Endoscopic assisted transoral approach with palatal splitting for a giant retropharyngeal schwannoma: a challenging case

Retropharyngeal schwannoma is rare. To the best of our knowledge, only 18 cases have been published in the English literature. Complete surgical excision is the treatment of choice for schwannomas. Transoral approaches have been applied for smaller lesions, and external cervical approaches are preferred for larger and more complex lesions. In this report, we present a case of large retropharyngeal schwannoma that was excised using an endoscopic-assisted transoral approach with palatal splitting. Postoperative functional and oncologic outcomes were satisfactory with no reported intraoperative/postoperative complications.

Effect of Pilates Exercises on Standing, Walking, and Balance in Children With Diplegic Cerebral Palsy

Objective@#To analyze how Pilates exercises affect standing, walking, and balance in children with diplegic cerebral palsy throughout a 10-week program. @*Methods@#We included 40 children aged 7–9 years with diplegic cerebral palsy, and randomly allocated them into two groups of the same size: conventional therapy group (group A) and conventional therapy+Pilates group (group B). We administered the same conventional physical therapy program to both groups for 45 minutes, with group B receiving additional Pilates exercises for 45 minutes. Both groups attended the intervention program three times/week for 10 weeks. We used the Growth Motor Function Measure Scale (GMFM-88) to evaluate standing and walking (Dimensions D and E), and the Pediatric Balance Scale to evaluate balance function before and after treatment. @*Results@#Comparison of the average values of all measured variables before and after therapy showed a statistically significant difference (p<0.05) between the two groups. All measured variables showed a significant difference between groups A and B, in favor of group B (p<0.05). @*Conclusion@#Pilates exercise in addition to conventional therapy is more effective in improving balance and gross motor function in children with diplegic cerebral palsy than the conventional therapy alone.

Value of fertility-sparing surgery for young females with epithelial ovarian cancer: a comparative study / Valor de la cirugía de preservación de la fertilidad en mujeres jóvenes con cáncer de ovario epitelial: un estudio comparativo

Resumen OBJETIVO: Comparar la cirugía radical con la cirugía conservadora de la fertilidad en mujeres con cáncer de ovario epitelial en estadio 1A-C con respecto a la tasa de recurrencia y las tasas de supervivencia. Además, evaluar los desenlaces reproductivos y obstétricos para las mujeres con cáncer de ovario epitelial en estadio I tratadas con una conducta conservadora de la fertilidad. PACIENTES Y MÉTODOS: Estudio prospectivo efectuado en pacientes con cáncer de ovario epitelial, estadio I, con edad ≤ 40 años. A las pacientes del grupo de preservación de la fertilidad se les practicó salpingooforectomía del lado del ovario afectado y una biopsia por incisión o escisión en cuña del ovario contralateral. A las pacientes del grupo de cirugía radical se les practicó la histerectomía total y salpingooforectomía bilateral. Para evaluar los desenlaces reproductivos y oncológicos se dio seguimiento a todas las pacientes durante cinco años. RESULTADOS: Se estudiaron 60 pacientes; las del grupo de cirugía de preservación de la fertilidad eran significativamente más jóvenes (30 ± 4 en comparación con 35 ± 5) (p < 0.001), el tamaño de sus tumores era más pequeño 3.4 ± 1.3 en comparación con 6.0 ± 2,6 (p < 0.001), de menor grado (p < 0.001). = 0.011), estadio más precoz (p < 0.001) y con más histología mucinosa que las pacientes del grupo de cirugía radical. No hubo diferencias estadísticamente significativas entre ambos grupos en cuanto a la recurrencia tumoral o las tasas de supervivencia. De 25 pacientes operadas para preservación de la fertilidad 18 de 25 intentaron quedar embarazadas. Se registraron 15 de 18 embarazos, incluidos 13 nacidos vivos, 1 aborto espontáneo y 1 muerte fetal intrauterina. CONCLUSIÓN: La cirugía conservadora de la fertilidad podría ser una alternativa adecuada a la cirugía radical para mujeres jóvenes con cáncer epitelial de ovario en estadio I.

Abstract OBJECTIVE: In the current study, we aimed to compare between radical surgery and fertility saving surgery in females with stage 1A-C EOC regarding recurrence rate and patients survival rates in addition to evaluating reproductive and obstetric outcomes for stage I EOC females who were managed by fertility saving surgery. PATIENTS AND METHODS: We prospectively identified 60 patients diagnosed with stage I EOC aged ≤ 40 years. Patients in the fertility-preservation group underwent salpingo-oophorectomy on the side of the affected ovary in addition to incisional biopsy or wedge excision of the ovary on the other side. Patients in the radical surgery group underwent total hysterectomy and bilateral salpingo-oophorectomy. We followed up all patients for 5 years to assess their reproductive and oncological outcomes. RESULTS: Patients in the fertility preservation surgery group were significantly younger (30 ± 4 versus 35 ± 5) (p < 0.001), their tumor sizes were smaller 3.4 ± 1.3 versus 6.0 ± 2.6 (p < 0.001), of lower grade (p = 0.011), earlier stage (p < 0.001) and has more mucinous histology than patients in the radical surgery group. There were no statistically significant differences between both groups regarding tumor recurrence or survival rates. Of 25 patients underwent fertility preservation surgery, 18/25 (72%) tried to get pregnant. 15/18 (83%) pregnancies were recorded, including 13 live births, 1 miscarriage, and 1 intrauterine fetal death. CONCLUSION: Fertility sparing surgery could be adequate alternative to radical surgery for young females with stage I EOC.

Topical onion juice mitigates the morphological alterations of the cornea in the aged male rats / 대한해부학회지

Aging is associated with structural and functional changes of the cornea. Fresh onion juice contains phenolic compounds and flavonoids that may provide an anti-aging effect. The aim of this study was to assess the ability of the onion juice to ameliorate these aging changes. Rats were grouped as adult and aged groups. Rats of both groups received eye drops of diluted onion juice in their right eyes every 8 hours for 12 weeks, while the left ones were served as control eyes. The corneas of both eyes underwent histopathological, immunohistochemical and morphometric assessments, in addition to measuring their intraocular pressure (IOP). The aged group exhibited a significantly elevated IOP, decreased tear secretion, degenerated corneal epithelium and endothelium, surface erosions and stromal edema with irregular collagen fibers. Administration of onion juice led to lowering of IOP, significant increase in tearing, restoration of most of epithelial, endothelial and stromal integrity, and increased epithelial, keratocystic and endothelial cell densities. Immunohistochemically, the epithelium and endothelium revealed positive immune reactions for both epidermal growth factor receptor (EGFR) and paired box protein-6 (PAX6) in the control and onion-treated corneas of the adult group, while these immune reactions were negative in the untreated aged ones. Onion drops in aged corneas showed a positive immune reaction for EFGR and PAX6 involving the epithelial and endothelial layers. In conclusion, topical onion juice improves corneal aging changes through its direct effect, and indirectly through lowering IOP and enhancing tear secretion.

Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses

Background@#Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. @*Methods@#Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. @*Results@#Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain −3.8 points on a 0–10 scale (95% Cl = −4.653 to −2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of −32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average −6.1 points on a scale of 0–10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of −75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. @*Conclusion@#Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

Topical onion juice mitigates the morphological alterations of the cornea in the aged male rats / 대한해부학회지

Aging is associated with structural and functional changes of the cornea. Fresh onion juice contains phenolic compounds and flavonoids that may provide an anti-aging effect. The aim of this study was to assess the ability of the onion juice to ameliorate these aging changes. Rats were grouped as adult and aged groups. Rats of both groups received eye drops of diluted onion juice in their right eyes every 8 hours for 12 weeks, while the left ones were served as control eyes. The corneas of both eyes underwent histopathological, immunohistochemical and morphometric assessments, in addition to measuring their intraocular pressure (IOP). The aged group exhibited a significantly elevated IOP, decreased tear secretion, degenerated corneal epithelium and endothelium, surface erosions and stromal edema with irregular collagen fibers. Administration of onion juice led to lowering of IOP, significant increase in tearing, restoration of most of epithelial, endothelial and stromal integrity, and increased epithelial, keratocystic and endothelial cell densities. Immunohistochemically, the epithelium and endothelium revealed positive immune reactions for both epidermal growth factor receptor (EGFR) and paired box protein-6 (PAX6) in the control and onion-treated corneas of the adult group, while these immune reactions were negative in the untreated aged ones. Onion drops in aged corneas showed a positive immune reaction for EFGR and PAX6 involving the epithelial and endothelial layers. In conclusion, topical onion juice improves corneal aging changes through its direct effect, and indirectly through lowering IOP and enhancing tear secretion.

Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses

Background@#Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. @*Methods@#Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. @*Results@#Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain −3.8 points on a 0–10 scale (95% Cl = −4.653 to −2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of −32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average −6.1 points on a scale of 0–10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of −75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. @*Conclusion@#Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

Effect of Core Stability Exercises on Hand Functions in Children With Hemiplegic Cerebral Palsy

Objective@#To investigate the effectiveness of core stability exercises on hand functions in children with hemiplegic cerebral palsy. @*Methods@#Fifty-two children with hemiplegic cerebral palsy ranging in age from 6 years to 8 years were enrolled in this study. They were randomly assigned to two (control and study) groups. The control group received the selected physiotherapy exercises, and the study group received the same selected physiotherapy exercise program and core stability exercises. Time motor performance, gross manual dexterity, and upper extremity skills assessed using the Jebsen Taylor Hand Function Test, Box and Block Test, and Quality Upper Extremity Skill Test, respectively, were measured before and after 12 weeks of the treatment program. @*Results@#There were significant improvements in both groups by comparing the mean values of all measured variables before and after treatment (p<0.05). There were significant differences between the control and study groups with respect to all measured variables when comparing the post-treatment outcomes (p<0.05). @*Conclusion@#This study suggests that core stability exercises can be an effective intervention that may improve hand functions in children with hemiplegic cerebral palsy.

Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule

ABSTRACT Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. Materials and methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Background: Device Associated Infection (DAI) namely Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infection (CLABSI) is one of the challenges for both neonatal nurses and doctors. Aims of the study were 1) Assess the rate of DAI occurrence among neonates, 2) explore the relationship between DAI rates and certain risk factors such as nurse patient ratio, hand hygiene practice, gestational age (GA), weight, and length of hospital stay among neonates.Methods: Descriptive correlational survey research design. Sample: All neonates admitted in twelve months-duration were included (total number 1090 neonates). Nurses and doctors were observed for compliance to adequate hand hygiene technique. Tools: 1) Center for Disease Control (CDC) criteria to calculate DAI rates, 2) Hand hygiene five points checklist 3) Review of neonates charts to collect data as weight, GA 4) Ballard score and 5) nurse/patient ratio.Results: 24 neonates developed DAI, high significant negative correlations between DAI and infants' weight, GA, nurse/patient ratio and overall compliance to hand hygiene techniques were reported (p-value ?0.05). Length of hospital stay, inadequate hand hygiene technique had strong positive correlations with DAI rate (p-value ?0.05).Conclusions: Factors that could affect DAI were infant's weight, GA, length of hospital stay, inadequate hand hygiene technique and nurse/patient ratio. Recommendations: implementation of infection control programs to raise nurses as well as physicians' compliance to adequate hand hygiene technique and increase number of nurses in the Neonatal Intensive Care Unit (NICU) per shift.

Heterotopic Ossification of the Elbow: A Literature Review

Background:Aberrant ectopic bone formation of the elbow is a common clinical presentation after neurologic, burn, and traumatic injuries to the joint. This represents a significant source of patient burden, delayed recovery times and increased medical costs. Although there is an abundance of literature on heterotopic ossification (HO) of the hip, there is little literature on HO of the elbow in comparison.Aims: This literature review seeks tosummarize consensus regarding the appropriate system of classification, pathophysiology, clinical presentation, risk factors, and prophylactic treatment options associated with HO formation of the elbow. Clinicians may utilize this information to identify high risk patient populations for potential prophylactic therapy to prevent the occurrence/complications of HO at the elbow. Methods:A PubMed literature review was conducted using combinations of the key words “heterotopic ossification,” “elbow,” and “fracture/dislocation.” All study types were consideredand relevant articles were utilized for this review Results: Higher levels of injury, severe neurologic and burn injuries, delay to surgery, delay in fixation/stabilization of the elbow, multiple surgical treatments, and genetics were correlated with ectopic bone formation. Single dose pre/postoperative radiotherapy with 700cGy or preoperative NSAID regiments were found to be the main prophylactic treatments.Conclusion:Clinicians must consider the HO risk profile of their patients as well as the risk factors of treatment before deciding on prophylactic options. Surgical resection is reserved for the most severe cases

Smile changes after intrusion of maxillary incisors with temporary anchorage devices (TADs) or accentuated compensating curve arch wire

Objective: The aim is to evaluate changes of smile and gingival line after intrusion of maxillary incisors using mini-implant anchorage system or conventional accentuated compensating curve archwire. Materials and Methods: Twenty participants having deep overbite with age ranged from 18 to 24 years were enrolled in this study and were divided into two groups of 10 each. Intrusion of maxillary incisors was performed using mini-implant anchorage system in group 1 and by conventional accentuated compensating curve archwire in group 2. For each participant, lip position, dental and skeletal measurements related to the gingival line were recorded from standardized photographs and cephalometric analyses. Statistical analyses including t-test and Chi-square were used to evaluate differences between groups. Results: There was an improvement of smile arc (consonance) from 30% smile consonance pretreatment to 90% consonance postintrusion in group 1, but the change was insignificant in Group 2. There was an increase in the outer intercommisural width in Group 2 compared to group 1 with a significant difference between both groups (P < 0.046). A significant decrease in the upper lip to upper incisal edge relationship in Group 1 and an insignificant decrease in Group 2 (P = 0.03 and P = 0.262, respectively) was detected. A significant decrease in overbite in Group 1and in Group 2 (P = 0.001) with an insignificant difference between both groups (P > 0.05) was also observed. Conclusion: Smile improvement in the mini-implant group was mainly the result of improved smile arc, increase in outer intercommisural width, decrease in upper lip to upper incisal edge relationship, and decrease in overbite. With the use of accentuated compensating archwires, the only significant change was increase in the interlabial gap.

Pyrrolidine dithiocarbamate and saxagliptin ameliorate ulcerative colitis in rats

Objective: To evaluate the antioxidant, immunomodulatory and anti-inflammatory activities of pyrrolidine dithiocarbamate and saxagliptin in rats with thioacetamide-induced ulcerative colitis. Methods: Animals were orally administered with a vehicle, sulfasalazine (500 mg/kg), pyrrolidine dithiocarbamate (100 mg/kg), and saxagliptin (10 mg/kg) for two weeks. Ulcerative colitis was induced by a single intrarectal instillation of thioacetamide on day 8. Colon samples were collected to assess mitogen-activated protein kinase (MAPK), phosphorylated extracellular signal-regulated kinase (ERK), cAMP response element-binding protein (CREB), interleukin-12 (IL-12), caspase-3, β-defensin, inducible nitric oxide synthase (iNOS) and glucagon like peptide-1 (GLP-1). Moreover, histopathological examination was performed. Results: Rats treated with thioacetamide caused increases in colonic MAPK, phosphorylated ERK, CREB, caspase-3, IL-12, β-defensin, iNOS, as well as decreases in body weight and GLP-1. In addition, distortion of colonic structure was found by histopathological examination. Pyrrolidine dithiocarbamate and saxagliptin mitigated colitis severity by improving body weight decrease and GLP-1, and reducing colonic MAPK, phosphorylated ERK, CREB, caspase-3, IL-12, β-defensin and iNOS. Conclusions: Pyrrolidine dithiocarbamate and saxagliptin are efficient against thioacetamide induced colitis through improving inflammatory and oxidative changes.

Evaluation of serum interleukin-34, as a marker of disease activity in systemic lupus erythematosus and rheumatoid arthritis patients

Aim of the work: To evaluate the role of IL-34 in the pathogenesis of SLE and RA and to assess its role as a biomarker of disease activity. Subjects and methods: This study was carried out on 29 patients with SLE, 29 patients with RA, and 29 healthy control subjects. SLE disease activity was measured by systemic lupus erythematosus disease activity index (SLEDAI). RA disease activity was measured by 28-joint disease activity score (DAS-28). Serum IL-34 was measured by enzyme-linked immunosorbent assay (ELISA) . Results: There was highly significant elevation in IL-34 level in SLE and RA when compared to control group (p<0.001). IL34 level did not differ significantly between SLE and RA groups (p˃ 0.05). There was a significant positive correlation between IL-34 level and SLEDAI in SLE patients as well DAS 28 score in RA patients. The highest level was detected in patients with high disease activity. There was statistically significant correlation between IL-34 levels and ESR, CRP, and anti-ds DNA antibodies but inversely correlated with C3 in SLE patients. There was also statistically significant correlation between IL-34 levels and ESR, CRP RF, and anti CCP antibodies in RA patients. Conclusion: IL-34 could be useful marker for disease activity in SLE and RA

Comparison impact of conventional versus conformal radiotherapy techniques on thyroid in breast cancer irradiation

Introduction: Adjuvant radiotherapy is considered one of treatment options for treatment of locally advanced breast cancer. Thyroid gland is not considered an organ at risk in supraclavicular (SC) nodal radiation therapy (RT) for breast cancer. Objectives: Comparison the impact of 2 different RT techniques on thyroid gland; group (I) conventional two-dimensional radiotherapy of SC node and Group (II) three-dimensional conformal radiation therapy (3DCRT) planning of SC node. Method: Twenty (20) patients with breast cancer received SC RT, with evaluation of thyroid functions in both groups, including thyroid stimulating hormone and free thyroxine prior to RT and 3, 6, 9, 12, 18 and 24 months after RT. Based on each patient's dose volume histogram (DVH),total volume of thyroid and mean radiation dose of the thyroid which received radiation doses 10-50 Gy (V10-V50) were considered for statistical analysis. The median follow-up time was 20 months (range, 12-30 months). Results: of 20 patients, 5 (20%) were diagnosed with hypothyroidism (HT), 4 group (II) and 1 group (I). The median time to the development of HT was 9 months. SC node V50 in group I was lower than average in group II (Average: 2.06% versus 55.38% p<0.001).Thyroid V20 in group I was lower than average in group II (Average: 37.65% versus 50.47%, p<0.001) mean TSH in group I was lower than mean in group II (Average: 1.60 IU/L versus 3.08 IU/L, p=0.043). Conclusion: Conformal supraclavicular RT in patients with breast cancer appear to amplify the risk of HT more than conventional, however conformal radiotherapy is better than conventional radiotherapy in locoregional control

Significance of neuropilin-1 expression, ceruloplasmin oxidase and copper in egyptian children with b-lineage acute lymphoblastic leukemia

Background: Neuropilins are transmembrane glycoproteins that act as receptors for vascular endothelial growth factors (VEGF) and are involved in the process of tumor angiogenesis. Ceruloplasmin is a member of the multi copper oxidase family. It has antioxidant properties that play a central role in protection of the body against advanced oxidation protein products.Objective: This study was aimed to assess the expression of Neuropilin-1(NRP-1) on blasts of B-lineage precursor lymphoblastic leukemia (ALL) to be used in the diagnostic panel of this disease. We also aimed to assess the alteration of the levels of ceruloplasmin oxidase and copper as a compensatory mechanism to minimize the effects of reactive oxygen species resulting from leukemias.Subjects and Methods: This study was conducted on 40 children with newly diagnosed B-lineage precursor lymphoblastic leukemia. 40 age-matched controls were enrolled to serve as control. The expression of NRP-1 on peripheral blood samples was evaluated by flow cytometry as the proportion of positive cells expressing the marker. Ceruloplasmin oxidase and copper levels were assessed by immunoturbidimetric assay.Results: There was highly significant increase in the proportion of positivity of NRP -1 in patients compared with control group (P<0.001) Ceruloplasmin oxidase and copper levels were also higher in patients compared with control group (P<0.001).Conclusions: It could be concluded that NRP-1 is a valuable marker for diagnosis of B-lineage ALL. There is an increase in the levels of ceruloplasmin oxidase and copper which at the time of diagnosis of B-ALL

Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities

Abstract Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many differentmodalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatmentmodalities of ISSNHL and to compare the results if HOTwas not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.

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.

Assessment of customer satisfaction with the clinical laboratory services provided in King Abdullah medical city, Makkah

Background: Patients and physicians are considered primary customers of laboratory services. Therefore, assessing customer satisfaction with laboratory services is an essential indicator in improving the quality of laboratory services

Objectives: This study measures the level of satisfaction of physicians and patients who avail of the clinical laboratory and phlebotomy services, respectively, at the outpatient department [OPD] in King Abdullah Medical City [KAMC], to evaluate the possible issues and carry out corrective actions

Methods: A cross-sectional survey to evaluate the level of satisfaction using a modified patient and physician questionnaires, the patients were randomly selected and interviewed in phlebotomy areas at the outpatient and chemotherapy clinics. A paper-based questionnaires were distributed to all physicians all available physicians in KAMC who were regularly requiring laboratory investigations. The collected data were coded, entered, and checked for outliers or missing data and analyzed using the SPSS statistical package version 21

Results: A total of 435 patients were interviewed and their mean satisfaction was 4.51+/-0.32 out of 5. Respondents were satisfied with the Availability of laboratory tests. However, they were dissatisfied with Explanation of the phlebotomy cautions by the phlebotomist [75.4%]. Twenty eight percent of physicians [132] participated, their mean satisfaction rate was 3.6+/-0.7 out of 5. The greatest satisfaction rate was related to critical results notification and the communication with laboratory personnel. Physicians were most dissatisfied with both specimen delivery process and incorrect test results

Conclusion: Both customers were satisfied with the laboratory service provided for them. Factors as "Explanation of the phlebotomy process by phlebotomist" and "specimen collection and delivery process" received lowest satisfaction score for patients and physicians respectively. Therefore, improving them is required to meet the needs of the customers and gain their satisfaction regarding the service