Publications in Plastic Surgery and Reconstruction: A Review from a Developing Country, Sudan.

Background: Plastic and reconstructive surgery services need to be improved in developing African countries. Research and article publications from those countries are limited. This review was conducted to identify published articles from Sudan in the area of plastic and reconstructive surgery. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for the preparation of this systematic review. A comprehensive systematic search was performed using PubMed, ScienceDirect, and Web of Science databases. Articles published in Sudan, specifically in the area of plastic and reconstructive surgery, and written in English were included in this review. Results: The total number of articles that fulfilled the inclusion criteria was 23. The articles were written from 1969 to 2023. Only two articles were published in the 20th century. The most common study type was a retrospective study of eight articles, and the most common study area was Khartoum Teaching Hospital. Regarding the publishing journals, the number of subscription journals was six (30%), whereas open access was 17 (70%). Conclusion: This review demonstrates the lack of articles published on plastic surgery in Sudan. Further investigation is needed to determine the challenges and problems associated with possible clarifications.

Retraction: A Rare Case of Solitary Schwannoma of Submandibular Gland.

[This retracts the article DOI: 10.7759/cureus.21373.].

Scrophularia peyronii Post. from Jordan: Chemical Composition of Essential Oil and Phytochemical Profiling of Crude Extracts and Their In Vitro Antioxidant Activity.

The genus Scrophularia is one of the largest genera belonging to the Scrophulariaceae family. Different members of the genus exhibit an interesting, wide spectrum of bioactivities. Accordingly, the current study aimed to investigate, for the first time, the chemical composition of the essential oil of Scrophularia peyronii Post. from Jordan. Additionally, extracts obtained from the aerial parts with solvents of different polarities were assayed for their phytochemical constituents and in vitro antioxidant activities. The major constituents detected in the essential oil, as revealed by GC/MS analysis, contained mainly Z,Z-farnesyl acetone (11.04%), ß-elemene (6.36%), n-octanal (5.98%), and spathulenol (4.58%). Each of the aqueous methanol (Sp-M) and butanol (Sp-B) extracts contained flavonoids, saponins, anthraquinone, and glycosides. Both extracts were evaluated for their total phenolic content (TPC), total flavonoid content (TFC), and their in vitro antioxidant activity, which were assayed using the DPPH radical scavenging activity and ABTS radical scavenging methods. Additionally, the two extracts were then subjected to LC-ESI-MS/MS for the qualitative determination of their secondary metabolite content, especially in flavonoids and phenolic compounds. The results showed that the Sp-B extract of S. peyronii had the highest contents of both phenolic compounds and flavonoids and showed high radical scavenging activity, as determined by the two assay methods, when compared with the Sp-M extract. The LC-ESI-MS/MS analysis resulted in the detection of 21 compounds, including 8 flavonoids, 6 phenolic acids, 6 iridoids, and 2 acids. Although the majority of compounds were detected in both extracts, it was noticed that scropolioside B, 6'-O-cinnamoylharpagide, isoferulic acid, and 6-O-methylcatapol were only detected in the Sp-M fraction.

Single-Anastomosis Sleeve Jejunal Bypass as a Treatment for Morbid Obesity: A Systematic Review and Meta-Analysis.

Single-anastomosis sleeve jejunal (SASJ) bypass is a bariatric surgery technique with promising results. However, evidence of its efficacy and safety is still lacking. This study aimed to summarize the evidence regarding the efficacy and safety of SASJ bypass surgery in the treatment of morbid obesity. The literature was searched for English-language studies published from inception till November 26, 2023, on MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, Scopus, SCINAPSE, and Google Scholar. The search terms included "morbid obesity," "bariatric surgery," and "single anastomosis sleeve jejunal bypass." Extracted data included the body mass index (BMI) before and after surgery, percent total weight loss (%TWL), percent excess weight loss (%EWL), and improvement in preoperative comorbidities. Pooling of the data was done using random effects or fixed-effect models based on the presence of significant heterogeneity. Nine studies were included in this systematic review and meta-analysis. The change in BMI from baseline at 12 months after SASJ bypass was significant (standardized mean difference (SMD) = -3.576, 95% confidence interval (CI) = -5.423, -1.730; I² = 99.23%). At 12 months after surgery, the pooled %TWL was 42.526 (95% CI = 37.948, 47.105; I² = 97.15%), and the pooled %EWL was 75.258 (95% CI = 67.061, 83.456; I² = 99.26%). The pooled incidence of postoperative improvement in diabetes mellitus was 91% (95% CI = 79.6%, 98%, I² = 82%). The overall rate of complications was 9.9% (95% CI = 2.5%, 21.6%; I² = 92.64%). Regarding the short- and mid-term outcomes, SASJ bypass is a safe and effective procedure for weight loss in patients with morbid obesity, with an acceptable rate of complications. The procedure is also associated with a marked improvement in obesity-related comorbidities.

Dupilumab: An emerging therapy in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

Mesenteric Panniculitis and COVID-19: A Rare Association.

Coronavirus disease 2019 (COVID-19) typically involves the respiratory system, but gastrointestinal involvement is common. Further, patients with severe COVID-19 are at high risk to develop gastrointestinal complications, including bowel ischemia, ileus, and deranged liver enzymes. We present the case of a 44-year-old woman with mild COVID-19 pneumonia who was in home isolation. Ten days after the isolation, the patient presented to the emergency department complaining of generalized abdominal pain that was sharp in nature and associated with nausea and recurrent episodes of vomiting. The patient did not complain of any respiratory symptoms. Physical examination showed diffuse tenderness with no clinical signs to suggest generalized peritonitis. The laboratory parameters showed normal hematological, renal, and hepatic profiles. No elevation in the inflammatory markers was observed. The amylase level was within the normal range. Abdominal computed tomography scan demonstrated the presence of misty mesentery with increased density of the mesentery with fat stranding encasing the mesenteric vessels along with mesenteric adenopathy. Such radiological features suggested the diagnosis of mesenteric panniculitis. Subsequently, intravenous corticosteroid therapy was initiated and the patient exhibited significant improvement after 24 hours. The patient was discharged after nine days of hospitalization. She was followed up after one month and she had no complaints. Mesenteric panniculitis is a rare idiopathic inflammatory condition involving the mesenteric adipose tissue. The case shed a light on the possible association of COVID-19 with mesenteric panniculitis. The clinical manifestations of mesenteric panniculitis are non-specific and imaging studies are essential to suggest the diagnosis.

A Rare Case of Solitary Schwannoma of Submandibular Gland.

Tumors of the salivary gland constitute a heterogeneous group of variable histological and biological behaviors. Patients with salivary gland tumors typically present with painless swelling. However, several neoplastic and non-neoplastic pathologies can result in salivary gland enlargement. We report the case of a 35-year-old woman complaining of a left neck swelling for 3 months duration. She had no relevant past medical or surgical history. On examination, there was a left submandibular swelling that was firm in consistency, non-tender, non-pulsatile, relatively mobile, and was not tethered to the underlying structures. Otherwise, examination of the head and neck was unremarkable. A CT scan of the neck revealed a well-defined hypodense lesion in the left submandibular region with foci of calcification along with multiple enlarged lymph nodes. After surgical exploration, the submandibular gland region, a mass lesion was found arising from the submandibular gland. Histopathological examination revealed the diagnosis of schwannoma. Salivary gland schwannoma is a very rare form of neurogenic tumor. Surgical resection is the treatment of choice; however, neural deficits are important and common postoperative complications.

Significance of BRAFV600E mutation in intra-axial brain tumor in Malaysian patients: case series and literature review.

BACKGROUND: To date, BRAF mutations in brain tumor patients have not been characterized in the Malaysian population. Based on the numerous reported studies, there are main mutations that exist in BRAF gene in various types of cancers. A missense mutation in codon 600 of the BRAF nuclear oncogene (BRAFV600E) is the most prevalent hotspot point mutation that has been identified in multiple human malignancies. AIM: We here aimed to find out the frequency of BRAFV600E mutation in a series of Malaysian patients with brain tumors and if any association exists between BRAFV600E mutation and clinicopathological features of patients. MATERIAL AND METHODS: Fresh frozen tumor tissue samples from 50 Malaysian brain tumor patients were analyzed for BRAFV600E mutational status, and its correlation with clinicopathological features (including age, gender, and tumor localization such as intra-axial: within the brain substance or extra-axial: outside the brain substance) was examined. RESULTS: The overall BRAFV600E mutation frequency was determined to be 22% (in 11 of 50 patients). BRAFV600E was significantly correlated with the tumor location group, which shows BRAFV600E was more frequent in the intra-axial tumor than the extra-axial tumor group. In this study, we also observed that male patients were slightly more susceptible to BRAFV600E mutation, and this mutation was predominant in patients of the age group < 40 years. However, these parameters did not translate to statistical significance. CONCLUSION: The data demonstrate that BRAFV600E mutation is observed significantly more often in intra-axial brain tumor patients, which can serve as baseline information for further research on genetic alteration that occurs during brain tumor progression in the Malaysian population.

Laparoscopic management of a small bowel obstruction caused by an unusual pericecal hernia: Case report.

INTRODUCTION: Pericecal hernia is a rare type of internal hernia and may present with unspecific signs and symptoms. Thus, preoperative recognition of pericecal hernias can be challenging and difficult. CASE PRESENTATION: We present a case of pericecal hernia in a rare location that was managed laparoscopically. A 63-year-old medically free gentleman presented to the emergency room with clinical and radiographic evidence of small bowel obstruction. An abdominal computed tomographic scan showed diffuse small bowel dilation and a transitional zone at the distal illeal loop near the ileocecal junction. The patient was admitted and started on conservative management. Two days later, there was no improvement in the patient's situation, and the patient underwent laparoscopic exploration where part of the distal ileum was seen going through a mesenteric defect superior to the ileocecal valve. The herniated bowel was reduced, and the hernia orifice was closed with sutures. The patient was discharged at day 9 postoperatively with excellent clinical and radiographic findings during the postoperative period. DISCUSSION: Pericecal hernia in the superior ileocecal recess is the least common location for this type of hernia. Previously, laparoscopic management of small bowel obstruction was not recommended. However, recent evidence has shown excellent outcomes of laparoscopic management of pericecal hernia. CONCLUSION: In pericecal hernia, having a high index of suspicion may help prevent delayed diagnosis and management. Laparoscopic exploration is a safe and acceptable modality for the diagnosis and treatment of small bowel obstruction due to pericecal hernias.

The use of magnetic resonance phase-contrast cine in Chiari malformation with syringomyelia.

INTRODUCTION: Chiari malformation (CM) is a disorder of mesodermal origin and is commonly associated with syringomyelia. Foramen magnum decompression is the first-line of standard treatment in symptomatic patients with a confirmed radiographic diagnosis. Magnetic resonance (MR) cine allows accurate evaluation of cerebrospinal fluid (CSF) physiology at the craniovertebral junction but often this is under-utilised in Malaysia. METHODS: In this series, we looked into nine cases of CM with syringomyelia from clinical and radiological perspective before and after surgery. The radiological parameters were herniated tonsillar length, syrinx: cord ratio, syrinx length and diameter. Flow velocity and morphologic changes in Chiari were illustrated. RESULTS: Seven patients showed either reduction in syrinx length, syrinx: cord ratio or both postoperatively. Clinical recovery somewhat varied in motor and sensory symptoms. Four patients gained better functional grade in modified Rankin scale (MRS) while the rest remained similar. The study highlighted the advantage of CSF flow dynamics information over MR anatomical radiographic improvement in addressing the neurologic and functional recovery. We also discussed the practicality of cine sequence in preoperative patient selection, syrinx analysis and postoperative flow evaluation in anticipation of clinical outcome. CONCLUSION: Phase-contrast cine MRI is a useful tool dictated by resource availability. We recommend its routine use in preoperative analysis and subsequent observational follow-up after surgery.

Surgical management of a retropharyngeal pseudomeningocele: Case report.

INTRODUCTION: Retropharyngeal pseudomeningocele is a very rare form of pseudomeningocele, that is known to be associated with cervical trauma. Identifying such pathology can be challenging leading to delayed management. CASE PRESENTATION: We report a case of post-traumatic retropharyngeal pseudomeningocele that was managed surgically in a 21-year-old gentleman with poly-trauma injuries due to a motor vehicle accident. After 10 weeks since the traumatic event, magnetic resonance imaging (MRI) and computerised tomography (CT) scan showed evidence of bilateral atlanto-occipital dislocation and a fluid collection of 8 × 4 × 2 cm in the retropharyngeal space. The patient was found to have dysphagia and muffled voice with difficult visualisation of the vocal cords upon examination. After a multidisciplinary team decision, the patient underwent cerebrospinal fluid (CSF) leak management, pseudomeningocele resection and dural defect repair with shunting conducted by the Neurosurgery and Otolaryngology. Postoperative assessments and patient's symptoms, at 9 months follow-up, were satisfactory and reassuring. DISCUSSION: It's believed that conservative management with bed rest, elevation of bed head and acetazolamide is the initial step in management. As an alternative measure, shunting of the CSF had led to resolution of the collection. However, surgical removal of the collection and direct dural defect repair have been suggested in the literature but needed to be properly studied. CONCLUSION: Early recognition of this condition is important to avoid management delay. With a multidisciplinary approach, surgical management can be safe and an acceptable option for retropharyngeal pseudomeningocele.

Is intra-arterial hepatic chemotherapy painful?

BACKGROUND: Liver metastases are mainly supplied by the hepatic artery, allowing the administration of intra-arterial hepatic chemotherapy (IAHC) while preserving normal parenchyma. The progression-free survival and response rate are prolonged by IAHC which can improve the rate of secondary resectability. Severe abdominal pain requiring high-dose opioids can appear during HIAC administration. This pain is related to extrahepatic infusion and gastroduodenal ulceration. However, intense abdominal pain was observed under oxaliplatin IAHC specifically without any extrahepatic infusion. METHOD: We retrospectively reviewed the charts of 68 patients who received IAHC in our center between 2011 and 2015. Patient's demographics and disease characteristics were collected. Other variables such as the type, duration, and dosage of the chemotherapy administered, as well as the usage of painkillers before, during, or after intra-arterial administration, were also registered. RESULTS: The mean age of the patients was 59 years. 61.7% were male (n = 42). The mean dose of oxaliplatin administered was 162 mg per cure over 6.7-h course. Fifty percent were diagnosed with a left colon cancer, and 85.2% had synchronous liver metastasis. While 47% of patients received IAHC as a third-line therapy, the main chemotherapeutic drug was oxaliplatin (85.2% of cases; n = 58), then OPTILIV protocol (5FU, irinotecan, oxaliplatin) (13.3%; n = 9), and mitomycin C (1.5%; n = 1). A dose reduction of 23.6% had been noted in 58.8% (n = 40) cases due to adverse effects. Among patients who received opioids during IAHC (n = 40), 20% required opioids in intercure. Before, during, and after IAHC administration, patients complained of abdominal pain in 8.8%, 58.8%, and 19.1%, and opioids were used in 10.2%, 57.3%, and 19.1%, respectively. The main onset of pain occurs during the third cycle of chemotherapy. Among our patients, 11.7% and 22% had ulcer and extrahepatic perfusion, respectively, while 7.3% of them were asymptomatic. The mean occurrence of these signs was during the fourth cycle of IAHC. 33.8% and 52.9% of patients had abdominal pain while an extended and short infusion time, respectively. CONCLUSION: Lengthening of the infusion time did not prevent the occurrence of abdominal pain significantly but was nonetheless decreased compared with patients undergoing short infusion durations. Pain was more common in patients who did not have a dose reduction and who presented with ulcer and extrahepatic perfusion. Abdominal pain occurred on average one cycle before ulcer or extrahepatic perfusion diagnosis. In current practice, pain should be an alarming indicator in patients receiving IAHC, as it may be associated with ulcer or extrahepatic perfusion and thus requiring opioids.

Unilateral Exserohilum Allergic Fungal Sinusitis in a Pediatric Host: Case Report.

INTRODUCTION: Allergic fungal sinusitis (AFS) is a result of an inflammatory reaction to fungi in the nasal and paranasal sinuses. Although the causative agents of AFS vary, Exserohilum species are among the rare ones, as only a few cases have ever been reported a few times in the literature. The objective of this report is to highlight this unusual fungal type causing unilateral AFS in Saudi Arabia. PRESENTATION OF THE CASE: We present a case of AFS who initially presented at the age of 15 years, and was operated on in 2015 by another health care provider. He presented again in 2019 complaining of intermittent loss of smell and greenish nasal discharge, mainly from the right side for 3 months, which was associated with right-sided nasal obstruction. Based on the history and physical examination, a diagnosis of refractory chronic rhinosinusitis was made. The patient underwent functional endoscopic sinus surgery (FESS) of the paranasal sinuses and polypectomy. Histopathology of the samples taken during the surgery showed Exserohilum specie. The diagnosis of AFS was confirmed using Bent and Kuhn's criteria. DISCUSSION: Allergic fungal sinusitis is believed to be an allergic reaction caused by a broad spectrum of species, the majority being Aspergillus in India and Saudi Arabia. Exserohilum species are one of the rare organisms causing AFS in our region. CONCLUSION: Most cases of AFS in our region have been reported to be caused by Aspergillus. Here we report a case of unilateral Exserohilum AFS in an immunocompetent pediatric patient.

A systematic review of the computerized tools and digital techniques applied to fabricate nasal, auricular, orbital and ocular prostheses for facial defect rehabilitation.

A systematic review was conducted in early 2019 to evaluate the articles published that dealt with digital workflow, CAD, rapid prototyping and digital image processing in the rehabilitation by maxillofacial prosthetics. The objective of the review was to primarily identify the recorded cases of orofacial rehabilitation made by maxillofacial prosthetics using computer assisted 3D printing. Secondary objectives were to analyze the methods of data acquisition recorded with challenges and limitations documented with various software in the workflow. Articles were searched from Scopus, PubMed and Google Scholar based on the predetermined eligibility criteria. Thirty-nine selected papers from 1992 to 2019 were then read and categorized according to type of prosthesis described in the papers. For nasal prostheses, Common Methods of data acquisition mentioned were computed tomography, photogrammetry and laser scanners. After image processing, computer aided design (CAD) was used to design and merge the prosthesis to the peripheral healthy tissue. Designing and printing the mold was more preferred. Moisture and muscle movement affected the overall fit especially for prostheses directly designed and printed. For auricular prostheses, laser scanning was most preferred. For unilateral defects, CAD was used to mirror the healthy tissue over to the defect side. Authors emphasized on the need of digital library for prostheses selection, especially for bilateral defects. Printing the mold and conventionally creating the prosthesis was most preferred due to issues of proper fit and color matching. Orbital prostheses follow a similar workflow as auricular prosthesis. 3D photogrammetry and laser scans were more preferred and directly printing the prosthesis was favored in various instance. However, ocular prostheses fabrication was recorded to be a challenge due to difficulties in appropriate volume reconstruction and inability to mirror healthy globe. Only successful cases of digitally designed and printed iris were noted.

Ambient air quality in the holy city of Makkah: A source apportionment with elemental enrichment factors (EFs) and factor analysis (PMF).

Air pollution remains a major global public health and environmental issue. We assessed the levels of PM2.5 and delineated the major sources in Makkah, Saudi Arabia. Fine particulate matter (PM2.5) sampling was performed from February 26, 2014-January 27, 2015 in four cycles/seasons. Samples were analyzed for black carbon (BC) and trace elements (TEs). PM2.5 source apportionment was performed by computing enrichment factors (EFs) and positive matrix factorization (PMF). Backward-in time trajectories were used to assess the long-range transport. Significant seasonal variations in PM2.5 were observed, Spring: 113 ±â€¯67.1, Summer: 88.3 ±â€¯36.4, Fall: 67.8 ±â€¯24, and Winter: 67.6 ±â€¯36.9 µg m-3. The 24-h PM2.5 exceeded the WHO (25 µg m-3) and Saudi Arabia's (35 µg m-3) guidelines, with an air quality index (AQI) of "unhealthy to hazardous" to human health. Most delta-C computations were below zero, indicating minor contributions from bio-mass burning. TEs were primarily Si, Ca, Fe, Al, S, K and Mg, suggesting major contributions from soil (Si, Ca, Fe, Al, Mg), and industrial and vehicular emissions (S, Ca, Al, Fe, K). EF defined two broad categories of TEs as: anthropogenic (Cu, Zn, Eu, Cl, Pb, S, Br and Lu), and earth-crust derived (Al, Si, Na, Mg, Rb, K, Zr, Ti, Fe, Mn, Sr, Y, Cr, Ga, Ca, Ni and Ce). Notably, all the anthropogenic TEs can be linked to industrial and vehicular emissions. PMF analysis defined four major sources as: vehicular emissions, 30.1%; industrial-mixed dust, 28.9%; soil/earth-crust, 24.7%; and fossil-fuels/oil combustion, 16.3%. Plots of wind trajectories indicated wind direction and regional transport as major influences on air pollution levels in Makkah. In collusion, anthropogenic emissions contributed >75% of the observed air pollution in Makkah. Developing strategies for reducing anthropogenic emissions are paramount to controlling particulate air pollution in this region.

Bilateral Valgus Slipped Capital Femoral Epiphysis in an 11-year-old Girl.

Valgus slipped capital femoral epiphysis (SCFE) is very infrequent, and it is characterized by a superolateral displacement of the epiphysis on the metaphysis. To date, less than 100 cases of valgus SCFE have been described in the literature. Bilaterality of valgus SCFE is extremely rare, and it presents management challenges to the treating orthopedic surgeons. Herein, we report the case of an 11-year-old Saudi Arabian girl presented to clinic with a one-year history of bilateral hip pain and limping. Past medical history was negative for endocrinopathies, hemoglobinopathies, bone disorders, trauma or radiation therapy to the pelvis. On physical examination, the patient looked tall and obese. On clinical examination, the patient showed a waddling gait and an external rotation on walking. A frog-leg lateral radiograph showed bilateral SCFE with a valgus deformity. The right and left femoral neck-shaft angles measured 154.3 and 148.2 degrees, respectively. Computed tomography (CT) scan suggested a moderate bilateral posterior slippage of femoral heads; the right and left femoral head-neck angles measured 60 and 52 degrees, respectively. A final diagnosis of bilateral valgus SCFE was established. Consequently, the patient underwent bilateral percutaneous in situ pinning with single cannulated screws. Postoperatively, the patient made an uneventful recovery. At one-year follow-up, hip radiograph showed bilateral atypical narrowing of the joint space and suspected chondrolysis and the physis of both proximal femoral heads were fused. On the right side, the fixating screw was penetrating into the articular surface of the femoral head with some osteoarthritic changes. Considering the patient's worsening situation, it was decided to perform a revisional surgery. The revisional surgery included the removal of bilateral screws and administration of local steroids and analgesics for pain control. Post-revisional surgery at three months, though the patient was limping with a pelvic tilt, she was able to ambulate with the aid of axillary crutches.

Prevalence of apical periodontitis and quality of root canal treatment in an adult Saudi population.

OBJECTIVES: To determine the health status of periradicular tissue and the quality of root canal fillings in an adult Saudi population attending dental clinics for the first time. Methods: This cross sectional study was conducted  in the dental clinics at King Saud University, Riyadh and other dental centers (Jeddah, Najran, and Albaha City), Kingdom of Saudi Arabia between year 2010   and 2012. Good-quality panoramic radiographs of 926 Saudi subjects (540 males and 386 females)were analyzed based on the gender, age, health status, smoking habits, periapical status of the endodontically treated teeth, technical quality of the root canal fillings, and the presence or absence of coronal restoration. Data were calibrated and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 17.  Results: Of the 25,028 teeth examined, 1,556 teeth (6.2%) had apical periodontitis (AP). Male subjects aged over 55 years and females between 36 and 45 years had higher AP. A total of 36 diabetic and 87 smokers subjects had AP. The AP was more common in male diabetics than female (p=0.383), and in female smokers more than male (p=0.44). Only 42.2% of male and 57.7% of female teeth had adequate root canal treatment.  Conclusions: Apical periodontitis was significantly related to diabetes, smoking, and inadequate endodontic treatment.

Rapid detection of Salmonella Typhi by loop-mediated isothermal amplification (LAMP) method

An in-house loop-mediated isothermal amplification (LAMP) reaction was established and evaluated for sensitivity and specificity in detecting the presence of Salmonella Typhi (S. Typhi) isolates from Kelantan, Malaysia. Three sets of primers consisting of two outer and 4 inner were designed based on locus STBHUCCB_38510 of chaperone PapD of S. Typhi genes. The reaction was optimised using genomic DNA of S. Typhi ATCC7251 as the template. The products were visualised directly by colour changes of the reaction. Positive results were indicated by green fluorescence and negative by orange colour. The test was further evaluated for specificity, sensitivity and application on field samples. The results were compared with those obtained by gold standard culture method and Polymerase Chain Reaction (PCR). This method was highly specific and -10 times more sensitive in detecting S. Typhi compared to the optimised conventional polymerase chain reaction (PCR) method.

Neuronavigation-guided endoscopic management of a pineal region tumour with obscured floor of the third ventricle: case report.

BACKGROUND: Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative. PATIENT: A 17-year-old man became symptomatic from widespread periventricular metastasis of a pineal region tumour which completely obscured the floor of the third ventricle. RESULTS: Endoscopic tumour biopsy followed by neuronavigation-guided endoscopic third ventriculotomy was performed successfully. CONCLUSION: This case report emphasizes the value of neuronavigation-guided endoscopic third ventriculostomy as a feasible surgical alternative for pineal region tumours with widespread periventricular metastasis that obscure the third ventricular floor.