Regeneration potential of bone marrow derived mesenchymal stem cells and platelet rich plasma (PRP) on irradiation-induced damage of submandibular salivary gland in albino rats.

Radiation-induced damage to salivary glands (SG) is a consequence of radiotherapy for head and neck cancers. Recovery of the irradiated SG has been studied using various regenerative approaches. This study aims to compare the regenerative potentials of platelet-rich plasma (PRP) and bone marrow mononuclear cells (BMMCs) on irradiated rat submandibular salivary glands (SMD). 32 healthy male albino rats were irradiated with a single dose of 6 Gy then classified into four groups. Group A received no treatment while the other 3 groups were injected 24 h post-radiation with a single dose of either; BMMCs (Group B), PRP (Group C), or BMMCs suspended in PRP (Group D). SMD regeneration was assessed in terms of histological changes and TGF- ß1 gene expression. The results showed that compared to the untreated group all groups showed successful regeneration with group D showing the best results. A statistically significant increase in the surface area of acini and TGF- ß1 gene expression was observed in group D, followed by group C, then B. Our results prove that using PRP and BMMCs could be promising in decreasing irradiation side effects on SG. Moreover, combining PRP and BMMCs gives better effects compared to each therapy alone.

Effect of exposure to different light colors on embryonic development and neurophysiological traits in the chick embryo.

BACKGROUND AND AIM: Many environmental factors exist that influence embryonic development which is missing in the poultry industry, such as light in incubation facilities or hatcheries. Light plays an important role in the growth and development of chick embryos, whereas dark environments can lead to hatching failure or embryo distortion. Therefore, this study aimed to demonstrate the importance of light and its various colors on the growth and development of broiler chick embryos. MATERIALS AND METHODS: Four treatments were used to study the impact of various light colors on the growth of embryos and their neurophysiological traits: Dark without light (D), red light (RL), blue light (BL), and green light (GL), with three replicates per treatment (25 eggs/replicate) for a total of 300 fertile Ross 308 eggs. Each treatment was assigned to one incubator (75 eggs/incubator), whereas all other conditions were kept the same. RESULTS: The results showed a significant increase (p<0.01) in embryonic development for embryo weight, chick body weight, hatchability, and embryo index for RL, BL, and especially GL. RL, BL, and especially GL significantly increased (p<0.01) neurophysiological traits of the neurons, brain weight, and brain index. CONCLUSION: The use of light during the embryonic period affects the development of the embryo and its neurophysiological traits.

Comorbidities in Patients with Psoriasis.

Psoriasis, a chronic inflammatory disease is associated with a long list of comorbidities. In our practice we like to draw attention in comorbidities of psoriatic arthritis and we are adapted with cardiovascular comorbidities. A great deal remains unknown about psoriasis associated comorbidities. An understanding of these comorbidity patterns can help us to ensure better care of patients with psoriasis. Objective of the study was to find out the comorbid conditions in the patients of psoriasis. This observational case control study was conducted 150 diagnosed cases of psoriasis and 150 age matched healthy control. Purposively 150 patients of psoriasis were selected from the Dermatology OPD of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to December 2018 as case. After a complete physical examination, a pre-designed structured questionnaire was fulfilled with patients and controls. To detect unknown comorbidities the following tests was done in both groups and compared: Blood sugar, urine routine and microscopic examination, serum creatinine, serum AST, ALT, GGT, and ALP levels measured by an enzymatic method, X-ray chest view, USG of whole abdomen/KUB. The diagnosed comorbidity was listed and referred for treatment accordingly. Charlson-age comorbidity index chart was used to estimate risk of mortality in two groups. The mean age of incident psoriasis was 38.64 years. Diabetes mellitus (4.67%), hypertension (4%), ischemic heart disease (IHD) (3.33%) were the top three comorbidities in patients with psoriasis. among them 11(7.33%) patients of psoriasis was with single comorbidity and 5(3.33%) of them was with multiple comorbidity. In control group 3(2%) participants was detected with comorbidity and that difference was significant statistically. In current study Charlson-Age Comorbidity index (CACI) was used as a tool to estimate the risk of mortality in two groups. The mean CACI score was 2.5 and 1 in two groups respectively and the difference was significant (p<0.05). The estimated risk of death (ERRD) score was calculated form CACI chart and the score was 2.78 and 1.47 in two groups respectively. There was no significant difference in two groups (p>0.05). The rate of occurrence of comorbidity was more in psoriasis group than in control. The listed comorbidity was in mild severity range but the risk of mortality was same in psoriasis group and control.

Association of serum level of vitamin D and VDR polymorphism Fok1 with the risk or survival of pancreatic cancer in Egyptian population.

BACKGROUND AND AIMS: Pancreatic cancer (PC) is the fourth most common cause of death from cancer in Egypt. Few studies have been conducted to assess the relationship between vitamin D serum level and vitamin D receptor (VDR) polymorphisms with the survival of PC patients. This is the first study in Egypt to investigate the association of the status of vitamin D serum level and genotypic distribution of single nucleotide polymorphisms (SNP) Fok1 with the risk of developing PC and whether they could detect survival or not. PATIENTS AND METHODS: The study included a total of 47 PC cases that were histopathologically proven to have PC, and 37 controls that were attending at the same time for investigation but proved that they were all PC free. Pre-diagnostic concentrations of vitamin D and VDR polymorphism Fok1 were assessed from all participants in the study. RESULTS: There was a 1.5-fold increase in the serum level of vitamin D in PC patients when compared to non-PC subjects. Regarding VDR Fok1, polymorphism distribution in PC was CC (Wild Type) 26 (55.3%), CT 16 (34%), and TT 5 patients (10.7%). For the control group, CC was found in 24 (64.8%), CT in 12 (32.4%), and TT genotype was found only in one individual 1 (2.8%) with no statistically significant difference between the two studied groups (P 0.72). CONCLUSION: Low serum vitamin D or VDR-SNP is not a risk factor for PC in Egyptian patients. Recommendations to increase vitamin D concentrations in healthy persons for the prevention of cancer and improving overall survival should be carefully considered.

Clinical significance of SNP (rs2596542) in histocompatibility complex class I-related gene A promoter region among hepatitis C virus related hepatocellular carcinoma cases.

The major histocompatibility complex class I-related gene A (MICA) is an antigen induced by stress and performs an integral role in immune responses as an anti-infectious and antitumor agent. This work was designed to investigate whether (SNP) rs2596542C/T in MICA promoter region is predictive of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) or not. Forty-seven healthy controls and 94 HCV-infected patients, subdivided into 47 LC and 47 HCC subjects were enrolled in this study. SNP association was studied using real time PCR and soluble serum MICA concentration was measured using ELISA. Results showed that heterozygous genotype rs2596542CT was significantly (P = 0.022) distributed between HCC and LC related CHC patients. The sMICA was significantly higher (P = 0.0001) among HCC and LC. No significant association (P = 0.56) between rs2596542CT genotypes and sMICA levels was observed. Studying SNP rs2596542C/T association with HCC and LC susceptibility revealed that statistical significant differences (P = 0.013, P = 0.027) were only observed between SNP rs2596542C/T and each of HCC and LC, respectively, versus healthy controls, indicating that the rs2596542C/T genetic variation is not a significant contributor to HCC development in LC patients. Moreover, the T allele was considered a risk factor for HCC and LC vulnerability in HCV patients (OR = 1.93 and 2.1, respectively), while the C allele contributes to decreasing HCC risk. Therefore, SNP (rs2596542C/T) in MICA promoter region and sMICA levels might be potential useful markers in the assessment of liver disease progression to LC and HCC.

LAPAROSCOPIC ASSISTED PER-CUTANEOUS RADIO-FREQUENCY ABLATION (LAPRFA) AS A NEW MODALITY FOR TREATMENT OF HCC IN CIRRHOTIC LIVER.

Laparoscopic assisted percutaneous radiofrequency ablation (LAPRFA) for hepatocellular carcinoma (HCC) under guidance of intra-operative laparoscopic ultrasound (IOLUS) is a new modality for obtaining additional assessment of the liver situation, better tumor staging and effective treatment for the hepatic focal lesion (HFL), in patients with a difficult percutaneous approach. Between September 2010 and July 2014, 1150 patients with HCC on top of liver cirrhosis were referred to HCC clinic (MDT clinic) at National Hepatology and Tropical Medicine Research Institute (NHTMRI). Fourty nine patients were submitted to LAPRFA under IOLUS guidanceby the Multidiscipplinary team decision. Operation time, hospital stay, post procedure complications were recorded. A routine spiral CT scan one month postoperative and laporatory investigations with AFP were mandatory during follow up. The results showed that LAPRFA was completed in all patients. The IOLUS examination identified new HFL in three patients. A total of 52 lesions were treated. The mean operative time was 92 minutes; eight procedures were associated in six patients: cholecystectomy (6) and adhesiolysis (2). A complete tumor ablation was observed in all patients during the procedure by the U/S assessment intra-operatively, and was documented via spiral computed tomography (CT scan) one mopth after treatment.

The role of H. pylori infection in gall bladder cancer: clinicopathological study.

Recent work demonstrated the presence of Helicobacter pylori (H. pylori) in the bile and gallbladder of more than 75 % of patients with gallbladder cancer and more than 50 % of patients with chronic cholecystitis. The aim of the work was to determine the prevalence of H. pylori in the gallbladder of patients operated on for chronic cholecystitis and relating their presence to the precancerous histological changes. In our study, fifty patients were operated on for chronic cholecystitis. The patients were subdivided into two groups (each includes 25 patients): H. pylori-positive group, who had H. pylori in their gallbladder mucosa detected by Giemsa stain, and H. pylori-negative group. The histological findings (mucosal erosions, atrophy, metaplasia, dysplasia, lymphoid infiltration, musculosa hypertrophy, and fibrosis) were compared between the two groups. Comparing the histological findings of the H. pylori-infected gallbladders with the non-infected ones, the gallbladders with mucosal hyperplasia, metaplasia/dysplasia, and lymphoid infiltration showed statistically significant differences, with a P value of 0.028, 0.049, and 0.022, respectively. On the other hand, no statistically significant differences were detected between the two groups in the degree of mucosal erosions (P = 0.299), atrophy, musculosa hypertrophy (P = 1.000), and fibrosis (P = 1.000). These results highlight the role of H. pylori infection in aggravating the mucosal lesions (mucosal hyperplasia, metaplasia, and lymphoid infiltration) of the gallbladder that is considered potentially precancerous.

Endoscopic transnasal resection of Eustachian-tube dermoid in a new-born infant.

INTRODUCTION: Dermoids of the Eustachian tube are rare benign developmental tumours that typically occur in female children. General consensus of classification and nomenclature has still not been reached. The treatment of choice consists of a radical surgical excision. Several approaches have been described and few cases are reported in literature. A gross total resection is now safely achievable through an endoscopic mini-invasive approach. MATERIALS AND METHODS: We have reported a case of dermoid pedicled in the left Eustachian tube and resected with a pure endoscopic transnasal approach. A review of the literature was performed. CASE STUDY: The aim of this paper is to present the first case of pure endoscopic transnasal resection in a 4-day-old infant as emergency treatment of Eustachian tube dermoid presenting an acute respiratory failure at birth. CONCLUSION: The endoscopic transnasal resection is a safe and feasible technique in selected dermoids of the Eustachian tube, when the middle ear is not involved. This approach could be used also in new-born children, decreasing the morbidity of the classic surgical treatment and avoiding the risk of craniofacial alterations.

DETECTION OF HELICOBACTER ANTIGEN IN STOOL SAMPLES AND ITS RELATION TO H. PYLORI POSITIVE CHOLECYSTITIS IN EGYPTIAN PATIENTS WITH CHRONIC CALCULAR CHOLECYSTITIS.

Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its noninvasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay (EIA) based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. Fifty patients were included presented with symptomatic qholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients (90%) by laparoscopic Cholecystectomy and 5 patients (10%) by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that (82%) were females with mean age (42.6 +/- 1 years). The mean BMI was (29 + 7.2) H. pylori-specific antigen in stool samples was detected in 40% of patients and 38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases.

Sonographic evaluation of thyroiditis with color flow study.

This cross sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Bangladesh in collaboration with the Department of Endocrinology and Department of Histopathology of the same hospital during the period of March 2007 to February 2008 to determine efficacy of ultrasonogram in the evaluation of thyroiditis and to compare its results with color flow Doppler study. For this purpose, a total of 50 patients having clinical suspicion of thyroiditis were enrolled in this study. Ultrasound and color Doppler were done in all these patients. Then all patients underwent for FNAC in the Histopathology department. Correlation between sonographic diagnosis and histopathological diagnosis were observed. Out of these 50 patients 10(20%) were male and 40 (80%) were female with age ranging from 12 to 50 years, highest between 21 to 30 years. The mean age of the patients was 30.42±9.57 years. On unltrasonographic findings of thyroid gland 42.0% patients had regular and 58.0% had irregular margin. Seventy percent had fibrosis, 14.0% had feature of necrosis, 48.0% had lymphadenopathy. Out of all patients 6.0% had normal echogenic feature, 16.0% had increased and 78.0% decreased echogeneic feature. Twelve percent (12.0%) patients had homogeneous and 88.0% had heterogeneous pattern of echogenecity. Thirty eight percent (38%) patients had focal nodules. Sixty percent (60.0%) patients had focal swelling and 40.0% had diffuse swelling. On color flow Doppler 28.0% had normal, 38.0% had increased and 34.0% decreased vascular flow pattern. USG reports revealed that 48.0% had thyromegaly, 36.0% had thyroid nodule, 10.0% had multinodular goiter and 6.0% had thyroid abscess. FNAC diagnosis revealed that 34.0% patients had Hashimoto's thyroiditis, 24.0% had lymphocytic thyroiditis, 18.0% had granulomatous thyroiditis, 6.0% had abscess, 8.0% had goitre and 10.0% nonspecific. USG and CFD are recommended modalities for the diagnosis of thyroiditis as these cost-effective and non invasive procedures.

Hybrid rhinoplasty: beyond the dichotomy of rhinoplasty techniques.

Although rhinoplasty and the development of facial aesthetic criteria can be traced to several millennia, contemporary techniques have passed through a rapid evolutionary process in the past century (1) (2). Although understanding human anatomy and the consequences of surgical excision occupied the minds of the founders of rhinoplasty, the process moved towards preservation of supporting structures, and maintaining the physiological functions of the nose. Initially, this endonasal approach created its own series of problems due to excessive tissue removal. External rhinoplasty provided a new impetus for growth in this field, and since its inception, has swung the pendulum of reconstruction firmly into its own sphere of influence. However, as no rhinoplasty technique holds all the answers, hybrid rhinoplasty seeks to combine the best achievements of 20(th) century rhinoplasty, from all schools of thought, in order to provide a safe, sensible and planned approach to the most demanding operation for the facial plastic surgeon.

Laparoscopic cholecystectomy as a day surgery procedure: is it safe?--an egyptian experience.

BACKGROUND/AIM: Major surgery performed as a day surgery procedure is not uncommon. The aim of this study is to evaluate the feasibility of day surgery procedures in laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: A total of 210 patients scheduled for elective LC between 2006 and 2008 were included in our study. The mean age was 40.63 years (range, 25 - 70 years). The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography without clinical or radiological evidence of acute cholecystitis. All patients were informed about the same-day discharge policy and received the postoperative instruction form on discharge. Preoperative work-up included history taking and physical examination in addition to standard laboratory and radiological tests. Patients above 35 years of age had an ECG done. All patients were examined in the outpatient clinic by a consultant anesthesiologist the night before surgery. Operative time, hospital stay, and complications were recorded. Telephonic feedback, on the morning after surgery was routinely done as an early follow-up. RESULTS: Out of the total number of patients, 140 patients were ASA (I) and 70 were ASA (II) (40 patients were controlled hypertensives and 30 were controlled diabetics). Conversion rate was 1.4%. The mean hospital stay was 6.7 hours (range, 6 - 8 hours). The mean operative time was 31.2 minutes (range, 20 - 60 minutes). None of the patients required an abdominal drain. No morbidities or mortalities were reported in this series. CONCLUSION: LC may be done as a day surgery procedure with optimal patient satisfaction and without complications.

Use of the intra-aortic balloon pump for dilatation of benign tracheobronchial strictures.

Tracheobronchial benign stenoses may cause life-threatening emergencies. Here, we will describe a novel technique for the management of tracheal and bronchial stenoses using an intra-aortic balloon pump. The intra-aortic balloon pump was used for dilatation of a postoperative tracheal stricture in a 43-year-old man and a bronchial stricture in a 29-year-old woman with Wegener's granulematosis. There were no intraoperative or postoperative complications in either patient, and the stenosis was relieved successfully in each patient. The intra-aortic balloon pump can be used safely and effectively for the management of difficult tracheobronchial strictures.

Oesophageal strictures: new indication for intra-aortic balloon pumps?

Oesophageal strictures regardless of aetiology are a difficult and challenging problem facing the oesophageal surgeon. Various methods and techniques have been described and are routinely used in clinical practice with varying rates of efficacy and complications. We describe here a novel graded atraumatic technique for the management of oesophageal strictures using intra-aortic balloon pumps.

Etretinate in the management of harlequin siblings.

Harlequin fetus is the severe form of congenital ichthyosis. There are very few reports of babies with this condition surviving the first few weeks of life. We treated two siblings who lived for 22 months and six weeks respectively. We started treatment with oral etretinate every early in their lives and achieved good improvement in the skin condition of these babies.

A technique for replacing a prosthetic aortic valve after total aortic root replacement.

The excision and replacement of a failed aortic valve bioprosthesis in a composite tubular graft in two patients with Marfan syndrome was accomplished without replacing the composite graft.

The use of an endotracheal tube for cannulation of left superior vena cava via coronary sinus for repair of a sinus venosus atrial septal defect.

A reinforced cuffed endotracheal tube was used to drain blood from a left superior vena cava via the coronary sinus during patch repair of a sinus venosus defect in a 65 year old patient. This approach produced good drainage and a bloodless operative field.

Mitral valve replacement in the first three months of life.

Two infants, aged 2 and 3 months, underwent mitral valve replacement with Björk-Shiley mechanical valves for severe congenital mitral regurgitation not amenable to valve repair. Both infants survived the operation and left hospital taking a low dose aspirin anticoagulant regimen. One child survived for three years without incident, but the other died at 11 months of pneumonia after valve replacement for tissue ingrowth and subsequent thrombosis.