Current Medical Research and Practice

Adaptive support ventilation versus synchronized intermittent mandatory ventilation in patients with chronic obstructive pulmonary disease Olfat M.N. A-N El-Shenawy, Mohamed M. A-H Metwally, Alaa E.T.H Abdel-Mabboud, Alaa S Abdel Ghany Journal of Current Medical Research and Practice 2018 3(1):1-5 Adaptive support ventilation (ASV) is a fully automated closed-loop ventilation mode that can act as pressure support (PS) and pressure-controlled ventilation. The aim of this study was to evaluate the benefits of using ASV in the initiation, maintenance, and weaning phases of the mechanical ventilation in comparison with synchronized intermittent mandatory ventilation (SIMV)+PS mode in patients with chronic obstructive pulmonary disease (COPD). Sixty patients with COPD requiring mechanical ventilation were recruited in this study. Among them, 37 patients were treated by SIMV+PS, whereas 23 patients were assigned for ASV. After resolution of the cause of acute respiratory failure, assessment of readiness for weaning was done. Patients were followed after 30, 60 min, and 24 h. Ventilator and hospital outcomes were recorded. Compared with SIMV+PS, ASV provided shorter weaning time (27.3 ± 12.3 vs. 62 ± 14.1 h). Moreover, there was a shorter hospital stay of 14.83 ± 6.14 for ASV group compared with 22.14 ± 17.39 days for SIMV+PS, with similar weaning failure rates, death rate, and intubation period in both groups. This study proved that ASV mode was successful as a mode of initiation, maintenance, and weaning in acute exacerbation of patients with COPD requiring mechanical ventilation with a shorter weaning time and shorter hospital stay compared with SIMV+PS mode.

Acute-on-chronic liver failure: a clinically important new syndrome Mohammed A Medhat, Abdel G.A. Soliman, Hanan M Nafeh, Francois Durand Journal of Current Medical Research and Practice 2018 3(1):6-21 Acute-on-chronic liver failure is a new syndrome characterized by multiple organ (s) failure and high short-term mortality. This review article focuses on the definitions, diagnosis, and different treatment options for this syndrome. Patient education, anticipation, early identification of the acute insult, and early detection of chronic liver disease would be immensely helpful to prevent the disease.

Clinical audit for insertion and removal of Cu T380a intrauterine device in a Secondary Care Center in Upper Egypt Momen A. M Kamel, Ali M. M El Saman, Mahmoud A.M Abd El Aleem, Hend S. Abd El Sabour Morsy Journal of Current Medical Research and Practice 2018 3(1):22-25 Clinical audit comes under the clinical governance umbrella and forms part of the system for improving the standard of clinical practice. Many organizations worldwide have published standards for intrauterine device (IUD) use and removal. There is no audit that has been published about using IUD in Egypt; therefore, our objective was to audit the current IUD insertion and removal, identifying the gap between the current practice and ideal practice and setting recommendations to fill the gap to improve client satisfaction and minimize complications and to reaudit the magnitude of improvement. A total of 500 IUD insertion/removal clients (350 cases for preaudit and 150 cases for postaudit) were included in the study. There were statistically significant improvement in several preinsertion, insertion, postinsertion, preremoval, and removal steps of IUD in postauditing in comparison to preauditing, but there are no statistically significant differences in the frequency of all postremoval steps of IUD in postauditing in comparison to preauditing. The present audit identified a gap in a number of items that were partially improved in the reaudit phase and this indicates the value of audit in IUD insertions and removal steps.

Treatment of third-degree marasmus among children admitted to Assiut University Children Hospital: a clinical audit Faida M Moustafa, Manal M Darwish, Osama M El-Asheer, Ebtesam A. A. Tayia Journal of Current Medical Research and Practice 2018 3(1):26-29 Introduction Optimal infant and young child feeding can be achieved easily by encouraging mothers to breastfeed exclusively for the first 6 months and to introduce nutritionally adequate, safe, age-appropriate, and responsive complementary feeding starting at 6 months. Patients and methods The present study aimed to assess the degree of adherence of medical physicians to protocols for treatment of severe marasmus among children attending Assiut University Children Hospital during the period from 1 January to 30 June 2015 according to WHO guidelines (2003), which is locally approved and documented by nutrition unit of Assiut University Children Hospital as a reference standard. The study included 31 patients with third-degree marasmus whose age ranged from 6 to 36 months. Results and conclusion Data about mid-upper arm circumference, Z-score, stabilization, transitional, and rehabilitation phases were not fully fulfilled. Regarding the assessment of conscious level, dehydration, hypothermia, hypoglycemia, severe anemia, shock, and types of complications, most items were fulfilled well.

The role of lung ultrasound in differentiating lung congestion and lung infection in pediatric cardiac patients Mahmoud Kamal Moustafa, Maha Mohammad Sayed Ahmed El Kholy, Gamal Ali Abdelaal Askar, Duaa Mohammad Raafat, Amal Mahmoud El Sisi Journal of Current Medical Research and Practice 2018 3(1):30-36 Background Lung sonography in emergency situations has become one of the most appropriate studies. This technique allows us to diagnose the major causes of acute respiratory distress at the bedside without major interventions. It is an easy and costless approach to diagnose many lung diseases. Patients and methods This work is a cross-sectional, prospective, and descriptive study that included cardiac patients admitted to the pediatric cardiology ward through a period of 6 months. They had their data completely revised and their treatment recorded and diagnosis traced with a direct question: is it congestion or infection. A lung ultrasound (LUS) was done to assure the diagnosis. Also, chest radiography and echocardiography correlation were assessed. Results A total of 60 patients were enrolled over a period of 6 months (58% were males), with a mean age ± SD of 17.33 ± 30.91 months. The B-profile was found in 27 patients; A-profile was found in 35 patients; AB-profile was found in six cases and hypoechoic areas were found in nine cases. LUS appeared to be normal in three cases. Conclusion LUS shows high reliability and accuracy in the diagnosis of pneumonia, pulmonary congestion, pulmonary edema, air trapping, and the possibility of a follow-up until complete resolution of many lung diseases, without exposure to harmful radiation.

Could metformin be used as a treatment for preeclampsia: A pilot study Hany Abdel-Aleem, Ayman H Shamash, Hanan G Abd El-Azeem, Alaa M Makhlouf, Omar M Shaaban Journal of Current Medical Research and Practice 2018 3(1):37-42 Objective To test the effect of metformin on serum level of antiangiogenic factors, soluble endoglin (sEng) and soluble fms-like tyrosine kinase-1 (sFLT-1), in patients with preeclampsia (PE). Patients and methods A controlled before and after prospective study was conducted on 40 patients with nonsevere PE conducted in a tertiary hospital setting. At admission, clinical and laboratory investigations had been done. Metformin tablets (500 mg three times daily) with meals were given from the time of study admission till delivery or termination of pregnancy. Serum level of sEng and sFLT-1 were measured before and 1 week after metformin treatment. Outcome of delivery had been obtained. Results One week after metformin treatment, there was a statistically significant reduction in maternal sEng and sFLT-1, with a mean difference of −448.86 ± 238.48 and −397.72 ± 125.52 pg/ml, respectively. In addition, there were significant reductions in both systolic blood pressure from 147 ± 12.4 to 131 ± 10.6 mmHg and diastolic blood pressure from 92 ± 7 to 85 ± 8.2 mmHg 1 week after metformin use. Five (12.5%) cases progressed to severe PE. Conclusion Metformin use for 1 week reduces the antiangiogenic biomarkers sEng and sFLT-1, and it could have a role in the treatment of PE.

Hemodynamic stability of ketamine/propofol admixture ketofol in patients undergoing endoscopic retrograde cholangiopancreatography Mohamed A Baker, Nagwa M Ibrahim, Mo'men M Makkey Journal of Current Medical Research and Practice 2018 3(1):43-46 Background and aim Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure for diagnosis of many gastrointestinal tract disorders. Propofol is a commonly used agent, but we decrease its adverse effects by adding ketamine. We aimed in this study to compare propofol versus propofol–ketamine regarding hemodynamic stability, recovery, and complications in ERCP. Patients and methods A total of 90 American Society of Anesthesiology status II–III patients aged 18–60 years who underwent ERCP were randomly allocated by sealed envelope assignment into two groups of 45 patients each: group P received intravenous 2 mg/kg propofol and group KF received intravenous propofol–ketamine 3:1 mixture (%1 15 ml propofol + 1 ml 50 mg/ml ketamine + 4 ml saline in a 20 ml syringe, which resulted in 0.25 mg/ml ketamine and 0.75 mg/ml propofol) until Ramsay sedation scale increased to 3–4. For each patient, the following data were collected: heart rate, mean arterial blood pressure, oxygen saturation, procedure time, total drug dosage, recovery score, and patients' and the doctor's satisfaction score (clinical trial NCT02618668). Results The total dosage of propofol consumed was significantly higher in group P compared with group KF (283.78 ± 144.23 and 110.94 ± 51.75 mg, respectively). Recovery time was slightly longer in group P compared with group KF (20.67 ± 5.29 and 19.44 ± 4.16 min, respectively). There was a significance difference in patient satisfaction scores between group KF (1.16 ± 0.64) and group P (1.82 ± 0.83). There was a significance difference in surgeon satisfaction scores between group KF (1.11 ± 0.49) and group P (2.13 ± 0.97). Conclusion Propofol ketamine combination (ketofol) is associated with greater satisfaction scores and a shorter recovery than propofol and without important adverse effects in ERCP interventions.

The effects of addition of dexamethasone to bupivacaine during ultrasound-guided femoral nerve block for postoperative analgesia in patients undergoing total knee replacement surgery Kawthar H Mohammed, Waleed S Hasan, Sherif M Bekhet Journal of Current Medical Research and Practice 2018 3(1):47-51 Introduction The goal of knee replacement is to relieve pain, improve quality of life, and maintain or improve knee function. The procedure is performed on people of all ages. However, a significant number of patients experience persistent pain and functional limitations following knee replacement, with ~20% of patients reporting unfavorable pain outcomes. Materials and methods Our study was done after obtaining Assiut University Hospital Ethical Committee approval and informed written consent from the patients who were admitted to the Department of Orthopedics in Assiut University Hospital and were planned for total knee replacement surgery in the period from December 2015 until July 2017. Our study included 60 patients aged between 18 and 80 years. Patients were randomized into two groups: group B (30 ml of 0.25% bupivacaine) and group BD (28 ml of 0.25% bupivacaine + 2 ml dexamethasone 8 mg). Results The current study showed that preemptive addition of 8 mg dexamethasone to 30 ml bupivacaine 0.25% for femoral nerve block guided with ultrasound for total knee replacement surgery on side of operation resulted in a reduction of visual analog scale pain score over the postoperative 24 h prolonged the duration of the block, required longer time till first analgesic, and led to more patient satisfaction and less incidence of nausea and vomiting. As seen in our results that the visual analog scale was significantly low starting from 4 h (1 ± 0 vs. 1.13 ± 0.35; P < 0.001), 8 h (1.07 ± 0.25 vs. 1.67 ± 0.71; P < 0.001), 12 h (1.23 ± 0.43 vs. 1.97 ± 0.67; P = 0.789), 16 h (1.67 ± 0.71 vs. 2.37 ± 0.67; P = 0.563), 20 h (1.9 ± 0.76 vs. 2.87 ± 0.82; P = 0.774), and 24 h (2.03 ± 0.76 vs. 2.97 ± 0.61; P = 0.052). Conclusion Our study results demonstrate that the addition of dexamethasone to bupivacaine suggestively prolongs its analgesic effect postoperatively. These results are consistent with the trend of previous studies using dexamethasone as an additive to local anesthetic in peripheral nerve blocking.

Urodynamic changes in women with pelvic organ prolapse Omar A Sayed, Ahmed S Elazab, Medhat A Abdallah, Mohamed I Taha Journal of Current Medical Research and Practice 2018 3(1):52-57 Aim To study the prevalence of urodynamic changes associated with female having pelvic organ prolapse (POP) and to correlate these changes with symptoms. Patients and methods A cross-sectional hospital-based study was performed on 29 women with POP seeking care at a Female Urology Clinic, Urology Department, Assiut University Hospital, Assiut, Egypt. A questionnaire was administered to gather information about symptoms. Urine analysis, abdominal ultrasound, and urodynamic study were done. Results Overactive bladder was more common in cystocele. Hydronephrosis was present in 24.1% of POP cases; all of them were fourth degree. As the degree of POP increases, overactive bladder decreases and infravesical obstruction is more likely. Conclusion Urodynamic and clinical findings are common among women with POP.

Outcome of percutaneous nephrolithotomy for renal stones in Assiut Urology and Nephrology Hospital Mohamed Gadelmoula, Ehab A Desouki, Atef Abdellatif, Mohamed Shalaby Journal of Current Medical Research and Practice 2018 3(1):58-62 Context Percutaneous nephrolithotomy (PCNL) has become the standard treatment for renal stones not amenable to extracorporeal shock wave lithotripsy in many countries. Aims The current study aims to evaluate the outcome of PCNL, in terms of efficacy and success rate, in the management of renal stones in our hospital. Settings and design This is a descriptive case-series study. Patients and methods A total of 230 patients, 173 men and 57 women underwent PCNL in our hospital between September 2013 and September 2015. The following clinical parameters were reported; stone site, size, serum creatinine, operative time, site of calyceal puncture, number of tracts, decrease in hemoglobin level, length of hospital stay, stone-free rate (SFR), and complications. Statistical analysis used Intercooled STATA, version 9.2 was used. χ-Test or Fisher's exact test was used for comparison of the categorical data and Mann–Whitney U-test used to compare the noncategorical data. Results The median age was 38 years (range: 3–75 years). The mean operative time was 110 ± 30 min, and hospital stay ranged from 2 to 8 days. The primary SFR was 70.9% after the first session of PCNL but the overall clearance was 87.7%. It was found that stone location, access puncture, access number, and operative time were statistically significant factors affecting SFR. The overall complications were 13%. Conclusion PCNL is considered a standard treatment for large renal stones. Stones distribution, access puncture, number of access, and operative time significantly affect the SFR. The usage of flexible nephroscope and a second-look nephroscopy improved the outcome.

Benha Medical Journal (Benha Med J)

Oral gabapentin premedication for post-tonsillectomy nausea, vomiting, and recovery Ibrahim M. Abdel Moety, Dina H.A El Barbari, Mohammed M.A Esmael Benha Medical Journal 2018 35(3):265-269 Background Gabapentin is a second-generation anticonvulsant that is successful in the management of chronic neuropathic pain. It was not previously known to be useful in acute perioperative conditions, but recently it has been used for acute perioperative conditions. However, evidence-based medicine suggests that perioperative administration is useful for postoperative analgesia, preoperative anxiolysis, attenuation of the hemodynamic response to laryngoscopy and intubation, and preventing chronic postsurgical pain, postoperative nausea and vomiting (PONV), and delirium. This article reviews the clinical trial data to describe the efficacy and safety of gabapentin for perioperative anesthetic management. Aim The aim of the study was to evaluate and update the effect of preoperative gabapentin on the incidence of postoperative vomiting and on analgesic requirements after adenotonsillectomy in pediatrics. Materials and methods This randomized, double-blind study was designed to explore the possible effects of oral gabapentin as a premedication on the incidence and severity of PONV and on the early recovery profile of pediatric patients undergoing adenotonsillectomy under sevoflurane anesthesia. Results The incidence of PONV in the gabapentin group was significantly lower than in the gabapentin group. However, the numbers of rescue ondansetron doses and the PONV severity score were comparable in the two groups. Conclusion The use of gabapentin as premedication in pediatric patients undergoing adenotonsillectomies under sevoflurane anesthesia reduces the incidence of PONV and emergence agitation in the early postoperative period. However, gabapentin did not reduce pain and analgesic consumption after surgery.

Left ventricular untwist in patients with diastolic dysfunction: speckle tracking imaging study Mahmoud A Soliman, Mahmoud K Ahmed, Morad B Mena, Mohamed S.S Montaser Benha Medical Journal 2018 35(3):270-276 Background There is no single noninvasive index that can directly assess diastolic function. Untwist contributes to diastolic suction and early filling. Speckle tracking imaging (STI) can be used to study the relation between diastolic indices and untwist in patients with diastolic dysfunction. Patients and methods A total of 75 patients with diastolic dysfunction and 25 normal volunteers were selected for this study. According to mitral flow pattern, the patients were classified into group I (abnormal relaxation), group II (pseudonormalized), and group III (stiffness pattern). Using STI, the basal and apical short-axis views were imaged. Stored data were processed to get apical and basal rotation, systolic twist, peak systolic twist ratio, diastolic untwist ratio, and time to peak twist and untwist ratio. Results Peak untwisting ratio was significantly higher in Group I Patients that decreased to be normalized and even decreased with progression of diastolic dysfunction from Group II to Group III. There was a highly significant positive and negative correlation with end-diastolic volume and end-systolic volume, respectively. Time to peak untwist ratio nonsignificantly increased from group I to III, with nonsignificant correlation between untwist ratio and peak E, A, and E/A ratio. Conclusion Patients with relaxation abnormality have a higher untwist ratio, which decreases gradually with progression from relaxation to stiffness pattern. It may appear as a compensatory mechanism to ensure early filling with relaxation abnormality.

The role of dynamic contrast-enhanced MRI analysis of perfusion changes in hepatocellular carcinoma Ahmed M Elzeneini, Mohamed I Yousef, Medhat M Refaat Benha Medical Journal 2018 35(3):277-281 Background Dynamic contrast-enhanced (DCE)-MRI functional imaging is primarily focused on quantitative evaluation of tumoral perfusion and permeability, thus enabling an insight into the pathophysiology of tissue and serving as early noninvasive biologic markers of tumorigenesis. Aim The aim was to evaluate the functional role of DCE-MRI analysis of perfusion changes in hepatocellular carcinoma (HCC). Patients and methods A total of 43 patients with liver cirrhosis having 65 HCCs all underwent 3 T multiphase DCE-MRI assessment. Maximum relative enhancement, area under curve, wash-in ratio, wash-out ratio, time to arrival, and time to peak semiquantitative measurements were analytically compared between the hepatocellular carcinogenic lesions and the adjacent lesion-free liver cirrhosis. Results Comparison of different perfusion metrics across hepatocellular carcinogenic lesions and adjacent lesion-free liver cirrhosis revealed exceling statistical significance. Diagnostic accuracies were highest when using wash-out ratio (86.2%) to detect HCC from background cirrhosis, whereas they were lowest using area under the curve (67.7%). Implementing wash-in ratio (81.9%), as a first-pass perfusion metric, surpassed its counterpart, maximum relative enhancement (73.4%), in diagnostic reliability. Regarding the timing of flow dynamics, time to arrival (84.1%) was more important than time to peak (78.1%) as a diagnostic indicator of hepatocarcinogenesis. Conclusion Multiphase DCE-MRI perfusion analyses provide quantitative hemodynamic metrics that promise potential usefulness as noninvasive biomarkers in the detection of HCC.

Noninvasive predictors of hepatic fibrosis in patients with chronic hepatitis C virus in comparison with liver biopsy Ayman N Menessy, Nancy A Ahmed, Nagwa I Abdallah, Salah S Arif Benha Medical Journal 2018 35(3):282-286 Background Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment by liver biopsy can help plan therapy. However, biopsy is an invasive procedure with occasional complications and poor patient acceptance. Aim The aim of this work was to compare noninvasive and invasive methods for evaluation of fibrosis in patients with chronic hepatitis C. Patients and methods This cross-sectional study was carried out at the Liver Unit of Mansoura University Hospital and Mansoura Health Insurance Hospital. The study was conducted on 100 patients with chronic active hepatitis. Biochemical and virological studies were performed in addition to abdominal ultrasonography and liver biopsy in all patients. Moreover, analyses of serum fibronectin (FN), AST-to-platelet ratio index (APRI), and alanine aminotransferase/aspartate aminotransferase (AST/ALT) ratio were performed. Results We found that FN has the highest sensitivity and specificity, and the independent variables related to fibrosis were FN, APRI, and AST/ALT ratio. Conclusion The biochemical tests including APRI, AST/ALT ratio, and particularly FN could be valuable noninvasive predictors for assessment of liver fibrosis in patients with chronic hepatitis C infection.

Orbitozygomatic approach results of 16 spheno-orbital hyperostotic meningiomas (en plaque) Ashraf El Badry, Azza Abdel Azeez, Ahmed Abdel Khalik Benha Medical Journal 2018 35(3):287-296 Objective This study aimed to evaluate the results of the orbitozygomatic approaches of intraosseous meningiomas that causes hyperostoses involving the greater wing of the sphenoid and orbital bones with a small soft tissue component. Patients and methods We carried out a prospective and retrospective study of 16 patients with meningiomas en plaque who underwent surgical procedures by the orbitozygomatic approach in the period between 1999 and 2014 at the Neurological Surgery Department, Mansoura University Hospital of Egypt. Results The mean age of the patients was 49.6 years, whereas the most common complaint was proptosis accounting for 81.25% of cases. The second most common complaint was visual impairment accounting for 56.25% of cases. The orbitozygomatic approach was used for all the cases and drilling of the greater wing of the sphenoid, lateral orbital wall, orbital, and optic canal roof was performed. The small soft tissue component of the meningiomas was in the anterior and middle cranial fossa involving hyperostoses in all surrounding bones in all cases, whereas four cases showed intraorbital soft tissue meningioma. The results after surgery indicated an improvement of proptosis in 75% of cases, with less improvement in visual impairment observed in 56.25% of cases. Complications included third nerve palsy in 87.25% (14) of cases, and improved only in five cases. The extent of tumor surgical resection was subtotal in 75% (12) of cases. These tumors progressed in eight cases and only two patients underwent a second surgical intervention; others were referred to radiotherapy. Conclusion Despite good surgical exposure in this approach, the radical excision of the tumors may be extremely difficult as the tumor in these areas showed involvement of very delicate structures (because of late medical consultation), which made the dissection impossible, but using this approach we can achieve good results including proptosis and visual impairment.

Intrathecal nalbuphine as an adjuvant to bupivacaine in spinal anesthesia for lower-limb surgeries: intraoperative and postoperative effects Saad I Saad, Ehab E Afifi, El-Sayed M Abd El-Azim, Walid H.I Moftah Benha Medical Journal 2018 35(3):297-306 Background Many opioids are added to intrathecal local anesthetics to provide longer duration of analgesia; however, we have to choose an additive with the longest analgesic time and least intraoperative and postoperative side effects. In this study, nalbuphine was compared with fentanyl and pethidine as additives to hyperbaric bupivacaine used in spinal anesthesia for lower-limb surgeries. Patients and methods A total of 100 patients of both sexes, American Society of Anesthesiologists I and American Society of Anesthesiologists II, scheduled for lower-limb surgeries under spinal anesthesia were assigned randomly into four groups: group B received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml sterile water; n=25); group N received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml nalbuphine 500 μg; n=25); group F received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml fentanyl 25 μg; n=25); and group P received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml pethidine 10 mg; n=25). We recorded the onset of sensory and motor blocks, peak sensory and motor block times, sensory block levels and two-segment regression time using the pin-prick method, motor block level using the modified Bromage scale, and any intraoperative or postoperative complications. Results The mean onset of sensory block significantly decreased in groups N, F, and P compared with group B, whereas the peak sensory time did not significantly change in all the four groups. In contrast, the mean onset of the motor block in all four groups was nonsignificantly different, whereas the mean time for peak motor block was significantly short in both the N group (nalbuphine and bupivacaine) and the P (pethidine and bupivacaine) group compared with the B (bupivacaine alone) and F (fentanyl and bupivacaine) groups. There was significant prolongation in both two-segment regression time and the first analgesic request time in groups N, F, and P (all narcotics and bupivacaine) compared with group B (bupivacaine alone). Conclusion Nalbuphine, fentanyl, and pethidine as adjuvants to spinal anesthesia prolong the duration for first-rescue analgesia with minimal hemodynamic and respiratory complications; however, nalbuphine at a dose of 0.5 mg has the best quality of spinal block when added to intrathecal 0.5% heavy bupivacaine in patients undergoing lower-limb surgeries.

Effect of Nigella sativa oil on Schistosoma mansoni immature worms in experimentally infected mice Azza S Al Hamshary, Ibrahim M Nagati, Maysa A Eraky, Eman A Abou-Ouf, Asmaa A Kholy, Ghada H Omar Benha Medical Journal 2018 35(3):307-311 Background Nigella sativa oil is one of the promising drugs of a plant origin that have an antischistosomal effect. Aim The aim of the present work was to explore the role of N. sativa oil either alone or in combination with praziquantel on immature worms of Schistosoma mansoni. Materials and methods N. sativa oil capsules dissolved in corn oil were administered to S. mansoni-infected mice aiming to study the therapeutic and prophylactic effects. The study included six groups of mice: (a) noninfected and nontreated, (b) infected and nontreated, (c) prophylactic N. sativa oil group, (d) praziquantel group, (e) therapeutic N. sativa oil group, and (d) combined group. All mice were killed 4 weeks after infection and treatment. The antischistosomal effect of N. sativa oil was assessed by worm burden, histopathology, and scanning electron microscopy. Results Therapeutic N. sativa oil group showed the highest significant decrease in the mean number of immature worm burden (R% was 57%) when given after infection followed by the combined group (R%=55.67%), whereas prophylactic N. sativa oil group showed nonsignificant decrease (R%=37%). The least changes were observed in praziquantel group (R%=0%). Conclusion N. sativa oil has a potent effect on immature S. mansoni which could be helpful for potentiating praziquantel effect and thus reducing development of resistance.

Diagnostic accuracy of lectin-reactive α-fetoprotein (AFP-L3) in the diagnosis of hepatitis C virus-related hepatocellular carcinoma Atef Ahmed Ali Ibrahim, Roshdy Mohamed Khalaf Allah, Amr M El Hammady, Rizk Sayad Rizk Sarhan, Medhat A Khalil, Marwa Mohiy Eldin Abdel Rahman Benha Medical Journal 2018 35(3):312-316 Background Hepatocellular carcinoma (HCC) is one of the most malignant neoplasms. It has a very poor prognosis because the diagnosis is very late. Therefore, early detection is important in the management of this neoplasm. α-fetoprotein (AFP)-L3 has been recommended as a marker for early-stage HCC in many countries all over the world. Aim The aim was to evaluate the potential clinical value of lens culinaris agglutinin-reactive AFP-L3 against total AFP in the diagnosis of hepatitis C virus-related HCC and to evaluate its role in disease diagnosis. Materials and methods This study included 40 patients who were diagnosed as hepatocellular carcinoma (diagnosis was based on the BCLC staging classification), 20 patients with chronic liver disease, and 20 healthy subjects as a control group. Results Results showed that there was a significant positive correlation between each of serum AFP and AFP-L3 and each of tumor size and tumor number among patients with HCC. The median value of both serum AFP-L3 and AFP-L3/AFP ratio was significantly higher in patients with HCC group when compared with patients with chronic liver disease and normal control individuals. Receiver operator characteristic curves were constructed for serum AFP, AFP-L3, and AFP-L3/AFP ratio as predictors of HCC. Serum AFP-L3 had the largest area under the curve. The best cut-off point for AFP as predictor of HCC was 128 ng/ml [sensitivity 75%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 66.7%, and efficacy 83.3%]. The best cut-off point for AFP-L3 as predictor of HCC was 23 ng/ml (sensitivity 97.5%, specificity 100%, PPV 100%, NPV 95.2%, and efficacy 98.3%). The best cut-off point for AFP-L3/AFP ratio was 16% (sensitivity 97.5%, specificity 100%, PPV 100%, NPV 95.2%, and efficacy 98.3%). Conclusion In conclusion, AFP-L3 is a promising marker for diagnosis of HCC especially when combined with AFP, as the diagnostic sensitivity was optimum, so both markers can be used in the screening of HCC.

Effect of ambroxol on experimentally induced acute oxidative stress in the heart, kidney, and intestine in rats Mahmoud M Elfouli, Mohie E Said, Hanan T Emam, Nashwa H Abu-raia, Manar A Metwally Benha Medical Journal 2018 35(3):317-325 Background Intestinal ischemia–reperfusion (IR) is a frequently occurring phenomenon during abdominal and thoracic vascular surgery, small bowel transplantation, hemorrhagic shock, and surgery using cardiopulmonary bypass, carrying high morbidity and mortality. Ambroxol hydrochloride is an active N-desmethyl metabolite of bromhexine hydrochloride. Ambroxol is indicated as ‘secretolytic therapy in bronchopulmonary diseases associated with abnormal mucus secretion and impaired mucus transport’. Aim The present study was designed to evaluate the effect of ambroxol on experimentally induced acute organ oxidative stress in the form of remote organ injury including kidney and heart after intestinal IR. Materials and methods Thirty animals were classified into five groups. First group: normal control group, second group: nontreated intestinal IR group (intestinal IR was induced by mesenteric artery ligation), third group: ambroxol pretreated intestinal IR group (35 mg/kg), fourth group: ambroxol pretreated intestinal IR group (70 mg/kg), fifth group: ambroxol pretreated intestinal IR group (140 mg/kg). Results Ambroxol significantly reduced the malondialdehyde level in the heart and the kidney when compared with intestinal IR with no medication group. It also improved cardiac troponin and, kidney functions (urea and creatinine) and histopathological affection when compared with intestinal IR with no medication group. Conclusively, in this study ambroxol could have a protective effect against intestinal IR through its antioxidative and anti-inflammatory effect.

The potential combined effect of vitamins E and C on fluoride-induced hepatic toxicity in albino rats Amany M.S El Din, Rania N Sherif, Salwa M.M El Khyat, Yassmin G Salem Benha Medical Journal 2018 35(3):326-335 Background Fluoride is a well-determined nonbiodegradable and moderate pollutant, which at high levels causes serious health problems. Aim The present study was designed to investigate the histopathological changes in liver as a result of exposure to sodium fluoride in albino rats and the possible therapeutic effect of both vitamins E and C. Materials and methods Eighteen adult albino mice were divided into three groups (six rats per each group). The first group served as control. The second group was treated with 3.6 mg/kg body weight sodium fluoride for 30 days, and the third group received 3.6 mg/kg body weight of sodium fluoride for 30 days followed by vitamins E and C for the next 13 days. At the end of the treatment period, the animals were sacrificed by means of cervical dislocation and the liver was dissected out. Blood samples were taken for the assessment of serum glutamic-pyruvic transaminase and serum glutamic oxaloacetic transaminase. Results Liver tissue was cleared and used for assessing the histopathological changes. Liver tissue homogenate was used for the assessment of malondialdehyde and glutathione peroxidase levels. The histopathological results in the present study indicated that exposure to sodium fluoride for 30 days caused degenerative changes in the liver. Light microscopic examination revealed the degenerative changes in the liver, such as disorganization of the cell plates, dilation of the central vein, pyknotic nucleus, ballooned hepatocytes and hepatocytes with empty nuclei, and disturbed mucopolysaccharide metabolism in liver cells. Biochemical examination revealed elevated serum glutamic-pyruvic transaminase, serum glutamic oxaloacetic transaminase, and malondialdehyde and decreased glutathione peroxidase level. Conclusion Administration of vitamins E and C during the first 13 days of the recovery period of sodium fluoride intoxication revealed minimal improvement, which was detected at the biochemical and metabolic level.

The Ability of Conditioned Media From Stem Cells to Repair Vocal Fold Injuries

Objective

This study investigated the ability of hypoxia‐induced 25‐fold concentrated conditioned media (hCM) from human nasal inferior turbinate‐derived mesenchymal stem cells (hTMSC) to repair injured vocal folds during the early phase of the wound‐healing process.

Methods

The vocal fold was injured in Sprague‐Dawley rats. Next, hCM from hTMSC (the hCM group) or hTMSC (the hTMSC group) were injected into the injured vocal folds. As a control, saline (the phosphate‐buffered saline group) or 25‐fold concentrated media (the media group) was injected in the same manner. The vocal folds were harvested for quantitative real‐time polymerase chain reaction (PCR) at 1 week and 2 weeks after injury. Histologic evaluation was performed at 3 weeks postinjury.

Results

In the hCM group at 1 week after injury, PCR showed that the genes encoding hyaluronan synthase (HAS), HAS 1, and HAS 2 were significantly upregulated compared to the media and normal groups. The gene encoding procollagen III was significantly downregulated compared to the media group. Nearly identical results were obtained for the hTMSC group at 1 week after injury. Histological examination showed that the hCM group was similar to or better than the hTMSC group in collagen deposition and hyaluronic acid production.

Conclusion

The injection of hCM into injured vocal folds produced antifibrotic effects in the early phase of wound healing. These effects were equivalent to those produced by the injection of hTMSC. These results provide a foundation for the future clinical use of hCM for vocal fold regeneration.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2FhkOzw

Preoperative quality‐of‐life measures predict acute postoperative pain in endoscopic sinus surgery

Objectives

Recent increases in opioid‐related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS).

Methods

Sixty‐four consecutive patients undergoing ESS were enrolled. Baseline 22‐item SinoNasal Outcomes Test (SNOT‐22) and Short‐Form 8 (SF‐8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT‐22/SF‐8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables.

Results

Day‐of‐surgery pain scores were significantly correlated with the SF‐8 role‐physical domain (Rs = 0.32, P = 0.04). Whereas SF‐8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF‐8 pain score became correlated with self‐reported pain (Rs = 0.39, P = 0.02). SNOT‐22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF‐8 role‐physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R² = 0.359, P < 0.0001).

Conclusion

Baseline patient‐reported global quality‐of‐life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS.

Level of Evidence

2c Laryngoscope, 2019

http://bit.ly/2FcrOya

Control of speech and voice in cochlear implant patients

Objective

Hearing plays an important role in the learning and production of speech, but the benefits of cochlear implantation for such vocal control are unclear. Here, we present a perspective and review of recent work on the control of speech and voice following cochlear implantation. We further discuss insights provided on the mechanisms of normal vocal control and implications for future rehabilitative approaches.

Data Sources

Peer‐reviewed articles on speech and voice production in cochlear implant patients were identified from PUBMED. Relevant articles were supplemented with selected publications describing normal vocal control mechanisms and behaviors.

Review Methods

Publications that discussed speech and voice outcomes following cochlear implantation were chosen, with a focus on those presenting measurements of specific speech or voice parameters.

Results

Recent studies demonstrate that hearing restoration by cochlear implantation has significant effects on many aspects of voice and speech production. These include changes in vocal pitch and loudness, as well as improved control of both vowels and consonants. Despite these improvements, however, the speech of many implant recipients remains abnormal as compared to normal hearing individuals. Such differences likely result from the impoverished auditory feedback provided by the implant.

Conclusions

Cochlear implants provide valuable insights into the role of hearing in vocal production. Although implants improve vocal production for most patients, there remains considerable room for future study and therapeutic improvement. Laryngoscope, 2019

http://bit.ly/2FiUbd8

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Objectives/Hypothesis

Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use.

Study Design

Retrospective cohort study.

Methods

A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival.

Results

The average age was 62 years, and the mean follow‐up was 38 months. Eighty‐three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty‐nine percent were HPV/p16 positive. Fifty‐seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration.

Conclusions

More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long‐term pain management in this patient population.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FcvJv2

Lubricin/proteoglycan 4 detected in vocal folds of humans and five other mammals

Objectives/Hypothesis

Lubricin/proteoglycan‐4 (PRG4) lubricates connective tissues such as joints and tendon sheaths, enabling them to better withstand shearing and frictional forces during motion. We wondered whether PRG4 might play a role in phonation, as normal vocal folds withstand repetitive, high‐velocity deformations remarkably well. As a first step, we tested whether PRG4 is expressed in vocal folds.

Study Design

Laboratory study.

Methods

Anatomical and molecular methods were applied to 47 larynges from humans, macaque (Macaca fascicularis), canines, pigs, calves, and rats. Immunohistochemistry (IHC), Western blot, and quantitative real‐time polymerase chain reaction (qRT‐PCR) methods were used to test for the presence of PRG4.

Results

In all species, the true vocal fold lamina propria (TVF‐LP) was positive for PRG4 by IHC, whereas immunoreactivity of the false vocal fold was weak or absent, depending on the species. Human TVF‐LP was strongly stained across all layers. Immunoreactivity was seen variably on the vocal fold surface and within the vocal fold epithelium, in the conus elasticus and thyroglottic ligament, and at the tip of vocal process. Western blots of four humans and six pigs demonstrated immunoreactivity at appropriate molecular weight. qRT‐PCR of pig tissues confirmed PRG4 mRNA expression, which was highest in the TVF‐LP.

Conclusions

PRG4 was found in phonatory tissues of six mammals. We suggest it might act as a lubricant within the lamina propria and possibly on the vocal fold surface, limiting phonation‐related damage to vocal fold extracellular matrix and epithelium, and enhancing vocal efficiency by reducing internal friction (viscosity) within the vocal fold.

Level of Evidence

NA Laryngoscope, 2018

http://bit.ly/2FiUdBM

Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation

Objectives/Hypothesis

There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual‐imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI‐predominant with selective HRCT imaging protocol.

Study Design

Retrospective review.

Methods

The protocol was implemented over a 4‐year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained.

Results

Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced.

Conclusions

MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI.

Level of Evidence

4 Laryngoscope, 2019

http://bit.ly/2FcvCQ8

Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta‐analysis

Objectives

Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high‐level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta‐analysis technique.

Methods

We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model.

Results

A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0–17.8, P < 0.001), 7.2% (95% CI 4.6–11.0, P < 0.001), and 15.1% (95% CI 9.8–22.5, P < 0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9–15.1, P < 0.001), 10.2% (95% CI 3.8–24.5, P < 0.001), and 6.4% (95% CI 1.8–20.9, P < 0.001), respectively.

Conclusion

Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures. Laryngoscope, 2018

http://bit.ly/2FdisBy

Bilateral cochlear implantation is regarded as very beneficial: results from a worldwide survey by online questionnaire

Abstract

Purpose

Bilateral cochlear implant (CI) provision is now widely regarded as the most beneficial hearing intervention for acceptable candidates. This study sought to determine if a number of well-regarded hearing professionals at highly reputable clinics shared similar practices and beliefs regarding bilateral CI provision, use, and rehabilitation in children and adults.

Methods

An 11-question online questionnaire was created and distributed to all 27 clinics in the HEARRING group. Questions 1–5 asked for facts; questions 6–11 asked for opinions.

Results

20 completed questionnaires were returned. All 20 respondents reported that their clinics perform bilateral cochlear implantation in children; 18 do so in adults. Regarding the fact-based questions, bilateral CI provision is more commonly performed and more likely to be reimbursed in children than in adults. Children are also much more likely to be implanted simultaneously than are adults. Regarding the opinion-based questions, respondents gave broadly similar answers. Communication between the CIs and speech coding strategies specifically developed for bilateral CI users were regarded as the two future technologies that would most enhance the benefit of bilateral CI use.

Conclusions

Most clinics in the HEARRING group are very familiar with bilateral CI provision and hold similar opinions on its results and benefits. Hopefully the results described herein will lead to a greater acceptance and regular reimbursement of bilateral CI provision, especially in adults.

http://bit.ly/2scwews

Is there a relationship between Onodi cell and optic canal?

Abstract

Objectives

We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT).

Methods

In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated.

Results

The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells.

Conclusion

Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi–optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.

http://bit.ly/2LT9bjj

Antibiotics

Volume 72, Issue 1
	In this issue  Article   Brief Communications   Correspondence   Index  Also new      AOP
ARTICLE
Isolation and structure determination of a new cytotoxic peptide, curacozole, from Streptomyces curacoi based on genome mining Issara Kaweewan, Hisayuki Komaki, Hikaru Hemmi, Kanata Hoshino, Takeshi Hosaka et al.  The Journal of Antibiotics 2018 72 :1 - 7; October 11, 2018; 10.1038/s41429-018-0105-4 Abstract | Full Text
Helvamide, a new inhibitor of sterol O-acyltransferase produced by the fungus Aspergillus nidulans BF-0142 Takashi Fukuda, Takun Furukawa, Keisuke Kobayashi, Kenichiro Nagai, Ryuji Uchida et al. The Journal of Antibiotics 2018 72 :8 - 14; October 10, 2018; 10.1038/s41429-018-0101-8 Abstract | Full Text
Cyathane diterpenoids and drimane sesquiterpenoids with neurotrophic activity from cultures of the fungus Cyathus africanus Rong-Wei Kou, Shuang-Tian Du, Yi-Xiao Li, Xi-Tao Yan, Qiang Zhang et al.  The Journal of Antibiotics 2018 72 :15 - 21; October 16, 2018; 10.1038/s41429-018-0106-3 Abstract | Full Text
Synthesis and evaluation of biological activity of benzoxaborole derivatives of azithromycin Anna N. Tevyashova, Alexander M. Korolev, Elena P. Mirchink, Elena B. Isakova & Ilya A. Osterman  The Journal of Antibiotics 2018 72 :22 - 33; October 12, 2018; 10.1038/s41429-018-0107-2 Abstract | Full Text
Isolation of 4,4′-bond secalonic acid D from the marine-derived fungus Penicillium oxalicum with inhibitory property against hepatocellular carcinoma Li Chen, Ya-Ping Li, Xin-Xin Li, Zhi-Hao Lu, Qiu-Hong Zheng et al.  The Journal of Antibiotics 2018 72 :34 - 44; September 27, 2018; 10.1038/s41429-018-0104-5 Abstract | Full Text
BRIEF COMMUNICATIONS
Cytotoxic anthracycline and antibacterial tirandamycin analogues from a marine-derived Streptomyces sp. SCSIO 41399 Ziwen Cong, Xiaolong Huang, Yunhao Liu, Yuxuan Liu, Pei Wang et al.  The Journal of Antibiotics 2018 72 :45 - 49; September 26, 2018; 10.1038/s41429-018-0103-6 Abstract | Full Text
Augmented antibacterial activity of ampicillin with silver nanoparticles against methicillin-resistant Staphylococcus aureus (MRSA) Priyanka Surwade, Christopher Ghildyal, Chase Weikel, Todd Luxton, Derek Peloquin et al.  The Journal of Antibiotics 2018 72 :50 - 53; October 25, 2018; 10.1038/s41429-018-0111-6 Abstract | Full Text
CORRESPONDENCE
MS network-based screening for new antibiotics discovery Nobuhiro Koyama & Hiroshi Tomoda  The Journal of Antibiotics 2018 72 :54 - 56; October 23, 2018; 10.1038/s41429-018-0109-0 Abstract | Full Text
INDEX
Author Index for Volume 71 Akemi Yoshida  The Journal of Antibiotics 2019 72 :57 - 61; January 07, 2019; 10.1038/s41429-018-0116-1 Abstract | Full Text

Nature and Science of Medicine

Whom do you want to treat you? Definitely more than looks! Majid Abdulrahman Almadi, Tarek Kashour Journal of Nature and Science of Medicine 2019 2(1):1-2

Unleashing the immune system to conquer cancer Abdulrahman Alsultan Journal of Nature and Science of Medicine 2019 2(1):3-4

Fundamentals of laparoscopic surgery: Principles, implementation, and comparison to other modalities Abdulaziz Alkanhal Journal of Nature and Science of Medicine 2019 2(1):5-9 The minimally invasive laparoscopic surgery has gained popularity among various surgical specialties. However, unique skills are required to perform it. These skills are not transferable from open approach and are associated with a steep learning curve. Therefore, they need to be obtained in a safe-simulated environment. Fundamental laparoscopic surgery program is currently considered the gold standard for assessing laparoscopic skills and a mandatory requirement for board certification in the United States and for promotional advancement of residents in different surgical residency programs. Despite its proven benefits and its superiority when compared to other training models, challenges exist related to its implementation outside North America. The lack of sufficient eligible examiners is the major obstacle. Once overcome, one can aspire to achieve the remaining standards required for full implementation.

Direct current stimulation and epilepsy in Kingdom of Saudi Arabia: Opportunity and challenges Abdulrahman Al-Thaqib, Ali Mir, Raidah S Albaradie, Shahid Habib, Shahid Bashir Journal of Nature and Science of Medicine 2019 2(1):10-13 Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnostic applications in treatment of neurological and psychiatric diseases. Epilepsy is a major problem with devastating effects on patients and their caregivers and has a tremendous socioeconomic impact on families and health-care systems in the Saudi Arabia and worldwide. tDCS is a low-cost, noninvasive portable neuromodulation technique which can transiently decrease or increase cortical excitability in humans and which was invasively demonstrated to reduce epileptiform discharges in animals. This article reviews the tDCS as tools of neuromodulation for epilepsy and discusses the opportunities and challenges available for clinicians and researchers interested in advancing neuromodulation therapy. The aim of this review is to highlight the usefulness of tDCS and to generate an interest that will lead to appropriate studies that assess the true clinical value of tDCS for epilepsy among local clinician and scientist.

Prepubertal vulvovaginitis Salwa Mohammed Neyazi Journal of Nature and Science of Medicine 2019 2(1):14-22 Vulvovaginitis is one of the most common gynecologic complaints in prepubertal girls. It accounts for 40%–80% of visits to pediatric gynecology services. It arouses parental anxiety because of the perceived rarity of vulvovaginitis in children, the fear of sexual abuse or concerns over lack of appropriate supervision, and hygiene in daycare or school. The majority of cases are due to nonspecific vulvovaginitis in which vaginal cultures will grow organisms considered to be part of the normal flora. The condition is easily managed with good perineal hygiene. In reluctant cases, oral antibiotics or local estrogen cream may be helpful. A small percentage will have a specific etiology and vaginal cultures will identify the pathogen. Most of these pathogens will be intestinal organisms, respiratory organisms, or sexually transmitted diseases. The isolation of sexually transmitted organisms should alert the physician to investigate for child sexual abuse. Other causes of prepubertal vulvovaginitis include systemic illness and foreign bodies which will result in foul-smelling bloody discharge most commonly toilet paper which can be removed by in-office vaginal irrigation but requires a cooperative child otherwise we may have to do vaginoscopy under general anesthesia.

Celiac disease in children Anjum Saeed, Asaad Mohamed Assiri, Huma Arshad Cheema Journal of Nature and Science of Medicine 2019 2(1):23-28 Celiac disease (CD) is a chronic enteropathy due to ingestion of gluten and related products leading to villous injury and its various manifestations. It has a strong genetic tendency with the presence of human leukocyte antigen (HLA-DQ 2, DQ 8) in more than 98% of these patients with CD. Western studies documented 0.5%–1% prevalence of CD but it is not an uncommon condition in the Arabic peninsula. Classical gastrointestinal (GI) manifestations are common in the toddler's age group while non-GI manifestations predominate in the adolescents and older children. High-risk groups and associated conditions need special considerations for screening CD. European and Americans guidelines are available for diagnosing these children and recommend to screen with anti-tissue transglutaminase antibodies which have got very high sensitivity and specificity. North American guidelines recommend to do small bowel biopsies and interpreted by Marsh grading. Gluten-free diet for the rest of life is still a recognized therapy for these children under the supervision of an expert dietician dealing with CD. National awareness programs and seminars may help in identifying this underdiagnosed condition to avoid morbidity and mortality related to this lifelong disorder.

Does physicians' gender have any influence on patients' choice of their treating physicians? Ghadah Alyahya, Hind Almohanna, Abdullah Alyahya, Mubarak Aldosari, Laila Mathkour, Abdulrahman Aldhibaib, Youssef Al-Namshan, Najwa Al-Mously Journal of Nature and Science of Medicine 2019 2(1):29-34 Objectives: The purpose of this study was to determine whether physicians' gender has any influence on patients' choice of their treating physician. Methods: A survey was conducted in different public places in Riyadh, Saudi Arabia, to determine preferences for the gender of a physician under various health-care aspects. Results: Three thousand and fifteen people participated in this cross-sectional survey. The majority of participants had no gender preference regarding their physician's attitude and professional competence. However, 49.8% of the female participants preferred a female physician and 37.4% of the male participants preferred a male physician when discussing family and psychological problems. Regarding general and genital examination, 65.8% and 86.4% of women and 53% and 67.5% of men, respectively, preferred to be examined by a physician of their same gender. The majority of women preferred a female physician during breast examination (90.1%) and delivery (71.4%). With regard to medical specialties, men preferred a male general surgeon (48.6%), male urologist (65.1%), and male orthopedic surgeon (54.4%). On the other hand, women preferred a female urologist (58.1%) and had no gender preference regarding their general surgeon (48.1%) and orthopedic surgeon (51.4%). Conclusion: Findings of this study highlight the difference in participants' choice for the gender of their treating physician in different medical specialties. Women participants preferred a female physician for psychosocial counseling and when visiting a gynecologist, obstetrician, or urologist. In addition, women of childbearing age favored a female physician during delivery. Men preferred a physician of the same gender when being treated by a urologist, general surgeon, or orthopedic surgeon.

Comparison of flow cytometric and immunohistochemical immunophenotyping data for diagnosis of B-cell neoplasms and classic hodgkin's lymphoma Fatma Saeed Alqahtani, Karim Hamda Farhat, Mashael Marzouq Alshebly Journal of Nature and Science of Medicine 2019 2(1):35-40 Objective: This study was aimed to compare the results of immunophenotyping by flow cytometry (FC) and immunohistochemistry (IHC) in the diagnosis of B-cell lymphomas and classic Hodgkin's lymphoma (cHL). Methods: This was a retrospective cohort study of 280 patients with chronic B-cell neoplasms and cHL performed between 2008 and 2013. Percentages of B- and T-cell markers detected by FC and IHC were compared regardless of the final diagnosis. Results: FC and IHC results were obtained from 280 patient medical records. There were 155 (55.4%) patients with non-Hodgkin's lymphoma (NHL), 110 (39.3%) with cHL, and 15 (5.4%) with chronic lymphocytic leukemia (CLL). Disparity between FC and IHC was observed for CD19 expression in cHL group where 73.6% (n = 81) CD19 expression was detected by FC and 59.1% (n = 65) detected by IHC (P < 0.02). In NHL group, a higher percentage (81.3%; n = 126) of CD19 was detected by FC as opposed to 61.3% (n = 95) detected by IHC (P < 0.0001). CD19 expression was no different between the two groups. CD20 expression assessed by FC (61.3%; n = 95) was lower than 85.2% (n = 132) detected by IHC in NHL group (P < 0.0001). Whereas no differences were observed in cHL, IHC performed better (100%; n = 15) than FC (66.7%; n = 10) for CD20 detection in CLL group (P < 0.01). In cHL and NHL groups, flow cytometric detections of CD21 of 61.8% and 56.1% were higher than 46.4% (P < 0.02) and 41.9% (P < 0.01) detection rates by IHC. No disparities were observed between FC and IHC detection rates for CD5, CD10, CD23, and CD30 expressions. Conclusion: There was a considerable amount of disparity between FC and IHC results, warranting further evaluation.

The top 100 articles on hepatitis C Manar Aleid, Othman Tawfiq Almutairi, Latifah Alfahad, Mohammed Jameel, Nouf Almutairi, Bandar Al-Judiabi Journal of Nature and Science of Medicine 2019 2(1):41-47 Background: Hepatitis C infection is considered one of the most common hepatological infections. Many papers have been published, but none have listed the most influential work in the field of hepatitis C. Objectives: The aim of this study is to produce a bibliometric historical review on hepatitis C and its management. Methods: We underwent a title-specific search using Scopus database in 2017; using hepatitis C as our search term. The top 100 most cited articles were obtained and analyzed. Results: The top 100 articles received an average of 1273 citation per paper. The most productive years of publication ranged between 1999 and 2003 which accounted for 33 articles in our list. The top two journals in our list were New England Journal and Hepatology Journal with a contribution to 21 and 20 articles in our list, respectively. Research study category was accounted as the most common study category (60%). The top two specialties of contribution were Medicine (26 articles) and Hepatology (25 articles). Albrecht, J and Mchutchison have produced 9 and 8 articles, respectively, from our 160 authors list. The majority of the papers were created in the United States of America (62%). Conclusions: The identification and clustering of the top 100 most impactful work in hepatitis C serve as an excellent overview of the current trends of publication in the field of hepatitis C to identify areas of research inadequacy and to serves as an efficient guide to achieving evidence-based clinical practice.

General public awareness, knowledge, and beliefs toward palliative care in a Saudi population Hasan Mohammed Alkhudairi Journal of Nature and Science of Medicine 2019 2(1):48-53 Objectives: Public awareness of palliative care (PC) is satisfactory in only twenty countries in 2013, which does not include Saudi Arabia in spite of the global efforts done to enhance the public awareness of PC. This study was conducted to evaluate the awareness, knowledge, and beliefs of the Saudi adult population about PC. Methods: A cross-sectional design study was conducted in December 2017 using a self-administered questionnaire survey that was sent through Google Docs to assess the Saudi general public on the awareness of PC. Results: There were 1987 (out of 3164, 62.8% response rate) Saudi adults who responded to the survey, in which 60.3% were males (mean age: 39.50 years, median: 39.0 years, and range: 15–77 years). There were 321 (16.2%) respondents who reported that they know PC and 454 (22.8%) answered that they have heard or were aware of PC. A total of 755 (38.2%) believe that PC improves the quality of life of sick people and 684 (34.4%) believe that PC can reduce the physical suffering of patients. Knowledge of PC was not statistically significantly affected by gender, place of residence, and marital status. On the other hand, employment and having higher levels of education led to better knowledge and more awareness of PC. Conclusion: The current study demonstrated that the knowledge and awareness of PC is still low among surveyed Saudis. There is a need for the government to advocate institutions to functionally devote programs and initiatives and promote literacy of PC in the general population. Nongovernmental sectors should also participate in programs to improve the knowledge and awareness of PC.