Effect of functional appliances on sleep-disordered breathing in Class II division 1 malocclusion children: Randomized controlled trial.

OBJECTIVES: A randomized controlled trial was undertaken to investigate the orthopaedic effect of functional appliances on the pharyngeal airway space and nocturnal breathing of children with skeletal class II due to mandibular retrusion. MATERIALS AND METHODS: Forty patients were randomized into a 1:1 ratio study (Twin block) group and a control (fixed appliance) group. Each group included equal numbers of boys and girls. Diagnosis with sleep-disordered breathing was not an inclusion criterion. The duration of the trial was 12 months (T0 - T12). Eligibility criteria included skeletal Class II division 1 malocclusion with mandibular retrognathism, SNA ≥82, SNB ≤78, ANB ≥4, overjet ≥6 mm, and patients in circumpubertal stage CVM2 and CVM3. The main outcomes were pharyngeal airway volume, oxygen desaturation index (ODI), and maximum expiratory pressure (MEP), while the secondary outcomes were skeletal and dental changes of the maxilla and mandible. Randomization was accomplished with random blocks of 20 patients with allocation concealed in sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for data analysis of radiographic measurements and data extracted from the pulse oximeter. RESULTS: The mean age of the patients was 10 ± 1.5 and 10 ± 1.2 at (T0) for the Twin Block and the control groups, respectively. The changes in the oropharyngeal (2.66 cc and 0.056; P = .03) and nasopharyngeal (1.3 cc and 0.84; P = .053) airway volumes for the Twin block and control groups, respectively, were significantly different for the oropharynx. There was a significant decrease in ODI by [median -3.55 (-5.05 to 0.50); P ≤ .001] and a significant increase [median 45 (0.0-110); P ≤ .001] in MEP for the Twin block group. A significant inverse correlation (r = -.589; P = .006) could be found between the total volume of the oropharynx and ODI. No serious harm was observed. CONCLUSIONS: The Twin block group showed significant change in oropharyngeal airway volume and improvement of nocturnal breathing. REGISTRATION: This trial was registered at https://www. CLINICALTRIALS: gov, registration number NCT04255511.

New Prospects in Nano Phased Co-substituted Hydroxyapatite Enrolled in Polymeric Nanofiber Mats for Bone Tissue Engineering Applications.

The most common forms of tissue impairment are fracture bones and significant bone disorders caused by multiple traumas or normal aging. Surgical care sometimes necessitates the placement of a temporary or permanent prosthesis, which continues to be a challenge for orthopedic surgeons, including those with large bone defects. Electrospun scaffolds made from natural and synthetic nanofiber-based polymers are studied as natural extracellular matrix (ECM)-like scaffolds for tissue engineering. Besides, nanostructured materials have properties and functions depending on the scale of natural materials such as hydroxyapatite (HAP), ranging from 1 to 100 nm, which activity was proficient upon enrolled in nanofiber mats. The use of nanofibers in combination with nano-HAP has increased the scaffold's ability to replicate the construction of natural bone tissue that is the aim of the present text. In bone engineering, nanofiber substrates facilitate cell adhesion, proliferation, and differentiation, while HAP induces cells to secrete ECM for bone mineralization and development. This review aims to draw the reader's attention to the critical issues with synthetic and natural polymers containing HAP in bone tissue engineering; co-substituted hydroxyapatite has also been mentioned.

Evaluation of Pesticide Residues in Vegetables from the Asir Region, Saudi Arabia.

This study's aim was to determine the pesticide residues in 10 different vegetable commodities from the Asir region, Saudi Arabia. We evaluated 211 vegetable samples, collected from supermarkets between March 2018 and September 2018, for a total of 80 different pesticides using ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and gas chromatography-tandem mass spectrometry (GC-MS/MS) after extraction with a multi-residue method (the QuEChERS method). The results were assessed according to the maximum residue limit (MRL) provided by European regulations for each pesticide in each commodity. All lettuce, cauliflower, and carrot samples were found to be free from pesticide residues. A total of 145 samples (68.7%) contained detectable pesticide residues at or lower than MRLs, and 44 samples (20.9%) contained detectable pesticide residues above MRLs. MRL values were exceeded most often in chili pepper (14 samples) and cucumber (10 samples). Methomyl, imidacloprid, metalaxyl, and cyproconazole were the most frequently detected pesticides. Based on the results of this study, we recommend that a government-supported program for the monitoring of pesticide residues in vegetables be established to promote consumers' health and achieve sustainable farming systems.

Congenital laryngomalacia: Is it an inflammatory disease? The role of vitamin D.

OBJECTIVES/HYPOTHESIS: Laryngomalacia is the most common cause of stridor in infants. The exact pathophysiology is still not well understood. Our objective was to investigate whether laryngomalacia is an inflammatory disease, focusing on the possible role of vitamin D. STUDY DESIGN: Case-control study. METHODS: Sixty Egyptian infants and 60 mothers were included in this study. They were divided into four equal groups (n = 30 for each): infants with laryngomalacia (LM-infants), control infants (C-infants), mothers of the infants with laryngomalacia (LM-mothers), and mothers of the control infants (C-mothers). Laryngoscopy was performed and serum 25-hydroxyvitamin D (25[OH]-vitamin-D) and interleukin 6 (IL-6) were estimated. RESULTS: Significant increase of serum IL-6 associated with a significant decrease in serum 25(OH)-vitamin D was observed in the LM-infants compared to the C-infants (P < .001 for both). LM-mothers had significantly lower 25(OH)-vitamin D status compared to C-mothers (P < .001). CONCLUSIONS: Deficiency of 25(OH)-vitamin D in LM-infants may result in dysregulation of the immune responses with elevation of a proinflammatory cytokine (IL-6). Laryngomalacia could be an inflammatory disease due to 25(OH)-vitamin D deficiency as evidenced by the high level of IL-6. This finding may open the door to the appropriate prevention, diagnosis, and treatment, especially for moderate to severe laryngomalacia. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:448-453, 2020.

Effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients.

BACKGROUND: Large number of patients with first-ever stroke developed spasticity. Spasticity can reduce the range of motion, hinder voluntary movements, provoke pain, and result in impairment of functional activities of daily living. OBJECTIVE: Demonstrate the effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients. METHODS: We included forty ischemic stroke patients divided into 2 groups; group I were subjected to the selected physical therapy program and shock wave therapy whereas group II received the selected physical therapy program as well as placebo shock wave for six weeks. Both groups were subjected to pre- and post-treatment assessment by H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking. RESULTS: Baseline characteristics showed no significant difference between the two groups regarding the grades of spasticity. Whereas After treatment, there were a highly significant difference between both groups regarding the grades of spasticity according to the 3 parameters, H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking test (P values; <0.001, 0.006, and 0.009 respectively). CONCLUSIONS: Shock wave therapy is effective in controlling spasticity, increase dorsiflexion active range of motion of ankle and improving ten- meters walking test in stroke patients.

Multiparametric Approach Enhances Detection of Patients with Cerebral TIAs at Risk of Stroke: A Prospective Pilot Case Series.

BACKGROUND: Patients with transient ischemic attack (TIA) are generally clinically unstable, with fear of developing a handicapping stroke. Identification of those at highest and lowest risk of stroke in the first days and weeks after a TIA would allow appropriate use of worthy secondary prevention strategies. OBJECTIVE: Incorporation of a clinical scoring system, neurovascular imaging, and magnetic resonance-diffusion-weighted imaging (MR-DWI) to help predicting risk of developing an ischemic stroke following a TIA. SUBJECTS AND METHODS: A prospective observational study was conducted on 25 patients with TIAs, 64% were females, and 26% were males, with a mean age of 57±10.36. Patients were assessed clinically and an ABCD(2) score was applied. Patients have undergone diffusion-weighted imaging (DWI), within 24 h from the event, and intra- and extracranial duplex study. Patients were followed up at intervals of one week, three months, six months, and one year. RESULTS: Six patients (24%) developed stroke on their follow-up, most of them (83.3%) had their strokes within the first three months and had an initial ABCD(2) score of ≥4. The development of stroke was associated with the presence of significant extra and/or intracranial vessel disease (P=0.006) and the presence of acute lesions on their DWI (P=0.035). CONCLUSION: Incorporation of brain MR-DWIs and neurovascular imaging together with the ABCD(2) score improves prediction of ischemic stroke following TIA.

An in vitro study into the efficacy of complex tooth alignment with conventional and self-ligating brackets.

OBJECTIVE: To evaluate the efficacy of tooth alignment achieved by various small cross-section archwire/bracket combinations using the orthodontic measurement and simulation system. MATERIALS AND METHODS: The study comprised three types of orthodontic brackets 1) conventional ligating (Victory Series and Mini-Taurus), 2) self-ligating (SmartClip a passive self-ligating bracket and Time3 an active self-ligating bracket), and 3) a conventional low-friction bracket (Synergy). All brackets had a nominal 0.022″ slot size. Brackets were combined with 1) 0.012″ stainless steel, 2) 0.012″ Orthonol, 3) 0.012″ Thermalloy, and 4) 0.0155″ coaxial archwires. Archwires were tied to the conventional brackets with stainless steel ligatures and elastomeric rings. The malocclusion simulated represented a central upper incisor displaced 2 mm gingivally (x-axis) and 2 mm labially (z-axis). RESULTS: The inciso-gingival correction achieved by the different archwire/bracket combinations ranged from 15 to 95%, while the labio-lingual correction ranged from 10 to 95%. The smallest correction was achieved by coaxial, Orthonol, and thermally archwires when ligated with the elastomeric rings to conventional brackets. Stainless steel archwires achieved from 65 to 90% of inciso-gingival correction and from 60 to 90% of labio-lingual correction. CONCLUSION: The resultant tooth alignment was the product of interaction between the archwire type, bracket type, and bracket design including ligature type. Small cross-sectional archwires might produce up to 95% correction if combined properly with the bracket system. Elastomeric rings when used with conventional brackets limit the efficacy of malalignment correction.

Pretreatment and on-treatment indicators of virologic breakthrough of lamivudine therapy in chronic hepatitis B patients: an Egyptian study.

The primary objectives of hepatitis B treatment include improved clinical and histological progression as well as virus eradication. For many years, lamivudine was a first-line therapy for treating hepatitis B virus (HBV) infection. However, its long-term use is associated with high resistance rates (up to 70% after 5 years) due to mutations in the viral YMDD motif. The purpose of this study was to outline factors responsible for the development of viral resistance during long-term lamivudine therapy. Initially, 230 patients receiving lamivudine therapy for chronic hepatitis B (CHB) infection were enrolled in the study. All subjects received follow-ups in the first year to assess viral and biochemical responses. Only 136 and 104 patients received follow-up assessments during the second and third years of treatment, respectively. Viral breakthrough (VBT) occurred in 49 of 230 patients (21.3%). Hepatitis B "e" antigen (HBeAg) status before treatment was significantly associated with VBT in the first 2 years of treatment; however, this effect was not significant in the third year. Pre-treatment HBV DNA levels were predictive of VBT in the HBeAg-positive subgroup after all years of treatment (P = 0.001, P = 0.002, and P = 0.002, respectively). These levels were also predictive in the HBeAg-negative subgroup after 1 year of treatment (P = 0.001). In resource-poor communities, financial concerns drive the selection of antiviral therapy to treat CHB. Lamivudine monotherapy is a relatively cheap and effective treatment to manage CHB. However, consistent follow-ups and treatment modifications appear essential to prevent long-term treatment failure.

Viral Satellite RNAs for the Prevention of Cucumber Mosaic Virus (CMV) Disease in Field-Grown Pepper and Melon Plants.

A benign viral satellite RNA, in combination with a mild strain of cucumber mosaic virus (CMV-S), was used as a "vaccine" or "preinoculum" to demonstrate the feasibility of protecting pepper (Capsicum annuum cv. California Wonder) and melon (Cucurbita melo cv. Janus des Canaries) against two severe CMV strains, CMV-D and CMV-16, in the final 2 years of a 4-year pilot field and greenhouse experiment. In the field, healthy pepper and melon seedlings challenged with CMV-D and CMV-16 reduced yields by 33 to 60%; CMV-S caused only limited yield reduction in pepper and had no effect on the yield of melon. Different time intervals between preinoculation of pepper and melon seedlings with CMV-S and challenge inoculation with the severe CMV strains were tested. All plants challenged 3 weeks after vaccination showed nearly complete protection from subsequent infection by severe strains. The yield from preinoculated and challenged pepper plants was 80% that of untreated plants, while the yield from preinoculated and challenged melon plants was increased slightly over the untreated control plants. The use of this technology for biological control of plant viruses is discussed.

Histopathological evidences for the antifibrogenic effect of colchicine in schistosomiasis mansoni in mice.

Colchicine treated mice showed significant decrease in prevalence of fibrocellular and fibrocellular and fibrous granulomas in liver specimens compared to corresponding control groups. Percentage of spindle cell component and red fibrillar (RF) material showed significant reduction compared to control groups. These evidences of the antifibrogenic effect of colchicine were more prominent when treatment was given early after infection. Combined therapy with colchicine and praziquantel gave the same results. Mice treated with praziquantel alone showed no significant change compared to control groups. Colchicine showed also an immunomodulant effect evidenced by a significant decrease in the intensity of small and medium-sized to large cell components compared to control groups.

A case of cervical lymphadenopathy due to pediculosis.

This paper reports a case of cervical lymphadenopathy due to infestation with Pediculus h. capitis. Clinically and histopathologically the case was diagnosed to a non malignant and a non specific one.

Schistosomiasis affection of the kidney as a possible cause of renal stone formation.

Nowadays, renal stone is one of the medical complaints. Many theories have been suggested to account for its formation. The present work aimed to find out a correlation between schistosomiasis affection of the kidney and the formation of renal stones. Three groups of patients with renal stones were selected. They had Schistosoma mansoni infection (1st group), with Schistosoma haematobuim infection (2nd group) and Schistosoma free (3rd group or control). The results showed pathological changes in the kidney biopsied materials, particularly the glomerulus, ranging from periglomerular fibrosis to complete atrophy and lymphoid follicles in the interstitium. Sometimes, distal-tubular atrophy was seen. The serum and tissue immunoglobulins, particularly the IgA, in schistosomiasis patients were above normal as compared to control ones. It is concluded that the schistosomiasis affection of the kidney, and the resulting immunopathological changes were factors predisposing, in one way or another, to the formation of renal stones.

Fatal complications of acute enteric fevers.

Eighty eight patients presenting with fatal typhoid complications were studied in Abbassia and Embaba fever hospitals during a 4 years period (1987-1991). Criterion of inclusion in the study was either positive blood culture in 70 (80%) cases or postmortem gross appearance of typhoid fever in 18 (20%) cases. Positive blood culture cases included 54 (77%) S. typhi and 16 (23%) S. paratyphi A. Seven (10%) cases were resistant in vitro to chloramphenicol. Postmortem examination performed in 18 (20%) cases revealed typical typhoid ulcers in ileum, jejunum and large intestine. The main clinical picture of 31 toxic, 22 encephalitic or meningeal irritating, 15 gastroenteritic, 9 pneumonic, 8 perforated and 3 haemorrhagic enteric fever cases were discussed. The tetrad of fever, toxic look, bronchitic chest, tumid tympanitic abdomen and splenomegaly was a good sign for suggestion of typhoid diagnosis.

Rapid diagnosis of non-prolonged febrile illnesses necessitating fever hospital admission.

Two hundred and seventy patients were studied during a 2 years period in Abbassia and Embaba fever hospitals. The duration of illness before admission was less than 20 days. Suggestive clinical symptoms and/or signs of each disease were stressed. Rapid laboratory investigations include slide typhoid agglutination test (98%) in enteric fevers, slide malta agglutination test (86%) in brucellosis, urine culture (100%) in urinary tract infection, gram stain of C.S.F. in bacterial meningitis (80%), encephalitis (0%) and meningeal irritation (0%), high vaginal swab culture (100%) in puerperal fevers, echocardiogram (100%) in infective endocarditis, high E.S.R. (100%) and positive C.R.P. (71%) and/or high A.S.O. (86%) in rheumatic fever, counterimmunoelectrophoresis (86%) in amoebic liver abscess, chest X-ray in pneumonia (100%), pulmonary tuberculosis (100%) and pleural effusion (100%), ultrasound of lymph nodes (100%) in tuberculous lymphadenitis. Erysipelas and tetanus were diagnosed on clinical grounds only.

Histological changes of the esophageal mucosa in bleeding versus non-bleeding varices.

There is considerable controversy as regards the exact cause of bleeding from esophageal varices. This study examined changes in the mucosa of such patients in an effort to understand the underlying mechanisms. Fifty patients were studied, 20 with a history of variceal bleeding and 30 without who served as controls. Endoscopic biopsies were taken from the inter-variceal mucosa within 5 cm from the cardia and were examined histopathologically. The results showed dilated intra-epithelial blood-filled channels within the squamous epithelium and the lamina propria in all bleeders, and in 50% of the non-bleeders. Evidence of esophagitis was also more pronounced in bleeders (50%) than in non-bleeders (23.3%). It is our opinion that esophagitis and the presence of dilated blood-filled channels may play a role in the initiation of variceal bleeding.

Evaluation of the dot enzyme-linked immunosorbent assay in diagnosis of leishmaniasis.

Human sera were collected from twenty patients of parasitologically proven cutaneous leishmaniasis, 35 cases of schistosomiasis mansoni and ten normal control sera. The antileishmanial antibodies were detected by the dot enzyme-linked immunosorbent assay (dot ELISA). The results showed that the dot ELISA had high sensitivity. However, there was a marked deal of cross reactivity with the antisera of schistosomiasis mansoni infected patients, particularly those with splenomegaly and ascites.

HLA haplotype discordance.

Previous work on the inheritance of disease has often used certain measures of HLA haplotype concordance (such as the number of haplotypes "identical by descent," IBD) among affected siblings from each of a number of sibships, each of which contains at least two affected siblings. Here we introduce a new measure of HLA haplotype discordance between the affected and unaffected siblings of each sibship (provided there is at least one of each). We show how the measure can be used to give a simple test for inheritance, which we exemplify with data.