Ángulo de bifurcación corregido versus ángulo de bifurcación distal para la predicción de la rama lateral. Compromiso después de la bifurcación provisional Intervención Coronaria / Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

Provisional bifurcation percutaneous coronary intervention (PCI) is recommended over two stent strategy but with the risk of side branch (SB) compromise. Prediction SB compromise is crucial for optimizing of the procedure outcome. Neglecting the proximal bifurcation angle (BA), the distal BA was presented as a reliable predictor of SB compromise supposing that the main vessel is always a straight vessel. However, its impact on the fate of side branch is debated. This study aims to compare between of the corrected BA, the sum of proximal and distal BAs, and the distal BA in terms of prediction of SB compromise. This prospective cohort study was conducted in Zagazig university hospitals in the duration between March 2019 and March 2020, and involved 185 patients who underwent provisional bifurcation PCI. Patients were divided according to the corrected BA into two groups; straight bifurcation model group which involved 73 patients with corrected BA = 180º, and wide bifurcation model group which involved 112 patients with corrected BA > 180 º. Compared to the wide bifurcation model, the incidence of SB compromise was substantially higher in the straight bifurcation model (52.1% vs. 15.2%; P < 0.001). The corrected BA had a better area under the curve compared to the distal BA with statistically significant difference (0.711 vs. 0.580; P = 0.023). Multivariate analysis demonstrated that the corrected BA was among the independent predictors of SB compromise. The study concluded that the corrected BA could be a novel strong predictor of SB compromise after provisional bifurcation PCI for future verification.

Mucoadhesive buccal patches of lornoxicam: II- in-vivo evaluation and clinical efficacy

Lornoxicam is a NSAID of the oxicam class and it has the same side effects of this group when taken orally. In attempts to avoid the systemic side effects of lornoxicam [e.g. gastric irritation] and to achieve sustained release of the drug, several buccal patch formulations containing lornoxicam were prepared using different polymers and were evaluated for in-vitro characteristics in part I of this study. In the current study, the selected formulations [based on the previous in-vitro data] are evaluated for in-vivo performance using experimental animals and clinical efficacy on human volunteers. Pharmacokinetic parameters were assessed following application of the selected patches in rabbits. A comparative clinical study was conducted on patients with post-operative pain and edema following maxillofacial operations. The results of the in-vivo animal experiment showed that lornoxicam formulated in different buccal patches was successfully delivered to the systemic circulation and showed high absolute bioavailability of lornoxicam. The clinical study results revealed that sodium carboxy methyl cellulose [NaCMC, 3%] formulation applied to the buccal mucosa was slightly better or equally effective to the orally administered commercial oxicam product [Feldene Flash tablets] in reducing pain level, swelling and tenderness within a period of 4 days with no observed side effects. These findings suggest that lornoxicam administered in this buccal patch may present a potential therapeutic use as a strong anti-inflammatory and analgesic agent

Mucoadhesive buccal patches of lornoxicam: 1-development and in-vitro characterization

Lornoxicam as a non-steroidal anti-inflammatory drug [NSAID] has the same side effects of this group if taken orally [GIT, renal, and hepatic disorders]. Lornoxicam and its metabolites bind extensively to plasma albumin [99%], beside that, it has a relatively short half-life [3 to 5 hrs]. The drug was formulated in mucoadhesive buccal patches using different polymers including, hydroxyethyl cellulose [HEC], hydroxypropyl cellulose [HPC], hydroxypropylmethyl cellulose [HPMC], chitosan, polyvinyl alcohol [PVA,], gelatin, sodium alginate and sodium carboxymethyl cellulose [Na CMC]. The physical characteristics of the formulated patches as mass uniformity, patch thickness, surface pH, folding endurance, swelling, residence time as well as mucoadhesion [in-vitro and ex-vivo mucoadhesion force] were evaluated. The in-vitro release of the drug from the formulated patches was studied using the USP dissolution apparatus, and the results indicated that HEC, HPC and chitosan showed the lowest drug release [70%, 76%, and 81%, respectively] while gelatin] sodium alginate and Na CMC gave the highest release [nearly 100%]. Permeation of larnoxicam formulated in different patches through rabbit buccal mucosa was also studied and the results showed that gelatin and chitosan patches resulted in the highest drug permeation. Kinetics of drug release from the different patches was found to follow zero order or diffusion kinetics

Ureteral stent versus percutaneous nephrostomy for diversion of stone-induced hydronephrosis

Urinary diversion of the obstructed hydronephrosis kidney is indicated by symptoms, such as persistent renal colic, febrile UTI [urosepsis], and uraemia. This study is an attempt to evaluate [PCN] versus ureteral stent in cases of stone-induced hydronephrosis regarding relief of symptoms and quality of life. A total of 40 patients with stone-induced hydronephrosis were randomized into either [PCN] or stent insertion groups. These patients were then evaluated regarding to [a]- the procedure [use of analgesics, x-ray exposure, success of insertion], [b]- relief of accompanying symptoms [duration of diversion, intravenous administration of antibiotics for high temperature]; and [c]- the quality of life. Two groups of patients: [a] - the group of [PCN] has an average age of 55 years, and a male-to-female ratio of 12:8. [b]- The group of ureteral stent has an average age of 49 years, and a male-to-female ratio of 9:11. - [PCN] was successfully completed in 100% of patients and stents were successful in 80%, with a 20% conversion to [secondary PCN].- The x-ray exposure was shorter in the [PCN] group [p = 0. 052].- Administration of analgesics was more frequent in the stent group [p = 0. 061]. - [PCN] indwelling time was shorter [50% less than 2 weeks] than that of stents [25% less than 2 weeks] [p = 0.043]. - Antibiotics were administered for greater than 6 days in 0% of patients who underwent [PCN] versus 70% in those with stents [p = 0.174]. - Reduction in quality of life was moderate but more pronounced in patients with stents compared to those who underwent [PCN], and was more distinct in males and younger patients. The quality of life progressively improved in the course of diversion with [PCN] but deteriorated with stents. Our results demonstrated that [PCN] is superior to ureteral stents when diversion is indicated in cases of stone-induced hydronephrosis, especially in patients with a high temperature, as well as in males

Clinically insignificant residual fragments [CIRFs] after [ESWL]

To assess the significance of asymptomatic residual stone fragments of less than 4 mm [clinically insignificant residual fragments [CIRFs] after extracorporeal shock wave lithotripsy [ESWL]. Eighty-one patients were followed up for 6 to 60 months [mean 15] after ESWL to determine the fate of the CIRFs. -Of the 81 patients, 6 were lost to follow-up, leaving 75 patients. -During follow-up, fragments passed spontaneously in 18 patients, remained stable in 13 patients, and became clinically significant in 44 patients who developed one or more complications. For the latter patients, repeated ESWL was done in 16, percutaneous nephrolithotomy in 3, and ureteroscopic stone removal in 4 patients. The remaining 21 patients were treated conservatively with analgesics. -We found that: a]- 53% of the CIRFs located in the pelvis passed spontaneously, and most of the CIRFs in caliceal location became clinically significant. b]- as the stone burden and number of stone fragments increased, the risk of CIRFs becoming clinically significant increased. c]- The clearance rate was highest in the first 6 months. Finally, as the duration of follow-up increased, the rate of complications increased. Patients with residual stones after ESWL require close follow-up and timely adjuvant therapy. As the number and size of residual fragments increased, the risk of complications increased. A pelvic location was a favorable factor for spontaneous passage. Although the complete clearance rate of CIRFs with repeated ESWL was lower than for the operative interventions, most patients improved with this modality

Cigarette smoking and its effect on gastro-pharyngeal and gastro-esophageal refluxes

Ciastro-pharyageal reflux appears to be associated with various otolaryngological complaints Cigarette smoking is known to affect adversely the defense mechanisms against reflux of gastric acid into the esophagus. To study the relationship between gastropharyngeal as well as gastroesophageal refluxes and cigarette smoking, fifteen subjects underwent 24-hour double - probe pH monitoring while smoking their daily amount of cigarettes. The percentage of time the PH was below 4 during the smoking period was significantly higher than the percentage of time the pH was below 4 during the non-smoking period, proximal, at the level of the upper oesophageal sphincter, as well as distal above the lower oesophageal sphincter. in conclusion, this study demonstrated and concluded that smoking increases both the gastropharyngeal and gastroesophageal refluxes by affection on the defense mechanisms against reflux of gastric acid or increased gastric acidity. Thus, smokers with disorders and / or complaints caused by reflux should, therefore, be advised to stop smoking in order to reduce reflux of gastric acid into the oesophagus and pharynx

Interlocking inramedullary nailing in humeral shaft fractures

This multicenteric study included 38 patients with a fracture of the humeral shaft, treated with antegrade Russel-Taylor interlocking humeral nail. Twenty patients had acute fractures, ten had pathological fractures and eight had pseudoarthrosis. A closed nailing was performed in 16 acute fractures and in all pathological fractures. All open fractures and pathological fractures had no reaming. All patients with pathological fractures had a good relief of pain and an improved function of the upper limb. The mean healing time was 1.2 weeks for acute fractures and 16.75 weeks for pseudoarthrosis. An excellent to satisfactory result was achieved in 96% of the patients for acute fractures and in 75% for pseudoarthrosis. Locking nailing with Russel-Taylor humeral nail is a valuable stabilization technique for acute and pathological humeral shaft, fractures and pseudoarthrosis yielding a high rate of union and good functional results with a few minor complications

Management of juvenile angiofibroma with intracranial extension

This study included 19 patients with angiofibromas with variable degrees of intracranial extension. Of those, patients with minimal intracranial-extradural extension [Fisch class IIIb] were managed through transmaxillary subcranial approach, while extensive intracranial extension [Fisch class IV] necessitated combined craniofacial approach through frontotemporal craniotomy with maxillary removal and reinsertion. The hospital stay, the blood loss, the operative time accessibility and complications of each approach were evaluated

cure rates of patients infected with heterophyiasis and treated with praziquantel versus niclosamide

83 heterophyiasis patients were classified in 5 groups and given praziquantel orally in doses of 40 mg/kg body weight t.d.s. for one day, 40 mg/kg body weight as a single dose, 25 mg/kg body weight t.d.s. for 2 successive days, 20 mg/kg body weight as a single dose and 10 mg/kg body weight as a single dose. Other 40 patients were given niclosamide 2 gm orally every other day for three doses. Praziquantel in the doses given in the first four groups gave 100% cure rate [P < 0.05], the niclosamide group gave 77.5% cure rate. Praziquantel in single dose of 20 mg/kg body weight orally is more superior and tolerated than niclosamide

Stability of aflatoxins in processed ras cheese during manufacture and storage

Processed Ras-cheese was made from Ras cheese naturally contaminated with aflatoxin B1, B2, G1 and G2, secreted from toxigenic strains of Aspergillus flavus and Aspergillus parasiticus. The processing of the cheese blend at 90-92 centigrade for 5 minutes reduced its total aflatoxin content by 18.7%, while aflatoxins B1, B2, G1, G2 were reduced by 18.8, 21.3, 16.3 and 20.3% respectively. The storage of processed Ras-Cheese for 60 days at 4 +/- reduced its total aflatoxins by 14.1%, whereas the levels of B1, B2, G1 and G2 were reduced by 13.0, 11.5, 17.2 and 13.8% respectively. The data indicate that the processed Ras-cheese manufactured from contaminated cheese will not be safe for human consumption