Re: Neuromuscular Ultrasonography of Cranial Nerves: The Authors Respond

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Neuromuscular Ultrasound of Cranial Nerves

Ultrasound of cranial nerves is a novel subdomain of neuromuscular ultrasound (NMUS) which may provide additional value in the assessment of cranial nerves in different neuromuscular disorders. Whilst NMUS of peripheral nerves has been studied, NMUS of cranial nerves is considered in its initial stage of research, thus, there is a need to summarize the research results achieved to date. Detailed scanning protocols, which assist in mastery of the techniques, are briefly mentioned in the few reference textbooks available in the field. This review article focuses on ultrasound scanning techniques of the 4 accessible cranial nerves: optic, facial, vagus and spinal accessory nerves. The relevant literatures and potential future applications are discussed.

Sevoflurane versus propofol sedation during periocular anesthetic injections in oculoplastic procedures: an open-label randomized comparison

The purpose of the current investigation was to make an objective controlled comparison of pain tolerance, patient satisfaction and potential complications during the injection of local anesthesia in oculoplastic procedures under short-term sedation using inhalational versus parenteral sedatives. This was an open-label, randomized clinical trial where patients were randomized to 3 groups. Group I: Sedation with intravenous propofol. Group II: Sedation with inhaled sevoflurane. Group 3: Control group receiving no sedation. A total of 396 patients were randomly assigned, and 375 were included in the final analysis. Study groups were similar in age, gender, and distribution of operative procedures performed. There was no statistically significant difference in the adjusted primary composite outcome measure between propofol and sevoflurane [pain scores and patient satisfaction]. Significantly more patients in group I required restraining during periocular injections than group II or III [p < 0.001]. Significantly more patients sneezed in group I than group II [p < 0.001] and none in the control group. Three patients in group II suffered severe excitation-disinhibition during emergence from sedation which was rapidly reversible, and 3 more suffered a severe bout of postoperative nausea and vomiting [PONV]. Sevoflurane and propofol during periocular anesthetic injections produce an equally favorable experience. Sevoflurane is introduced painlessly, and offers better patient control with less induction of the sneezing reflex which may provide a higher safety profile, however short-term aggression/disinhibition and PONV may be an issue in some patients

Computed tomography of the orbit - a review and an update

Computed tomography [CT] and magnetic resonance imaging [MRI] of the orbit have been competing for the hearts and minds of health care providers for well over 2 decades. While several drawbacks pertaining to CT have been outlined since the introduction of MRI, CT remains the standard diagnostic test for evaluating cross-sectional, 2 or 3-dimensional images of the body

Dermatophagoides in childhood asthma allergy to dermatophagoides associates more severe childhood asthma with a potential role for acaricides

To evaluate hypersensitivity to Dermatophagoides pteronyssinus [D. pteronyssinus] and Dermatophagoides farinae [D. farinae] in pediatric patients with asthma, and the use of acaricides. This is a randomized controlled trial in 82 asthmatic children. They were recruited and evaluated for severity and chronicity according to the Global Initiative for Asthma Guidelines. The study was carried out in the Pediatric Allergy Clinic, Al Noor Hospital, Khalifa Branch, Abu Dhabi, United Arab Emirates between September 2008 and June 2010. Skin prick test [SPT] was performed including D. pteronyssinus and D. farinae, and for those who were sensitive to one, or the other. The therapeutic value of acaricides was evaluated by assessing the severity of asthma before and after their use. Approximately 81.7% of asthmatics were sensitive to house dust mites [HDM]. Hypersensitivity was associated with the more severe and persistent asthma [p=0.029]. The manifested severity of asthma was not HDM species-specific. There was a linear association between response of children to acaricides and increasing severity of asthma. Hypersensitivity to HDM is an important factor for persistent and severe forms of asthma. Acaricides can help control childhood asthma, and we recommend SPT as part of the routine work-up of patients with asthma to determine HDM sensitive patients that can benefit from acaricides use

Surgically mismanaged ptosis in a patient with congenital fibrosis of the extraocular muscles type I

Fibrosis syndromes comprise a rare form of severe limitation of ocular motility. An 11-year-old girl was referred for the correction of eyelid retraction. The eyelid retraction occurred immediately following levator resection surgery performed by a plastic surgeon who missed the restrictive extraocular muscle abnormalities. On examination, both eyes were fixed in an infraducted position [20 prism diopters [DELTA]], with a chin-up position and significant lagophthalmos. Bilateral 12-mm inferior rectus recession with adjustable sutures was performed, which resulted in significant reduction of lagophthalmos and elimination of the head tilt

Sensing of chlorpheniramine in pharmaceutical applications by sequential injector coupled with potentiometer / 药物分析学报

This paper reports on development of a system consisting of a portable sequential injector coupled with potentiometric unit for sensing of chlorpheniramine (CPA), based on the reaction of CPA with potassium permanganate in acidic media. Various experimental conditions affecting the potential intensity were studied and incorporated into the procedure. Under the optimum conditions, linear relationship between the CPA concentration and peak area was obtained for the concentration range of 0.1-50ppm. The method reflects good recovery with relative standard deviation (RSD)＜3％. The detection limit was 0.05 ppm. The developed method was successfully applied for determination of CPA in pure form and in pharmaceutical dosage forms. The results, obtained using the method, are in accord with the results of the British pharmacopoeia method. In addition to its accuracy and precision, the method has the advantages of being simple, inexpensive and rapid.

Prognostic and predictive factors of breast cancer among Egyptian women

To assess the prognostic as well as the predictive factors among the female Egyptian breast cancer patients to evaluate how much they affect the outcome; being free or had local recurrence or distant metastasis on follow up. From January 1998 to December 2003, 3985 Egyptian women having breast cancer, with their prognostic factors which were: age, nodal status and number of affected lymph nodes, tumor size, tumor grade, hormone receptor status, surgical therapy that patients underwent [Modified radical mastectomy versus conservative breast surgery], and whether they received hormonal therapy or not. All data were analyzed retrospectively to detect the 5-year survival rate, using the patients' data sheets and pathology reports that were included. Furthermore, for confirmation the slides were reexamined for the histopathological diagnosis as well as studying their hormonal receptors immunohistochemically. Uni-variant analysis showed that, age 4 affected lymph nodes had more than double fold incidence of having recurrence within the 5- year follow up [RR 2.1; 95% CI; 1.13- 3.99]. Tumor size of more than 2cm increases the risk of recurrence by 18.8 [95%CI; 2.19-161.9]. number of lymph node metastasis, age less than 35 years and tumor size were the most significant prognostic factors affecting the breast cancer behavior among female Egyptian breast cancer patients

Evaluation of osseous response to bioglass/dextran composite in induced mandibular defects: an experimental study

This experimental study was made to evaluate the osteogenic potential of Bioglass/Dextran composite clinically, radiographically and histologically in induced mandibular bone defects in 12 mongrel dogs and suitability of this material to the ridge augmentation procedures. In the right mandibular side, first molar was removed followed by localized alveolectomy then the site was compressed with the composite graft while in the left side, a rectangular defect was surgically induced with dimensions 20 x l0x 5 mm just below the inferior alveolar canal then compressed with the graft material. Both grafted defects were compared with the control animals along intervals 3, 6 and 12 weeks postoperative periods clinically, radiographically, histologically and histomorphometrically. the current study proved that this composite is bioactive, has high osteogenic potential and could be used effectively in large osseous defects without any adverse inflammatory, allergic or cytotoxic reactions. In addition, this composite could be used in alveolar ridge augmentation procedures as it caused a statistically significant increase in rate and density of bone formation in these defects compared to the control animals. Bioglass/Dextran composite is an effective osteoconductive and osteostimulatory graft material that could be used in large osseous defects and in ridge augmentation procedures especially with the use of barrier membrane

Immunohistochemical analysis of P53 protein in odontogenic cysts

The p53 is a well-known tumor suppressor gene, the mutations of which are closely related to the decreased differentiation of cells. Findings of studies on immunohistochemical P53 expression in odontogenic cysts are controversial. The present study was carried-out to investigate the immunohistochemical expression of P53 protein in odontogenic cysts. Thirty paraffin blocks of diagnosed odontogenic cysts were processed to determine the immunohistochemical expression of P53 protein. Nine of the 11 odontogenic keratocysts [81.8%] expressed P53, one of three dentigerous cyst cases expressed P53, while none of the 16 radicular cysts expressed P53 protein. The findings of the present work supported the reclassification of OKC as keratocystic odontogenic tumor

Early detection of diabetic nephropathy in children and adolescents with type 1 diabetes mellitus

Recent studies have demonstrated that the onset and course of diabetic nephropathy can be ameliorated to a very significant degree by several interventions but these interventions would have their greatest impact if instituted at a point very early in the course of development of this complication. This study has been designed to explore the problem of diabetic nephropathy in type 1 Diabetes Mellitus particularly its early detection in a sample of children and adolescent patients up to 18 yrs of age. Estimating the prevalence of microalbuminuria and hyperfiltration, and assessing the relationship between microalbuminuria and GFR in type 1 diabetic children and adolescents. A cross-sectional design and a consecutive sampling procedure were adopted to enroll 115 patients [59 males and 56 females] who met the inclusion criteria, from those attending the National Diabetic Center of AL Mustansiriyah University / Baghdad during the period from the 1st of August 2005 to the end of July 2006. Micral test II was used to screen early morning [spot] urine samples for increased albumin excretion rate while the novel use [in Iraq] of Schwartz formula made possible estimating the GFR from serum creatinine and demographic characteristics. The results were used for assessing the relationship between microalbuminuria and GFR. Important risk factors including patients age and disease duration, have also been evaluated. The mean patients age was 14.05 [ +/- 2.95] years, and the mean disease duration was 6.52 [ +/- 2.85] years. The prevalence of microalbuminuria in the study sample was [48.70%] estimated as increased urinary albumin excretion [20-200mg/l]. Statistically significant associations were found between microalbuminuria and longer duration of diabetes [p value = 0.017], and older age of diabetic patients [p value = 0.031]. The overall prevalence of hyperfiltration [estimated as GFR of >/= 130ml/min/1.73m2] was [16.52%], comprising [63%] normoalbuminuric and [37%] exhibiting microalbuminuria. Male preponderance was evident [89.48%]. Factors showing significant association with hyperfiltration state were: male gender [p value = 0.013], and older age of diabetic patients [p value = 0.031]. There was a statistically significant inverse correlation between the different levels of albumin excretion rate and the levels of estimated GFR. [r = - 0.79 p value =0.024]

Frequency of fragile-x in x-linked mental retardation

Fragile X syndrome [FXS] is the most common form of inherited mental retardation and accounts for about one third of all cases of X linked mental retardation [XLMR]. It is inherited as an X-linked dominant trait with a fragile site at Xq27.3 locus named fragile X mental retardation gene [FMR-1]. The FMR-1 protein is widely expressed, with the highest expression in brain, testes, ovaries, esophagus, thymus, eye and spleen. This study was conducted on twenty mentally retarded boys aged 8.5 +/- 3.84 years, attending the genetic clinics at Menoufiya University hospitals. They represented 11 families. All patients were subjected to detailed history, family pedigree, anthropometric measurements, thorough clinical examination with clinical scoring for the 13 items fragile X checklist, IQ assessment, routine investigations and cytogenetic studies which included conventional karyotyping using G banding and cytogenetic analysis for fragile X detection. Positive consanguineous marriage was found in 15% of our studied cases. Nine families out of total eleven families had positive family history most of them were second degree relative males through maternal cousins. Craniofacial abnormalities included high arched palate in 65% of patients, large ears in 55%, prominent forehead in 45% and elongated face and abnormal teeth in 30% for each. Speech problems were present in 75% and hyperactivity in 55% of patients. Sixty five percent had mild mental retardation [IQ= 50-70%].By applying the clinical scoring fragile X checklist, it was found that 3 patients [15%] had score more or equal to 19 and 3 [15%] had score from 16 to less than 19, while 14 [70%] had score less than 16. As regards cytogenetic studies, 80% of our patients had normal karyotyping [46 XY] while four cases [20%] had positive fragile site on X-chromosome of whom two cases from the same family had 46, Y, Frg [X] [q27.3], while the other two cases, also from a single family, had inversion of Y chromosome beside positive fragile X chromosome site 46, Fra[X] [q27.3], inv [Y]. So, in a child with isolated mental retardation or autism of unknown etiology with considerable fragile X dysmorphic features or established family history of fragile X syndrome, chromosomal study that identifies the fragile site at Xq27.3 in addition to other cytogenetic abnormalities could be useful or early diagnosis and intervention by a special services team

Treatment of a combined dairy and domestic wastewater in an up-flow anaerobic sludge blanket [UASB] reactor followed by activated sludge [AS-system]

The feasibility of using an Up-flow Anaerobic Sludge Blanket [UASB] reactor followed by activated sludge [AS-system] for the treatment of wastewater discharged from Dairy factory was explored. The UASB reactor was operated at a Hydraulic Retention Time [HRT] of 24 h and Organic Loading Rates [OLR's] ranging from 1.9 to 4.4 kg COD/m[3].d. Despite variation in OLR, the reactor provided a more or less constant effluent quality of 1385 mg/I for COD total, and 576 mg/l for total BOD5, corresponding to removal values of 69 and 79%, respectively. Total suspended solids [TSS] and volatile suspended solids [VSS] removal averaged above 72 and 75%, respectively. Residual phosphorous and oil and grease concentrations were 8.2 mg P/l and 44 mg/l, respectively, corresponding to removal values of 63 and 83%. This high performance could be attributed to the long Sludge Residence Time [SRT =76 d] imposed to the reactor. Total and faecal coliform counts were reduced by a value of 1.07 and 0.9 log10, respectively. The VS/TS ratio of 0.66 of excess sludge revealed its good quality. Net sludge yield coefficient was found to be around 0.2g VSS per g COD total removed per day, corresponding to 20% of the total influent COD. Preliminary results of activated sludge [AS] batch experiments indicated first order removal kinetics between total organic carbon [TOC] and contact time. The TOC removal reached 98.4% within 2.0h. Accordingly, the AS-system was operated at a HRT of 2.0 h. The AS- step achieved a substantial reduction of COD total, BOD5 total, TSS and oil and grease resulting in residual concentrations of only 35.0, 7.0, 14.0 and 2.8 mg/l, respectively. The geometric mean of total and faecal coliform counts was reduced by a value of 1.28 and 1.64 log10, respectively. The results obtained indicated that the use of an integrated system consisting of UASB followed by an AS-system for the treatment of dairy wastewater could achieve over 98.9% of COD total. 99.6% of BOD5 total and 98.9% of oil and grease

Odontoma of the jaws: a clinical study of 15 cases

Odontomas are benign tumor of odontogenic origin characterized by their slow growth. They may lead to interference with eruption of its associated tooth. A retrospective study was conducted on patients with odontoma of the jaws who were treated between 1999 and 2006. Patients were analyzed with regard to the following parameters: age, gender, anatomic location, size of the lesion, histopathological classification, and associated tooth. Fifteen patients with odontomas of the jaws were included, [8 females and 7 males]. Their age ranged from 9 to 38 years [mean 21.1 years]. Of the 15 cases, 11 were complex odontoma, and 4 were compound odontoma. Whereas no site preference for complex odontoma, compound odontoma had a predilection for the anterior maxilla. Although odontoma has a limited growth potential, it should be removed because it contains various tooth formulations that can predispose to cystic change, interference with eruption of permanent teeth and cause considerable destruction of bone

Redescription of some monogenean parasites belonging to family: Ancyrocephalidae, bychowsky, 1937

Gills of 782 fish samples collected from the Suez Gulf Red Sea were examined for monogenean parasites. Four species of monogenean parasites belonging to family; Ancyrophalidae, were recorded. Pseudohaliotrematoids polymorphus eilaticus, and Pseudohaliotrema plectocirra from siganus reviulatus, Ancyrophalus atherinae, from Letherinus elongates and L. variegates and Haliotrema austral, from sclopsis ghanum

Effect of moxonidine on drug induced cardiac arrhythmias and its possible antinociceptive effect in rats

Moxonidine is a new second generation, centrally acting antihypertensive drug. It causes peripheral sympathoinhibition, triggered at the level of central nervous 11-receptors. The present study was designed to screen various cardiovascular effects of moxonidine both in-vivo and in-vitro as well as to investigate the possible analgesic effect of moxonidine. In-vitro results revealed that moxonidine produced dose related inhibition of the force of contraction of the isolated perfused rabbit's heart. A vagal like action was suggested because both muscarinic and nicotinic receptors antagonist abolished this effect. In vivo results showed that acute intravenous injection of moxonidine significantly reduced heart rate of normotensive rats dose dependantly. Moxonidine in different doses exhibited pronounced antiarrhythmic effects characterized by dose-dependent increase in adrenaline arrhythmogenic dose and significant decrease in the number of extrasystoles. Furthermore, moxonidine in different doses, increased both the arrhythmogenic and ventricular fibrillatory doses of ouabain in a dose-dependent manner. Lastly, acute moxonidine administration was found to provide potent antinociceptive efficacy in control of acute pain in rats and yohimbine, was able to antagonize this effect

Characterization of specific trichomonas vaginalis target antigens from different isolates by immuno-blotting against hyperimmune rabbit serum

The SDS-PAGE and immunoblot methods were used to identify Trichomonas vaginalis specific target antigen[s]. Ten T. vaginalis isolates, cultured on TYM media, were analyzed by Sodium Dodecyl Sulphate Poly Acrylamide Gel Electrophoresis [SDS-PAGE], revealed 34 distinct bands. Immunoblotting against a hyperimmune rabbit serum, showed 20 reactive bands ranging from 14-205 kDa. There was isolate to isolate variability among 8 isolates, while 2 isolates [6, 7] showed a similar antigenic patterns. Imunoblotting of the isolates showed a total of 20 molecular weight bands, 80% of isolates gave positive immunologic reactions above 100 kDa, while below 100 Kda all the isolates recognized the different molecular weight bands. Out of 20 reacting bands, 5 main bands were detected, 29, 66, 84, 95 and 115 kDa gave positive percent of 60, 60, 60, 90 and 80% among the 10 isolates respectively

Growth patterns and antigenic analysis of Egyptian trichomonas vaginalis isolates

In this study, the vaginal washouts from symptomatic and asymptomatic patients were examined by wet mount examination and culture on modified TYM medium. Among the 320 examined cases, 10 were positive for T. vaginalis trophozoites by wet mount examination and culture. Modified TYM medium proved to be very satisfactory for the isolation as well as the maintenance of the ten T. vaginalis isolates. The comparison between the growth patterns of all isolates, by counting the number of viable organisms every 24 hours for 7 days, showed that there is a wide variability in the growth characteristics, as regards lengths of log phase, growth peaks reached, generation times, division rate and number of divisions. The antigenic differentiation of the ten T. vaginalis isolates through sodium dodecyl sulfate- polyacrylamide gel electrophoresis [SDS-PAGE] demonstrated a total of 34 bands using 10% resolution gel. The bands ranged in molecular weight from 12-189 kDa. Most of the bands were common among several isolates, while isolate 2 appeared different than other isolates with two characteristic bands, one at 136 kDa and the other at 25 kDa. Also, isolates 4 and 8 had characteristic bands at 163 kDa and 189 kDa, respectively

Sythesis of new benzopyranone mannich bases

Reaction of 7-hydroxy-5-methoxy-2-methyl-4-oxo-benzopyran-6- carboxaldehyde [1] with formaldehyde and piperidine [or morpholine] to give the corresponding 8-substituted piperidinomethyl or morpholinomethyl derivatives [compounds 2 and 3, respectively]. When formaldehyde and diethylamine were used, bis-[6-formyl-7-hydroxy-5- methoxy-2-methyl-4-oxo-benzopyran-8-yl]-methane [4] was formed. Reaction of 1 with hydroxylamine gave the aldoxime [5], which upon reaction with acetic anhydride gave the corresponding 7-acetyloxy-6- cyano-5-methoxy-2-methyl-4-oxo-benzopyran [6]. Mild hydrolysis of [6] with sodium hydroxide gave 6-cyano-7-hydroxy-5-methoxy-2-methyl- 4-oxo-benzopyran [7]. Reaction of 7 with piperidine and formaldehyde afforded the corresponding Mannich base [8]. Reaction of 1 with urea in ethanol gave the unexpected 5-ethoxy-7-hydroxy-2-methyl-4-oxo- benzopyran [10] which reacted with piperidine and formaldehyde to give the corresponding Mannich base [11]. Reaction of 1 with acetic anhydride gave 3-[7-hydroxy-5-methoxy-2-methyl-4- oxo-benzopyran-6- yl]-acrylic acid [12], while with acetic anhydride in the presence of anhydrous sodium acetate afforded 5-methoxy-8-methyl-2,6- dioxo- [2H,5H]-benzo-[3,2-b:4,5-b']-dipyran [13]. The Mannich bases 3, 14 and the dimer 4 were obtained from compound 12. The dimer 4 could be also obtained by reaction of 1 with formaldehyde. Structures of the compounds prepared were determined by MS, 1H-NMR, IR and elemental analyses. The compounds prepared showed promising antimicrobial activity