Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. It is often quite concerning to patients and their partners, and sometimes frustrates couples' attempts to conceive. This article aims to review the pathophysiology of DE and anejaculation (AE), to explore our current understanding of the diagnosis, and to present the treatment options for this condition. Electronic databases were searched from 1966 to October 2017, including PubMed (MEDLINE) and Embase. We combined “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” or “anejaculation” as Medical Subject Headings (MeSH) terms or keywords with “epidemiology,” “etiology,” “pathophysiology,” “clinical assessment,” “diagnosis,” or “treatment.” Relevant sexual medicine textbooks were searched as well. The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. An approved form of drug therapy does not exist. A number of approaches can be employed for infertile men, including the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, sperm retrieval by aspiration from either the vas deferens or the epididymis, and testicular sperm extraction.

Phalangeal Osteosarcoma Mistaken for Tuberculosis: A Case Report

We report a 21-year old female patient who presented with an 18-month history of a swelling in the distal phalanx of her right little finger. Although the history, clinical features and MRI were suggestive of a benign tumour or a tuberculous lesion, the histo-pathological examination of the swelling was reported as a conventional osteosarcoma. Osteosarcoma of the hand is very rare. This article highlights the possibility of a seemingly benign lesion seen in a routine clinic could well turn out to be malignant, and the need to maintain a high index of suspicion

Quantitative evaluation of the dosimetric effects of balloon deformation and source position in high-dose rate mammosite breast brachytherapy

To investigate quantitatively the deformation of the mammosite balloon, eccentricity of the source position and their effects on the dose delivered to the tumor lumpectomy site and critical structures. The distances of the brachytherapy source to the surface of the mammosite balloon were measured in using radiographic images for fractions 1 to 10 for twelve patients. The dose at the balloon surface [nearly 680cGy] and prescription dose of 340cGy at 1cm from the balloon surface were calculated for the different fractions and their dependence on the balloon volume and source position were investigated. The position of the source can be offset from the center of the mammosite balloon by up to 6mm. Deformation of the balloon led to variations in its dimensions by up to 8mm. The dose at 1cm from the balloon surface that covers the lumpectomy site varied by up to 19% from 340cGy along the elongated diameter of the balloon and by up to 40% along the short diameter. Maximal doses to the skin, ribs and lung were 420cGy, 630cGy and SOOcGy per fraction, respectively, which depended mostly on their distance from the balloon surface. The geometric variations in the shape of the balloon and position of the source can cause lack of dose coverage to the lumpectomy site or create hot dose spots in the surrounding normal tissue that might compromise intended clinical goals. Users as well as vendors should consider correction measures for the deformation of the balloons and the eccentricity of the position of the high dose source

Determinants of diabetes and hypertension control in ambulatory healthcare in Al Ain, United Arab Emirates

This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before [p<0.001], the number of chronic disease clinic visits [p=0.042] and triglyceride levels [p=0.007] predicted worse control of diabetes. A predictor of poor control of blood pressure [p<0.001] for patients with hypertension was poor control of blood pressure in the year before. In this population, the healthcare system and the team played major roles as determinants in the control of patient's diabetes and blood pressure more than any of the other factors examined

Maternal complications and neonatal outcome in Arab women of a fast developing country

The objective of the study was to examine maternal complications that occur during the third trimester and their neonatal outcome in Arab women residing in Qatar. This is a prospective hospital-based study. The survey was carried out in women's hospital. The study was based on the log book of the women's hospital, from which we recruited women in their third trimester of pregnancy between the first week of January 2010 and April 2011. Of the 1824 Arab women who were approached to participate in the study, 1432 [78.5%] consented. Face-to-face interviews were conducted with the pregnant women in the third trimester attending routine antenatal clinics at a women's hospital. The questionnaire covered variables related to sociodemographic factors, family history, medical history, maternal complications, and neonatal outcome. Medical records of the patients were referred to collect the clinical variables. Of the pregnant women studied, 39.8% were less than 30 years of age. The risk of maternal complications was higher in housewives [60.8%] and women with a low monthly household income [38.2%]. Most of the pregnant women [77.6%] had antenatal care. Normal delivery [69.7%] was more common in expatriate Arab women, whereas caesarean was more prevalent in Qatari women [22.2%]. Women aged 35 years or older had a significantly higher risk of maternal complications such as gestational diabetes [20.8% vs 13.4%; P < 0.01], gestational hypertension [21.6% vs 15.2%; P = 0.003], and ante-partum hemorrhage [17.9% vs 13.7%; P = 0.042] than younger women. Gestational diabetes increased the risk of caesarean delivery [25.1%] and macrosomia [42.3%]. The frequency of caesarean delivery [22.1%] was higher in women with gestational hypertension. Neonatal complications such as Apgar score [<7] 1 minute [33.1% vs 21.2%; P < 0.001], 5 minutes [13.1% vs 8.2%; P = 0.005], and congenital anomalies [2.9% vs 0.9%; P = 0.007] were significantly higher in newborns of older women. Low birth weight [11.1%] and Apgar 1[st] minute < 7 rate [28.2%] were higher in newborns of mothers with ante-partum hemorrhage. The study findings revealed that maternal complications such as gestational diabetes, gestational hypertension, ante-partum hemorrhage, and maternal anemia were significantly higher in older pregnant women. Similarly, neonatal complications were higher in the newborns of older women. Gestational hypertension was the leading maternal complication observed in Arab women

Local reference ranges of thyroid hormones in Sudanese normal subjects using RIA

The current study aimed to establish a local reference range of thyroid related hormones using Radio-immunoassay [RIA] in healthy adults Sudanese volunteers. Serum levels of thyroxine [T4], triiodothyronine [T3] and thyroid-stimulating hormone [TSH], were measured in 40 healthy subjects. The reference range of thyroid related hormones level [mean +/- 2SD] was found to be as follows: T3 =1.38 +/- 2 [0.5] n mole/ L, T4= 132.5 +/- [44.0] nmol/L and TSH= [mean +/- SD] 1.20 +/- 0.82 mU/L. The results showed that no correlation was found between thyroid related hormones versus body height, and weight. A local reference range of thyroid related hormones was established and could be used instead of those were in use before

Comparative study of anabolic natural products and synthetic steroids on male sex hormones

To compare the effects of synthetic anabolic steroid [nandrolone decanoate] and natural anabolic products [wheat, soy flour, baker's yeast and whey protein either individually or in combination form] on serum sex hormones and histopathology of testes of male albino rats. Biochemistry Department, Faculty of Pharmacy, Zagazig University. Seven groups of male albino rats were used, each group was subdivided into two subgroups and supplied with one of the following compounds for 5 and 10 weeks, respectively; rodent chow, whole wheat [10 g/kg/day], soy flour [1.2 g/kg/day], baker's yeast [0.005 g/kg/day], whey protein [I g/kg/day] and mixture of the aforementioned products. The last group was intramuscularly injected with nandmione decanoate [0.001 g/kg/2 week]. Serum luteinizing hormone [LH], follicle stimulating hormone [FSH], were estimated by immuncradoet assay. Serum testosterone and dehydroepiandrosterone [DHEA] were determined by eIectrochemiluminescence immunoassay. Specimen from testes were taken for histopathological study. Rats received wheat and soy flour elicited significant decrease of serum testosterone after short and long term use, however, yeast displayed significant increase in testosterone. Whey protein revealed a significant degree in testosterone after short term intake but the result was reversed following Jung rera intake. Anabolic natural mixture displayed significant increase in testosterone following both periods, term anabolic steroid injection recorded significant decrease in serum testostene Throughout this work, dietary supplementation with wheat, decreased DHEA level, however yeast:.. puteia and natural mixture significantly elevated its level. Natural mixture induced non-significant change in FSH level but FSH was decreased after injection of anabolic steroid. Short and long intake of wheat significantly decreased LH, but soy, yeast and mixture caused a significant elevation in its level. Meanwhile anabolic steroid displayed a significant elevation after long term use. Groups supplemented with natural products either individually or in a mixture exhibited normal Sertoli cells, complete series of spermatogenesis and seminiferous tubules filled with sperm cells. Anabolic steroid-injected group showed necrosis of some sperm cells in addition to atrophy of some seminiferous tubules and decreased the number of sperm cells in other seminiferous tubules. The use of natural mixture of wheat; soy flour, baker's yeast and whey protein as a dietary supplement increases fertility instead of anabolic steroid which may cause serious damage in the testes and reduce the level of sex hormones

Biodegradation of anthraquinone dye by Aspergillus niger SA1 in self designed fluidized bed bioreactor

Biodegradation and decolorization of Drimarene blue K2-RL [anthraquinone] dye by a fungal isolate Aspergillus niger SA1 was studied in self designed lab scale bioreactor system with different solid supports. Aspergillus niger SA1, was efficiently immobilized on sand and sodium alginate beads. The immobilized cells were used in the form of fluidized bed reactor for textile dye [Drimarene blue] removal. Both the reactors were operated at room temperature and pH=5.0 in continuous flow mode with increasing concentrations of dye in simulated textile effluent. The reactors were run on fill and draw mode, with hydraulic retention times of 24-72 h. The fluidized bed bioreactor with sand as immobilizing support [FBR1] showed overall better performance as compared to fluidized bed bioreactor with sodium alginate as immobilizing support [FBR2]. The average overall color, BOD and COD removal in the FBR1 system were up to 78.29, 70.81 and 83.07% respectively, with 50 ppm initial dye concentration and HRT of 24 h. While 72.19%, 86.63% and 74.74% removal of color, BOD and COD were observed, respectively, in FBR2 with the same conditions. Reductions in BOD and COD levels along with color removal proved that decolorization and biodegradation occurred simultaneously

Role of biopsy in pediatric lymphadenopathy

To determine the role of lymph node biopsy in the diagnosis of lymphadenopathy and to find out the pattern of different diseases in relation to age, gender, and the site of lymph nodes involved. This retrospective study was carried out at the Histopathology Department of the Children's Hospital and The Institute of Child Health, Lahore, Pakistan, over a period of 9 years, from January 1999 to December 2007. Tissue samples were collected from 898 children presenting with lymphadenopathy, and the diagnosis was confirmed on histology and through various specific tests. The clinical data of the patients were collected from computerized hospital records. Among the total 898 consecutive lymph node biopsies, the most common pathology encountered was reactive hyperplasia in 356 children [39.6%], followed by tuberculosis in 262 [29.1%] and malignant lymphomas in 132 children [14.6%]. The rest of the lesions include; 72 cases of granulomatous lymphadenitis [8%], 13 of histiocytosis X [1.4%], 44 [4.9%] of metastatic tumors, 16 of chronic inflammation [1.8%], and 3 cases of Kikuchi's disease [0.3%]. The cause of lymphadenopathy was found to be significantly associated with age, gender, and site of the lymph nodes involved. Lymphadenopathy is a relatively common condition in the pediatric age group. Although 39.6% of children had reactive hyperplasia of unknown etiology, 60.3% children presented with a specific diagnosis

Identification and preservation of the external laryngeal nerve during thyroid surgery: surgical and anatomic considerations

Iatrogenic injuries of external branch of superior laryngeal nerve [EBSLN] during thyroid surgery are not uncommon due to the possibility of anatomic variations in the relationship of this nerve with superior thyroid vessels and the result may be devastating to those patients who rely on their voices professionally. The study included 2 groups. Group A was a prospective nonrandomized analytical series of all consecutive patients undergoing thyroidectomies for various conditions in Surgical Unit II, Shaikh Zayed Postgraduate Medical Complex, Lahore, Pakistan during a three years period [November 2004 - November 2007]. This group consisted of 133 patients. Male to female ratio was 1:3. Mean age was 35.22 years [range: 17-71 years]. Ninety one [68.42%] patients had bilateral dissection [total, sub-total or neartotal thyroidectomies] and 42 [31.57%] had unilateral dissection [hemithyroidectomy I lobectomy and isthumusectomy]. Thus, a total of 224 superior polar dissections were carried out. Three [3 .296 %] patients out of the 91 patients in the bilateral dissection group had asymmetrical nerves. Eighty one [60.9%] patients had benign disease, 32 [24.06%] had malignancy and 20 [15.03%] had toxic goiter. Nerve could not be identified in 42 [18.75%] polar dissections [positive identification in 182 [81.25%] polar dissections]. Three [2.25 %] patients in this study had clearly documented EBSLN injury as determined by voice changes, patient interview and IDL. In Group B, the anterior neck triangles of 19 embalmed human cadavers [i.e. 38 neck half preparations] of both sexes and variable ages with neither enlarged thyroid glands nor any other signs of abnormality in this region were dissected in the dissection halls of two medical colleges in Lahore. The course and topographical relations [especially in relation to the superior thyroid vessels, superior pole of the thyroid and the cricothyroid muscle] of the EBSLN as well as bilateral asymmetry were noted as for Group A. Nerves were classified according to classification of Cernea et al. Good knowledge of the anatomy and relations of the EBSLN with meticulous dissection and ske letonisation and individual ligation of the superior polar vessels is the key to success

Inhibitory effect of propolis on elevated TNFalpha level In CCI4 intoxicated rats

Propolis is a resinous substance collected by honeybees and used in hive construction and maintenance. It is extensively used in folk medicine and as dietary supplement. To investigate the possible therapeutic effect of propolis on acute CCI4-induced toxieity in rats. Department of Biochemistry, Faculty of Pharmacy. Zagazig University and Agricultural Research Center, Egypt. A total of 30 rats were divided into 3 equal groups: the normal control rats received liquid paraffin [l.5 ml/kg, IP], the second group was given a single dose of CCI4 [1.5 mI/kg. IP] and rats in the third group were given CCI4 plus propolis [200 mg/kg. orally for 10 days]. The first and second groups were subjected to blood and tissue sampling following 24 [h] post injection whereas the third one was subjected to sampling after 10 days of treatment. Serum TNF alpha was estimated by Enzyme Linked Immunosorbent Assay. Liver and kidney function biomarkers were evaluated by colorimetric and enzymatic methods. Hepatic and renal contents of lipid pcroxides, hydroxyproline [HPR] and glutathione [GSH] were estimated using colorimetry. Routine histopathological examination of hepatic arid renal tissues was applied by light microscopy. CCI4 administration induced significant deleterious effects on hepatic and renal tissues of rats as mianifcsted by significant elevated levels of serum TNF alpha, transaminases, urea, creatinine and hepatic and renal contents of lipid peroxides and HPR. MeanwhiIe, reduced levels of serum total proteins, uric acid and tissue content of GSH in comparison with normal controls. Sever damage was observed in both hepatic and renal tissues. These biochemical changes were improved in rats treated with CCI4 plus propolis. Elevated TNF alpha and transaminases were reduced together with uric acid, creatinine. lipid peroxides and HPR. Meanwhile serum total proteins hepatic and renal GSH were increased significantly in comparison with CCI4 intoxicated rats. The histopathological alterations of hepatic as well as renal tissues were significantly improved following propolis supplementation. These findings indicate that propolis displays good therapeutic aetivity in hepatic and renaI toxicity. further large scale studies are required to corroborate the folk use of propolis and contribute for its pharmacological validation

Synthesis and pharmacological screening of certain imidazoquinazolone derivatives

Certain imidazoquinazolin-5[4H]-one derivatives have been synthesized by replacement of the 4-amino group compound I with different moieties of expected biological activity. Representative example of the synthesized compounds were tested for their anti-inflammatory, analgesic, antipyretic and anticonvulsant activities. Certain derivatives showed activities higher than that of the reference drugs

Carbohydrate -Food knowledge of Emirati and Omani Adults with Diabetes: Results of a pilot study

There is limited research on nutrition knowledge related to diabetes management in persons with diabetes in the United Arab Emirates and other Arabian Gulf countries. Carbohydrate - containing foods have the greatest impact on post-meal blood glucose levels. The purpose of this exploratory study was to determine nutrition knowledge related to carbohydrate- containing foods of adults with diabetes in Oman and the United Arab Emirates. A culturally-appropriate questionnaire was used to assess carbohydrate - food knowledge in a convenience sample of 94 Emirati and Omani men and women with diabetes [age [mean +/- s.d.]: 50 +/- 13.5 years] residing in the cities of Al Ain and Al Bureimi. Carbohydrate-food knowledge score [mean +/- s.d.] was 6.3 +/- 2 [maximum 14], reflecting low knowledge of food sources of carbohydrate. Ninety-three percent of the study participants believed that whole wheat bread does not increase their blood glucose levels and 88% of them did not think that unsweetened fruit juices can increase blood glucose levels. Further, scores for the Omani citizens were significantly lower than those of Emirati counterparts, mean difference 2.3 [95% confidence interval:1.5-3.1]. Significant [p < 0.05] differences in carbohydrate food knowledge scores between the 2 groups were found for 5 of the 14 food items assessed. The results of this study underscore the importance of nutrition education programs for persons with diabetes in these 2 communities

Oxidative stress, inflammation and infertility in valproate treated rats

To investigate the effect of valproate monotherapy on total testosterone, dehydroepiandrosterone [DHEA], tumor necrosis factor alpha [TNF-alpha], oxidative stress markers, lipids and trace elements following acute, chronic and withdrawal of the drug in rats. Biochemistry Department, Faculty of Pharmacy, Zagazig University and Agricultural Research Center, Egypt. Four groups of male rats were used. The first one was kept on a standard-pellet rat diet [control group]. The other treated groups were either injected with valproate [50 mg/Rat, I.P] 2h prior to sampling [acute group], fed 20g valproate/kg diet for 2 weeks [chronic group] or fed valbproate for 2 weeks and then fed normal diet for 2 days [withdrawal group]. Serum testosterone and DHEA were evaluated by the electrochemiluminescence immunoassay. TNF-alpha was estimated by Enzyme Linked Immunosorbent Assay [ELISA]. Testicular lipid peroxides, hydroxyproline [HPR] and glutathione [GSH] were determined by colorimetry. Serum triacylglycerols [TG] and total cholesterol [TC] were estimated enzymatically using commercially available kits. Atomic absorption/flame Emission Spectrophotometry was used for evaluating trace elements [Cu[2+], Zn[2+], Se[2+]]. Histopathological assessment was done by light microscopy. Significant increase in serum levels of TNF-alpha and Se[2+], testicular lipid peroxides, and HPR were observed. Meanwhile, total testosterone, DHEA, TG and testicular GSH were significantly decreased. Non significant fluctuations were reported in the other tested parameters. Remarkable histopathological alterations were found in testicular tissues following acute and chronic supplementation of valproate. The present study has shown a drug-specific effect of valproate monotherapy on the tested parameters in non-epileptic male rats, indicating the comorbidity associated with valproate including altered levels of TNF-alpha, testosterone and testicular contents of lipid peroxides, GSH and HPR. Further studies are required to reveal the clinical implication of these findings

Capillary electrophoresis at nano level detection: applications in pharmaceutical analysis

Analysis of drugs and pharmaceuticals, at nano scale detection, is a challenging job and the urgent need of today and tomorrow. Capillary electrophoresis is a growing technique and developing continuously by improving in its detectors, sample preparation units and other parts. This article describes the analysis of drugs and pharmaceuticals by capillary electrophoresis at nano scale detection in various standard solutions, dosage formulations and biological samples. Nano scale detection analysis is discussed in terms of the advancement in the detectors and sample preparation methods. The coupling of the detectors and sample preparation units to capillary electrophoresis has also been discussed. Attempts have been made to evaluate the optimization strategies of capillary electrophoresis conditions to achieve the detection at nano scale. The applications of capillary electrophoresis for the analyses of simple and chiral mixtures of several drugs and pharmaceuticals at nano scale detection have been included

Anterior abdominal wall fistula: a clinicopathological challenge

Aim of the work was to study the anterior abdominal wall fistulae connected to the gut from etiological, clinical and therapeutic aspects regarding their incidence, presentations, response to conservative or surgical treatment and final outcome. This study was carried out on 30 patients with external fistulae connecting the anterior abdominal wall and Originating from the intestine, biliary radicles and the pancreas. All patients were admitted to Department of Surgery, Main Alexandria University Hospital There were 18 males and 12 females, the age ranged from 12 to 65 years with a mean value of 48.15 +/- 3.24 years. Eleven patients [36.7%] were of high output fistulae, 4 patients [13.3%] were of moderate output fistulae and 15 patients [50%] were of low output fistulae. The complications were sepsis in 10 patients [33. 3%], fever in 10 patients [33.3%], electrolyte depletion and weight loss in 4 patients [13.3%] and skin complications in 22 patients [73.3%]. Abdominal ultrasound and CT scans were done in all cases and revealed internal collection in 7 patients [23.3%], fistulogram was done in 7 cases [23.3%] and endoscopic retrograde cholangiopancreatography [ERCP] in one case. The origin of fistulae was the small intestine In 10 patients [33.3%], the colon in l6 patients [53.3%], from biliary- enteric anastomosis in 3 patients [10%] and from pancreatic duct in one patient [3.3%]. The etiological factors were gut carcinoma in 8 patients [26.7%], hernia repair in 10 patients [33.3%], neglected appendicitis in 3 patients [10%], post Whipple operation in 3 patients [10%], post pancreatic necrosectomy in one case [3.3%], iatrogenic trauma to sigmoid colon during gynaecological surgery in 2 cases [6.7%], rupture sigmoid diverticulitis in 2 patients [6.7%] and one case [3.3%] following typhoid perforation. Spontaneous closure was achieved in 25 patients [83.3%] by conservative treatment which included total parenteral nutrition, enteral nutrition, somatostatin analogue and antibiotics. Surgical intervention was required in spatients [16.7%] in the form of resection of the fistula- bearing segment and anastomosis of the two healthy ends. Five fistulae [16.7%] closed between 2 and 4 weeks, 8 fistulae [26.67%] between 4 and 8 weeks, 9 fistulae [30%] between 6 and 8 weeks and 8 fistulae [26.7%] closed after more than 8 weeks. Only one patient [3.3%] died from sepsis and multiple organ failure. spontaneous closure is depending on a number of factors which include anatomical site, distal obstruction, presence of inter current disease and whether or not the fistulous track is simple or complex. Sepsis in the peritoneal cavity is the major cause of mortality. The use of octreotide is highly recommended as It definitely converts high output to low output fistulae. The enterocutaneous fistulae that fail to resolve within 4 to 6 weeks under conservative treatment require surgical intervention

comparison of medical treatment versus surgical treatment for the management of otitis media with effusion

This study is designed: To assess outcome of the two modes of treatment [medical and surgical] of otitis media with effusion in terms of their effectiveness and patient compliance, and to compare in terms of side effects and complications. Forty patients who fulfilled the inclusion criteria included in the study. They were divided into two groups by random allocation of medical or surgical mode of treatment. Thus each group consisted of twenty patients. The study was conducted in the Department of ENT Jinnah Hospital, Lahore. In Medically Treated Twenty patients effusion did not resolve in most of the cases, and recovered after some time during the follow-up period. In remaining twenty patients treated surgically, there was immediate improvement in hearing in most of the patients. Complications rate is more in surgical treatment as compared to medical treatment. But in spite of this, surgical treatment is better option in our set-up r egarding effectiveness and patient compliance

clinical audit on venous thromboembolism prophylaxis of medical patients in west medical ward, Mayo Hospital

To reduce risk of Deep Venous Thrombosis/ Pulmonary Embolism in an acutely ill hospitalized medical patient and the consequent clinical complications. The study was carried out in the West Medical Unit of Mayo Hospital, Lahore from January, 2005 to May, 2005. A total of 100 cases were selected from the patients hospitalized in the ward on the basis of presence of risk factors with no contraindications to heparin prophylaxis, taking into account the age, gender, final diagnosis of the patient, the existing risk factors, the risk stratification, the exclusion criteria, whether heparin prophylaxis was given or not, if given type of heparin administered, and whether patients receiving prophylaxis were monitored or not using Platelet Count, APTT or other monitoring techniques. 19 cases were under Moderate Risk of developing Venous Thromboembolism [VTE] and 81 cases were under High Risk. 7 received Heparin prophylaxis. 3 of them were at Moderate Ri sk and 4 cases at High Risk of developing VTE. All acutely ill medical adult patients admitted should be adequately assessed and screened for presence of Risk Factors and categorized according to the SAVE Risk Stratification. In the absence of Exclusion factors, all cases of High Risk and Moderate Risk should be started on Heparin Prophylaxis as early as possible in hospital admission. The audit should be repeated for re-evaluation after adequate time

Living donor kidneys: usefulness of 16-slice multi-detector row CT for preoperative evaluation

To assess in living renal donors the accuracy of 16-slice multi-detector row CT [MDCT] in the evaluation of renal vasculature and the upper urinary tract by using surgery as the reference standard. This study was approved by our institutional review board for human investigation. 63 consecutive potential kidney donors [38 men and 25 women; mean age, 40.7 years] underwent 16-channel MDCT. Unenhanced CT of the abdomen was performed. Next, 100mL of nonionic contrast material was injected at a rate of 4-5mL/sec. Arterial, nephrographic and excretory phase volumetric data sets were acquired at 20-25 seconds, 70-75 seconds, and 10min after start of injection respectively. Volumetric reconstructions were performed at a CT workstation for the 1mm sections of the arterial and nephrographic phases. These included coronal and oblique coronal overlapping thin MIP as well as 3D MIP reconstructions parallel to the renal hilar vessels. CT urographic images were reconstructed from the excretory phase CT data in the coronal or oblique coronal plane by using MIP. Each scan was evaluated independently for renal vascular and ureteral anatomic variants. Findings at CT were compared with those at surgery. Sensitivity, specificity and accuracy of MDCT were calculated on the basis of presence or absence of variant anatomy at surgery. CT depicted 76 of 77 renal arteries confirmed at surgery, one accessory artery was misinterpreted at CT as early branching artery. CT depicted 66 of 67 renal veins confirmed at surgery. Overall accuracy of CT was 98.4%, 98.4% and 100% for identification of variant anatomy of renal arteries, veins and ureters, respectively. 16-channel MDCT used as the sole minimally invasive imaging technique in the comprehensive evaluation of living renal donor candidates provides high accuracy for detecting renovascular and ureteric anomalies

Serum levels of p53, bcl-2 and lipids during experimental breast carcinogenesis and the protective effect of some natural and chemical agents

To investigate the possible protective effects of natural agents Nigella sativa [NS], Soybean [SB] and Vitamin C [Vit.C.] as well as chemical agent Aspirin [Asp.] against breast carcinogenesis induced in experimental animals using 9,10 Dimethyl benz [a] 1,2 anthracine [DMBA] as a potent breast.carcinogen. Materials and A single dose of dimethylbenz[a]anthracene [DMBA, 15mg], was administered to rats via intragastric intubation. The animals were divided into six groups [control, DMBA, [DMBA + Aspirin], [DMBA + Vitamin C], [DMBA + Nigella sativa] and [DMBA + Soybean] group]. Biochemical and histopathological analyses were done on serum and mammary glands tissue. The level of serum p53 and bcl-2 proteins was measured by ELISA and western blot techniques. The level of serum triacylglycerol [TG], cholesterol, high density lipoprotein [HDL] and low density lipoprotein [LDL] were determined spectrophotolmetrically. The protective effect of Asp, Vit.C, NS and SB was demonstrated by reducing the incidence of glandular tumors induced by DMBA from 73.3% to 50%, 43.3%, 40% and 36.6%, respectively. These protective agents, reduced also the levels of p53, bcl-2, TG and LDL, and attenuated the effect on HDL level. DMBA induced mutant p53 and bcl-2 over-expression were associated with early onset of carcinogenesis. Asp., NS, SB and Vit. C exhibited chemoprotective effect against tumor induction, through their antimutagenic effect