Giant urinary bladder with left scrotal swelling: An unusual presentation of chronic urinary retention

@#Chronic Urinary Retention (CUR) can be either asymptomatic or associated with lower urinary tract symptoms. There has been no report of case of CUR presented with unilateral scrotal swelling. In the present report, a 69-year-old man came with an abdominal distension and left scrotal swelling. He was initially diagnosed with ascites secondary to a possible malignancy. A diagnosis was established after a computed tomography (CT) scan was done that revealed a giant bladder distension with volume of 10.1 litres. The left scrotal swelling was resolved after catheterization was carried out. There was a possibility that the patient had inferior vena cava obstruction secondary to the huge bladder

Outcomes of cardiopulmonary resuscitation and estimation of healthcare costs in potential 'do not resuscitate' cases

Objectives: Cardiopulmonary resuscitation [CPR] is a life-saving procedure which may fail if applied unselectively. 'Do not resuscitate' [DNR] policies can help avoid futile life-saving attempts among terminally-ill patients. This study aimed to assess CPR outcomes and estimate healthcare costs in potential DNR cases

Methods: This retrospective study was carried out between March and June 2014 and included 50 adult cardiac arrest patients who had undergone CPR at Sultan Qaboos Hospital in Salalah, Oman. Medical records were reviewed and treating teams were consulted to determine DNR eligibility. The outcomes, clinical risk categories and associated healthcare costs of the DNR candidates were assessed

Results: Two-thirds of the potential DNR candidates were >/=60 years old. Eight patients [16%] were in a vegetative state, 39 [78%] had an irreversible terminal illness and 43 [86%] had a low likelihood of successful CPR. Most patients [72%] met multiple criteria for DNR eligibility. According to clinical risk categories, these patients had terminal malignancies [30%], recent massive strokes [16%], end-stage organ failure [30%] or were bed-bound [50%]. Initial CPR was unsuccessful in 30 patients [60%]; the remaining 20 patients [40%] were initially resuscitated but subsequently died, with 70% dying within 24 hours. These patients were ventilated for an average of 5.6 days, with four patients [20%] requiring >15 days of ventilation. The average healthcare cost per patient was USD [dollar sign]1,958.9

Conclusion: With careful assessment, potential DNR patients can be identified and futile CPR efforts avoided. Institutional DNR policies may help to reduce healthcare costs and improve services

Can the prevalence of dental caries be used as an indicator of the quality of dental services? a cross-sectional study among children in Almadinah Almunawwarah, KSA

Objectives: To report on the caries status and utilization of dental services of 6- and 12- year-old children

Methods: This cross-sectional analytical study was conducted in four primary schools during January through March 2013. Quantitative and qualitative data were collected by using an interview-based questionnaire and a clinical oral examination. Clinical oral examination recorded caries status using the decayed [D/d], missing [M/m] and filled [F/f] index; Decayed, Missing and Filled Index [DMFT]

Results: Of a total of 384 students, 330 responded [response rate of 86%]. Two thirds [65%] of participants were females and they had significantly more caries [p < 0.05] in both primary and permanent dentitions as compared to males. The mean DMFT for 6-year-old and 12-year-old children were 4.9 and 1.3, respectively. The prevalence of caries amongst 6-year-old children was reported to be 86% and that for 12-year-old was 68%. All respondents reported using a toothbrush and 20% claimed to visit a dentist regularly. Those who did not regularly visit a dentist had 78% prevalence of caries and they suggested "fear" [29%] and "no reason to visit a dentist" [20%] as reasons for not visiting a dentist. Of those who recently visited dentists, 69% were diagnosed with caries and the most common treatment modalities received were medication [50%] and oral hygiene instructions [19%]

Conclusion: The prevalence of dental caries in this cohort of children was similar to that of earlier studies done in the KSA. The utilization of dental services remained fairly low and those children who did attend dental clinics primarily received preventive services

Association between body mass index, diet and dental caries in Grade 6 boys in Medina, Saudi Arabia

The prevalence of obesity is increasing in Saudi Arabia and although caries is associated with obesity, this association has not been investigated in Medina. This study aimed to determine the association between dental caries, body mass index [BMI] and dietary habits of 12-year-old boys from four geographically distinct schools in Medina. Mean BMI was 22.17 kg/m[2] [ +/- 5.15]; 41% had normal BMI, 25% were overweight and 30% were obese. The mean Decayed, Missing and Filled Teeth [DMFT] score was 1.46 [ +/- 2.04]. Those in the normal BMI range had a significantly higher prevalence of caries [57%] and DMFT score [1.92] compared with the overweight and obese groups [P < 0.05]. These differences remained significant after controlling for possible confounders via linear regression. Mean BMI was significantly lower in boys with severe compared with mild or no caries. Normal and underweight participants had an almost 2 times greater risk of developing caries compared with their overweight and obese counterparts. The children had poor dietary habits and there were no significant associations between dietary variables and caries

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

effects of estrogen receptor gene-alpha polymorphism on bone mineral density and serum osteoprotegerin levels in postmenopausal Egyptian women

The gene coding for estrogen receptor-alpha [ER-a] is a potential candidate for the regulation of bone mineral density [BMD] in postmenopausal women. The present study was aimed at elucidating the role of two restriction fragment lengths Pvu II and Xba I polymorphisms of the ER-a gene as determinants of bone mineral density; special attention was paid to the correlation between serum osteoprotegerin [OPG] levels and BMD in different ER-a genotypes in postmenopausal [PM] Egyptian women. BMD was measured at the femur neck [FN-BMD]. ER-a gene polymorphisms were detected by PCR-RFLP. Serum OPG levels were measured by an enzyme linked immunosorbent assay. There were significant differences in BMD and OPG according to different genotypes of Pvu II Single-nucleotide polymorphism [SNP]. Carriers of the pp genotype were more likely to have lower BMD and lower OPG values than noncarriers. While there was no significant relationship between Xbal polymorphism and these variables. Postmenopausal [PM] women were stratified into; those with osteoporosis and those without osteoporosis. The difference in BMD and OPG among genotypes were significant in PM with osteoporosis. Further we confirmed that the frequency of p allele. and pp genotype of Pvu II polymorphism were significantly higher in PM with osteoporosis as compared to PMwithout osteoporosis. Xba I failed to show any significant difference in genotype and allele frequencies between the two groups. Genotypes modulate the relationships between BMD and OPG levels, in women with the PP [r=0.512, p<0.000l] and Pp [r=0.346, p<0.0009] genotypes but not in women with the other genotypes [p>0.05]. These results suggest that the Pvu II polymorphism of ER-a may be associated with the FN-BMD in PM Egyptian women. Further, P allele carriers supposed to protect against PM osteoporosis at least partly by increasing serum OPG

psychometric characteristics of maslach burnout inventory student survey: a study students of Isfahan university

In order to fill the gap of tool for measurement of student burnout in Iran, this study was performed on the 238 female students of Isfahan university that were selected by simple random sampling. The inventory is including 15 items and three subscales. Data were presented by analytical and descriptive statistic and draw table. In order to determine reliability of MBI-SS were used internal consistency method and test-retest. Coefficient Cronbach's alpha for the exhaustion, cynicism and academic efficacy respectively was 88, 90, 84 [p<0.05] and showed good internal consistency. Also test-retest reliability about 4 weeks later, obtaining a reliability coefficient of 89, 84 and 67 [p<0.01] respectively for exhaustion, cynicism and academic efficacy. Principle component factor analysis with exploration method with warimax rotation was used to determine construct validity. In order to check the concurrent validity and divergent validity of this inventory were used respectively from the University Student Depression Inventory and the researcher made of scale interest to academic filed and coefficients for the exhaustion, cynicism and academic efficacy respectively were obtained -21, -53, -32 [p<0.01]. Also concurrent validity for exhaustion, cynicism and academic efficacy respectively were obtained 74, 68 and 50 [p<0.01]. This finding was that the Maslach burnout inventory-student survey is a valid and reliable instrument to measure academic burnout girls

Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia

Studies from Saudi Arabia have reported that the prevalence of dental caries among children is relatively high compared with other developing countries The aim was to determine the oral hygiene status and significant caries [SiC] index of 12-year-old males in Medina . In a cross-sectional, analytical study 360 students participated from 4 boys' schools. Dental caries, plaque, gingivitis, fluorosis and malocclusion were recorded using standard methods and indices. The mean DMFT score was 1.53 [SD 1.88]. Caries prevalence was low [57.2%] but the mean SiC index was relatively high [3.63 [SD 1.66]]. The prevalences of plaque and gingivitis were high [82.8% and 70.8% respectively]. Lower molars had the highest rate of caries. No children presented with dental fluorosis and 82.5% had a class I jaw relationship. Oral hygiene awareness programmes at schools, together with brushing and flossing programmes, are recommended in order to maintain and improve the oral health of young children in Medina

Kearns-Sayre syndrome: an unusual ophthalmic presentation

Kearns-Sayre syndrome [KSS] belongs to the group of neuromuscular disorders known as mitochondrial encephalomyopathies. It has characteristic syndromal features, which include: chronic progressive external ophthalmoplegia, bilateral atypical pigmentary retinopathy, and cardiac conduction abnormalities. So far, only a single case has been reported where a patient with KSS had a normal retina. Herein, we report this extremely rare variant of KSS, which not only presented later than the normal age of presentation, but also had minimal pigmentary retinopathy

Enhance transdermal delivery of flurbiprofen via microemulsions: Effects of different types of surfactants and cosurfactants

Microemulsions are therniodynamically stable, clear dispersions of water, oil, surfactant, and cosurfactant. This study was aimed to develop flurbiprofen microemulsion for enhanced transdermal delivery and investigate the effects of different surfactants and cosurfactants on its delivery and phase behavior. Method: Various surfactant-cosurfactant mixtures in ratio of 2:1 [Smix] along with oleic acid [oil] were selected and phase diagrams were constructed. Six microemulsions each containing 5% drug, 5% oil, 56% Smix and 34% water, were prepared and compared for their permeation and phase behaviors to determine the effects of the type of Smix. In vitro transdermal permeation through rabbit skin of all microemulsions was high than saturated aqueous drug solution. Tween 20 and ethanol as Smix produced the highest flux amongst all the Smix, and were used to prepare formulations with different values of oil and Smix. While the type of surfactant did not affect the droplet size, propylene glycol as cosurfactant produced the largest droplets and highest viscosity. Decrease in oil or Smix concentration resulted in decrease of the droplet size and increase in permeation flux while decrease in viscosity'also increased the permeation flux of microemulsions. Finally the selected microemulsion formulation comprising 5% flurbiprofen, 5% oleic acid, 46% Tween 20:ethanol [2:1] and 44% water, showed the highest transdermal flux and caused no skin irritation. Type of surfactant and cosurfactant affect both the phase behavior and transdermal drug delivery of microemulsion; and results of this study showed that they are promising vehicles for improved transdermal delivery and sustained action of flurbiprofen

Female spouses of injection drug users in Pakistan: a bridge population of the HIV epidemic?

An estimated 21% of injection drug users [IDUs] in Pakistan are HIV-positive and data suggest that the spouses of IDUs may be a critical component of the HIV transmission chain. This study interviewed 101 spouses of male IDUs about their sexual practices and drug use. We found that 43% had been sexually active with their partners in the past month but only 4% reported selling sex. Almost a quarter [23%] used drugs and 19% injected drugs, usually a combination of diazepam and pheniramine. Although sex work was infrequent among spouses of IDUs, their risk of contracting HIV and transmitting it to others was high because they received injection drugs, sometimes along with their IDU husbands, from the same health centres that provided therapeutic injections to the rest of the community. IDU spouses may thus serve as a bridge group via therapeutic injections, rather than via sex work

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

Cephalometric correlation between facial dimensions and sagital and vertical position of anterior teeth

Description of relationship between dental and skeletal parameters can help diagnosis and treatment of malocclusions. This study evaluated the relationship between facial height and vertical and sagital position of anterior teeth. The lateral cephalogerams of 89 patients between ages of 14 to 18 years old were studied. The study casts were analyzed then samples were divided into 2 groups of with or without crowding. Cephalograms were traced and Pearson correlation was determined between parameters that explain facial dimensions and parameters that showed sagital and vertical position of anterior teeth. High correlation was found between ANB and Ul to SN, Ul to FH, and Ui to NA [mm]. SNB had also correlation with Ui to FH and Ul to SN. Additionally, Jaraback index showed a great correlation with L to MP, IMP A and SNB. FMA was similarly correlated with IMP A and FMIA. Significant correlation was detected between basal angle and IMP A [P< 0.001]. The remaining subjects did not have crowding and demonstrated high correlation between ANB and LI to NB. SN-GoGn displayed a great correlation with SNB and FMIA. Ui to FH was highly correlated with FMA, SN-GoGn and L! to MP. High correlation was observed between LI to NB [mm] and LI to MP [P<0.001]. There was correlation between position of anterior teeth and facial dimensions that confirms the existence of balance between dentofacial parts. Therefore, establishment of equilibrium is essential for stability of treatment results

Angiomyfibroblastoma of the vulva: report of a rare distinct entity

Angiomyofibroblastoma is a rare benign mesenchymal tumor of lower female genital tract. It has characteristic histomorphology and shows myofibroblastic differentiation. Clinically it is imperative to differentiate angiomyofibroblastoma from other mesenchymal tumors of this region especially aggressive angiomyxoma which is locally infiltrative and needs long term follow-up. We report clinical, histological, and immunohistochemical features of a case of angiomyofibroblastoma and discuss relevant points regarding histogenesis and biological behaviour. We stress the need to recognize this tumor on clinicopathologic basis to avoid any potential therapeutic implications

Caesarean section in the Islamic Republic of Iran: prevalence and some sociodemographic correlates

The aim of this study was to investigate the prevalence of caesarean section in the Islamic Republic of Iran in different provinces and to compare the sociodemographic characteristics of married women with and without caesarean section. Data were analysed from the Iranian Demographic and Health Survey of a representative sample of married women [n = 17 991] who delivered a baby between September 1998 and October 2000. Overall, 35.0% of deliveries were by caesarean section. Women having a caesarean section were older, better educated, married at a later age and with lower parity than those who delivered normally. Provincial variations in rates were significantly correlated with indices of socioeconomic development

Mothers' care of children suffering from acute - leukemia undergoing chemotherapy at home in Benha city

The aim of the present study is to assess mothers' knowledge and practices regarding care of their children suffering from acute leukemia undergoing chemotherapy, establish and implement a health educational program for mothers based on their needs, data obtained and reviewing literature and evaluate the outcome of the health educational program directed towards the mothers of acute leukemia children undergoing chemotherapy. The study conducted at the pediatric oncology out patient clinics at the waiting areas in the specialized pediatric hospital in Benha city, which this is the only established known place in kalubyia governorate that provides care to such children. A quasi experimental design was utilized to conduct the study. The study involved [53] children suffering from acute leukemia undergoing chemotherapy and accompanying their mothers and attending the out patients clinics for follow up and treatment. Two tools were used for data collection an interviewing questionnaire to assess the children's and their mothers' socio-demographic data, also the mothers' knowledge and an observation checklists to assess the mothers' practices towards care of their acute leukemic children undergoing chemotherapy. The findings showed that after the program implementation there was a significant improvement of mothers' knowledge and practices regarding care of their acute leukemic children undergoing chemotherapy. The study recommended that, continuous health education for mothers caring of acute leukemic children at home based on their needs and teaching them the principles of care for problems emerged as a result of their children disease and its related therapy

Benefits and harms associated with hormone replacement therapy: clinical decision analysis

To evaluate harms and benefits associated with use of combined hormone replacement therapy [HRT] for five years in women with different baseline risks for breast cancer. Probabilistic clinical decision analysis. Population of women aged 50 years with different baseline risks for breast cancer. Gain or loss in quality adjusted life years [QALYs]. Women free of menopausal symptoms showed a net harm from HRT use, which increased for increasing baseline risk of breast cancer. Those with a baseline risk of 1.2% would expect a loss in QALYs of 0.4 months [-0.03 QALYs, 95% credibility interval -0.05 to -0.01]. The main analysis showed HRT to be on average beneficial in women with symptoms, with benefit decreasing with increasing baseline risk of breast cancer. The results were sensitive to the assumed value of quality of life with menopausal symptoms; therefore a contour plot was developed to show the probability of net harm for a range of different values and baseline risks. HRT for primary prevention of chronic diseases in women without menopausal symptoms is unjustified. Perceived quality of life in women with symptoms should be taken into account when deciding on HRT. Thus, a decision analysis tailored to an individual woman is more appropriate in clinical practice than a population based approach

Malignant epignathus teratoma

A baby boy who had a left facial mass detected on antenatal ultrasound was delivered by Caesarian section after foetal distress was detected. Imaging investigations by plain radiographs and MRI showed a large mass with calcifications, soft tissue, fat and fluid components. A total surgical excision was perfomed and histology examination showed teratoma with no malignant features. Two weeks postoperatively, there was rapid recurrence of the tumour with intracranial involvement and obstructive hydrocephalus shown on MRI. The tumour was inoperable at surgery and the baby subsequently died at 5 weeks of life. This case describes the clinical course and imaging features of a neonatal epignathus teratoma with malignant and aggressive features.

Osteosarcoma of the rib

This case describes the radiological-surgical correlation of a rare case of osteosarcoma of the rib in a 15-year-old boy. Successful repair of his chest wall defect using a wire mesh following extensive surgical resection of the tumour is highlighted,such a procedure being the first instituted at our centre.