Success rate of silver nano-particles in comparison to silver diamine fluoride in management of deep carious lesions: a randomized controlled clinical trial / Taxa de sucesso de nanopartículas de prata em comparação ao fluoreto de diamina de prata no manejo de lesões cariosas profundas: um estudo clínico controlado randomizado

Objective: Evaluate the effectiveness of nanosilver fluoride in comparison to silver diamine fluoride in management of deep carious lesions. Material and Methods: This double-blinded randomized controlled clinical trial included thirty-six patients with deep carious mandibular molars. Patients were recruited form the outpatient clinic of Suez canal university, Egypt and randomly allocated into three groups, Nanosilver fluoride group, Silver diamine fluoride group and control group. For all groups, teeth were isolated by rubber dam. Access was done followed by partial caries removal. Silver diamine fluoride or Nanosilver fluoride were applied, and all teeth were restored with composite resin restorative. Patients were recalled after 3 and 6 months to follow-up the pulp vitality. R-statistical analysis software for Windows, version 4.1.1, was used to conduct the statistical analysis Results: At 3 month, for all groups, all teeth were successful. After 6 months, for silver diamine fluoride group, a single case failed. Regarding the nanosilver fluoride, all cases were successful. For the control group, two cases failed. No statistically significant difference was found between the tested groups. Conclusion: Application of 5% Nanosilver to fluoride varnish has similar clinical efficacy as silver diamine fluoride in arresting the dentin caries progression (AU)

Objetivo: Avaliar a eficácia de fluoreto de nanoprata em comparação ao fluoreto de diamina de prata no manejo de lesões profundas de cárie. Material e Métodos: Este estudo clínico controlado randomizado duplo-cego incluiu trinta e seis pacientes com lesões de cárie profunda em molares inferiores. Os pacientes foram recrutados no ambulatório da Universidade do Canal de Suez, no Egito, e alocados aleatoriamente em três grupos de tratamento: fluoreto de nanoprata, fluoreto de diamina de prata e grupo controle. Para todos os grupos, os dentes foram submetidos ao isolamento absoluto. O acesso à lesão foi feito seguido pela remoção parcial de tecido cariado. Tanto o fluoreto de diamina quanto fluoreto de nanoprata foram aplicados, e todos os dentes foram restaurados com resina composta. Os pacientes foram avaliados após 3 e 6 meses para o acompanhamento da vitalidade pulpar. O software estatístico R-statistical para Windows, versão 4.1.1, foi usado para as análises. Resultados: Em 3 meses, para todos os grupos, todos os dentes apresentaram sucesso no tratamento. Após 6 meses, para o grupo que utilizou o fluoreto de diamina de prata um único caso falhou. Em relação ao fluoreto de nanoprata, todos os casos apresentaram sucesso. Para o grupo controle, dois casos falharam. Não houve diferença estatística entre os grupos testados. Conclusão: A aplicação de verniz de fluoreto de nanoprata a 5% tem eficácia clínica semelhante ao fluoreto de diamina de prata na interrupção da progressão de cárie no tecido dentinário (AU)

Paraspinous Sagittal Shift (PSSS): a novel approach for transmuscular quadratus lumborum block for hip surgery analgesia - four cases report / Paraespinhoso Sagital (PES): nova técnica no bloqueio transmuscular do quadrado lombar para analgesia em cirurgia de quadril - relato de quatro casos

Abstract Background: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients. Methods: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique. Results: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases. Conclusions: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.

Resumo Justificativa: O controle efetivo da dor é essencial para a reabilitação bem-sucedida e melhor recuperação após artroplastia. O bloqueio do quadrado lombar tem sido descrito principalmente para cirurgia abdominal, mas recentemente também tem sido usado para pacientes submetidos a cirurgia de quadril. Método: Na série de casos a seguir, sugerimos modificação na técnica do bloqueio transmuscular do quadrado lombar descrita como bloqueio do Quadrado Lombar Paraespinhoso Sagital (PES). Nossa hipótese é de que a técnica permitiria melhor dispersão do anestésico local para as raízes dos nervos lombares. Tal técnica envolve acesso craniocaudal para injeção do anestésico local entre os músculos quadrado lombar e psoas maior atrás da Fáscia Toracolombar Anterior (FTLA) no nível de L4. Os casos foram submetidos a anestesia geral combinada a técnica modificada PES para bloqueio do quadrado lombar via injeção única ou cateter. Resultados: Verificou-se que a distribuição sensorial do bloqueio nos quatro pacientes estudados cobriu a área entre os dermátomos T11-12 e L4-5. A dispersão do anestésico injetado foi confirmada via fluoroscopia A-P da coluna lombo-sacral após injeção, em dois casos, de solução de anestésico local e contraste no plano entre os músculos quadrado lombar e psoas maior. Conclusões: A técnica PES para bloqueio transmuscular do quadrado lombar pode ser benéfica como componente da analgesia multimodal para cirurgias de quadril. A técnica pode ser alternativa segura para bloqueio do compartimento psoas; entretanto, estudos comparativos futuros são recomendados. A técnica PES para bloqueio transmuscular do quadrado lombar pode também fornecer acesso fácil para inserção do cateter.

Traumatic cerebrospinal fluid leakage following septorhinoplasty

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

Prevalence of some gastro-intestinal parasites in diabetic patients in Tanta city, Gharbia Governorate, Egypt

It is well known that diabetes mellitus affects the immune system negatively through various ways. Diabetic patients are also considered as the immunocompromised group of patients. Infections with intestinal parasites are uncommon to cause high morbidity or mortality to man, but they are risky to diabetic patients. The study investigated the prevalence of common intestinal parasites in diabetic patients in Tanta City. Among the patients who were attending gastrointestinal department [360 patients], complaining of variouse abdominal symptoms and discomfort, thirty three [33] patients were known to be diabetic and on current treatment. Fecal samples were collected from diabetic patients and the same number from non-diabetic patients. Samples were examined macroscopically and microscopically by direct smear and different concentration methods then stained with iodine. The study was carried out through six months from March to August 2015 for common intestinal parasites. In diabetic group E histolytica were detected in 13 patients [39.4%], compared to [43%] among controls, G. lamblia was detected in a patient [3%] compared to [3%] in controls, A. lumbricoides was detected in one patient [3%] compared to [5%] in controls, and E. vermicularis was detected in one patient [3%] compared to [3.8%] in controls. The highest level of parasitosis among diabetic patients was E. histolytica [39%], but without significant difference between controls and patients. There for one can assume that E. histolytica could be considered as a monitor for environmental pollution, low stander hygiene and low standard of living

efficacy of ranibizumab in the treatment of macular edema secondary to central retinal vein occlusion [CRVO]

Purpose: To evaluate the effect of 3 consecutive intravitreal injections of ranibizumab [Lucentis] on visual acuity [VA] and central macular thickness [CMT] for central retinal vein occlusion [CRVO] induced macular edema. Study design: Our study was a prospective interventional case series

Patients and Methods: Twenty eyes of 19 consecutive patients diagnosed as CRVO-related macular edema [eight perfused, twelve ischemic CRVO] treated with 3 monthly intravitreal injections of ranibizumab at presentation as a monotherapy. Follow up visits were scheduled on the first, third and sixth months post-injections. Main outcome measures included mean changes in BCVA and CMI as measured by OCT

Results: The mean time from diagnosis until injection was 20 days. The mean BCVA of 0.03 +/- 0.03 [2/60] at baseline improved to a mean BCVA of 0.07 +/- 0.02 [5/60] six months after the last injection [final outcome], which was statistically significant [p<0.05] .Eleven eyes showed improved visual acuity [ 55%], 8 eyes [40%] had a stable visual acuity and 1 eye [5%] had worse visual acuity compared with baseline. A mean CMT of 679 um +/- 198 at baseline was improved to a mean CMT of 411 um +/- 158 six months after the last injection [final outcome], which was statistically significant [p<0.001]. The improvement in BCVA was superior in perfused CRVO compared to ischemic CRVO No ocular or systemic side-effects were noted

Conclusion: Intravitreal injection of ranibizurnab has shown promising results in VA improvement and decrease in CMT in patients with macular edema associated with CRVO especially the perfused form. However, long term results need to be further investigated

Pattern of community acquired pneumonia in pregnant ladies in Ain Shams University Hospitals

Community acquired pneumonia [CAP] is recognized as a common problem that carries a substantial morbidity and mortality. The burden of disease falls mainly on people at the extremes of age and while the occurrence of CAP in young adults is uncommon. Nevertheless, pneumonia in young adults can be severe and fatal. Pneumonia in the pregnant patient is the most frequent cause of fatal non-obstetric infection. The aim of this study was to assess the pattern of community acquired pneumonia among pregnant ladies in Ain Shams University hospitals. The present study included 168 pregnant ladies with community acquired pneumonia, who were selected from out patient's clinics of obstetrics and gynecology department, Ain Shams University [ASUH]. The present study included 168 pregnant ladies with community acquired pneumonia, who were selected from out patien's clinics of obstetrics and gynecology department, Ain Shams University [ASUH]. Their ages ranged from 18-42 years old with mean age of 25.32 years old [ +/- 4.20 SD]. Morbidity and mortality in pregnant patients with pneumonia continue to present a significant challenge. Early recognition of the diseases process and prompt treatment are required to ascertain an optimal outcome. The treatments in the gravid patients generally follow standard guide lines for the treatment of pneumonia in adults. Concern for fetal outcome should not delay treatment as improvement in maternal oxygenation and status is the best way to ensure fetal protection

diagnostic value of faecal calprotectin in differentiating inflammatory bowel disease [IBD] from Irriable bowel syndrome [IBS]

Patients with inflammatory bowel disease and irritable bowel syndrome can have overlapping symptoms, yet a different management. Hence, a noninvasive biological marker is needed for the assessment of patients with lower bowel symptoms. This study aimed at evaluating the diagnostic value of faecal calprotectin as a potential marker in differentiating patients with inflammatory bowel disease from those with irritable bowel syndrome. Twenty patient with IBD and twenty patients with lBS were recruited from Am Shams hospital gastroenterology outpatient clinic in the period between January 2008 to November 2009, In addition, a control group of 10 healthy individuals was included. Faecal calprotectin level using an ELISA technique [Calprest [R] was measured in the stool of all groups. Also, atypical p-ANCA and ASCA were performed in the IBD group. At a cut off value of 8.1 mg/L, fecal calprotectin had a negative predictive value [NPV] of 100% to exclude lBS patients with a sensitivity of 100% and a positive predictive value [PPV] to confirm IBD of 95.24% with a specificity of 95%. The diagnostic accuracy of faecal caiprotectin in predicting IBD activity was 100% at a cut off value of 25.5 mg/L. Fecal calprotectin appears to be a clinically useful noninvasive marker in differentiating IBD from lBS

Spontaneous viral clearance of chronic HCV infection in Upper Egypt: a community-based study with a 10 year follow-up

Hepatitis C virus [HCV] infection is a global blood-borne disease with the highest prevalence in Egypt. The natural course of HCV infections in highly variable. The reason why the infection persists in some patients and resolves spontaneously in others is not known. The aim of this study was to detect the frequency of spontaneous clearance of chronic HCV infection in Upper Egypt and to determine the predictors of persistence of HCV infection. In 1997, a community-based study was performed in Sallam village in Upper Egypt. Out of the 329 patients who had the start of the study and those who had received specific treatment for HCV infection. These patients were followed up every six months prospectively starting from 2004 till 2007 by clinical, ultrasonographic, and laboratory examinations [liver functions, complete blood count, prothrombin time and concentration]. Serum HCV-RNA was tested for at the end of the follow up period. After a 10-year follow-up, spontaneous clearance of chronic HCV infection was detected in 35 [17.5%] out of 200 patients. Most of clinical and laboratory abnormalities were detected in patients with HCV-RNA persistence than those who had cleared HCV-RNA. By ultrasonographic examination, normal liver echopattern was found in 30 [85.7%] cases with HCV-RNA clearance and in75 [45.5%] patients who had HCV-RNA persistence. Evidence of liver cirrhosis was found only in 9 cases with HCV-RNA persistence [5.5%]. Old age [>60 years] was the strongest predictor of persistence of HCV infection followed by obesity and history of blood transfusion. Spontaneous clearance of chronic HCV infection could occur without any specific antiviral therapy in 17.5% of patients. Older age was the strongest predictor of persistence of HCV infection followed by obesity and infection by blood transfusion

Non-invasive diagnosis to predict adynamic bone disease in haemodialysed patients

Precise evaluation of the underlying type of bone disease in hemodialysed patients frequently requires bone histomorphometry [including static and kinetic variables after double tetracycline labeling], which is an invasive and costly method. Due to the prevalence of Adynamic bone disease in hemodialysis patients, different biochemical noninvasive markers such as [serum intact osteocalcin, serum intact parathyroid hormone [iPTH] and bone specific alkaline phosphatase [bAP] have been shown to be helpful in differentiation between low and high bone turnover. Our study was conducted to detect the usefulness of measuring serum intact osteocalcin and its correlation with serum iPTH and bAP to distinguish Adynamic bone disease from other forms of renal osteodystrophy in hemodialysed patients. The study included 60 patients and 20 normal control subjects, presented at renal dialysis units, Ain Shams University hospitals. The hemodialysed patients were classified according to the results serum iPTH and bAP into two groups: Group I: Included 18 patients [30%] with serum iPTH level £150 pg/ml and serum bAP >/= 27 ng/ml. Group II: Included 42 patients [70%] with serum iPTH level > 150 pg/ml and serum bAP > 27 ng/ml. The serum level of intact osteocalcin was measured for the control group and for all hemodialysed patients. The results revealed highly significant statically differences in serum level of intact osteocalcin between all patients group and the control subjects being lower in control group. Also, the results revealed that 30% of all patients group had Adynamic bone disease and comparison between serum level of intact osteocalcin in Adynamic bone disease group versus other patients group was highly significant, being higher in other patients group. There was no significant difference between Adynamic bone disease patients and other patients as regard serum phosphorus, and serum calcium but there was a significant difference as regard age, while highly significant difference as regard sex, duration of hemodialysis, serum intact osteocalcin, iPTH and bAP. These results suggest that combined estimation of serum iPTH, serum intact osteocalcin, and bAP can provide a useful information on the bone status in uremic patients and represent reliable noninvasive diagnostic tools for the prediction of Adynamic bone disease

Biochemical modifications induced in rabbits by schistosoma mansoni antigens and the beneficial effect of carnosine treatment

This immunological study involved individual injection of the three Schistosoma mansoni antigens [Ags], soluble egg antigen [SEA], cercarial antigen preparation [CAP] or soluble worm antigen preparation [SWAP] in three rabbits groups [Ag], respectively. Three other groups each received the same specific antigen conjoined with administration of L-carnosine [Ag-C] were also included in this study. Determination of three hepatic parameters and ten serum proteins was done. These were total protein, glycogen content and glycogen phosphorylase b activity of liver as well as serum total protein and nine protein fractions [alpha 2-macrglobulin, beta galactosidase, phosphorylase b, serum albumin, fumarase, carbonic anhydrase, beta- lactoglobulin, alpha-lactalbumin and aprotinin]. Conjoined carnosine treatment produced numerous variations. SEA-I-C group presented sex decreased parameters. In CAP-I-C animals, hepatic glycogen content was increased; while phosphorylase b activity was decreased as well as the concentration of serum parameters, total serum protein, alpha2-macroglobulin, phosphorylase b, albumin, fumarase, carbonic anhydrase, alpha-lactalbumin and aprotinin. In SWAP-I-C group, the concentration of only one fraction was decreased; carbonic anhydrase. In batch A, both the Ags. of the egg and cercaria, developmental stages having transient residence in the animal host, showed more affection by the specific Ag. Although, carnosine modified the results of all the three groups in batch B, its effect on both the egg and cercaria Ags. was still more than that of worm

use of island groin flap in the reconstruction of the lower abdomen and perineal region

In this study, an island groin flap was used for a satisfactory reconstruction of soft tissue defects of the lower abdomen and perineal region in eight patients. This flap had several advantages; simple operation, wide range of coverage, large rotation arc, direct closure of the donor site and no sacrifice of muscle in comparison with musculocutaneous flaps. It was of a great value in the reconstruction of lower abdominal wall soft tissue defects with intact underlying fascia or sufficient scarring to prevent herniation. It can be used in the reconstruction of almost all defects in perineal region