Trans-antral Endoscopic Assisted Excision of Dentigerous and Radicular Maxillary Cyst; our Experience.

Background: maxillary cysts of dental origin are not common diagnosis. There is still debate about their perfect treatment method. There are many approaches to manage the odontogenic maxillary cysts; either intraoral, sublabial, or transnasal endoscopic approach. In this study, we present our technique of trans-antral endoscopic assisted excision of maxillary cysts of dental origin with assessing feasibility, results, and complications. Results: Thirty-two patients were reported; 14 dentigerous cysts (43.75%) and 18 dental (radicular) cysts (56.25%). Complete cyst removal could be achieved in all cases without jeopardizing the maxillary sinus drainage through its natural ostium to the nasal cavity. Postoperative pain and facial swelling were mild in all cases and resolved within few days. No tooth loss, Sino nasal symptoms, infection or recurrence was reported throughout follow-up period ranging from 2 to 6 years. Conclusion: Trans-antral endoscopic assisted approach for excision of odontogenic maxillary cyst is a reliable, safe, and effective procedure without recurrence, or permanent negative sequels over the long-term follow-up. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-022-01772-9.

Reconstruction of the outer attic wall by cortical bone and bone cement.

OBJECTIVE: To asses using cortical bone and bone pate with and without glass ionomer bone cement (GIBC) for reconstructing the outer attic wall (OAW) defect during cholesteatoma surgery without mastoid cavity obliteration. METHOD: This is a prospective case series of 25 patients who underwent primary surgery for cholesteatoma with presence of OAW defect that was reconstructed by cortical bone graft and bone pate, further fixation of the cortical bone graft in place was done by GIBC in 18 patients. RESULTS: There was significant improvement of persistent otorrhea and hearing loss after surgery (P < 0.001). Recurrence of cholesteatoma was found in 2 patients (8%), residual TM perforation was found in one patient (4%). CONCLUSION: Reconstruction of OAW by cortical bone and bone pate is an effective surgical option to decrease the incidence of recurrence in cholesteatoma surgery. Glass ionomer bone cement can be added safely to fix the cortical bone graft in the OAW defect.

Sphenopalatine Foramen Computed Tomography Landmarks.

OBJECTIVE: The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF). METHODS: Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed. RESULTS: In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ±â€Š2.4, 8.5 ±â€Š1.38, 36.4 ±â€Š2.6, 34.6 ±â€Š4.26, 8.1 ±â€Š1.27, and 13.7 ±â€Š1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638). CONCLUSION: Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.

Vitamin K2 alleviates type 2 diabetes in rats by induction of osteocalcin gene expression.

OBJECTIVES: The biological mechanisms behind the association between vitamin K (Vit K) and glucose metabolism are uncertain. We aimed to analyze the expression of insulin 1 (Ins 1), insulin 2 (Ins 2) and cyclin D2, the expression of adiponectin and UCP-1 . In addition, we aimed to estimate the doses of Vit K2 able to affect various aspects of glucose and energy metabolism in type 2 diabetes. METHODS: Thirty adult male rats were allocated equally into five groups: control group, diabetes mellitus group, and groups 3, 4, and 5, which received Vit K2 at three daily dose levels (10, 15, and 30 mg/kg, respectively) for 8 wk. At the end of the study, blood samples were collected to quantify total osteocalcin, fasting plasma glucose, fasting insulin, and relevant variables. The expression of OC, Ins 1, Ins 2, cyclin D2, adiponectin, UCP-1 genes was analyzed by real-time polymerase chain reaction. RESULTS: After administration of Vit K2, a dose-dependent decrease in fasting plasma glucose, hemoglobin A1c and homeostatic model assessment method insulin resistance, and a dose-dependent increase in fasting insulin and homeostatic model assessment method ß cell function levels, when compared with diabetes mellitus rats, were detected. There was significant upregulation of OC, Ins 1, Ins 2, or cyclin D2 gene expression in the three treated groups in a dose-dependent manner when compared with the diabetic rats. However, expression of adiponectin and UCP-1 were significantly increased at the highest dose (30 mg/kg daily) only. CONCLUSIONS: Vit K2 administration could improve glycemic status in type 2 diabetic rats by induction of OC gene expression. Osteocalcin could increase ß-cell proliferation, energy expenditure, and adiponectin expression. Different concentrations of Vit K2 were required to affect glucose metabolism and insulin sensitivity.

Transconjunctival versus subciliary approach to the infraorbital margin for open reduction of zygomaticomaxillary complex fractures: a randomized feasibility study.

INTRODUCTION: Although some studies addressed the differences between subciliary and transconjunctival approaches, no previous prospective comparative study on displaced zygomaticomaxillary complex (ZMC) fracture that repaired by three-point internal fixation using also upper gingivolabial incision and upper eye lid incision. So, the effect of these incisions on the comparison was not investigated. PURPOSE: The purpose of this study was to compare transconjunctival and subciliary approaches for open reduction and internal rigid fixation (OR/IF) of ZMC fractures. METHODS: This prospective study was carried out on 40 patients had displaced ZMC fractures repaired by OR/IF. Patients were randomly assigned into two equal groups (20 patients for each); subciliary group subjected to subciliary approach and transconjunctival group subjected to transconjunctival approach for inferior orbital rim repair. In both groups, frontozygomatic and zygomaticomaxillary buttresses were also approached by lateral eye brow and superior gingivolabial incision, respectively. Primary outcome measures include accessibility (need for lateral canthotomy), the exposure duration, postoperative pain, early postoperative edema, and operative complications. Secondary outcome measures include dental occlusion, average intrinsic vertical mouth opening, post subciliary scar assessment, late postoperative complication, and opthalmological assessment concerning ectropion, entropion, scleral show, and eye globe affection (enophthalmos or diplopia). RESULTS: The mean duration from incisions to fracture exposure was 13.7 ± 2.17 min in subciliary approach and 14.6 ± 2.31 min in transconjunctival approach with nonsignificant difference (p = 0.1284). Lateral canthotomy was required for proper exposure of the fracture and OR/IF using transconjunctival approach while not needed with subciliary approach. Ectropion and scleral show occurred in 10 and 15% respectively in subciliary group and were not encountered in transconjunctival group. Although postoperative periorbital edema was significantly more sever in transconjunctival group within the first postoperative week (p = 0.028), no persistent periorbital edema was reported. Infection, hematoma, and globe complication were not detected in any patient. All authors characterized all scars of the subciliary group as unnoticeable. CONCLUSION: Transconjunctival approach mostly needs lateral canthotomy that was not needed with subciliary approach. Transient postoperative edema is more in transconjunctival approach while postoperative ectropion and sclera show was detected only with subciliary approach. So, building up of experience in transconjunctival approach will be beneficial for maxillofacial surgeons and more measures to avoid ectropion are needed with subciliary approach.

Intestinal Parasite Infections and Accuracy of Direct Thin and Thick Smear, Formol-Ether Sedimentation, Centrifugal Flotation, and Mini-FLOTAC Techniques Among Patients with Gastrointestinal Tract Disorders from the Greater Cairo Region, Egypt.

The aim of the present study was to assess the frequency of intestinal parasitic infection among patients with gastrointestinal tract disorders from the Greater Cairo region, Egypt. In addition, a comparison was made of the accuracy of direct thin and thick smear, formol-ether sedimentation (FEC), centrifugal flotation (CF), and mini-FLOTAC techniques in the diagnosis of infection. Out of 100 patients, the overall prevalence of parasitic infection was 51%. Only 6% had dual infection. Giardia lamblia was the most common parasite (26%), followed by Hymenolepis nana (20%), Entamoeba coli (8%), and Enterobius vermicularis (3%). Except the statistically significant association between E. vermicularis infection and perianal itching and insomnia (P < 0.001), age, gender, and complaints of the examined individuals had no association with prevalence of parasitic infection. Both FEC and CF were equally the most accurate techniques (accuracy = 98.2%, confidence interval [CI] = 0.95-1.0, and κ index = 0.962), whereas the Kato-Katz method was the least accurate (accuracy = 67.5%, CI = 0.57-0.78, and κ index = 0.333). However, mini-FLOTAC-ZnSO4 was the most accurate for diagnosis of helminthic infection, and FEC was more accurate for diagnosis of protozoal infection (accuracy = 100%, CI = 1.0-1.0, and κ index = 1).

Evaluation of the Anti-schistosomal Effects of Turmeric (Curcuma longa) Versus Praziquantel in Schistosoma mansoni Infected Mice.

BACKGROUND: Curcumin is the major active ingredient of Curcuma longa L., traditionally known as turmeric and has been shown to exhibit a wide range of pharmacological activities including anti-parasitic effect. However, it is found to be water-insoluble and has low bioavailability. The aim of this study was to explore the potential role of turmeric solved in olive oil either alone or in combination with praziquantel (PZQ) in treatment of schistosomiasis mansoni. METHODS: The whole turmeric powder suspended in olive oil (as a solvent) is indicated to S. mansoni-infected mice aiming to study its potential therapeutic role, either alone or in combination with PZQ. RESULTS: Turmeric significantly reduced S. mansoni worm burden and complete absence of adult worms achieved in mice treated with combination of turmeric and PZQ. Turmeric has slight non-significant effect on the oogram pattern in all examined S. mansoni infected mice. Turmeric and PZQ found to exert a significant reduction of granuloma size in comparison with control. However, turmeric has a non-significant effect on granuloma number. On the other hand, turmeric or/and PZQ treated mice showed obvious improvement of pathology with mild cloudy swelling and less hydropic degeneration. CONCLUSION: Turmeric significantly reduced parasite worm burden, granuloma size and consequently the pathology of affected liver, it still far less effective than PZQ.

Prevalence, Clinical Criteria and Sociodemographic Predictors of Trichomonas vaginalis Infection in Suspected Egyptian Women, Using Direct Diagnostic Techniques.

BACKGROUND: The present study aimed to determine the prevalence and associated risk factors of vaginal trichomoniasis in women referred to gynecologic clinic in Benha University Hospital, Egypt. METHODS: Two hundred female patients enrolled in the study. Vaginal samples were obtained from them and examined for T. vaginalis by wet mount, Giemsa stain, Acridine orange (AO) stain and culture on modified Diamond's medium. For analysis of accuracy of the methods used, the receiver operating characteristic (ROC) curve concept with culture as a gold standard was applied. RESULTS: Out of 200 patients, T. vaginalis was found in 22 (11%) patients by any of the diagnostic methods used. The accuracy of AO staining comes next to Diamond's culture (AUC 0.909, sensitivity 81.8%, specificity 100%, CI 0.81-1.0) followed by Giemsa staining (AUC 0.835, sensitivity 68.2%, specificity 98.9%, CI 0.72-0.95). The wet mount was the least accurate method (AUC 0.795, sensitivity 59.1%, specificity 100%, CI 0.67-0.92). There was no significant association between potentially supposed risk factors and trichomoniasis except patients complaining of either dysuria and dyspareunia or back pain and abdominal pain. CONCLUSION: Trichomoniasis is a common disease in our community. Sociodemographic factors do not seem to affect the prevalence among different Egyptian population. For accurate diagnosis, laboratory investigation is essential. A positive wet smear is diagnostic, but negative samples should be examined by methods that are more sensitive.

Quantitation of Blomia tropicalis allergen Blo t 5 in cereal and cereal-based foods consumed in the Nile Delta, Egypt.

The mite Blomia tropicalis has significant prevalence worldwide. Blo t 5 is a major B. tropicalis allergen that has been associated with sensitization and allergic symptoms in many asthmatic patients. Besides house dust, contaminated foodstuffs are an important source of exposure to B. tropicalis allergens. In this study, a double sandwich enzyme-linked immunosorbent assay (ELISA) using mAb 4D4 and biotinylated mAb 4G9 was done to detect Blo t 5 allergen in different types of raw and processed foods, including wheat, corn, rice, bean, wheat and corn flour, cake, and rusk, which were collected from retail stores in the Nile Delta of Egypt. Out of 88 samples, 38 (43.2%) were positive for Blo t 5 allergen with no significant statistical difference in positivity according to food type. In positive samples, the Blo t 5 concentration ranged from 10 ng/g to 790 ng/g. This study showed that Blo t 5 should be considered as an important allergen that presents a risk to the Egyptian population and should become a routine allergen in the skin prick test to improve the management of allergic disease.

CYP1A1 gene polymorphisms and smoking status as modifier factors for lung cancer risk.

OBJECTIVE: Lung cancer remains the most prevalent malignancy worldwide. Susceptibility to lung cancer has been shown to be modulated by inheritance of polymorphic genes. Several metabolic enzymes are currently under investigation for their possible role in lung cancer susceptibility, including members of the cytochrome P450 (CYP) superfamily. The aim of this work was to identify the correlation between CYP1A1 m1 and m2 polymorphisms and lung cancer risk and figure its interactions with smoking as genetic modifiers in the etiology of lung cancer in the Egyptian population. MATERIALS AND METHODS: One hundred and ten patients with lung cancer and one hundred and ten controls were enrolled in the study. CYP1A1 m1 and m2 polymorphisms were determined using polymerase chain reaction restriction fragment length polymorphism. RESULTS: Subjects carrying TC and CC genotypes of CYP1A1 m1 and AG and GG genotypes of CYP1A1 m2 were significantly more likely to develop lung cancer especially squamous cell carcinoma. The proportion of lung cancer attributable to the interaction of smoking and CYP1A1 m1 and CYP1A1 m2 polymorphisms was 32% and 52% respectively. CONCLUSION: Our results revealed that CYP1A1 m1 and m2 polymorphisms contribute to smoking related lung cancer risk in the Egyptian population.

Synergism of CYP2R1 and CYP27B1 polymorphisms and susceptibility to type 1 diabetes in Egyptian children.

CYP2R1 (25α-hydroxylase) catalyzes vitamin D(3) to 25-hydroxyvitamin D(3), while the CYP27B1 (1α-hydroxylase) catalyzes the 25(OH)D(3) to 1, 25(OH)(2)D(3). 1, 25(OH)(2)D(3) prevents the development of autoimmune diabetes. We aimed to investigate CYP2R1 and CYP27B1 genes polymorphisms and susceptibility to type 1 diabetes in children. One hundred and twenty type 1 diabetic patients and One hundred and twenty controls were genotyped for CYP2R1 (rs10741657) and CYP27B1 (rs10877012) polymorphism. GG genotype of CYP2R1 increased risk to develop type 1 diabetes, and CC genotype of CYP27B1 increased risk to develop type 1 diabetes. Our finding suggested that GG genotype of CYP2R1 polymorphism and/or CC genotype of CYP27B1 polymorphism increased the risk of developing of type 1 diabetes in Egyptian children. In addition there was a synergism between GG genotype of CYP2R1 and CC genotype of CYP27B1 regarding the risk of development of type 1 diabetes.

Orbital steroid injection versus oral steroid therapy in management of thyroid-related ophthalmopathy.

BACKGROUND: The aim of this study was to evaluate the efficacy, safety and complications of orbital steroid injection versus oral steroid therapy in the management of thyroid-related ophthalmopathy. METHODS: A total of 29 patients suffering from thyroid ophthalmopathy were included in this study. Patients were randomized into two groups: group I included 15 patients treated with oral prednisolone and group II included 14 patients treated with peribulbar triamcinolone orbital injection. Only 12 patients in both groups (16 female and 8 male) completed the study. RESULTS: Both groups showed improvement in symptoms and in clinical evidence of inflammation with improvement of eye movement and proptosis in most cases. Mean exophthalmometry value before treatment was 22.6 ± 1.98 mm that decreased to 18.6 ± 0.996 mm in group I, compared with 23 ± 1.86 mm that decreased to 19.08 ± 1.16 mm in group II. Mean initial clinical activity score was 4.75 ± 1.2 and 5 ± 1.3 for group I and group II before treatment, respectively, which dropped to 0.83 ± 1.2 and 0.83 ± 1.02, 6 months after treatment, respectively. There was no change in the best-corrected visual acuity in both groups. There was an increase in body weight, blood sugar, blood pressure and gastritis in group I in 66.7%, 33.3%, 50% and 75%, respectively, compared with 0%, 0%, 8.3% and 8.3% in group II. No adverse local side effects were observed in group II. CONCLUSION: Orbital steroid injection for thyroid-related ophthalmopathy is effective and safe. It eliminates the adverse reactions associated with oral corticosteroid use.

Management of neovascular glaucoma with panretinal photocoagulation, intravitreal bevacizumab, and subsequent trabeculectomy with mitomycin C.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of using intravitreal bevacizumab, panretinal photocoagulation, and trabeculectomy with mitomycin C in the management of neovascular glaucoma. PATIENTS AND METHODS: The study included 17 eyes of 15 patients with neovascular glaucoma. Panretinal photocoagulation was performed combined with intravitreal bevacizumab injection (1.25 mg in 0.05 mL). A fornix-based conjunctival flap trabeculectomy with intraoperative mitomycin C (0.4mg/mL for 3min) was then performed. RESULTS: The causes of neovascular glaucoma included: diabetic retinopathy (10 eyes), central retinal vein occlusion (5 eyes), and branch retinal vein occlusion (2 eyes). Complete regression of iris neovascularization after intravitreal bevacizumab injection and panretinal photocoagulation occurred in 14 eyes (82.4%). After trabeculectomy with mitomycin C, mean intraocular pressure was reduced from 42.9±4.2 mm Hg preoperatively to 15.1±2.2, 16.3±2.0, and 19.7±2.1 mm Hg at first week, first month, and sixth months postoperatively, respectively. This reduction was statistically significant (P<0.05). The mean number of antiglaucoma medications used before surgery was 2.8±0.4 (range: 2 to 3) that decreased to 0.8±0.6 (range: 0 to 3) after surgery. Postoperative hypotony (intraocular pressure 7 mm Hg) was observed in 17.6% (3 of 17 eyes), conjunctival dehiscence in 5.9%, shallow anterior chamber in 11.8%, hyphema in 23.5%, choroidal detachment in 11.8%, and epithelial corneal erosions related to applications of mitomycin C in 1 eye (5.9%). CONCLUSIONS: Trabeculectomy with intraoperative mitomycin C after an adjunctive treatment with intravitreal bevacizumab and panretinal photocoagulation is a good treatment modality in the management of eyes with neovascular glaucoma.

Adiponectin and some inflammatory and endothelial markers in type-2 diabetes with and without cardiovascular disease.

This study was designed to examine the association between adiponectin and C-reactive protein (CRP), interleukin-6 (IL-6) and endothelin-1, (ET-1) and their possible role in prediction of type-2 diabetes and development of diabetes and macrovascular complications. Forty subjects were studied. They were classified into four equal groups: Control, newly diagnosed type-2 diabetes, diabetics with old myocardial infarction (OMI) and acute myocardial infarction (AMI) groups. They were matched for body mass index (BMI), age, and sex. Adiponectin and IL-6 were determined by ELISA technique, CRP was determined by immunonephlometry and ET-1 was determined by radioimmunoassay. Adiponectin was found to be decreased in newly diagnosed diabetics (6.64 +/- 2.3 microg/ml), OMI (4.7 +/- 1.05 microg/ml) and AMI (4.23 +/- 0.73 microg/ml) when compared to controls (9.81 +/- 2.2 microg/ml), whereas CRP, IL- 6 and ET-1 were significantly elevated in AMI (18.6 +/- 5.3 mg/l, 12.6 +/- 4.2 pg/ml and 36.8 +/- 10.4 fmol/ml, respectively). The changes were marked in AMI group compared to other diabetic groups. Only adiponectin significantly decreased in newly diagnosed type-2 diabetics, but CRP, IL-6 and ET-1 did not significantly altered in newly diagnosed diabetics (4.9 +/- 1.6 mg/l, 6.9 +/- 2.3 pg/ml and 22.1 +/- 8.6 fmol/ml, respectively) compared to control. Adiponectin correlated negatively with CRP, IL-6 and ET-1, BMI and HbA1c, whereas inflammatory and vascular markers correlated positively with each other and with BMI and HbA1c. In conclusions, adiponectin may be implicated in the development of type-2 diabetes and macrovascular complications and can be used as an early predictor of type-2 diabetes. Whereas, none of the inflammatory and vascular markers can predict diabetes, but can be used as markers of acute vascular events and in follow up of these cases. Immunomodulation of adiponectin may help prevention and treatment of type-2 diabetes and its complications.

Demonstration of species-specific and cross-reactive components of hydatid cyst fluid antigens.

ELISA-hydatid cyst fluid antigen (HCF-Ag-ELISA) and conventional echinococcosis IHAT were assessed for cystic hydatid disease (CHD), confirmed by HCF-Ag immunoblotting assay. The sensitivity of the tests was 94.4% and 83.3% for HCF-Ag-ELISA and IHA respectively. HCF-Ag-ELISA showed some cross-reaction in tumor cases (5.5%), but no cross-reaction was observed in Rheumatoid arthritis patients. IHA showed 100% specificity. To confirm this data SDS-PAGE immunoblotting using HCF-Ag was applied. Echinococcus specific reactions were reported with 44Kda, 34Kda, 29Kda and 8Kda HCF-Ag resolved bands. Cross-reaction was found with 27Kda, 21Kda, 16Kda and 13Kda bands in tumor patients. Moreover, cross-reaction was found with 200Kda, 175Kda, 62Kda, 52Kda and 40Kda in serological anti-Schistosoma antibodies positive cases. So, using specific HCF-Ag components, immunoblotting provided 100% sensitivity and specificity in CHD.

Evaluation of IgM-ELISA versus PCR in diagnosis of recent Toxoplasma gondii infection.

Whereas Toxoplasma gondii infection in the immunocompetent adult usually causes no serious clinical symptoms, congenital infection can lead to abortion or severe disease in the newborn infant. Early diagnosis should be made as soon as possible particularly in pregnant women and newborn babies since early treatment can minimize fetal sequelae. This work evaluates IgM-ELISA and PCR in diagnosis of recent T. gondii infection. The results revealed that PCR detected very recently infected cases (23 out of 70 suspected cases) than IgM-ELISA (only 18 cases). The combination of both tests may help to improve the sensitivity of diagnosis (45% in suspected group) more than either PCR (32.8%) or IgM-ELISA alone (25.7%).