Antibacterial effect of Asphodelus fistulosus aqueous and ethanolic crude extracts on gram positive and gram negative bacteria.

Asphodelus fistulosus (A. fistulosus) is a wild plant grows in Jordan. Traditionally, it is used to treat different medical conditions and diseases such as respiratory ailments, against burns and dermatomucosal infections.This study aims to find out the effects of A. fistulosus aqueous and ethanolic crude extracts on Staphylococcus aureus(S. aureus) as gram positive bacteria and Escherichia coli (E. coli) as gram negative bacteria and to investigate which one will be affected either by aqueous and/or ethanolic crude extracts of A. fistulosus shooting parts that were collected from Jerash in the north of Jordan. Agar well diffusion method was used to evaluate the antibacterial activity of the crude extracts. In addition, MIC (minimum inhibitory concentration) as well as MBC (minimum bactericidal concentration) were determined against both types of bacteria. The results showed that flower aqueous extract of A. fistulosus was very effective against E. coli (20.0 ± 0.50) mm and caused a (14.0 ± 0.50) mm inhibition to S. aureus. The ethanolic extract of stem was very effective cauesed a (19.0 ± 0.50) mm inhibition in both bacterial species. Respectively, both S. aureus and E. coli were inhibited by ethanolic and aqueous extracts (mixture1 and mixture2) (15.0 ± 0.00 mm and 10.5 ± 0.50 mm). The highest antimbacterial activity was observed for the leaves aqueous extract against E.coli (0.06120 mg/mL). The obtained MIC values from A. fistulosus parts extracts demonstrated antibacterial activity ranged between 7.606 and 0.06120 mg/mL. The highest antimicrobial activity was recorded in the leaves aqueous extract against E. coli.The MBC value of stem aqueous extract was 5.00 mg/mL against both S. aureus and E. coli. On the other hand, ethanolic and aqueous extracts of the leaves gave MBC values 5.00 mg/mL, and 0.156 mg/mL, respectively, against E. coli.Based on the results of this study, it can be concluded that there is good inhibitory effect of aqueous and ethanolic of A. fistulosus shooting parts extracts on growth of E. coli and S. aureus. Adding to that, stem ethanolic extract has the most effective against S. aureus while aqueous extract of flower has the most effective against E. coli.So, it is recommended to have further future studies on the A. fistulosus shooting parts crude extract bioactive components and the mechanism of how these constituents affect these types of bacteria.

Functional endoscopic sinus surgery outcome in chronic rhinosinusitis patients with hypoplastic maxillary sinus.

OBJECTIVE: To review the clinical characteristics, prevalence and outcomes of chronic rhinosinusitis patients with a hypoplastic maxillary sinus who underwent functional endoscopic sinus surgery. METHODS: A retrospective review was performed for the 814 consecutive, elective functional endoscopic sinus surgery procedures performed at an academic centre from 2010 to 2020, to identify patients with a hypoplastic maxillary sinus. RESULT: A total of 56 hypoplastic maxillary sinus cases were detected. Maxillary sinus hypoplasia presented unilaterally in 20 cases and bilaterally in 18 cases. Of the maxillary sinus hypoplasia cases, 38 were type I, 17 were type II and 1 was type III. The average Lund-McKay score was 8.6. No major post-operative complications were reported. Four patients had minor complications and one had persistent post-nasal drip. CONCLUSION: Functional endoscopic sinus surgery is a safe and effective procedure for improving the clinical condition of patients with a hypoplastic maxillary sinus; however, careful pre-operative radiological evaluation, identification of intra-operative endoscopic landmarks and use of additional techniques may be essential to achieve satisfactory results and avoid possible serious complications.

Success rate of type 1 tympanoplasty: a comparative study.

OBJECTIVES: This study aimed to compare graft take rate after tympanoplasty between adults and paediatric patients, cartilage and fascia grafts, and overlay and underlay techniques. METHODS: Data were analysed in groups according to the technique (underlay vs overlay), age (paediatric patients vs adults) and graft (cartilage vs temporalis fascia). The main outcome measures were full graft take and the incidence of complications. RESULTS: A total of 198 patients (208 ears) were included. Overall, full graft take was achieved in 200 ears (96 per cent). The success rate was higher in adults compared with paediatric patients (97.5 per cent vs 92.25, respectively) but the difference was insignificant. Similarly, higher but insignificant graft take rate was found in the cartilage group compared with fascia group (98.6 per cent vs 94.9 per cent, respectively). CONCLUSION: All cases of overlay tympanoplasty had full graft take (success rate 100 per cent). In the underlay group, successful graft take was achieved in 154 cases (95 per cent). This difference was statistically insignificant.

Hearing results after stapedotomy for otosclerosis: comparison of prosthesis variables.

OBJECTIVE: To evaluate the influence of different piston variables on hearing following stapedotomy. METHODS: Data were analysed in groups according to: piston material (titanium vs fluoroplastic), shaft diameter (0.4 mm vs 0.5 mm) and crimping style (manual crimping vs self-crimping). Pre- and post-operative average air-bone gap, air-bone gap difference, success rate and operative time were evaluated. RESULTS AND CONCLUSION: Fifty-one patients (58 ears) were included. A post-operative air-bone gap of 10 dB or lower was achieved in 44 cases, with a success rate of 75.9 per cent; 52 cases (89.7 per cent) had an air-bone gap of 20 dB or lower. The success rate was higher, but not significantly, in fluoroplastic than in titanium pistons (85 per cent vs 70 per cent). Pistons with shaft diameters of 0.5 mm and 0.4 mm had success rates of 79 per cent and 72 per cent, respectively. No significant differences were found for any audiometric parameters. There were no significant differences between manual crimping and self-crimping pistons in terms of audiometric results or success rate.

Anatomical variation of the sphenoid sinus in paediatric patients and its association with age and chronic rhinosinusitis.

OBJECTIVE: To report the prevalence of different anatomical variations of the sphenoid sinus and its related structures among paediatric patients with or without chronic rhinosinusitis. METHODS: Computed tomography scans of 50 paediatric patients with chronic rhinosinusitis were reviewed and compared to 50 scans of paediatric patients without chronic rhinosinusitis. The type of sphenoid sinus pneumatisation and the surrounding structures were thoroughly analysed. The patients were divided into three groups according to age. RESULTS: Mean age was 10.9 years (range, 4-16 years). The sellar configuration was the commonest in all groups, while the conchal type was the least common. There were significant differences between paediatric patients with or without sinusitis in: sphenoid sinus pneumatisation type, vidian canal type and Onodi cell presence. In addition, there were significant differences between age groups in: sphenoid sinus pneumatisation type, single sinus septum and multiple septa presence, and internal carotid artery bulging. CONCLUSION: Age and sinusitis have a significant impact on sphenoid pneumatisation type and surrounding structure variation. Recognition of these variations can be useful for mapping this region, and enables a safer and more efficient endoscopic surgical procedure.

Dextran sodium sulphate (DSS)-induced colitis alters the expression of neurotrophins in smooth muscle cells of rat colon.

Neurotrophins are present in the gastrointestinal tract where they participate in the survival and growth of enteric neurons, augmentation of enteric circuits, elevation of colonic myoelectrical activity and also in different aspects of colitis. Previous studies largely focused on the role of neural and mucosal neurotrophins in gut inflammation. The expression of neurotrophins in colonic smooth muscle cells (SMCs) and the interactions of this potential source with colitis has not been studied in the gut. The expression of NGF, BDNF, NT-3 and NT-4 in SMCs from longitudinal and circular muscle layers of rat colon from normal and dextran sodium sulphate (DSS)-induced colitis rats was measured by ELISA. NGF, BDNF, NT-3 and NT-4 are differentially expressed in both longitudinal and circular SMCs, where the expressions of BDNF and NT-4 proteins were greater in SMCs from the longitudinal muscle layer than from the circular muscle layer, while NGF protein expression was greater in circular SMCs and NT-3 expression was equal in cells from both muscle layers. Induction of colitis with DSS significantly alters neurotrophins expression pattern in colonic SMCs. NGF levels upregulated in circular SMCs. BDNF level was increased in DSS-induced colitis in longitudinal SMCs. NGF, NT-3 and NT-4 levels were downregulated in longitudinal SMCs of DSS-induced colitis rats' colon. Disturbances of neurotrophins expression in SMCs resulted from colitis might account for the structural and functional changes in inflammatory bowel disease (IBD) such as loss of innervation and characteristic hypercontractility of longitudinal muscle in IBD.

Stimulation of synthesis and release of brain-derived neurotropic factor from intestinal smooth muscle cells by substance P and pituitary adenylate cyclase-activating peptide.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) is a neurotrophin present in the intestine where it participates in survival and growth of enteric neurons, augmentation of enteric circuits, and stimulation of intestinal peristalsis and propulsion. Previous studies largely focused on the role of neural and mucosal BDNF. The expression and release of BDNF from intestinal smooth muscle and the interaction with enteric neuropeptides has not been studied in gut. METHODS: The expression and secretion of BDNF from smooth muscle cultured from the rabbit intestinal longitudinal muscle layer in response to substance P (SP) and pituitary adenylate cyclase-activating peptide (PACAP) was measured by western blot and enzyme-linked immunosorbent assay. BDNF mRNA was measured by reverse-transcription polymerase chain reaction. KEY RESULTS: The expression of BNDF protein and mRNA was greater in smooth muscle cells (SMCs) from the longitudinal muscle than from circular muscle layer. PACAP and SP increased the expression of BDNF protein and mRNA in cultured longitudinal SMCs. PACAP and SP also stimulated the secretion of BDNF from cultured longitudinal SMCs. Chelation of intracellular calcium with BAPTA (1,2-bis-(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid) prevented SP-induced increase in BDNF mRNA and protein expression and SP-induced secretion of BDNF. CONCLUSIONS & INFERENCES: Neuropeptides known to be present in enteric neurons innervating the longitudinal layer increase the expression of BDNF mRNA and protein in SMCs and stimulate the release of BDNF. Considering the ability of BDNF to enhance smooth muscle contraction, this autocrine loop may partially explain the characteristic hypercontractility of longitudinal muscle in inflammatory bowel disease.

Brain-derived neurotrophic factor enhances cholinergic contraction of longitudinal muscle of rabbit intestine via activation of phospholipase C.

Brain-derived neurotrophic factor (BDNF) belongs to the neurotrophin family of proteins best known for its role in neuronal survival, differentiation, migration, and synaptic plasticity in central and peripheral neurons. BDNF is also widely expressed in nonneuronal tissues including the gastrointestinal tract. The role of BDNF in intestinal smooth muscle contractility is not well defined. The aim of this study was to identify the role of BDNF in carbachol (CCh)- and substance P (SP)-induced contraction of intestinal longitudinal smooth muscle. BDNF, selective tropomyosin-related kinase B (TrkB) receptor agonists, and pharmacological inhibitors of signaling pathways were examined for their effects on contraction of rabbit intestinal longitudinal muscle strips induced by CCh and SP. BDNF activation of intracellular signaling pathways was examined by Western blot in homogenates of muscle strips and isolated muscle cells. One-hour preincubation with BDNF enhanced intestinal muscle contraction induced by CCh but not by SP. The selective synthetic TrkB agonists LM 22A4 and 7,8-dihydroxyflavone produced similar effects to BDNF. The Trk antagonist K-252a, a TrkB antibody but not p75NTR antibody, blocked the effect of BDNF. The enhancement of CCh-induced contraction by BDNF was blocked by the phospholipase C (PLC) antagonist U73122, but not by ERK1/2 or Akt antagonists. Direct measurement in muscle strips and isolated muscle cells showed that BDNF caused phosphorylation of TrkB receptors and PLC-γ, but not ERK1/2 or Akt. We conclude that exogenous BDNF augments the CCh-induced contraction of longitudinal muscle from rabbit intestine by activating TrkB receptors and subsequent PLC activation.

Luteal phase support with GnRH-a improves implantation and pregnancy rates in IVF cycles with endometrium of

OBJECTIVE: The objective of this study was to examine the use of gonadotrophin-releasing hormone agonist (GnRH-a) for luteal phase in a group of patients with thin endometrium (

Malleus-stapes assembly: experience with two prostheses.

Tympanoplasty is often a necessary part of middle-ear surgery, the most common defect being that between an intact, mobile stapes and the malleus handle. The most readily available tissue is the patient's incus, reshaped to bridge the space between an intact stapes and the malleus. When the incus cannot be used, the hydroxyapatite Wehrs incus prosthesis can be used as an alternative.Twenty-six patients had an autograft incus ossiculoplasty and 20 patients underwent modified Wehrs incus prosthesis ossiculoplasty. The average post-operative air-bone gaps (ABGs) were 16.2 dB hearing loss (dBHL) and 17.2 dBHL, respectively. Air-bone gap closure to within 15 dBHL was achieved for 48 per cent of incus autografts and for 57 per cent of Wehrs prostheses, and to within 20 dBHL for 77 per cent and 62 per cent, respectively. Over four years follow up, the reconstruction was stable for each group, the ABGs being 17.7 dBHL and 17.1 dBHL, respectively.

How we do it: modified Wehrs incus ossiculoplasty.

Keypoints * Ossiculoplasty is commonly performed as part of tympanoplasty. Hydroxyapatite is a favoured material for ossicular protheses. * A modification to the Wehrs incus prosthesis is described. * Twenty-one procedures were performed on 20 patients and the results are reported. * On average there was a 4-5 dB closure of the air-bone gap (ABG), with patients having a hearing gain procedure averaging 11 dB closure. Air-bone gap closure to

Willingness of dentists in Jordan to treat HIV-infected patients.

UNLABELLED: Reluctance of dentists to treat human immunodeficiency virus (HIV) positive patients represents a major concern. Many efforts have been extended towards the documentation of the extent of this reluctance and speculation of factors that influence it. OBJECTIVES: Assess the willingness of dentists in Jordan to treat HIV-infected patients. MATERIALS AND METHODS: Two hundred and forty-two general dental practices were surveyed for their willingness to provide treatment of toothache and routine dental care of an HIV-infected individual. RESULTS: Only 15% of the dental practices were willing to provide such care. Willingness to provide treatment did not seem to be influenced by financial factors or the local prevalence of HIV disease. CONCLUSION: Present data suggest that HIV-infected individuals will have difficulty in obtaining dental health care in Jordan.

Risk indicators associated with tooth loss in Jordanian adults.

OBJECTIVES: The purpose of this study was to evaluate the risk indicators of tooth loss in Jordanian adults. METHODS: A sample of 509 Jordanian adults was randomly selected. The subjects were interviewed regarding demographics, social economic status, smoking habits, and oral hygiene practices and then clinically examined by a single examiner. Multiple regression analysis was performed to estimate the simultaneous impact of risk indicators on tooth loss. RESULTS: The subjects' mean age was 42.6 years with an average of 20.9 teeth remaining per person. The overall educational level of the subjects was low. More than 40% reported not brushing their teeth regularly and 56% had had no professional teeth cleaning during the last year. Monthly family income averaged JOD 231, and about a third of the subjects were smokers. The mean number of remaining teeth decreased significantly with age. Smokers, those who brushed irregularly, and those who had not had professional teeth cleaning in the last year had significantly fewer remaining teeth. Men also had significantly fewer remaining teeth. Education and income were also significantly associated with the number of remaining teeth. Age, income, brushing, prophylaxis, and gender collectively explain 75.1% of the variance in the number of remaining teeth. CONCLUSION: Modification of non-disease independent factors could reduce tooth loss and improve oral health in Jordanians.

Appendectomy in pregnancy: the experience of a university hospital.

The files of pregnant patients who underwent appendectomy at our hospital over the period 1977-96 were studied retrospectively. Forty-six patients were operated upon amongst 52 108 deliveries over this period. Of those 27 had uncomplicated acute appendicitis and six had one of the complications of acute appendicitis (a prevalence of 0.063%). Thirteen had normal appendices (71.7% accuracy). Obstetric complications occurred in four patients, with three fetal losses (6.5%). Those with complicated appendicitis had significantly delayed presentation, in-hospital delay and prolonged postoperative stay. Recently we used diagnostic laparoscopy in two patients for diagnosis and to perform appendectomy in one. In conclusion, the incidence of acute appendicitis in pregnancy seems to be the same over the period of gestation and the diagnostic accuracy seems to be related both to the late presentation by the patient and to physician delay. Maternal morbidity and fetal loss are mostly limited to those with complicated appendicitis.

Treatment of mandibular odontogenic keratocysts.

OBJECTIVE: The purpose of this study was to report our experience with surgical treatment of 31 mandibular odontogenic keratocysts, with special reference to their recurrence, and to review the literature on this subject. STUDY DESIGN: A retrospective analysis was conducted of all odontogenic cysts treated in the Department of Oral Surgery and Oral Medicine at Jordan University of Science and Technology between 1989 and 1995. Of a total of 227 odontogenic cysts, 31 odontogenic keratocysts were histopathologically diagnosed preoperatively. They were surgically treated through an intraoral approach by resection without continuity defects. The lower border of the mandible and/or the posterior border of the ramus was left intact. In cases where teeth were in continuity with the lesion, they were extracted. In cases where cortical perforation occurred, any associated overlying mucoperiosteum was excised. All patients were reviewed annually for a follow-up period of 2 to 8 years. RESULTS: All odontogenic keratocysts were found in the mandible. Of these, 23 were in the ramus and angular region (74.2%) and 8 were located in the body of the mandible. No recurrences of the operated odontogenic keratocysts were observed during the follow-up period. CONCLUSION: Our findings indicate that removal of odontogenic keratocysts by resection without continuity defects is a satisfactory method of treatment.

True caecal diverticulitis.

Nine patients (six females and three males), median age = 27.5 years (range 13-36) with caecal diverticulitis are presented. All underwent surgery with a suspected diagnosis of acute appendicitis. Per-operative diagnosis was possible in five cases, two cases were thought to have other benign pathology, but malignancy could not be excluded in the remaining two cases. Local excision was carried out in five cases, a right hemicolectomy was performed in the rest. Histology showed true diverticuli in eight cases, severity of the inflammation made it difficult to comment on the ninth case. Postoperative barium enema was carried out in six cases, which showed no further diverticuli in the colon. We conclude that preoperative diagnosis of caecal diverticulitis is difficult, and that true solitary caecal diverticuli present in a younger age group than the false caecal and ascending colon diverticuli and that they are probably congenital in origin.

Postpartum pain due to thrombosed varicose veins of the round ligament of the uterus.

Postpartum thrombosis of varicose veins of the round ligament may present in a clinical picture similar to an irreducible inguinal hernia. Two such unusual cases are reported. One patient underwent surgery while the other, with a presumptive diagnosis of the same condition, was observed, with no complications occurring in both patients. This condition has not to my knowledge been previously reported. The increased incidence of both varicose veins and thrombosis in the postpartum period should alert the physician to the diagnosis of such conditions.