Clinical and Preventive Cardiology

Editor's page january 2019 Ravi R Kasliwal Journal of Clinical and Preventive Cardiology 2019 8(1):1-1

Clinical characteristics of peripartum cardiomyopathy patients admitted in tertiary hospital Jishu Deb Nath, Anannya Das, Rajat Sanker Roy Biswas Journal of Clinical and Preventive Cardiology 2019 8(1):2-5 Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition marked by left ventricular (LV) dysfunction and heart failure. The disease incidence is rising and most of the cases are identified now due to availability of widespread echocardiography and possible suspicion by cardiologist. Materials and Methods: This was hospital-based study conducted in the department of medicine of a tertiary hospital, Bangladesh. The study population consisted of postpartum patients admitted to medicine ward for evaluating dyspnea from January 2012 to January 2017. Totally 31 patients were diagnosed as PPCM and taken as a sample after exclusion of all criteria. Results: Most of the patients belonged to 20–24 years of age group (51.6%, n = 16) and most patients developed PPCM in primigravida (51.6%). About 67.7% admitted from rural area and 32.3% from urban area. Exertional breathlessness (45.1%, n = 14) and orthopnea (32.2%, n = 10) are the predominant symptoms in all age groups, while exertional breathlessness was 50% presentations from early age group and 14.3% from elder group, while orthopnea was Observed 70% from early age group. Nearly 9.3% of participants in the study had twin pregnancy. Association of gestational hypertension and diabetes mellitus was found in this study group as 12.9%, n = 4, and 16.1%, n = 5. Majority of the patients (35.5%, n = 11) had no specific electrocardiography changes; sinus tachycardia and ST-T changes were found equally (22.5%, n = 7). About one-third of the patients (29%, n = 9) were found to have severe LV systolic dysfunction (ejection fraction [EF] <30%) and more than half of the patients had moderate LV systolic dysfunction (EF: 31%–40%). Conclusion: As PPCM is rising worldwide, so proper suspicion, early referral, early intervention, and prevention can overcome the misdiagnosis of PPCM which often leads to clinical deterioration and in some instances death.

Clinical and angiographic profile of young patients with ischemic heart disease: A central India study Sunita Dinkar Kumbhalkar, Vikas V Bisne Journal of Clinical and Preventive Cardiology 2019 8(1):6-12 Objective: The present study was undertaken in young patients of ischemic heart disease (IHD) to assess clinical, biochemical and angiographic profile, conventional and newer risk factors, and correlation of risk factors with significant and nonsignificant coronary artery disease (CAD). Materials and Methods: This was a hospital-based cross-sectional study conducted in 70 cases of young IHD (male ≤35 years and females ≤40 years). Patients were evaluated for clinical, biochemical and angiographic profiles, and conventional risk factors such as dyslipidemia, hypertension (HT), diabetes mellitus (DM), and family history of premature CAD (PCAD). Newer risk factors such as lipoprotein (a) (Lp [a]), homocysteine, and plasma fibrinogen were also assessed in some (n = 44) cases. Results: Mean age of patients was 32.97 ± 3.93 years; 11 (15.7%) were women. Various risk factors such as tobacco/gutka chewing, HT, smoking, DM, and family history of PCAD were observed in 35.7%, 22.8%, 17.1%, 11.5%, and 8.6% of patients, respectively. Nearly 77.6% of patients presented with anterior wall myocardial infarction and 61.4% were having moderate left ventricular dysfunction on echocardiography. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and TC/high-density lipoprotein cholesterol (TC/HDL-C) were increased in 38.6%, 41.4%, 32.9%, and 25.7% patients, respectively. Newer risk factors such as Lp (a), homocysteine, and plasma fibrinogen were elevated in 61.4%, 77.3%, and 18.2% of patients, respectively. On coronary angiography, single-vessel disease was found in more than half of the patients (57.1%) followed by double-vessel disease (11.5%) and triple-vessel disease (7.1%). Coronary angiogram was normal in 24.3% of patients. Positive family history of PCAD, serum TGs, TC/HDL-C, and LDL-C/HDL-C were significantly (P < 0.05) associated with significant CAD as compared to nonsignificant CAD, whereas no such correlation was found in relation to newer risk factors. Conclusion: Indian males in South Asian population appear more prone to develop CAD; therefore, screening for risk factors should start at an earlier age. Smoking and tobacco chewing cessation, promotion of physical activities, and healthy dietary pattern have to be strongly encouraged in this vulnerable group.

Levels of physical inactivity in rural and urban Tamil Nadu, India: A cross-sectional study Carol Susan Devamani, Anu Mary Oommen, GK Mini, Vinod Joseph Abraham, Kuryan George Journal of Clinical and Preventive Cardiology 2019 8(1):13-17 Background and Objectives: Physical inactivity is an important cardiovascular risk factor. This study assessed the prevalence and factors associated with insufficient physical activity (PA) in urban and rural Vellore, Tamil Nadu, India, among adults aged 30–64 years. Methodology: A cross-sectional World Health Organization STEPS survey was carried out in 48 wards of Vellore Municipality and nine rural villages of Tamil Nadu in 2010–2012. Adults (n = 6164, men 43.9%) aged 30–64 years were interviewed using the Global PA Questionnaire (2390 urban and 3774 rural). Insufficient PA was defined as not meeting the recommendation of 150 min of moderate aerobic PA, or 75 min of vigorous aerobic PA, or an equivalent combination, achieving at least 600 metabolic equivalent-minutes per day. Results: The prevalence of insufficient PA was 63.3% (95% confidence interval [CI]: 61.3%–65.3%) in the urban area and 40.6% (95% CI: 39.0%–42.2%) in the rural area. Women had a higher prevalence of insufficient PA compared to men, in both urban (70.8% vs. 53.8%) and rural (44.5% vs. 35.6%) areas. Those with higher education (odds ratio [OR]: 1.36, 95% CI: 1.20–1.53) and who were unemployed (OR: 2.97, 95% CI: 2.59–3.39) reported insufficient PA which was significantly higher than their counterparts. While urban participants had higher leisure time PA, rural participants had higher work- and travel-related PA. Conclusions: The high prevalence of insufficient PA found in this study shows that targeted interventions are needed to reduce insufficient PA, especially for women and urban populations.

Distribution of conventional lipids in Indians with premature coronary artery disease: A substudy of the premature coronary artery disease registry Rahul S Patil, TR Raghu, CN Manjunath, Santu Ghosh, Laxmi H Shetty Journal of Clinical and Preventive Cardiology 2019 8(1):18-24 Context: Conventional lipids in young Indians with Coronary Artery Disease. Aims: To study distribution of conventional lipids and their quantification in demographic subgroups of Indians with Premature Coronary Artery Disease (PCAD). Settings and Design: PCAD Registry is a Prospective Multisite Descriptive Observational study of Indians aged below 40 years with Coronary Artery Disease. This Lipid sub study is based on preliminary data of first year of the PCAD registry. Methods and Material: Of 1380 patients registered in PCAD registry, 1061 satisfied entry criteria. Conventional lipids were estimated using commercially available kits. Each of risk factor subgroups were compared by statistical analysis of lipid values. Statistical significance was derived by independent t-test or one-way ANOVA wherever appropriate. The distribution of different lipid profile parameters was visualised by nonparametric density plot. The data was analysed by statistical software R version 3.5.0. Results: A total of 1380 patients were registered. of which 1061 patients satisfied the entry criteria and were enrolled for the lipid analysis study. The mean age of all patients registered was 34.27 (±4.30) years. Mean total cholesterol of entire study population was 171.95 ± 47.11, LDL was 116.39 ± 84.81 mg/dl, HDL was 34.50 ± 9.64, TG was 165.18 ± 87.11, non-HDL was 138.09 ± 46.18. Conclusions: Among all the conventional lipid parameters, low HDL-C along with high TGs seems to be more relevant for premature coronary artery in Indians. Primary cardiovascular disease prevention for Young Indians cannot be solely on the basis of LDL-C. All risk factors should be considered together. Larger sample population studies are needed to draw population specific cutoff values for risk factors and to discover novel risk factors (CTRI/2018/03/012544).

Cardiometabolic risks in India Gundu H R Rao Journal of Clinical and Preventive Cardiology 2019 8(1):25-33 In a recent article in this journal, we discussed diabetes and Cardiovascular disease (CVD) risks in Indians living abroad. The article was written to complement the information that was published by an elite group of the American Heart Association (AHA);-”the council members of the various subcommittees.” In the journal Circulation, AHA published a scientific statement about the CVD risk of Indians living in the USA. In the June issue of the journal PLoS Medicine, The George Institute for Global Health (GIGH), Sydney, Australia, with collaborators from; Harvard T. H. Chan School of Public Health, USA; Department of Economics, University of Gottingen, Heidelberg University, Germany; School of Public Health Johannesburg, South Africa; King's College London, UK, Indian Institute of Public Health, and Public Health Foundation of India, have published a one of a kind article on, “Geographic and sociodemographic variation of CVD disease risk in India: A cross-sectional study of 797,540 adults.” I am writing this article, as a complement to the topic reviewed by the George Institutes of Global Health and associates and other expert groups. The specific objectives of this academic exercise by the GIGH were, to determine how the CVD risk- and the factors that determine risk varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. Rajeev Gupta and associates from Jaipur, under the aegis of South Asian Society on Atherosclerosis and Thrombosis, did a study in 2012, on “Regional variations in CVD risk in India: India heart watch.” The researchers found a wide regional variation in CVD mortality. They concluded, “that although no nationwide study of risk factors exists, there were significant state-level and rural-urban level differences in major CVD risk factors such as smoking, obesity, central adiposity, hypertension, hypercholesterolemia, and diabetes. They also stressed the need for uniform protocols, to assess the regional differences. Whereas, the report by the GIGH Collaborators group, did pooled analysis of CVD risk for 797,540 adults across India, and identified important variation in risk among individuals living in different States. According to them, CVD risk was the highest in the northern (Himachal Pradesh, Uttarakhand), northeastern (West Bengal, Nagaland, Manipur, and Mizoram), and Southern States (Kerala, Andhra Pradesh) of India. CVD risk was found to be higher in urban areas, that too among males, while mean body mass index was higher among wealthy, blood glucose, high systolic blood pressure was common in poor people of middle and older age. We have access to data from three important studies, related to the variation of CVD risk in Indians living in India, as well as abroad. It is high time, that we use these data to develop guidelines, guidance statements, novel clinical studies for validating safety and efficacy of complementary therapies for early risk factors such as oxidative stress, inflammation, and endothelial dysfunction, put together integrated noninvasive diagnostic platforms for risk assessment, risk prediction, and reduction or reversal of metabolic diseases. Having said that, I would like to emphasize the need for a national platform, to address the issues related to this very important public health problem, and to coordinate the prevention strategies.

Homozygous familial hypercholesterolemia with valvulopathy Ashokan Nambiar, Robin George Manappallil, VG Pradeep Kumar, Avinash Sarpamale Journal of Clinical and Preventive Cardiology 2019 8(1):34-37 Familial hypercholesterolemia (FH) is an autosomal codominant genetic disorder of lipid metabolism. The occurrence of its homozygous form is rare. This is a case of a young girl who presented with syncope and was found to have multiple tuberous xanthomas and valvulopathy, along with deranged lipid profile, suggestive of homozygous FH.

Should aspirin be used for primary prevention? Mohit Bhagwati, Rahul Mehrotra Journal of Clinical and Preventive Cardiology 2019 8(1):38-41

The Voice Performance After Septoplasty

 With Surgical Efficacy Demonstrated Through Acoustic Rhinometry and Rhinomanometry

Emre Apaydın'Correspondence information about the author Emre ApaydınEmail the author Emre Apaydın, Aykut İkincioğulları, Mustafa Çolak, Doğan Atan, Serdar Ensari, Hacı Hüseyin Dere

DOI: https://doi.org/10.1016/j.jvoice.2019.01.008

Abstract

Objective

To demonstrate the surgical efficacy of septoplasty using acoustic rhinometry (AR) and anterior rhinomanometry (ARM) and to evaluate the effect of septoplasty on voice performance through subjective voice analysis methods.

Materials and Methods

This prospective study enrolled a total of 62 patients who underwent septoplasty with the diagnosis of deviated nasal septum. Thirteen patients with no postoperative improvement versus preoperative period as shown by AR and/or ARM tests and three patients with postoperative complications and four patients who were lost to follow-up were excluded. As a result, a total of 42 patients were included in the study. Objective tests including AR, ARM, acoustic voice analysis and spectrographic analysis were performed before the surgery and at 1 month and 3 months after the surgery. Subjective measures included the Nasal Obstruction Symptom Evaluation questionnaire to evaluate surgical success and Voice Handicap Index-30 tool for assessment of voice performance postoperatively, both completed by all study patients.

Results

Among acoustic voice analysis parameters, F0, jitter, Harmonics-to-Noise Ratio values as well as formant frequency (F1-F2-F3-F4) values did not show significant differences postoperatively in comparison to the preoperative period (P > 0.05). Only the shimmer value was statistically significantly reduced at 1 month (P < 0.05) and 3 months postoperatively (P < 0.05) versus baseline. Statistically significant reductions in Voice Handicap Index-30 scores were observed at postoperative 1 month (P < 0.001) and 3 months (P < 0.001) compared to the preoperative period and between postoperative 1 month and 3 months (P < 0.05).

Conclusion

In this study, first operative success of septoplasty was demonstrated through objective tests and then objective voice analyses were performed to better evaluate the overall effect of septoplasty on voice performance. Shimmer value was found to be improved in the early and late postoperative periods.

Key Words:

Septoplasty, Voice, Acoustic Rhinometry, Rhinomanometry

Pitch-Synchronous Analysis of Human Voice

C. Julian Chen'Correspondence information about the author C. Julian ChenEmail the author C. Julian Chen, Donald A. Miller

DOI: https://doi.org/10.1016/j.jvoice.2019.01.009

Objective

Based on simultaneous voice and electroglottograph (EGG) signals, to gain a better understanding of human voice production process, to make pitch-synchronous segmentation of voice signals, and to make visual representations of pitch marks and timbre spectra with high resolution.

Methods/Design

The traditional spectrogram segments the voice signals with a process window of fixed size and fixed shift, then performs fast Fourier transformation after multiplied with a window function, typically a Hamming window. Then display power spectrum in both frequency and time. Pitch information and timbre information are mixed. The new design segments the signals into pitch periods, either using the derivatives of the EGG signals or based on the voice signals, then performs Fourier analysis to the segment of signals in each pitch period without using a window function. The pitch information and the timbre information are cleanly separated. The graphical representations of both pitch marks and timbre spectra exhibit high resolution and high accuracy.

Results

Detailed analysis of simultaneously acquired voice and EGG signals provides a more precise understanding of human-voice production process. The transient theory of voice production, proposed by Leonhard Euler in early 18th century, is substantiated with modern data. Based on the transient theory of voice production, a pitch-synchronous spectrogram software is developed, which makes a visual representation of pitch marks and timbre spectra. In addition, the timbre spectrum and the power evolution pattern in each pitch period can be displayed individually.

Conclusions

Simultaneously acquired voice and EGG signals indicates that each glottal closing triggers a decaying elementary wave in the vocal tract. A superposition of those elementary waves constitutes voice. Based on that concept and using EGG data, a pitch-synchronous voice signal processing method is developed. The voice signal is first segmented into pitch periods, then the two ends are equalized. Fourier analysis is applied to obtain the timbre spectrum of each pitch period. High resolution display of timbre spectrum is generated. The power evolution pattern in each pitch period is also displayed.

Key Words:

Human voice, Production, Analysis, Pitch period, Timbre spectra, Graphical display

Spontaneous bacterial peritonitis in hepatitis C virus cirrhotic patients

Does ascitic fluid lactoferrin has a role in the diagnosis and follow up of spontaneous bacterial peritonitis in hepatitis C virus cirrhotic patients p. 53

Soheir Abuelfadl, Ahmed A Heikl, Mahmoud M El-Nokeety, Laila A Rashed

DOI:10.4103/kamj.kamj_27_17  

Background Polymorphonuclear leukocyte (PMNL) count in the ascitic fluid (AF) is the gold standard method for the diagnosis of spontaneous bacterial peritonitis (SBP). Its measurement is routinely performed by traditional manual counting which is operator dependent and false-negative results may occur due to lysis of the leukocyte during transport. Aims The aims of the study were to assess the accuracy of AF lactoferrin and the best cutoff value for the diagnosis of SBP and also to compare its level before and after treatment to be used as a marker for follow up. Patients and methods The present study included 150 Egyptian patients with hepatitis C virus-related liver cirrhosis and ascites. The cases were divided into 100 patients with SBP and 50 patients with no SBP based on an elevated AF PMNL count of greater than or equal to 250 cells/mm3, ascitic samples were examined for PMNL count, culture, chemistry, and lactoferrin concentration in non-SBP patients and in SBP patients before and after systemic antibiotic treatment. Results AF lactoferrin concentration is significantly higher in SBP patients than in non-SBP patients with a cutoff value of 75.55 ng/ml, significantly higher in culture positive than in culture-negative SBP patients and its concentration is decreased significantly in SBP patients after systemic antibiotic therapy. Conclusion Elevated AF lactoferrin levels in cirrhotic patients are reliable for the diagnosis and follow up of SBP after systemic antibiotic therapy. The level of AF lactoferrin level is higher in resistant cases of SBP than the cases that respond to systemic antibiotic treatment.

Mast cell, a new player in type 2 diabetes

Nehal Hamdy, Randa F Salam, Nagwa Abd EL-Ghaffar Mohamed

DOI:10.4103/kamj.kamj_18_18  

Background Mast cells plays critical role in inflammatory diseases, including cardiovascular and metabolic diseases and their associated complications. These cells exert their physiological and pathological activities by releasing granules containing histamine, cytokines, chemokines, and proteases, including mast cell-specific chymases and tryptases Aim of our study is to detect the role of mast cell in diabetic obese and its correlation to different diabetic complications Method 70 Type 2 diabetic obese patients attending the Diabetes and Endocrinology clinic in Kasr El Ani hospital compared to 15 healthy controls All patients were subjected to: Full medical history, complete physical examination, Anthropometric measurements (BMI, waist circumference) fasting glucose(assessed after 8 hours fasting) –A1C – serum cholesterol –triglycerides-LDL-HDL(assessed after 12 hours fasting) Tryptase level Results Statistical significant difference between patients and control regarding BMI, glucose,cholesterol, HDL, LDL,tryptase (p<0.001) ,triglycerides(p=0.001) Tryptase statistically correlated with BMI,fastingglucose,A1C,triglycerides(p=0.014,r=0.031)/(p=0.012,r=0.297)/(p<0.001,r=0.862),(p=0.039,r=0.247) Higher mean level of tryptase in patients with diabetic complications mainly in retinopathy (32.32 ng/ml) Conclusion Tryptase participate in the pathogenesis of diabetes mellitus and its complication targeting mast cells as novel therapy for diabetes requires further investigations

Does CBD Oil Lower Blood Pressure?

This article was originally published at SundayScaries."

Madeline Taylor POSTED ONJanuary 13, 2019

High blood pressure is a serious condition that currently affects thousands of adults in America. Statistics show that 33% of adults who are above the age of 20 struggle with high blood pressure and that figure reaches a whopping 66% for those in their mid-60 and over. It goes without saying that high blood pressure is becoming a nasty rising trend, which is only going to worsen if changes to the system aren't made. While there is already a substantial amount of research into hypertension, a succinct cure is yet to be found. And, thanks to the rise of natural medicines, including medical marijuana, many people now suspect that cannabis-based products could provide the answers we have been looking for with regards to lowering blood pressure in modern society.

Hypertension doesn't immediately strike us as a fatal condition when you compare it to aggressive illnesses like cancer of epilepsy. However, high blood pressure has been coined as a silent killer in the medical industry, based on the reality that hypertension is often not accompanied by any warning symptoms. This dreaded condition will put you at a higher risk of having a heart attack, heart failure, strokes, and even kidney disease. It is a condition that must be taken seriously in order to avoid its fatal repercussions.

What Are the Symptoms of Hypertension?

While there are some medical conditions in existence that can be diagnosed at home, high blood pressure is not one of them. It is virtually impossible to tell if your blood pressure is too high without experiencing other negative symptoms and by that point, it could be too late. You should always schedule regular check-ups with your physician to monitor blood pressure and you should make an appointment at your local medical center as soon as possible if you start noticing any of the following symptoms:

• A more severe headache than normal
• Feeling permanently tired
• Problems with your vision
• An irregular heartbeat
• Difficulty breathing

How Can CBD help?

The big question is: "Does CBD oil lower blood pressure?" CBD is a natural that is relatively new to the mainstream market. It is known to help with chronic pain and cancer-related pain, severe diabetes, multiple sclerosis, and Alzheimer's disease. One of its primary uses, however, is to manage and lower the symptoms of anxiety and stress disorders like post-traumatic stress disorder; therefore, lowering your blood pressure. When you feel calm, you are able to relax, so your blood pressure responds accordingly and decreases in time with your heart rate. Cannabidiol is a natural vasodilator; it will help ensure that your blood is flowing easily and smoothly. A particularly nasty symptom of hypertension is that it can cause irreversible damage to your arteries and heart. You then tend to end up with conditions like coronary heart disease. Fortunately, CBD has proven to be effective to alleviate the negative consequences of affected blood vessels.

The Benefits of Taking CBD for High Blood Pressure

As time passes, more states are moving to legalize marijuana for medicinal purposes and other derivatives from the cannabis plant and that means more people across the U.S. are using cannabis-based products like CBD hemp oil to treat and reduce the effects of a wide range of ailments. CBD contains some incredibly unique properties, which all contribute to making it a very effective and in-demand alternative medication for patients worldwide.

Without a doubt, one of the primary benefits to consider when you use CBD to lower blood pressure is that it not only targets your hypertension, it also works to lower anxiety, relieve insomnia, and heal any pain you might have in your body. The average American who suffers from high blood pressure is usually prescribed a range of pharmaceuticals to overcome the multitude of symptoms that come with hypertension. And over time all of these toxic medicines can have negative consequences to their overall health, so this is the primary driving force behind people turning to CBD for their health issues, as it naturally heals all aspects of hypertension.

CBD specifically lowers high blood pressure in two primary ways:

It Has Anti-Inflammatory Properties

When a part of your body becomes swollen and painful, it is referred to as inflammation. Hypertension can cause inflammation and in turn, inflammation causes hypertension.  Many patients battling hypertension find that they also have to deal with inflammation and pain on an almost daily basis. CBD is an entirely natural anti-inflammatory, which helps eliminate and soothe any swelling you might have, so by healing your inflammation CBD also causes your blood pressure to lower.

It Reduces Anxiety

Hypertension can often be caused by anxiety and stress and vice versa. Many people are surprised to learn that the reason they feel stressed and anxious is because of high blood pressure. CBD will take care of any anxiety issues by lowering your heart rate and keep you in a calmer state. When your stress levels drop, so does your blood pressure.

Ways to Take Cannabis

There are a variety of ways that you can consume CBD in order to experience its potency, including:

• Oils or tinctures
• CBD sprays
• Gummy sweets
• Tea
• Edibles

Thanks to a variety of ingestion methods, you can try each one until you find a method that suits you best.

Dosage

If you want to enjoy all of the positive benefits of CBD, then you will need to get your dosage right. Dosage is a very individual aspect of CBD, so sometimes what works for one person doesn't work for another. It is always recommended that you start with a smaller dose and increase it gradually if you feel you need to. You can also consult a holistic physician to get more clarity on the best dose for your needs.

Final Thoughts

Modern society is that it comprises a variety of aspects that result in many of us having busy lifestyles and we always seem to be rushing from A to B. If this culture continues in the same way, even more people will develop hypertension, which is why it is so important to understand all of your treatment options in advance. CBD can be an effective and non-damaging way to treat the symptoms of high blood pressure and gives patients more of a choice with regards to moving forward with treatment.

SOURCES:

https://www.ncbi.nlm.nih.gov/pubmed/21238581

Kasr Al Ainy Medical Journal

ORIGINAL ARTICLES
	Cyclooxygenase-2 and estrogen receptor-β as possible therapeutic targets in desmoid tumors	p. 47
	Rasha A Khairy DOI:10.4103/kamj.kamj_1_18   Background and aim Desmoid tumors are mainly treated by surgical excision and radiotherapy, but the failure to achieve complete response has given rise to the need for investigating the role of possible target therapy. The aim of this study was to evaluate the immunohistochemical detection of cyclooxygenase-2 (COX-2) and estrogen receptor-β (ERβ) in desmoid tumors and to assess their correlation with available clinicopathologic variables. Materials and methods A total of 17 desmoid tumor cases (11 abdominal, five extra-abdominal, and one intra-abdominal) were examined for immunohistochemical detection of COX-2 and ERβ using monoclonal antibodies. Toluidine blue staining was performed to confirm or exclude that COX-2 immunostained cells coincide with mast cells in co-localized sections. Correlation of results with available clinicopathologic variables was done and a P value less than 0.05 was considered significant. Results COX-2 was expressed in tumor cells in 92% of examined desmoid cases (16/17). Toluidine blue staining has shown that COX-2 immunostained cells do not coincide with the few metachromatically stained mast cells in co-localized sections. ERβ was expressed in 67.1% of tumor cells in desmoid cases (11/17); eight cases displayed high ERβ expression and three cases displayed low ERβ expression. No significant correlation was detected between ERβ or COX-2 immunohistochemical expression and patient's age, sex, tumor size, site, margins status, and recurrence history (P>0.05).Conclusion This study confirmed the immunohistochemical expression of COX-2 and ERβ in tumor cells of the majority of studied desmoid cases. These results introduce COX-2 and ERβ as potential therapeutic targets in desmoid tumors. Further studies with a large sample size and follow-up are recommended to validate the current results.
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	Does ascitic fluid lactoferrin has a role in the diagnosis and follow up of spontaneous bacterial peritonitis in hepatitis C virus cirrhotic patients	p. 53
	Soheir Abuelfadl, Ahmed A Heikl, Mahmoud M El-Nokeety, Laila A Rashed DOI:10.4103/kamj.kamj_27_17   Background Polymorphonuclear leukocyte (PMNL) count in the ascitic fluid (AF) is the gold standard method for the diagnosis of spontaneous bacterial peritonitis (SBP). Its measurement is routinely performed by traditional manual counting which is operator dependent and false-negative results may occur due to lysis of the leukocyte during transport. Aims The aims of the study were to assess the accuracy of AF lactoferrin and the best cutoff value for the diagnosis of SBP and also to compare its level before and after treatment to be used as a marker for follow up. Patients and methods The present study included 150 Egyptian patients with hepatitis C virus-related liver cirrhosis and ascites. The cases were divided into 100 patients with SBP and 50 patients with no SBP based on an elevated AF PMNL count of greater than or equal to 250 cells/mm3, ascitic samples were examined for PMNL count, culture, chemistry, and lactoferrin concentration in non-SBP patients and in SBP patients before and after systemic antibiotic treatment. Results AF lactoferrin concentration is significantly higher in SBP patients than in non-SBP patients with a cutoff value of 75.55 ng/ml, significantly higher in culture positive than in culture-negative SBP patients and its concentration is decreased significantly in SBP patients after systemic antibiotic therapy. Conclusion Elevated AF lactoferrin levels in cirrhotic patients are reliable for the diagnosis and follow up of SBP after systemic antibiotic therapy. The level of AF lactoferrin level is higher in resistant cases of SBP than the cases that respond to systemic antibiotic treatment.
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	Mast cell, a new player in type 2 diabetes	p. 59
	Nehal Hamdy, Randa F Salam, Nagwa Abd EL-Ghaffar Mohamed DOI:10.4103/kamj.kamj_18_18   Background Mast cells plays critical role in inflammatory diseases, including cardiovascular and metabolic diseases and their associated complications. These cells exert their physiological and pathological activities by releasing granules containing histamine, cytokines, chemokines, and proteases, including mast cell-specific chymases and tryptases Aim of our study is to detect the role of mast cell in diabetic obese and its correlation to different diabetic complications Method 70 Type 2 diabetic obese patients attending the Diabetes and Endocrinology clinic in Kasr El Ani hospital compared to 15 healthy controls All patients were subjected to: Full medical history, complete physical examination, Anthropometric measurements (BMI, waist circumference) fasting glucose(assessed after 8 hours fasting) –A1C – serum cholesterol –triglycerides-LDL-HDL(assessed after 12 hours fasting) Tryptase levelResults Statistical significant difference between patients and control regarding BMI, glucose,cholesterol, HDL, LDL,tryptase (p<0.001) ,triglycerides(p=0.001) Tryptase statistically correlated with BMI,fastingglucose,A1C,triglycerides(p=0.014,r=0.031)/(p=0.012,r=0.297)/(p<0.001,r=0.862),(p=0.039,r=0.247) Higher mean level of tryptase in patients with diabetic complications mainly in retinopathy (32.32 ng/ml) Conclusion Tryptase participate in the pathogenesis of diabetes mellitus and its complication targeting mast cells as novel therapy for diabetes requires further investigations
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	High-mobility group box 1, early activity marker in lupus nephritis	p. 65
	Aysha I Badawi, Hanan H Fouad, Randa F Salam, Amira M Bassam, Sahar A Ahmed DOI:10.4103/1687-4625.251936   Objectives Systemic lupus erythematosus is an autoimmune disease characterized by the involvement of multiple organ systems. High-mobility group box 1 (HMGB1) is a nuclear nonhistone protein secreted by many cells during activation or cell death. We aim to study the potential pathogenetic role of HMGB1 in lupus and whether urinary, serum, and renal biopsy levels reflect renal inflammation and correlate with disease activity. Patients and methods In a case–control study, 61 systemic lupus patients and 18 healthy volunteers were divided into four groups. Group 1 included 21 patients with lupus nephritis (LN). Group 2 included 21 patients with lupus activity without nephritis. Group 3 included 19 patients without activity. Group 4 included 18 healthy volunteers who were age and sex matched. Participants were subjected to assessment of history, physical examination, activity scoring using SLE disease activity index (SLEDAI), and laboratory investigations including plasma and urinary levels of HMGB1 by enzyme-linked immunosorbent assay. Study of the HMGB1 immunohistochemical expression pattern in renal biopsy was carried out in group 1. Results Plasma and urinary HMGB1 levels and the renal tissue extranuclear expression (cytoplasmic and extracellular) pattern of HMGB1 were significantly increased in patients with active LN compared with the other groups (P<0.001), and were significantly correlated with SLEDAI, suggesting active release of HMGB1. Plasma and urinary levels in patients without active LN were also significantly higher compared with the control group (P<0.001). Conclusion HMGB1 plays an important role in the pathogenesis of LN and reflects disease activity. Thus, HMGB1 can be utilized as a biomarker for renal disease activity in patients with lupus and the therapeutic value of HMGB1-blocking agents must be investigated.
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	Role of color doppler ultrasound for assessment of arteriovenous fistula dysfunction in hemodialysis patients	p. 72
	Omar Abdelaziz, Mirna Adel Fahmy, Sahier O El-Khashab DOI:10.4103/kamj.kamj_2_18   Background and objective Arteriovenous fistulas (AVFs) are the vascular access of choice for hemodialysis with a lower incidence of complications and longer survival than prosthetic grafts or central venous catheters. Our aim was to evaluate the role of color Doppler ultrasound (CDUS) in the detection and characterization of complications of AVF dialysis access. Materials and methods During a 9-month duration, we prospectively evaluated 25 patients with clinically suspected AVF complications using CDUS examination of the upper limbs. There were 11 (44%) males and 14 (56%) females, ranging in age from 8 to 70 years. All patients were examined after reconstruction of AVF for the assessment of vascular access complications. Doppler indices were measured in the afferent arteries, at the site of anastomosis, and the draining veins. Results All 25 patients had shunt complications. Venous thrombosis was the highest among all complication (n=12, 48%), followed by stenosis (n=11, 44%), aneurysm and pseudoaneurysmal formation (n=5, 20%), and infection (n=1, 4%). Four patients had more than one complication. Sixteen (64%) patients had complicated fistulas requiring further intervention, either surgical management [reconstruction of new fistula (n=3), ligation (n=1), graft (n=1), and superficialization (n=2)] or radiological intervention [percutaneous transluminal angioplasty (n=5), thrombectomy (n=2), and percutaneous transluminal angioplasty and thrombectomy (n=2)]. Conclusion CDUS is a noninvasive diagnostic tool for early detection and localization of complications of AVFs that allows detection of possible causes of vascular access malfunction.
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	Ultrasonic wave's influence on the changes of the number of bacteria in the infected root canal	p. 79
	Ri Myong-Un, Ri Myong-Gil, Ju Gyong-Il, Yun Son-Yong, Ri Gyong-Sok, Kim Chang-Song DOI:10.4103/kamj.kamj_24_18   Background We have focused on the making an attempt toward making ultrasonic scaler available for the endodontic treatment and assess the changes in the bacterial numbers in the infected root canal when using it. Materials and methods An ultrasonic root canal irrigator was used. A sterilized paper point was inserted in the root canal of the tooth that had been clinically diagnosed as having necrosis of the pulp. After a few minutes, it was suspended in the transport culture medium of 1 ml. This suspension was diluted 10 times and inoculated in the thioglycolate agar medium to calculate the number of alive bacteria.Results Ultrasonic irrigation leads to the remarkable reduction in the number of bacteria in the infected root canal, and bactericidal rate was 99.88% and treatment efficacy was 95.6% when combined with canal irrigants. Conclusion Ultrasonic wave showed remarkable irrigation effect and higher antibacterial rate when combined with various irrigants; however, it alone cannot kill 100% of bacteria in the infected root canal.
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	Prediction of clinical outcome in patients with nonvariceal gastrointestinal bleeding using Forrest classification and Rockall score	p. 83
	Nam Hun Jong, Hye Song Kim, Chol Jin Han DOI:10.4103/kamj.kamj_20_18   Background Predicting outcome of upper gastrointestinal bleeding has significant importance to reduce mortality, duration of hospital stay, and medical cost. Objective The aim was to investigate the predictive value of Forrest classification and Rockall score in assessing rebleeding rate and mortality rate in patients with nonvariceal gastrointestinal bleeding (NVUGIB). Patients and methods A total of 518 patients with NVUGIB from January 2013 to July 2017 were enrolled in this retrospective study. Logistic regression analysis was used to assess the association between these scores and clinical outcome. Results Forrest classification is significantly associated with rebleeding, whereas Rockall score is closely associated with mortality. The risks of rebleeding in patients with Forrest Ia-b [odds ratio (OR): 39.2; 95% confidence interval (CI):19.2–79.8], FIIa (OR: 29.7; 95% CI:13.5–65.4), and FIIb (OR: 6.5; 95% CI: 3.0–14.1) were significantly increasing compared with FIII. The risks of mortality in patients with Rockall score 4–6 (OR: 9.4; 4.1–21.6), 7–11 (OR: 101.5; 50.2–205.3), were significantly increasing compared with the group with Rockall score less than 4. Conclusion Forrest classification can be used as a predictor for rebleeding and Rockall score can be used as a predictor for mortality in patients with NVUGIB.
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ERRATUM
	Erratum: Studying the correlation between transforming growth factor β1 and chitinase-3-like-1 in assessment of bronchial asthma severity	p. 89
	DOI:10.4103/1687-4625.251934
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Comparative Study Between Microscopic and Endoscopic Tympanoplasty Type I

Abstract

Tympanoplasty is surgical reconstruction of tympano-ossicular system and includes—Canalplasty, Meatoplasty, Myringoplasty and Ossiculoplasty. To analyse and compare the intraoperative and postoperative aspects and the outcomes of conventional postauricular microscopic tympanoplasty and permeatal endoscopic tympanoplasty this study was conducted on 50 patients undergoing type I tympanoplasty (25 patients divided into two groups; group A—microscopic tympanoplasty and group B—endoscopic tympanoplasty). Advantages, disadvantages and results were compared between the two groups. Success rates and hearing improvement were comparable in both groups while intraoperative ease, postoperative morbidity and operative time was seen superior in endoscopic group. Although, endoscopic technique being minimally invasive yet has disadvantages such as single handed difficult instrumentation, frequent cleaning of scope and thus a steep learning curve. In conclusion permeatal endoscopic tympanoplasty can be considered as a good alternative to the conventional microscopic tympanoplasty.

http://bit.ly/2I4ZrUZ

Comparative Study Between Microscopic and Endoscopic Tympanoplasty Type I

Abstract

Tympanoplasty is surgical reconstruction of tympano-ossicular system and includes—Canalplasty, Meatoplasty, Myringoplasty and Ossiculoplasty. To analyse and compare the intraoperative and postoperative aspects and the outcomes of conventional postauricular microscopic tympanoplasty and permeatal endoscopic tympanoplasty this study was conducted on 50 patients undergoing type I tympanoplasty (25 patients divided into two groups; group A—microscopic tympanoplasty and group B—endoscopic tympanoplasty). Advantages, disadvantages and results were compared between the two groups. Success rates and hearing improvement were comparable in both groups while intraoperative ease, postoperative morbidity and operative time was seen superior in endoscopic group. Although, endoscopic technique being minimally invasive yet has disadvantages such as single handed difficult instrumentation, frequent cleaning of scope and thus a steep learning curve. In conclusion permeatal endoscopic tympanoplasty can be considered as a good alternative to the conventional microscopic tympanoplasty.

http://bit.ly/2I4ZrUZ

Feasibility of transnasal flexible carbon dioxide laser surgery for laryngopharyngeal lesions

The fiber-guided carbon dioxide (CO2) laser is a useful device for laryngopharyngeal surgery. The flexible CO2 wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO2 flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO2 TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO2 TNFLS procedure.

http://bit.ly/2TIH7lN

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure

To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.

http://bit.ly/2Bw1tHY

Thyroid Lobectomy Versus High-Intensity Focused Ultrasound (HIFU) for the Management of Benign Thyroid Nodules

Clinical Thyroidology, Volume 31, Issue 2, Page 61-64, February 2019.


http://bit.ly/2GlX8va

Failure of RAI Therapy in Graves' Disease Is Related to Higher Initial Serum FT4 and TRAb Levels

Clinical Thyroidology, Volume 31, Issue 2, Page 46-48, February 2019.


http://bit.ly/2I9a0q1

EU-TIRADS Can Decrease Unnecessary Fine-Needle Aspirations of 18F-FDG-Positive Thyroid Nodules

Clinical Thyroidology, Volume 31, Issue 2, Page 65-68, February 2019.


http://bit.ly/2GqKaML

Iodine Content Is Low or Absent in Some U.S. Multivitamin and Prenatal Vitamin Brands

Clinical Thyroidology, Volume 31, Issue 2, Page 58-60, February 2019.


http://bit.ly/2GmKYBX

Maternal Iodine Deficiency in Pregnancy Is Associated with Decreased Language Skills in Infancy and Toddlerhood

Clinical Thyroidology, Volume 31, Issue 2, Page 55-57, February 2019.


http://bit.ly/2IagEMK

Greetings From the Editor of Clinical Thyroidology

Clinical Thyroidology, Volume 31, Issue 2, Page 45-45, February 2019.


http://bit.ly/2GmKRGx

Treatment of Hyperthyroidism Decreases but Does Not Completely Abolish the Increased Risk of Cardiovascular-Related Hospitalization

Clinical Thyroidology, Volume 31, Issue 2, Page 49-51, February 2019.


http://bit.ly/2I2iPBU

Patients with Advanced Thyroid Cancer Containing TRK Fusions May Benefit from Recently FDA-Approved Larotrectinib

Clinical Thyroidology, Volume 31, Issue 2, Page 76-79, February 2019.


http://bit.ly/2GmYoxM

The Value of Thyroid-Function Testing in the Pediatric Inpatient Setting Is Low

Clinical Thyroidology, Volume 31, Issue 2, Page 52-54, February 2019.


http://bit.ly/2I5QSta

Is It Time to Update the Classification for Radioiodine-Refractory Differentiated Thyroid Cancer?

Clinical Thyroidology, Volume 31, Issue 2, Page 69-72, February 2019.


http://bit.ly/2GmwxOC

I-131 Dosing Based on Stimulated Radioiodine Uptake and Thyroglobulin Is Favorable in Differentiated Thyroid Cancer

Clinical Thyroidology, Volume 31, Issue 2, Page 73-75, February 2019.


http://bit.ly/2I2iQFY

Chitosan hydrogel containing amelogenin-derived peptide: inhibition of cariogenic bacteria and promotion of remineralization of initial caries lesions

Publication date: Available online 10 February 2019

Source: Archives of Oral Biology

Author(s): Qian Ren, Longjiang Ding, Zhongcheng Li, Xiuqing Wang, Kun Wang, Sili Han, Wei Li, Xuedong Zhou, Linglin Zhang

Abstract

Objective

Nowadays, caries prevention focuses on controlling pathogenic bacteria, inhibiting demineralization and promoting re-mineralization. The aim of this study is to design a more clinically powerful anti-caries treatment by combining amelogenin-derived peptide QP5 with antibacterial chitosan in a hydrogel (CS-QP5 hydrogel), and characterize its effects on inhibition of cariogenic bacteria and promotion of remineralization of initial caries lesions.

Design

CS-QP5 interactions at different pH and chitosan concentrations were studied using UV–vis spectroscopy, fluorescence spectroscopy and circular dichroism. Antibacterial activity was measured using broth microdilution and biofilm assays. Remineralizing activity was measured using tests of surface micro-hardness(SMH), polarized light microscopy(PLM) and transverse microradiography(TMR) in a pH cycling model that simulates intra-oral pH conditions.

Results

The results of UV–vis spectroscopy, fluorescence spectroscopy and circular dichroism analyses suggest that the micro-environment of QP5 changes upon addition of chitosan and the interaction between QP5 and chitosan is reversible and dependent on pH. CS-QP5 hydrogel showed good antibacterial potency towards Streptococcus mutans with MIC/MBC of 5 mg/mL, reducing adhesion and biofilm formation up to 95.43% and nearly 100% respectively. According to the results of remineralizing studies, CS-QP5 hydrogel demonstrated 50.06% surface micro-hardness recovery, shallower lesion depth, significantly less mineral loss and more mineral content at different depth in the lesion body after pH cycling.

Conclusions

The hydrogel showed promise as a dual-action caries control agent in vitro, whether it could present good effects in vivo still needs to be determined, which requires further study. Nonetheless, the new design of bioactive hydrogel with antibacterial and remineralizing properties has the potential to substantially benefit oral health.

http://bit.ly/2BvNd1Y

Selected ENT symptoms in functional disorders of the upper cervical spine and temporomandibular joints

Abstract

This paper discusses otorhinolaryngological symptoms associated with functional disorders of the upper cervical spine. Hints aimed to avoid misdiagnoses of cross-organ otorhinolaryngological symptoms as phobic or psychogenic disorders are presented. Clinically relevant neuroanatomical convergence of the upper cervical spine (occiput to C3) is fundamental for the interpretation of functional otorhinolaryngological symptoms. Based thereon, evidence for the most common cervical differential diagnoses of dizziness, tinnitus, dysphagia, and craniomandibular dysfunction is presented separately. The corresponding therapeutic options and their contraindications are discussed in the concluding chapter. The importance of interdisciplinary cooperation in related fields is emphasized.

http://bit.ly/2E3wLaW

Predictive values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and other prognostic factors in pediatric idiopathic sudden sensorineural hearing loss

Publication date: Available online 11 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ryun Ha, Byeoung Woo Lim, Dong Hyun Kim, Jung Woo Park, Chang Hyun Cho, Ju Hyoung Lee

Abstract

Background and Objectives

No consensus has been reached regarding the optimum treatment or factors affecting prognosis in pediatric idiopathic sudden sensorineural hearing loss (ISSNHL) due to its rarity. In the present study, treatment outcomes and prognostic factors of ISSNHL were investigated in pediatric patients who underwent steroid therapy.

Subjects

and Methods: Forty-two patients diagnosed with ISSNHL were enrolled in this retrospective study and compared with 39 normal healthy controls with respect to demography and complete blood cell count test results. In addition, prognosis factors were sought by dividing the 42 ISSNHL patients to 3 groups according to their response to the treatment.

Results

Neutrophil-to-lymphocyte ratio (NLR) value in the ISSNHL group were significantly higher than in the control group. NLR value in the three treatment response groups differed significantly. Early treatment with steroid and accompanying tinnitus were positive prognostic factor for hearing recovery. Other characteristics were not significant.

Conclusion

The results of this study suggest that good hearing recovery in children may be associated with early time of initial treatment and accompanying tinnitus. Also, NLR value might be useful readily accessible prognostic markers in pediatric ISSNHL patients. Further studies are required to confirm prognostic factors useful to predict prognosis and treat ISSNHL in pediatric patients.

http://bit.ly/2BvUOxD

Mucoepidermoid Carcinoma of the Head and Neck in Children

Publication date: Available online 10 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Natasha D. Dombrowski, Nikolaus E. Wolter, Alexandria L. Irace, Michael J. Cunningham, Jennifer W. Mack, Karen J. Marcus, Sara O. Vargas, Antonio R. Perez-Atayde, Caroline D. Robson, Reza Rahbar

Abstract

Introduction

Mucoepidermoid carcinoma is a rare malignant salivary gland neoplasm in the pediatric population. Few studies have discussed best practice with respect to diagnosis and treatment in children.

Objective

To present our institution's experience with the evaluation and management of pediatric mucoepidermoid carcinoma of the head and neck.

Methods

Retrospective chart review of patients under 20 years of age diagnosed with mucoepidermoid carcinoma of the head and neck between 1998 and 2017. Data assessed includes demographics, clinical presentation, imaging examinations, histopathology, treatment, complications, local recurrence, distant metastasis, and follow-up.

Results

Sixteen patients (10 female, 6 male) were identified with a median age of 12.9 (IQR: 10.9-15.0) years. Tumors were located within the parotid gland (n = 11, 68.8%), accessory lobe of the parotid gland (n = 2, 12.5%), palate (n = 2, 12.5%), and submandibular region (n = 1, 6.3%). In 9 patients (56.3%) a neoplastic etiology was suspected based on the clinical and/or radiographic findings and confirmed pathologically on biopsy or excision. All patients were treated surgically and five patients required adjuvant radiotherapy. One patient had recurrence requiring re-excision. Seven patients (43.8%) had transient facial paresis post-operatively and one had Frey syndrome. Median follow-up time was 59.7 months (IQR: 18.9-99.3).

Conclusion

The malignant nature of mucoepidermoid carcinoma requires comprehensive, multidisciplinary management. Imaging and tissue sampling by fine needle aspiration give clinicians the best insight into location and nature of the mass. Complete surgical excision with attention to preservation of facial nerve and achieving negative margins is desired.

http://bit.ly/2TDTW0N

Elective neck dissection in oral squamous cell carcinoma: Past, present and future

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Remco de Bree, Robert P. Takes, Jatin P. Shah, Marc Hamoir, Luiz P. Kowalski, K. Thomas Robbins, Juan P. Rodrigo, Alvaro Sanabria, Jesus E. Medina, Alessandra Rinaldo, Ashok R. Shaha, Carl Silver, Carlos Suárez, Manuel Bernal-Sprekelsen, Alfio Ferlito

Abstract

In 1994 a decision analysis, based on the literature and utility ratings for outcome by a panel of experienced head and neck physicians, was presented which showed a threshold probability of occult metastases of 20% to recommend elective treatment of the neck. It was stated that recommendations for the management of the cN0 neck are not immutable and should be reconfigured to determine the optimal management based on different sets of underlying assumptions. Although much has changed and is published in the almost 25 years after its publication, up to date this figure is still mentioned in the context of decisions on treatment of the clinically negative (cN0) neck. Therefore, we critically reviewed the developments in diagnostics and therapy and modeling approaches in the context of decisions on treatment of the cN0 neck. However, the results of studies on treatment of the cN0 neck cannot be translated to other settings due to significant differences in relevant variables such as population, culture, diagnostic work-up, follow-up, costs, institutional preferences and other factors. Moreover, patients may have personal preferences and may weigh oncologic outcomes versus morbidity and quality of life differently. Therefore, instead of trying to establish "the" best strategy for the cN0 neck or "the" optimal cut-off point for elective neck treatment, the approach to optimize the management of the cN0 neck would be to develop and implement models and decision support systems that can serve to optimize choices depending on individual, institutional, population and other relevant variables.

http://bit.ly/2GEi67F

The Tooth Crossing the Confinement of Mandible: An Unique Expression of Central Variety of Dentigerous Cyst

Abstract

Dentigerous cyst (DC) is the most common developmental cyst that occurs in either jaw with a reported frequency of 18.1% (Jones et al. J Oral Pathol Med 35:500–507, 2006). DC literally means a tooth bearing cyst, and it is named due to the fact the it is almost always associated with an impacted or unerupted tooth in the jaw. The most common tooth involved by DC is mandibular third molar, since it is most common tooth to get impacted, followed by mandibular canine, maxillary third molars and mandibular premolars and less commonly maxillary central incisor. However, the association of mandibular second molar is unusual with an incidence of about 1.1%. We report a case of a 28 years old male diagnosed with an impacted mandibular third molar associated with DC and its surgical management.

http://bit.ly/2GE9sWL

CemiplimAb Survivorship Epidemiology

Condition:   Cutaneous Squamous Cell Carcinoma
Intervention:   Drug: cemiplimab
Sponsor:   Regeneron Pharmaceuticals
Not yet recruiting

http://bit.ly/2E5uiwB

A Study to Assess the Safety and Pharmacokinetics of Verinurad and Allopurinol in Asian and Chinese Subjects

Condition:   Chronic Kidney Disease
Interventions:   Drug: Verinurad;   Drug: Allopurinol;   Drug: Placebo
Sponsors:   AstraZeneca;   Parexel
Recruiting

http://bit.ly/2GyQnp0

The Tooth Crossing the Confinement of Mandible: An Unique Expression of Central Variety of Dentigerous Cyst

Abstract

Dentigerous cyst (DC) is the most common developmental cyst that occurs in either jaw with a reported frequency of 18.1% (Jones et al. J Oral Pathol Med 35:500–507, 2006). DC literally means a tooth bearing cyst, and it is named due to the fact the it is almost always associated with an impacted or unerupted tooth in the jaw. The most common tooth involved by DC is mandibular third molar, since it is most common tooth to get impacted, followed by mandibular canine, maxillary third molars and mandibular premolars and less commonly maxillary central incisor. However, the association of mandibular second molar is unusual with an incidence of about 1.1%. We report a case of a 28 years old male diagnosed with an impacted mandibular third molar associated with DC and its surgical management.

http://bit.ly/2GE9sWL

A Case‐control Study of the Association between Sialolithiasis and Osteoporosis

Abstract

Objective

The purpose of this study was to evaluate the association between osteoporosis and salivary gland stone using a population‐based claims database.

Design

A case‐control design.

Setting

Taiwan.

Participants

We retrieved the sample for this case‐control study from the Taiwan "Longitudinal Health Insurance Database 2005". All 557 patients aged 40 years or older with a diagnosis of sialolithiasis were cases and 1671 matched controls (without sialolithiasis) were selected.

Subjects and Methods

We used the chi‐square test to explore differences between cases and controls on socio‐demographic characteristics. Furthermore, conditional logistic regressions were used to examine the association of sialolithiasis with previously diagnosed osteoporosis.

Results

Of 2228 sampled patients, 171 (7.68%) had ever been previously diagnosed with osteoporosis; 58 (10.41%) among cases and 113 (6.76%) among controls (p=0.005). Conditional logistic regression analysis found that the odds ratio (OR) of prior osteoporosis for cases was 1.79 (95% confidence interval [CI]: 1.24‐2.59, p=0.002) relative to controls after adjusting for urbanization, and the selected medical co‐morbidities. Furthermore, we found that among patients aged ≥65 years, the adjusted OR of prior osteoporosis for cases was 1.89 (95% CI=1.02‐3.51).No significant relationship was observed among patients aged <65 years old.

Conclusion

This study demonstrates an association between sialolithiasis and osteoporosis. Although the finding warrants further investigation, the results call for more awareness of the possible concurrence of osteoporosis among physicians and patients with salivary gland stones.

This article is protected by copyright. All rights reserved.

http://bit.ly/2SzRBXB