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BACKGROUND: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) improves overall survival in muscle-invasive bladder cancer (MIBC), but successful completion rates of NAC are low. A retrospective analysis was undertaken to determine the etiology of deviations of NAC administration for MIBC. METHODS: We performed a retrospective review of MIBC patients in an institutional database who received NAC followed by RC from 2008 to 2016. Patients were characterized as having completed NAC without deviation (“No Deviation”) or with deviation (“Deviation”). Factors associated with “Deviation” were assessed with logistic regression models. RESULTS: 172 MIBC patients received NAC followed by RC; 49 were excluded due to incomplete NAC data. Of the remaining 123 patients, 80 (65%) received Gemcitabine and Cisplatin (GC) and 25 (20%) received dose-dense MVAC (ddMVAC). In all, 85 (69%) patients had “Deviation” in planned NAC administration, while the remaining 38 (31%) patients had “No Deviation.” Twenty-six (33%) of GC patients experienced delays (mean = 21.5±17.0 days) and 6 (24%) ddMVAC patients experienced delays (mean = 10.5±9.5 days). Receipt of GC was associated with higher likelihood of “Deviation” in comparison to ddMVAC (OR = 15.4; 95% CI 4.43–53.72, p

Highlights • Gallbladdercarcinosarcoma is a rare disease: The first case of a carcinosarcoma of the gallbladder (CSGB) was reported by Landsteiner in 1907. Up to now less than 100 Cases have been reported in the literature. • Non-specific signs: the clinical (abdominal pain, weight loss and jaundice, biological (including inflammatory sign, hepatic result), and radiological signs are nonspecific of gallbladder carcinosarcoma, The final diagnosis is anatomopathological of the specimen. • The diagnosis is delayed: Because of the nonspecific symptoms, a delayed diagnosis is generally associated with CSGB. Only 54 cases have undergone surgical resection as a treatment. • Surgical treatment remains the only cure for gallbladder carcinosarcoma: Chemotherapy and/or radiotherapy’s roles, they remain unclear because of the limited number of cases described in the literature, as chemotherapy has shown no a significant benefit in terms of morbidity or mortality. • Prognosis: The prognosis of this disease is normally poor. Most cases present with locally advanced disease and metastasis., Introduction Gallbladder Carcinosarcoma is a rare and fatal cancer characterized by the presence of a combination of a cancerous epithelial and mesenchymal components. Presentation of case We present the case of a 66 years old patient with a carcinoma gallbladder carcinoma who received a surgical treatment. The histological assessment revealed two histological components consisting of an adenocarcinoma and a spindle cell sarcoma compatible with the carcinosarcoma. Discussion This cancer is known to be extremely severe in that less than 100 cases have been documented in international medical review of literature. surgical treatment remains the only cure for gallbladder carcinosarcoma, The prognosis of this disease is extremely poor because it normally presents at advanced stages. Conclusion We present an extremely rare example of carcinosarcoma, and its attributes might be suggestive of a greater malignant potential. Consequently, the later the diagnosed worse is the prognosis.

Background Erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are known outcomes of traditional surgery and some pharmacotherapies for treatment of benign prostatic hyperplasia (BPH). Minimally invasive treatment options, including water vapor thermal therapy (WVTT), are now available to treat lower urinary tract symptoms (LUTS) due to BPH. Aim The objective of this analysis was to evaluate long-term impact of a single water vapor thermal therapy procedure on erectile and ejaculatory function in subjects enrolled in the Rezum II prospective, multicenter, randomized, blinded controlled trial. Methods Fifteen centers enrolled 197 subjects with International Prostate Symptom Score (IPSS) ≥ 13, maximum flow rate (Qmax) ≤ 15 mL/s, and prostate volume 30–80 cc. Subjects were randomized (2:1) to (WVTT) or sham procedure (control) and followed for 5 years. Erectile and ejaculatory functions were quantitatively assessed at baseline and yearly thereafter. After 3 months, control subjects could opt to requalify for cross-over to WVTT and were followed for 5 years. Results of the per protocol analysis were reported previously. The current post hoc analysis was performed on all treated subjects who were sexually active at baseline with no other surgical or medical management for BPH during the 5-year study period. Outcomes LUTS was evaluated using IPSS, Benign Prostatic Hyperplasia Impact Index (BPHII), and Qmax. Sexual function was assessed using the International Index of Erectile Function (IIEF-EF) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD). Results A total of 197 subjects (136 treated, 61 control) were enrolled in the study, and 53 control subjects opted to cross-over and receive WVTT. All subgroups experienced significant, durable improvement in IPSS (P < .0001). Subjects with normal sexual function at baseline had little change in function over 5 years (IIEF-EF: −2.4 ± 8.9, P = .1414; MSHQ-EjD Function: −1.6 ± 3.2, P = .0083; MSHQ-EjD Bother: −0.5 ± 1.6, P = .1107). Subjects with baseline medical history of ED and EjD showed slight decline over time that was not clinically significant (ED, IIEF-EF: −3.0 ± 10.1, P = .1259; MSHQ EjD Function: −2.3 ± 4.7, P = .0158; MSHQ-EjD Bother: −0.1 ± 2.6, P = .7764; EjD, IIEF-EF: −4.1 ± 9.2, P = .0127; MSHQ EjD Function: −1.6 ± 4.8, P = .1970; MSHQ-EjD Bother: −0.4 ± 2.6, P = .440). Clinical Implications Treatment for BPH with Rezum durably improved IPSS without clinically significant impact on sexual function. Patients with baseline ED/EjD may expect continued decline from other causes but are unimpacted by the therapy. Strengths & Limitations, Conclusion The results are limited by the post-hoc nature of the analysis and attrition over the 5-year follow-up but provide long-term evidence of durable outcomes after treatment with Rezum without impact on sexual function scores. McVary KT, El-Arabi A, Roehrborn C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sex Med 2021;9:100454.

Highlights • Acute hemoperitoneum after a spontaneously ruptured hepatocellular carcinoma (HCC) is a rare complication. • In cases with stable conditions, imaging guided by computed tomography (CT) enables arterial embolisation. • Surgery is a choice after failure of embolisation or in case of severe hemodynamic instability. • The prognostic outcomes of ruptured HCC depend mostly on the underlying liver function. • Successful management by one-stage surgery allowed radical treatment of this rare entity., Introduction Acute hemoperitoneum with a spontaneously ruptured hepatocellular carcinoma (HCC) is a rare type of internal bleeding that requires a multidisciplinary management approach. Presentation of case In this case report, we describe a fortuitously ruptured peripheral and discovered HCC in an 81-years-old woman treated effectively using hepatectomy. Discussion The use of the computed tomography (CT) angiography to diagnose the stability of the patient’s condition allows both arterial embolization in case of active bleeding and the evaluation of the underlying hepatopathy. The place of surgery is particularly upon after both the failure of arterial embolization and while facing a severe hemodynamic instability. The surgical strategy varies between perihepatic tamponnade and a surgical resection in one or more stages. The prognosis of a ruptured HCC depends mainly on the underlying liver’s function. Conclusion Multidisciplinary management of spontaneously ruptured HCC results in the same survival outcome as non-ruptured HCC at the same stage of hepatopathy.

Objective: The aim of the present study was to assess the prevalence of the early childhood caries (S-ECC) and its impact on preschool children’s life (aged 4-6), as well as on their parents, in one of the most popular prefectures in Casablanca, Morocco. Materials and Methods: Parents of 546 children attending 11 randomly selected preschools (7 private and 4 public institutions) were invited to complete 13 items of an oral health questionnaire and had their children undergo a dental examination. The quality of life was evaluated using the Early Childhood Oral Health Impact Scale (ECOHIS). Statistical analysis: The data collected were analyzed using the SPSS (Statistical Package for the Social Sciences). To find the comparison between groups, Chi-square test was used. Results: The prevalence of the ECC and the S-ECC were 74.2% and 47.3% respectively. The negative effect of S-ECC on children’s quality of life has many aspects: 59.3% of them have experienced tooth pain, 41.5% have reported eating difficulties, and 41.3% have had drinking difficulties. Moreover, 40% of parents expressed feelings of guilt and 10.6% had to take time off work due to their children’s oral health status. On another note, the financial impact of the S-ECC was also significant. Conclusion: The S-ECC negatively impacts the life quality of children aged between 4 and 6 years old in addition to their parents’. This suggests a need for further strategic planning and preventive program adapted to such a public health problem.

Introduction:We determined the usefulness of ultrasound compared to cross-sectional imaging in the detection of intra-abdominal recurrences after radical or partial nephrectomy for localize...

INTRODUCTION AND OBJECTIVE:Erectile dysfunction (ED) and ejaculatory dysfunction (EjD) are well documented outcomes of traditional prostate surgery and pharmacotherapy for treatment of benign prost...

Objectives: Evaluate clinical outcome, recurrence, morbidity, and cost associated with laparoscopic surgical ligation versus percutaneous embolization of adolescent varicocele. We hypothesize that ...

This paper reports the case of a Moroccan girl with a phenotype within the clinical spectrum of both Hallermann-Streiff (HSS, OMIM 234100) and Oculodentodigital Dysplasia (ODDD, OMIM 164200) syndromes. The patient presented with repeated dental abscesses and severe early childhood caries. She had no learning deficit nor psychomotor regression; however, a language delay was noted. She also presented with obstructive sleep apnea syndrome and specific craniofacial features pathognomonic of HSS. Radiographic examination showed enamel and dentin defects, giving a ghost-like tooth appearance. Several clinical features of ODDD overlap those of HSS and may confuse diagnosis, considering that the inheritance of HSS is not described yet. The diagnostic odyssey of this patient ended with the identification by exome sequencing of a novel homozygous alteration in the GJA1 gene. A missense substitution in exon 2 [Chr6(GRCh37): g.121768554C>G NM_000165.4: c.561C>G p.Cys187Trp] was identified by whole-exome sequencing (WES), suggesting a diagnosis of ODDD. This is the first report of a homozygous mutation affecting the second extracellular loop of the CX43 protein.

Ganglioneuroma is a nerve tumor arising from the sympathetic neural crest. It is a rare benign tumor. Retroperitoneum is its second location after the posterior mediastinum. Usually asymptomatic, it is discovered incidentally on imaging. Surgical resection is the sole treatment. The prognosis is good if the diagnosis is made early with quality R0 surgical excision. We report a case in a 14-year-old female admitted to the emergency department for obstructive pyelonephritis. Imaging features found a retroperitoneal mass with characteristics suggestive of a retroperitoneal ganglioneuroma, which was confirmed by histological study. Ganglioneuroma should be a part of differential diagnoses for any retroperitoneal mass in children and young adults.

Highlights • From: The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration, Ann. Surg. 199 (1984) 28–30. • Many risk factors of Abdominal Compartment Syndrome have been reported. • Guidelines treating the disease have been published from different perspectives including diagnosis, measurement and management. • From: Updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39 (7): 1190–1206. • There are 2 therapeutic options: surgical and non-surgical. • From: The polycompartment syndrome: a concise state-of-the-art review. Anaesthesiol Intensive Ther. 2014; 46 (5): 433–50. • During Abdominal Compartment Syndrome, multiple organ dysfunctions may be revealed leading to a polycompartment syndrome., Background Abdominal Compartment Syndrome (ACS) is a pathological condition that results from an increase in pressure within the abdomen associated with organ failure. It can be acute or chronic, primary or secondary. ACS poses a serious diagnostic challenge for physicians as the clinical presentation is varied and can mimic other medical pathologies. To prevent a multi-organ failure and ultimately death due to this disease, the World Society of Abdominal Compartment Syndrome (WSACS) suggested clinical criteria and biology tests to facilitate an early diagnosis of acute ACS. Case presentation We report a case of 61 year-old man diagnosed with chronic mesenteric ischemia that has been successfully treated by prosthetic bypass. The postoperative period was eventual, the patient presented complications corresponding essentially to a manifest acute ACS. The treatment consisted on abdominal decompression and resuscitation measures. Conclusions An early diagnosis of ACS disease for an appropriate therapeutic initiation is mandatory to prevent its complications and save the patient's life prognosis.

INTRODUCTION: Le but de cette A©tude A©tait de faire une corrA©lation entre le syndrome mA©tabolique et le niveau de l´activitA© physique chez une population de Marrakech, au Maroc. METHODES: l´A©tude a A©tA© menA©e A l´hA´pital rA©gional Ibn Zohr A Marrakech. L´indice de masse corporelle (IMC) a A©tA© calculA© pour A©valuer le degrA© d´obA©sitA© de chaque sujet. Pour dA©terminer le niveau d´activitA© physique, nous avons utilisA© la version courte du questionnaire IPAQ (International Physical Activity Questionnaire); Les paramA¨tres sanguins ont A©tA© mesurA©s par un automate de biochimie. Toutes les analyses statistiques ont A©tA© effectuA©es A l´aide du logiciel SPSS. RESULTATS: au total, 300 sujets ont participA© A l´A©tude, dont 57,3% de femmes et 42,7% d´hommes avec un sex-ratio de 0,74. L´A¢ge moyen de notre population A©tait de 51,6 ± 13,42 ans. Soixante-dix-neuf des participants (26,3%) avaient un syndrome mA©tabolique, avec une prA©dominance fA©minine: 60 femmes (34,9%) et 19 hommes (14,8%). Il existe une relation significative entre le niveau d´activitA© physique et la prA©sence de syndrome mA©tabolique (p = 0,002), entre le niveau d´activitA© physique et l´IMC et le tour de taille (p < 0,001) et (p = 0,003) respectivement. CONCLUSION: les rA©sultats approuvent l´association significative entre l´obA©sitA©, le syndrome mA©tabolique et le niveau de l´activitA© physique, ce qui nous inciterait A encourager l´application des rA¨gles hygiA©no-diA©tA©tiques, notamment l´activitA© physique, qui reste l´une des meilleures actions de prA©vention contre cette pathologie.

Background:Children in the USA face increasing nutrition-related health risks, including obesity rates of 16.9% – a figure that has more than tripled over the past four decades. Nutrition education is beneficial to improve children’s health through obesity prevention and the promotion of healthy habits, and the elementary school years are a key time to implement health education interventions.Objective:To develop a medical student created and operated nutrition education intervention for urban underserved elementary school students.Design:The Food Doctors (TFD) programme is a hands-on, interactive, in-class nutrition education pilot initiative for elementary school students and adheres to the established tenets of effective in-class nutrition education whenever possible: (1) interactive hands-on curriculum, (2) use of culturally relevant topics and (3) the inclusion of effective evaluation techniques.Setting:Urban elementary school classrooms in Milwaukee, Wisconsin, USA.Method:A literature review and feedback from partner schools’ needs informed curriculum development. Institutional review board approval was sought and study materials prepared. The pilot programme was carried out at partner schools during class time.Results:A total of 83 students participated in the pilot study: 46 third-grade students and 37 fourth graders. Evaluation focused on assessing student baseline knowledge and exploring post-programme nutrition knowledge gains.Conclusion:TFD pilot programme demonstrated gaps in baseline nutrition knowledge among elementary school students and showed improved post-programme ability to correctly answer basic nutrition knowledge questions.

Background: Diabetic Retinopathy (DR) is the most common cause of blindness, affecting 1.9% of patients with DM. Furthermore, 2.64% of diabetic patients have visual Sight-Threatening Diabetic Retinopathy (STDR). The major cause of visual impairment in DM patients is Diabetic Macular Edema (DME) [1]. Although the long-term effects of D.M on vascular tissues are very well known, its effect on retinal neurons isn't very clear [2].Aim of Study: To detect early neurodegenerative retinal changes preceding the microvasculopathy in patients with type 1 Diabetes Millets (DM) with no Diabetic Retinopathy (DR).Patients and Methods: We measured mean Nerve Fiber Layer (NFL) and Ganglion Cell Layer (GCL) thickness by Optical Coherence Tomography (OCT) 8 ETDRS map zones, the inner circle (pericentral) and the outer circle (peripheral) area of the macula in sixty-three patients with type 1 DM with no DR underwent full ophthalmic examination and OCT compared to 36 healthy controls.Results: We found insignificant mean thickness difference of NFL and GCL of each ETDRS zone of patients and controls, main effect of group, F=2.952, p=.090 by slip-plot (mixed design) ANOVA. There was insignificant interaction between group and zones of ETDRS, F=.821, p=.548. By independent samples Student's t-test there were no significant difference between diabetic patients and healthy controls except in temporal zone of inner circle in the left eye was statistically significant thinning in diabetic patient by only 2.02μm which is clinically insignificant.Conclusion: Nerve Fiber Layer (NFL) and Ganglion Cell Layer (GCL) were not affected in early type 1 diabetic patient without minimal DR in the absence of macular edema. The theory of early neurodegenerative changes preceding the microvasculopathy in DM type 1 patient is not supported. Therefore, there is no advantage in performing OCT routinely in patients with type 1 diabetes without minimal DR.

Introduction Ovarian cancer is a gynecological cancer with a very poor prognosis despite the improvement of therapeutic means, of which metastases at the colic level are exceptional. We report an exceptional case which makes it possible to enrich the poor literature published on the subject. Case presentation Through this article, we present a very rare case of colonic metastases from ovarian cancer. Biological monitoring and rectal bleeding allowed this rare secondary location to be discovered. Resection then anastomosis allowed our patient to heal. The objectives of this work are threefold: i), to report this very rare case ovarian metastasis ii), to highlight nulliparity as a risk factor in our patient iii), to report that our therapeutic management interrupted and delayed because of COVID 19. Discussion and conclusion Our case report shows that we have to take into consideration this very rare presentation and this even in the absence of true clinical sign. Our work reported also another case of colonic metastasis of a primary ovarian in the very rare case described in the literature and emphasizes the importance of surgical management., Highlights • We report a sporadic case which makes it possible to enrich the poor literature published on the subject. • Ovarian cancer has a poor prognosis which metastases at the colic level are exceptional. • We believe that this manuscript can add new perspectives to the surgery practice of this very rare presentation.

Introduction the purpose of this study was to bring out some epidemiological and clinical characteristics of metabolic syndrome. Methods a total of 300 subjects willingly participated in the present study which was conducted at Ibn Zohr regional hospital in Marrakesh. We were interested in socio-demographic variables, body mass index (BMI) which assesses the degree of obesity of each subject. The blood parameters were determined by an adequate biochemistry automaton. All statistical analyses were performed using SPSS software. Results among the 300 subjects who participated in the study, 57.3% were females and 42.7% were males with a sex-ratio of 0.74. The average age was 51.6 ± 13.42 years old. Seventy nine of the participants (26.3%) had a metabolic syndrome, with a predominance of women: 60 women (34.9%) and 19 men (14.8%). Illiterates (33.8%) and married subjects (25.6%) were the most affected by the metabolic syndrome. The high waist circumference found in 97.5% was the predominant criteria in our study. Finally, the statistical analysis showed a significant association between high waist circumference, BMI and the presence of metabolic syndrome (P = 0.001>) and (P < 0.001) respectively. Conclusion the metabolic syndrome is slowly but surely setting. Implementing prevention strategies and encouraging healthy lifestyles will surely minimize serious public health problems in the city.

Aims To determine if minimizing the number of onabotulinumtoxinA (BTX) injection sites to one to three locations provides similar clinical efficacy and duration of effect compared to the established technique in treating patients with neurogenic (NDO) or idiopathic detrusor overactivity (IDO). Methods Prospective data were collected on BTX naive patients with NDO or IDO who were intolerant or refractory to oral medications. Patients were treated with 100–300 U of BTX via one to three injection sites. Patients completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) prior to and after treatment. The primary endpoint was defined as ICIQ-SF score improvement of >5 points. Secondary endpoints included subjective success, complete continence, quality of life score, post void residual (PVR), duration of effect and adverse events. Results Fourty-five patients (22 IDO, 23 NDO) were included. ICIQ-SF score improvement of >5 points was achieved in 73% (IDO 55%, NDO 91%) and the subjective success rate was 69% (50% IDO, 87% NDO). 52% of NDO patients attained complete continence. PVR increased by a mean of 32 and 156 ml in the IDO and NDO groups. Hematuria occurred in 6.7% and symptomatic urinary tract infection occurred in 11.1%. No systemic BTX adverse events occurred. Mean duration of effect was 31 weeks. Conclusions Our technique for administering BTX via one to three intradetrusor injection sites has similar clinical efficacy and rates of adverse events compared to the established technique for treating patients with IDO and NDO. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.

Irisin is an exercise-regulated myokine inducing browning of white adipose tissue and has gained interest as a potential new strategy to combat obesity and its associated disorders, such as type 2 diabetes mellitus (T2DM). The aim of this study is to evaluate the circulating serum irisin levels in obesity and T2DM and also to elucidate possible relationships between serum irisin levels with anthropometric and metabolic parameters of obesity and T2DM. One hundred fifty newly diagnosed T2DM patients as well as 150 nondiabetic control subjects were enrolled in this study. Nondiabetic controls were then stratified according to their body mass index (BMI) into three subgroups; lean, overweight, and obese. Serum irisin levels were evaluated by enzyme-linked immunosorbent assay. Serum irisin levels were significantly decreased in T2DM patients compared with nondiabetic controls. Obese nondiabetic controls had significantly higher serum irisin levels compared with lean nondiabetic controls. In both nondiabetic controls and T2DM patients, serum irisin was significantly positively correlated with BMI (r = 0.985, P < 0.001 and r = 0.218, P = 0.007, respectively), fat mass (r = 0.959, P < 0.001 and r = 0.202, P = 0.013, respectively), fat-free mass (r = 0.606, P < 0.001 and r = 0.194, P = 0.017, respectively), fat-free mass index (r = 0.820, P < 0.001 and r = 0.179, P = 0.028, respectively), waist-to-hip ratio (r = 0.880, P < 0.001 and r = 0.194, P = 0.017, respectively), fasting insulin (r = 0.989, P < 0.001 and r = 0.207, P = 0.011, respectively), and HOMA-IR (r = 0.989, P < 0.001 and r = 0.185, P = 0.023, respectively), whereas; significantly negatively correlated with insulin sensitivity (r = -0.992, P < 0.001 and r = -0.187, P = 0.022, respectively). In this study, we demonstrated that circulating serum irisin levels were increased in obese nondiabetic subjects, while decreased in T2DM patients. Moreover, serum irisin levels were correlated with anthropometric and metabolic markers of obesity and T2DM. © 2016 IUBMB Life, 68(7):544-556, 2016.

The effects of different types of dietary fats on some biochemical and histological parameters were investigated and gene expression of lipogenesis-related genes in rats was evaluated. Five groups of Wister rats were randomly selected. Rats in group 1 (control) were given only rodent chow. Rats in groups 2, 3, 4 and 5 were fed with rodent chow supplemented with 10% buffalo butter oil, buffalo butter oil solid fraction (S30), hydrogenated palm kernel oil shortening, and margarine, respectively. As a result of adding shortening (group 4), there was an increase in the rats’ weight and some of the serum biochemical parameters compared to the other experimental groups. Those increments were parallel to an increase in serum acetate of the same group. Histologically, photographs of the livers of rats in group 3 showed slight cytoplasmic vacuolization of centrilobular hepatocytes and asporadic cell necrosis. The livers of rats in group 4, however, showed activation of Kupffer cells, hydropic degeneration of hepatocytes and cytoplasmic vacuolization of centrilobular hepatocytes. The gene expression of sterol regulatory element-binding protein (SREBP) 1c and fatty acid synthase (FAS) showed that feeding rats with S30 and shortening led to an increase in SREBP-1c and FAS mRNA levels, thus indicating the activation of lipogenesis genes in the liver. Supplementing rat diets with margarine showed no changes in SREBP-1c and FAS mRNA levels compared with other treatments. In conclusion, diets with shortening or S30 resulted in an increase in weight gain, histopathological lesions, lipid profile levels changes and a significant up-regulation of SREBP-1c and FAS gene expression levels compared with butter oil and margarine.

Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient’s understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient’s cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient’s education is imperative.

Diabetic nephropathy is a serious complication of both type 1 and type 2 diabetes and, unless arrested, leads to end-stage renal disease. Therefore, early prediction and detection of DN would greatly benefit the disease management and delay its progression. The aim of this study is to evaluate the levels of urinary monocyte chemoattractant protein-1 (uMCP-1) and urinary vitamin D-binding protein (uVDBP) in type 2 diabetic patients with different degrees of diabetic nephropathy (DN) and to assess the value of uMCP-1 and uVDBP in the early detection of DN. Seventy-five type 2 diabetic patients with normoalbuminuria (n = 25), microalbuminuria (n = 25), macroalbuminuria (n = 25), and 25 healthy controls were included in this study. Urinary MCP-1 and VDBP levels were evaluated by enzyme-linked immunosorbent assay. A significant elevation in the uMCP-1 and uVDBP levels was found in macroalbuminuric (p < 0.001) and microalbuminuric (p < 0.01) diabetic patients compared to that in normoalbuminuric diabetic patients and control subjects (p < 0.001). Correlation study revealed that both uMCP-1 and uVDBP were significantly positively correlated to urinary albumin/creatinine ratio (r = 0.968, p < 0.001 and r = 0.973, p < 0.001, respectively), serum urea (r = 0.461, p = 0.001 and r = 0.456, p = 0.002, respectively), and serum creatinine (r = 0.475, p = 0.001 and r = 0.448, p = 0.004, respectively) and significantly inversely correlated to glomerular filtration rate (r = -0.983, p < 0.001 and r = -0.988, p < 0.001, respectively). Receiver operating characteristic (ROC) curve analysis of uMCP-1 and uVDBP levels for early diagnosis and detection of DN revealed that the cut-off value of uMCP-1 was 110 pg/mg with 92% sensitivity and 100% specificity; whereas, the cut-off value of uVDBP was 550 ng/mg with 96% sensitivity and 84% specificity. The findings of the present study suggest that uMCP-1 and uVDBP may be considered as novel potential diagnostic biomarkers for the early detection of diabetic nephropathy.

To evaluate the rate of perioperative complications after plasmakinetic bipolar and monopolar transurethral resection of bladder tumor (BTURB and MTURB). In addition, the study identifies patient and procedure characteristics associated with early complications.Retrospective review was conducted on patients undergoing transurethral resection of bladder tumor procedures at a single institution from 2003 to 2013 to assess the 30-day complication rates associated with BTURB and MTURB.Four hundred twenty-seven patients met inclusion criteria and underwent 586 procedures (379 BTURB and 207 MTURB). Baseline patient demographics, tumor stage, and tumor grade were similar in BTURB and MTURB cohorts. The overall complication rate was 34.3% for MTURB and 26.7% for BTURB. The most frequent complications were acute urinary retention (AUR) 11%, hematuria 8%, and urinary tract infection (UTI) 7%. There was no statistical difference in rates of AUR, hematuria, UTI, or readmission for continuous bladder irrigation or hemostasis procedures between BTURB and MTURB cohorts. There was a trend toward lower perforation rate during BTURB (2.6% vs 5.8%). In multivariate logistic regression analysis, MTURB, male gender, and large resections were predictive of overall complications. Male gender was associated with hematuria and AUR. Large bladder tumor resection size was also associated with increased risk of overall complications and AUR.BTURB was associated with a lower risk of overall complications, but there was no difference in the rate of hematuria in the two cohorts. Male gender and large tumor size are associated with higher risk of early complications.

Objectives: The present work was designed to studythe role of endocannabinoid system in the obesity associated atherogenesis and trying to clarify its possible mechanism/s of action. Methods: Thirty adult male wistar albino rats were utilized in the present experiment. They were divided into three equal groups (10 rats each); Group 1: Lean control group, which were fed normal laboratory chow diet and gavaged once daily by dimethyl sulfoxide in a dose of 0.6ml/kg /day for 10 weeks. Group 2: Atherogenic diet group which were fed high fat diet and gavaged once daily by dimethyl sulfoxide as group 1. Group 3: Atherogenic diet treated group which were fed high fat diet and gavaged once daily by NIDA-41020 (a selective cannabinoid receptor 1 blocker) in a dose of 10mg/ kg /day for 10 weeks. Then body mass index (BMI), bleeding time, and total clotting time were assessed. After that, the animals were sacrificed and lipid profile, atherogenic index, bleeding time, platelet aggregation percentage, clot retractions, clotting time, prothrombin time (PT), activated partial thromboplastin time (aPTT), total & differential leukocytic counts and serum adiponectin levels were assessed in all groups. The aorta was obtained from each animal dissected and stained by haematoxylin/eosin and oil Red O staining for histological examination and detection of aortic thickness and foam cells deposition. Results: The laboratory investigations and histological examination revealed, significant increases in BMI, lipid profile, atherogenic index, platelet aggregation%, peripheral monocytic count, and aortic thickness in the high fat diet received group versus lean controls which were otherwise associated with significant decreases in total clotting time, PT, aPTT, serum HDL & adiponectin levels. These changes were significantly and profoundly inhibited by the administration of the cannabinoid receptor antagonist. Conclusion: The endocannabinoid system is involved in the atherogenic changes associated with obesity. These effects were attributed to interference with serum adiponectin level, dyslipidemia, hypercoagulability, increased platelet activation & peripheral as well as endothelial recruitment of monocytes. These effects were found to be via activation of cannabinoid 1 receptor.

Asthma is the most common chronic medical condition affecting pregnancy. Optimizing asthma management in pregnancy is paramount for the well-being of both the mother and the baby. The primary objectives of this study were to assess patient’s knowledge about asthma, the level of asthma care, and fetal and maternal outcomes among pregnant asthmatic women in this wealthy country with tremendous improvement in maternal and fetal health care. The secondary objective was to identify barriers to asthma control. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. About 56% of patients reported worsening of their asthma control during pregnancy, of which 52.3% felt this worsening in the third trimester. About 65% of patients had uncontrolled asthma during their pregnancy, and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the difference between controller and reliever asthma medications, 12.7% of patients had received written asthma action plan, 17% had a spirometry done in the previous 5 years, and 3.8% had peak expiratory flow meter at home. The main reasons for uncontrolled asthma were lack of knowledge about right asthma medications in 30% and fear of side effects of inhaled corticosteroids in 19% of patients. No financial reason was reported. Significant associations between total number of pregnancies, poor perception of asthma medications, asthma exacerbation during delivery and poor asthma control were observed. Preeclampsia and congenital anomalies occurred at higher rates than previously reported among general population in this country. The tremendous improvements in maternal health care and socioeconomic status do not seem to be a barrier to the globally recognized poor asthma care in pregnancy. Important strategies are much needed.

Problem statement: The metabolism of several trace elements has been reported to alter in diabetes mellitus. The disturbance of their serum levels may have a role in the pathogenesis and progress of this disease. In addition, the reports about the status of antioxidants and antioxidant enzymes in diabetic patients are very contradictory. Though α-Lipoic Acid (LA) has long been touted as antioxidant, it has also been shown to improve glucose handling. Approach: The present study aimed to investigate the effect of exogenous supplementation of LA (600mg day−1) on the serum levels of some antioxidants (Superoxide Dismutase (SOD), Glutathione (GSH) and vitamin C) and trace elements (Zn, Se, Cu and Co) in type 2 diabetic patients. The aim of this study was also extended to study the association of these parameters with the glycemic status. The studied participants were categorized into 3 groups (15 each): Control group: Non diabetic healthy volunteers. Diabetic group: Type 2 diabetic patients. Lipoic acid treated group: Type 2 diabetic patients received α-lipoic acid for 2 months in a daily oral dose of 600 mg. All participants were subjected to full history taking and complete clinical examination during the experimental period. Fasting serum samples were taken for determination of glucose, insulin, lipid profile and antioxidants as well as some trace elements. Homeostasis Model Assessment (HOMA) was also calculated as a marker of insulin resistance. Results: The results revealed that LA improved insulin resistance present in diabetic patients. The effects of oral treatment with LA were pronounced by improvement of serum levels of antioxidants (SOD and GSH, p

Based on the beneficial influence of melatonin administration on the course of schistosomiasis and on its possible action on the immune system, we aimed in this study to establish an immunization program using Schistosoma mansoni adult worm antigen (SWAP) and cercarial antigen (CAP) alone or concurrently with melatonin treatment, for 30 successive days, in an attempt to enhance their efficacy against the infection in hamsters. Results showed that the worm reduction percentages were 53.8%, 67.01%, 56.4% and 99.3% for CAP, CAP+melatonin, SWAP, SWAP+melatonin, respectively, indicating that melatonin enhanced efficacy of SWAP but only produced a slight increase in efficacy of CAP. Highly significant reductions in egg load in the liver and alteration in the oogram pattern with a high percentage of immature eggs and few dead eggs were recorded in the groups that received melatonin treatment suggesting a possible role for melatonin in the regulation of egg production and development. On the other hand, melatonin clearly improved the oxidative status in the immunized groups. No antibody (Ab) response was recorded in the groups immunized with SWAP+melatonin while low Ab level was seen in the other melatonin-treated group. In addition to the antioxidant properties of melatonin, our results suggested that the early and continuous melatonin administration may result in immunomodulatory actions which in turn enhanced the efficacy of SWAP and CAP in different ways. This indicates the importance of further investigation of the mechanisms of melatonin action and the possible application in a vaccination program.

Background Eurycoma longifolia (EL) has been shown recently to protect against bone calcium loss in orchidectomised rats, the model for androgen-deficient osteoporosis. The mechanism behind this is unclear but it may be related to its ability to elevate testosterone levels or it may directly affect bone remodeling. The aim of this study is to determine the mechanism involved by investigating the effects of EL extract on serum testosterone levels, bone biomarkers, biomechanical strength and gene expression of Receptor Activator of Nuclear Factor kappa-B ligand (RANKL), Osteoprotegerin (OPG) and Macrophage-Colony Stimulating Factor (MCSF) in orchidectomised rats. Methods Thirty-two male Sprague–Dawley rats were divided into: Sham-operated group (SHAM); orchidectomised-control group (ORX); orchidectomised and given 15 mg/kg EL extract (ORX + EL) and orchidectomised and given 8 mg/kg testosterone (ORX + T). The rats were treated for 6 weeks. The serum levels of testosterone, osteocalcin and C-terminal telopeptide of type I collagen (CTX) were measured using the ELISA technique. The femoral bones were subjected to biomechanical testing. The tibial bone gene expressions of RANKL, OPG and MCSF were measured using the branch DNA technique. Results The post-treatment level of testosterone was found to be significantly reduced by orchiectomy (p < 0.05). Both ORX + EL and ORX + T groups have significantly higher post-treatment testosterone levels compared to their pre-treatment levels (p < 0.05). The bone resorption marker (CTx) was elevated after orchiectomy but was suppressed after treatment in the ORX + EL and ORX + T groups (p < 0.05). There was no significant finding for the femoral biomechanical parameters. The tibial OPG gene expression in the ORX group was significantly lower compared to the SHAM and ORX + EL groups (p < 0.05). Conclusion Supplementation with EL extract elevated the testosterone levels, reduced the bone resorption marker and upregulated OPG gene expression of the orchidectomised rats. These actions may be responsible for the protective effects of EL extract against bone resorption due to androgen deficiency.

Although persistent transmission of hepatitis C virus (HCV) from infected mothers to their infants is reported in 4-8%, transient HCV perinatal infection also occurs. This prospective cohort study determined perinatal HCV infection- and early and late clearance-rates in 1,863 mother-infant pairs in rural Egyptian villages. This study found 15.7% and 10.9% of pregnant women had HCV antibodies (anti-HCV) and HCV-RNA, respectively. Among 329 infants born of these mothers, 33 (10.0%) tested positive for both anti-HCV and HCV-RNA 2 months following birth-29 (12.5%) having HCV-RNA positive mothers and 4 (with transient infections) having mothers with only anti-HCV. Fifteen remained HCV-RNA positive at one and/or 2 years (persistent infections), while 18 cleared both virus and antibody by 1 year (transient infections). Among the 15 persistent cases, 7 cleared their infections by 2 or 3 years. At 2- to 6- and at 10- to 12-month maternally acquired anti-HCV was observed in 80% and 5% of infants, respectively. Four perinatally infected and one transiently infected infant were confirmed to be infected by their mothers by the sequence similarity of their viruses. Viremia was 155-fold greater in mothers of infants with persistent than mothers of infants with transient infections. Maternal-infant transmission of HCV is more frequent than generally reported. However, both early and late clearance of infection frequently occurs and only 15 (4.6%) and 8 (2.4%) infants born of HCV-RNA positive mothers had detectable HCV-RNA at one and 2-3 years of age. Investigating how infants clear infection may provide important information about protective immunity to HCV.

OBJECTIVE To assess the usefulness of aspiration sclerotherapy in the treatment of hydroceles in the tropics. PATIENTS AND METHODS This prospective study included 82 patients with 94 primary vaginal hydroceles of which 62 hydroceles were treated by aspiration and tetracycline hydrochloride sclerotherapy as an outpatient procedure (mean age of patients 56.5 years, range 40-82) and 28 were treated surgically and included as controls (mean age 52.4 years, range 40-70). All patients were followed for a year. RESULTS In the sclerotherapy group, the overall cure rate after a year was 95%. Few complications were encountered in this group: six patients (10%) experienced pain during the procedure, seven patients (12%) had local infection and three patients (5%) developed haematoma. No recurrence was encountered in the surgical group, seven patients (25%) had infection and two patients (7%) developed haematoma. The mean hospital stay for the surgical group was 3.4 +/- 1.3 days (range 1-7). Four patients with thick-walled hydroceles had persistent swelling after sclerotherapy, the recurrence of which dissatisfied the patients. CONCLUSIONS Aspiration sclerotherapy for thin-walled hydroceles proved to be a curative, simple, safe and cost-effective out-patient procedure. It can be an alternative to surgery in developing countries where resources are limited.

Recurrent and often serious infections are common in sickle cell anaemia. The predisposing causes are multiple, and immune abnormalities are frequently blamed. In this study, immune complexes, lymphocyte subpopulations, immunoglobulins and complement were determined in 40 Arabs with sickle cell anaemia to ascertain some aspects of their immunological profile. Immunoglobulins were found to be either normal or high, C3 and C4 values mostly clustered at the lower level of normal with a few values below normal, and some patients had low T4/T8 lymphocyte ratios. The results are discussed and compared with previous studies.

Serum levels of the circulating form of vitamin D3, 25-hydroxycholecalciferol [25-(OH)D3], were determined in 59 university students, 26 males and 33 females, aged 18 to 26 yr and in 24 elderly subjects, 13 males and 11 females, with a mean age of 62 +/- 13 yr. The level of 25-(OH)D3 was significantly lower in the elderly persons (p less than 0.001) than in young students of both sexes, and was significantly higher in females than in males. Serum levels of 1, 25- and 24, 25-dihydroxycholecalciferol were measured in adult males and found to be within the normal range. A group of elderly patients were exposed to natural uv light, and the circulating levels of 25-(OH)D3, serum phosphorus, and alkaline phosphatase were determined both before and 1 day after the last exposure. The exposure to natural uv light resulted in a 2 1/2-fold increase in the level of 25-(OH)D3 and a significant decrease in the activity of alkaline phosphatase, but no significant change in serum phosphorus concentrations was observed. It is concluded that the low vitamin D3 status in Saudis is mainly due to avoidance of sunlight exposure and other factors discussed below.