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Intentional penetration of dental implants into the maxillary sinus: a retrospective study
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1536-1539
Omed
Ikram Shihab* * Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.001
Background and objective: Perforation of the maxillary sinus by a dental implant is an issue of concern by many dental implant clinicians. This study aimed to assess the success rate and consequences of dental implants emerging into the maxillary sinus. Methods: The maxillary sinus was intentionally perforated for dental implant placement in 35 patients with reduced posterior maxillary bone height (4 mm or more). A total of 70 implants engaged bicortically and emerged into the sinus. Nineteen female and 16 male patients were involved in the study. The patients were followed up for sinus complications and dental implant success. Results: From the total, only two implants were failed; one during gingival former placement and the other after loading by one year. No patient presented with sinusitis clinically and radiographically. Three patients developed epistaxis just on the day of surgery and became well after on. Conclusion: Within the limits of this study, dental implant emergence into healthy maxillary sinus is considered a safe and successful procedure. Keywords: Dental implant; Maxillary sinus; Complications.
1. Cordioli G, Mazzocco C, Schepers E, Brugnolo E, Majzoub Z. Maxillary sinus floor augmentation using bioactive glass granules and autogenous bone with simultaneous implant placement. Clinical and histological findings. Clin Oral Implants Res 2001; 12:270–8. 2. Van den Bergj JP, ten Ruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000; 11:256-5. 3. Tatum H. Maxillary and sinus implant reconstruction. Dent Clin North Am 1986; 30: 207–29. 4. Chanavaz M. Maxillary sinus: anatomy, physiology, surgery, and bone grafting related to implantology - eleven years of surgical experience (1979-1990). J Oral Implantol 1990; 16:199–209. 5. Shlomi B, Horowitz I, Kahn A, Dobriyan A, Chaushu G. The effect of sinus membrane perforation and repair with Lambone on the outcome of maxillary sinus floor augmentationa radiographic assessment. Int J Oral Maxillofac Implants 2004; 19:559–62. 6. Barone A, Santini S, Sbordone L, Crespi R, Covani U. A clinical study of the outcomes and complications associated with maxillary sinus augmentation. Int J Oral Maxillofac Implants 2006; 21(1):81–5. 7. Abi Najm S, Malis D, El Hage M, Rahban S, Carrel JP, Bernard JP. Potential adverse events of endosseous dental implants penetrating the maxillary sinus: long-term clinical evaluation. Laryngoscope 2013; 123(12):2958–61. 8. Weijian Z, Binke C, Xin L, Guowu MA. Experimental study on penetration of dental implants into the maxillary sinus in different depths. J Appl Oral Sci 2013; 21(6):560–6. 9. Nooh N. Effect of schneiderian membrane perforation on posterior maxillary implant survival. Journal of International Oral Health 2013; 5(3): 28–34. 10. Givol N, Taicher S, Halamish-Shant T, Chaushu G. Risk management aspects of implant dentistry. Int J Oral Maxillofac Implants 2002; 17:258–62. 11. Berengo M, Sivolella S, Majzoub Z, Cordioli G. Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure. Int J Oral Maxillofac Surg 2004; 33:189–94.
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Chemoprotective effect of ascorbic acid on cyclophosphomide induced oral toxicity
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1540-1551
Ali Sultan Al-Refai* * Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.002
Background and objective: Oral mucositis is currently considered to be the most severe complication of anticancer therapy such as cyclophosphamide (CTX). Ascorbic acid is a well-known antioxidant, which can protect the body from damage caused by free radicals that can be generated during normal metabolism as well as through exposure to toxins and carcinogens. This study aimed to evaluate the effectiveness of ascorbic acid as a treatment for CTX induced oral mucositis. Methods: Forty Wister-albino rats, age about 6-8 weeks and weighing 150-200 g were used. The rats were randomly divided by simple random allocation into two groups (20 animals each). The control group was intraperitoneally injected with physiological saline and the animals were grouped randomly into two groups: Saline/Water treated group which were daily received intraperitoneal injection of distilled water, while the Saline/Ascorbic acid treated group received a daily intraperitoneal injection of ascorbic acid (12mg/kg/day). For the induction of mucositis, a single dose (300 mg/kg) of CTX was administered intraperitoneally to each animal in the study group, and the animals were grouped randomly into two groups: CTX /Water treated group which was daily received intraperitoneal injection of distilled water, while the CTX /Ascorbic acid treated group were daily received intraperitoneal injection of 12 mg/kg /day of ascorbic acid. The animals were sacrificed at day four and eight (five animals each) and the tongue was dissected from the jaw for histological and immunohistochemical analysis. Results: Ascorbic acid decreased the severity of the induced CTX oral mucositis by a significant increase in epithelial thickness, significant decrease in damage score, and significant increase in PCNA immune expression at day four and eight respectively (P <0.05). Conclusion: CTX chemotherapy has a deleterious effect on the oral mucosa leading to marked morphometric and microscopic changes. Ascorbic acid can protect the oral mucosa from CTX-induced cytotoxicity, and attenuate or decrease the associated injury. Keywords: Ascorbic acid; Cyclophosphamide; Oral mucositis; Antioxidant; PCNA.
1. Ghom AG, Jedhe SM. Text book of oral pathology. 2nd edition. New Delhi: Jaypee Brothers, Medical Publishers Pvt. Limited; 2013. 2. Da Cruz Campos MI, Campos CN, Aarestrup FM, Aarestrup JV. Oral Mucositis in cancer treatment: Natural history, prevention and treatment (review). Mol Clin Oncol 2014; 2(3):337–40. 3. Miller MM, Donald DV, Hagemann TM. Prevention and treatment of oral mucositis in children with cancer. J Pediatr Pharmacol Ther 2012; 17(4): 340–50. 4. Sonis ST. A biological approach to mucositis. J Support Oncol 2004; 2(1):21–32. 5. Aras MH, Sezer U, Erkilic S, Demir T, Dagli SN. Effect of dietary boron on 5- fluorouracil induced oral mucositis in rats. Eur J Dent 2013; 7(3):10–4. 6. Javed A, Ashwini LS, TS, Sagar S, Medam SK. Effect of quercetin on cyclophosphamide induced biochemical profiles in rat liver. Int J Res Stud Biosci 2014; 2:40–6. 7. Khan S, Jena G. Sodium cylophosphamide-induced genotoxicit and cytotoxicity in the colon of mice. J Basic Clin Physiol Pharmacol 2014; 27:1–11. 8. Panigrahy SK, Jatawa S, Archana Tiwari A. Therapeutic use of cyclophosphamide and its cytotoxic action : A challenge for researchers. J Pharm Res. 2011; 4(8):2755–7. 9. Doloff JC, Chen C,David J Waxman DJ. Anti-tumor innate immunity activated by intermittent metronomic cyclophosphamide treatment of brain tumor xenografts is preserved by anti-angiogenic drugs that spare VEGF receptor-2. Mol Cancer 2014; 13:158–71. 10. Fassbinder T, Saunders U, Mickholz E, Jung E, Becker H, Schlüter B, et al. Differential effects of cyclophosphamide and mycophenolate mofetil on cellular and serological parameters in patients with systemic lupus erythematosus. Arthritis Res Ther 2015; 17:92–114. 11. Fukazawa M, Kawaguchi H, Shigematsu H, Koga C, Mori E, Nishimura S, et al. High incidence-rate of oral mucositis in breast cancer patients receiving anthracycline-based chemotherapy (FEC100). Jpn J Cancer Chem 2012; 39(3): 395–8. 12. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, et al. Mucositis study section of the multinational association of supportive care in cancer and the International Society for Oral Oncology. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer 2007; 109(5): 820–31. 13. Al-Refai AS, Al-Barazenchy H, Khalil A K. Immunohistochemical study of the effect of green tea extract on methotrexate- induced oral mucositis in albino rats. J Cytol Histol 2014; 5(3):1–7. 14. El-Gendy KS, Aly NM, Mahmoud FH, Kenawy A, El-Sebae AK. The role of vitamin C as antioxidant in protection of oxidative stress induced by imidacloprid. Food Chem. Toxicol 2010; 48:215–21. 15. Nadia RA, Abou-Zeid. Ameliorative effect of vitamin C against 5-fuorouracil –induced hepatotoxicity in mice: A light and electron microscope study. J Basic Appli Zool 2014; 67:109–18. 16. Owari M, Wasa M, Oue T, Nose S, Fukuzawa M. Glutamine prevents intestinal mucosal injury induced by cyclophosphamide in rats. Pediatr Surg Int 2012; 28(3):299–303. 17. Ücuncu H, Ertekin MV, Yoruk Ö, Sezen O, Özkan A, Erdog˘ AN F, et al. Vitamin E and L-carnitine, separately or in combination, in the prevention of radiation-induced oral mucositisband myelosuppression: a controlled study in a rat model. J Radiat Res 2006; 47:91–102. 18. Seleit IA, Asaad N, Maree A, Abdel Wahed M. Immunohistochemical expression of p53 and Ki-67 in cutaneous lupus erythematosus. J Egypt Women Dermatol Soc 2010; 7(1):5–15. 19. Sonis ST. Efficacy of palifermin (keratinocyte growth factor-1) in the amelioration of oral mucositis. Core Evid 2010; 4:199–205. 20. Riordan NH, Riordan HD, Casciari JJ. Clinical and experimental experiences with intravenous vitamin C. J Orthomol Med 2000; 15:201–3. 21. Riordan HD, Hunninghake RB, Riordan NH, Jackson JJ, Meng X, Taylor P, et al. Intravenous ascorbic acid: protocol for its application and use. P R Health Sci J 2003; 22 (3):287–90. 22. Sakagami H, Satoh K, Hakeda Y, Kumegawa M. Apoptosis- inducing activity of vitamin C and vitamin K. Cell Mol Biol 2000; 46:129–35. 23. Kim J, Lee SD, Chang B, Jin DH, Jung S, Park MY, et al. Enhanced antitumor activity of vitamin C via p53 in cancer cells. Free Radic Biol Med 2012; 53(8):1607–15. 24. Zhao J, Kim KA, De Vera J. Spondin 1 protects mice from chemotherapy or radiation-induced oral mucositis through the canonical Wnt/beta-catenin pathway. Proc Natl Acad Sci 2009; 106:2331–6. 25. Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer. Dent Clin North Am 2008; 52:61–77. 26. Lima V, Vidal FD, Rocha FA, Brito GA, Ribeiro RA. Effects of tumor necrosis factor-alpha inhibitors pentoxifylline and thalidomide on alveolar bone loss in short-term experimental periodontal disease in rats. J Periodontol 2004; 75:162–8. 27. Shih A, Miaskowski C, Dodd M, Stotts N, MacPhail L. Mechanisms for radiation-induced oral mucositis and the consequences. Cancer Nurs 2003; 26(3):222–9. 28. Cawley MM, Benson LM. Current trends in managing oral mucositis. Clin J Oncol Nurs 2005; 9(5):584–92. 29. Aboushady IM, Mubarak RT,; El-mougy SAF, Rashed LA, El-desouky AA. The effect of transplanted bone marrow Sstem cells on the tongue of irradiated rats (Histological and Immunohistochemical study). J Am Sci 2012; 8(11):553–61. 30. Jezernik K1, Romih R, Mannherz HG, Koprivec D. Immunohistochemical detection of apoptosis, proliferation and inducible nitric oxide synthase in rat urothelium damaged by cyclophosphamide treatment. Cell Biol Int 2003; 27(10):863–9. 31. Ratnam DV, Ankola DD, Bhardwaj V, Sahana DK, Ravi Kumar MNV. Role of antioxidants in prophylaxis and therapy: a pharmaceutical perspective. J Control Release 2006; 113(3): 189–207. 32. Naidu KA. Vitamin C in human health and disease is still a mystery? An overview. Nutr J 2003; 2:7–11. 33. Mikirova N, Casciari J, Rogers A, Taylor P. Effect of high-dose intravenous vitamin C on inflammation in cancer patients. J Transl Med 2012; 10(1):189–98. 34. Saeed RW, Peng T, Metz CN. Ascorbic acid blocks the growth inhibitory effect of tumor necrosis factor-alpha on endothelial cells. Exp Biol Med 2003; 228:855–65. 35. Suhail N, Bilal N, Khan HY, Hasan S, Sharma S, Khan F, et al. Effect of vitamins C and E on antioxidant status of breast-cancer patients undergoing chemotherapy. J Clin Pharm Ther 2012; 37:22–6. 36. Podmore ID, Griffiths HR, Herbert KE, Mistry N, Mistry P, Lunec J. Vitamin C exhibits pro-oxidant properties. Nature 1998; 392(6676):559–64. 37. Lee KW, Lee HJ, Surh YJ, Lee CY. Vitamin C and cancer chemoprevention: reappraisal. Am J Clin Nutr 2003; 78(6):1074–8. 38. Mohan S, Priya V. Changes in lipid peroxidation, glutathione,ascorbic cid, vitamin E and antioxidant enzymes in patients with ovarian cancer. Acta Med Acad 2009: 38(1):1–5.
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Evaluation of the effect of chamomile extract on lingual histological changes in rabbit received 5-fluorouracil (histological and immunohistochemical study)
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1552-1560
Shukria
Muhammed Zahawi*, Ali Sultan Al-Refai**, Hanan Abdulla
Abdulqader*** * Department of Oral Diagnosis, College of Dentistry, Hawler Medical University, Erbil, Iraq. ** Department of Oral and Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq. *** Department of Oral Diagnosis, College of Dentistry, Duhok University, Duhok, Iraq.
doi.org/10.15218/zjms.2017.003
Background and objective: Chamomile has been used as an herbal medication since ancient times and is still popular until today. This study aimed to investigate the potential anticytotoxic effect of chamomile extract on the lingual mucosa of rabbits treated with 5-fluorouracil (5-FU). Methods: Thirty six rabbits were used in the study. For induction of tongue mucositis for the study group, 5-FU at a dose of (4 mg/kg) was administered intraperitoneally one time daily for five successive days. The control animals were intraperitoneally injected by normal saline one time daily for five successive days. The rats in each group were randomly divided into two groups: Distilled water and chamomile extract treated groups (9 animals each). A volume of distilled water equal to chamomile extract was given by gavage tube, while the other group was gavaged with chamomile extract at a dose of (100 mg/ kg) one time daily. The treatment with distilled water or the chamomile extract was continued for sixteen days and then the animals were sacrificed, and the tongues were excised for histopathological and immunohistochemical analysis. Results: The 5-FU/water treated group showed a significant increase in histological damage scores, decrease in the ki-67and increase in caspase -3 epithelial immune expression (P <0.05) in comparison with saline/water treated group. The 5-FU/chamomile treated group showed a significant increase in damage score, significant decrease in ki-67 immune expression and significant increase in caspase-3 immune expression (P <0.05) in comparison with 5-FU/water treated group. Conclusion: Chamomile extract at a dose of (100 mg/ kg) one time daily for sixteen days cannot be used for the treatment of oral mucositis. It causes damage to the tissue, decreases proliferation, and increases apoptosis. Keywords: Lingual papillae; Chamomile; 5-FU; Ki-67; Caspase- 3.
1. Ghom AG, Jedhe SM. Text book of oral pathology. 2nd ed. New Delhi; Jaypee Brothers Medical Publishers; 2013. 2. Da Cruz Campos MI, Campos CN, Aarestrup FM, Aarestrup JV. Oral mucositis in cancer treatment: Natural history, prevention and treatment (review). Mol clin oncol 2014; 2(3):337–40. 3. Noordhuis P, Holwerda U, Van der Wilt CL, Van Groeningen CJ, Smid K, Meijer S, et al. 5-Fluorouracil incorporation into RNA and DNA in relation to thymidylate synthase inhibition of human colorectal cancers. Ann Oncol 2004; 15:1025–32. 4. Mead GM. Management of oral mucositis associated with cancer chemotherapy. Lancet 2002; 359(23):815–6. 5. Chen P, Lingen M, Sonis ST, Walsh-Reitz MM, Toback FG. Role of AMP-18 in oral mucositis. Oral Oncol 2011; 47(9):831–9. 6. Miller MM, Donald DV, Hagemann TM. Prevention and treatment of oral mucositis in children with cancer. J Pediatr Pharmacol Ther 2012; 17(4):340–50. 7. Srivastava JK, Eswar-Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Rep 2010; 3(6):895–901. 8. Al- Bahtiti NH. Chemical analysis and biological activity of Jordanian chamomile extracts. Adv J Food Sci Technol 2012; 4(1):22–5. 9. Svenningsen AB, Madsen KD, Liljefors T, Stafford GI, Van Staden J, Jäger AK. Biflavones from Rhus species with affinity for the GABA (A) benzodiazepine receptor. J Ethno pharmacol 2006; 103(2):276–80. 10. Srivastava JK, Gupta S. Antiproliferative and apoptotic effects of chamomile extract in various human cancer cells. J Agric Food Chem 2007; 55:9470–8. 11. Ferreira RJ, Carvalho AE, Souza W, Alvarenga FB, Rodrigues FB. Anatomia da Artéria Lingual Profunda em Sus scrofa domestica, LINNAEUS, 1758. Ciência Animal Brasileira 2011; 12(2): 298–305. 12. Miyawaki Y,Yoshimura K, Shindo J, Kageyama I. Light and scanning electron microscopic study on the tongue and lingual papillae of the common raccoon, Procyon lotor. Okajimas Folia Anatomica Japonica 2010; 87(2):65–73. 13. Fonseca ET, Oliveira CM, Franciolli ALR, Miglino MA. “Caracteristicas das papilas do dorso da lingua de cabras (Capra hircus): estudo por de microscopia eletrônica de varredura e luz. Pesquisa Veterinária Brasileira 2011; 31(1): 67–73. 14. Zheng J, Kobayashi K. “Comparative morphological study on the lingual papillae and their connective tissue cores (CTC) in reeves' muntjac deer (Muntiacus reevesi),” Ann Anat 2006; 188(6):555–64. 15. Cooper LS, Gillett CE, Smith P, Fentiman IS, Barnes DM. Cell proliferation measured by MIB1 and timing of surgery for breast cancer. Br J Cancer 1998; 77:1502–7. 16. Ermiah E, Buhmeida A, Abdalla F, Khalid BR,Salem N, Pyrhonen S. Prognostic Value of Proliferation Markers: Immunohistochemical Ki-67 Expression and Cytometric S-Phase Fraction of Women with Breast Cancer in Libya. J Cancer 2012; 3:421–31. 17. Green DR, Kroemer G. The pathophysiology of mitochondrial cell death. Science 2004; 305: 626–9. 18. Decker P, Muller S. Modulating poly (ADP-ribose) polymerase activity: potential for the prevention and therapy of pathogenic situations involving DNA damage and oxidative stress. Curr Pharm Biotechnol 2002; 3:275–83. 19. Degterev A, Boyce M, Yuan J. A decade of caspases. Oncogene 2003; 22:8543–67. 20. Emam MAL. Comparative evaluation of antidiabetic activity of Rosmarinus officinalis and Chamomile recutita in streptozotocin induced diabetic rats. Agric Biol J N Am 2012; 3:247–52. 21. Ozel O, Aycicek A, Kenar F, Aktepe F, Sargin R, Deniz M, et al. Histopathologic changes in the rabbit submandibular gland after5-fluorouracil chemotherapy. Turk J Med Sci 2010; 40:213–20. 22. Barakat SA. The possible role of green tea in protecting submandibular salivary gland function in rats receiving 5-Fluorouracil 2014. M.Sc. Thesis. Mansoura University, Egypt. 23. Ücuncu H, Ertekin MV, Yoruk Ö, Sezen O, Özkan A, Erdoğan F, et al. Vitamin E and L-carnitine, separately or in combination, in the prevention of radiation-induced oral mucositis and myelosuppression: A controlled study in a rat model. J Radiat Res 2006; 47:91–102. 24. Seleit IA, Asaad N, Maree A, Abdel Wahed M. Immunohistochemical expression of p53 and Ki-67 in cutaneous lupus erythematosus. J Egypt Women Dermatol Soc 2010; 7(1):5–15. 25. Christopher AS, Mary JK: Biology of oral mucosa and esophagus. J Natl Cancer Inst Monogr 2001; 29:7–15. 26. Zheng WK, Inokuchi A, Yamamoto T, Komiyama S. Taste dysfunction in irradiated patients with head and neck cancer. Fukuoka Igaku Zasshi 2002; 93(4):64–76. 27. Alvariño-Martín C, Sarrión-Pérez MG. Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent 2014; 6(1):74–80. 28. López BC. Oral toxicity produced by chemotherapy: A systematic review. J Clin Exp Dent 2014; 6(1):81–90. 29. Sonis ST. Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol 1998; 34(1):39–43. 30. Sonis ST. A biological approach to mucositis. J Support Oncol 2004; 2(1):21–32. 31. Wright TH, Yazbeck R, Lymn KA, Whitford EJ, Cheah KY, Butler RN, et al. The herbal extract, Iberogast, improves jejunal integrity in rats with 5-Fluorouracil (5-FU)-induced mucositis. Cancer Biol Ther 2009; 8:923–9. 32. Pritchard DM, Watson AJ, Potten CS, Jackman AL, Hickman JA. Inhibition by uridine but not thymidine of p53 dependent intestinal apoptosis initiated by 5-fluorouracil: Evidence for the involvement of RNA perturbation. Proc Nat Acad Sci 1997; 94(5):1795–9. 33. Green DR, Kroemer G. The pathophysiology of mitochondrial cell death. Science 2004; 305: 626–9. 34. Carl W, Emrich LS. Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 1991; 66:361–9. 35. Fidler P, Loprinzi CL, O'Fallon JR, Leitch JM, Lee JK, Hayes DL, et al. Prospective evaluation of chamomile mouth wash for prevention of 5-FU induced mucositis. Cancer 1996; 77(3):552–5. 36. Al-Refai AS. Immunohistochemical study of the effect of chamomile extract on 5-fluorouracil induced intestinal mucositis in albino rats. J Clin Cell Immunol 2014; 5:1–10. 37. Zadeh JB, Moradi Kor N, Moradi Kor Z. Chamomile (Matricaria recutita as a valuable medicinal plant. IJABBR 2014; 2(3):823–9. 38. Cavalieri E, Rigo A, Bonifacio M, Carcereri de Prati A, Guardalben E, Faculi M, et al. Pro- apoptotic activity of α-bisabolol in preclinical models of primary human acute leukemia cells. J Transl Med 2011; 9:45–51.
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Evaluation of the antibacterial activity of human cathelicidin peptide-LL-37 in the presence of acidified nitrite
PDF
1561-1566
Safaa
Toma Hanna Aka* * Department of Pharmacogonsy, College of Pharmacy, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.004
Background and objective: Bacterial resistance to conventional antibacterial agents has increased recently and this resistance results in complicated infections. Multiple protective mechanisms can evolve in mammalians to maintain the body protected from infections. Human cathelicidin antimicrobial peptide LL-37 and acidified nitrite are important components of the innate immune system that partake in preventing infections. Cathelicidin peptide LL-37 can be produced by epithelial tissues as well as by macrophages after microbial infections. This study was carried out to evaluate the antibacterial activity of LL-37 and acidified nitrite (AN) both individually and combined for their effect against the standard the strains of E.coli ATCC 25922 and S. aureus ATCC 25923. Methods: Flat-bottom micro well plates (96 wells) were used for the determination of bacteriostatic activity. Sodium nitrite (NaNO2) and ascorbic acid (AA) were used to produce acidified nitrite (AN). The singular and combined forms of the antibacterial agents were used for evaluating the antibacterial activities of LL-37 through estimation optical density values at 480nm (OD480nm). Results: The LL-37 peptide showed antibacterial activity against E.coli ATCC 25922 and S. aureus ATCC 25923. The antibacterial efficacy was enhanced when the peptide was tested in combination with AN (P <0.001). In contrast, the combination of LL-37 with NaNO2 and AA has an antagonistic effect (P <0.001) on its antimicrobial properties. Conclusion: The combination of LL-37 with AN has a synergistic on the peptide’s antimicrobial effect. Therefore, LL-37 which might show little antibacterial activity when used alone can provide protection when used in combination therapy with other antimicrobial agents. Keywords: Antibacterial; Cathelicidin LL-37; Acidified nitrite.
1. Lundberg J, Carlsson S, Engstrand L, Morcos E, Wiklund N, Weitzberg E. Urinary nitrite: more than a marker of infection. Urology 1997; 50(2):189–91. 2. Gallo RL, Hooper LV. Epithelial antimicrobial defence of the skin and intestine. Nature Reviews Immunology 2012; 12(7):503–16. 3. Waterer GW. Airway defense mechanisms. Clin Chest Med 2012; 33(2):199–209. 4. Do TQ, Moshkani S, Castillo P, Anunta S, Pogosyan A, Cheung A, et al. Lipids including cholesteryl linoleate and cholesteryl arachidonate contribute to the inherent antibacterial activity of human nasal fluid. J Immunol 2008; 181(6):4177–87. 5. Chromek M, Slamová Z, Bergman P, Kovács L, Podracká Lu, Ehrén I, et al. The antimicrobial peptide cathelicidin protects the urinary tract against invasive bacterial infection. Nat Med 2006; 12(6):636–41. 6. Levy O. Innate immunity of the newborn: basic mechanisms and clinical correlates. Nat Rev Immunol 2007; 7(5):379–90. 7. Newell A, Riley P, Rodgers M. Resistance patterns of urinary tract infections diagnosed in a genitourinary medicine clinic. Int J STD AIDS 2000; 11(8):499–500. 8. Benjamin N, O'Driscoll F, Dougall H, Duncan C, Smith L, Golden M, et al. Stomach NO synthesis. Nature 1994; 7(6471):502. 9. De Groote MA, Fang FC. NO inhibitions: antimicrobial properties of nitric oxide. Clin Infect Dis 1995; 21(Supplement 2):S162–5. 10. Carlsson S, Wiklund N, Engstrand L, Weitzberg E, Lundberg J. Effects of pH, nitrite, and ascorbic acid on nonenzymatic nitric oxide generation and bacterial growth in urine. Nitric oxide 2001; 5(6):580–6. 11. Dykhuizen R, Frazer R, Duncan C, Smith C, Golden M, Benjamin N, et al. Antimicrobial effect of acidified nitrite on gut pathogens: importance of dietary nitrate in host defense. Antimicrob Agents Chemother 1996; 40(6):1422–5. 12. Weller R, Pattullo S, Smith L, Golden M Ormerod A, Benjamin N. Nitric oxide is generated on the skin surface by reduction of sweat nitrate. J Invest Dermatol 1996; 107(3):327–31. 13. Lundberg JO. Nitrate transport in salivary glands with implications for NO homeostasis. Proc Nati Acad Sci 2012; 109(33):13144–5. 14. McKnight G, Duncan C, Leifert C, Golden M. Dietary nitrate in man: friend or foe? Br J Nutr 1999; 81(05):349–58. 15. Shai Y. Mechanism of the binding, insertion and destabilization of phospholipid bilayer membranes by α-helical antimicrobial and cell non-selective membrane-lytic peptides. Biochim Biophys Acta 1999; 1462(1):55–70. 16. Wu M, Maier E, Benz R, Hancock RE. Mechanism of interaction of different classes of cationic antimicrobial peptides with planar bilayers and with the cytoplasmic membrane of Escherichia coli. Biochemistry 1999; 38(22): 7235–42. 17. Bechinger B. Towards membrane protein design: pH-sensitive topology of histidine-containing polypeptides. J Mol Biol 1996; 263(5):768–75. 18. Aisenbrey C, Bechinger B, Gröbner G. Macromolecular crowding at membrane interfaces: adsorption and alignment of membrane peptides. J Mol Biol 2008; 375(2):376–85. 19. Noore J, Noore A, Li B. Cationic antimicrobial peptide LL-37 is effective against both extra-and intracellular Staphylococcus aureus. Antimicrob Agents Chemother 2013; 57(3):1283–90. 20. Alaiwa MHA, Reznikov LR, Gansemer ND, Sheets KA, Horswill AR, Stoltz DA, et al. pH modulates the activity and synergism of the airway surface liquid antimicrobials β-defensin-3 and LL-37. Proceed Nati Acad Sci 2014; 111(52):18703–8. 21. Bower JM, Gordon-Raagas HB, Mulvey MA. Conditioning of uropathogenic Escherichia coli for enhanced colonization of host. Infect Immun 2009; 77(5):2104–12. 22. Ciornei C, Egesten A, Bodelsson M. Effects of human cathelicidin antimicrobial peptide LL‐37 on lipopolysaccharide‐induced nitric oxide release from rat aorta in vitro. Acta Anaesthesiol Scand 2003; 47(2):213–20.
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Ureteroscopy for management of ureteric calculi: Five years experience in Erbil, Iraq
PDF
1567-1574
Wishyar
Jamal Al Bazzaz*, Tarq Aziz Toma** * Department of Urology, Rizgari teaching Hospital, Erbil, Iraq. ** Department of Urology, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.005
Background and objective: Retrograde ureteroscope has recently gained a broaden indication for use in from diagnostic to a variety of disorders that occur in the upper urinary tract. This study aimed to review our five years experience with ureteroscopic management for ureteral stones and to compare our rates of efficacy and safety of ureteroscopy with other centers. Methods: Review of 736 consecutive patients who underwent ureteroscopic procedures for the treatment of upper urinary tract problems between January 2010 and January 2015 was done in Erbil, Iraq. Out of those patients, 587 patients underwent a ureteroscopic procedure for the treatment of ureteric calculi. The studied variables were patients and stones characteristics, in addition to the mean operative time and mean hospital stay, the stone-free rate, and complication rates were also calculated. Results: The overall success rate (complete stone clearance) in 587 patients was 550 patients (93.7%). Mean operative time was 26.1 minutes and mean hospital stay was <24 hours. The overall complication rate was 12%. The intra-operative complication rate was 3.2%, the early postoperative complication rate was 8 %, and the late postoperative complication rate was 0.85%. Conclusion: Growing skill and experience of ureteroscopy will lead to a significant increase in the success rate and reduce complications. Keywords: Semi-rigid ureteroscope; Pneumatic and laser lithotripter; Accessories; Instruments.
1. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, et al. Guideline for the management of ureteral calculi. European urology 2007; 52(6):1610–31. 2. Segura JW. Ureteroscopy for lower ureteral stones (editorial). Urology1993; 42:356–7. 3. Stefano CM, Picozzi, Marenghi C, Casellato S, Ricci C, Gaeta M, et al. Management of ureteral calculi and medical expulsive therapy in emergency departments. J Emerg Trauma Shock 2011; 4(1):70–6. 4. Segura JW, Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, et al. EAU/AUA nephrolithiasis guideline. American Urological Association Education and Research/European Assoc. of Urology; 2007. 5. Meldrum KK, Mathews R, Gearhart JP. Hugh Hampton Young: a pioneer in pediatric urology. J Urol 2001; 166(4):1415-17. 6. Marshall VF. Fiber Optics in Urology. J Urol 1964; 91:110-14. 7. Ather MH, Paryani J, Memon A, Sulaiman MN. A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention–is there a role for open surgery? BJU Int 2001; 88(3):173–7 8. Francesca F, Scattoni V, Nava L, Pompa P, Grasso M, Rigatti P. Failures and complications of transurethral ureteroscopy in 297 cases: conventional rigid instruments vs. small caliberssemirigidureteroscopies. Euro Urol 1995; 28:112. 9. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol 1997; 157(1):28–32. 10. Johnson DB, Pearle MS. Complications of ureteroscopy. UrolClin North Am 2004; 31:157. 11. Mugiya S. Guidelines on urolithiasis: update of diagnosis and treatment. Hinyokika Kiyo 2012; 58(12):703–6. 12. Geavlete P, Georgescu D, Niţǎ G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006; 20(3): 179–85. 13. Hart JB. Avulsion of distal ureter with dormia basket. J Urol 1967; 97(1):62–3. 14. Hodge J. Avulsion of a long segment of ureter with Dormia basket. Br J Urol 1973; 45(3):328. 15. Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 2014; 66(1):102–9. 16. M El-Qadhi. Outcome of ureteroscopy for management of distal ureteric calculi: 5-year experience. African Journal of Urology 2015: 21(1):67–71. 17. Yu W, Cheng F, Zhang X. Reterograde ureteroscopic treatment for upper ureteral stone: a 5 year reterospective study. J Endourol 2010; 24:1753–7. 18. Byrne RR, Auge BK, Kourambas J, Munver R, Delvecchio F, Preminger GM. Routine ureteral stenting is not necessary after ureteroscopy and ureteropyeloscopy: a randomized trial. J Endourol 2002; 16:9. 19. Chen YT, Chen J, Wong WY, Yang SS, Hsieh CH, Wang CC. Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial. J Ural 2002; 167:1977. 20. Borboroglu PG, Amling CL, Schenkman NS, Monga M, Ward IF, Pipeer NY, et al. Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain outcomes and complications. J Urol 2001; 166:1651. 21. Denstedt JD, Wollin TA, Sofer M, Nott L, Weir M, D’A Honey RL. A prospective randomized controlled trial comparing nonstented versus stented ureteroscopic lithotripsy. J Urol 2001; 165:1419. 22. Damiano R, Autorino R, Esposito C, Cantiello F, Sacco R, de SioM, et al. Stent positioning ureteroscopy for urinary calculi Eur Urol 2004; 46:381.
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Views of Erbil interns on the adequacy of undergraduate clinical skills training
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1575-1583
Maaroof
Tahseen Hassan*, Othman Arab Hamad*, Sherzad Ali Ismael** * Department of Community Medicine, Kurdistan Board for Medical Specialties, Erbil, Iraq. ** Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.006
Background and objective: One of the fundamental aims of all medical schools is to ensure that medical graduates are prepared to start work safely as junior doctors. The transition of medical students to junior doctors has long been considered a primary practice of passage. In Iraqi Kurdistan Region, a two year internship (residency) is mandatory for medical graduates’ registration as practitioner doctors. This study aimed to determine the perceptions of Erbil intern on whether undergraduate clinical skills training adequately prepared them for internship responsibilities. Methods: This descriptive cross-sectional analytical study included 369 interns working in the public hospitals of Erbil Governorate. A questionnaire including two sections: the first is interns’ demographic characteristics and the second is their views on clinical skills training (communication and practical). The collected data was analyzed by the statistical package for the social sciences (version 19.1). Results: Out of the 369 interns, 213 were filled the questionnaire. The majority of them felt that their undergraduate communication skills training were adequate in all the studied areas. However, more than half of the respondents felt that undergraduate practical skills training were inadequate in several areas. Female interns felt that training was adequate in all areas of communication and practical skills more than males with a statistical difference in female catheterization (P <0.001). Interns of <30 years old felt that they received more than adequate training in both areas of communication and practical skills than those of ≥30 years old with a significant difference in interviewing patients (P = 0.047), measuring blood pressure (P = 0.023), Pap smear (P = 0.043), and resuscitation - basic cardiopulmonary resuscitation (P = 0.001). Conclusion: This study suggests that there are deficiencies in undergraduate practical skills training particularly in specific areas. Deficiencies presented by the interns should be considered and addressed. In-depth studies are required to identify ways to improve training. Keywords: Internship and residency; Medical school; Clinical skills training.
1. Blackwell B. Prevention of impairment among residents in training. JAMA 1986; 255:177–8. 2. Prince KJ, Boshuizen HP, van der Vleuten CP, Scherpbier AJ. Students’ opinions about their preparation for clinical practice. Med Educ 2005; 39:704–12. 3. Pitkala KH, Mantyranta T. Professional socialization revised: medical students’ own conceptions related to adoption of the future physicians role – a qualitative study. Med Teach 2003; 25:155–60. 4. Lempp H, Cochrane M, Seabrook M, Rees J. Impact of educational preparation on medical students in transition from final year to PRHO year: a qualitative evaluation of final-year training following the introduction of a new Year 5 curriculum in a London medical school. Med Teach 2004; 26(3):276–8. 5. Luthy C, Perrier A, Perrin E, Cedraschi C, Allaz AF. Exploring the major difficulties perceived by residents in training: A pilot study. Swiss Med Wkly 2004; 134:612–7. 6. Fox RA, Ingham Clark CL, Scotland AD, Dacre JE. A study of pre-registration house officers’ clinical skills. Med Educ 2000; 34:1007–12. 7. Goldacre MJ, Lambert T, Evans J, Turner G. Preregistration house officers’ views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey. BMJ 2003; 326:1011–2. 8. Lempp H, Seabrook M, Cochrane M, Rees J. The transition from medical student to doctor: perceptions of final year students and preregistration house officers related to expected learning outcomes. Int J Clin Pract 2005; 59(3):324–9. 9. Hesketh EA, Allan MS, Harden RM, Macpherson SG. New doctors' perceptions of their educational development during their first year of postgraduate training. Med Teach 2003; 25(1):67–76. 10. Jones A, McArdle PJ, O'Neill PA. How well prepared are graduates for the role of pre-registration house officer? A comparison of the perceptions of new graduates and educational supervisors. Med Educ 2001; 35(6):578–84. 11. Irvine D. The performance of doctors. I: professionalism and self-regulation in a changing world. BMJ 1997; 314 (7093):1540–2. 12. Alan T. The current state of medical education in Japan: a system under reform. Med Educ 2007; 41(3):302–8. 13. Seguoin C, Jouquan J, Hodges B, Bre´chat P, David S, Maillard D, et al. Country report: medical education in France. Med Educ 2007; 41(3):295–301. 14. General Medical Council. Tomorrow’s Doctors. Recommendations on undergraduate Medical Education. London: GMC; 1993. 15. General Medical Council. Tomorrow’s Doctors. Outcomes and standards for undergraduate medical education. London: GMC; 2003. 16. General Medical Council. Tomorrow’s Doctors. Medical students: Professional values and fitness to practice. London: GMC; 2009. 17. O’Neill PA, Jones A, Willis SC, McArdle PJ. Does a new undergraduate curriculum based on Tomorrow’s Doctors prepare house officers better for their first post? A qualitative study of the views of pre-registration house officers using critical incidents. Med Educ 2003; 37:1100–8. 18. Chan SC. Views of Malaysian interns and their supervisors on the adequacy of undergraduate clinical skills training. Singapore Med J 2012; 53(3):196–202. 19. Rhamani S, Ring BN, Lowe R, Hunter D. A pilot study assessing knowledge of clinical signs and physical examination skills in incoming medicine residents. J Grad Med Educ 2010; 2(2):232–5. 20. Kugler J, Verghese A. The physical exam and other forms of fiction. J Gen Intern Med 2010; 25(8):756–7. 21. Schildmann J, Cushing A, Doyal L, Vollmann J. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med 2005; 19:93–8. 22. Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC Med Educ 2015; 15:178.
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Discovery of a sexual cycle in Aspergillus clavatus
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1584-1593
Sameira
S. Swilaiman*, Adel O. Ashour**, Paul S. Dyer*** * Department of Basic Sciences, College of Dentistry, Hawler Medical University, Erbil, Iraq. ** Department of Microbiology, Faculty of Science, School of Biology, Misurata University, Libya. *** School of Biology(Life Science), University of Nottingham, United Kingdom.
doi.org/10.15218/zjms.2017.007
Background and objective: Aspergillus clavatus is an opportunistic human pathogen causing invasive aspergillosis. It is an economically important species because it can grow on rotting fruit (apples) and stored food products and able to produce a variety of mycotoxins. It has only been known to reproduce mitotically. This study aimed to discover the sexual reproduction in A. clavatus. Methods: Identifying mating-type (MAT1-1 or MAT1-2) using PCR of 20 worldwide clinical and environmental isolates, crossing isolates on oatmeal agar in darkness with plate sealing, Recombination in ascospore offspring was demonstrated using molecular markers. Results: There were similar ratios of the two mating types (45% MAT1-1 n = 9, 55% MAT1-2 n = 11). A. clavatus possesses a functional sexual cycle with mature cleistothecia fawn to brown/yellow in color, containing heat-resistant ascospores, produced after four weeks incubation at 25˚C and 28˚C on Nescofilm- sealed oatmeal agar plates. The cleistothecia contain hyaline ascospores that have two equatorial ridges. Recombination, leading to increased genotypic variation demonstrated in the ascospore offspring using molecular markers. Conclusion: The ability of A. clavatus to undergo sexual reproduction is highly significant in understanding the biology and evolution of the species. The presence of a sexual cycle provides an invaluable tool for classical genetic analysis and will facilitate research into the genetic basis of pathogenicity and fungicide resistance. Keywords: Cleistothecium; Ascospore; Aspergillus clavatus.
1. Varga J, Frisvad JC, Samson RA. Taxonomic revision of Aspergillus section Clavati based on molecular, morphological and physiological data. Stud Mycol 2007; 59:89–106. 2. Fliege R, Metzler M. Electrophilic properties of patulin. Adduct structures and reaction pathways with 4-bromothiophenol and other model nucleophiles. Chem Res Toxicol 2000; 13:363–72. 3. McKenzie RA, Kelly MA, Shivas RG, Gibson JA, Cook PJ, Widderick K, et al. Aspergillus clavatus tremorgenic neurotoxicosis in cattle fed sprouted grains. Austalian Vet J 2004; 82:635–8. 4. Nesci A, Morales M, Etcheverry M. Interrelation of growth media and water activity in sclerotia characteristics of Aspergillus section Flavi. Lett Appl Microbiol 2007; 44(2):149–54. 5. Pierrotti LC, Baddour LM. Fungal endocarditis, 1995-2000. Chest 2002; 122;302–10. 6. Varga J, Rigo K, Molnar J, Toth B, Szencz S, Teren J, et al. Mycotoxin production and evolutionary relationships among species of Aspergillus section Clavati. Antonie Van Leeuwenhoek 2003; 83:91–200. 7. Loretti AP, Colodel EM, Driemeier D, Correa AM, Bangel JJ, Ferreiro L. Neurological disorder in dairy cattle associated with consumption of beer residues contaminated with Aspergillus clavatus. J Vet Diagn Invest 2003; 15(2):123–32. 8. McKee DH, Cooper PN, Denning DW. Invasive aspergillosis in a patient with MELAS syndrome. J Neurol Neurosurg Psychiatry 2000; 68(6):765–7. 9. Loretti AP, Colodel EM, Driemeier D, Correa AM, Bangel J, Ferreiro L. Neurological disorder in dairy cattle associated with consumption of beer residues contaminated with Aspergillus clavatus. J Vet Diagn Invest 2003; 15(2):123–32. 10. Blyth W, Hardy J. Mutagenic and tumourigenic properties of the spores of Aspergillus clavatus. Br J Cancer 1982; 45:105–17. 11. Scudamore KA, Livesey TC. Occurrence and Signiücance of Mycotoxins in Forage Crops and Silage: a Review. J Sci Food Agric 1998; 77:1–17 12. Matumba L, Monjerezi M, Khonga E, Lakudzala D. Aflatoxins in sorghum, sorghum malt and traditional opaque beer in southern Malawi. Food Control 2011; 22:266–9. 13. Samson RA, Hong S, Peterson SW, Frisvad JC, Varga J. Polyphasic taxonomy of Aspergillus section Fumigati and its teleomorph Neosartorya. Stud Mycol 2007; 59:147–203. 14. Udagawa Si, Uchiyama. Neocarpenteles: A new ascomycete genus to accommodate Hemicarpenteles acanthosporus. Mycoscience 2002; 43(1):3–6. 15. Nierman WC, May G, Kim HS, Anderson M J, Chen D, Denning DW.What the Aspergillus genomes have told us. Med Mycol 2005; 43:S3–5. 16. Eagle C E. Mating-type genes and sexual potential in the Ascomycete genera Aspergillus and Penicillium. University of Nottingham. PhD thesis; 2009. 17. Dyer PS, O'Gorman CM. Sexual development and cryptic sexuality in fungi: insights from Aspergillus species. FEMS Microbiol Rev 2011; 36(1):165-92. 18. Paoletti M, Rydholm C, Schwier EU, Anderson MJ, Szakacs G, Lutzoni F, et al. Evidence for sexuality in the opportunistic fungal pathogen Aspergillus fumigatus. Curr Biol 2005; 15:1242–8. 19. O'Gorman C M, Fuller H, Dyer PS. Discovery of a sexual cycle in the opportunistic fungal pathogen Aspergillus fumigatus. Nature 2009; 457:471–4. 20. Robert V, Groenewald M, Epping W, Boekhout T, Smith M, Poot G, et al. CBS Yeasts Database, The Netherlands, Centraalbureau voor Schimmelcultures, Utrecht; 2007. 21. Murtagh GJ, Dyer PS, McClure PC, Crittenden PD. Use of randomly amplified polymorphic DNA markers as a tool to study variation in lichen-forming fungi. Lichenologist 1999; 31: 257–67. 22. Fisher RA. Statistical Methods for Research Workers. 7th edition. Oliver and Boyd, Edinburgh, Scotland; 1938. 23. Peterson SW. Integration of Modern Taxonomic Methods for Penicillium and Aspergillus Classification. Amsterdam. Chapter in book Phylogenetic relationships in Aspergillus based on rDNA sequence analysis. In: Samson RA, Pitt JI editor Harwood Academic Publishers; 2000. p. 323–55. 24. Yaguchi T, Someya A, Miyadoh S, Udagawa S. Aspergillus ingratus, a new species in Aspergillus section Clavati.Trans. Mycol Soc Jpn 1993; 34:305–10. 25. Tamura M, Hamamoto M, Canete-Gibas CF, Sugiyama J, Nakase T. Genetic relatedness among species in Aspergillus section Clavati as measured by electrophoretic comparison of enzymes, DNA base composition, and DNA-DNA hybridization. Gen Appl Microbiol 1999; 45(2):77–83. 26. Peterson SW. Neosartorya pseudofischeri sp. nov. and its relation -ship to other species in Aspergillus section fumigati. Mycol Res 1992; 96:547–54. 27. Horn BW, Moore GG, Carbone I. Sexual reproduction in Aspergillus flavus. Mycologia 2009; 101(3):423–9. 28. Dyer PS, O'Gorman CM. A fungal sexual revolution: Aspergillus and Penicillium show the way. Curr Opin Microbiol 2011; 14:649–54.
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Doppler ultrasound in intrauterine growth retardation and its indices in correlation with gestational age
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1594-1600
Zainab
A. Othman*, Maysaloon S. Saeed** * Department of Radiology, Maternity Hospital, Duhok, Iraq. ** Department of Surgery, College of Medicine, Duhok University, Duhok, Iraq.
doi.org/10.15218/zjms.2017.008
Background and objective: Intrauterine growth retardation remains the most frequent cause of perinatal morbidity and mortality. Doppler ultrasound has become an indispensable tool in evaluating pregnancies at risk, on the basis of the vascular resistance to blood flow. This study aimed to evaluate non-invasively the fetoplacental and uteroplacental circulations in clinically confirmed high-risk pregnancies, using Doppler parameters of some vessels to apply clinical interventions which could result in reduced prenatal morbidity and mortality and help to decide the type of delivery. Methods: This cross-sectional study was conducted in Duhok city from June 2014 to January 2015. The study involved 100 pregnant women between 26–42 weeks of gestation with known last menstrual period and a definite clinical high-risk for intrauterine growth retardation. Various Doppler indices were performed including the resistive index, pulsatility indices of both umbilical and middle cerebral arteries, and the resistive index of the uterine artery to predict fetal health, correlated with physical and clinical outcomes, taking into consideration the variability in Doppler measurements of gestational age. Data have been described and then analyzed statistically for their correlation with gestational age. Results: Umbilical artery and fetal middle cerebral artery Doppler indices are correlated inversely with gestational age. Although the uterine artery has a major role in Doppler examination of high-risk pregnancies, there is only a weak correlation between maternal uterine artery Doppler index and gestational age in late pregnancy. Doppler measurement of three arteries was more conclusive and show more sensitivity than one arterial Doppler measurement in the third trimester. Conclusion: Significant inverse correlations were found between Doppler indices of fetal middle cerebral and umbilical arteries, and gestational age, while the correlation with maternal uterine artery index was not significant with advancing gestational age. Keywords: Intrauterine growth restriction; Resistive index; Pulsatility index; Middle cerebral artery; Umbilical artery; Uterine artery.
1. Giles WB, Trudinger BJ, Cook CM. Fetal umbilical artery flow velocity-time waveforms in twin pregnancies. Br J Obstet Gynaecol 1985; 92: 490–7. 2. Giles WB, Trudinger BJ, Baird PJ. Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation. Br J Obstet Gynaecol 1985; 92:31–8. 3. Arbielle P. Fetal arterial Doppler – IUGR and hypoxia. Eur J Obstet Gynecol 1997; 75:51–3. 4. Adamson SL. Arterial pressure, vascular input impedance, and resistance as determinants of pulsatile blood flow in the umbilical artery. Eur J Obstet Gynecol 1999; 84:119–25. 5. Arabin B, Bergmann PL, Saling E. Simultaneous assessment of blood flow velocity waveforms in uteroplacental vessels, the umbilical artery, the fetal aorta and the fetal common carotid artery. Fetal Ther 1987; 2:17–26. 6. Ertan A. Doppler Sonography in obstetrics. Donald school text book of ultrasound in obstetrics and gynecology. 2nded. London New York Washington Baco Raton: Parthenon Publishing group; 2008. p. 521–33. 7. Fleischer A, Schulman H, Farmakides G, Bracero L, Blattner P, Randolph G. Umbilical artery flow velocity waveforms and intrauterine growth retardation. Am J Obstet Gynecol 1985; 151:502–5. 8. Bowe S, Vyas S, Campbell S, Color Doppler imaging of uterine artery in pregnancy; normal ranges of impedance to blood flow, mean velocity and volume flow. Ultrasound Obstetric Gynecol 1992; 2:256–61. 9. Allan P, McDicken N, Pozniak M, Dubbins P. Clinical doppler ultrasound. 2nded. Curchill Livingstone: Elsevier; 2006. p. 14–5. 10. Brosens I, Dixon HG, Robertson W. Fetal growth retardation and the arteries of the placental bed. Br J Obstet Gynaecol 1977; 84:656–64. 11. Trudinger BJ, Cook CM, Giles WB, Fong E, Connelly A, Wilcox W. Fetal umbilical artery velocity waveform and subsequent neonatal out com. Br J Obestet Gynecol 1991;98: 378–84. 12. Fleischer A ,Toy E, Lee W, Manning F, Romero R. Sonography in obstetric and Gyncology. 7th ed. McGraw Hill Professional; 2011. p. 258. 13. Tekay A, Campbell S. Ultrasonography in Obstetrics and Gynaecology. 4th ed. Philadelphia: Saunders; 2011. P. 677–717. 14. Nicholson S, Nimrod .Doppler Assessment of Pregnancy. Diagnostic Ultrasound. 1st ed. St. Louis: Mosby; 1991. p. 955–68. 15. Schneider KT, Loos W. The 10th anniversary of obstetric Doppler sonography-development and perspectives. Geburtshilfe Frauenheilkd 1989; 49:407–15. 16. Sachin Kh, Umesh P, Shazia B, Samarjit B, Anurag B. Comparison of Diagnostic efficacy of umbilical artery and middle cerebral artery waveform with color Doppler study for Detection of intrauterine growth retardation. Journal of Obstetrics and Gynecology of India 2013; 64(4):249–55. 17. Bano S, Chaudhary V, Pande S, Mehta V, Sharma A. Color Doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome.Indian J Radiol Imaging 2010; 20(1):20–5. 18. Tarzamni KM, Nezami N, Sobhani N, Eshraghi N, Tarzamni M and Talebi Y. Nomograms of Iranian fetal middle cerebral artery Doppler wave form and uniformity of their pattern with other population nomograms. BMC Pregnancy Childbirth 2009; 8(1):50. 19 . Baschat A, Gembruch U. The cerebroplacental Doppler ratio revisited. Ultrasound Obstet Gynecol 2003; 21:124–7. 20. Arduini D, Rizzo G. Normal values of Pulsatility Index from fetal vessels: a cross sectional study on 1556 healthy fetuses. J Perinat Med 1990; 18:65–72. 21. Antasklis A, Doskalakis G, Tzortzis E, Mechalas S. The effect of gestational age and placental location in the prediction of pre-eclampsia by uterine artery Doppler velocity in low risk nuliparous women. Ultrasound Obestet Gynecol 2000; 16:635–9. 22. Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH. Uterine artery Doppler in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2008; 32(2):138–46.
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Cell blocks histopathology versus FNA cytology in diagnosis of primary malignant lung mass: A comparative study
PDF
1601-1607
Tenya
T. Abdulhameed*, Jawhar T. Omer*, Salah A. Ali* * Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.009
Background and objective: Fine needle aspiration cytology with cell block preparation is widely used for preoperative confirmation of solitary lung mass and classification of the histologic types. This study aimed to highlight the importance of cell-block preparation in the diagnosis of primary malignant lung lesion by comparing cytomorphological preservation on paired cell block and conventional fine needle aspiration samples. Methods: During January 2012 to October 2015, a total of 100 cases with solitary lung mass were included, either visited Rizgary Teaching Hospital or Walfare private hospital. All the patients had undergone fine needle aspiration and cell block preparation under a CT-guide. Results: The samples were evaluated by the fine needle aspirations and cell blocks preparations from primary lung lesion under a CT-guide. 74% were male, and the majority of them were in the sixth and seventh decade. Squamous cell carcinoma was the most common histologic type consisting 42% of the studied cases, followed by adenocarconima (31%), small cell carcinoma (19%) and the remaining 8% were large cell carcinomas. In the assessment of agreement of cellularity between the two methods of sample preparation, cell block served better than fine needle aspiration (P = 0.715). However, this difference was statistically non-significant. A significant relation was found for morphology which was preserved in fine needle aspiration samples better than that in cell block samples (P <0.05). In contrast, all cell block samples displayed a statistically highly significant architectural preservation compared to fine needle aspiration samples (P <0.001). The sensitivity and specificity of the present study were 98.46%, 99.2% respectively. Conclusion: Direct fine needle aspiration smears and cell blocks complement each other, and our results indicate that both are needed in the diagnostic work-up of patients with a primary malignant lung mass. Keywords: Cell block; Fine needle aspiration; Lung mass.
1. Brandman S, Ko JP. Pulmonary nodule detection, characterization, and management with multidetector computed tomography. J Thorac Imaging 2011; 26(2):90–105. 2. Kumar V, Abbas AK, FaustoN, Aster JC. Neoplasia. Robbins and Cotran Pathologic basis of disease.8th edition. Philadelphia: Elsevier Saunders; 2010. p. 220. 3. Mondal SK, Nag D, Das R, Mandal PK, Biswas PK and Osta M. Computed tomogram guided fine-needle aspiration cytology of lung mass with histological correlation: A study in Eastern India. South Asian J Cancer 2013; 2(1):14–8. 4. Miller RT, Kubier P. Immunohistochemistry on cytologic specimens and previously stained slides (When no paraffin block is available). J Histotechnol 2002; 25:251–7. 5. Varsegi GM, Shidham V. Cell block preparation from cytology specimen with predominance of individually scattered cells. J Vis Exp 2009; 29:1316. 6. Bhatia P, Dey P, Uppal R, Shifa R, Srinivasan R, Nijhawan R. Cell blocks from scraping of cytology smear: comparison with conventional cell block. Acta Cytol 2008; 52:329–33. 7. Akalin A, Lu D, Woda B, Moss L, Fischer A. Rapid cell blocks improve accuracy of breast FNAs beyond that provided by conventional cell blocks regardless of immediate adequacy evaluation. Diagn Cytopathol 2008; 36:523–9. 8. Saha A, Kumar K, Choudhuri MK. Computed tomography-guided fine needle aspiration cytology of thoracic mass lesions: A study of 57 cases. J Cytol 2009; 26(2):55–9. 9. Tan KB, Thamboo TP, Wang SC. Audit of transthoracic fine needle aspiration of the lung: Cytological sub classification of bronchogenic carcinomas and diagnosis of tuberculosis. Singapore Med J 2002; 43:570–5. 10. Bandyopadhyay A, Laha R, Das TK. CT guided fine needle aspiration cytology of thoracic mass lesions: A prospective study of immediate cytological evaluation. Indian J Pathol Microbiol 2007; 50:51–5. 11. Madan MB. Evaluation of FNAC in lung diseases. Turk J Pathol 2010; 26:1–6. 12. Shah S, Shukla K, Patel P. Role of needle aspiration cytology in diagnosis of lung tumors. A study of 100 cases. Indian J Pathol Microbiol 2007; 50:56–8. 13. Basnet SB, Thapa GB, Shahi R. Computed tomography guided percutaneous transthoracic fine needle aspiration cytology in chest masses. J Nepal Med Assoc 2008; 47:123–7. 14. Syed A, Shabab M, Uddin A. Computed tomography guided fine needle aspiration cytology of lung lesions: A study of 162 cases. J Chittagong Med Coll Teach Assoc 2009; 20:50–2. 15. Khan SH, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. Cytol 2012; 29(3):177–182. 16. Thapar M, Mishra RK, Sharma A. Critical analysis of cell block versus smear examination in effusions. J Cytol 2009; 26(2):60–4. 17. Khouri NF, Stitik FP, Erozan YS. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1984; 144: 281–8. 18. Hamper UM, Khouri NF, Stitik FP. Pulmonary Hamartoma: Diagnosis of transthoracic needle aspiration biopsy. Radiology 1985; 155:15–8. 19. Rangaswamy M, Zacharia TT, Krishnamurthy J. Study of computed tomography-guided fine needle aspiration cytology of thoracic lesions. J Cytol 2012; 29(1):30–4. 20. Jaya Shankar E, Pavani B, Chandra E. Computed tomography guided percutaneous thoracic: Fine needle aspiration cytology in lung and mediastinum. J Cytol Histol 2010; 107:1–3. 21. Mullan CP, Kelly BE, Ellis PK. CT-guided fine-needle aspiration of lung nodules: Effect on outcome of using coaxial technique and immediate cytological evaluation. Ulster Med J 2004; 73:32–6.
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Assessment of serum interleukin-1receptor antagonist (IL-1RN) levels in overweight-obese women and its relation to the cardiovascular risk using Framingham score
PDF
1608-1613
Zhian
M.I. Dezayee* * Department of Immunology, Hawler Medical University, Erbil, Iraq. doi.org/10.15218/zjms.2017.010
Background and objective: Interleukin 1 receptor antagonist (IL1RN) is an acute-phase protein that blocks the interleukin-1A and 1B receptors and thereby exerting an anti-inflammatory effect. Expression and secretion of IL1R are under the influence of the metabolic derangement. This study aimed to assess the serum levels of IL1RN in obese subjects taking into consideration its relationship to the cardio-metabolic risk factors in asymptomatic obese subjects. Methods: This cross-sectional study was conducted in Martyr LaylaQasm Center for Diabetes Mellitus in Erbil, Iraq. A total number of 170 women were recruited and distributed into three groups according to their body mass index (BMI): Group I (normal; ≤ 24.99 kg/m2); Group II (overweight; 25-29.99 kg/m2) and Group III (obese; ≥30 kg/m2). The measurements of cardio-metabolic risk factors including the anthropometric measurements, blood pressure, lipid profiles and the score of cardiovascular events using Framingham Heart Study scoring were determined. Interleukin 1RN and high sensitive C-reactive protein (hs-CRP) were also determined. Results: Overweight (Group II) and Obese (Group III) women had significant high values of cardio-metabolic risk factors. Group III have significant high values of hs-CRP, and IL IL-1RN levels compared with Group I and II. The serum levels of IL-1RN are increased as the body mass index is increased but is not associated with increased risk of the cardiovascular events or a proportional increased of hs-CRP. A significant correlation between serum IL-1RN levels with cardiovascular risk (%) was observed among subjects of Group II. Conclusion: The study concludes that serum IL-1RN levels are significantly increased withy body mass index in over-weight-obese subjects and its increment is not correlated with low-grade of inflammation assessed by measurement of hs-CRP. The clinical significant of determination of IL-1NR to predict cardiovascular events risk is marginal in overweight subjects. Keywords: Interleukin1 RNR; Cardiovascular risk; Overweight-obese women.
1. Erion JR, Wosiski-Kuhn M, Dey A, Hao S, Davis CL, Pollock NK, et al. Obesity elicits interleukin 1-mediated deficits in hippocampal synaptic plasticity. J Neurosci 2014; 34(7): 2618–31. 2. Khalkhal A, Haddar A, Semiane N, Mallek A, Abdelmalek A, Castex F, et al. Obesity, insulin resistance and diabetes in the sand rat exposed to a hypercaloric diet; possible protective effect for IL1-beta. C R Biol 2012; 335(4):271–8. 3. Juge-Aubry CE, Meier CA. Immunomodulatory actions of leptin. Mol Cell Endocrinol 2002; 194 (1-2):1–7 4. Dasu MR, Devaraj S, Jialal I. High glucose induces IL-1beta expression in human monocytes: mechanistic insights. Am J Physiol Endocrinol Metab 2007; 293(1):E337–46 5. Böni-Schnetzler M, Boller S, Debray S, Bouzakri K, Meier DT, Prazak R, e al. Free fatty acids induce a proinflammatory response in islets via the abundantly expressedinterleukin-1 receptor I. Endocrinology 2009; 150(12):5218–29. 6. Somm E, Henrichot E, Pernin A, Juge-Aubry CE, Muzzin P, Dayer JM, et al. Decreased fat mass in interleukin-1 receptor antagonist-deficient mice: impact on adipogenesis, food intake, and energy expenditure. Diabetes 2005; 54(12):3503–9. 7. Yang SA. Exonic polymorphism (rs315952, Ser133Ser) of interleukin 1 receptor antagonist (IL1RN) is related to overweigh/obese with hypertension. J Exerc Rehabil 2014; 10(5):332-–6. 8. Interleukin 1 Genetics Consortium. Cardiometabolic effects of genetic upregulation of the interleukin 1 receptor antagonist: a Mendelianrandomisation analysis. Lancet Diabetes Endocrinol 2015; 3(4):243–53 9. Saltevo J, Laakso M, Jokelainen J, Keinänen-Kiukaanniemi S, Kumpusalo E, Vanhala M. Levels of adiponectin, C-reactive protein and interleukin-1 receptor antagonist are associated with insulin sensitivity: a population-based study. Diabetes Metab Res Rev 2008; 24(5):378–83. 10. Bissonnette S, Saint-Pierre N, Lamantia V, Cyr Y, Wassef H, Faraj M. Plasma IL-1Ra: linking hyperapoB to risk factors for type 2 diabetes independent of obesity in humans. Nutr Diabetes 2015; 5:e180. 11. Siklova M, Simonsen L, Polak J, Stich V, Bülow J. Effect of short-term hyperglycemia on adipose tissue fluxes of selected cytokines in vivo during multiple phases of diet-induced weight loss in obese women. J Clin Endocrinol Metab 2015; 100(5):1949–56. 12. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117(6):743–53. 13. Andersson N, Strandberg L, Nilsson S, Ljungren O, Karlsson MK, Mellström D, et al. Variants of the interleukin-1 receptor antagonist gene are associated with fat mass in men. Int J Obes (Lond) 2009; 33(5):525–33. 14. Latkovskis G, Licis N, Kalnins U. C-reactive protein levels and common polymorphisms of the interleukin-1 gene cluster and interleukin-6 gene in patients with coronary heart disease. Eur J Immunogenet 2004; 31(5):207–13. 15. Hoppmann P, Koch W, Laugwitz KL, Kastrati A. Genetic risk of restenosis after percutaneous coronary interventions in the era of drug-eluting stents. Coronary Artery Dis 2014; 25(8):658–64. 16. Fragoso JM, Delgadillo H, Llorente L, Chuquiure E, Juárez-Cedillo T, Vallejo M, et al. Interleukin 1 receptor antagonist polymorphisms are associated with the risk of developing acute coronary syndrome in Mexicans. Immunol Lett 2010; 133(2):106–11. 17. Xu P, Li Y, Zhang PA, Li XY, Li GS. The distribution of gene polymorphisms in the intron 2 and exon 2 of interleukin-1 receptor antagonist and their correlation with the serum lipoprotein level. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(6):522–6.
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Osseointegration of dental implants without primary stability: an experimental study in sheep
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1616-1618
Omed
Ikram Shihab*, Abduljaleel Azad Samad*, Hozak Zahir Ali*, Othman A. Omer*, Ahmed A. Haider* * Department of Oral Maxillofacial Surgery, College of Dentistry, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.011
Background and objective: Primary implant stability is considered necessary for achieving and maintaining osseointegration. This experimental study aimed to evaluate the outcome of implants without primary stability, clinically and radiographically. Methods: Two adult sheep (3-4 years of age), 70 kg in weight, were included in the study. After sedation and local anesthesia, the lateral side of the basal bone of mandible is exposed by a single long incision. The implant bed performed in the inferior border of the basal bone of mandible drilling to 5 mm in diameter and 10 mm in length. Five implants were inserted into the basal bone of mandible for each side (right and left), but the sizes of inserted implant was 3.8 mm in diameter and 10 mm in length, after 4 months the 2 sheep were sacrificed and the universal torque ratchet was used to measure the stability of the implant by a counter torque 30 N/cm test. Cone Beam Tomography (CBCT) was used to evaluate the implants radiographically. Results: Nineteen (from 20) implants successfully tolerated a 30 N/cm countertorque test comprising (95%). Only one implant failed to osseointegrate (5%). During the healing period, no any adverse clinical signs reported. Conclusion: Dental implants may have a chance to osseointegrate even in the lack of primary stability. Keywords: Dental implant, Osseointegration, Primary stability.
1. Brunski JB. In vivo bone response to biomechanical loading at the bone/dental-implant interface. Adv Dent Res 1999; 13:99–119. 2. Kim DG. Micromechanical Analysis of Bone at a Bone-Implant Interface. PhD Dissertation. Troy, NY: Rensselaer Polytechnic Institute; 2001. 3. Fazel A, Aalai S, Rismanchian M, Sadr-Eshkevari P. Micromotion and stress distribution of immediate loaded implants: A finite element analysis. Clin Implant Dent Relat Res 2009; 11:267–71. 4. Javed F and Romanos GE. The role of primary stability for successful immediate loading of dental implants: A literature review. J Dent 2010; 38:612–20. 5. Brånemark PI. Introduction to osseointegration. In: Brånemark PI, Janal MN, Coelho PG.editors. Tissue integrated prostheses. Chicago (IL): Quintessence Publishing Co. Inc; 1985: p. 29. 6. Ottoni JM, Oliveira ZF, Mansini R, Cabral AM. Correlation between placement torque and survival of single-tooth implants. Int J Oral Maxillofac Implants 2005; 20:769–76. 7. Irinakis T, Wiebe C. Initial torque stability of a new bone condensing dental implant. A cohort study of 140 consecutively placed implants. J Oral Implantol 2009; 35:277–82. 8. Kawahara H, Kawahara D, Hayakawa M, Tamai Y, Kuremoto T, Matsuda S. Osseointegration under immediate loading: Biomechanical stresss train and bone formation-resorption. Implant Dent 2003; 12:61–8. 9. Freitas AC, Bonfante EA, Giro G, Janal MN, Coelho PG. The effect of implant design on insertion torque and immediate micromotion. Clin Oral Implants Res 2012; 23:113–8. 10. Ostman PO, Hellman M, Sennerby L. Direct implant loading in the edentulous maxilla using a bone density-adapted surgical protocol and primary implant stability criteria for inclusion. Clin Implant Dent Relat Res 2005; 7:60–9. 11. Hui E, Chow J, Li D, Liu J, Wat P, Law H. Immediate provisional for single-tooth implant replacement with Brånemark system: preliminary report. Clin Implant Dent Relat Res 2001; 3:79–86. 12. Li W, Chow J, Hui E, Lee PK, Chow R. Retrospective study on immediate functional loading of edentulous maxillas and mandibles with 690 implants, up to 71 months of follow-up. J Oral Maxillofac Surg 2009; 67:2653–62. 13. Esposito M, Hirsch JM, lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. Eur J Oral Sd 1998; 106:721–64. 14. Sennerby l, Roos J. Surgical determinants of clinical success of osseointegrated implants. lnt J Prosthodont 1998; 11:408–20. 15. Chong L, Khocht A, Suzuki JB, Gaughan J. Effect of implant design on initial stability of tapered implants. J Oral Implantol 2009; 35:130–5. 16. Romanos GE, Johansson CB. Immediate loading with complete implant-supported restorations in an edentulous heavy smoker: Histologic and histomorphometric analyses. Int J Oral Maxillofac Implants 2005; 20:282–90. 17. Romanos GE, Toh CG, Siar CH, Wicht H, Yacoob H, Nentwig GH. Bone-implant interface around titanium implants under different loading conditions: a histomorphometrical analysis in the Macaca fascicularis monkey. J Periodontol 2003; 74:1483–90. 18. Delaunay CP, Kapandji AI. Acetabular screw rings and surface treatment. Clin Orthop Relat Res 1997; 340:130–41. 19. Davies JE. Mechanisms of endosseous integration. Int J Prosthodont 1998; 11:391–401.
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Daily living activities among geriatric residents at geriatric homes in Erbil and Sulaimaniyah cities, Kurdistan Region
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1619-1628
Sideeq
Sadir Ali*, Jawdat Mamand Alhagbaker**, Nazar P. Shabila***
* Department of Adult Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.
** Department of Community Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.
*** Department of Community Nursing, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.012
Background and objective: Maintaining the ability to perform basic self-care activities by the older adults is fundamental to maintaining their independence and quality of life. This study aimed to assess the level of functional dependency of the residents of geriatric homes in Erbil and Sulaymaniyah cities. Methods: This cross-sectional study involved 94 older adults living in geriatric homes in Erbil and Sulaymaniyah cities. Data was collected on the socio-demographic characteristics, clinical characteristics, social issues and daily recreation activities of the participants using a questionnaire. Nine essential activities of daily living were assessed through a three-point Likert scale of independent, requires assistance and dependent. Results: The mean and standard deviation age of the participants was 71.88 ± 8.94 years (range 60-81 years). Around half (43.6%) of the participants had at least one dependent activity. The level of dependency was highest in shopping, climbing stairs and bathing activities. Dependency of activities of daily living was significantly (P <0.001) higher in females than males; in illiterate and those read and write than primary school graduates and secondary school and higher level graduates; in those self-employed before entering geriatric home than retired and unemployed; and in ex-smokers and non-smokers than smokers. Conclusion: The level of independency in the different daily living activities was relatively high, which might be attributed to having a younger age group of elderly in the geriatric homes. Dependency was significantly associated with the sex, education level, employment status and smoking status of the participants. Keywords: Activities; Daily living; Geriatric; Dependency; Independency; Kurdistan.
1. Sekhon H, Minhas S. A study of activities of daily living of elderly in an urban community of North India. Sch J App Med Sci 2014; 2(4):1450–4. 2. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003; 51(4):451–8. 3. Helvik A, Høgseth LD, Bergh S, Šaltytė-Benth J, Kirkevold O, Selbæk G. A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care. BMC Geriatr 2015; 15:47. 4. Pascal Iloh GU, Chuku A, Dike OJ, Amafili OP, Nnaji BC. Burden of limitations of activities of daily living among geriatric Nigerians with musculoskeletal disorders in a resource-limited Nigerian primary care clinic in Eastern Nigeria. Am J Health Res 2013; 1(1):9–16. 5. UNESCO. World education indicators. Review report, Northern Iraq; 2002. p. 11. (Accessed November 15, 2015, available at http://www.uis.unesco.org/Library/Documents/wei02_en.pdf). 6. Seniar ME. Functional status of residents in Geriatric home in Erbil city. MSc Thesis. Hawler Medical University, College of Nursing, Erbil, Iraq; 2013. 7. Amen MR. The effectiveness of the physical rehabilitation program on psychological, nutritional status and physical functions of the elderly residents in Sulaimani geriatric home. PhD Thesis. University of Sulaimani, College of Nursing, Sulaimani, Iraq; 2012. 8. Fricke J. Activities of Daily Living. In: JH Stone, M Blouin, editors. In Encyclo Rehabil; 2010. (Accessed November 15, 2015, available at: http://cirrie.buffalo.edu/encyclopedia/en/article/37/). 9. Gebreyohannis B, Kharel K. Needs assessment for assisted living facilities among elderly population. Thesis. Central University of Applied Sciences. Degree Program in Nursing; 2012. 10. Marouf I. Quality of life and morbidity pattern of geriatric population in Erbil city. PhD thesis. Hawler Medical University, College of Medicine: Erbil, Iraq; 2010. 11. Ahmed K. Older adults’ social support and its effect on their everyday self-maintenance activities: findings from the household survey of urban Lahore-Pakistan. J S Asian Stud 2011; 26(1):37–52. 12. Elisabeth J, Gunnar L, Palmi J, Bucht G. Functional status in elderly people after acute care and quality of life at one-year follow-up. Health Sci J 2006; 1. (Accessed November 15, 2015, available at http://www.hsj.gr/medicine/functional-status-in-elderly-people-after-acute-care-and-quality-of-life-at-oneyear-followup.pdf). 13. Gallo JJ, Paveza GJ. Activities of daily living and instrumental activities of daily living assessment, Handbook of Geriatric Assessment. 4th ed. MA: Jones and Bartlett Publishers; 2006. p. 193–240. 14. Fisher T. Assessing Function in the Elderly: Katz ADL and Lawton IADL. Dalhousie University. Measuring Health Outcomes; 2008. (Accessed November 15, 2015. Available at: http://clas.uiowa.edu/socialwork/files/socialwork/NursingHomeResource/documents/Katz%20ADL_LawtonIADL.pdf) 15. Millán-Calenti JC, Tubío J, Pita-Fernández S, González-Abraldes I, Lorenzo T, Fernández-Arruty T, et al. Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Arch Gerontol Geriatr 2010; 50:306-10. 16. Terret C. How and why to perform a geriatric assessment in clinical practice. Ann Oncol 2008; 19(7):300–3. 17. Del Duca GF, Thumé E, Hallal PC. Prevalence and factors associated with home care among older adults. Rev Saude Publica 2011; 45(1):113–20. 18. Loh KY, Khairani O, Norlaili T. The prevalence of functional impairment among elderly aged 60 years and above attending Klinik Kesihatan Batu 9 Ulu Langat, Selangor. Med J Malaysia 2005; 60(2):188–93. 19. Donmez L, Zuhal G, Necati D. Disability and its effects on quality of life among older people living in Antalya city center. Arch Gerontol Geriatr 2005; 40 (2):213–23. 20. Nilsson I. Occupational engagement among older people, Evaluation, Repertoire and Relation to Life satisfaction. Umeå, Sweden 2006; 1043. 21. Min J, Park JB, Lee K, Min K. The impact of occupational experience on cognitive and physical functional status among older adults in a representative sample of Korean subjects. Ann Occup Environ Med 2015; 27:11. 22. World Health Organization. Non communicable diseases and mental health cluster non communicable disease prevention and health promotion department ageing and life course. A contribution of the World Health Organization to the Second United Nations World Assembly on Ageing, Madrid, Spain. Geneva 27, Switzerland; 2002. (Accessed November 15, 2015, available at: http://www.who.int/hpr/ageing). 23. Freitas RS, Fernandes MH, Coqueiro RS, Reis Júnior WM, Rocha SV, Brito TA. Functional capacity and associated factors in the elderly: a population study. Acta Paul Enferm 2012; 25(6):933–9. 24. Huang Y, Wueng S, Cheng C, Su K. Nutritional status of functionally dependent and non-functionally dependent elderly in Taiwan. J Am Coll Nutr 2001; 20(2):135–42. 25. Ammar W. Health system and reform in Lebanon. WHO Regional Office for the Eastern Mediterranean and Lebanese Ministry of Public Health; 2003. p. 60-75. (Accessed November 15, 2015, available at: http://www who.int/hac/crises/lbnLenon_Health_System_and_reform_September2005.pdf). 26. Nourhashémi F, Andrieu S, Gillette-Guyonnet S, Vellas B, Albarède JL, Grandjean H. Instrumental activities of daily living as a potential marker of frailty: A study of 7364 community-dwelling elderly women (the EPIDOS Study). J Gerontol 2001; 56(7):448–53.
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Immunoexpression of P53 protein in trophoblastic diseases
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1629-1635
Sanarya
M. Ali*, Nadya Y. Ahmedi**, Tenya T. Abdulhameed**, Tara
M. Shalal** * Department of Pathology, Ministry of Health, Erbil, Iraq. ** Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.013
Background and objective: Trophoblastic diseases constitute a spectrum of tumors and tumor- like conditions characterized by proliferation of pregnancy associated trophoblastic tissue of progressive malignant potential. This study aimed to assess the value of p53 protein immunoexpression in the diagnosis of hydatidiform molar pregnancy and the differential diagnosis of its subtypes (complete and partial) from abortions. Methods: A cross-sectional study of tissue sections from 68 formalin-fixed, paraffin- embedded specimens of products of conception, including 1st trimester abortion (n=15), partial hydatidiform mole PHM (n=24), complete hydatidiform CHM (n=24) and full term placenta (n=5), all were examined at the Histopathology Department of Maternity Teaching Hospital in Erbil, Iraq during the period of Jan.2013-Jun.2013. Immunohistochemistry was performed using p53 antibody and the standard streptavidin-biotin immunoperoxidase method. The labeling index (number of positive nuclei/total number of nuclei) for villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were evaluated separately. Statistical analysis was carried out by one way ANOVA and Fisher’s exact tests, statistical significance was determined at P ≤0.05. Results: All villous trophoblastic lesions showed higher p53 immunoexpression in all villous components especially cytotrophoblasts, being the highest in complete hydatidiform mole (>50%) and partial hydatidiform mole (>20%). A statistically significant difference was found in immunoexpressins of p53 that was useful in separating abortion from complete hydatidiformmole, P <0.001, and partial hydatidiform mole, P <0.0002. It was also useful in separating between the complete hydatidiform mole and partial hydatidiform mole (P <0.001). Conclusion: p53 immunoexpression was valuable in differentiation between molar and non molar pregnancies and between subtypes of molar pregnancies. Keywords: Hydatidiform Mole; Abortion; p53; Immunohistochemistry.
1. Hextan YS, Michael J, Ross S, Yang X, François G, Sekharan PK, et al. Update on the diagnosis and management of gestationaltrophoblastic disease. IJGO 2015; 132:123–6. 2. Clement PB, Young RH. Trophoblastic lesions, miscellaneous primary uterine neoplasms, hematopoietic neoplasms, and metastatic neoplasms to the uterus. In: Clement PB, Young RH, editors. Atlas of Gynecologic Surgical Pathology. 3rd ed. Oxford: Saunders, Elsevier Inc; 2014. p. 284–310. 3. Merchant SH, Amin MB, Viswanatha DS, Malhotra RK, Moehlenkamp C, Joste NE. P57kip2 Immunohistochemistry in early molar pregnancies: Emphasis on its complementary role in the differential diagnosis of hydropicabortuses. Human Pathol 2005; 36:180–6. 4. Fukunaga M, Katabuchi H, Nagasaka T, Mikami Y, Minamiguchi S, Lage JM. Interobserver and intraobserver variability in the diagnosis of hydatidiform mole. Am J Surg Pathol 2005; 29:942–7. 5. Etebary M, JahanzadI ,Mohagheghi MA, Azizi E. Immunohistocmechemical analysis of p53 and its correlation to the other prognositic factors in breast cancer. Acta Medica Iranica 2002; 40(2):88–94. 6. Srendini ST, Zerbin MCN, Latorre MR, Alves VAF. p53 as aprognostic factor in adrenocortical tumors of adults and children. Braz J Med Biol Res 2003; 36:23–7. 7. Yazaki-Sun S, Daher S, de Souza Ishigai MM, Alves MT, Mantovani TM, Mattar R. Correlation of c-erbB-2 oncogene and p53 tumor suppressor gene with malignant transformation of hydatidiform mole. J Obstet Gynaecol Res 2006; 32:265–72. 8. Hsu SM, Raine L, Fanger H. Use of avidin-peroxidase coplex (ABO) in immunoperoxidasetechniques:a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem 1981; 29:577–80. 9. Erfanan M, Sharifi N, Omidi AA. p63 and Ki-67 expression in trophoblastic disease and spontaneous abortion; JRMS 2009; 14(6):375–84. 10. Hasanzadeh M, Sharifi N, Esmaieli H, Daloee MS, Tabari A. Immunohistochemical expression of the proliferative marker Ki67 in hydatidiform moles and its diagnostic value in the progression to gestational trophoblastic neoplasoia. J Obstet Gynaecol 2013; 39(2):572–7. 11. Sebire NJ, Rees H. Diagnosis of gestational trophoblastic disease in early pregnancy. Current Diagnostic Pathology 2002; 8(6):430–40. 12. Nizam K, Haidar G, Memon N, Haidar A. Gestational Trophoblastic Disease: Experience at Nawabshah Hospital. JAyub Med Coll 2009; 21:67–9. 13. Chen YX, Shen DH, Gu YQ, Zhong PP, Xie JL, Song QJ, et al. Immunohistochemistry of p57 and p53 protein in differential diagnosis of hydropic abortion, partial and complete hydatidiform mole. Zhonghua Bing Li XueZaZhi 2011; 40(10):694–700. 14. Ichikawa N, Zhai YL, ShiozawaT, Toki T, Nouguchi H, Nikaido T, et al. Immunohistochemical Analysis Of Cell Cycle Regulatroy Gene Products in normal Trophoblast and Placental site Trophoblastic Tumor. Int J Gynaecol Pathol 1998; 17(3):235–40. 15. Petigant P,Laurini R, Goffin F, Bruchim I, Bischof P. Expression of matrix metalloproteinase-2 and mutant p53 is increased in hydatiform mole as compared with normal placenta. Int J Gynecol Cancer 2006; 16(4):1679–84. 16. Al-Bozom IA. p53 and bcl2 oncoprotein expression in placentas with hydropic changes and partial and complete moles. APMIS 2000; 108:756–60. 17. Halperin R, Peller S, Sandbank J, Bukovsky I, Schneider D. Expression of p53 Gene and Apoptosis in Gestational Trophoblastic Disease. Placenta 2000; 21:58–62. 18. Hussein MR. Analysis of p53, Bcl2 and epidermal growth factor receptor protein expression in the partial and complete hydatiform moles. Exp Mol Pathol 2009; 87(1):63–9. 19. Kale A, Soylemez F, EnsariA. Expression of proliferation marker (ki-67, proliferating cell nuclear antigen, and silver staining nuclear organizer regions) and of p53 tumor protein in gestational trophoblastic disease. Am J Surg Pathol 2001; 33:176–85. 20. UzunlarAK, YilmazF, Bayhan G, Akkus Z. Expression of p53, proliferation cell nuclear antigen, and ki-67 in gestational trophoblastic disease. Eur J Gynaecol Oncol 2002; 23:79–83. 21. Chen Y, Shen D, Gu Y, Zhong P, Xie J, Song Q. The Diagnostic value of Ki-67, p53, and p63 in distinguishing partial HM from hydropic abortion. Wien Klin Wochenschr 2012: 124:184–7. 22. Shih IM, Kurman RJ. P63 expression is useful in distinction of epithelioid trophoblastic and placental site trophoblastic tumors by profiling trophoblastic subpopulations. Am J Surg Pathol 2004; 28(9):1177–83.
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Open-label uncontrolled pilot study on antipsoriatic activity of Rosa hemisphaerica
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1636-1644
Lana
Y. Muttalib*, Aveen N. Adham*, Salah Abu Baker**, Alaadin
M. Naqishbandi* * Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Erbil, Iraq. ** Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.014
Background and objective: Rosa hemisphearica (Rosaceae) is highly cultivated worldwide as an ornamental plant and medicinally have an antibacterial and antioxidant effect. This study aimed to investigate clinically and histopathologically the anti-inflammatory activity of Rosa hemisphearica in psoriasis and to correlate the anti-inflammatory activity with the active constituents in the plant by the phytochemical study. Methods: In this open-label uncontrolled pilot study, a topical preparation of R. hemisphearica stem extract was used by 20 patients suffering from psoriasis for three weeks. Three histopathological slides for each patient, one each week for three weeks was done for anti-inflammatory response evaluation. Subsequently, total phenolic content was measured followed by thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) analysis for the identification of phenolic acid content in the stem. Results: By histopathological examination revealed that both Munro’s and Kogoj’s abscesses were gradually disappeared, the granular layer gradually restored to normal and the inflammatory cells gradually reduced in number prominently polymorph (neutrophils) and eventually histocytes disappeared. Total phenolic contents in R. hemisphearica stem extract were determined as 205.625 µg gallic acid equivalent\ each gm of the sample extract, TLC, and HPLC results showed the presence of rosmarinic acid in the stem extract. On quantitative HPLC analysis, the percentage of rosmarinic acid in the stem extract was 0.024 with a retention time (Rt) of 3.4 min. The proposed HPLC method was found to be linear, accurate and precise. Conclusion: The organic solvent extract of R. hemisphearica stem showed a significant reduction in an inflammatory cell among psoriatic patients under study. Rosmarinic acid was identified by TLC and HPLC as important phenolic acid constituents. Keywords: Rosa hemisphearica; Antipsoriatic; HPLC; TLC; Total phenolic.
1. Rechinger HK. Flora Iranica. Rosaceae II: Rosa, J. Zielinski. Graz: Akademische Druck und Verlagsanstalt publishing; 1982. p.8. 2. Zargari A. Medicinal plants, 2nd ed. Tehran: Tehran University Publication; 1991. p.162–4. 3. Kashani AD, Rasooli I, Sharafi SM, Rezaee MB, Nadoushan MRJ, Owlia P. Phytobiological characteristics of Rosa hemisphaerica Herrm. Extract. J Med Plant 2010; 9(6):97–106. 4. Basim E, Basim H. Antibacterial activity of Rosa damascena essential oil. Fitoterapia 2003; 74:394–6. 5. Boskabady MH, Kiani S, Rakhshandah H. Relaxant effects of Rosa damascena on guinea pig tracheal chains and its possible mechanism(s). J Ethnopharmacol 1995; 106:377–82. 6. Orhan DD, Hartevio˘glu A, K¨upeli E, Yesilada E. In vivo anti-inflammatory and antinociceptive activity of the crude extract and fractions from Rosa canina L. fruits. J Ethnopharmacol 2007; 112:394–400. 7. Safaei-Ghomi J, Bamoniri A, Hatami A, Batooli H. Determination of volatile components in Iranian Rosa hemisphaerica. Chem Nat Comp 2007; 43(6):738–40. 8. Gudjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol 2007; 25(6):535–46. 9. Alupuli A, Calinescu I,Lavric V. Ultrasonic vs. microwave extraction intensification of active principles from medicinal plants. AIDIC conference series; 2009. 10. Ramanauskienė K, Žilius M, Briedis V. Rheological and biopharmaceutical studies of the experimental propolis semisolid preparations. konferencijosmedžiaga 2012; 18(2):181–8. 11. Arain M, Campbe JM, Cooper LC, Lancaster AG. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Method 2010; 10(67):1–7. 12. Mcdonald S, Prenzler PD, Autolovich M, Robards K. Phenolic content and antioxidant activity of olive oil extracts. Food Chem 2001; 73:73–84. 13. Adesegun SA, Fajana A, Orabueze CI, Coker HAB. Evaluation of antioxidant properties phaulopsis fascisepala. Evid Based Complement Alternat Med 2009; 6:227–31. 14. Khoddami A, Wilkes AM and Roberts HT. Techniques for analysis of plant phenolic compounds. Molecules 2013; 18:2328–75. 15. Pavel M, Voştinaru O, Mogoşanu C, Ghibu S. Phytochemical and pharmacological research on some extracts obtained from Serpylli herba. Farmacia 2011; 59(1):77–83. 16. Nour V, Trandafir I,Cosmulescu S. HPLC Determination of phenolic acids, flavonoids, and juglone in walnut leaves. J Chrom Sci 2012; 6:1–8. 17. International Conference on Harmonization, guideline Q2A, Text on validation of analytical procedures: Methodology. USA: Federal register publishing; 1995. p. 11260–2. 18. International Conference on Harmonization, guideline Q2B, validation of analytical procedures: Methodology. USA: Federal register publishing; 1997. p. 27463–7. 19. Tsao R. Chemistry and biochemistry of dietary polyphenols. Nutrients 2010; 2:1231–46. 20. Fadel O, El Kirat K, Morandat S. Anti-inflammatory actions of flavonoids and structural requirements for new design. Biochimica Biophysica Acta 2011; 1808:2973–80. 21. Theoharides TC, Alexandrakis M, Kempuraj D, Lytinas M. The antitumor activities of flavonoids. Int Immunopathology Pharmacol 2001; 14(3); 119–27. 22. Kandaswami C, Lee LT, Lee PP, Hwang JJ, Ke Fc, Huang T, et al. The antitumor activities of flavonoids. In vivo 2005; 19(5):895–909. 23. Vinatoru M. An overview of the ultrasonically assisted extraction of bioactive principles from herbs. Ultrason Sonochem 2001; 8:303–13.
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Clinical and pathological characteristics of primary focal segmental glomerulosclerosis in adult
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1645-1652
Salam
Fareed Wadee*, Safa Ezzidin Al-Mukhtar** * Ministry of Health, Erbil, Iraq. ** Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.015
Background and objective: Focal segmental glomerulosclerosis shares overlapping patterns of injury with segmental consolidation and obliteration of glomerular architecture by the accumulation of collagenous extracellular matrix or by increased cellularity or both. This study aimed to investigate the patterns of primary focal segmental glomerulosclerosis in adults in Erbil. The specific objectives of this study included determining the frequency of histological variant of Focal segmental glomerulosclerosis, defining the clinical characteristics of the primary type in general and recognizing the clinical and pathological characteristics for each variant separately. Methods: A cross-sectional, clinico-pathologic study was conducted for 50 patients attending the Nephrology Department in Erbil Teaching Hospital between March and December 2013. This study included patients of >16 years old with biopsy-proven idiopathic focal segmental glomerulosclerosis. Results: A total of 50 patients were enrolled into this study. The median age of patients was 33 years, ranged from 18 to 54, 31 (62%) males and 19 (38%) females. The frequency of histopathological variants was 80% not otherwise specific focal segmental glomerulosclerosis, 14% glomerular tip lesion, and 6% cellular type. Nephrotic syndrome and hypertension were the main presenting features (92% and 68%, respectively). The mean percentage of sclerosed glomeruli was 40% and the mean interstitial fibrosis and tubular atrophy was 24%. Conclusion: A not otherwise specific variant is a common morphological lesion in many glomerular and non-glomerular diseases, and it is just like a junk drawer of multiple glomerular alterations with this common pattern of the lesion. Keywords: Primary Focal Segmental Glomerulosclerosis; Nephrotic syndrome; Hypertension.
1. Rich A. A hitherto undescribed vulnerability of the juxtamedullary glomeruli in lipoid nephrosis. Bull Johns Hopkins Hosp 1957; 100:173–86. 2. Churg J, Habib R, White RH. Pathology of the nephrotic syndrome in children: a report for the International Study of Kidney Disease in Children. Lancet 1970; 760:1299–302. 3. Agarwal SK, Dash SC, Tiwari SC, Bhuyan UN. "Idiopathic adult focal segmental glomerulosclerosis: a clinicopathological study and response to steroid." Nephron 1993; 63(2):168–71. 4. Ponticelli C, Villa M, Banfi G, Cesana B, Pozzi C, Pani A, et al. Can prolonged treatment improve the prognosis in adults with focal segmental glomerulosclerosis? Am J Kidney Dis 1999; 34:618–25. 5. Rydel JJ, Korbet SM, Borok RZ, Schwartz MM. Focal segmental glomerular sclerosis in adults: presentation, course and response to treatment. Am J Kidney Dis 1995; 25:534–42. 6. Thomas DB. Focal segmental glomerulosclerosis: a morphologic diagnosis in evolution. Arch Pathol Lab Med 2009; 133(2):217–23. 7. Kitiyakara C, Kopp JB, Eggers P. Trends in the epidemiology of focal segmental glomerulosclerosis. Semin Nephrol 2003; 23:172–82. 8. United States Renal Data System. USRDS 2010 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2010. 9. Freedman BI, Hicks PJ, Bostrom MA, Cunningham ME, Liu Y, Divers J, et al. Polymorphisms in the non-muscle myosin heavy chain 9 gene (MYH9) are strongly associated with end-stage renal disease historically attributed to hypertension in African Americans. Kidney Int 2009; 75(7):736–45. 10. D'Agati VD, Fogo AB, Bruijn JA, Jennette JC. Pathologic classification of focal segmental glomerulosclerosis: a working proposal. Am J Kidney Dis 2004; 43:368–82. 11. Ponticelli C, Glassock RJ. Treatment of Primary Glomerulonephritis. 2nd Ed.UK: Oxford University Press; 2009. p. 215–65. 12. Friedman EA, Tao TK. Disappearance of uremia due to heroin-associated nephropathy. Am J Kidney Dis 1995; 25(5):689–93. 13. Markowitz GS, Appel GB, Fine PL. Collapsing focal segmental glomerulosclerosis following treatment with high-dose pamidronate. J Am Soc Nephrol 2001; 12:1164–72. 14. Pascual J, Torrealba J, Myers J. Collapsing focal segmental glomerulosclerosis in a liver transplant recipient on alendronate. Osteoporos Int 2007; 1435:8–18. 15. Markowitz GS, Nasr SH, Stokes MB, D'Agati VD. Treatment with IFN -α, -β, or -γ is associated with collapsing focal segmental glomerulosclerosis. Clin J Am Soc Nephrol 2010; 5:607–15. 16. Bruggeman LA, Dikman S, Meng C, Quaggin SE, Coffman TM, Klotman PE. Nephropathy in human immunodeficiency virus-1 transgenic mice is due to renal transgene expression. J Clin Invest 1997; 100(1):84–92. 17. Kimmel PL, Bosch JP, Vassalotti JA. Treatment of human immunodeficiency virus (HIV)-associated nephropathy. Semin Nephrol 1998; 18(4):446–58. 18. Kumar V, Fausto N, Abbas A. Robbins & Cotran Pathologic Basis of Disease. 7th ed. Saunders; 2003. p. 982–3. 19. Asanuma K, Mundel P. The role of podocytes in glomerular pathobiology. Clin Exp Nephrol 2003; 7(4):255–9. 20. Barisoni L, Kriz W, Mundel P, D’Agati V. The dysregulated podocyte phenotype: a novel concept in the pathogenesis of collapsing idiopathic focal segmental glomerulosclerosis and HIV-associated nephropathy. J Am Soc Nephrol 1999; 10(1):51–61. 21. Kriz W. The pathogenesis of “classic” focal segmental glomerulosclerosis—lessons from rat models. Nephrol Dial Transplant 2003; 18:vi39–44. 22. Howie AJ, Brewer DB. The glomerular tip lesion: a previously undescribed type of segmental glomerular abnormality. J Pathol 1984; 142:205–20. 23. Howie AJ, Brewer DB. Further studies on the glomerular tip lesion: early and late stages and life table analysis. J Pathol 1985; 147:245–55. 24. Detwiler RK, Falk RJ, Hogan SL. Collapsing glomerulopathy: a clinically and pathologically distinct variant of focal segmental glomerulosclerosis. Kidney Int 1994; 45:1416–24. 25. Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int 1999; 55:713–23. 26. Post TW, Rose BD. Urinalysis in the diagnosis of renal disease. In: Curhan GC and Forman JP (Eds). Up To Date 13(2006):3. 27. Lab Tests Online. (Accessed February 10, 2012, at: http://www.labtestsonline.org/understanding/analytes/urinalysis/tab/sample). 28. National Cholesterol Education Program (Ncep) Expert Panel On Detection, E. "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation 2002; 106(25):3143–421. 29. Chobanian AV. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42:1206–52. 30. Hsu CY, Chertow GM, Curhan GC. Methodological issues in studying the epidemiology of mild to moderate chronic renal insufficiency. Kidney Int 2002; 61:1567–76. 31. Stokes MB, Markowitz GS, Lin J, Valeri AM, D'agati VD.Glomerular tip lesion: a distinct entity within the minimal change disease/focal segmental glomerulosclerosis sectrum. Kidney Int 2004; 65:1690–702. 32. Chun MJ, Korbet SM, Schwartz MM, Korbert SM and Lewis EJ. Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants. J Am Soc Nephrol 2004; 15:2169–77. 33. Arias LF, Jiminez CA, Arroyave MJ. Histologic variants of primary focal segmental glomerulosclerosis: presentation and outcome. J Bras Nefrol 2013; 35(2):112–9. 34. Kopp JB, Winkler C. HIV-associated nephropathy in African Americans. Kidney Int Suppl 2003; 63:S43–9. 35. Weisinger JR, Kempson RL, Eldridge FL, Swenson RS. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med 1974; 81:440–7. 36. Gutierrez-Millet V, Nieto J, Praga M, Usera G, Martinez MA, Morales JM. Focal glomerulosclerosis and proteinuria in patients with solitary kidneys. Arch Intern Med 1986; 146:705–9. 37. Praga M, Morales E, Herrero JC. Absence of hypoalbuminemia despite massive proteinuria in focal segmental glomerulosclerosis secondary to hyperfiltration. Am J Kidney Dis 1999; 33:52–8.
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Molecular detection of Helicobacter species in the bile and histopathological evaluation of gall bladders of patients with calculus cholycystitis in Duhok province, Kurdistan region of Iraq
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1653-1658
Amir
Hani. Raziq*, Alaa Hani. Raziq**, Sardar Hassan Arif***
* Department of Engineering and biotechnology, College of Sciences, Duhok University, Duhok, Iraq.
** Department of Pathology, College of Medicine, Duhok University, Duhok, Iraq.
*** Department of Surgery, College of Medicine, Duhok University, Duhok, Iraq.
doi.org/10.15218/zjms.2017.016
Background and objective: The presence of bile-resistant Helicobacter spp. in bile and gallbladder tissues has been proposed as a cause of gallbladder disease. This study aimed to assess the histopathological events in calculus cholecystitis and investigate the presence of the DNA of Helicobacter spp. in the bile. Methods: Forty patients who underwent cholecystectomy for calculus cholecystitis were evaluated for the presence of Helicobacter spp. by polymerase chain reaction methods and gallbladder tissue was evaluated histopathologically. Gall bladders were fixed in formalin and subjected to histopathological investigation while bile sample was used for the extraction of DNA. Results: The histopathological findings revealed that twenty-seven (67.5%) samples showed mild chronic inflammation, one (2.5 %) sample with acute inflammation, four (10 %) samples with acute on chronic inflammation, eight (20 %) samples have normal histological findings. The molecular investigation revealed that twenty one (52 %) samples out of the forty showed the presence of genomic DNA after being subjected to DNA extraction and that fourteen (66.7 %) samples out of the twenty one showed amplification bands of 300 bp after PCR amplification indicating the presence of Helicobacter spp. within the samples. But no sample revealed the presence of H. pylori DNA when PCR was applied. Conclusion: Helicobacter spp. are considered as a determining factor for the development of gall bladder inflammation. Keywords: Helicobacter spp.; Gallbladder; Bile; PCR; 16 S rRNA; HPU1; HPU2.
1. Fox JG. The non-H. pylorihelicobacters: their expanding role in gastrointestinal and systemic diseases. Gut 2002; 50:273–83. 2. Kusters JG, VanVliet AHM, Kuipers EJ. Pathogenesis of Helicobacter pylori Infection. Clin Microbiol Reviews 2006; 19(3):449–90. 3. García A, Zeng Y, Muthupalani S, Ge Z, Potter A, Mobley MW, et al. Helicobacter hepaticus–induced liver tumor promotion is associated with increased serum bile acid and a persistent microbial-induced immune response. Cancer Res 2011; 71(7):2529–40. 4. Nillson HO, Taneera J, Castedal M, Glatz E, Olsson R, Wadstrom T. Identification of Helicobacter pylori and other Helicobacter species by PCR, hybridization and partial DNA sequencing in human liver samples from patients with primary sclerosing cholangitis or primary biliary cirrhosis. J Clin Microbiol 2000; 38:1072–6. 5. Swidsinski A, Ludwig W, Pahlig H, Priem F. Molecular genetic evidence of bacterial colonization of cholesterol gallstones. Gastroenterology 1995; 108(3):860–4. 6. Nilsson B, Friman S, Thune A, Jivegard L, Svanvik J. Inflammation reduces mucosal secretion of hydrogen ions and impairs concentrating function and luminal acidification in feline gallbladder. Scand J Gastroenterol 1995; 30:1021–6. 7. Cetta F, Figura N, Montalto G, Cetta D, Baldi C, Amoroso M, et al. Helicobacter pylori in the bile could play a facilitating role in the pathogenesis of the some types of gallstones. Gastroenterology 2000; 118:A7. 8. Pandey M. Helicobacter species are associated with possible increase in risk of biliary lithiasis and benign biliary diseases. World J Surg Oncol 2007; 5:94. 9. Rosai J. Rosai and Ackerman’s surgical pathology. New York: Elsevier Corporation; 2011. 10. Bancroft JD, Steven A. Theory and practice of histopathological techniques. Edinburgh Churchill Livingstones; 1999. 11. Silva CP, Pereira-Lima JC, Oliveira AG, Guerra JB, Marques DL, Sarmanho L, et al. Association of the presence of Helicobacter in gallbladder tissue with cholelithiasis and cholecystitis. J Clin Microbiol 2003; 41:5615-8. 12. Sambrook J, Fritsch EF, Maniatis T. Molecular cloning: A laboratory manual. New York: Cold spring harbor laboratory press; 1989. 13. Ward JM, Anver MR, Haines DC, Benveniste RE. Chronic active hepatitis in mice caused by Helicobacter hepaticus. Am J Pathol 1994; 145:959–68. 14. Ghazal A, El Sabbagh N, El Riwini M. Presence of Helicobacter spp. DNA in the gallbladder of Egyptian patients with gallstone diseases. East Mediterr Health J 2011; 17(12):925–9. 15. Lee JW, Lee DH, Lee JI, Jeong S, Kwon KS, Kim HG, et al. Identification of Helicobacter pylori in gallstone, bile, and other hepatobiliary tissues of patients with cholecystitis. Gut and Liver 2010; 4:60–7. 16. Tiwari SK, Khan AA, Ibrahim M, Habeeb MA, Habibullah CM. Helicobacter pylori and other Helicobacter species DNA in human bile samples from patients with various hepato-biliary diseases. World J Gastroenterol 2006; 12:2181–6. 17. Fox JG, Dewhirst FE, Shen Z. Hepatic Helicobacter species identified in the bile and gallbladder tissue from Chileans with chronic cholecystitis. Gastroenterology 1998; 114:755–63. 18. Fallone CA, Tran S, Semret M, Discepola F, Behr M, Barkun AN. Helicobacter DNA in bile: correlation with hepato-biliary diseases. Aliment Pharmacol Ther 2003; 17:453–8. 19. Chen DF, Hu L, Yi P, Liu WW, Fang DC, Cao H. H. pylori exist in the gallbladder mucosa of patients with chronic cholecystitis. World J Gastroenterol 2007; 13:1608–11. 20. Rudi J, Rudy A, Maiwald M, Stremmel W. Helicobacter sp. are not detectable in bile from German patients with biliary disease. Gastroenterology 1999; 116:1016–7. 21. Nilsson B, Friman S, Thune A, Jivegard L, Svanvik J. Inflammation reduces mucosal secretion of hydrogen ions and impairs concentrating function and luminal acidification in feline gallbladder. Scand J Gastroenterol 1995; 30:1021–6. 22. Erden E, Kiyan M. Evaluation of the presence of Helicobacter species in the biliary system of Turkish patients with cholelithiasis. Turk J Gastroenterol 2010; 21:421-427. 23. Pellicano R, Menard A, Rizzetto M, Megraud F. Helicobacter species and liver diseases: association or causation? Lancet Infect Dis 2008; 8(4):254–60.
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Thermal change assessment in the pulp chamber during orthodontic bonding with different light curing sources (An in vitro study)
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1659-1663
Omar
Fawzi Abduljabbar*, Diyar Kh. Bakr**, Sazan Sh. Saleem* * Department of P.O.P, College of Dentistry, Hawler Medical University, Erbil, Iraq. ** Department of Conservative, College of Pharmacy, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.017
Background and objective: Thermal change in pulp chamber with the use of light cured adhesives is one of the contemporary concerns for orthodontists. This study aimed to evaluate intra pulpal temperature rises during bracket bonding using three different light sources. Methods: Sixty intact-extracted mandibular premolars were divided into three groups of twenty teeth for each. Orthodontic brackets were bonded to the buccal surface of all the teeth with Transbond XT adhesive applying a constant force, first group light cured with halogen light, in second group light emitting diode was used, in third group plasma, arc light was used. The measurements were taken with a J-type thermocouple wire, placed in the center of the pulp chamber and connected to a data plugger. Results: Statistical analysis showed that temperatures of pulp chamber change were influenced by a type of light source. The intra pulpal temperature changes for halogen was higher than a light emitting diode and both were higher than plasma arc. All the groups revealed a significant difference between each other. Conclusion: Orthodontic bonding with using different light source did not exceed the critical 5.5° C temperature rise that may induce a thermal change in the pulp. Keywords: Pulp temperature; Orthodontic bonding; Light cure; Thermal change.
1. Gottlieb EL, Nelson AH, Vogels DS. Study of orthodontic diagnosis and treatment procedures. Part 1. Results and trends. J Clin Orthod 1996; 12:615–30. 2. Keim RG, Gottlieb EL, Nelson AH, Vogels DS. JCO study of orthodontic diagnosis and treatment procedures. Part 1. Results and trends J Clin Orthod 2002; 36:553–68. 3. Oesterle LJ, Newman SM, Shellhart WC. The comparative bond strength of brackets cured using a pulsed xenon curing light with 2 different light-guide sizes. Am J Orthod Dentofacial Orthop 2002; 122:242–50. 4. Oesterle LJ, Newman SM, Shellhart WC. Rapid curing of bonding composite with a xenon plasma arc light. Am J Orhod Dentofacial Orthop 2001; 119:610–6. 5. Dunn WJ, Taloumis LJ. Polymerization of orthodontic resin cement with light-emitting diode curing units. Am J Orthod Dentofacial Orthop 2002; 122:236–41. 6. Hannig M, Bott B. In-vitro pulp chamber temperature rise during composite resin polymerization with various light- curing sources. Dent Mater J 1997; 15:275–81. 7. Ramglu SI, Karamehmetoglu H, Sari T, Usumez S. Temperature rise caused in the pulp chamber under simulated intra-pulpal microcirculation with different light curing mode. Angle Ortho 2015; 85(3):381–5. 8. Malkoc S, Uysal T, Usmez S, Isman E, Baysal A. In-vitro assessment of temperature rise in the pulp during orthodontic bonding. Am J Orthod Dentofacial Orthop 2010; 137:379–83. 9. Uzel A, Buyukyilmaz T, Kayalioglu M, Uzel I. Temperature rise during orthodontic bonding with various light curing units an in vitro study. Angle Ortho 2006; 76:330–4. 10. Weerakoon AT, Meyers IA, Symons AL, Walsh LJ. Pulpal heat changes with newly developed resin photopolymerization systems. Aust Endod J 2002; 28:108–11. 11. Hofmann N, Hugo B, Klaiber B. Effect of irradiation type (LED or QTH) on photo-activated composite shrinkage strain kinetics, temperature rise, and hardness. Eur J Oral Sci 2002; 110:471–9. 12. Hansen EK, Asmussen E. Correlation between depth of cure and temperature rise of a light-activated resin. Scand J Dent Res 1993; 101:176–9. 13. Kleverlaan CJ, de Gee AJ. Curing efficiency and heat generation of various resin composites cured with high-intensity halogen lights. Eur J Oral Sci 2004; 112:84–8. 14. Cobb DS, Dederich DN, Gardner TV. In vitro temperature change at the dentin/pulpal interface by using conventional visible light versus argon laser. Lasers Surg Med 2000; 26:386–97. 15. Yu D, Powell GL, Higuchi WI, Fox JL. Comparison of three lasers on dental pulp chamber temperature change. J Clin Laser Med Surg 1993; 11:119–22. 16. Powell GL, Anderson JR, Blankenau RJ. Laser and curing light induced in vitro pulpal temperature changes. J Clin Laser Med Surg 1999; 17:3–5. 17. Goodis HE, White JM, Andrews J, Watanabe LG. Measurement of temperature generated by visible-light cure lamps in an in vitro model. Dent Mater 1989; 5:230–4. 18. Hofmann N, Hugo B, Klaiber B. Effect of irradiation type (LED or QTH) on photo-activated composite shrinkage strain kinetics, temperature rise, and hardness. Eur J Oral Sci 2002; 110:471–9. 19. Oesterle LJ, Newman SM, Shellhart WC. Rapid curing of bonding composite with a xenon plasma arc light. Am J Orthod Dentofacial Orthop 2001; 119:610–6. 20 Kodonas K, Gogos C, Tziafa C. Effect of simulated pulpal microcirculation on intra-chamber temperature changes following application of various curing units on tooth surface. J Dent 2009; 37:485–90. 21. Weerakoon AT, Meyers IA, Symons AL, Walsh LJ. Pulpal heat changes with newly developed resin photopolymerization systems. Aust Endod J 2002; 28:108–11. 22. Sheridan JJ, Brawley G, Hastings J. Electrothermal de- bracketing. Part II. An in vivo study. Am J Orthod Dentofacial Orthop 1986; 89:141–5. 23. Ozturk B, Ozturk AN, Usumez A, Usumez S, Ozer F. Temperature rise during adhesive and resin composite polymerization with various light curing sources. Oper Dent 2004; 29:325–32. 24. Attrill DC, Davies RM, King TA, Dickinson MR, Blinkhorn AS. Thermal effects of the Er:YAG laser on a simulated dental pulp: a quantitative evaluation of the effects of a water spray. J Dent 2004; 32:35–40. 25. Baysal A, Uysal T, Usumez S. Temperature rise in the pulp chamber during different stripping procedures. Angle Orthod 2007; 77:478–82. 26. Uysal T, Eldeniz AU, Usumez S, Usumez A. Thermal changes in the pulp chamber during different adhesive cleanup procedures. Angle Orthod 2005; 75:220–5. 27. Read MJ. The bonding of orthodontic attachments using a visible light cured adhesive. Br J Orthod 1984; 11:16–20. 28. Tarle Z, Meniga A, Knezevic A, Sutalo J, Ristic M, Pichler G. Composite conversion and temperature rise using a conventional, plasma arc and experimental blue LED curing unit. J Oral Rehabil 2002; 29:662–7. 29. Usumez A, Ozturk N. Temperature increase during resin cement polymerization under a ceramic restoration: effect of type of curing unit. Int J Prosthodont 2004; 17:200–4. 30. Ozturk B, Ozturk AN, Usumez A, Usumez S, Ozer F. Temperature rise during adhesive and resin composite polymerization with various light curing sources. Oper Dent 2004; 29:325–32. 31. Rajesh Ebenezar AV, Anilkumar R, Indira R, Ramachandran S, Srinivasan MR. Comparison of temperature rise in the pulp chamber with different light curing units: an in-vitro study. J Conserv Dent 2010; 13:132–5.
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Antibacterial and antibiofilm activity of Ammi majus seed against Gram-positive bacteria
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1664-1672
Aveen
Nozad Adham*, Zheen Abdulelah Abdulah* * Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Erbil, Iraq.
doi.org/10.15218/zjms.2017.018
Background and objective: Ammi majus belongs to family Apiaceae is an important plant used in a different country traditionally for treatment bacterial infection. This study aimed to investigate in vitro antibacterial and antibiofilm activity of Ammi majus seed extracts against six isolated Gram-positive bacteria. Methods: The antibacterial activity of seed extracts were screened by disk diffusion and agar overlay bioautography method and their activities were further determined by minimum inhibitory and minimum bactericidal concentration. Biofilm formation was evaluated by the microtiter plate crystal violet assay. The quantity of bound bacteria was determined by measuring absorbance at (OD630 nm) using microtiter plate reader. Results: Ethanol 80% and ethyl acetate extracts showed variable activity against all isolated bacteria while petroleum ether extract revealed resistance against studied bacteria. Streptococcus mitis showed more pronounced sensitivity against both extracts by disk diffusion (12 mm and 10 mm) and bioautography method with minimum inhibitory concentration 7.8125 mg/ml of ethanol 80% and 15.625 mg/ml for ethyl acetate extracts. Ethanol 80% and ethyl acetate extract significantly reduced biofilm formation as compared to control, showed antibiofilm activity at 0.4883-62.5 mg/ml and exhibited strongest antibiofim activity against Staphylococcus aureus. Conclusion: Ammi majus seed extracts revealed highest antibacterial activity against Streptococcus species and strongest antibiofilm activity on Staphylococcus species. Keywords: Ammi majus; Disk diffusion; Bioautography; minimum inhibitory concentration; Antibiofilm.
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