Lactoferrin versus Long-Acting Penicillin in Reducing Elevated Anti-Streptolysin O Titer in Cases of Tonsillopharyngitis.

Background: Beta-Hemolytic streptococci are the most frequent bacteria causing tonsillitis. Lactoferrin may play a role in the treatment of chronic tonsillitis due to its direct antimicrobial activity. Objective: To assess the possible role of lactoferrin in reduction of raised serum Anti-Streptolysin O Titer (ASOT) in cases of chronic tonsillopharyngitis in comparison to long acting penicillin. Methods: This study included 117 children with tonsillopharyngitis with high ASOT randomly divided into three groups; group 1 treated with lactoferrin, group 2 treated with long acting penicillin and group 3 treated with both drugs. For all patients ASOT was measured after three and six months of starting treatment. Results: This study included 60 males and 57 females with the mean age (8.5 ± 2.4). There is statistically significant reduction in ASOT in all groups after three months of treatment. ASOT after 3 months was significantly lower in group1 (370±440) and group 3 (350±450) in comparison to group 2 (420±560) with p value 0.02, 0.004, respectively, with no significant difference in comparing group 1 to group 3 p value 0.4. Also, ASO titre after 6 months was significantly lower in group1 (350±420) and group 3 (340±440) in comparison to group 2 (420±550) with p value 0.02, 0.007, respectively, with no significant difference in comparing group 1 to group 3 p value 0.5. In comparing ASOT at three months and six months of treatment in the three studied groups; it decreased by 2% in group 1, and 1.6% in group 3 and no change in group 2. Conclusion: Lactoferrin alone or in combination with long acting penicillin is safe and more effective than long acting penicillin alone in reducing ASOT. Treatment for six months with lactoferrin alone or in combination with long acting penicillin could offer a better response.

Neurogenic Appendicitis: A Reappraisal of the Clinicopathological Features and Pathogenesis.

In 1921; Masson and Maresch first coined the term "neurogenic appendicitis (NA)" to describe "neuroma-like" lesions in the appendix. To date, our knowledge about NA is limited; therefore, we conducted a comprehensive analysis of the literature (1921 to 2020) to examine the clinicopathological features of NA. We also addressed the pathophysiology of acute abdominal pain and fibrosis in this entity. We performed a meta-analysis study by searching the PubMed database, using several keywords, such as: "appendix," "neurogenic," "obliterative," "neuroma," "fibrous obliteration," "appendicopathy," and "appendicitis." Our study revealed that patients with NA usually present clinically with features of acute appendicitis, bud2t they have grossly unremarkable appendices. Histologically, the central appendiceal neuroma was the most common histological variant of NA, followed by the submucosal and intramucosal variants. To conclude, NA represents a form of neuroinflammation. The possibility of NA should be considered in patients with clinical features of acute appendicitis who intraoperatively show a grossly unremarkable appendix. Neuroinflammation and neuropeptides play roles in the development of pain and fibrosis in NA.

Non-Invasive Prediction of Coronary Artery Disease by Multiple Abdominal Fat and Anthropometric Indices: Revisit.

PURPOSE: The aim of this study was to evaluate the efficiency of multiple abdominal fat indices measured by ultrasound and anthropometric indices to predict the presence and severity of coronary artery disease (CAD) assessed by coronary angiography. PATIENTS AND METHODS: All participants subjected to clinical and laboratory assessments. Anthropometric measurements were taken followed by an ultrasound examination to measure fat thickness at multiple abdominal areas. Lastly, selective coronary angiography performed by the Judkins technique. Statistical analysis was performed to detect the association between all variables and CAD, followed by regression analysis, and Odds ratio (OR) was used to quantifies the strength of the association between two events. RESULTS: From the abdominal indices, the posterior right perinephric fat thickness (PRPFT) above the best cutoff value had the highest hazard ratio (HR: 12.3, p = 0.001), followed by visceral adipose tissue volume (VAT) (HR: 10.7, p < 0.001), waist circumference (WC) (HR: 6.7, p = 0.001), visceral fat thickness (VFT) (HR: 5.7, p = 0.002), and body mass index (BMI) (HR: 5.48, p = 0.017). It also showed an independent association between the severity of CAD and WC (HR: 4.28, p = 0.012), VFT (HR: 3.7, p = 0.032), VAT (HR: 3.7, p = 0.034), and waist to height ratio (WHtR) (HR: 3.3, p = 0.033). CONCLUSION: Posterior perinephric fat thickness and visceral adipose tissue volume measured by ultrasound are strong noninvasive predictors for coronary artery disease, followed by body mass index, waist circumference and visceral fat thickness.

Noninvasive prediction of carotid artery atherosclerosis by multiple abdominal fat indices measured via ultrasonography.

PURPOSE: The purpose of this study was to evaluate the efficiency of multiple abdominal fat indices as measured via ultrasonography for predicting the presence and severity of carotid artery atherosclerosis and to compare the predictive capacity of ultrasonographic measurements to that of anthropometric measurements. METHODS: A total of 92 patients were included in this study. All participants underwent clinical and laboratory assessments, and anthropometric measurements were obtained. Ultrasound examinations were performed to measure the values of all abdominal fat indices and the intimamedia thickness, as well as to detect the presence of atherosclerotic plaques. Univariate and multivariate logistic regression analyses were performed. RESULTS: In the multivariate analysis, significant associations were detected between carotid artery atherosclerosis and posterior right perinephric fat thickness (PRPFT) (hazard ratio [HR], 15.23; P<0.001), preperitoneal fat thickness (PPFT) (HR, 4.31; P=0.003), visceral adipose tissue volume (VAT) (HR, 7.61; P<0.001), visceral fat thickness (VFT) (HR, 8.84; P<0.001), the ratio of VFT to subcutaneous fat thickness (VFT/SCFT) (HR, 9.39; P<0.001), and waist-to-height ratio (WHtR) (HR, 2.65; P=0.046). In the multivariate analysis, significant associations were also detected between carotid artery plaque and PRPFT (HR, 7.09; P<0.001), the abdominal wall fat index (AFI) (HR, 3.58; P=0.010), and VFT/SCFT (HR, 4.17; P=0.006). CONCLUSION: Many abdominal fat indices as measured by ultrasound were found to be strong predictors of carotid artery atherosclerosis, including PRPFT, VFT/SCFT, VFT, VAT, PPFT, and WHtR. Moreover, PRPFT, VFT/SCFT, and AFI were identified as strong predictors of the presence of carotid artery plaque.

Olfactory Disturbances as Presenting Manifestation Among Egyptian Patients with COVID-19: Possible Role of Zinc.

COVID-19 is a severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). Deficiency of zinc has been supposed to contribute to loss of smell and taste in COVID-19 patients. Our study aimed to assess the serum zinc levels among patients with COVID-19 of various severities, with and without olfaction dysfunction, and to evaluate the effect of zinc therapy in recovery of smell dysfunction among such patients. This study included 134 patients; real-time reverse transcription-polymerase chain reaction (rRT-PCR) proved SARS-CoV-2. Serum zinc levels were measured for all infected patients. One hundred and five patients were detected to have anosmia and/or hyposmia and were categorized randomly into 2 groups; the first group included 49 patients who received zinc therapy and the second group included 56 patients who did not received zinc. All patients were followed up for the recovery duration of olfactory and gustatory symptoms and duration of complete recovery of COVID-19. Olfactory dysfunction was reported in 105 patients (78.4%). Serum zinc levels were not significantly different between the patient subgroups regarding disease severity or the presence or absence of olfactory and/or gustatory dysfunction (p ˃ 0.05). The median duration of recovery of gustatory and/or olfactory function was significantly shorter among patients who received zinc therapy than those who did not received zinc (p < 0.001), while the median duration of complete recovery from COVID-19 was not significantly different among the two groups (p ˃ 0.05). Although the zinc status of COVID-19 patients did not exhibit a significant role in development of anosmia and/or hyposmia or disease severity, zinc therapy may have a significant role in shortening the duration of smell recovery in those patients without affecting the total recovery duration from COVID-19.

Self-assessed impact of oral health on the psychological well-being and depressive symptoms of older adults living in Melbourne.

OBJECTIVES: This study aimed to investigate oral health-related factors affecting the self-assessed psychological well-being (PW) and depressive symptoms of independent-living Australians aged 79 years and over living in the community in metropolitan Melbourne. METHODS: The Melbourne Longitudinal Studies on Healthy Aging (MELSHA) program was used as the data source in this study and includes data on the health and well-being of older participants. The MELSHA baseline data collection occurred in 1994, the current study used data from the 2008 data collection and included 201 participants, who remained in the study. Data were analyzed using multiple linear regression (MLR) analysis with a stepwise procedure to identify the variables that accounted for a significant proportion of the variance in the participants' PW scores. RESULTS: Present findings indicate that oral health may play a significant mediating role in PW through maintaining a presentable and acceptable physical appearance. Some 16.4 percent of participants reported feeling concerned about their dental appearance, either "Sometimes," "Often," or "Very often." Multivariate analysis showed significantly influences on PW positive and negative affect scores (P < 0.0001); and depressive symptoms (P < 0.0001) by participants' dentition status, enjoyment of meals, self-reported feeling of concern about the appearance of the mouth, social activity and self-assessment of general health. Final models explained 17.8, 20.1, and 24.6 percent of the variance of PW positive, negative affect scores, and depressive symptoms, respectively. CONCLUSIONS: Oral health, specifically the appearance of the mouth and dentition, plays a significant role in the PW of older Melbournians. Future cross-sectional and longitudinal studies are indicated to raise awareness on the changes required to improve the quality of life of the older population.

Factors associated with self-reported dental visits among older melbournians: the MELSHA study 2008 data collection / Factores asociados con visitas dentales autoinformadas entre melbournianos mayores: el estudio MELSHA 2008 recopilación de datos

Objective: To describe self-reported oral health-care visits and associated factors in older adults in Melbourne, Australia. Material and Methods: 201 older adults, 79-96 years, took part in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) in 2008. Participants who visited a dentist within 12-months prior were identified. Logistic regression examined factors associated with the 12-month visits. Results: 47.7% reported visits to the dentist in the previous 12 months. Multivariate analyses showed dentate participants (OR=11.27; 95% CI: 4.38-29.00) were more likely to have a 12-month visit, and; those receiving a government pension or benefit were less likely to have a 12-month visit (OR=0.38; 95% CI 0.18-0.79). Conclusion: Compared with existing data on the oral health of older Australians, MELSHA participants appear to have lower dental attendance. Findings highlight the need to increase older people sl eeking oral health-care, and the need to collect information to identify influencers of oral health service usage.

Objetivo: Describir las visitas de atención de salud bucal autoreportadas y los factores asociados en adultos mayores en Melbourne, Australia. Métodos: 201 adultos mayores, de 79 a 96 años, participaron en los Estudios longitudinales de Envejecimiento Saludable en Melbourne (MELSHA) en 2008. Se identificaron los participantes que visitaron a un dentista dentro de los 12 meses anteriores. La regresión logística examinó los factores asociados con haber visitado el dentists en los ultimos 12 meses. Resultados: el 47,7% informó visitas al dentista en los 12 meses anteriores. Los análisis multivariados mostraron que los participantes dentados (OR=11.27; IC 95%:4.38-29.00) tenían más probabilidades de haber visitado al dentista en los ultimos 12 meses; y aquellos que recibieron una pensión o beneficio del gobierno tenían menos probabilidades de haber reportado una visita en los ultimos 12 meses (OR=0,38; IC del 95%:0,18 a 0,79). Conclusión: en comparación con los datos existentes sobre la salud oral de los australianos adultos mayores, los participantes de MELSHA reportaron una menor asistencia dental. Los resultados resaltan la necesidad de aumentar que adultos mayores busquen atención de salud bucal, y la necesidad de recopilar información para identificar influyentes en el uso de servicios de salud bucal.

Dysphagia aortica in a young patient with Behcet's Disease: Case report.

Dysphagia aortica is a rare aetiology of dysphagia resulting from an abnormality in thoracic aorta that causes extrinsic compression on the oesophagus. Dysphagia aortica includes aortic aneurysm, aortic dissection or even tortuous aorta and is seldom considered in the differential diagnosis of dysphagia. Herein, we report a 30-year-old man with Behcet's disease who presented with rapid progressive dysphagia and diagnosed as dysphagia aortica caused by saccular aortic aneurysm complicated by large para-aortic haematoma compressing the oesophagus. The case reveals the importance of early and proper identification of the rare causes of dysphagia in young adults with complaint of dysphagia and history of recurrent oral and genital ulcers in absence of obvious cardiovascular diseases.

Predictive factors of worsening of esophageal varices after balloon-occluded retrograde transvenous obliteration in patients with gastric varices.

OBJECTIVES: Although balloon-occluded retrograde transvenous obliteration (B-RTO) is useful for management of gastric varices, worsening of esophageal varices (EV) is the most important complication of B-RTO. The predictive factors of worsening of EV have not been evaluated in detail. This study was designed to evaluate the role of endoscopic color Doppler ultrasonography (ECDUS) in the detection of possible risk factors for worsening of EV after B-RTO. METHODS: A total of 39 cirrhotic patients with high-risk gastric varices successfully treated by B-RTO were included in this study. All patients underwent ECDUS before B-RTO to measure hemodynamic parameters of gastric varices and regular endoscopic follow-up after B-RTO to detect worsening of EV. The risk factors were analyzed by Cox's proportional hazards regression. RESULTS: Worsening of EV was found in 24 (61.5%) patients. The presence of esophageal varices before B-RTO and a lower degree of liver dysfunction (Child-Pugh class B) were statistically independent risk factors for worsening of EV after B-RTO (hazard ratio, HR, 5.81, 95% confidence interval, CI, 1.71-19.77 and HR 2.92, 95% CI: 1.21-7, respectively). High resistance index (> or =0.24), measured by ECDUS, is also an independent risk factor for worsening of EV after B-RTO (HR 4.06, 95% CI: 1.14-14.38) and increase in resistance index is associated with worsening of EV (P for trend=0.028). CONCLUSIONS: The presence of EV, higher Child-Pugh class, and higher resistance index assessed by ECDUS before B-RTO were significant risk factors for worsening of EV after B-RTO.