Nuclear Medicine

Distribution of bone tracer uptake in symptomatic knees after ACL reconstruction compared to asymptomatic non-operated knees: a method for better differentiating patient-specific from disease-specific bone tracer uptake in SPECT/CT Abstract Objective To evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic contralateral knees in patients after reconstruction of the anterior cruciate ligament (ACL-R) and to identify typical BTU patterns and threshold values to differentiate pathological from physiological BTU. Methods 53 patients after unilateral ACL-R were retrospectively included in the study. The population was subdivided into a group of symptomatic operated knees and a group of contralateral asymptomatic non-operated knees. BTU was measured in SPECT/CT using a validated anatomical localization-scheme and normalized mean BTU values were calculated in both knees. Wilcoxon signed rank-test and Pearson's rank-correlation coefficient were used (p < 0.05). Results Symptomatic knees after ACL-R showed significantly more BTU than asymptomatic ones (p < 0.01).Based on the measured BTU activity in SPECT/CT in symptomatic operated and asymptomatic non-operated knees, intensity thresholds of pathological BTU were established. A BTU threshold of greater than the Median + 1 SD of the asymptomatic non-operated knee was defined as pathological. In both groups the highest mean BTU was found on the femoral, tibial and patellar articular surfaces, the lowest BTU in femoral and tibial regions far from the joint. Conclusions The established BTU thresholds for SPECT/CT in knees after ACL-R help to differentiate disease-specific from patient-specific BTU. It could be speculated that BTU in asymptomatic knees equates to the preoperative condition of the knee joint before ACL-R. Therefore, the results of this study help to understand in-vivo loading of the knee and ultimately lead to prediction of development of osteoarthritis in an early stage.

18 F-DOPA uptake does not correlate with IDH mutation status and 1p/19q co-deletion in glioma Abstract Objective The role of amino acid positron emission tomography (PET) in glioma grading and outcome prognostication has not yet been well established. This is particularly true in the context of the new WHO 2016 classification, which introduced a definition of glioma subtypes primarily based on molecular fingerprints. The aim of the present study was to correlate 3,4‑dihydroxy‑6‑[18F]‑fluoro-l‑phenylalanine (F-DOPA) uptake parameters with IDHmutation, 1p/19q status, and survival outcomes in patients with glioma. Methods The study population consisted of 33 patients (17 M/16 F, mean age: 46 ± 13 years) who underwent F-DOPA PET/CT for the evaluation of tumor extent before the start of chemo or radiotherapy. The presence of IDHmutation and 1p/19q status was assessed in all the cases. Tumor volume and semiquantitative uptake parameters, namely SUVmax, tumor-to-normal brain ratio and tumor-to-normal striatum ratio, were calculated for each tumor. Imaging-derived parameters were compared between patients stratified according to molecular fingerprints, using parametric or non-parametric tests, where appropriate. The Kaplan–Meier method was used to assess differences of overall survival (OS) and progression-free survival (PFS) between groups. PET parameters were also tested as prognostic factors in univariate Cox survival regression models. Results There were 12 IDH-wild-type and 21 IDH-mutant patients. Stratification according to 1p/19q co-deletion resulted in 20 non-co-deleted and 13 co-deleted patients. Median follow-up time from PET/CT exam was 30.5 months (range 3.5–74 months). Semiquantitative uptake parameters did correlate neither with IDH mutation nor with 1p/19q status. Uptake was similar in low-grade and high-grade tumors, respectively. In addition, F-DOPA uptake parameters, macroscopic tumor volume, or tumor grade did not stratify OS, while a correlation between SUVmax and PFS was shown in the subgroup of astrocytomas. On the other hand, IDH mutation status and presence of 1p/19q co-deletion had a significant impact on survival outcomes. The prognostic value of IDH mutation status was also confirmed in the subgroup of patients with astrocytic tumors. Conclusions F-DOPA uptake parameters do not correlate with tumor molecular and histological characteristics. The predictive value of PET-derived parameters on outcomes of survival is limited.

Fundamental study of radiogallium-labeled aspartic acid peptides introducing octreotate derivatives Abstract Objective Somatostatin receptors are highly expressed in neuroendocrine tumors, and many radiolabeled somatostatin analogs for diagnosis and treatment have been developed. To simultaneously detect not only primary cancer but also bone metastases, this study aimed to develop a positron emission tomography probe using generator-produced nuclide Gallium-68 (T1/2 = 68 min), in which a carrier for primary cancer, a carrier for bone metastases lesions, and a stable gallium complex are introduced into the one molecule. Based on this strategy, the somatostatin receptor-targeted peptide, [Tyr3]-octreotate (TATE), aspartic acid peptide (Dn) with high binding affinity for hydroxyapatite, and Ga-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) as a stable gallium complex were selected. The novel complexes, Ga-DOTA-Dn-TATE (n = 0, 2, 5, 8, or 11), were designed, synthesized, and evaluated. The radiogallium complexes were prepared using the easy-to-handle radioisotope 67Ga due to relatively long half-life. Methods The radiogallium complex precursor DOTA-Dn-TATE was synthesized by the Fmoc-based solid-phase method and by the air oxidation method to form the disulfide bond. [67Ga]Ga-DOTA-Dn-TATE was synthesized by reacting DOTA-Dn-TATE and 67Ga. Hydroxyapatite binding assays, in vitro cellular uptake experiments in AR42J tumor cells, in biodistribution experiments in AR42J tumor-bearing mice, were performed using [67Ga]Ga-DOTA-Dn-TATE. Results The radiochemical purities of [67Ga]Ga-DOTA-Dn-TATE were > 96.0%. In in vitro and in vivo experiments, [67Ga]Ga-DOTA-D11-TATE had a high affinity for hydroxyapatite and highly accumulated in bone. However, the uptake of [67Ga]Ga-DOTA-D11-TATE into somatostatin receptor-positive AR42J cells was lower than that of [67Ga]Ga-DOTA-TATE, and the accumulation of [67Ga]Ga-DOTA-D11-TATE in tumor was significantly low. Conclusion Ga-DOTA-D11-TATE may not be recognized by somatostatin receptor by the introduction of D11, and the charge adjustment may be important for somatostatin receptor-positive cell uptake.

Brain 18 F-FDG distribution: which region is most affected by increased plasma glucose levels?

Clinical feasibility of early scanning after administration of 68 Ga-DOTATOC Abstract Objective Positron emission tomography (PET)/computed tomography (CT) using 68Ga-labeled 1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid-d-Phe1-Tyr3-octreotide (DOTATOC) is usually performed about 1-h post-injection; however, because of rapid blood clearance, the waiting time for scanning could possibly be shortened without affecting diagnostic performance. The purpose of this study was to investigate the feasibility of early scanning at 30 min post-injection. Methods Thirty-eight patients who underwent DOTATOC-PET/CT were analyzed. After administration of 68Ga-DOTATOC, data acquisition was performed twice, at 30-min and 60-min post-injection. The number of known or suspected pathological lesions, and quantitative values of those lesions and physiological uptake were compared. SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion uptake (TLU) were calculated as quantitative values of the pathological lesions. Results A total of 125 known or suspected pathological lesions were found at both timepoints, with no differences between the two datasets. The SUVmax, SUVpeak, MTV, and TLU were highly reproducible, with Spearman's ρ of 0.983, 0.986, 0.918, and 0.981, respectively. The average percent differences (%DIFFave) defined as the differences of the values divided by the value at 1-h post-injection were 11.1% for SUVmax, 8.5% for SUVpeak, 15.1% for MTV, and 20.6% for TLU. Physiological uptake in the two datasets was closely comparable in the pituitary gland (Spearman's ρ = 0.954, %DIFFave = 11.0%), liver (0.989, 3.9%), spleen (0.970, 6.3%), adrenal glands (0.879, 13.0%), and pancreatic uncus (0.946, 12.7%). Conclusion The diagnostic performance of visual interpretation should be comparable between DOTATOC-PET/CT images obtained at 30-min and 60-min post-injection. Some differences between quantitative values may exist; however, they appear to be minimal.

Techniques for generating attenuation map using cardiac SPECT emission data only: a systematic review Abstract To reliably interpret and perform quantitative analysis, attenuation correction for cardiac single-photon emission computed tomography (SPECT) is fundamental. Thus, knowledge of the patient-specific attenuation map for accurate correction is required in SPECT quantitative imaging. The aim of this systematic review is to present general principles of attenuation correction and provide a structured summary of the approaches that have been proposed for generating the attenuation map for cardiac SPECT. We identified relevant articles published in English pertaining to the attenuation map (AM) determination using SPECT emission data only by searching PubMed, EMBASE, Scopus, and Web of Science databases. Moreover, other articles were hand searched. The protocol of this systematic review was registered in PROSPERO and the code given is CRD42017060512. Transmissionless techniques of determining attenuation map including calculated methods, statistical modeling for simultaneous estimation of attenuation and emission, consistency conditions criteria, using scattered data and other methods were reviewed. Methods for performing attenuation map for cardiac SPECT are developing and the progresses made are promising. However, much work is needed to assess the efficacy of the correction schemes in the clinical routine.

The significant value of predicting prognosis in patients with colorectal cancer using 18 F-FDG PET metabolic parameters of primary tumors and hematological parameters Abstract Objects The purpose was to evaluate the correlation of the pre-treatment hematological parameters with metabolic parameters of primary tumor in baseline 18F-FDG PET/CT in patients with colorectal cancer (CRC) and estimate the prognostic value of both. Methods We retrospectively investigated 231 patients with CRC who underwent baseline 18F-FDG PET/CT. Routine blood sampling was tested in the same term. PET parameters in term of hematological parameters and pathological characteristics of primary tumor were compared. Kaplan–Meier survival analysis was performed in the patients without distant metastasis. The differences of disease-free survival between groups were compared by log-rank tests. Results Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were significantly correlated with all the metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG). The patients with NLR > 3 had higher MTV (24.82 ± 18.16 vs 19.06 ± 13.30, P = 0.039) and TLG (219.04 ± 186.94 vs 166.45 ± 146.39, P = 0.047) than those whose NLR ≤ 3. NLR in those patients with distant metastasis was significantly higher than those without distant metastasis (P = 0.018) while LMR in those patients with distant metastasis was significantly lower than those without distant metastasis (P = 0.032). Survival analysis showed that those patients with low MTV (P = 0.015), low NLR (P = 0.008) and high LMR (P = 0.027) revealed significant survival benefit. Conclusions There was a significant association between the pre-treatment hematological parameters and metabolic parameters of baseline 18F-FDG PET/CT in the patients with CRC. It might be helpful in those patients with high NLR and low LMR to undergo 18F-FDG PET/CT to detect distant metastasis and predict prognosis.

Comparison of 18 F-Choline PET/CT and MRI functional parameters in prostate cancer Abstract Aim 18F-Choline (FCH) uptake parameters are strong indicators of aggressive disease in prostate cancer. Functional parameters derived by magnetic resonance imaging (MRI) are also correlated to aggressive disease. The aim of this work was to evaluate the relationship between metabolic parameters derived by FCH PET/CT and functional parameters derived by MRI. Materials and methods Fourteen patients with proven prostate cancer who underwent FCH PET/CT and multiparametric MRI were enrolled. FCH PET/CT consisted in a dual phase: early pelvic list-mode acquisition and late whole-body acquisition. FCH PET/CT and multiparametric MRI examinations were registered and tumoral volume-of-interest were drawn on the largest lesion visualized on the apparent diffusion coefficient (ADC) map and projected onto the different multiparametric MR images and FCH PET/CT images. Concerning the FCH uptake, kinetic parameters were extracted with the best model selected using the Akaike information criterion between the one- and two-tissue compartment models with an imaging-derived plasma input function. Other FCH uptake parameters (early SUVmean and late SUVmean) were extracted. Concerning functional parameters derived by MRI scan, cell density (ADC from diffusion weighting imaging) and vessel permeability (Ktrans and Ve using the Tofts pharmakinetic model from dynamic contrast-enhanced imaging) parameters were extracted. Spearman's correlation coefficients were calculated to compare parameters. Results The one-tissue compartment model for kinetic analysis of PET images was selected. Concerning correlation analysis between PET parameters, K1 was highly correlated with early SUVmean (r = 0.83, p < 0.001) and moderately correlated with late SUVmean (r = 0.66, p = 0.010) and early SUVmean was highly correlated with late SUVmean (r = 0.90, p < 0.001). No significant correlation was found between functional MRI parameters. Concerning correlation analysis between PET and functional MRI parameters, K1 (from FCH PET/CT imaging) was moderately correlated with Ktrans (from perfusion MR imaging) (r = 0.55, p = 0.041). Conclusions No significant correlation was found between FCH PET/CT and multiparametric MRI metrics except FCH influx which is moderately linked to the vessel permeability in prostate cancer.

Count-based method for specific binding ratio calculation in [I-123]FP-CIT SPECT analysis Abstract Objective To calculate the specific binding ratio (SBR) appropriately in dopamine transporter (DAT) imaging, a method for extracting the striatal volume of interest (VOI) was developed. Methods This study included 200 patients (72 ± 10 years) who were suspected of parkinsonian syndromes (PS) or dementia with Lewy body (DLB). The patients were divided into three groups of PS with dopaminergic degeneration, DLB and non-PS after [123I]ioflupane (FP-CIT) SPECT and clinical follow-up. The image data were reconstructed with CT attenuation correction and scatter correction, and with only CT attenuation correction (CTAC). The new method extracted striatal VOI according to the high-level counts and the average striatum volume, and calculated SBR using the reference occipital counts. The SBR values for each patient were obtained using the Tossici-Bolt method (SBRBolt) and our method. Reproducibility of SBR calculation using our method was compared by two operators. Results The mean SBR values for the PS and DLB groups were significantly different from that of the non-PS group with both methods. The coefficients of variation of the SBR were significantly smaller with the proposed method compared with those of SBRBolt (p < 0.001), except for the CTAC images. There were no differences in SBR between the two operators using our method. The diagnostic accuracies with our method for the PS and DLB groups were 98.4 and 96.0%, respectively. Conclusion Our new method for SBR calculation in the FP-CIT SPECT showed less coefficients of variation with high reproducibility, which would be useful for clinical diagnosis and in assessing the severity of diseases in follow-up studies.

The role of 13 N -ammonia in the differential diagnosis of gliomas and brain inflammatory lesions Abstract Objective To investigate the utility of 13N-ammonia PET/CT imaging in the differential diagnosis of gliomas and brain inflammations. Methods 13N-ammonia PET/CT imaging data of 77 patients with gliomas and 34 patients with brain inflammations were retrospectively analyzed. No patients received any treatment before 13N-ammonia imaging. All the patients were diagnosed by stereotactic biopsy or clinical follow-up. Visual and semi-quantitative analysis was performed to analyze the results of 13N-ammonia imaging. Finally, the uptake ratios of each lesion were calculated and its differences among different groups were tested with one-way ANOVA. Results 29.4% inflammations, 51.6% low-grade gliomas and 91.3% high-grade gliomas were positive by visual analysis in 13N-ammonia imaging. The sensitivity, specificity and accuracy for the diagnosis of gliomas were 75.3%, 55.8% and 67.8%, respectively. As for semi-quantitative analysis, the T/G ratios of inflammatory lesions, low-grade gliomas and high-grade gliomas were 0.88 ± 0.24, 1.04 ± 0.43 and 1.43 ± 0.49, respectively. One-way ANOVA revealed that the T/G ratios of high-grade gliomas were significantly higher than those of low-grade gliomas and inflammations (P < 0.05), but there was no statistical difference between low-grade gliomas and inflammations (P = 0.118). Among the inflammatory lesions, T/G ratios were not statistically different between infectious and demyelinating lesions (P > 0.05). ROC curve analysis showed that the optimal cut-off value of T/Gratio in distinguishing gliomas from inflammations was 1.21 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 52.9%, 94.4%, 65.3%, 95.7% and 45.9%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas was 1.06 with the AUC 0.78. The sensitivity, specificity, accuracy, PPV and NPV were 81.5%, 67.7%, 76.5%, 81.5% and 67.7%, respectively. ROC curve analysis showed that the optimal cut-off value of T/G ratio in distinguishing high-grade gliomas from low-grade gliomas and inflammations was 1.19 with the AUC 0.84. The sensitivity, specificity, accuracy, PPV and NPV were 70.4%, 85.1%, 78.5%, 79.2% and 78.1%, respectively. Conclusions 13N-ammonia imaging is effective in distinguishing high-grade gliomas from low-grade gliomas and inflammations, but its role in the differential diagnosis of low-grade gliomas and brain inflammatory lesions is limited, and the accuracy needs to be improved.

Dental Research

Load-deflection characteristics of coated and noncoated nickel-titanium wires in self-ligating brackets using a modified bending test: An in vitro study Tripti Tikku, Rohit Khanna, Akhil Agarwal, Kamna Srivastava, Shashank Shekhar, Ivy Shukla Dental Research Journal 2019 16(1):1-6 Background: To determine and compare the force-deflection values of different types of nickel-titanium (NiTi) wires during unloading phase at varying deflections, that is 1 mm, 1.5 mm, 2 mm, and 2.5 mm, with the use of self-ligating ceramic brackets using modified bending test on a typodont under controlled temperature conditions. Materials and Methods: In this in vitro study total of 45 wires of ovoid shape of three different NiTi wires – pseudoelastic NiTi (Group I), heat activated NiTi (Group II), and esthetic coated NiTi (Group III) for maxillary arch were tested after insertion in ceramic self-ligating brackets bonded to plastic teeth of phantom jaw . The maxillary left lateral incisor was removed to simulate a malpositioned tooth which acted as the load site, and load-deflection characteristics were measured during unloading using Instron, and data analyzed statically by two-way analysis of variance ,Tukey's post hoc test, intraclass correlation coefficient and Pearson correlation coefficient. A two-sided (α = 2) P < 0.05 was considered statistically significant. Results: When wires were compared at each deflection statistically significant difference was observed between the three groups of wires (Group I > Group II > Group III) at all the four levels of deflection except for Group II versus Group III at 1 mm, 1.5 mm, and 2 mm of deflection. Statistically significant difference was noted in mean load values for comparisons made at different deflections for each wire except for the comparison made at 1.5 versus 2 mm for Group II and Group III. Conclusion: Overall comparison showed esthetic coated Ni-Ti wires gave significantly lower mean load values, followed by heat activated and pseudoelastic NiTi wires. Thus, heat activated NiTi wires are best suited in patients with severe malpositions/periodontitis, while for esthetically conscious patients esthetic coated NiTi can be used.

Effects of menthol-flavored substances at the cellular level on oral mucosal sites Nanda Prasad, Sarvesh Vijay, A Yashwanth Reddy, S Nonitha Dental Research Journal 2019 16(1):7-11 Background: The purpose of this study was to determine the effects of menthol-flavored substances at the cellular level in different mucosal sites of the oral cavity and to compare the cellular changes between individuals without the habit of chewing menthol-flavored substances and individuals with the habit. Materials and Methods: This was an experimental cytology study including a total of 500 individuals belonging to the age group of 18–45 years based on the inclusion or exclusion criteria. The selected participants were divided into two groups of 250 participants each, based on participants not having the habit of chewing menthol-flavored substances (Group I) and participants having the habit of chewing menthol-flavored substances (Group II). Cytological smears were taken by gently scraping the mucosal surfaces in different sites of the oral mucosa using a wooden spatula and stained with Papanicolaou, analyzed under microscope for any cellular changes. The results were tabulated and statistically analyzed using Chi-square test and Fisher's exact test. P < 0.05 was considered statistically significant. Results: Micronuclei seen in all the participants belonging to group with the habit of chewing menthol-flavored substances with a P < 0.001 which was considered highly significant. Alteration in the nuclear-cytoplasmic ratio was also seen P = 0.001, which showed significant at 1% significance level. Conclusion: Participants with habit of chewing menthol-flavored substances showed the presence of micronuclei and slight alteration in the nuclear-cytoplasmic ratio, which could be directly related to genotoxicity and cell damage.

Impact of occupational dental erosion on oral health-related quality of life among battery factory workers in Bengaluru, India Amit Kumar, Manjunath P Puranik, KR Sowmya, Soni Rajput Dental Research Journal 2019 16(1):12-17 Background: A greater understanding of impact of occupational dental erosion on oral health-related quality of life (OHRQoL) will sensitize both employee and employers to adopt strict protective measures for oral health. The research aimed to determine the relationship between occupational dental erosion and OHRQoL among battery and other factory workers in Bengaluru, India. Materials and Methods: This cross-sectional comparative study enrolled a total of 400 workers. Structured proforma assessed information on sociodemographic details, oral hygiene practices, adverse oral habits, and work-related practices. OHRQoL was determined using oral health impact profile-14 (OHIP-14). Dental erosion was measured using Smith and Knight's tooth wear index modified by Millward et al. 1994 scoring system independent t-test, Mann–Whitney U-test and Spearman's correlation was performed. P < 0.05 was considered statistically significant. Results: The mean age of the participants in the study and control groups was 43.11 ± 8.02 and 45.93 ± 6.16 years, respectively. Less than half of the participants in the study group had positive behavioral work practice. The prevalence and severity of dental erosion was significantly higher in study group (39.5%) than control group (11.5%). Mean OHIP-14 score was significantly lower in study group (23.88 ± 0.88) than control group (26.06 ± 9.67). Dental erosion significantly correlated with work experience and OHIP-14. Conclusion: The findings highlight the impact of occupational dental erosion on OHRQoL. Measures to enhance occupational safety thereby reducing exposure to occupational hazards are needed.

Comparative investigation of primary stability of four different dental implants in low-density bone model Saied Nokar, Amirali Reza Rasouli-Ghahroudi, Elham Shidvash, Faezeh Atri Dental Research Journal 2019 16(1):18-23 Background: Primary stability is one of the prerequisites of immediate loading. The aim of this study was to compare the primary stability of four different implant systems in low-density bone models. Materials and Methods: In this in vitro experimental study, 20 fixtures from four implant body designs were selected: Zimmer Tapered Screw-Vent (ZTSV), NobleReplace Tapered (NRT), Replace Select Tapered (RST), and Dentium SuperLine (DSL). Fixtures were inserted in low-density bone models according to manufacturer drilling protocol by one surgeon. Measurement of insertion torque value (ITV), resonance frequency analysis (implant stability quotient [ISQ]), and reverse torque value (RTV) was recorded for each fixture. The data were analyzed with one-way ANOVA and post hoc tests (Tukey honestly significant difference) (P < 0.05). Results: ZTSV had significantly lower amount of insertion torque in comparison to other systems (P = 0.045). RTV was significantly lower in ZTSV in comparison to DSL and NRT (P = 0.004). ISQ value in NRT (ISQ = 67) was significantly higher than other systems (P = 0.000). The lowest amount of ISQ was in RST system (ISQ = 53) with significant difference (P = 0.000). Conclusion: This study demonstrated that primary stability of different implant systems was not comparable and implant design was effective on ITV, RTV, and ISQ.

Assessment of antimicrobial activity of different concentrations of Tinospora cordifolia against Streptococcus mutans: An in vitro study Sankalp Agarwal, Priyadarshini H Ramamurthy, Bennete Fernandes, Avita Rath, Preena Sidhu Dental Research Journal 2019 16(1):24-28 Background: The antimicrobial property of Tinospora cordifolia has been tested against a variety of microorganisms in the literature. The present study aimed to assess the antimicrobial activity of different concentrations of commercially available T. cordifolia powder against Streptococcus mutans. Materials and Methods: An in vitro study was undertaken in which extract of T. cordifolia was obtained using 100% ethanol by maceration. Seven different concentrations were prepared and tested against S. mutans in brain–heart infusion agar medium. Plates were incubated aerobically at 37°C for 48 h, and zone of inhibition was measured using Vernier caliper. 0.2% chlorhexidine and dimethylformamide were used as positive and negative controls respectively. The data were analysed by descriptive analytic tests. Results: The maximum antibacterial activity of T. cordifolia was observed with a volume of 40 μl at 2% concentration with a zone of inhibition of 19 mm. A 30 μl volume of 0.2% chlorhexidine showed a zone of inhibition of 28 mm, and no zone of inhibition was observed with dimethylformamide. Conclusion: Tinospora exhibited antimicrobial activity against S. mutans. However, it needs to be confirmed further with in vivo studies.

Association between quality of sleep and chronic periodontitis: A case–control study in Malaysian population Vijendra Pal Singh, Joe Yin Gan, Wei Ling Liew, Htoo Htoo Kyaw Soe, Sowmya Nettem, Sunil Kumar Nettemu Dental Research Journal 2019 16(1):29-35 Background: Periodontitis is a public health concern since it is a major factor in tooth loss worldwide and has association with many systemic diseases. Sleep is a complex and essentially biological process and a critical factor for maintaining mental and physical health. Since inflammation is characteristic of both chronic periodontitis and sleep deprivation, few studies in recent years present the contradictory results regarding this potential association. The objective of the present study was to investigate the association between quality of sleep and chronic periodontitis. Materials and Methods: A total of 200 individuals participated in this study. All participants underwent a comprehensive clinical periodontal examination. Case–control were identified using the Centers for Disease Control and Prevention/American Academy of Periodontology case definitions for periodontal disease. The quality of sleep was assessed by Pittsburgh Sleep Quality Index. The univariate and multivariate logistic regression analysis was used to test the influence of variables (quality of sleep, age, sex, ethnicity, education, and socioeconomic status), in the occurrence of periodontitis. Odds ratio (OR) and respective confidence intervals (CIs) were calculated and reported. P ≤0.05 was considered statistically significant. Results: The prevalence of poor quality of sleep was 56.75% in cases (periodontitis group) and 43.24% in control group. There was positive association between quality of sleep and chronic periodontitis (OR = 3.04; 95% CI = 1.42–6.5; P = 0.004). In multivariate logistic regression analysis, only the age was significantly related to the periodontitis (OR = 1.11; 95% CI = 1.07–1.41; P < 0.001), other variables failed to reach the significant level. Conclusion: Poor quality of sleep was significantly associated with chronic periodontitis. Only the age was significantly related to periodontitis among the other covariable measured.

Sealants revisited: An efficacy battle between the two major types of sealants – A randomized controlled clinical trial B Prathibha, P Parthasarthi Reddy, Md Shakeel Anjum, M Monica, BH Praveen Dental Research Journal 2019 16(1):36-41 Background: The aim of this study is comparing the retention and caries preventive effect of the glass-ionomer fissure sealant and resin-based fissure sealant. Materials and Methods: A randomized-controlled split-mouth study was conducted to compare the retention and the caries preventive effect of light-cured resin-based sealant (3M ESPE) and glass ionomer sealant (Fuji VII). The sealants were applied to either the right or the left lower mandibular molars (7-9 yrs of age) in 120 school children, based on the randomization process. They were recalled for assessment of clinical retention at intervals of 3, 6, and 12 months. The caries-preventive effect between the two materials was tested statistically by the McNemar's test for matched pairs, and the differences observed with regard to the retention of the materials was tested by Chi-square tests. The level of significance was set to be at P < 0.05. Results: At the end of 12th month, sealant retention is found to be higher in the resin-based sealant group compared to the glass ionomer group. In the glass ionomer sealants placed, 101 (91%) were caries-free and 10 (9%) had caries. In the resin-based sealant, 105 (94.60%) had sound teeth and 6 (5.4%) had dental caries (P = 0.34). Conclusion: The glass ionomer sealant was less retentive when compared to resin sealants. The caries incidence between the glass ionomer and resin-based sealants was not statistically significant.

A comparative study of the clinical efficiency of chemomechanical caries removal using Carie-Care gel for permanent teeth of children of age group of 12–15 years with that of conventional drilling method: A randomized controlled trial Priyanka Sontakke, Prateek Jain, Aniket Dhote Patil, Gautam Biswas, Pramod Yadav, Diljot Kaur Makkar, Vikas Jeph, Banu Pyari Sakina Dental Research Journal 2019 16(1):42-46 Background: Dental caries is considered as one of the most serious dental diseases that results in localized dissolution and destruction of the calcified tooth tissues. As possible alternatives to conventional techniques of caries removal, chemomechanical caries removal systems have emerged. This study aims to clinically observe the advantages of chemomechanical method of caries removal over conventional technique. Materials and Methods: Inthis randomized controlled trial a total of 60 children with Class 1 open carious lesions were selected for the study. They were divided into two equal groups according to a method of caries removal (30 chemomechanical and 30 conventional on permanent molars). In Group A, caries was removed using the Carie-Care system and in Group B with the conventional drill and were restored equally with glass ionomer cement. The visual analogy face scale was used to determine the level of anxiety in children at baseline, during treatment and after treatment. Results: The results were subjected to statistical analysis using Student's unpaired t-test. It showed that though chemomechanical technique took a marginal increase in time compared to the conventional technique, it was found to be more comfortable for all the children. Conclusion: Chemomechanical technique though time-consuming is definitely superior compared to the conventional technique provided we use a less technique sensitive restorative material which retains in the oral cavity for longer period. It is definitely a better treatment protocol in school-based dental treatment and atraumatic restorative dentistry compared to the conventional technique.

The effect of office bleaching on the color and bond strength of resin restorations Homayoon Alaghehmand, Marzieh Rohaninasab, Ali Bijani Dental Research Journal 2019 16(1):47-52 Background: Bleaching may affect the bond strength of existing composite fillings and may weaken it. Hence, the aim of this study was to find the best method of in-office bleaching with the least effect on microshear bond strength (MSBS) of existing composite resin fillings to tooth structure. Materials and Methods: In this in vitro study, Class V cavities were prepared on buccal surface of 50 extracted third human sound molars. The cavities in 25 teeth had enamel axial walls, Group E, which were divided into five subgroups of E1 through E5 and in 25 teeth had dentin axial walls, Group D, which were divided into five subgroups of D1 through D5. Cavities were treated with Single Bond 2 adhesive system and restored with composite resin (Z250). The corresponding subgroups received similar bleaching methods and materials; 1 – not bleached, 2 – hydrogen peroxide (HP) 25%, 3 – HP + ultraviolet light, 4 – HP + light-emitting diode-curing device, and 5 – HP + diode laser. Teeth colors were monitored before and after bleaching, and MSBS test and failure modes were examined. Results were analyzed with one-way ANOVA and Kruskal–Wallis tests. P < 0.05 was considered significant. Results: One-way ANOVA did not show differences in MSBS of enamel subgroups but showed significant differences in dentin subgroups (P < 0.00). Adhesive fracture in all of the subgroups was the most frequent mode of failure. Kruskal–Wallis test showed that laser was the most effective instrument to change ΔE. Conclusion: Diode laser was the best method for tooth bleaching because lowering the shear bond strength between composite resin and enamel was minimum and also had the most ΔE in tooth bleaching.

In vitro evaluation of coronal discoloration following the application of calcium-enriched mixture cement, Biodentine, and mineral trioxide aggregate in endodontically treated teeth Solmaz Araghi, Atefeh Khavid, Mostafa Godiny, Mahshid Saeidipour Dental Research Journal 2019 16(1):53-59 Background: This study sought to assess and compare coronal discoloration following the application of white mineral trioxide aggregate, Biodentine, and calcium-enriched mixture cement in endodontically treated teeth. Materials and Methods: In this in vitro experimental study, 64 freshly extracted sound human premolars were selected, cleaned, and stored in saline. After cleaning, shaping, and obturation the root canal of the teeth, the teeth were randomly assigned to one control (n = 4) and three experimental (n = 20) groups. In the experimental groups, the cement were applied over the canal orifices in 3-mm thickness. All teeth were then restored with composite resin. Color parameters, according to the CIE L*a*b* system, were measured using Vita Easyshade spectrophotometer before application of cement and at 1 week, 1 month, 2 months, and 3 months after the application of cement. The recorded values were statistically analyzed using descriptive and analytical statistics. For analytical statistics, Kolmogorov–Smirnov test was applied to assess normal distribution of data. ANOVA was used to compare the results at baseline and repeated measures. P < 0.05 was considered statistically significant Results: Significant differences were noted in color change (ΔE) between all time points except between ΔE4 (2 months) and ΔE5 (3 months) (P < 0.01). However, tooth discoloration caused by the three cement was not significantly different (P = 0.343). Conclusion: The three tested cement were not significantly different in terms of causing coronal discoloration in endodontically treated teeth.

Chronic obstructive pulmonary disease : Adaptive support ventilation versus synchronized intermittent mandatory ventilation

Adaptive support ventilation versus synchronized intermittent mandatory ventilation in patients with chronic obstructive pulmonary disease

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Olfat M.N. A-N El-Shenawy, Mohamed M. A-H Metwally, Alaa E.T.H Abdel-Mabboud, Alaa S Abdel Ghany DOI:10.4103/JCMRP.JCMRP_11_18   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.

Oral gabapentin premedication for post-tonsillectomy nausea, vomiting, and recovery

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Ibrahim M. Abdel Moety, Dina H.A El Barbari, Mohammed M.A Esmael DOI:10.4103/bmfj.bmfj_24_18   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.

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.