Modified malleable prosthesis with a fixed mesh: case series for the Ghattas technique / 亚洲男科学杂志(英文版)

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction (ED) that is refractory, unsatisfactory, or contra-indicated for other approved medical or mechanical options. In this study, we introduce the "Ghattas technique," wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder, which can increase the cylinder diameter for cases that need a larger prosthesis. All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire (IIEF-5). Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at final follow-up. The mean age of the 23 included patients was 57.9 (standard deviation [s.d.]: 11.4) years and the mean duration of ED was 8.5 (s.d.: 7.9) years. Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores (8.3 [s.d.: 3.9] vs 24.6 [s.d.: 0.6], P < 0.001). High treatment satisfaction was determined according to a mean EDITS score of 94.9 (s.d.: 9.9). The proposed Ghattas technique was safe and effective in our patients, and provides opportunity for cases that need a diameter larger than 13 mm. Further studies are needed to confirm these results.

Diabetes education the Arab world. A call for action

Diabetes education is effective for improving clinical outcomes and quality of life. The barriers to patient education in the Arab World include: Attitude of the administration and policy makers, the negative view of health professionals and patients towards education, lack of curriculum / programs, lack of trained/certified personnel in the field of Therapeutic Patient Education [TPE], economic barriers, misconcepts, environmental and ecological barriers, lack of legislation for food labels, lack of premises for TPE, the absence of a positive role for the patients in their therapeutic choices, unawareness of patients about their rights, lack of time for both the patient and health care providers and high prevalence of illiteracy. Strategic plans should address all these barriers. Content areas that need to be addressed are determined in collaboration with the patient. Any health care professional can provide diabetes education. The lack of trained personnel in the domain of TPE in our region dictates the need to fill this gap by adopting a strategic plan, implemented in successive steps, starting by the formation of a number of Health Care Professionals [HCPs] in short term training. This document is a call for action, inviting all who are concerned with diabetes to establish national diabetes programs in the Arab World, and to start to undertake educational initiatives

Recommendations for management of hyperglycemia in type 2 diabetes in the Arab Countries based on the consensus statement from the American Diabetes Association [ADA] and the European Association for the Study of Diabetes [EASD]

We would like to emphasize that stepwise interventions will help to achieve glycemic goals. Unfortunately there are barriers to effective management of hyperglycemia in type 2 diabetes, particularly in much of the Arab world [38]. We would like to emphasize that antihyperglycemic therapies with the possible exception of TZD should be titrated frequently [at intervals of days to at most weeks] based on glucose levels achieved and tolerability. Most patients can achieve A1C levels less than 7% in a matter of a few months. Suboptimal healthcare systems impede achievement of glycemic goals. Other barriers to effective management include insufficient communication with patients due to limited physician consultation time. This often contributes to inappropriate prescription of medications which patients cannot afford or will not tolerate and contributes to poor adherence. A multidisciplinary team approach to diabetes care - involving diabetologists, primary care providers, diabetes specialist nurses, pharmacists, dieticians and health educators, among others, with the patient at the centre of the team - has been demonstrated to improve both glycemic control and patient quality of life [39]. Equally or arguably more critical to optimizing patient outcomes is adequate treatment of comorbid conditions [e.g. dyslipidemia, hypertension, hypercoagulability] and early complications [e.g. retinopathy, microalbuminuria and the insensate foot]. A team approach with appropriate attention to patient education, motivation and adherence is critical to success, even if the team is just a patient and a primary care provider working together in a context of mutual respect with shared goals, understanding of their individual roles and open communication [40]. We strongly feel that these basic principles should guide every practitioner working with every patient with type 2 diabetes to ensure optimal care in their individual circumstance with an overall aim of reducing the proportion of patients who do not achieve control of diabetes with its asso-ciated omorbidities and complications from current levels of more than 60% [41,42]. Putting into consideration the local concerns mentioned above, our group supports the ADA/EASD consensus algorithm. Our aim is to highlight specific barriers in the Arab world and to adapt these recommendations to be more consistent with local circumstances in our countries

Transforaminal lumbar interbody fusion: surgical technique and early outcome

Objectives: This study was done to evaluate the functional outcome of transforaminal lumbar interbody fusion [TLIF] as a new technique for treatment of spondylolisthesis and degenerated lumbar disc disease, and the early outcome of the patients

Methods: This prospective study was carried out on 10 adult patients suffering from of spondylolysis and degenerated lumbar disc disease. The patients were admitted to the Alexandria university hospital over a period of 15 months starting from January 2005 to March 2006. The female to male ratio was 3 to 2, their ages ranged from 32 till 55 years with mean age of 42,5. All patients suffered from low back pain, while 9 patients showed signs of root affection and radiculopathy. All patients were subjected to preoperative, dynamic plain X-ray study and MRI of the lumbosacral spine. Eight patients [80%] had spondylolysis and the rest two 2 patients [20%] had degenerated lumbar disc disease. The level L4-L5 was affected in 6 patients [60%] while the level L5-SI was affected in 4 patients [40%]

Results: There was no operative mortality, and surgery did not provoke any permanent neurological aggravation. CSF leak was the mostfrequent postoperative complication [10%].After surgery 8 patients [ 80%] improved, and one patient [10%] stabilized, and one case [ 10%] suffered from exaggeration of back pain postoperatively, also all the patients were independent. Preoperative Prolo score was 14.4 and after surgery was 15.9

Conclusion: TLIF is a less invasive, reliable and safe technique for interbody fusion that can be performed with a posterior approach. It allows good decompression with minimal nerve root retraction. It restore the disc space height with preservation of the lumbar lordosis and augmentation of the posterior tension band via a screw-rod construct

Physical, psychosocial stressors and coping patterns of children under haemodialysis therapy: effect of nursing intervention study

This study sample involved 50 children under hemodialysis [HD] therapy. Tools of data collection were questionnaire, physical assessment sheet, psychometric assessment, hemodialysis stressor scale and Jalowiec coping scale. The study concluded that nursing intervention enhanced knowledge about renal failure and its care, decreased levels of anxiety and depression and increased self-esteem that consequently result in better coping patterns of the studied children with their illness and stressors imposed by its related therapy. The study recommended further interventions to larger study samples to acquaint children under HD therapy with the required skills to cope with their illness that consequently will improve the quality of their lives