The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle: our clinical experience

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey's syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection

Assisted arthrscopic microfracture treatment of osteochondral lesions of the knee

Background: chondral injuries in the knee are a common source of pain and morbidity. Treatment of symptomatic chondral defects is challenging due to the limited healing capacity of articular cartilage. Microfracture is the most common surgical technique used to treat chondral defects in the knee and utilizes marrow stimulation to generate a fibrocartilage repair. Microfracture has demonstrated good short-term postoperative outcomes. Long-term outcomes following microfracture are variable, with loss of improvement attributed to the poor mechanical qualities of the fibrous repair tissue

Aim of the work: this prospective study with a 12 months follow-up was conducted to determine the efficacy of microfracture in the postoperative follow-up. We prospectively followed up these patients preoperatively and postopertively, clinically and radiologically. The final diagnosis was confirmed during arthroscopy

Patients and Methods: thirty symptomatic patients with articular cartilage defects of the knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twelve months with a combination of validated outcome scores, subjective clinical rating and cartilage-sensitive magnetic resonance imaging

Results: at the time of the latest follow-up, knee function was rated good to excellent for twenty patients [60%], fair for four patients [13%] and poor for eight [26%]. A lower body-mass index correlated with higher scores for the activities of daily living, with the worst results for patients with a body-mass index of >30 kg/m2. Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months [p < 0.05]. Magnetic resonance imaging in 15 knees demonstrated good healing in tissue fill of eight patients [54%], moderate fill in four [29%] and poor fill in three patients [17%]. The fill grade was correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twelve months

Conclusions: microfracture healing of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of one year. The best short-term results were observed with good fill grade, low body-mass index and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade was associated with limited short-term durability

Cutaneous manifestations of systemic lupus erythematosus - an experience from Bahawal-Victoria Hospital, Bahawalpur

To document the frequency of cutaneous manifestation of systemic lupus erythematosus [SLE]. It was a case-series collected from Dermatology Department and all four Medical Units of Bahawal-Victoria Teaching Hospital of Quaid-e-Azam Medical, Bahawalpur. A total of 100 patients with diagnosis of SLE and fulfilling the inclusion criteria were included in the study. All the patients were evaluated for the cutaneous manifestations of SLE. All the information was collected in a specially designed proforma and analyzed with the help of SPSS version 10. The mean age of the patients was 25.97 +/- 4.64 years. 92% patients were female and 8% were male. Out of 100 patients, 85% patient presented with cutaneous manifestations. Photosensitivity was seen in 40 [40%] patients, discoid rash in 35 [35%], malar rash in 25 [25%], and oral ulcers in 24 [24%]. SLE is predominantly seen among female patients of young age. Photosensitivity is most common presentation, followed by discoid rash

Phenotypic and genotypic patterns of aminoglycosides-resistant staphylococcus aureus clinical isolates

Aminoglycosides still play an important role in anti-staphylococcal therapies, although emerging resistance amongst Staphylococcus aureus is widespread. The aim of this work is to study the different phenotypic patterns of aminoglycosides-resistant S. aureus in relation to the results of a multiplex PCR assay for the genes encoding aminoglycoside-modifying enzymes [AMEs]. This study was carried out in Microbiology and Immunology and Surgical Departments, Faculty of Medicine, Zagazig University during the period from August, 2008 to June, 2009. One hundred and seventy clinical samples were collected and cultured. S. aureus isolates were identified using the standard microbiology laboratory techniques. Antimicrobial susceptibility testing was performed using disc diffusion method with 5 aminoglycoside antibiotics. A multiplex PCR assay was used to identify AMEs-encoding genes. A total of 81 [47.6%] S. aureus isolates were collected during this work and 43 [53.1%] isolates of which were methicillin resistant [MRSA]. In this study, 31 [38.3%] isolates were resistant to at least one of the tested aminoglycosides, and the highest resistance was to kanamycin [38.3%], followed by tobramycin [30.9%], gentamicin [29.6%], amikacin [9.9%] and netilmicin [8.6%]. As regard the results of the multiplex PCR assay, the aac[6']-Ie+ aph[2"] gene encoding the bifunctional enzyme was the most common, followed by the ant[4']-Ia gene encoding the ANT[4']-Ia enzyme and the aph[3']-IIIa gene encoding the APH[3']-IIIa enzyme. The results of this study showed statistically significant agreement between phenotypic and genotypic aminoglycoside resistance and methicillin resistance. In conclusion, this study has increased knowledge of the distribution of AMEs in S. aureus isolated in our hospitals. Continued surveillance at both the phenotypic and genotypic levels is recommended for monitoring the presence of other variants of the genes or new aminoglycoside resistant genes that may be produced within the S. aureus population and detecting early emergence of resistant organisms to establish effective antibiotic therapies and prevent nosocomial as well as environmental spread of resistant isolates

Detection of metallo beta lactamase producing pseudomonas aeruginosa in clinical isolates

Background and objectives: Metallo beta lactamase [MBL] producing Pseudomonas aeruginosa have been reported to be important cause of nosocomial infections. The appearance of MBL genes and their spread among bacterial pathogens is a matter of concern with regard to the future of antimicrobial therapy. The present study aimed to assess the susceptibility and cross-resistance of the widely used antimicrobials against P. aeruginosa and to study the prevalence of MBL enzyme by phenotypic and genotypic methods

Methods: A total of 45 isolates of P. aeruginosa from 120 different clinical specimens [37.5%] between May 2009 and January 2010 were subjected to susceptibility testing against various antibiotics by disc diffusion method. Imipenem and l or ceftazidime resistant isolates by MIC method were selected for detection of MBL production by disc potentiation test. All P.aeruginosa isolates were subjected to duplex polymerase chain reaction to detect IMP and VIM genes of transferable MBLs

Results: Out of 45 P. aeruginosa isolates, 21 [46.7%] were resistant to imipenem [IPM] and 45[100%] were resistant to cefepime. 18[62%] of ceftazidime [CAZ] resistant P. aeruginosa and 15[21%] of imipenem resistant P. aeruginosa were MBL producers by disc potentiation test. Among 45 P. aeruginosa isolates, 15 [33.3%] were positive by duplex PCR. All MBL producer P. aeruginosa were resistant to all tested antimicrobial agents. In comparing the results of disc potentiation test with PCR results IPM / EDTA disc potentiation test was highly sensitive and specific while CAZ/EDTA was highly sensitive but less specific

In conclusion: MBL- mediated IPM and /or CAZ resistance in P. aeruginosa is a cause for concern in therapy of critically ill patients, so there is a need to do surveillance to detect MBL producers

Completeness of adult death registration in Sudan in 2002

Mortality rates are very important for decision making in public health and in measuring the burden of disease. In Sudan under-registration of adult deaths is expected. In the background of a study to measure the burden of disease in Sudan, adult death registration completeness was assessed using Brass Growth Balance method. Partial birth and death rates were calculated from registered deaths in 2002 and total mid-year population projections. Linear regression of partial birth rates on partial death rates was used to calculate the completeness of death registration. The analysis showed that only 4.4% of deaths were registered and registration completeness was more for male deaths [6.5%] than for female deaths [2.8%]. A wide gap in mortality information in Sudan was found. This should be addressed by adequate sources of adult mortality information until a high quality vital registration system is constructed

Use of Rt-PCR in detecting disseminated cancer cells after incisional biopsy among oral squamous cell carcinoma patients.

PURPOSE: Tumour metastasis is the most clinically significant and enigmatic aspect of tumour behavior and is an unequivocal hallmark of malignancy. Until recent years little has been known about the transportation phase of vascular dissemination during biopsy, because of the technical difficulties in demonstrating circulating cancer cells. AIMS: This study examined whether cancer cell dissemination results from incisional biopsy in the peripheral blood by using Cytokeratin 19(CK-19) as the marker for Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). In-house recipes without utilizing kits were employed to extract genomic and total RNA to make the procedure user friendly. MATERIALS AND METHODS: The study population consisted of n=10 patients who were clinically diagnosed for oral squamous cell carcinoma and who had not undergone any previous biopsies. 5 patients who were to undergo incisional biopsies for benign conditions served as controls. 5 ml of blood aspirates were collected before and within 15 minutes after incisional biopsy. CK-19 gene and a positive control gene beta actin were isolated to confirm the primers. Using the total RNA, RT-PCR was performed for beta actin and Ck 19 gene expression. RESULTS: Rt-PCR did show any expression for the CK-19 gene. CONCLUSION: In conclusion there was no evidence of dissemination of cancer cells in our study and the patients are on a regular follow up for the past one and half years. But larger sample size should be examined to make the procedure a diagnostic tool for cancer metastasis.

Primary extranodal non-Hodgkin's lymphoma of the oral cavity.

Non-Hodgkin's lymphoma (NHL) belongs to a group of lymphoid neoplasms that is diverse in manner of presentation, response to therapy and prognosis. Usually the oral manifestations of NHL are secondary to a more widespread involvement throughout the body. Though primary intraoral lesions in NHL are uncommon, it is important to be aware of them, since intraoral manifestations are the presenting symptom in these patients. A 55 year old woman presented with a swelling in the maxillary right alveolus and buccal vestibule. There were no palpable lymph nodes. A CT scan revealed a mass on the labial aspect of the right maxilla with no involvement of the maxillary sinus. Incisional biopsy of the lesion showed a dense lymphocytic infiltrate with formation of variably sized lymphoid follicles. The infiltrate showed a mixed neoplastic lymphocyte composition which was suggestive of follicular mixed type of malignant B cell primary extranodal lymphoma. The patient was treated with chemotherapy followed by radiation.

Role of oxyuriasis in maintenance of urinary tract infection among female children

With the fact that oxyuriasis is frequent in early childhood and that renal scarring due to urinary tract infection almost always occurs before puberty, this study investigated 451 female children [4-9 years] with urinary tract infection to assess the role of oxyuriasis in inducing and maintaining UTI among them. Oxyuris infection was detected among 242 girls by perianal adhesive tape technique. Specific antioxyuris and antimicrobial therapy was applied empirically as a first line treatment, however 42 girls [9.3%] showed recurrence of UTI, 21 of them were oxyuris re-infected. The recurrence of UTI was represented by 18 relapses detected within 7 days and 24 reinfections detected after two weeks post treatment. After culture isolation and sensitivity testing, second line specific antimicrobial therapy was applied togehter with antioxyuris therapy. After second line therapy, oxyuris infection was detected in 15 cases out of 19 reinfections [78.9%] and in 4 out of 13 relapses [30.7%], these 32 girls were subjected to intravenous urography [IVU] to detect renal scarring or anatomical abnormalities of the urinary tract, voiding cystourethrogram [VCUG] to detect vesicoureteral reflux [VUR] and to serum IgA assay. The study emphasized the significant role of vesicoureteral reflux in developing renal scarring. However the striking finding was that persistent oxyuriasis among IgA deficient girls in the absence of reflux was as significant as the reflux in developing UTI attributed renal scarring. So the study considered these young girls with combined persistent oxyuriasis and IgA deficiency being under high risk of developing UTI, renal scarring and later in life end stage renal failure. The oxyuris induced perianal pruritis should alert the parents for early detection and treatment of UTI and oxyuriasis especially in view of the high prevalence of asymptomatic IgA deficiency [1:500] together with the nonspecificity of the symptoms of UTI in childhood