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Objective: To evaluate the short-term efficacy of Dutasteride in the management of chronic prostatitis (CP)/chronic pelvic pain syndrome. Materials and methods: A randomized placebo-controlled double-blind study was conducted that including 50 patients diagnosed with CP based on the presence of pelvic pain for ≥3 months of the preceding 6 months. Patients were randomized into 2 equal groups to evaluate Dutasteride of 0.5 mg once daily that was given for 3 months compared to a placebo. Results: Forty-nine patients were evaluated after the follow-up period with no statistically significant difference in the perioperative demographic data. The mean age of the Dutasteride group was 48.3 (range 41–62) compared to a mean age of 46.5 (range 44–60) in the placebo group. There was a highly statistically significant improvement in the Dutasteride group compared to its preoperative parameters and the placebo compared group in the terms of pain, urinary scores, and total National Institutes of Health CP symptom score. Moderate and marked improvement in patients’ symptomatology was seen in 56% of the dutasteride group, while only 8% in the dutasteride group failed to show an improvement with no significant side effects noted in our study. Conclusion: The short-term outcome of dutasteride therapy showed an improvement in the National Institutes of Health-CP symptom score compared to a placebo in the treatment of category IIIB CP. The trial was registered in the clinical trial.gov registry with a registration number: NCT04756206.

Muffling devices are essential parts of any vehicle/machine that uses internal combustion engines. From automotive manufacturers point of view, they contribute massive sheet metal processing and production time, especially mufflers that are produced at high rates for commercial vehicles. This paper is concerned with applying manufacturing procedures to reduce the production cost of any commercial automotive mufflers through theoretical studies and experimental measurements verification. Mufflers design parameters such as transmission loss, flow generated noise and pressure drop were selected for performance judgment, parameters were simulated and experimentally measured. The transfer matrix method was used to calculate the propagation of sound waves along the muffler. A commercial automotive muffler with a hybrid combination of dissipation and reflection was selected for application and a new design was proposed for this muffler with a reduced manufacturing cost. The manufacturing processes were reduced by 77.7% and consequently the cost relative to the original muffler. Keywords: Commercial vehicle, Vehicle economics, Perforated muffler, Dissipative muffler, Exhaust system manufacturing

This paper introduces acoustics software for mechanical engineers and architects to aid in the early design stages or later consultations. The software uses governing equations for mechanical equipment and HVAC components in standards such as ASHARE, ASTM E477 and ARI coupled with room acoustics equations. Along the sound propagation path the noise sound pressure levels are calculated starting from the first source to the receiving point. The transmission loss of any obstacles/walls are taken into consideration to give a reliable estimation to the real values. In this paper two case studies are presented to show the efficiency of the software and verify the outputs with measurements. The sound pressure levels and noise criteria of the indoor and outdoor spaces studied showed a variation around 6.4% compared to measured values. Through this software the designer could map and manipulate the design to reach the standard or regulated noise criteria. Keywords: Noise control, Noise mapping, Acoustic software, HVAC noise, Transmission loss

Background: The fluid responsiveness of patients who are mechanically ventilated is evaluated using the reversible fluid loading technique known as passive leg raising. Objective: This study purpose to determine if intra-abdominal hypertension, which reduces venous return, affected the ability of passive leg raising to detect fluid responsiveness in critically ill patients. Patient and methods: Our study is a prospective study done at the critical care Medicine Department of Helwan University Faculty of Medicine on 400 mechanically ventilated patients with a pulse pressure variation greater than 12%. The esophageal Doppler was used to continually monitor the stroke volume. The bladder pressure was used to calculate intra-abdominal pressure. Fluid loading with 500 ml of saline was conducted after a passive leg-raising exercise and a return to baseline, with hemodynamic parameters recorded at each stage. Results: Four hundred patients were divided into two groups based on their response to passive leg raising: responders (at least a 12% increase in stroke volume) and non-responders (all patients in both groups were responders to volume loading). Two hundred patients responded to passive leg raising (50%), whereas the non-responders (i.e. false negatives) were similarly 50%. At baseline, the non-responders to passive leg raising had considerably greater median intraabdominal pressure than the responders to passive leg raising (20 [5.5]- vs 10 [4.5], respectively, with a p-value < 0.001). Conclusion: Passive leg raising has false negatives are caused by intra-abdominal pressures more than 12 mmHg. In severely sick ventilated patients, intra-abdominal pressure (IAP) should be assessed before doing passive leg raising. [ABSTRACT FROM AUTHOR]

Background: Stenting has been primarily used to treat urinary obstruction and the frequency of this use is increasing with the increase in ureteroscopic management. In cases of acute obstruction, a stent is used temporarily to stabilize the patient until definitive therapy. The stent is generally placed if there is accompanying ureteric injury or in those with a residual stone after ureteroscopic lithotripsy. Placing a ureteric stent after ureteroscopy with stone extraction is done by some urologists routinely to prevent possible stenosis or to decrease secondary pain caused by mucosal oedema. However, routinely placing a stent to prevent late complications or to relieve flank pain from a ureteric stricture or mucosal oedema after surgery is questionable. Stent-related symptoms are quite problem in nearly 80% of patients that has been implicated in short-term morbidities in terms of negative impact on the patients’ quality of life, body pains and hematuria. Various attempts had been made to minimize these symptoms but pharmacological treatment is the simplest and a noninvasive option. Numerous drugs had been tried to relieve these symptoms like alpha blockers, anticholinergics and analgesics. Objective: To compare the efficacy of tamsulosin alone, tamsulosin in combination with solifenacin and tamsulosin in combination with trospium chloride in in the relief of Double-J stent-related symptoms following uncomplicated ureteroscopic lithotripsy (URSL). Patients and Methods: The present study was a prospective randomized comparative study conducted on 60 patients whith double-J stent inserted following uncomplicated ureteroscopic lithotripsy (URSL) in Ain Shams University Hospital and Karmouz Hospital over a period of 1 year. The patient were randomized into 3 equal groups (1:1:1 randomization): Group A:20 patients were treated by Tamsulosin (0.4mg) alone once daily. Group B:20 patients were treated by Tamsulosin (0.4mg) once daily in combination with Solifenacin (5 mg) once daily. Group C: 20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Trospium chloride (20 mg) twice daily. All patients were assessed 1 week postoperatively after Double-J stent insertion. Then, the patients were start the medical treatment and were assessed 3 weeks after starting the medical treatment. Results: The study shows that the combination of the tamsulosin 0.4 mg/day and trospium chloride 20mg twice/day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5mg/day are signicantly superior. Also, the drugs are safe with mild few side effects. There were no significant differences regarding headache, dizziness, backache, myalgia and orthostatic hypotension. Conclusion: The study show that the combination of the tamsulosin 0.4 mg/day and the trospium chloride 20mg twice /day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5mg/day are signicantly superior. [ABSTRACT FROM AUTHOR]

Background Spinal cord injury ( SCI) patients with lesions above T6 are susceptible to develop autonomic dysreflexia (AD) during surgery. The aim of this study was to investigate the efficacy of epidural fentanyl for the prevention of AD in chronic SCI patients undergoing urological procedures. Patients and methods Thirty chronic SCI patients scheduled for cystoscopy were randomized to receive epidural anesthesia using 5 ml bupivacaine 0.25% with fentanyl 50 μ g in 10 ml saline (group F) or 5 ml bupivacaine 0.25% in 10 ml saline (group C). Results There was a significant decrease in the blood pressure and the heart rate 20 min after epidural anesthesia in both groups, with significantly lower systolic and diastolic blood pressures in group F compared with group C; however, the systolic and diastolic blood pressure showed a significant increase, with a decrease in the heart rate, in group C compared with group F during bladder manipulation (25 min). Six patients in group C showed manifestations of autonomic dysreflexia, with an increase in the systolic blood pressure more than 160 mmHg and diastolic blood pressure more than 100 mmHg in three of them. Conclusion The addition of fentanyl to epidural bupivacaine succeeded in preventing AD manifestations in chronic SCI patients undergoing cystoscopy. [ABSTRACT FROM AUTHOR]

Background: Chronic Obstructive Pulmonary Disease (COPD) predominantly prevalent in men, is a chronic inflammatory disorder of the airway and lungs. COPD is associated with increased risk of Benign prostatic hyperplasia (BPH). Judging from the association between COPD and BPH in ageing male population, and the samilarities between receptors in airways and the urinary bladder. Objectives: the aim of the study was to show the effect of treatment of symptomatic BPH on the airways of COPD patients by spirometric assessment before and after starting treatment of BPH. Patients and Methods: The present study was conducted upon 60 subjects during the period from March 2019 to August 2019 in Ain Sham University Hospitals. Type of Study: prospective study, there were two groups of patients first group received tamsulosin and the second group received tamsulosin and solifenacin Results: By comparison of the two groups, there was non-significant change. as regard percent of change of forced vital capacity (FVC), first group’s median was 7.9% and second group median was 5.6%. as regard percent of change of forced expiratory volume 1 (FEV1), in first group’s median was 5.7% and second group’s median was 7.4%. Conclusion: There was significant improvement in spirometric values in each group before and after starting treatment, but by comparison between the two groups, there was insignificant change. [ABSTRACT FROM AUTHOR]