Characterization of the root and canal anatomy of maxillary premolar teeth in an Iraqi subpopulation: a cone beam computed tomography study

This study aims to evaluate the number of roots and root canal morphology types of maxillary premolars in relation to a patient's gender and age in an Iraqi population using two classification systems. Cone beam computed tomography (CBCT) scans of 1116 maxillary premolars from 385 patients were evaluated for the number of roots and root canal morphology types according to Vertucci's classification and Ahmed et al. classification systems. Differences in the number of roots and root canal morphology types with regard to tooth type, patients' gender and age groups were evaluated and the degree of bilateral symmetry was determined. Chi-squared test was used for statistical analysis. About 51.1% of the 1st premolars were double rooted. The majority (87.9%) of the 2nd premolars were single rooted. The three-rooted form presented in only 1.2% and 0.7% of the 1st and 2nd premolars, respectively. Vertucci Type IV (Ahmed et al. code 2MaxP B1P1) and Vertucci Type I (Ahmed et al. code 1MaxP1) were the most common canal morphology types in the 1st and 2nd premolars, respectively. Females showed a lower number of roots and a higher prevalence of Vertucci Type I configuration (P < 0.05). Younger age groups showed a higher prevalence of Vertucci Type I configuration (P < 0.05). Bilateral symmetry was seen in more than half of the maxillary premolars. There is a considerable variation in the number of roots and root canal configurations of maxillary premolars in the studied Iraqi population, with a significant difference by gender and age groups. Ahmed et al. classification provided more accurate presentation of the root and canal anatomy in maxillary premolars compared to Vertucci's classification.

Bioactivity and remineralization potential of modified glass ionomer cement: A systematic review of the impact of calcium and phosphate ion release

This systematic review investigates the effectiveness of calcium and phosphate ions release on the bioactivity and remineralization potential of glass ionomer cement (GIC). Electronic databases, including PubMed-MEDLINE, Scopus, and Web of Science, were systematically searched according to PRISMA guidelines. This review was registered in the PROSPERO database. Five eligible studies on modifying GIC with calcium and phosphate ions were included. The risk of bias was assessed using the RoBDEMAT tool. The incorporation of these ions into GIC enhanced its bioactivity and remineralization properties. It promoted hydroxyapatite formation, which is crucial for remineralization, increased pH and inhibited cariogenic bacteria growth. This finding has implications for the development of more effective dental materials. This can contribute to improved oral health outcomes and the management of dental caries, addressing a prevalent and costly oral health issue. Nevertheless, comprehensive longitudinal investigations are needed to evaluate the clinical efficacy of this GIC's modification.

Efficacy and bone-contact biocompatibility of glass ionomer cement as a biomaterial for bone regeneration: A systematic review

Bone regeneration is a rapidly growing field that seeks to develop new biomaterials to regenerate bone defects. Conventional bone graft materials have limitations, such as limited availability, complication, and rejection. Glass ionomer cement (GIC) is a biomaterial with the potential for bone regeneration due to its bone-contact biocompatibility, ease of use, and cost-effectiveness. GIC is a two-component material that adheres to the bone and releases ions that promote bone growth and mineralization. A systematic literature search was conducted using PubMed-MEDLINE, Scopus, and Web of Science databases and registered in the PROSPERO database to determine the evidence regarding the efficacy and bone-contact biocompatibility of GIC as bone cement. Out of 3715 initial results, thirteen studies were included in the qualitative synthesis. Two tools were employed in evaluating the Risk of Bias (RoB): the QUIN tool for assessing in vitro studies and SYRCLE for in vivo. The results indicate that GIC has demonstrated the ability to adhere to bone and promote bone growth. Establishing a chemical bond occurs at the interface between the GIC and the mineral phase of bone. This interaction allows the GIC to exhibit osteoconductive properties and promote the growth of bone tissue. GIC's bone-contact biocompatibility, ease of preparation, and cost-effectiveness make it a promising alternative to conventional bone grafts. However, further research is required to fully evaluate the potential application of GIC in bone regeneration. The findings hold implications for advancing material development in identifying the optimal composition and fabrication of GIC as a bone repair material.

Performance of the World Health Organisation suspected COVID-19 case definition in cluster-associated and sporadic SARS-CoV-2 transmission in Malaysia

INTRODUCTION

Cluster-associated transmission has contributed to the majority of COVID-19 cases in Malaysia. Although widely used, the performance of the World Health Organization (WHO) case definition for suspected COVID19 in environments with high numbers of such cases has not been reported.

MATERIALS AND METHODS

All suspected cases of COVID-19 that self-presented to hospitals or were cluster screened from 1st April to 31st May 2020 were included. Positive SARS-CoV-2 rRT-PCR was used as the diagnostic reference for COVID-19.

RESULTS

540 individuals with suspected COVID-19 were recruited. Two-third of patients were identified through contact screening, while the rest presented sporadically. Overall COVID-19 positivity rate was 59.4% (321/540) which was higher in the cluster screened group (85.6% vs. 11.6%, p<0.001). Overall, cluster-screened COVID-19 cases were significantly younger, had fewer comorbidities and were less likely to be symptomatic than those present sporadically. Mortality was significantly lower in the cluster-screened COVID-19 cases (0.3% vs. 4.5%, p<0.05). A third of all chest radiographs in confirmed COVID-19 cases were abnormal, with consolidation, ground-glass opacities or both predominating in the peripheral lower zones. The WHO suspected case definition for COVID-19 accurately classified 35.4% of all COVID-19 patients, a rate not improved by the addition of baseline radiographic data. Misclassification rate was higher among the cluster-associated cases (80.6%) compared to sporadic cases (35.3%).

CONCLUSION

COVID-19 cases in Malaysia identified by active tracing of community cluster outbreaks had lower mortality rate. The WHO suspected COVID-19 performed poorly in this setting even when chest radiographic information was available, a finding that has implications for future spikes of the disease in countries with similar transmission characteristics.

Effect of Oral Environmental pH on the Dynamic Characterization of Bioactive Restorative Materials

The objective of this study was to investigate the effects of oral environmental pH on the viscoelastic properties of bioactive restorative materials (BRMs) by using dynamic mechanical analysis. Stainless steel molds were used to fabricate 40 beam-shaped specimens (12 × 2 × 2 mm) for each material. The specimens were finished, measured, randomly divided into four groups (n = 10), and immersed in aqueous solutions of pH 3.0, 5.0, 6.8, and 10.0 at 37 °C for seven days. The specimens were then subjected to dynamic mechanical analysis with a 5 N load and frequency range of 0.1-10.0 Hz. Data were analyzed using one-way ANOVA/Dunnet T3’s test (α = 0.05). Mean elastic modulus spanned from 2.68 ± 0.17 to 6.49 ± 0.71 GPa, while viscous modulus ranged from 0.43 ± 0.03 to 0.62 ± 0.12 GPa. Loss tangent differed from 77.30 ± 4.90 to 164.50 ± 9.12. Significant differences among pH were discerned for (i) Elastic modulus: Cention N - pH 3.0, 5.0, 10.0 > 6.8; Activa Bioactive - pH 3.0, 6.8, 10.0 > 5.0, (ii) Viscous modulus: Cention N - pH 3.0, 5.0, 10.0 > 6.8, and (iii) Loss tangent: Activa Bioactive - pH 5.0 > 3.0, 6.8, 10.0. Significant differences in viscoelastic properties were noted among the BRMs with Activa Bioactive presenting the lowest elastic modulus for all pH. Immersion of all materials in pH 6.8 yielded the highest elastic modulus, except for Activa Bioactive. The effects of environmental pH on viscoelastic properties of BRMs are material-dependent.

Identification of warning signs in Malaysian patients having COVID-19 infection who progress to severe form of the illness

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus, now widely known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused 3 major pandemic waves in Malaysia. We aimed to identify the warning signs as indicators that predict the progression of disease.

MATERIALS AND METHODS

This is a retrospective cohort study of adult patients more than 12 years of age presenting with laboratory-confirmed COVID-19 admitted in three separate hospitals around the country.

RESULTS

Of the 228 patients initially admitted with mild illness, 47 had progressed requiring oxygen. The median time from admission to deterioration was 3 days (IQR 2 - 5). Age more than ≥50years old (median age = 42.5, IQR = 28.8 - 57.0), higher temperature (mean = 37.3, IQR 36.8 - 38.0), MEWS score >3 (9, 19.1%), Neutrophil-to-lymphocyte ratio (NLR) >3.13 , (18, 38.3%) C-reactive protein (CRP) >5. (12, 27.3%), multiple zonal involvement on the chest radiography on admission (2, IQR 1-3) were more common in the deteriorated group on admission. On multivariate analysis, multiple comorbidities (HR = 7.40, 95 percent CI 2.58-21.2, p0.001), presence of persistent fever (HR = 2.88, 95 percent CI 1.15 - 7.2, p = 0.024), MEWS scoring >3 (HR of 6.72 ;95 percent CI 2.81-16.0, p0.001) were associated with progression to severe illness.

CONCLUSION

In our cohort, we found that several factors were associated with the severity of COVID19. Early detection of these factors could correctly identify patients who need more intensive monitoring, and early referral for ICU care.

Impact of early biofilm on the assessment of initial enamel erosion with swept-source optical coherence tomography

Objective: This study examined the impact of early biofilm on the tooth surface, during the assessment of initial enamel erosion using swept-source optical coherence tomography (SS-OCT). Method and materials: Forty-five enamel windows of 2 × 4 mm2 were prepared on 23 extracted human teeth. The specimens were exposed to citric acid (pH 3.2) for 30 minutes and randomly divided into three groups (n = 15): Group 1, no biofilm; Group 2, 1-day-old biofilm; and Group 3, 3-day-old biofilm. Specimens in Groups 2 and 3 were inoculated with oral bacteria (Streptococcus sanguinis, Streptococcus mitis, and Actinomyces naeslundii) to produce early laboratory-cultivated biofilms for 1 and 3 days respectively. Surface microhardness (SMH) measurements were taken at pre- (t1) and post-erosion (t2); and SS-OCT scans were done at t1, t2, and post-biofilm cultivation (t3). Integrated reflectivity (IR) of the tooth-air interface (IRsurface) and enamel (IRenamel) were computed from the mean A-scans. Statistical analysis was performed using paired t tests and one-way ANOVA (α = .05). Results: A significant increase in IRenamel was observed at t2 (P < .05). At t3, IRsurface between Group 1 (control) and Group 2 (P = .012) as well as Group 3 (P = .001) were significantly different. Significant variances in IRenamel were perceived between t2 and t3 for Groups 2 and 3 but not for Group 1. Conclusion: As early biofilm affected SS-OCT assessment of initial enamel erosion, they should be removed from the tooth surface prior to OCT procedures..

Anti-diabetic medication burden amongst older persons with diabetes and associated quality of life

BACKGROUND

Older persons with diabetes are the major demographic of diabetic patients followed up in primary health clinics. Despite their increasing age and morbidities, they are still being managed strictly towards good sugar control in order to achieve the ideal HbA1c level without taking their quality of life into consideration. This study aimed to determine the prevalence in the use of antidiabetic drugs among older persons with diabetes and its association with their quality of life.

METHODOLOGY

A cross-sectional study was conducted among 269 older persons with diabetes in all government health clinics in Kuantan using Diabetes Quality of Life questionnaire. SPSS version 23 was used for the statistical analysis.

RESULTS

Majority of the respondents were females (61%), Malays (84.8%), pensioners (54.3%) with education up to primary school (52%) and are staying with family members (93.7%). Most of the patients were on two antidiabetic agents (48%) followed by a single antidiabetic agent (32%). Despite the risk of hypoglycaemia, 0.4% of them are on glibenclamide. The use of insulin is still common among 21% of them that are on intermediate-acting insulin, 15.6% on premixed insulin and 7.8% on short-acting insulin. Those taking a higher number of antidiabetic agents were found to be associated with poorer quality of life (p=0.001) compared to those taking one or two antidiabetic medications. Those on insulin also have significantly poorer quality of life score (p=0.012).

CONCLUSION

Despite aiming for controlled diabetes, older persons suffer poor quality of life with further intensification of their antidiabetic medications according to the guidelines. This includes the complexity of insulin usage and polypharmacy, which contribute to the low quality of life score.

Knowledge of Good Blood Culture Sampling Practice among Healthcare Staffs in An Emergency Department - Are We Getting It Right?

BACKGROUND

Although a vital test, blood culture is often plagued with the problem of contamination and false results, especially in a chaotic emergency department setting. The objectives of this pilot study is to find out the level of understanding among healthcare staffs in emergency department, Hospital Universiti Sains Malaysia (HUSM) regarding good blood culture sampling practice.

METHODS

All healthcare staffs in emergency department, HUSM who consented to this study were given a set of selfadministered anonymous questionnaire to fill.

RESULTS

More than half (53.1%) of the 64 participants are emergency medicine residents. Majority of them (75%) have been working in the emergency medicine, HUSM for more than 2 years. More than half of them were able to answer correctly the amount of blood volume needed for culture in adult and pediatric patients. When asked what are the factors required to improve the true yield as well as to reduce the risk of culture contamination, the four commonest answers given were observing proper aseptic technique during blood sampling, donning sterile glove, proper hand scrubbing as well as ensuring the sterility of the equipments.

DISCUSSION AND CONCLUSION

This study suggests that there is a lack of proper knowledge of good blood culture sampling practice among our healthcare staffs in emergency department.

Theme 4. Effective Models for Medical and Health Response Coordination: Summary and Action Plan

Introduction:

To effectively respond to this relatively new, complex mandate it is essential to find effective models of coordination to ensure that medical and health services can meet the standards now expected in a disaster situation. This theme explored various models, noting both the strengths that can be built on and the weaknesses that still need to be overcome.

Methods:

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 1 and Theme 4 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.

Results:

The main points developed during the presentations and discussion included: (1) preplanning (predisaster goals), (2) information collection (assessment), (3) communication (materials and methods); and (4) response centres and personnel. There exists a need for institutionalization of processes for learning from experiences obtained from disasters.

Discussion:

Action plans presented include: (1) creation of an information and data clearinghouse on disaster management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) action on lessons learned from evidence-based research and practical experience.

Conclusions:

There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.

Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: a preliminary study

BACKGROUND AND AIM

The role of caretakers at day-care centers has become more imperative in promoting oral health care in children since many new mothers opt to work outside their homes, leaving their children at day-care centers. The aim of this study is to assess the knowledge, attitude and practice of oral health promoting factors among secondary caretakers of children attending day-care centers.

SETTINGS AND DESIGN

This was a cross-sectional exploratory study conducted among secondary caretakers in Kubang Kerian, Malaysia.

MATERIALS AND METHODS

Thirty-four caretakers fulfilling the inclusion and exclusion criteria participated in the study. The data were collected using a self-administered questionnaire addressing various aspects of knowledge, attitude and practice of oral health in children. Analysis was done using SPSS version 12.0.

RESULTS

The knowledge of factors causing dental caries was found to be good among majority of the caretakers, but the concepts of transmissibility of caries and effect of hidden sugars were not evident. Seventy one percent did not know that frequent bottle feeding could cause tooth decay. Attitudes seemed to be governed by the cultural practices of the region rather than the knowledge obtained. The knowledge was not translated to practice adequately. Giving sweetened liquid in bottles was practiced by 53% of the caretakers.

CONCLUSION

Implementation of nursery-based oral health promotion programs for secondary caretakers is needed to counteract early childhood caries.

A mimicry of melioidosis by Klebsiella ozaenae infection

Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofloxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of i.v. ceftazidime and i.v. amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.

The National Mental Health Registry (NMHR)

The National Mental Health Registry (NMHR) collects information about patients with mental disorder in Malaysia. This information allows us to estimate the incidence of selected mental disorders, and to evaluate risk factors and treatment in the country. The National Mental Health Registry (NMHR) presented its first report in 2004, a year after its establishment. The report focused on schizophrenia as a pioneer project for the National Mental Health Registry. The development of the registry has progressed with data collected from government-based facilities, the academia and the private sector. The 2003-2005 report was recently published and distributed. Since then the registry has progressed to include suicides and other mental illnesses such as depression. The NMHR Report 2003-2005 provides detailed information about the profile of persons with Schizophrenia who presented for the first time to various psychiatry and mental health providers throughout Malaysia. More detailed description regarding pharmacotherapy is reported and few cross tabulations done in an effort to provide better understanding and more clinically meaningful reports.

Peginterferon {alpha}-2b and ribavirin therapy in chronic hepatitis C genotype 4: impact of treatment duration and viral kinetics on sustained virological response

BACKGROUND

The response rates and duration of peginterferon alpha (PEG-IFN-alpha) and ribavirin combination therapy in chronic hepatitis C genotype 4, the prevalent genotype in the Middle East and Africa, are poorly documented.

AIMS

To compare the efficacy and safety of 24, 36, or 48 weeks of PEG-IFN-alpha-2b and ribavirin therapy in chronic hepatitis C genotype 4.

METHODS

In this prospective, randomised, double blind study, 287 patients with chronic hepatitis C genotype 4 were randomly assigned to PEG-IFN-alpha-2b (1.5 mug/kg) once weekly plus daily ribavirin (1000-1200 mg) for 24 weeks (group A, n = 95), 36 weeks (group B, n = 96), or 48 weeks (group C, n = 96) and followed for 48 weeks after completion of treatment. Early viral kinetics and histopathological evaluation of pre- and post treatment liver biopsies were performed. The primary end point was viral clearance 48 weeks after completion of treatment.

RESULTS

Sustained virological response was achieved in 29%, 66%, and 69% of patients treated with PEG-IFN-alpha-2b and ribavirin for 24, 36, and 48 weeks, respectively, by intention to treat analysis. No statistically significant difference in sustained virological response rates was detected between 36 and 48 weeks of therapy (p = 0.3). Subjects with sustained virological response showed greater antiviral efficacy (epsilon) and rapid viral load decline from baseline to treatment week 4 compared with non-responders and improvement in liver histology. The incidence of adverse events was higher in the group treated for 48 weeks.

CONCLUSION

PEG-IFN-alpha-2b and ribavirin for 36 or 48 weeks was more effective in the treatment of chronic hepatitis C genotype 4 than treatment for 24 weeks. Thirty six week therapy was well tolerated and produced sustained virological and histological response rates similar to the 48 week regimen.

Prediction of the dewatering of selected inorganic sludges

There are a number of laboratory techniques traditionally used in the characterisation of sludges for the prediction of the efficient operation of dewatering processes such as centrifugation and filtration. In industry, capillary suction time and specific resistance to filtration measurements are common. Whilst useful in predicting trends, they do not assist in the design and optimisation of devices from first principles. Recent work in our laboratories has developed a technique for the fast measurement of the permeability and compressibility of sludge. This information, when coupled with first-principle models is useful for the prediction of the performance of solid-liquid separation devices. The work has shown that a single volume fraction dependent parameter, namely the solids diffusivity, calculated from permeability and compressibility, is able to fully characterise the dewaterability of sludge. This allows different sludges to be compared in an unequivocal fashion. Data will be presented for a range of sludges from different sources showing vastly different dewatering properties. The dewaterability of the different sludges is easily compared and the true role of flocculants in dewatering is highlighted.

Antioxidant flavonols from fruits, vegetables and beverages: measurements and bioavailability

Flavonols are polyphenolic secondary plant metabolites that are present in varying levels in commonly consumed fruits, vegetables and beverages. Flavonols have long held an interest for nutritionists, which has increased following a Dutch study in the early 1990's showing that dietary intake of flavonols was inversely correlated with the incidence of coronary heart disease. The main factors that have hindered workers in the field of flavonol research are (i) the accurate measurement of these compounds in foods and biological samples, and (ii) a dearth of information on their absorption and metabolism. This review aims to highlight the work of the authors in attempting to clarify the situation. The sensitive and selective HPLC procedure to identify and quantify common flavonols and their sugar conjugates is described. In addition, the results of an on-going screening program into the flavonol content of common produce and beverages are presented. The bioavailability of dietary flavonols is discussed with reference to an intervention study with onions, as well as pilot studies with tea, red wine and cherry tomatoes. It is concluded that flavonols are absorbable and accumulate in plasma and that consuming high flavonol-containing varieties of fruits and vegetables and particular types of beverages could increase their circulatory levels.

Lift-flap retreatment after laser in situ keratomileusis

PURPOSE

To demonstrate the effectiveness of lifting the flap for retreatment of undercorrected eyes after laser in situ keratomileusis (LASIK).

METHODS

We reviewed the results of 11 LASIK patients (12 eyes) who underwent retreatment for residual myopia by lifting the previously cut flap. This was followed by treatment with the Summit Apex excimer laser and repositioning of the flap. Average time prior to retreatment was 5 months (range, 1 to 9 mo). Follow-up was 100% at 3 months after retreatment.

RESULTS

The average preoperative spherical equivalent refraction was -8.73 D; average prior to retreatment was -2.24 D (range, -0.67 to -5.75 D). At 1 month after retreatment, average deviation from intended correction was 0.08 D; at 3 months it was -0.12 D. Eleven of 12 treated eyes (92%) had uncorrected visual acuity of 20/40 or better and 4 eyes (33%) saw 20/20 or better without correction. Six eyes (50%) were within +/- 0.50 D of intended correction at 3 months. No patients lost any lines of spectacle-corrected visual acuity.

CONCLUSION

Retreatment of residual myopia after LASIK by lifting the flap appears to be effective and associated with minimal complications.

Absorption and excretion of conjugated flavonols, including quercetin-4'-O-beta-glucoside and isorhamnetin-4'-O-beta-glucoside by human volunteers after the consumption of onions

Flavonols are polyphenols found ubiquitously in plants and plant-products. Flavonols, particularly quercetin, are potent antioxidants in vitro and their intake has been associated inversely with the incidence of coronary heart disease. The aim of this study was to investigate the accumulation in plasma and excretion in urine of flavonol glucosides following ingestion of lightly fried onions. Five healthy volunteers followed a low-flavonoid diet for 3 days. On day 4, after an overnight fast, subjects were given 300 g of lightly fried yellow onions which contain conjugates of quercetin and isorhamnetin, including quercetin-3,4 '-diO-beta-glucoside, isorhamnetin-4'-O-beta-glucoside and quercetin-4'-O-beta-glucoside. Blood collection was carried out at 0 min, 0.5, 1.0, 1.5, 2, 3, 4, 5 and 24h after the supplement. In addition, subjects collected all their urine for 24h following the onion supplement. Isorhamnetin-4'-O-beta-glucoside and quercetin-4 '-O-beta-glucoside accumulated in plasma with maximum levels, defined as proportion of intake, of 10.7+/-2.6% and 0.13+/-0.03% respectively. The time of the quercetin-4'glucoside peak plasma concentration was 1.3+/-0.2 h after the ingestion of onions while a value of 1.8+/-0.7 h was obtained for isorhamnetin-4'-glucoside. Excretion in urine, as a proportion of intake, was 17.4+/-8.3% for isorhamnetin-4'-O-beta-glucoside and 0.2+/-0.1% for quercetin-4'-O-beta-glucoside. Possible reasons for the accumulation and excretion of isorhamnetin-4'-glucoside in proportionally much higher amounts than quercetin-4'-glucoside are discussed. It is concluded that flavonols are absorbed into the bloodstream as glucosides and minor structural differences affect markedly both the level of accumulation and the extent to which the conjugates are excreted.

Prevalence of certain sexually transmitted diseases in Egypt

The prevalence of STD continues to increase throughout the world threatening millions of people. However, the actual incidence of STD is not known in most countries. Little work was done to evaluate the size of this problem in Egypt. This study aimed to identify the most prevalent sexually transmitted organisms among patients attending the STD clinic at Cairo Hospital for Skin and Venereal Diseases (El-Haud El-Marsoud). Among the patients attending this clinic complaining of one or more STD or not complaining, but attending the clinic for screening for fear from STD due to their sex behavior, from October 1993, to April 1995, 95 cases were studied. This was done by history taking, clinical, bacteriological and Certain demographic and interacting with sexual serological examinations. socioeconomic factors attitudes and practices were also studied. Data were recorded in special sheets. The results of this study showed that 68 (71.6%) patients had one or more ST organisms (positive cases) while no ST organisms could be detected in the remaining 27 (28.4%) cases (negative cases). Positive cases were more prevalent n adolescents and young adults (58.8%). A high prevalence of STD was detected in males (73.5%) than females (26.5%); in sinlges (64.7%) than married (30.9%), divorced (2.9%) or widowed (1.5%). The rate of the positive cases was high among those having 5 or more sexual partners and in heterosexuals. All STD positive patients were not condom users except one patient. Most of patients were not drug abusers (66.2%) and were of low socioeconomic class (85.3%). STD were common among those with preparatory school education level (32.4%), or illiterate (26.5%) than those with primary school level (16.2%) or university or institute degree (13.2%) or secondary school degree (11.8%) of education. Among the 68 positive cases, N. gonorrhoeae was isolated from 36.8%, T. pallidum was detected in 30.9%. Using the appropriate serological techniques, HBV and HIV were detected in 14.7% and HCV in 11.8%. G. vaginalis was isolated from 11.8%; each of group B Streptococci and Strept. pneumoniae was isolated from 4.4% and each of T. vaginalis and C. albicans was isolated from 1.5%. Concomitant STD were detected in 18 out of 68 patients. So, STD is a variable state regarding the number of the causative organisms and their relative incidence according to several factors. For that, the state of STD in any location must be checked periodically to plan restrictive managing and controlling programs.

Antibacterial evaluation of some xanthate derivatives and their diorganotin (IV) complexes

The antibacterial activity of some xanthate derivatives K(SSCOR), where R = C6H5-(CyX), CH3NHCH2CH2-(MAEX), (CH3)2NCH2CH2-(DMAX), (CH3)2NCH2CH(CH3)-(DMAIX) and (C2H5)2NCH2CH2-(DEAEX) together with their diorganotin (IV) complexes R2Sn(SSCOR)2, where R' = Me, Bu(n), Ph, has been studied against eight species of bacteria in vitro. A significant activity against S. typhimurium was displayed by the xanthate derivative CyX and its complex Ph2Sn(CyX)2 at concentrations ranging from 1-10 micrograms/ml, and a remarkable activity was exhibited by the complexes Ph2Sn(CyX)2, Ph2Sn(MAEX)2 and Ph2Sn(DMAX)2 against P. aeruginosa at concentrations ranging from 0.1-10 micrograms/ml. By contrast, no such activity was demonstrated by the antibiotics used in this study (amoxicillin and chloramphenicol) against the same bacterial species.

Survival factors in rhino-orbital-cerebral mucormycosis

Mucormycosis is a highly aggressive fungal infection affecting diabetic, immunocompromised, and, occasionally, healthy patients. This infection is associated with significant mortality. We have reviewed 208 cases in the literature since 1970, 139 of which were presented in sufficient detail to assess prognostic factors, and added data from six of our patients. The histories of these 145 patients were analyzed for the following variables: 1) underlying conditions associated with mucormycotic infections; 2) incidence of ocular and orbital signs and symptoms; 3) incidence of nonocular signs and symptoms; 4) interval from symptom onset to treatment; and 5) the pattern of sinus involvement seen on imaging studies and noted at the time of surgery. Factors related to a lower survival rate include: 1) delayed diagnosis and treatment; 2) hemiparesis or hemiplegia; 3) bilateral sinus involvement; 4) leukemia; 5) renal disease; and 6) treatment with deferoxamine. The association of facial necrosis with a poor prognosis fell just short of statistical significance, but appears clinically important. This is the first review that documents the heretofore intuitive claim that early diagnosis is necessary to cure this disease. Standard treatment with amphotericin B and aggressive surgery are reviewed and adjunctive therapeutic modalities are discussed, including local amphotericin B irrigation, hyperbaric oxygen, and optimizing the immunosuppressive regimen in transplant patients. Hyperbaric oxygen was found to have a favorable effect on prognosis. In addition, possible treatment options for patients with declining renal function are reviewed.

Testotoxicosis: gonadotrophin-independent male sexual precocity

In this era of rapidly developing investigational tools and pharmacology, the pathophysiology of precocious puberty is becoming well defined. What was previously thought to be a form of gonadotrophin releasing hormone (GNRH)-dependent central precocious puberty is now classified as GNRH-independent familial testotoxicosis. We present two such cases and review the clinical features, pathophysiology and treatment of testotoxicosis.

Aspergillus endophthalmitis: a clinical and experimental study

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Chondrosarcoma in fibrous dysplasia of the pelvis. A case report and review of the literature

Malignant transformation of fibrous dysplasia to chondrosarcoma is rare. We report a case in which malignancy developed in an area of fibrous dysplasia in the ilium. We believe this to be the second reported case at this site. Treatment was by excision of the hemipelvis including the ala of the sacrum. A review of the literature is presented.

Tetrahydrobiopterin metabolism in senile dementia of Alzheimer type

Tetrahydrobiopterin metabolism was shown to be disturbed in 18 patients with senile dementia of Alzheimer type. This may have a bearing on the pathogenesis of the disease.

Clinical and bacteriological evaluation of a twice daily regimen of epicillin capsules for the treatment of skin infections

Fifty-five patients with impetigo, ecthyma, or folliculitis caused by epicillin-sensitive strains of Streptococcus pyogenes or Staphylococcus aureus were treated with 500 mg epicillin capsules twice daily for an average duration of 9 days. Bacteriological and clinical examinations were performed at 2-day intervals. Favourable clinical responses (excellent or good) were obtained in 95% of the patients. No side effects were observed.