Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital

Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers [HCPs] at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines [June 2010]. The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. Seventy-two and 63 HCPs submitted the pre- and post-test, respectively [62% physicians, 28% nurses, from different clinical disciplines]. The mean scores were 7.8 +/- 2.1 [median = 8.0, range = 2-12, maximum possible score = 15] for the pre-test and 8.4 +/- 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians [7.9 +/- 1.7 and 8.2 +/- 2.4, respectively, P = 0.67]. For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 +/- 1.7 and 8.8 +/- 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. Education via didactic lectures resulted in a modest improvement of HCPs' knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines

guide for surgical treatment of ruptured vertebral artery dissecting aneurysm based on a new angiographic classification and supported by pathological and surgical treatment studies

The surgical treatment strategy of ruptured vertebral artery dissecting aneurysm [VA-DA] is still controversial. We performed clinical and pathological studies based on a new angiographic classification aiming to guide for the surgical treatment of this disease. 19 patients with VA-DA and SAH, underwent surgery and/ autopsy, formed the subject of this study. We classified these patients, according to the longitudinal length of dilatation and narrowing [pearl and string sign] on the A-P view angiography into 3 groups: 1] small sized [>10 mm], 2] medium sized [11-20 mm], and 3] large sized [> 21 mm]. Outward appearance study was performed for 16 aneurysms during surgery and for 5 autopsy cases. The aneurysmal size [longitudinal length] was nearly the same in both the angiographic picture and the actual measurement, but it was difficult to anticipate the detailed shape of the aneurysm only from the angiographic picture. Two distinctive morphological types were revealed: lateral protrusion [saccular] and fusiform. The saccular type [4 cases] was present only in the small sized group and 3 cases treated by surgical clipping. The fusiform type was inspected in small, medium and large sized groups, but, surgical trapping [6 cases] was successful in the aneurysmal size less than 15 mm, while, operations in the aneurysmal size more than 15 mm, ended by proximal clipping [6 cases]. Histopathological Study, for 5 autopsy cases, examined the detailed pathological features of the saccular and fusiform types and speculated that dissection was localized to the base in the saccular type and to the dilated portion in the fusiform type. Also, there was only one entry point at the dilated portion in the fusiform type and these points are important for radical surgery. 1-When VA-DA with SAH is less than about 15 mm in the longitudinal length of the A-P view angiography, specially in the small sized group, surgical exploration is mandatory to explore the actual shape of the aneurysm and to decide radical treatment either by clipping or trapping. 2-In the aneurysmal size more than about 15 mm, the access to distal lesion is difficult and PICA and/or perforators usually come from the dilated portion, so proximal occlusion might be a resultant procedure and endovascular treatment may achieve the same and less invasive

Role of survivin in glioma progression: a clinico-pathological study

Gliomas are among the most aggressive of all human malignancies. Glioblastoma multitbrme is the most malignant histopathological subtype. Survivin is one of the inhibitors of apoptosis. It is over-expressed in many human cancers. We performed clinical and pathological study aimed to clarify its role in glioma progression. Gliomas are among the most aggressive of all human malignancies. Glioblastoma multiforme is the most malignant histo-pathological subtype. Survivin is one of the inhibitors of apoptosis. It is over-expressed in many human cancers. We performed clinical and pathological study aimed to clarify its role in glioma progression. This study included 34 glioma patients. Clinical evaluation including age, sex, clinical presentation and location of the tumor, was done. Sections from glioma specimens were stained with H and E, classified and graded according to WHO classification, [2000] and then immunostained to detect Survivin protein expression. The study included 34 glioma cases. Survivin was expressed to a variable extent in most groups of gliomas [in 21/24, 1/4, 1/1 and 5/5 cases of astrocytomas, oligodendrogliomas, mixed oligoastrocytoma and ependymomas respectively]. Survivin expression showed gradual up-regulation with increasing grade of astrocytomas from pilocytic astrocytomas [66.7%] [right arrow] diffuse astrocytomas [77.8%] [right arrow] anaplastic astrocytomas [100%] [right arrow] glioblastoma multiforme [100%]. This study showed that there is a strong correlation between the distribution and staining intensity of Survivin protein expression and the tumor grade [P< value< 0.01 and < 0.00 respectively]. Also there is a strong correlation hetueen Survivin protein expression as evidenced by immunoreactivity score [IRS] and tumor grade and proliferative activity [P value< 0.00 and <0.002 respectively]. Survivin plays an important role in the initiation of gliomas and their progression towards higher grades

value of trnsrectal power doppler ultrasonography in cancer prostate

In attempt to assess the usefulness of transrectal power Doppler ultra-sonography [PDU] for improving the diagnoses of cancer prostate in-patients with abnormally elevated PSA, forty male patients with a mean age 65 years were assessed using a digital rectal examination [DRE], transrectal ultrasonography [TRUS] and [PDU]. All cases of prostatitis were excluded. The vascularity on PDU was graded on a scale of 0-3 where grade 0 negative and grade 1-3 was considered positive Transrectal needle prostatic biopsies were obtained from hypoechoic lesions or hyspervascular lesions under TRUS and PDU and systematic biopsy was taken in all cases. The results of PDU, DEE and TRUS were evaluated according to histopathological examination of needle biopsy. Prostatic biopsy confirmed prostate cancer in 11 patients out of 40 patients [27.5%], PDU was positive in 16 patients, of whom 10 had prostate cancer [62.5%], all those but one having prostate cancer were positive on PDU. Thus PDU had a higher sensitivity of 90.9% [10/11], than DRE [54.5%] and TRUS 72.7% and PDU had a higher negative predictive value in 95.8%, while 85% with TRUS and 80.7% for DRE. So, PDU increases the sensitivity and negative predictive value of TRUS in detection of cancer prostate if is it used as a routine investigation with conventional TRUS. This does not need any added manipulations. PDU is more useful for detecting prostate cancer in-patients with abnormally high serum PSA levels and if PDU is negative, needle biopsy may be avoided especially if PSA is not conclusively high

Ocular findings in diabetes mellitus

Four hundred patients from the attendants of the diabetes clinic of Assiut Hospital were subjected to complete ophthalmological examination to find out the incidence of different ocular complications in insulin dependent diabetes IDD and non-insulin dependent diabetes NIDD and their relation to age, sex of the patient and duration of the diabetes. It was found that ocular complications were found in almost all the tissues of the eye