Gender-based analysis of the characteristics and outcomes of surgery for anal fistula: analysis of more than 560 cases / Análise baseada no sexo das características e desfechos de cirurgia para fístula anal: análise de mais de 560 casos

ABSTRACT Background: Fistula-in-ano commonly affects males more than females. Some differences in the characteristics of fistula-in-ano between both genders have been recognized, yet the impact of these differences on the outcomes of surgery for fistula-in-ano is still unclear. The present study conducted a gender-specific analysis aiming to assess the characteristics and the outcomes of surgery of fistula-in-ano in each gender. Patients and methods: The records of patients with fistula-in-ano were retrospectively reviewed and the following variables were extracted: patients' demographics, type of fistula-in-ano, position of the external opening, operation performed, incidence of recurrence and complications, particularly fecal incontinence. Gender-based analysis of the characters and outcomes of surgery for fistula-in-ano was performed. Results: 565 (491 males) patients of a mean age of 41.7 years were included. Females had a significantly higher percentage of low fistula-in-ano than males (70.2% vs. 50.3%, p = 0.002). Males had a significantly higher percentage of high trans-sphincteric fistula-in-ano (48.5% vs. 29.7%; p = 0.003). Anterior fistula-in-ano was more common in female patients (69% vs. 16.3%; p < 0.0001). Recurrence of fistula-in-ano was detected in 42 (7.4%) patients. Males had higher recurrence rate than females (7.9% vs. 4%; p = 0.34). Fecal incontinence developed in 1.7% of patients with higher incidence observed in females (4% vs. 1.4%). Conclusion: The majority of fistula-in-ano in males were posterior and high trans-sphincteric whereas most fistula-in-ano in females were low and anteriorly based. Despite the different characteristics of fistula-in-ano; no significant differences in the rates of fistula recurrence and fecal incontinence between males and females could be recorded.

RESUMO Background: A fístula anal comumente acomete mais os homens que as mulheres. Algumas diferenças nas características da fístula anal entre ambos os sexos têm sido reconhecidas, embora o impacto dessas diferenças nos desfechos da cirurgia para fístula anal ainda seja incerto. O presente estudo realizou uma análise específica para sexo, com o objetivo de avaliar as características e os desfechos da cirurgia de fístula anal em cada sexo. Pacientes e métodos: Os prontuários de pacientes com fístula anal foram revisados retrospectivamente e as seguintes variáveis foram extraídas: dados demográficos dos pacientes, tipo de fístula anal, posição da abertura externa, cirurgia realizada, incidência de recidiva e complicações, particularmente incontinência fecal. Realizou-se uma análise baseada no sexo dos sujeitos e desfechos da cirurgia para fístula anal. Resultados: Foram incluídos 565 pacientes (491 do sexo masculino) com idade média de 41,7 anos. As mulheres apresentaram uma porcentagem significativamente mais alta de fístula anal baixa do que os homens (70,2% vs. 50,3%, p = 0,002). Os homens tiveram uma porcentagem significativamente maior de fístula anal transesfincteriana alta (48,5% vs. 29,7%; p = 0,003). A fístula anal anterior foi mais comum em pacientes do sexo feminino (69% vs. 16,3%; p < 0,0001). A recorrência de fístula anal foi detectada em 42 (7,4%) pacientes. Os homens apresentaram maior taxa de recorrência do que as mulheres (7,9% vs. 4%; p = 0,34). A incontinência fecal desenvolveu-se em 1,7% dos pacientes com maior incidência observada no sexo feminino (4% vs. 1,4%). Conclusão: A maioria das fístulas anais no sexo masculino foi posterior e transesfincteriana alta, enquanto a maioria das fístulas anais no sexo feminino foi baixa e anterior. Apesar das diferentes características da fístula anal, não foi possível registrar diferenças significativas nas taxas de recorrência de fístula e incontinência fecal entre homens e mulheres.

In vitro antischistosomal activity of venom from the Egyptian snake Cerastes cerastes

Abstract INTRODUCTION: We studied the potential in vitro antischistosomal activity of Cerastes cerastes venom on adult Schistosoma mansoni worms. METHODS: Live specimens of the horned viper snake, C. cerastes were collected from the Aswan Governorate (Egypt). Venom was collected from snakes by manual milking. Worms of S. mansoni were obtained from infected hamsters by perfusion and isolated from blood using phosphate buffer. Mortality rates of worms were monitored after 3 days of exposure to snake venom at LC50 and various sublethal concentrations (10, 5, 2.5µg/ml). Scanning electron microscopy was used to investigate tegumental changes in treated worms after exposure to LC50 doses of venom. RESULTS: The LC50 of C. cerastes venom was 21.5µg/ml. The effect of C. cerastes venom on Schistosoma worms varied according to their sex. The mortality rate of male and female worms after 48-h exposure was 83.3% and 50%, respectively. LC50 of C. cerastes venom induced mild to severe tegumental damage in Schistosoma worms in the form of destruction of the oral sucker, shrinkage and erosion of the tegument, and loss of some tubercle spines. CONCLUSIONS: The present study demonstrated that C. cerastes venom exerts potential in vitro antischistosomal activity in a time and dose-dependent manner. These results may warrant further investigations to develop novel schistosomicidal agents from C. cerastes snake venom.

Chemical composition, antimicrobial and antifungal activities of essential oils of the leaves of Aegle marmelos (L.) Correa growing in Egypt.

The essential oil obtained by hydro-distillation of Aegle marmelos (L.) Correa leaves were analyzed by GC/MS yield (0.9% v/w). Twenty seven components were identified representing 97.76% of the total oil composition. The major components were α-phellenderene (20.97%), α-pinene (17.76%) and δ-carene (16.37%) and other abundant components asγ-cadinene (8.01%), trans-2-hydroxycinnmic acid (6.85%) and β-myrcene (4.32%). The essential oil exhibited significant antibacterial activity against Gram-positive bacteria as Streptococcus faecalis with inhibition zone (30 mm) and Gram-negative bacteria as Pseudomonas aeruginosa (28 mm). Moreover, moderate activity was observed against Bacillus subtilis (23mm), Staphylococcus aureus (23mm), Sarcina lutea (20mm), Arthrobacter citreus (20 mm) and Escherichia coli (25mm) in comparison with antibiotics. The antifungal activity against Aspergillus niger (30 mm) and Candida albicans (30 mm) was higher than the antifungal antibiotics. Moreover, the oil inhibited the germination of Aspergillus niger and Fusarium oxysporum spores at different concentrations.

Chemical Composition, Antiviral against avian Influenza (H5N1) Virus and Antimicrobial activities of the Essential Oils of the Leaves and Fruits of Fortunella margarita, Lour. Swingle, Growing in Egypt.

Essential oils of the fresh leaves and fruits of Fortunella margarita Lour. Swingle (Family: Rutaceae) were prepared by hydrodistillation method, which resulted with 0.27 and 0.30% respectively. The resulted oils of both organs were analyzed by GC/MS which revealed the presence of twenty compounds in the leaves oil representing 86.96% of the oil, from which gurjunene, eudesmol and muurolene were identified as major compounds. The fruit’s oil was found to contain fourteen compounds representing 77.77% of the oil, of which terpineol, t-carveol, limonene, muurolene and cadinene represented the major compounds. The antiviral activity of the essential oils of both leaves and fruits was tested against avian influenza-A virus (H5N1), and the results revealed higher potency of fruits oil. Moreover, the essential oils of the leaves and fruits were investigated for their antimicrobial and antifungal activities. The oil of the leaves showed antimicrobial activity higher than that of the fruits at dilution (1:50 v/v) against Bacillus subtilis, Staphylococcus aureus, Sarcina luta and Streptococcus faecalis, also it has a moderate activity against Escherichia coli, Klebsilla pneumonia and Pseudomonas aeroginosa. On the other hand, the antifungal activity of the leaves and fruits revealed that the fruits exhibited higher activity than that of the leaves against Aspergillus niger and Candida albicans.

Digoxin like immunoreactive substance in preeclampsia

50 normotensive pregnant vronen in the third trimester and 30 pre-eclamptic [group I, group II] were enrolled for studying the Digoxin like immunoreactive substance, there, was statistically significant increase in pre-eclampse group [120.8 +/- 8.9] compared to [78.3 +/- .9 in control group [P < 0.001]. these was a positive correlation between Doppler ultrasound, systolic, diastolic blood pressure and blood uric acid. So this substance may be implicated in the pathogensis and as indicator of severity of pre-eclampsia

Interrelationship between ultrasonography and biology in the diagnosis of polycystic ovarian disease by cluster analysis [A new concept]

In order to compare the diagnostic signification of hormonal and ultrasonic criteria of polycystic ovarian disease [PCOD], the presence or the absence of ultrasonographic and homonal features of PCOD were recorded in an, heterogeneous population of 90 women presenting with hyperandrogenism and/or menstrual disorders. On clinical and hormonal grounds exclusively, these patients could be separated in five diagnostic subgroups: presumed cases of PLOD- [n = 21], idiopathic hisutism [IH] [n = 26], hypothalamic anovulation [HA] [n = 11], hyperprcrlactinaemia [HPRL] [n = 9], and miscellaneous or undetermined diagnosis [u = 23]. By the means of computed automatic classification of patients [cluster analysis] using hormonal and ultrasonic criteria of PCOD, four homogeneous clusters of patients were obtained. Cluster number sign 1 [25 patients] had the most characteristic profile of PCOD. It included 15 cases of POD and 7 cases of III. Cluster [47patients] had the less characteristic profile of PCOD. It included the majority of patients with HA and HPRL and half of the patiests with IH. Cluster number sign 2 included only 2 hyperandrogenic patients who were massively obese and in whom ultrasonography [US] may have failed to detect PCOD. Cluster number sign 3 [1.6 patients] included patients from each diagnostic group, who are gathered. together because US and hormonal features were Present and absent in nearly all of them, respectively. With the same analysis, the criteria of PCOD could be graded according to their grouping potency. The presence of an abnormal ovarian stroma by US appeared as the most potent criterion. Elevated serum Testosterone and Androstenedione levels and the polyfollicular pattern of ovariess gave intermediate results while the elevated basal LH level was a ranch weaker grouping parameter. In conclusion, the automatic classification of patients by cluster analysis using both hormonal and US eriteria revealed that the classical diagnostic classification lying upon hormonal data exclusively may arbitrarily separate patients having the,carne disease andd that ultrasanography affords pertinent information that should help to a better diagnostic definition of [PCOD]