Cranio-Maxillofacial Surgery

Scaffold implantation in the omentum majus of rabbits for new bone formation Publication date: Available online 3 June 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Falk Birkenfeld, Andre Sengebusch, Chiara Völschow, Björn Möller, Hendrik Naujokat, Jörg Wiltfang Abstract Restoration of the mandible after defects caused by ablative surgery remains challenging. Microvascular free flaps from the scapula, fibula or iliac crest remain the 'gold standard'. A drawback of these methods is donor-side morbidity, availability and the shape of the bone. Former cases have shown that prefabrication of a customized bone flap in the latissimus dorsi muscle may be successful; however, this method is still associated with high donor-side morbidity. Osteogenesis in the omentum majus of rabbits by wrapping the periosteum into it was confirmed recently and is particularly interesting for bone endocultivation. Twelve adult male New Zealand white rabbits were used. In each, two hydroxyapatite blocks were implanted in the greater omentum with autologous bone or autologous bone+rhBMP-2. Bone density measurements were performed by CT scans. Fluorochrome labelling was used for new bone formation detection. The animals were sacrificed at week 10, and the specimens were harvested for histological and histomorphometric analysis. In histological and fluorescence microscopic analysis, new bone formation could be found, as well as new blood vessels and connective tissue. No significant differences were found regarding the histological analysis and bone density measurements between the groups. It could be demonstrated that the omentum majus is a practical way to use one's own body as a bioreactor for prefabrication of tissue-engineered bony constructs. Regarding the influence and exact dose of rhBMP-2, further research is necessary. To establish and improve this method, further large-animal experimental studies are also necessary.

Microdialysis in postoperative monitoring of microvascular free flaps: experiences with a decision algorithm Publication date: Available online 28 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Falk Birkenfeld, Hendrik Naujokat, Ann-Kristin Helmers Nicolai Purcz, Björn Möller, Jörg Wiltfang Abstract Background Reconstruction with free flaps has become a usual practice in maxillofacial surgery. Clinical monitoring is still the standard approach for postoperative follow-up, but can be difficult or impossible with intraorally situated or buried flaps. Microdialysis is a sampling technique that offers the possibility to monitor the metabolism of flaps continuously. It is a reliable method for early diagnosis of ischemia. Materials and methods 48 microvascular free flaps applied following oral cancer resection were monitored with a microdialysis (MD) catheter, placed in the flap. Glucose, lactate, and lactate/pyruvate ratio were monitored using a bedside analyser for 5 days. 48 free flaps served as controls and were assessed (refill, flap temperature, and color) by clinical monitoring (CM). Results 12 flaps monitored by MD showed abnormal metabolism and underwent revision. Eight flaps were saved and four were lost within the first 5 days postoperatively. In addition, two flaps were lost at days 15 and 30 postoperatively, without previous complications. Four flaps assessed by CM developed complications, underwent revision, and were saved. In addition, five flaps were lost between the 8th and 23rd days postoperatively, without revision, due to missing previous clinical signs. Conclusion Postoperative monitoring of free flaps using a microdialysis decision algorithm allows early diagnosis of anastomotic complications. It is a clinically feasible and sensitive monitoring method for microvascular flaps, allowing surgical revision to be undertaken before clinical alteration takes place.

Computed tomography visualizing alterations in the upper airway after orthognathic surgery Publication date: Available online 10 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Luis Fernando Azambuja Alcalde, Paulo Esteves Pinto Faria, Renato Luiz Maia Nogueira, Letícia Chihara, Eduardo Sant'Ana Abstract Three-dimensional (3D) software has revolutionized planning in orthognathic surgery. This technology allows the simulation of surgical movements and evaluation of the volume and area of the pharyngeal airway space (PAS), which are not possible with two-dimensional (2D) software. Many patients undergo orthognathic surgery to improve occlusion and facial profile. The PAS may increase or decrease depending on the surgical movements. This study aimed to evaluate the changes in the area and volume of the PAS in patients having bimaxillary movement in orthognathic surgery. The minimum axial area and volume of the PAS (preoperative (T0) and postoperative (T1) air volumes) of 68 patients (26 male and 42 female, mean age 36.6 ± 12.1 years) were analyzed. Evaluations were conducted using cone-beam computed tomography in the Nemoceph 3D-OS program. A paired t-test was used to compare pre- and postoperative volume data, and the Wilcoxon test was used to compare pre- and postoperative data of the minimal axial area. All the tests were performed with Statistica software (StatSoft Inc., Tulsa, OK, USA), and a significance level of 5% was adopted. In the study of the method error, no casual or systematic error was found between the first and second measurements of the variables (p > 0.05 in all measurements). Bimaxillary surgery presented a mean of 70.46% in volume and a median increase of 61.27% in the minimum axial area, which varied from −22.50% to 659.06%. The results demonstrated that bimaxillary advancement significantly increased the volume and minimum axial area of the upper airway; however, the increase was not homogeneous in all the patients.

Association Between Gender, Estrogen Receptors Genes and Anxiety Levels In Patients Undergoing Orthognathic Surgery Publication date: Available online 10 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Rafaela Scariot, Camila Oliveira Tomaz, Robson Diego Calixto, Jennifer Tsi Gerber, Maria Fernanda Pivetta Petinati, Rafael Correia Cavalcante, Erika Calvano Küchler, Delson João da Costa Abstract Orthognathic surgery is a procedure that is performed for the correction of dentofacial deformities and can lead to a change in an individual's anxiety levels. Anxiety is a multifactorial condition in which hormones and genes play an important role. This study aimed to evaluate if gender and genetic polymorphisms in estrogen receptor alpha (ESR1) and beta (ESR2) are associated with anxiety levels in patients undergoing orthognathic surgery. In this longitudinal observational study, 44 patients were included. Anxiety level assessments were performed at three time periods: 2 days before the surgical procedure and 1 and 6 months postoperatively, using the State-Trait Anxiety Inventory Scale. Gender, age, and facial profile were also evaluated. Additionally, a saliva sample from each individual was collected for the genotypic evaluation of ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) using real time polymerase chain reaction. Data were analyzed with a significance level of 0.05. There was a decrease in trait-anxiety and state-anxiety when comparing the preoperative measurements with those obtained 1 and 6 months postoperatively (p < 0.05). Females were more anxious than males at each time point during the study (p < 0.05). The genetic polymorphism rs9340799 in ESR1 was associated with state-anxiety during the preoperative period (p = 0.046). In conclusion, an individual's gender and genetic polymorphism in ESR1 are associated with anxiety in orthognathic surgery patients.

Epidemiological Analysis Of Management Of Severe Odontogenic Infections Before Referral To The Emergency Department Publication date: Available online 10 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Konstantinos Katoumas, Dimitrios Anterriotis, Maria Fyrgiola, Violetta Lianou, Dimitrios Triantafylou, Ioannis Dimopoulos Summary Purpose The aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). Methods A retrospetive study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. Results During the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. Conclusion The data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.

In vitro proinflammatory gene expression changes in human whole blood after contact with plasma-treated implant surfaces Publication date: Available online 9 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Merlind Becker, Susanne Quabius, Thorben Kewitz, Luka Hansen, Gesa Becker, Matthias Kern, Holger Kersten, Sönke Harder Summary Background The aim of this in vitro study was to identify changes in gene expression of proinflammatory cytokines in human whole blood after contact with titanium implant surfaces after plasma treatment. Materials and methods Grade 4 titanium dental implants were conditioned with low-pressure plasma (LPP) and atmospheric-pressure plasma (APP) and submerged in human whole blood in vitro. Unconditioned implants and blood samples without implants served as control and negative control groups, respectively. Sampling was performed at 1, 8, and 24 h. Changes in mRNA expression levels of interleukin 1-beta (IL1-β) and tumor necrosis factor-alpha (TNF-α) were assessed using RT-qPCR. Results In the control group, significant increases in IL1-β and TNF-α expression were observed. Significant decreases in the expression of IL1-β and TNF-α were identified in blood with implants after plasma treatment. Conclusion Differences in gene expression of proinflammatory cytokines after implantation of plasma-conditioned titanium implants can be assessed using human whole blood. The results of the present study indicate that plasma treatment (APP and LPP) of titanium dental implants leads to downregulation of proinflammatory cytokine gene expression, which might be beneficial in early osseointegration.

Impact of orthognathic surgery on quality of life: predisposing clinical and genetic factors Publication date: Available online 9 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Marilisa Gabardo, João Zielak, Gabriela Tórtora, Jennifer Gerber, Michelle Meger, Nelson Rebellato, Erika Küchler, Rafaela Scariot Summary Introduction Dentofacial deformities have an impact on quality of life (QOL). Many factors can influence this perception, including genetic aspects. ANKK1 and DRD2 genes are associated with dopaminergic system and could modulate behavioral dysfunction. Purpose The impact of orthognathic surgery and associated factors on QOL of adults was ealuated. Material and Methods The abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was applied to patients from two surgery services one week before (T0) and six months after surgery (T1). The independent variables were age, sex, race, facial pattern, presence of jaw asymmetry and vertical deformities, and polymorphisms associated with ANKK1 and DRD2 genes. Descriptive and bivariate analyses were performed. Results There was improvement in the perception of QOL from T0 to T1 in the general score, in the physical and psychological domains, and in the quality of life and general health perception (QOLGHP) (p < 0.001). In this interval, individuals aged ≥ 30 years reported positive impacts on all outcomes (p < 0.05), whereas in women this improvement did not occur only for the physical domain (p = 0.136). There was an association between the polymorphisms associated with the ANKK1 gene (rs1800497) and the perception of QOL in the social relationship's domain (p = 0.021) and QOLGHP (p = 0.042). The other clinical conditions were not associated with outcomes (p > 0.05). Conclusion Perception of QOL of patients improved following orthognathic surgery in physical, psychological, and QOLGHP domains. Aged ≥30 years, being women and polymorphisms associated with the ANKK1 gene were related to positive impacts.

Single-step surgical treatment of odontogenic maxillary sinusitis: A retrospective study of 98 cases Publication date: Available online 4 May 2019 Source: Journal of Cranio-Maxillofacial Surgery Author(s): Fabio Costa, Enzo Emanuelli, Leonardo Franz, Alessandro Tel, Massimo Robiony Abstract Purpose The aim of this study was to review clinical and radiological presentation, surgery, and results of treatment in patients with chronic odontogenic maxillary sinusitis (OMS) treated with a single surgical procedure, including endoscopic sinus surgery (ESS) and oral surgical approaches to treat the odontogenic source of infection. Materials and methods A retrospective case series analysis of 98 patients was performed. All the patients received ESS. 88 patients required oral surgical approaches. Results Nasal symptoms were present in 58 patients (59.2%). Nasal endoscopy was positive in 65 patients (66.3%). A positive nasal endoscopy was significantly associated with nasal symptoms (p < 0.05). 60 patients (61.2%) had OMS of iatrogenic origin. Total opacification of the maxillary sinus was the most common radiological presentation (74.5%) and was significantly associated with nasal symptoms (p < 0.05). 91 patients (92.9%) had complete clinical and radiological resolution of the OMS. Conclusions Iatrogenic origin, sinonasal symptoms and positive clinical endoscopy are common in patients with OMS. Nasal symptoms were significantly associated with total maxillary sinus opacification and positive endoscopic clinical examination. Combining treatment of the odontogenic source of infection via an oral surgical approach and of the sinus inflammation by ESS appears to be sufficient for successfully treating patients with OMS.

Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants Publication date: May 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 5 Author(s): Sameh Attia, Jörg Wiltfang, Philipp Streckbein, Jan-Falco Wilbrand, Thaqif El Khassawna, Katharina Mausbach, Hans-Peter Howaldt, Heidrun Schaaf Abstract Purpose Microvascular fibula flap surgery is a reliable and effective procedure for reconstructing the jaws after tumour surgery. This procedure allows the placement of dental implants after bone consolidation. This study was designed to evaluate the oral, functional, and aesthetic rehabilitation of tumour patients with immediate fibula transfer and dental implants and included assessment of diet, speech, and aesthetics. Materials and methods The study included 34 patients who underwent ablative tumour surgery and immediate jaw reconstruction using a fibula free flap with consecutive rehabilitation by dental implants. In total, 134 implants were inserted into the transferred fibula. The functional and aesthetic results were assessed using a questionnaire. Implant loss and oral excursion were compared with diet type, speech ability, functionality, and patient satisfaction. Results Of the 34 patients included in this study, 33 completed the questionnaire. Twenty-six patients (76%) could eat normally without the limitation of a hard or soft diet, 73% could speak intelligibly, and 31 rated the aesthetic result from good to excellent. Conclusion The fibula flap with the early application of endosseous implants allowed primary immediate reconstruction of the jaw, significantly leading to functional and aesthetic satisfaction in patients who underwent ablative tumour surgery.

Catching condyle – Endoscopic-assisted transoral open reduction and rigid fixation of condylar process fractures using an auto reposition and fixation osteosynthesis plate Publication date: May 2019 Source: Journal of Cranio-Maxillofacial Surgery, Volume 47, Issue 5 Author(s): Philipp Poxleitner, Pit Jacob Voss, David Steybe, Stefan Schlager, Steffen Schwarz, Marc Anton Fuessinger, Rainer Schmelzeisen, Marc Metzger Abstract Introduction Fractures of the mandibular condyle are reported to account for 9 %–45 % of all mandibular fractures. There has been a long lasting controversy on the superiority of different treatment options with endoscopic-assisted transoral approaches gaining increasing attention in recent years. In this article, we report the application of a newly developed osteosynthesis plate for an auto reposition, reconstruction and rigid fixation of condylar process fractures. Material and methods We present 6 cases of uni- or bilateral fractures of the condylar process treated with a transoral open reduction and rigid fixation using an auto reposition plate. Via a transoral endoscopic assisted approach the proximal condyle fragment is captured using an anatomical defined clinch of the cranial part of the plate. The reposition of the condyle is facilitated with the distal bridge of the plate ranging around the posterior part of the ascending ramus. Results The results show a sufficient reposition, rigid fixation and no facial nerve palsy or postoperative long-term occlusal disturbances. The mean operating time was 86 min. Conclusion Transoral endoscopic-assisted surgery with application of an auto reposition, reconstruction and fixation plate offers a quick and convenient way for open reconstruction and rigid fixation of condylar process fractures.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Artificial Intelligence in Medicine

Combining clustering and classification ensembles: A novel pipeline to identify breast cancer profiles Publication date: June 2019 Source: Artificial Intelligence in Medicine, Volume 97 Author(s): Utkarsh Agrawal, Daniele Soria, Christian Wagner, Jonathan Garibaldi, Ian O. Ellis, John M.S. Bartlett, David Cameron, Emad A. Rakha, Andrew R. Green Abstract Breast Cancer is one of the most common causes of cancer death in women, representing a very complex disease with varied molecular alterations. To assist breast cancer prognosis, the classification of patients into biological groups is of great significance for treatment strategies. Recent studies have used an ensemble of multiple clustering algorithms to elucidate the most characteristic biological groups of breast cancer. However, the combination of various clustering methods resulted in a number of patients remaining unclustered. Therefore, a framework still needs to be developed which can assign as many unclustered (i.e. biologically diverse) patients to one of the identified groups in order to improve classification. Therefore, in this paper we develop a novel classification framework which introduces a new ensemble classification stage after the ensemble clustering stage to target the unclustered patients. Thus, a step-by-step pipeline is introduced which couples ensemble clustering with ensemble classification for the identification of core groups, data distribution in them and improvement in final classification results by targeting the unclustered data. The proposed pipeline is employed on a novel real world breast cancer dataset and subsequently its robustness and stability are examined by testing it on standard datasets. The results show that by using the presented framework, an improved classification is obtained. Finally, the results have been verified using statistical tests, visualisation techniques, cluster quality assessment and interpretation from clinical experts.

Recurrent neural networks with segment attention and entity description for relation extraction from clinical texts Publication date: June 2019 Source: Artificial Intelligence in Medicine, Volume 97 Author(s): Zhi Li, Jinshan Yang, Xu Gou, Xiaorong Qi Abstract At present, great progress has been achieved on the relation extraction for clinical texts, but we have noticed that the current models have great drawbacks when dealing with long sentences and multiple entities in a sentence. In this paper, we propose a novel neural network architecture based on Bidirectional Long Short-Term Memory Networks for relation classification. Firstly, we utilize a concat-attention mechanism for capturing the most important context words for relation extraction in a sentence. In addition, a segment attention mechanism is proposed to improve the performance of the model processing long sentences. Finally, a tensor-based entity description is used to overcome the performance degradation of the model when there are multiple entities in a sentence. The performance of the proposed model is evaluated on a part of the i2b2-2010 shared task clinical relation extraction dataset. The result indicates that our model can effectively overcome the above two problems and improve the F1-score by approximately 3% compared with baseline model.

Incorporated region detection and classification using deep convolutional networks for bone age assessment Publication date: June 2019 Source: Artificial Intelligence in Medicine, Volume 97 Author(s): Toan Duc Bui, Jae-Joon Lee, Jitae Shin Abstract Bone age assessment plays an important role in the endocrinology and genetic investigation of patients. In this paper, we proposed a deep learning-based approach for bone age assessment by integration of the Tanner-Whitehouse (TW3) methods and deep convolution networks based on extracted regions of interest (ROI)-detection and classification using Faster-RCNN and Inception-v4 networks, respectively. The proposed method allows exploration of expert knowledge from TW3 and features engineering from deep convolution networks to enhance the accuracy of bone age assessment. The experimental results showed a mean absolute error of about 0.59 years between expert radiologists and the proposed method, which is the best performance among state-of-the-art methods.

Texture descriptors and voxels for the early diagnosis of Alzheimer's disease Publication date: June 2019 Source: Artificial Intelligence in Medicine, Volume 97 Author(s): Loris Nanni, Sheryl Brahnam, Christian Salvatore, Isabella Castiglioni, the Alzheimer's Disease Neuroimaging Initiative Abstract Background and objective Early and accurate diagnosis of Alzheimer's Disease (AD) is critical since early treatment effectively slows the progression of the disease thereby adding productive years to those afflicted by this disease. A major problem encountered in the classification of MRI for the automatic diagnosis of AD is the so-called curse-of-dimensionality, which is a consequence of the high dimensionality of MRI feature vectors and the low number of training patterns available in most MRI datasets relevant to AD. Methods A method for performing early diagnosis of AD is proposed that combines a set of SVMs trained on different texture descriptors (which reduce dimensionality) extracted from slices of Magnetic Resonance Image (MRI) with a set of SVMs trained on markers built from the voxels of MRIs. The dimension of the voxel-based features is reduced by using different feature selection algorithms, each of which trains a separate SVM. These two sets of SVMs are then combined by weighted-sum rule for a final decision. Results Experimental results show that 2D texture descriptors improve the performance of state-of-the-art voxel-based methods. The evaluation of our system on the four ADNI datasets demonstrates the efficacy of the proposed ensemble and demonstrates a contribution to the accurate prediction of AD. Conclusions Ensembles of texture descriptors combine partially uncorrelated information with respect to standard approaches based on voxels, feature selection, and classification by SVM. In other words, the fusion of a system based on voxels and an ensemble of texture descriptors enhances the performance of voxel-based approaches.

Supporting the Distributed Execution of Clinical Guidelines by Multiple Agents Publication date: Available online 18 May 2019 Source: Artificial Intelligence in Medicine Author(s): Alessio Bottrighi, Luca Piovesan, Paolo Terenziani Abstract Clinical guidelines (GLs) are widely adopted in order to improve the quality of patient care, and to optimize it. To achieve such goals, their application on a specific patient usually requires the interventions of different agents, with different roles (e.g., physician, nurse), abilities (e.g., specialist in the treatment of alcohol-related problems) and contexts (e.g., many chronic patients may be treated at home). Additionally, the responsibility of the application of a guideline to a patient is usually retained by a physician, but delegation of responsibility (of the whole guideline, or of a part of it) is often used\required (e.g., delegation to a specialist), as well as the possibility, for a responsible, to select the executor of an action (e.g., a physician may retain the responsibility of an action, but delegate to a nurse its execution). To manage such phenomena, proper support to agent interaction and communication must be provided, providing agents with facilities for (1) treatment continuity (2) contextualization, (3) responsibility assignment and delegation (4) check of agent "appropriateness". In this paper we extend GLARE, a computerized GL management system, to support such needs. We illustrate our approach by means of a practical case study.

Project INSIDE: towards autonomous semi-unstructured human–robot social interaction in autism therapy Publication date: May 2019 Source: Artificial Intelligence in Medicine, Volume 96 Author(s): Francisco S. Melo, Alberto Sardinha, David Belo, Marta Couto, Miguel Faria, Anabela Farias, Hugo Gambôa, Cátia Jesus, Mithun Kinarullathil, Pedro Lima, Luís Luz, André Mateus, Isabel Melo, Plinio Moreno, Daniel Osório, Ana Paiva, Jhielson Pimentel, João Rodrigues, Pedro Sequeira, Rubén Solera-Ureña Abstract This paper describes the INSIDE system, a networked robot system designed to allow the use of mobile robots as active players in the therapy of children with autism spectrum disorders (ASD). While a significant volume of work has explored the impact of robots in ASD therapy, most such work comprises remotely operated robots and/or well-structured interaction dynamics. In contrast, the INSIDE system allows for complex, semi-unstructured interaction in ASD therapy while featuring a fully autonomous robot. In this paper we describe the hardware and software infrastructure that supports such rich form of interaction, as well as the design methodology that guided the development of the INSIDE system. We also present some results on the use of our system both in pilot and in a long-term study comprising multiple therapy sessions with children at Hospital Garcia de Orta, in Portugal, highlighting the robustness and autonomy of the system as a whole.

BDI personal medical assistant agents: The case of trauma tracking and alerting Publication date: May 2019 Source: Artificial Intelligence in Medicine, Volume 96 Author(s): Angelo Croatti, Sara Montagna, Alessandro Ricci, Emiliano Gamberini, Vittorio Albarello, Vanni Agnoletti Abstract Personal assistant agents can have an important role in healthcare as a smart technology to support physicians in their daily work, helping to tackle the increasing complexity of their task environment. In this paper we present and discuss a personal medical assistant agent technology for trauma documentation and management, based on the Belief-Desire-Intention (BDI) architecture. The purpose of the personal assistant agent is twofold: to assist the Trauma Team in doing precision tracking during a trauma resuscitation, so as to (automatically) produce an accurate documentation of the trauma, and to generate alerts at real-time, to be eventually displayed either on smart-glasses or room-display.

Personalized conciliation of clinical guidelines for comorbid patients through multi-agent planning Publication date: May 2019 Source: Artificial Intelligence in Medicine, Volume 96 Author(s): Juan Fdez-Olivares, Eva Onaindia, Luis Castillo, Jaume Jordán, Juan Cózar Abstract The conciliation of multiple single-disease guidelines for comorbid patients entails solving potential clinical interactions, discovering synergies in the diagnosis and the recommendations, and managing clinical equipoise situations. Personalized conciliation of multiple guidelines considering additionally patient preferences brings some further difficulties. Recently, several works have explored distinct techniques to come up with an automated process for the conciliation of clinical guidelines for comorbid patients but very little attention has been put in integrating the patient preferences into this process. In this work, a Multi-Agent Planning (MAP) framework that extends previous work on single-disease temporal Hierarchical Task Networks (HTN) is proposed for the automated conciliation of clinical guidelines with patient-centered preferences. Each agent encapsulates a single-disease Computer Interpretable Guideline (CIG) formalized as an HTN domain and conciliates the decision procedures that encode the clinical recommendations of its CIG with the decision procedures of the other agents' CIGs. During conciliation, drug-related interactions, scheduling constraints as well as redundant actions and multiple support interactions are solved by an automated planning process. Moreover, the simultaneous application of the patient preferences in multiple diseases may potentially bring about contradictory clinical decisions and more interactions. As a final step, the most adequate personalized treatment plan according to the patient preferences is selected by a Multi-Criteria Decision Making (MCDM) process. The MAP approach is tested on a case study that builds upon a simplified representation of two real clinical guidelines for Diabetes Mellitus and Arterial Hypertension.

Indexing the Event Calculus: Towards practical human-readable Personal Health Systems Publication date: May 2019 Source: Artificial Intelligence in Medicine, Volume 96 Author(s): Nicola Falcionelli, Paolo Sernani, Albert Brugués, Dagmawi Neway Mekuria, Davide Calvaresi, Michael Schumacher, Aldo Franco Dragoni, Stefano Bromuri Abstract Personal Health Systems (PHS) are mobile solutions tailored to monitoring patients affected by chronic non communicable diseases. In general, a patient affected by a chronic disease can generate large amounts of events: for example, in Type 1 Diabetic patients generate several glucose events per day, ranging from at least 6 events per day (under normal monitoring) to 288 per day when wearing a continuous glucose monitor (CGM) that samples the blood every 5 minutes for several days. Just by itself, without considering other physiological parameters, it would be impossible for medical doctors to individually and accurately follow every patient, highlighting the need of simple approaches towards querying physiological time series. Achieving this with current technology is not an easy task, as on one hand it cannot be expected that medical doctors have the technical knowledge to query databases and on the other hand these time series include thousands of events, which requires to re-think the way data is indexed. Anyhow, handling data streams efficiently is not enough. Domain experts' knowledge must be explicitly included into PHSs in a way that it can be easily readed and modified by medical staffs. Logic programming represents the perfect programming paradygm to accomplish this task. In this work, an Event Calculus-based reasoning framework to standardize and express domain-knowledge in the form of monitoring rules is suggested, and applied to three different use cases. However, if online monitoring has to be achieved, the reasoning performance must improve dramatically. For this reason, three promising mechanisms to index the Event Calculus Knowledge Base are proposed. All of them are based on different types of tree indexing structures: k-d trees, interval trees and red-black trees. The paper then compares and analyzes the performance of the three indexing techniques, by computing the time needed to check different type of rules (and eventually generating alerts), when the number of recorded events (e.g. values of physiological parameters) increases. The results show that customized jREC performs much better when the event average inter-arrival time is little compared to the checked rule time-window. Instead, where the events are more sparse, the use of k-d trees with standard EC is advisable. Finally, the Multi-Agent paradigm helps to wrap the various components of the system: the reasoning engines represent the agent minds, and the sensors are its body. The said agents have been developed in MAGPIE, a mobile event based Java agent platform.

Towards a modular decision support system for radiomics: A case study on rectal cancer Publication date: May 2019 Source: Artificial Intelligence in Medicine, Volume 96 Author(s): Roberto Gatta, Mauro Vallati, Nicola Dinapoli, Carlotta Masciocchi, Jacopo Lenkowicz, Davide Cusumano, Calogero Casá, Alessandra Farchione, Andrea Damiani, Johan van Soest, Andre Dekker, Vincenzo Valentini Abstract Following the personalized medicine paradigm, there is a growing interest in medical agents capable of predicting the effect of therapies on patients, by exploiting the amount of data that is now available for each patient. In disciplines like oncology, where images and scans are available, the exploitation of medical images can provide an additional source of potentially useful information. The study and analysis of features extracted by medical images, exploited for predictive purposes, is termed radiomics. A number of tools are available for supporting some of the steps of the radiomics process, but there is a lack of approaches which are able to deal with all the steps of the process. In this paper, we introduce a medical agent-based decision support system capable of handling the whole radiomics process. The proposed system is tested on two independent data sets of patients treated for rectal cancer. Experimental results indicate that the system is able to generate highly performant centre-specific predictive model, and show the issues related to differences in data sets collected by different centres, and how such issues can affect the performance of the generated predictive models.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Medical Research

Creating political commitment for antimicrobial resistance in developing countries Rajesh Bhatia, Vishwa Mohan Katoch, Hajime Inoue Indian Journal of Medical Research 2019 149(2):83-86

Antimicrobial susceptibility profile & resistance mechanisms of Global Antimicrobial Resistance Surveillance System (GLASS) priority pathogens from India Balaji Veeraraghavan, Kamini Walia Indian Journal of Medical Research 2019 149(2):87-96 Antimicrobial resistance is a major concern globally. Infections due to drug-resistant pathogens are becoming difficult and a challenge to treat. As treatment choices are limited due to the high-drug resistance rates, there is an increase in the health care cost, duration of hospital stay, morbidity and mortality rates. Understanding the true burden of antimicrobial resistance for a geographical location is important to guide effective empirical therapy. To have a national data, it is imperative to have a systemic data capturing across the country through surveillance studies. Very few surveillance studies have been conducted in India to generate national data on antimicrobial resistance. This review aims to report the cumulative antibiogram and the resistance mechanisms of Global Antimicrobial Resistance Surveillance System (GLASS) priority pathogens from India.

Next-generation strategy for treating drug resistant bacteria: Antibiotic hybrids Varsha Gupta, Priya Datta Indian Journal of Medical Research 2019 149(2):97-106 Resistance against nearly all antibiotics used clinically have been documented in bacteria. There is an ever-increasing danger caused by multidrug-resistant Gram-negative bacteria in both hospital and community settings. In Gram-negative bacteria, intrinsic resistance to currently available antibiotics is mainly due to overexpressed efflux pumps which are constitutively present and also presence of protective outer membrane. Combination therapy, i.e., use of two or more antibiotics, was thought to be an effective strategy because it took advantage of the additive effects of multiple antimicrobial mechanisms, lower risk of resistance development and lower mortality and improved clinical outcome. However, none of the benefits were seen in in vivo studies. Antibiotic hybrids are being used to challenge the growing drug resistance threat and increase the usefulness of current antibiotic arsenal. Antibiotic hybrids are synthetic constructs of two molecules which are covalently linked. These could be two antibiotics or antibiotic with an adjuvant (efflux pump inhibitor, siderophore, etc.) which increases the access of the antibiotics to the target. The concepts, developments and challenges in the future use of antibiotic hybrids are discussed here. Majority of the studies have been conducted on fluoroquinolones and aminoglycosides molecules. The antibiotic tobramycin has the property to enhance the action of antimicrobial agents against which the multidrug-resistant Gram-negative bacteria were earlier resistant, and thus potentiating the action of legacy antibiotics. Antibiotic hybrids may have a role as the silver bullet in Gram-negative bacteria to overcome drug resistance as well as extend the spectrum of existing antibiotics

Understanding policy dilemmas around antibiotic use in food animals & offering potential solutions Kamini Walia, Monica Sharma, Sonam Vijay, Bibek R Shome Indian Journal of Medical Research 2019 149(2):107-118 The looming concern of antimicrobial resistance (AMR) has prompted the government of many countries of the world to act upon and come up with the guidelines, comprehensive recommendations and policies concerning prudent use of antibiotics and containment of AMR. However, such initiatives from countries with high incidence of antibiotic-resistant bacteria in food animals are still in infancy. This review highlights the existing global policies on antibiotics use in food animals along with details of the various Indian policies and guidelines. In India, in spite of availability of integrated policies for livestock, poultry and aquaculture sector, uniform regulations with coordinated initiative are needed to formulate strict policies regarding antimicrobial use both in humans and animals. In an attempt to create effective framework to tackle the AMR, the Indian Council of Medical Research initiated a series of dialogues with various stakeholders and suggested various action points for urgent implementation. This review summarizes the recommendations made during the various consultations. The overarching aim of this review is to clearly delineate the action points which need to be carried out urgently to regulate the antibiotic use in animals.

Antimicrobial resistance in the environment: The Indian scenario Neelam Taneja, Megha Sharma Indian Journal of Medical Research 2019 149(2):119-128 Antimicrobial resistance (AMR) continues to pose a significant public health problem in terms of mortality and economic loss. Health authorities of several countries including India have formulated action plans for its containment. In this fight against AMR, it is important to realize the contribution by all the following four spheres: humans, animals, food and environment. This review incorporates all the spheres of One Health concept from the Indian perspective. India has one of the highest rates of resistance to antimicrobial agents used both in humans and food animals. The environment, especially the water bodies, have also reported the presence of resistant organisms or their genes. Specific socio-economic and cultural factors prevalent in India make the containment of resistance more challenging. Injudicious use of antimicrobials and inadequate treatment of waste waters are important drivers of AMR in India. Use of sludge in agriculture, improper discard of livestock animals and aquaculture industry are considered AMR contributors in other countries but Indian data regarding these are lacking. Efforts to combat AMR have been initiated by the Indian health authorities but are still at preliminary stages. Keeping in view the challenges unique to India, future directions are proposed.

Efflux pump inhibitors for bacterial pathogens: From bench to bedside Atin Sharma, Vivek Kumar Gupta, Ranjana Pathania Indian Journal of Medical Research 2019 149(2):129-145 With the advent of antibiotics, bacterial infections were supposed to be a thing of past. However, this instead led to the selection and evolution of bacteria with mechanisms to counter the action of antibiotics. Antibiotic efflux is one of the major mechanisms, whereby bacteria pump out the antibiotics from their cellular interior to the external environment using special transporter proteins called efflux pumps. Inhibiting these pumps seems to be an attractive strategy at a time when novel antibiotic supplies are dwindling. Molecules capable of inhibiting these pumps, known as efflux pump inhibitors (EPIs), have been viewed as potential therapeutic agents that can rejuvenate the activity of antibiotics that are no longer effective against bacterial pathogens. EPIs follow some general mechanisms of efflux inhibition and are derived from various natural as well as synthetic sources. This review focuses on EPIs and identifies the challenges that have kept these futuristic therapeutics away from the commercial realm so far.

Mismatch amplification mutation assay-polymerase chain reaction: A method of detecting fluoroquinolone resistance mechanism in bacterial pathogens Vijaya Kumar Deekshit, Kadeeja Jazeela, Gunimala Chakraborty, Anusha Rohit, Anirban Chakraborty, Indrani Karunasagar Indian Journal of Medical Research 2019 149(2):146-150 The mismatch amplification assay is a modified version of polymerase chain reaction (PCR) that permits specific amplification of gene sequences with single base pair change. The basis of the technique relies on primer designing. The single nucleotide mismatch at the 3' proximity of the reverse oligonucleotide primer makes Taq DNA polymerase unable to carry out extension process. Thus, the primers produce a PCR fragment in the wild type, whereas it is not possible to yield a product with a mutation at the site covered by the mismatch positions on the mismatch amplification mutation assay (MAMA) primer from any gene. The technique offers several advantages over other molecular methods, such as PCR-restriction fragment length polymorphism (RFLP) and oligonucleotide hybridization, which is routinely used in the detection of known point mutations. Since multiple point mutations in the quinolone resistance determining region play a major role in high-level fluoroquinolone resistance in Gram-negative bacteria, the MAMA-PCR technique is preferred for detecting these mutations over PCR-RFLP and sequencing technology.

A systematic review of antimicrobial resistance of typhoidal Salmonella in India Carl D Britto, Jacob John, Valsan P Verghese, Andrew J Pollard Indian Journal of Medical Research 2019 149(2):151-163 Background & objectives: The temporal trends in the development of antimicrobial resistance (AMR) among Salmonella Typhi and Salmonella Paratyphi in India have not been systematically reported. We aimed to systematically review the temporal AMR trends (phenotypic and molecular mechanisms) in bacterial isolates from patients with enteric fever over two decades in India. Methods: To identify trends in AMR in India, resistance patterns among 4611 individual S. Typhi isolates and 800 S. Paratyphi A isolates, reported from 1992 to 2017 in 40 publications, were analysed. Molecular resistance determinants were extracted from 22 publications and also reviewed in accordance with the PRISMA guidelines. Articles were sourced using a predefined search strategy from different databases. Results: The analyses suggested that multidrug-resistant (MDR) enteric fever was declining in India and being replaced by fluoroquinolone (FQ) resistance. Mutations in gyrA and parC were key mechanisms responsible for FQ resistance, whereas MDR was largely driven by resistance determinants encoded on mobile genetic elements (plasmids, transposons). Interpretation & conclusions: The results reflect the effect of antimicrobial pressure which has been driving AMR in typhoidal Salmonella in India. Understanding these trends is important in planning future approaches to therapy, which serve as a baseline for assessment of the impact of new typhoid conjugate vaccines against these resistant organisms.

Establishing Antimicrobial Resistance Surveillance & Research Network in India: Journey so far Kamini Walia, Jayaprakasam Madhumathi, Balaji Veeraraghavan, Arunaloke Chakrabarti, Arti Kapil, Pallab Ray, Harpreet Singh, Sujatha Sistla, VC Ohri Indian Journal of Medical Research 2019 149(2):164-179 The Indian Council of Medical Research, in 2013, initiated the Antimicrobial Resistance Surveillance & Research Network (AMRSN) to enable compilation of data on six pathogenic groups on antimicrobial resistance from the country. The overarching aim of this network was to understand the extent and pattern of antimicrobial resistance (AMR) and use this evidence to guide strategies to control the spread of AMR. This article describes the conception and implementation of this AMR surveillance network for India. Also described are the challenges, limitations and benefits of this approach. Data from the Network have shown increasing resistance in Gram-negative bacteria in the hospitals that are part of this network. Combined resistance to third-generation cephalosporins and fluoroquinolones and increasing carbapenem resistance are worrisome, as it has an important bearing on the patients' outcome and thus needs to be addressed urgently. Data generated through this Network have been used to develop treatment guidelines, which will be supportive in harmonizing treatment practices across the tertiary level healthcare institutions in the country. While, the major benefit of having a surveillance system is the collection of real-time accurate data on AMR including the mechanisms of resistance, representativeness to community, sustaining the current effort and expanding the current activities to next levels of healthcare settings are the major challenges. The data emanating from the network besides providing evidence, expose several gaps and lacunae in the ecosystem and highlight opportunities for action by multiple stakeholders.

Policy document on antimicrobial stewardship practices in India Kamini Walia, VC Ohri, Jayaprakasam Madhumathi, V Ramasubramanian Indian Journal of Medical Research 2019 149(2):180-184 Antimicrobial resistance (AMR) in India has become a great threat because of high rate of infectious diseases. One of the key contributing factors is high antibiotic use due to poor prescription practices, self-medication, over-the-counter sale of drugs and lack of awareness. Antimicrobial stewardship programme (AMSP) have been proved to be successful in restraining sale and use of antibiotics to a large extent in many countries. An AMSP programme for a hospital is imperative for rational and evidence-based antimicrobial therapy. The ultimate aim is to improve patient outcomes, reduce emergence of bacterial resistance and ensure longevity of the existing antimicrobials. The primary goal of AMSP is to encourage cautious use of available antibiotics by training the healthcare workers and creating awareness. This article describes the strategies and recommendations for formulation of AMSP policy for India.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Allergy, Asthma ,Immunology

Association Between Early-Childhood Antibiotic Exposure and Subsequent Asthma in the US Medicaid Population Publication date: Available online 31 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Ezra Fishman, Geoffrey Crawford, Andrea DeVries, Jesse Hackell, Kevin Haynes, Mark Helm, Eric Wall, Abiy Agiro

The significance of CD163 expressing macrophages in asthma Publication date: Available online 30 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Yoshihisa Tokunaga, Haruki Imaoka, Yoichiro Kaku, Tomotaka Kawayama, Tomoaki Hoshino

Successful intravenous heparin administration during coronary revascularization surgery in a patient with alpha-gal anaphylaxis history Publication date: Available online 28 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Stephanie L. Mawhirt, Erin Banta

Asthma exacerbation trajectories and their predictors in children with incident asthma Publication date: Available online 23 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Sharifa Nasreen, Piotr Wilk, Tara Mullowney, Igor Karp

Review Article: Providing Cost-effective Care for Food Allergy Publication date: Available online 23 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Marcus Shaker, Matthew Greenhawt

CME Review Article: A Primer on Cost-effectiveness in the Allergy Clinic Publication date: Available online 23 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Marcus Shaker, Matthew Greenhawt

The prevalence and persistence of atopic dermatitis in urban United States children Publication date: Available online 22 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Costner McKenzie, Jonathan I. Silverberg

Breakthrough reactions during rapid drug desensitization: Clinical outcome and risk factors Publication date: Available online 18 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Yewon Kang, Oh Young Kwon, Heewon Jung, Minkyoung Kang, Jin An, Ji-Hyang Lee, Ha-Kyeong Won, Woo-Jung Song, Hyouk-Soo Kwon, You Sook Cho, Hee-Bom Moon, Tae-Bum Kim

Phenotypes favoring fractional exhaled nitric oxide discordance vs guideline based uncontrolled asthma Publication date: Available online 18 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Tricia Morphew, Hye-Won Shin, Sara Marchese, N. Pires-Barracosa, Stanley P. Galant

Successful Oral Desensitization with Dasatinib in Delayed Cutaneous Hypersensitivity Reactions Publication date: Available online 18 May 2019 Source: Annals of Allergy, Asthma & Immunology Author(s): Betul Karaatmaca, Selin Aytac, Umit Murat Sahiner, Bulent Enis Sekerel, Ozge Soyer

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Oral Biology and Craniofacial Research

Development of Moxifloxacin Hydrochloride loaded in-situ gel for the treatment of periodontitis: In-vitro drug release study and antibacterial activity Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Ganesh P. Swain, Shivani Patel, Jaimini Gandhi, Pranav Shah Abstract Periodontitis is one of the most widespread oral diseases. Medicated in-situ gels of Moxifloxacin Hydrochloride for extended period of retention in infected cavity were prepared for improved local action for the treatment of periodontitis. Medicated formulations were prepared using temperature sensitive (poloxamer 407), ion sensitive (gellan gum) and pH sensitive (carbopol 934P) polymers. 32 Full Factorial Design has been applied and prepared batches were characterized by FTIR, pH, syringeability, drug content, clarity, gelation temperature, gelling time, in-vitro gelling capacity, in-vitro diffusion study. Gelation temperature, (in-vitro) gelling time and the nature of gel formed in simulated saliva showed polymeric concentration dependency. Diffusion study of in-situ gel had been performed which showed augmented arrival of medication from 7-12 hours and the discharge was dependent on polymer utilized. The best fitted model was zero order kinetics which indicated that the formulation gave controlled delivery. All preparations were non-Newtonian and display pseudoplastic conduct. InvitroAntimicrobial study was carried out by utilizing E. coli and S. aureus. Optimized formulation containing 19.072 %w/v poloxamer 407 and 0.245 %w/v gellan gum exhibited desired characteristics for developing periodontal drug delivery systems.

Loricrin expression and its implication in oral submucous fibrosis, hyperkeratosis and normal mucosa with association to habits – An immunohistochemical study Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Nithya S, Elizabeth Joshua, Ranganathan K, Rooban Thavarajah, Umadevi K. Rao Abstract Objective The coarse fibres of areca nut and the continuous friction from occluding teeth are major causes of mechanical stress to the oral mucosa in conditions like oral submucous fibrosis and frictional keratosis. The continuous micro trauma provided in areca nut chewers, creates an environment where the keratinocytes exhibit alteration. Loricrin, is expressed abundantly in keratinizing epithelium in response to mechanical stress. Their expression or absence could play a role in malignant transformation. This study attempts to assess the potential of Loricrin as an early diagnostic marker in patients with chewing habit. Methods 73 archival samples of formalin fixed, paraffin embedded tissue specimens histopathologically confirmed, were segregated as normal mucosa 11, hyperkeratotic 32 and oral submucous fibrosis 30 and stained with antibodies to Loricrin and graded as negative, mild, moderate and intense based on the staining intensity. Pearson's chi square test was done for statistical analysis. Results Loricrin expression was observed in all groups with staining in the stratum granulosum showing a significant association to habits (P = 0.000). Conclusion This prominent staining indicates a compensatory cytoskeletal rearrangement of surface epithelium during cell division in early oral submucous fibrosis showing potential as an early marker of the condition.

Herbal medicine as adjunct in periodontal therapies- A review of clinical trials in past decade Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Hossam Abdelatty Eid Abdelmagyd, Dr Shishir Ram Shetty, Dr Manea Musa Musleh Al-Ahmari Abstract The aim of this paper was to analyze the literature published in the research related to herbal medicine as adjunct in periodontal therapies. An internet search using search engines- Google, Researchgate and PubMed was carried out. The keywords used for search were-periodontal therapy, adjunct, herbal, and periodontitis. Full text articles of the articles were collected from the year 2007–2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.

MIDAS (Minimally Invasive Drilling And Styptic) protocol - A modified approach to treating patients under therapeutic anticoagulants Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Yazad Gandhi, Neel Bhatavdekar Abstract Patients with cardiac or allied medical conditions mandating long term oral anticoagulant therapy form a sizeable database in an implant practice today. The management of such patients during surgical and dental procedures has always been debatable. Literature has documented evidence that indicates towards stopping the anticoagulant for a finite period. However, discontinuing anticoagulants is not always possible, given the risks of greater significance than the edentulous state. In such patients a minimally invasive flapless approach is preferred, having the potential to reduce bleeding, surgical time and postoperative edema. The purpose of this case series is to show a possible modified approach for dental implant placement using a CAD-CAM stent guided flapless approach without stopping of therapeutic anticoagulant medication.

Diamond-like carbon films over reconstructive TMJ prosthetic materials: Effects in the cytotoxicity, chemical and mechanical properties Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Alecsandro de Moura Silva, Viviane Maria Gonçalves de Figueiredo, Renata Falchete do Prado, Gabriela de Fátima Santanta-Melo, Milagros del Valle El Abras Ankha, Luana Marotta Reis de Vasconcellos, Argemiro Soares da Silva Sobrinho, Alexandre Luiz Souto Borges, Lafayette Nogueira Junior Abstract Increasingly more young patients have been submitted to reconstruction of the Temporomandibular Joint (TMJ), so, the prostheses must to present more functional longevity. Objective To evaluate the effect of diamond-like carbon film (DLC) over titanium alloy (Ti6Al4V) and polyethylene (UHWPE) samples, their mechanical and chemical properties and cellular cytotoxicity. Methods Titanium and UHWPE specimens, with 2.5 cm in diameter and 2 mm thickness were coated through plasma enhanced chemical vapor deposition (PECVD) with DLC or DLC doped with silver (DLC-Ag). Scanning electron microscopy (SEM) morphological analysis, Energy-dispersive spectroscopy (EDS) chemical analysis, scratching test, mechanical fatigue test, surface roughness analysis, and cellular cytotoxicity were performed. Data were statistically analyzed using one-way ANOVA (p < 0.05) or two-way ANOVA and multiple comparison Tukey test. Results In the SEM analysis, morphological differences were observed on substrates after DLC deposition. The film chemically modified the substrate surfaces, according to the EDS analysis. The initial critical load failure occurred at 6.1 N for DLC and 9.7 N for the DLC-Ag film. The DLC film deposition over the polyethylene promoted a decrease in the polymer's damaged area after mechanical fatigue cycling. The cytotoxicity analysis demonstrated less biocompatibility in experimental groups, when compared to control, however, increased biocompatibility was observed, at 10 days, in all groups. Conclusion The diamond-like carbon coating enhanced the chemical and mechanical properties from substrates, however modified biological interaction course of the titanium alloy (Ti6Al4V) and polyethylene (UHWPE) samples. Parameters for film deposition remain to be improved in order to obtain best biocompatibility.

Extensive temporomandibular joint ankylosis involving medial pterygoid plates and the maxillary tuberosity- a case report Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Sujay M. Bhave, Divya Mehrotra, Praveen Singh, Anand Shukla Abstract Background Temporomandibular joint ankylosis is a distressing condition which leads to significant functional debility and facial blemish. It can be surgically managed with gap or interposition arthroplasty, with an objective to restore joint function and prevent re-ankylosis. Sometimes TMJ ankylosis can present with atypical presentations like skull base ankylosis. The main aim of this surgery is to successfully treat such conditions efficiently without any possible complications. However, surgical procedures for such atypical presentations in this disease are rarely reported. Case summary Here we report a 27 year old male with Left TMJ ankylosis involving the skull base. The patient presented with reduced mouth opening with a previous history of trauma. For treatment we performed a surgery by doing osteoarthrectomy with interpositional arthroplasty of left TMJ using piezosurgery. To our knowledge this is the only TMJ ankylosis case with involvement of bones of the skull base treated with piezosurgery. Intraoperatively we achieved a mouth opening of 30 mm, and postoperatively after 15 days mouth opening up to 30 mm was achived with physiotherapy. Conclusion Some times TMJ ankylosis can present with atypical presentations in which bones of the skull base are involved. These are very rare and could be termed as 'skull base ankylosis'. Such cases can be surgically challenging and some surgical treatment modalities like Computer Assisted Surgery (CAS), 3D Navigation and Piezo-electric surgery could be beneficial in avoiding complications and facilitating efficient treatment.

Can placement of an immediate bone level tapered implant and subperiosteal xenograft help maintain bone architecture in esthetic areas? Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Alfonso Caiazzo, Federico Brugnami, Pushkar Mehra

Current status and applications of additive manufacturing in dentistry: A literature-based review Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Mohd Javaid, Abid Haleem Abstract Objective To study the current status and applications of additive manufacturing (AM) in dentistry along with various technologies, benefits and future scope. Methods A significant number of relevant research papers on the additive manufacturing application in dentistry are identified through Scopus and studied using bibliometric analysis that shows an increasing trend of research in this field. This paper briefly describes various types of AM technologies with their accuracy, pros and cons along with different dental materials. Paper also discusses various benefits of AM in dentistry and steps used to create 3D printed dental model using this technology. Further, ten major AM applications in dentistry are identified along with primary references and objectives. Results Additive manufacturing is an innovative technique moving towards the customised production of dental implants and other dental tools using computer-aided design (CAD) data. This technology is used to manufacture elaborate dental crowns, bridges, orthodontic braces and can also various other models, devices and instruments with lesser time and cost. With the help of this disruptive innovation, dental implants are fabricated accurately as per patient data captured by the dental 3D scanner. The application of this technology is also being explored for the precise manufacturing of removal prosthetics, aligners, surgical templates for implants and produce models that for the planning of treatment and preoperative positioning of the jaws.

Comparison between N-butyl cyanoacrylate tissue adhesive and Ethilon nylon sutures in extraoral maxillofacial incisions: A randomized prospective study Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Sudipto Sahu, Sobhan Mishra, Sthitaprajna Lenka, Rajarshi Banerjee, Sandeep Pachisia, Sucharu Ghosh Abstract Objectives Wound closure is a part of any surgical procedure. Wound care and healing process are concepts, which are usually reliant upon sutures. The suture and non-suture repair of the tissues has been a major concern to surgeons for over four thousand years. The objective of this study is to compare the rates of infection, wound dehiscence, necrosis and time required by N-butyl cyanoacrylate tissue adhesive and nylon sutures in extraoral maxillofacial wound closer. Materials and methods 24 patients requiring external wound closing were included in this study. Patients were divided in two groups, in one group wound closer was done by N-butyl cyanoacrylate tissue adhesive and by conventional nylon suture in the other group. The software STATA® of StataCorp was used in statistical analysis if this study. Results Wound infection, dehiscence, necrosis of tissue edges, time taken for closure was much less in case of tissue adhesive than conventional sutures. Conclusion Advantages of tissue adhesives over conventional wound closure techniques include easy to use, excellent bacteriostatic property, decreased repair time, elimination of recall visits and comparable short and long-term cosmetic outcome. Though tissue adhesives have many advantages over conventional wound closure techniques, they can be used as an alternative to sutures only in superficial small and tension free skin incisions or lacerations.

Factors associated with Oral Health Related Quality of Life of children with severe -Early Childhood Caries Publication date: July–September 2019 Source: Journal of Oral Biology and Craniofacial Research, Volume 9, Issue 3 Author(s): Shahnaz Mansoori, Abhishek Mehta, Mohd. Irfan Ansari Abstract Background Early Childhood Caries (ECC) is a chronic childhood disease affecting children worldwide. Severe cases of ECC can significantly affect child's Oral Health Related Quality of Life (OHRQoL) owing to its consequences. The purpose of present study was to find out association between severe early childhood caries (s-ECC) and OHRQoL of children and their parents/care-givers visiting a Government dental hospital in Delhi, India. Methods Data was collected from a hospital - based sample of 454 child-parent pair. OHRQoL of the child and parent was assessed using the Hindi version of Early Childhood Oral Health Impact Scale (Hi-ECOHIS). Children with s-ECC were identified as per definition given by American Academy of Paediatric Dentistry. Chi square test and Binary regression analysis were used to evaluate the effect of s-ECC on OHRQoL and to study role of various socio demographic factors. Results The prevalence of s-ECC was 77.1% (n = 350).The mean dmft index score was 5.67 ( ±3.72) and dmfs was 11.21 ( ±11.03). The mean overall ECOHIS score was 7.02 ( ±5.47). Child impact items such as Pain, fever, caries associated swelling along with difficulty in eating food, halitosis, disturbed sleep, frequent absenteeism from school were found to be more significantly more frequent in children with s-ECC than ECC. Children with bottle-feeding habit of more than one year, having fewer siblings, and whose parents belong to upper socio economic class were at higher odds of suffering from s-ECC. Conclusion: s-ECC has significantly more detrimental impact on the OHRQoL of children and their parents in comparison to ECC.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Al-Azhar Medical Faculty, Girls

Airway management in morbidly obese adolescents: a comparison between Bonfils fiberscope and fiberoptic bronchoscope assisted with direct laryngoscopy Mostafa M Sabra The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):1-6 Background and aim Pediatric patients presenting to bariatric surgery is increasing in percentage in the last years and has become a fast growing epidemic problem. The aim of this study was to evaluate the usefulness of Bonfils fiberscope (BF-L) and fiberoptic bronchoscope (FO-L), assisted by direct laryngoscopy for intubation in morbidly obese adolescents with predicted easy intubation using the El-Ganzouri risk index score. Patients and methods Thirty adolescent American Society of Anesthesiologist II–III patients, aged 12–19 years, scheduled for laparoscopic bariatric surgery were randomized into two equal groups for intubation, with assistance of regular Mackintosh laryngoscope in both groups, either group BF-L and group FO-L. The standard protocol for general anesthesia was used for both groups. The primary outcome measure was the visualization quality using the percentage of glottis opening score. The secondary outcome measures were: duration of intubation and number of intubation attempts. Results Percentage of glottis opening scores were significantly better in group BF-L, when compared with group FO-L (93±6.44%/83±8%, respectively, P=0.002). The intubation success rate was 100% in both groups, and the mean intubation time was significantly longer (16±4.67 s) in group FO-L compared with 11±3.50 s in group BF-L (P=0.02). As regards the number of attempts, all patients were successfully intubated on the first attempt in group BF-L, while intubation was successful in 14 patients in group FO-L and one patient on the second attempt, which was statistically insignificant (P<0.05). Conclusion Orotracheal intubation was performed more rapidly and easily with BF-L and FO-L, with superiority of BF-L than FO-L in patients with predicted easy intubation using the El-Ganzouri risk index score

Pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease Eman M Mahmoud, Magd M. Galal El-Din, Manal R Hafez, Eman Sobh, Radwa S Ibrahim The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):7-13 Background Pulmonary fungal infection (PFI) is increasing among patients with chronic obstructive pulmonary disease (COPD). Survival depends on rapid diagnosis and early treatment. Aims To assess the prevalence of PFI in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the clinical, demographic, and radiological findings related to PFI in COPD patients. Patients and methods This observational cross-sectional study was conducted on 80 patients with AECOPD. High-resolution computed tomography, fiberoptic bronchoscopy with bronchoalveolar lavage, spirometry, sputum and bronchoalveolar lavage fungal culture and measurements of serum 1, 3 beta-D-glucan (BDG) were done for all patients. They were classified into possible PFI and probable PFI based on the Bulpa and colleagues criteria. Results Among the 80 studied patients, 19 patients had possible PFI, and 61 patients had probable PFI; of them 12 patients had positive BDG and 49 had negative BDG. The use of either systemic steroids and/or antibiotics in the last 3 months was higher in patients with probable PFI than those with possible PFI (P=0.003). The daily dose (mg/kg) and duration of systemic steroids were higher in patients with probable PFI (P=0.001). The use of inhaled corticosteroids (ICS), its dose, and its duration did not differ between both groups. Conclusion Probable PFI is prevalent among patients with AECOPD 61 (76.3%); of them 19.7% was invasive form. PFI in AECOPD is related to the use, dose, and duration of systemic steroids and antibiotic use in the last 3 months. Therefore, a lower dose or interrupted course of systemic steroid must be considered in COPD patients.

Methylenetetrahydrofolate reductase C677T gene polymorphism and diabetic nephropathy susceptibility in patients with type 2 diabetes mellitus Amena R Zidan, Hala M El Mougy, Hasnaa S Moustafa, Shahinaz El attar, Eman F Mohamed The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):14-22 Background Type 2 diabetes mellitus (T2DM) is becoming increasingly prevalent throughout the world. Diabetic nephropathy (DN) is one of the most serious microvascular complications of diabetes mellitus. The C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene has been reported to cause reduced MTHFR enzyme activity and impaired homocysteine metabolism, leading to hyperhomocysteinemia. Aim The aim of the study was to evaluate the role of MTHFR C677T gene polymorphism in the susceptibility to DN in type 2 diabetic patients. Patients and methods The study was conducted on 180 adult Egyptian participants (60 healthy controls, 60 patients with T2DM without nephropathy, and 60 patients with T2DM complicated with nephropathy). C677T genotypes were determined by PCR-RFLP analysis, and homocysteine levels were measured by enzyme-linked immunosorbent assay. Results The prevalence of polymorphic genotype of CT and TT and T allele was statistically significantly increased in diabetic patients than in controls (P<0.001). There was a statistically significant increase in polymorphic genotypes (CT and TT) and T allele in T2DM with nephropathy in comparison to T2DM without nephropathy group (P<0.001, 0.05, respectively). Serum homocysteine levels were significantly higher in patients with nephropathy than in patients without nephropathy or controls with P less than 0.001. The higher serum homocysteine level was observed with polymorphic genotypes TT and CT compared with CC genotypes (P<0.001). Conclusion The TT genotype and T allele of MTHFR C677T may represent a significant genetic molecular marker to predict the risk of DN in T2DM.

Association of platelet endothelial cell adhesion molecule-1 gene polymorphism (Leu125Val) with coronary artery disease in type II diabetics and nondiabetics Maha M.S El-Kishki, Amal M Abdelfattah Alramly, Mohamed O Taha, Rana A El Din Medhat The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):23-32 Background and objectives Platelet endothelial cell adhesion molecule-1 (PECAM-1) plays a key role in the transendothelial migration of circulating leukocytes (diapedesis) during vascular inflammation. Polymorphism (Leu125Val) of the PECAM-1 gene (373C/G) is functional. It was reported to be associated with high serum level of PECAM-1. We hypothesized that this genetic variation of the PECAM-1 gene could be associated with the development of atherosclerosis. Therefore we conducted a study to investigate the association between single-nucleotide polymorphism of the PECAM-1 gene, C+373G (Leu125Val) at exon 3, in Egyptian patients with coronary artery disease. Patients and methods Blood samples were withdrawn from 40 coronary artery disease patients and 20 age-matched and sex-matched controls. The single-nucleotide polymorphism of the PECAM-1 gene was analyzed by PCR-restriction fragment length polymorphism strategy. Results Genotype distributions between patient and control groups showed no significant statistical difference regarding the CC genotype, where 22.5% of patients and 35% of controls carried this genotype (P=0.470). As for the CG genotype, a statistically significant higher CG genotype distribution was found in patients, where 52.5% of patients and only 20% of controls carried this genotype (P=0.033). There was no statistically significant difference in GG distributions between patient and control groups, where 25% of patients and 45% of controls carried this genotype (P=0.202). No significant statistical difference was observed in allele frequency between the two groups, where 51.25% of patients and 55% of controls carry the G allele and 48.7% of patients and 45% of controls carry the C allele (P=0.846). Interpretation and conclusion We concluded that our study demonstrated a possible effect of PECAM-1 (Leu125Val) polymorphism on the development of atherosclerosis.

Prolotherapy for knee osteoarthritis Hesham El-Dosoky, Saad M El Zokm, El Sayed Abd El-Hamid, Yousra Abo State The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):33-43 Background and aim Osteoarthritis (OA) is the most common type of chronic arthritis and represents a major cause of pain and disability. Prolotherapy is an injection of hypertonic dextrose used for painful chronic musculoskeletal pain conditions, including knee OA. Patients and methods This study was done to evaluate the effect of prolotherapy in treatment of knee OA. It was carried out on 200 patients with mild to moderate knee OA. The patients were classified into two groups: group 1 (100 patients) was treated by prolotherapy at 1, 5, and 9 weeks with re-evaluation after 6 months, and group 2 (100 patients) was treated by NSAIDS and physiotherapy for 6 months and served as a control group. Results The 6-month post-treatment visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index showed significant difference in pain, stiffness, and functional disability (P=0.001 and 0.043; 0.032 and 0.027; and 0.007 and 0.015, respectively) in both groups when compared with the baseline. However, on comparing both groups after treatment, we noticed significant difference in pain and disability favoring group 1 (P=0.031 and 0.048, respectively), whereas stiffness did not show significant difference between them (P=0.83). By knee ultrasound, degree of synovitis showed significant difference in groups 1 and 2 when compared with the baseline (P=0.004 and 0.007, respectively), but other parameters showed no significant differences. However, when comparing both groups after treatment, we noticed significant difference in cartilage thickness favoring group 1 (P=0.01), whereas other parameters did not show significant difference between them, although the degree, signs, and symptoms of knee effusion were improved in favor of prolotherapy group. Conclusion Prolotherapy is a promising line for treatment of knee OA. Prolotherapy reduces pain and improves the functional status in patients with knee OA.

A comparative study between the effect of intrathecal hyperbaric bupivacaine with fentanyl and hyperbaric levobupivacaine with fentanyl for knee arthroscopy Ayman Esmail Hussien, Mohamed Adel Gawad Abdel Halim The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):44-49 Background The use of levobupivacaine as a pure S (−) enantiomer of bupivacaine was progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration. The aim of this work was to compare the effectiveness of lower-dose local anesthetics’ use together with higher opioid dose to decrease the side effects of drugs. We compared sensorial, motor block levels and side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in knee arthroscopy. Patients and methods After hospital ethics committee approval and getting written informed consent from patients, 100 patients with American Society of Anesthesiologists grade I–II, aged 18–40 years were included in the study. They were randomized to either group A receiving 7.5 mg (1.5 ml) hyperbaric levobupivacaine with 25 μg (0.5 ml) fentanyl, or group B receiving 7.5 mg (1.5 ml) hyperbaric bupivacaine with 25 μg (0.5 ml) fentanyl. Results Hemodynamic parameters such as the 45th minute mean arterial pressure of group B was found to be lower (P<0.05). In group A, maximum sensorial block level and postoperative visual analog scale scores were higher (P<0.05). Onset of motor block time, time to maximum motor block, time to sensorial block, reversal of two dermatome and first analgesic need were similar in both groups. Conclusion Intrathecal hyperbaric levobupivacaine–fentanyl combination is a better and good alternative to bupivacaine–fentanyl combination in knee arthroscopy, as it maintains hemodynamic stability.

Challenges in the management of primary lower extremity varicose veins: what is the best treatment option? Ahmed Mousa, Mohamed El Azzazi, Bosat E Bosat The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):50-59 Background Varicose vein is considered as one of the commonly practiced venous problems for decades not only by vascular surgeons but also by general surgeons. Aim The purpose of the current study was to compare the results of management of lower limb superficial varicosities using conventional surgery versus endovenous laser ablation (EVLA) therapy. Patients and methods A retrospective study took place in the period of three years from January 2015 until December 2017. Patients were selected for having reflux of the great saphenous vein (GSV) with primary varicosities of the lower limb presenting to the vascular surgery clinic. Patients were divided into two groups: group I included those who were treated with GSV short stripping and saphenofemoral junction disconnection, whereas group II involved patients who underwent EVLA. Results The study included 80 patients. There were 50 females and 30 males, with a female to male ratio of 5 : 3. Patients’ age ranged from 22 to 44 years, with a median age of 34 years. There was a significantly higher initial technical success rate of 95% (n=38) in the group treated with EVLA versus 90% (n=36) in the group treated surgically (P=0 · 006). Operative outcome was statistically significantly higher in the group treated with EVLA compared with the surgically treated group (P=0.002). A significant difference between operative procedures versus operative outcome was seen (P=0.002). Recurrent varicosities were observed in 10% and 5% in group I and group II, respectively. Heat-induced deep vein thrombosis was reported in 2.5% of cases. Conclusion Treatment of superficial varicosities with EVLA had a lower incidence recurrence rate than traditional surgery in the short-term follow-up. Moreover, the minimally invasive EVLA therapy, especially, in female patients seems to be a highly effective and safe modality for treatment of primary GSV varicosities.

Diagnostic utility of flexible bronchoscopy in mediastinal and hilar lymphadenopathies Taghreed S Farag, Abeer S Farag The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):60-71 Background Mediastinal and/or hilar lymphadenopathy with or without parenchymal lesions are difficult in the diagnosis via noninvasive techniques. Objective To assess the role of flexible fiberoptic bronchoscopy (FOB), in particular, blind transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal and/or hilar lymphadenopathies. Patients and methods A cross-sectional study was carried out on 42 out of 83 patients presented by chest radiography of hilar and/or mediastinal lymphadenopathies with or without parenchymal lesions. Contrast-enhanced computed tomography chest and FOB, TBNA, and bronchoalveolar lavage were done for all patients. Forceps biopsy and bronchial brushing were done for some patients with bronchoscopic airway abnormalities. Results A total of 52 patients underwent FOB procedures; among them 10 (19.2%) patients were excluded due to nonconclusive diagnosis for further evaluations; final histopathological and/or microbiological diagnosis was confirmed in 42 (80.8%) patients, and they were included in data analysis. Among them, 25 (59.5%) patients had malignant lymphadenopathies (five patients had small cell lung cancer, 18 patients had nonsmall cell lung cancer, and two patients had lymphoma) and 17 (40.5%) had benign lymphadenopathies (eight patients had sarcoidosis, three patients had tuberculosis, six patients had reactive lymphadenitis). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TBNA in the diagnosis of intrathoracic lymphadenopathies were 75.00, 54.50, 60.00, 70.60, and 64.29%, respectively. Conclusion Bronchoscopy with TBNA has good sensitivity and negative predictive value with fair specificity and positive predictive value in the diagnosis of intrathoracic lymphadenopathies. TBNA is a safe, effective procedure and can be performed easily during routine diagnostic bronchoscopy, and minimize the requirement for mediastinoscopy and thoracotomy.

Dexmedetomidine and fentanyl combination versus dexmedetomidine and pethidine as sedatives during colonoscopy Ahmed M.M El-Garhy, Khaled S.S Makboul The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):72-78 Background and aim Endoscopy procedures are generally performed under sedation, which ranging from minimal sedation to deep sedation. Conscious sedation during colonoscopic procedures provides a high level of patient and physician satisfaction. An ideal sedative agent should allow rapid modification of the sedation level by modifying the dose and should not have any adverse effects. Because such an ideal sedative agent does not exist, the combination use of dexmedetomidine with opioids (fentanyl or pethidine) may have the advantages over the use of a single agent. The goal of this study was to assess the effect of dexmedetomidine in combination with fentanyl or pethidine as a sedative for outpatient colonoscopy on hemodynamics, level and onset of sedation, analgesia, and degree of satisfaction of the colonoscopist and patients. Patients and methods A total of 60 colonoscopy patients between 21 and 60 years of age were included in the study. The patients scheduled for elective outpatient colonoscopy (with conscious sedation) were randomized into two groups: group 1 ‘DF group’ (N=30): dexmedetomidine 1 μ/kg/h infusion by syringe pump along with 1 μ/kg fentanyl was administered before the start of colonoscopy as a single shot, and Group 2 ‘DP group’ (N=30): dexmedetomidine 1 μ/kg/h infusion by syringe pump along with 1 mg/kg pethidine was administered before the start of colonoscopy as a single shot. The assessment includes heart rate (HR, beats/min), mean arterial blood pressure (MAP, mmHg), oxygen saturation at baseline and every 5 min, onset and level of sedation by Ramsay Sedation Score (RSS) after administration of the drugs, Numeric Pain Rating Scale at the end of colonoscopy, and the degree of satisfaction of the patients and the colonoscopist. Results The average value of the 6 h measurements in fentanyl group was 75.6±0.91 beats/min; whereas in pethidine group was 92.2±0.67 beats/min, with highly significant statistical difference (P<0.001), whereas there were nonsignificant differences regarding MAP and oxygen saturation. There was a highly significant decrease in the onset of sedation and increase in RSS and Numeric Pain Rating Scale in fentanyl group compared with pethidine group (P<0.01 for all). Moreover, there were nonsignificant differences regarding the degree of satisfaction for the colonoscopist and the patient (P>0.05). Multiple regression analysis shows that the increase in baseline HR had an independent effect on increasing onset of sedation (P<0.0001). Moreover, the fentanyl usage and the decrease in baseline HR had an independent effect on increasing RSS (P<0.01). Conclusion Patients who underwent colonoscopy and received dexmedetomidine-fentanyl regimen showed better hemodynamics (decreased HR, normal MAP, and oxygen saturation measurements), along with rapid onset of sedation and satisfied RSS compared with patients who received dexmedetomidine–pethidine regimen. In contrast, pethidine group showed better analgesia than fentanyl group. Both groups showed comparable satisfaction results in the colonoscopist and patients.

Comparative study the levels of plasma transforming growth factor-β1, serum crp, fecal lactoferrin, and fecal calprotectin as biomarkers for disease activity in Egyptian patients with ulcerative colitis Arafat Kassem, Hosam A.S Shabana, Mabrouk M Aboelenin The Scientific Journal of Al-Azhar Medical Faculty, Girls 2019 3(1):79-90 Aim This study aimed to analyze the utility of transforming growth factor-β1 (TGF-β1), C-reactive protein (CRP), fecal lactoferrin (LF), fecal calprotectin, and the Mayo score for severity of ulcerative colitis (UC) in monitoring disease activity in Egyptian patients with UC. Patients and methods This study was carried out on 130 patients with UC and scored according to the Mayo score for severity of UC. Patients and controls were exposed to fecal and blood samples to assess TGF-β1, CRP, fecal LF, and fecal calprotectin. Results The values of TGF-β1, CRP, fecal LF, and fecal calprotectin in UC patients (n=130) compared with controls (n=30) were as follows: TGF-β1: 489.32±315.68 versus 5.93±1.81 pg/ml, CRP: 15.97±9.13 versus 3.17±0.95 mg/l, fecal LF: 497.06±448.95 versus 7.01±4.00 μg/g, fecal calprotectin: 809.70±554.36 versus 36.33±15.51 µg/g (for all P<0.001). The parameters of Mayo Score that determine the severity of ulcerative colitis correlated significantly with TGF-β1 (Spearman’s rank correlation coefficient r=0.925), CRP (r=0.957), LF (r=0.932), and calprotectin (r=0.953). TGF-β1, CRP, fecal LF, and calprotectin levels were significantly lower in UC patients with inactive disease (TGF-β1: 46.4±37.1 pg/ml; CRP: 4.8±1.3; LF: 28.6±28.3 μg/g; calprotectin: 71.7±24.2 µg/g; P<0.001 for both LF and calprotectin, but P>0.05 for both TGF-β1, and CRP) compared with patients with mild (TGF-β1: 343.4±110.7 pg/ml; CRP: 9.8±2.1; LF: 177.8±66.8 μg/g; calprotectin: 459.0±206.7 µg/g; P<0.001), moderate (TGF-β1: 640.6±141.0 pg/ml; CRP: 18.6±3.5; LF: 561.0±181.9 μg/g; calprotectin: 1080.8±224.1 µg/g; P<0.001), and high active disease (TGF-β1: 814.5±132.9 pg/ml; CRP: 27.1±3.0; LF: 1048.3±296.8 μg/g; and calprotectin: 1421.7±95.5 µg/g; P<0.001). The overall accuracy for the detection of histopathologic active disease was 87.7% for TGF-β1, 89.2% for the Mayo score for severity of UC, 84.6% for CRP, 90% for fecal LF, and 91.5 for fecal calprotectin. Conclusion Fecal LF, fecal calprotectin and TGF-β1, and CRP correlated significantly with the Mayo score for UC and histopathology. Furthermore, calprotectin and LF are appropriate markers that can distinguish endoscopic and histopathologic inactive from active disease. Also, TGF-β1 and CRP were used as suitable markers to differentiate mild from moderate and the moderate from high active disease. Thus, these four biomarkers may be used for surveillance of UC activity.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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6948891480

alsfakia@gmail.com