi, actinomycetes, nitrogen-fixing microorganism and phosphate-solubilizing microorganism were determined using five different selective media. Soil physical and chemical properties as well as total nitrogen in plant tissues were also determined. It was found that microbial functional diversity during plant growth (except for microbial evenness) varied between the soil types. Correlation analysis revealed different relationships between carbon source utilization and microbial functional diversity in both soil types. @*Conclusion, significance and impact of study@#Microbial community in rhizosphere responded according to plant development which is primarily determined by soil type. Therefore, it is concluded that soil type particularly the soil physical and chemical properties are important factors in shaping the microbial community by directly influencing the rhizosphere environment.

Zein based magnesium oxide nanoparticles: assessment of antimicrobial activity for dental implications

MgO nanoparticles have been recently discovered as an antibacterial, however, they limited by property degradation due to agglomeration. The addition of a coating agent, such as a zein polymer, is effective in preventing agglomeration without affecting nanosized properties. The aim of this study was to assess the antimicrobial property of MgO nanoparticles when coated with a zein polymer against several oral bacteria and fungi. This was done by utilizing various assessment techniques. The ultimate aim is to use these nanoparticles in dental preparations. The antimicrobial activity of zein-coated MgO nanoparticles at different concentrations of 0.5, 1 and 2% were tested against four different microorganisms: Staphylococcus aureus, Streptococcus mutans and Enterococcus faecalis [gram positive bacteria], and Candida albicans [as oral fungus]. Two different techniques were utilized: the Kirby-Bauer test, and a modified direct contact test. The results indicated that the antibacterial effect of 1% or 2% zein-coated MgO nanowires were statistically significant [p<0.05] against the four organisms studied: S. mutans, S. aureus, E. faecalis and C. albicans. Zein-coated MgO nanoparticles are a new human friendly and potent antimicrobial agent that can be incorporated in the formulation of a variety of new dental materials and products that should provide improvements in dental care and oral health

synergetic effect of alternative medicine with acyclovir in the treatment and control of herpes labialis; HSV1

Background: herpes simplex is a common viral infection of the skin or mucous membranes. The lesions caused by this infection are often painful, burning, or pruritic, and tend to recur in most patients. Short term treatment with acyclovir can accelerate the healing of an acute outbreak, and continuous acyclovir therapy is often prescribed for people with frequent recurrences. While this drug can reduce the recurrence rate by 60-90 percent, it can also cause a wide array of side effects, including renal failure, hepatitis, and anaphylaxis. Safe and effective alternatives are therefore needed

Aim of the Study: is to examine and provide evidence on the potent effect of alternative medicine in Herpes treatment and recurrence prevention

Patients and methods: 60 Patients were divided into 3 major groups according to the severity of the infection with 7 subgroups split according to the treatment protocol

Results: among 60 patients with varies severity, recurrence of outbreaks was significantly reduced when a combined therapy was used while 0-10 percent outbreak recurrence rate was observed for a year when alternative therapy was used alone for mild cases

Conclusion: there is evidence that certain dietary modifications and the use of alternative medicine can be significantly useful for treating active Herpes simplex lesions and preventing recurrences

Myasthaenia Gravis - clinical management issues before, during and after pregnancy

Myasthaenia gravis [MG] is an autoimmune neuromuscular disorder which is twice as common among women, often presenting in the second and third decades of life. Typically, the first trimester of pregnancy and first month postpartum are considered high-risk periods for MG exacerbations. During pregnancy, treatment for MG is usually individualised, thus improving its management. Plasma exchange and immunoglobulin therapies can be safely used to treat severe manifestations of the disease or myasthaenic crises. However, thymectomies are not recommended because of the delayed beneficial effects and possible risks associated with the surgery. Assisted vaginal delivery-either vacuum-assisted or with forceps-may be required during labour, although a Caesarean section under epidural anaesthesia should be reserved only for standard obstetric indications. Myasthaenic women should not be discouraged from attempting to conceive, provided that they seek comprehensive counselling and ensure that the disease is under good control before the start of the pregnancy

Laparoscopic appendectomy between the advantages and complicationsra cross section study -Jeddah - Saudi Arabia - 2016

Background: Appendectomy is the most common surgical procedure performed in emergency surgery. Laparoscopic appendectomy [LA] for acute appendicitis has several advantages over open appendectomy [OA]

In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy [CA]. In this study, we aimed to assess the LA complication and the prevalence of CA

Methods: A cross Sectional survey conducted among 243 patients with acute appendicitis who were suitable for the study between April and July 2016. Operative time, length of hospital stay, post-operative complication return to normal activity has been assessed among the all patients

Results and Conclusion: Our results showed the advantages of the laparoscopic appendectomy approach including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return to work, lower rate of wound infection. Furthermore we found a considerable preference [during the collection of consent] of patients and a high satisfaction after the surgery

Treatment of iron deficiency anaemia in patients with inflammatory bowel disease

In spite of the fact that anemia is the most widely recognized systemic sign of inflammatory bowel disease [IBD], among the expansive range of extraintestinal malady complexities experienced in IBD, including joint inflammation and osteopathy, it has for the most part gotten little thought. In any case, as far as recurrence, as well as to its potential impact on hospitalization rates and on the personal satisfaction and work, sickliness is, in fact, a huge and expensive intricacy of IBD

Frailty is multifactorial in nature, the most predominant etiological structures being iron deficiency anemia [IDA] and anemia of a chronic disease. In a condition related to irritation, for example, IBD, the assurance of iron status utilizing normal biochemical parameters alone is insufficient. A more exact evaluation might be achieved utilizing new iron lists including reticulocyte hemoglobin content, the rate of hypochromic red cells or zinc protoporphyrin. While oral iron supplementation has generally been a backbone of IDA treatment, it has likewise been connected to a broad gastrointestinal reactions and conceivable infection compounding. Be that as it may, numerous doctors are as yet hesitant to administer iron intravenously, in spite of the wide accessibility of an assortment of new IV arrangements with enhanced safety profiles, and in spite of the proposals of worldwide master rules. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD

Flexible ureteroscopy and laser lithotripsy intervention for the management of stone disease

Background: The role of ureteroscopy has dramatically evolved over the past twenty years driven by profound enhancement in various factors and assisting techniques such as the ureteroscope size, deflection capabilities, video-imaging, and in lithotripsy [stone breakage] with the advent of holmium laser, however, the stone size plays a critical role in determining outcomes and operative approach

Aim of the work: we conducted a systematic review of the literature to look at the safety and efficacy of flexible utereroscopy and laser lithotripsy intervention in patients with stone disease; particularly those with stones larger than 2 cm

Methods: A systematic search was performed in the scientific database particularly MEDLINE [2000-2017], EMBASE [2000- 2017], Cochrane Central Register of Controlled Trials, CINAHL [2000-2017], Google Scholar, and individual urologic journals

Results: The search yielded eight studies involving 392 patients, [390 renal units] were reportedly treated with FURSL

The mean operative time was 80.7 minutes [26-215 min]

The mean stone-free rate was 91.2% [77%-96.7%], with an average of 1.6 procedures per patient. The mean stone size was 2.5 cm except for one most recent study which reported stones size less than 0.5 cm. An overall complication rate was 8.1%. Major complications developed in 21 [4.2%] patients and minor complications developed in 19 [3.9%] patients

Conclusion: Flexible Ureteroscopy and Laser Lithotripsy intervention has proven to be not only a less invasive treatment but also a successful with a low complication and stone free rate [SFR] for renal calci larger than 2 cm. FURSL may represent an alternative therapy to standard percutaneous nephrolithotomy [PCNL] with satisfactory efficacy and low morbidity

Prevalência e incidência de obesidade sarcopênica em coorte de idosos domiciliados no município de São Paulo / Prevalence and incidence of sarcopenic obesity in the elderly people cohort in community-dwelling in São Paulo

Introdução: Evidências epidemiológicas mostram que a obesidade sarcopênica (OS) em idosos está associada a um acelerado declínio funcional e alto risco de morbimortalidade, sendo que seu impacto tem se tornado grande preocupação dos profissionais de saúde. Objetivo: Estimar a prevalência e a incidência de obesidade sarcopênica, em coorte de idosos domiciliados no município de São Paulo/Brasil 2000 e 2010. Casuística e Métodos: Foram utilizados dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento), realizado no município de São Paulo em 2000 (2.143 idosos), e em 2010 (795 idosos). A população deste estudo foi constituída por idosos ( 70 anos), de ambos os sexos, que apresentaram todos os dados necessários para este estudo e que concordaram em participar, totalizando 871 idosos analisados em 2000 e 656 idosos em 2010. As variáveis de estudo foram: 1. Dependente - obesidade sarcopênica, identificada segundo: obesidade, diagnosticada pelo valor da circunferência da cintura (CC 94 cm e CC 80 cm para homens e mulheres, respectivamente); sarcopenia, identificada por: 1- força muscular, pelo teste de preensão manual (FPM - kg) (baixa P25; normal > P25, da mesma população), 2- massa muscular (MM), obtida pelo índice de massa muscular.

Background: Epidemiological evidence shows that sarcopenic obesity (SO) is associated with accelerated functional decline and high risk of morbidity and mortality, and its impact has become major concern of health professionals. Objective: To estimate the prevalence and incidence of sarcopenic obesity in the elderly cohort domiciled in São Paulo / Brazil - 2000 and 2010. Methods: We used data from the SABE Survey (Health, Well-being and Aging), held in São Paulo in 2000 (2.143) and 2010 (795). The study population consisted of elderly ( 70 years) of both sexes, who had all the necessary data for this study and who agreed to participate, totaling 871 elderly analyzed in 2000 and 656 elderly in 2010. The variables of study were: 1.Dependent sarcopenic obesity, identified according to: obesity, diagnosed by the value of the waist circumference (WC 94 cm and WC 80 cm for men and women, respectively); sarcopenia, identified by: 1-muscle strength, by handgrip test (kg) (low P25; normal > P25, of the same population), 2-muscle mass (MM), obtained by muscle mass index.

Investigation of cryoprotection on the viability of freeze dried probiotics

Aims: The aim of the present work was to evaluate the effect of various cryoprotective agents on the survival of freezedried probiotic Lactobacillus rhamnosus. Methodology and results: Investigation was done on the viability and stability of probiotics L. rhamnosus. The effect of different cryoprotective agents (namely, sodium chloride, sucrose, dextran, sorbitol, monosodium glutamate, glycerol, skim milk and skim milk with malt extract) with modified De-Man Rogosa Sharpe (MMRS) medium were examined. Commercial De-Man Rogosa Sharpe (MRS) medium was proved to be more expensive than the modified MRS medium with relatively low yield of probiotics L. rhamnosus. Significantly high viable counts were achieved with monosodium glutamate, skim milk and skim milk with malt extract, with optimum concentration at 0.3% w/v. There was a reduction in cell viability at concentration above 0.5% w/v, which could be attributed to cell shrinkage associated with osmotic pressure changes. The cells were found to be stable at room temperature (28 °C) for eight weeks. A significant growth of probiotics was produced from skim milk. Conclusions: Modified MRS medium with skim milk is suggested for the remarkable growth and yield of probiotic lactobacilli.

Adulticidal efficacy of azadirachta indica [Neem Tree], sesamum indicum [Til] and pinus sabinaena [Pine Tree] extracts against aedes aegypti under laboratory conditions

Background: Emergence of resistance to insecticides against mosquitoes and other disease vectors has prompted the need for alternate sources of mosquito control which are more target-specific, easily bio-degradable and effective against mosquitoes

Materials and Methods: The adulticidal efficacy of crude Neem oil extract, Pine oil extract and Til oil extract with five different concentrations i.e. 2%, 4%, 6%, and 8% was tested against five to six days old sugar fed female Aedes aegypti using standard WHO Bioassay test kit. The percentage mortality was observed after 24 and 48 hours under laboratory condition

Results: The LC[50] [Lethal Concentration] values of Neem oil extract against adults of Aedes aegypti were 1.17 ml and 0.09 ml after 24 and 48 hours of exposure respectively, while the LC[99] were 4.27 ml and 1.17 ml after 24 and 48 hours of exposure respectively. The LC[50] values of Pine oil extract after 24 and 48 hours were 0.25 and, 0.06 ml respectively, while LC[99] values at 24 and 48 hour were and 0.89 ml and 0.64 ml respectively. The LC[50] values of Til oil extract after 24 and 48 hours of exposure were 1.17 ml and 0.05 ml respectively while LC99 values were 4.18 ml and 1.28 ml after 24 and 48 hours of exposure respectively. The LC[50] and LC[90] values were indicative that the plant extracts were highly toxic after 48 hours of exposure. Among the tested plant oil extracts the maximum adulticidal efficacy was observed in the pine oil extract. No mortality was observed in controls

Conclusion: Crude extract of Pine oil was more effective against Aedes aegypti as compared to Neem and Til oil

Screening of growth impairment in juvenile rheumatoid arthritis, systemic lupus erythematosus and autoimmune chronic liver disorders

Introduction: Autoimmune disease are frequently associated with growth impairment

This may be a consequence of the inflammatory process associated with disease activity and it also caused by the high-dose corticosteroids that are often used for treatment

Aim: Screening of growth impairment in juvenile rheumatoid arthritis, systemic lupus erythematosus and autoimmune chronic liver disorders

Subject and methods: One thousand cases of school age children of both sexes of juvenile rheumatoid arthritis, systemic lupus erythematosus and autoimmune chronic liver disorders, the study will be conducted in the 4 main pediatric hospitals in Alexandria, to detect growth impairment in those children as indicated by auxological parameters from June 2010 to August 2015

Results: in the studied juvenile rheumatoid arthritis[No. 593] group of school male [No. 118] and female [No. 475] children <3[rd]-<10[th] height for age percentile category [short stature] the percentage in males and females were 51.7 and 46.5 respectively, which the highest percentages are statistically significant and in the studied autoimmune chronic liver disorders [ACLD] group of school age female [N. 69] children and adolescents in the short stature category [<3[rd]-<10[th] height for age percentile] a high percentage was observed which was 45.5 that is statistically significant

Pubertal assessment [Tanner staging] of the studied systemic lupus erythematosus[SLE] group of school age male children and adolescents [No. 69] shows that 48% of cases were in the Tanner stage 1 category is statistically significant which means delayed puberty was in a large number of this cases

Conclusion: Juvenile rheumatoid arthritis, systemic lupus eryth-ematosus and autoimmune chronic liver disorders are frequently associated with growth impairment and delayed puberty. It is important to regularly monitor physical development and control inflammation associated with disease activity

Prevalence of anterior open bite in sample of Peshawar population - a study

Anterior open bite is said to exist when there is an actual vertical gap between the upper and lower incisors with the teeth in centric occlusion. The etiology of anterior open bite is multifactorial and can be attributed to genetic and environmental traits, reflected in pathologic [muscular dystrophy and cleft lip/palate] and developmental factors. The objective of this study was to determine the prevalence of anterior open bite in sample of Peshawar population. Three hundred patients reporting to the department of orthodontic for treatment were included in the study. After taking detailed history and clinical examination an impression of each patient was recorded in alginate impression material and models were poured in dental stone. Measurements were done on dental casts for anterior open bite in millimeters [mm] with vernier caliper having least count of 0.01 mm. SPSS [16.0] was used to analyze the data statistically. Frequencies and percentages were tabulated for each variable. The chronological age range of the sample was 15-30 years with a mean age of 16.2 +/- 5.2 years. Female are more in number i.e. 56.6%]. Anterior open bite was present in 14[4.6%] patient. Less severe open bite [<1mm] was more common [9[3%]] than severe [>1mm-2mm] one [5[1.6%]]

Utilization of nasolabial flap for reconstruction of oral cavity defects

Objective of this study was to highlight the utilization of nasolabial flap for reconstruction of oral cavity defects. The study revealed the results of 21 nasolabial flaps in 14 patients over the period of two and a half year. The patients presented at the Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore from November 2009 to November 2011 and at the Department of Oral and Maxillofacial Surgery, Fatima Memorial Hospital Lahore from May 2012 to October 2012. In 08[57.14%] patients the defects were secondary to Oral Submucous Fibrosis of buccal mucosae; 03[21.43%] patients were with biopsy proven Squamous Cell Carcinoma of the oral cavity and in 02[14.28%] patients flap was used to cover the post traumatic oro-antral defects secondary to firearm and machine injuries to the maxilla. One patient [7.14%] had the defect after resection of the cystic lesion of the maxilla. Uneventful flap healing was observed in 20[95.24%] and partial flap loss occurred in only 01[4.76%]. It was concluded that the nasolabial flap is a reliable and minimally traumatic local flap for reconstruction of small-to-medium sized oral cavity defects with predictable functional and good aesthetic results

Dosage comparison of snake anti-venom on coagulopathy

This study was done to determine whether high or low dose of anti-snake venom [ASV] is better in coagulopathy in victims of envenoming by vipers. This retrospective study was conducted on the 154 patients [Mean age +/- SD, Range] of viper snake bites who were referred to the emergency ward of Razi Hospital, Ahvaz, Iran over 2 years period [2004 - 2006]. According to the treatment dosage the patients were divided in two groups include group 1 [78 cases], low dose regimen and group 2 [76 cases], high dose one. In group 1, the treatment was performed by administration of 4 to 6 vials of ASV through intravenous infusion. In group 2, the patients were given 5 to 10 vials of ASV as an initial dose. In low dose regimen, the number of received packed red blood cell was higher [14 vs. 3] in comparison with high dose group. The number of ASV vials the patients received was 5.5and 21.06 in group 1 and 2, respectively [5.5 +/- 1.7 vs. 21.06 +/- 10.89; p < 0.01]. The difference in frequency of coagulopathy complications, and need for using packed red blood cell were statistically significant [96.2% and 17.9% in group 1 vs. 34.2% and 3.9% in group 2, p < 0.01]. It seems that cautious usage of high dose of ASV [10 - 20 vials] without very special concerns about the cost, dose, and without hazardous side effects is essential for the routine management of sever snake envenoming

Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries; a review of 47 cases

Background: Firearm injuries cause significant morbidity and mortality among its victims. The type and extent of tissue damage vary from simple small size wound to a large soft tissue or skeletal defect. The selection of the appropriate surgical technique is as important as the timing because incorrect selection or improper application of surgical techniques may also lead to infection, sequestration, wound dehiscence, graft rejection, facial deformity and subsequent re-visional operations

Objective: The present study, carried out at Oral and Maxillofacial Surgery department, King Edward Medical University/ Mayo Hospital, Lahore, was aimed at highlighting the frequency of Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries

Study design: Descriptive case series

Setting: Department of Oral and Maxillofacial Surgery, King Edward Medical University/ Mayo Hospital, Lahore, from November 2010 to November 2012; including 6 months follow up

Patients and methods: The study was conducted on 47 patients. All patients suffered gunshot injuries to the mandible and had soft and hard tissue defects at a single site. Patients ranged in age from 17 to 54 years with a mean age of 32.31 years. Males dominated in the study and were n=37 and females n=10. All patients were treated definitively in the first operation by addressing the hard and soft tissue defects

Results: All had single site fracture with angle of the mandible being most common 27 [57.44%]. For reconstruction of soft tissue defect local advancement by undermining and primary closure was carried out in 35 [74.47%] patients, buccal pad of fat in 4 [8.51%] patient, deltopectoral flap in 5 [10.64%] patients and skin graft in 3 [6.38%] patient. For hard tissue reconstruction, nonvascularized bone graft was given in all cases i.e. n=47 [100%]. Iliac crest bone graft was given in 34 [72.34%] patients, rib graft in 6 [12.77%] patients and symphyseal outer cortex bone graft in 7 [14.89%] patients. Post-operative complications were noted in terms of infection, plate exposure, plate fracture and malocclusion which appeared to be 9 [19.1%], 5 [10.6%], 2 [4.3%], 5 [10.6%] respectively

Conclusion: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary definitive hard and soft tissue management can be considered in patients suffering from gunshot injuries to the mandible. Although post-operative complications can result at higher rates in such injuries yet properly selected surgical techniques and post-operative infection control can produce excellent desired esthetic and functional results

On pump versus off pump coronary artery bypass surgery in patients over seventy years old with triple vessels disease and severe left ventricle dysfunction: focus on early clinical outcomes

Cardiovascular disease is the leading reason of morbidity in older people. Coronary artery bypass graft [CABG] surgery is the most common type of operations in world. This study was designed to characterize comparison of early clinical outcome following on pump vs. off pump in patients over 70 years old with triple vessels disease and severe left ventricle dysfunction. 80 patients were divided into two groups: In group A [n=40] on pump CABG was performed with hypothermic cardiopulmonary bypass and cold blood cardioplegic arrest and in group B [n=40] the patients had off pump coronary artery bypass [OPCAB] surgery. Exclusion criteria included emergency or urgent operation, combined valve surgery, history of renal insufficiency [Cr >2 mg/dl], stroke. Early postoperative complications such as occurrence, duration and frequency of recurrence of atrial fibrillation were recorded. All patients underwent Holter monitoring after ICU discharge during their hospital stay. The average age of patients was 79.5 +/- 7.5 years. Post operative atrial fibrillation [POAF] occurred in 24 cases [30%]; 17 cases [42.5%] related to on pump CABG group and 7 cases [17.5%] related to OPCAB group [P=0.03]. The frequency of the recurrence of AF in the on pump group was 3.8 +/- 1.3 days and in the off pump group was 2.4 +/- 1.1 days [P=0.02]. ICU stay in on pump group was 3.6 +/- 1.80 days, while for the off pump was 2.5 +/- 0.6 days [P=0.001]. Also hospital stay duration was 8.5 +/- 2.1 days for the on pump group compared to the other group that was 6.34 +/- 1.06 days. Off pump in patients over 70 years old with triple vessels disease and severe LV dysfunction is safer than on pump and can reduce POAF, ICU and hospital stay and some early surgical complications

N-acetylcysteine instead of theophylline in patients with COPD who are candidates for elective off-pump CABG surgery: is it possible in cardiovascular surgery unit?

Forced expiratory volume in one second [FEV1] is a good predictor of chronic obstructive pulmonary disease [COPD]. COPD is characterized by a chronic limitation of airflow. This study was designed to compare the effects and complications of theophylline alone, N-acetylcysteine [NAC] alone, and a combination of the two drugs on the rates of FEV1 in patients with COPD who were candidates for off-pump coronary artery bypass graft [CABG] surgery. This clinical trial was performed on 100 patients who had a smoking history of 27 pack years with a range of 20 to 40 pack years but were not heavy smokers and were candidates for elective off-pump CABG surgery in Afshar Cardiovascular Hospital, Yazd, Iran. The patients with a history of asthma and bronchospasm and non-COPD respiratory disorders were excluded. There were three groups, that is, the theophylline group [n=33] that received theophylline 10 mg/kg TDS after consumption of food, NAC group [n=33] who received NAC 10-15 mg/kg BD after consumption of food, and the combined group [n=32] who received theophylline and NAC together. Data were analyzed by analysis of variance [ANOVA], Chi-square, and exact test for quantitative and qualitative variables. One hundred patients with COPD enrolled in this study as possible candidates for CABG surgery. Average age of the patients was 60.36 +/- 10.21 years. Of the participants, 83 [83.3%] were male and 17 [17%] were female. Rate of postoperative FEV1 to basal FEV1 was 0.76 +/- 0.32, 0.66 +/- 0.22, and 0.69 +/- 0.24 in the treatments with theophylline, NAC, and the combination, respectively. Theophylline, NAC, and a combination of these drugs can decrease the rate of postoperative FEV1 compared to basal FEV1 significantly. [P=0.0001] Theophylline alone, NAC alone, and a combination of these drugs improve pulmonary function, and there are no significant differences between these protocols. Stomach discomfort and cardiac complications in treatment with theophylline alone is significantly higher than NAC alone and the combination