The significance of Epstein Barr Virus (EBV) & DNA Topoisomerase II alpha (DNA-Topo II alpha) immunoreactivity in normal oral mucosa, Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC)

<p>Abstract</p> <p>Background</p> <p>Head and neck cancer including oral cancer is considered to develop by accumulated genetic alterations and the major pathway is cancerization from lesions such as intraepithelial dysplasia in oral leukoplakia and erythroplakia. The relationship of proliferation markers with the grading of dysplasia is uncertain. The involvement of EBV in oral carcinogenesis is not fully understood.</p> <p>Aim</p> <p>The present study was designed to investigate the role of EBV and DNA Topoisomerase II∝ (DNA-Topo II∝) during oral carcinogenesis and to examine the prognostic significance of these protein expressions in OSCCs.</p> <p>Methods</p> <p>Using specific antibodies for EBV and DNA-Topo II∝, we examined protein expressions in archival lesion tissues from 16 patients with oral epithelial dysplasia, 22 oral squamous cell carcinoma and 20 normal oral mucosa by immunohistochemistry. Clinical information was obtained through the computerized retrospective database from the tumor registry.</p> <p>Results</p> <p>DNA-Topo II∝ was expressed in all examined specimens. Analysis of Variance ANOVA revealed highly significant difference (P < 0.01) in young aged labial tissues and significant (P ≤ 0.05) in gingival and not significant (P > 0.05) in inferior surface of tongue and in hard palatal tissues. Significant differences were observed between OEDs and NSE (P < 0.001) and SCCs and controls (P < 0.001), also, significant differences could be observed between SCCs and OEDs. DNA-Topo II∝ expression was significantly higher in tumors of low differentiation versus tumors of moderate and high differentiation (P < 0.001), DNA-Topo II∝ expression was correlated with age, tumor size, tumor stage, node metastasis and tumor differentiation, but not with gender and tumor site. None of normal squamous epithelium (NSE) expressed EBV. Heterogenous reactivity for EBV was observed through the series of dysplasia and squamous cell carcinoma. Its expression increased progressively with lymph node metastasis and low tumor differentiation, but no significant association could be observed with other clinicopathological parameters. EBV protein expression was increased with elevated Topo II-∝ LI in OEDs and OSCCs. A tendency to positive correlation between EBV and Topo II∝ expression was observed in OEDs but not in OSCCs.</p> <p>Conclusion</p> <p>EBV and DNA Topo II-αLI expression are possible indicators in oral carcinogenesis and may be valuable diagnostic and prognostic indices in oral carcinoma.</p

Efficacy and Safety of AmBisome in Combination with Sodium Stibogluconate or Miltefosine and Miltefosine Monotherapy for African Visceral Leishmaniasis: Phase II Randomized Trial.

BACKGROUND: SSG&PM over 17 days is recommended as first line treatment for visceral leishmaniasis in eastern Africa, but is painful and requires hospitalization. Combination regimens including AmBisome and miltefosine are safe and effective in India, but there are no published data from trials of combination therapies including these drugs from Africa. METHODS: A phase II open-label, non-comparative randomized trial was conducted in Sudan and Kenya to evaluate the efficacy and safety of three treatment regimens: 10 mg/kg single dose AmBisome plus 10 days of SSG (20 mg/kg/day), 10 mg/kg single dose AmBisome plus 10 days of miltefosine (2.5mg/kg/day) and miltefosine alone (2.5 mg/kg/day for 28 days). The primary endpoint was initial parasitological cure at Day 28, and secondary endpoints included definitive cure at Day 210, and pharmacokinetic (miltefosine) and pharmacodynamic assessments. RESULTS: In sequential analyses with 49-51 patients per arm, initial cure was 85% (95% CI: 73-92) in all arms. At D210, definitive cure was 87% (95% CI: 77-97) for AmBisome + SSG, 77% (95% CI 64-90) for AmBisome + miltefosine and 72% (95% CI 60-85) for miltefosine alone, with lower efficacy in younger patients, who weigh less. Miltefosine pharmacokinetic data indicated under-exposure in children compared to adults. CONCLUSION: No major safety concerns were identified, but point estimates of definitive cure were less than 90% for each regimen so none will be evaluated in Phase III trials in their current form. Allometric dosing of miltefosine in children needs to be evaluated. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov, number NCT01067443

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Accuracy of panoramic radiographic predictor signs in the assessment of proximity of impacted third molars with the mandibular canal

الملخص: أهداف البحث: هدفت هذه الدراسة إلى التحقق من دقة علامات الخطورة في التصوير الاشعاعي البانورامي من خلال الكشف عن وجود أو عدم وجود التكون القشري بين ضرس الرحى السفلي الثالث المدفون والقناة السنخية السفلية في الأشعة المقطعية المخروطية. طرق البحث: دَرست هذه الدراسة الاسترجاعية ٢١٠ ضرسا فكيا سفليا ثالثا منغرسا من ١٣٥ مريضا (بأعمار من ١٧ -٥١ سنة) والذين أظهروا واحدا أو أكثر من علامات الخطر البانورامية السبع المقترحة للتعرض العصبي السنخي السفلي. أُحيل هؤلاء المرضى للفحص بالأشعة المقطعية المخروطية. واستُخدمت الصور ثلاثية الأبعاد لتقييم موقع القناة بالنسبة للضرس الثالث، وقرب القناة من الضرس الثالث وزاوية ميول الضرس الثالث. وقورنت نتائج الأشعة البانورامية والأشعة المقطعية المخروطية. النتائج: كانت نتائج الأشعة البانورامية عندما بينت انقطاع جدار القناة السنخية السفلية، سواء كان ذلك مقترنا أو غير مقترن بإحدى هذه العلامات؛ سواد جذور الضروس الثالثة، وضيق القناة، وانحراف القناة، وبخاصة سواد الجذور، وضيق القناة كان مرتبطا ارتباطا ذا قيمة إحصائية بالاتصال المباشر بين قناة الفك السفلي والأضراس الثالثة المنغرسة في الأشعة المقطعية المخروطية. الاستنتاجات: يُوصى بعمل الأشعة المقطعية المخروطية قبل العملية في الحالات التي تبين سواد الجذور، أو ضيق القناة، أو التي تبين الانقطاع والضيق معا، أو انحراف أو سواد الجذور معا في الأشعة البانورامية. وقد قيمت هذه الدراسة علاقة الخطورة بين العصب السنخي السفلي والأضراس الثالثة في الفك السفلي المنغرسة وآلية الحد من حدوث إصابة ما بعد الجراحة في العصب السنخي السفلي. Abstract: Objectives: This study aimed to validate the accuracy of panoramic radiographic risk signs through detection of presence or absence of corticalization between an impacted mandibular third molar and the inferior alveolar canal on cone beam computed tomography (CBCT). Methods: This retrospective study analyzed 210 impacted mandibular third molars from 135 patients (aged 17–51 years) who showed one or more of the seven previously established panoramic radiographic risk signs of inferior alveolar nerve exposure. These patients were referred for CBCT examination. Three-dimensional images were used to assess the canal position relative to the third molar, the proximity between the canal and third molar, and third molar angulation. The correlation of panoramic findings and CBCT was evaluated using a Chi-square test. Results: Panoramic findings of interruption of inferior alveolar canal wall, isolated or combined with one of these signs (darkening of third molar roots, narrowing of canal, and diversion of canal); darkening of the roots; and narrowing of canal were significantly correlated with direct contact between the inferior alveolar canal and impacted third molars on CBCT (P < 0.001). Conclusion: Preoperative CBCT is recommended for cases showing interruption of canal wall; darkening of the roots or narrowing of the canal; or association between interruption and narrowing, diversion, or darkening of roots in a panoramic view. This study evaluated the risk relationship between the inferior alveolar nerve and impacted mandibular third molars, with the aim of reducing the occurrence of postoperative injury to the inferior alveolar nerve. الكلمات المفتاحية: الأشعة المقطعية المخروطية, قناة الفك السفلي, صورة الأشعة البانورامية, الضرس الثالث, Keywords: Cone beam CT, Mandibular canal, Panoramic radiograph, Third mola

Mechanical ventilation practice in Egyptian pediatric intensive care units

Introduction: Mechanical ventilation is one of the indispensable tools in pediatric intensive care units. Few studies addressed the epidemiology of pediatric patients on mechanical ventilation and the frequently used modes of ventilation. This is the first study to describe the practice of mechanical ventilation (MV) in Egyptian pediatric intensive care units (PICUs). Methods: This prospective observational study was conducted from January 2014 to December 2014 in two pediatric intensive care units at Cairo University Pediatric Hospital. The study included all children who were intubated and mechanically ventilated for more than 12 hours of admission. Pre-coded data was entered into the SPSS version 21 for data analysis. Comparison between groups was performed using Mann Whitney test for quantitative variables and Chi square with Fisher’s exact test for qualitative ones. Multivariate logistic regression model was conducted to explore the significant predictors for PICU mortality. Results: In total, 893 children were admitted and 293 were mechanically ventilated. The incidence of utilizing MV in children was 32.8%. Neurologic causes were the most common reasons for initiation of MV, with 114 (38.9%) cases. The most commonly preferred mode for initiation of MV is SIMV with PS. Complication occurred in 117 (39.9%) of the cases. The most commonly preferred method of weaning was PS with CPAP in 115/154 (74.7%) cases. Mortality occurred in 134/293 (45.7%) of patients. Duration of mechanical ventilation was significantly longer with neuromuscular diseases, and with the occurrence of complications (p<0.001). There was a significant relationship between mortality and higher PRISM III score, cardiovascular cases, sepsis, multiple organ dysfunction syndrome (MODS), ventilator-associated pneumonia (VAP), and with barotrauma. Conclusions: In our practice, MV is used oftentimes with almost a third of admissions requiring intubation for different reasons. Most children are ventilated due to neurologic causes. This study paves the way for improving our knowledge of MV with avoiding the fatal complications

Heterologous live infectious bronchitis virus vaccination in day-old commercial broiler chicks: clinical signs, ciliary health, immune responses and protection against variant infectious bronchitis viruses

Groups of one-day-old broiler chicks were vaccinated via the oculo-nasal route with different live infectious bronchitis virus (IBV) vaccines: Massachusetts (Mass), 793B, D274 or Arkansas (Ark). Clinical signs and gross lesions were evaluated. Five chicks from each group were humanely killed at intervals and their tracheas collected for ciliary activity assessment and for the detection of CD4+, CD8+ and IgA-bearing B cells by immunohistochemistry (IHC). Blood samples were collected at intervals for the detection of anti-IBV antibodies. At 21 days post-vaccination (dpv), protection conferred by different vaccination regimes against virulent M41, QX and 793B was assessed. All vaccination programmes were able to induce high levels of CD4+, CD8+ and IgA-bearing B cells in the trachea. Significantly higher levels of CD4+ and CD8+ expression were observed in the Mass2 + 793B2-vaccinated group compared to the other groups (subscripts indicate different manufacturers). Protection studies showed that the group of chicks vaccinated with Mass2 + 793B2 produced 92% ciliary protection against QX challenge; compared to 53%, 68% and 73% ciliary protection against the same challenge virus by Mass1 + D274, Mass1 + 793B1 and Mass3 + Ark, respectively. All vaccination programmes produced more than 85% ciliary protection against M41 and 793B challenges. It appears that the variable levels of protection provided by different heterologous live IBV vaccinations are dependent on the levels of local tracheal immunity induced by the respective vaccine combination. The Mass2 + 793B2 group showed the worst clinical signs, higher mortality and severe lesions following vaccination, but had the highest tracheal immune responses and demonstrated the best protection against all three challenge viruses

Do dental procedures affect lung function and arterial oxygen saturation in asthmatic patients?

Background: Asthma is a chronic inflammatory condition of the airways. Pain and anxiety triggered by dental treatment can induce the secretion of endogenous catecholamines. When the situation is combined with the use of local anesthetics with vasoconstrictors, it may increase its undesirable effects on the cardiovascular system and respiratory systems. Aim of the work: To evaluate the effects of dental procedures with and without local anesthesia on pulmonary function and arterial oxygen saturation in healthy volunteers and asthmatic patients. Patients and methods: Our study included 30 asthmatic patients, and 20 healthy volunteers. Careful history taking, clinical examination, spirometry and pulse oximetry to measure O2 saturation before and 10 min after dental procedures were obtained. Results: Pulmonary function showed a statistically significant decrease in PEF and O2 saturation in asthmatic patients and a statistically significant decrease in O2 saturation in the healthy group after dental procedures compared to pre-procedure results. Asthmatic patients receiving local anesthesia had a statistically significant decrease in PEF and O2 saturation after dental procedures compared to pre-procedure results. In the healthy group, there was a statistically significant decrease in O2 saturation after dental filling and dental prosthesis and in asthmatic patients after dental filling, extraction, prosthesis, and scaling compared to that before. Conclusion: Asthmatic patients may be at a higher risk of developing oxygen desaturation after dental procedures regardless of their type with and without local anesthesia and a decrease in PEF after dental procedures with local anesthesia

Effect of Probiotics and Natural Extracts on Hygienic Quality of Some Dairy Products

Dairy products are responsible of contamination with multiple microorganisms by different ways during handling, processing, and production, thus it would be unfit for consumption and form a public health hazard. Food borne diseases become a great trouble containing an extensive range of disorders caused by viral, bacterial, parasitic, or even chemical contamination of food. That reflected a problem due to the massive use of traditional antibiotics in human and animal diseases treatment and from this time, the persisted development of new programs of antimicrobial agents has become of rising importance to medicine. Probiotics not only used in treating gastrointestinal disease, but also used in food industry as natural antimicrobial substances which have a lot of bacteriostatic or bactericidal effect against different food borne pathogens. Contamination by foodborne pathogen in foods represents a serious challenge that may lead to severe disorders as toxic infection, food poisoning and intoxication. These pathogens caused illness, mortality and product withdraws. In fact, attention the using of herbal products has increased during the recent decades. Plants play an significant role in human health, it is likely that 25% of modern medicine were originated directly or indirectly from herbs. Many compounds present in plants have been reported to be antimicrobial, allopathic antioxidants, biologically active and have bioregulatory properties that have been proven real anti-bacterial, insecticidal, antifungal, antiparasitic, anti-viral and antioxidants. Aromatic essential oils are used as flavouring and prevent the growth of microbial contaminants and mould in food industry. Recently, probiotic bacteria have been used as substitutes for antibiotics to treat or different prevent intestinal infections. Studies of using natural preservatives either alone or in combination with other alternative have been verified (as probiotic) not only to evaluate synergism but also to produce effective combinations. Finally, we will discuss the effect of probiotic and natural extract on hygienic quality of some dairy products