Maxillary Sinus Augmentation Using a Titanium Mesh: A Randomized Clinical Trial

BACKGROUND: Various attempts have been implemented using different materials and techniques to augment the maxillary sinus floor for prospect dental implant positioning.AIM: This contemplate was conducted to assess the osteogenic capability of the maxillary sinus in a two-step sinus membrane elevation using titanium mesh to keep the formed space to place dental implants in atrophic ridges.MATERIALS AND METHODS: Titanium micromesh was customized and positioned into the sinus on one side to preserve the elevated membrane in position. On the other side xenograft was applied. Instant and 6-months postoperative cone beam computed tomography (CBCT) was done to assess the gained bone height and density. Bone core biopsies were obtained during implant placement for histological and histomorphometric evaluation.RESULTS: The average bone height values increased in both groups. Meanwhile the average bone density value was higher at the graft group than the titanium mesh group. Histological and histomorphometric evaluation presented the average bone volume of the newly formed bone in the graft group which is superior to that of the titanium mesh group.CONCLUSION: The use of the titanium micromesh as a space-maintaining device after Schneiderian membrane elevation is a trustworthy technique to elevate the floor of the sinus without grafting

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine. </jats:sec

Role of MRI in the assessment of treatment response after radiofrequency and microwave ablation therapy for hepatocellular carcinoma

Purpose: The purpose of this study was to assess the role of dynamic contrast enhanced and diffusion MR imaging in the detection of tumor viability after radiofrequency and microwave ablation therapy of hepatocellular carcinoma. Subjects and methods: The study was done on 50 patients with HCC underwent radiofrequency or microwave ablation. Patients were classified into resolved group if there’s no MRI evidence of tumor viability at the ablated lesion and unresolved group if there’s evidence of tumor viability. Results: In the early 1 month post-ablation period, heterogenous signal of the ablation zone in the precontrast T1 and T2 images was noted that gradually become more homogenous in the 3–12 months follow-up. Ill defined persistent perilesional enhancement is considered as a benign finding that was present in 100% of patients imaged within the 1st month and persists only in 5% after 9–12 months. The mean ADC value of the malignant lesions was 0.91 ± 0.09 × 10−3 mm2/s, while the mean ADC value of the benign post-ablation parenchymal changes was 1.29 ± 0.12 × 10−3 mm2/s with a cutoff value of 1.05 × 10−3 mm2/s. Conclusion: MRI provides a powerful tool in the assessment of treatment response after RFA and MWA of hepatocellular carcinoma

Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding

The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P=0.223; P=0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB

Effect of Titanium and Vanadium on Antioxidants Content and Productivity of Red Cabbage

The present work studied the effect of foliar spray of different concentrations of titanium (Ti, applied as titanium dioxide) and vanadium (V, applied as vanadium pentoxide) on growth, chemical composition, antioxidant contents, antioxidant enzymes, antioxidant capacity, yield and quality criteria of red cabbage plants. For this purpose, 2.0, 4.0 and 6.0 mg L&minus;1 of Ti and V were used to treat red cabbage plants. The control plants were treated with tap water. Our results showed that plants treated with 4.0 mg L&minus;1 of Ti recorded the highest values of plant growth and bioactive compounds, while antioxidant capacity was decreased compared to the other treatments. In addition, plants treated with Ti and V at 2.0 and 4.0 mg L&minus;1, respectively, showed higher values of all of the growth, yield, non-enzymatic antioxidants and antioxidants enzymes&rsquo; parameters compared to the untreated plants. Based on the obtained results, it could be concluded that the low concentrations of both Ti and V (2.0 and 4.0 mg L&minus;1) were able to enhance red cabbage growth and yield, as well as the antioxidant contents, enzymes and capacity

Effect of Titanium and Vanadium on Antioxidants Content and Productivity of Red Cabbage

The present work studied the effect of foliar spray of different concentrations of titanium (Ti, applied as titanium dioxide) and vanadium (V, applied as vanadium pentoxide) on growth, chemical composition, antioxidant contents, antioxidant enzymes, antioxidant capacity, yield and quality criteria of red cabbage plants. For this purpose, 2.0, 4.0 and 6.0 mg L−1 of Ti and V were used to treat red cabbage plants. The control plants were treated with tap water. Our results showed that plants treated with 4.0 mg L−1 of Ti recorded the highest values of plant growth and bioactive compounds, while antioxidant capacity was decreased compared to the other treatments. In addition, plants treated with Ti and V at 2.0 and 4.0 mg L−1, respectively, showed higher values of all of the growth, yield, non-enzymatic antioxidants and antioxidants enzymes’ parameters compared to the untreated plants. Based on the obtained results, it could be concluded that the low concentrations of both Ti and V (2.0 and 4.0 mg L−1) were able to enhance red cabbage growth and yield, as well as the antioxidant contents, enzymes and capacity.</jats:p