ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.
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ABSTRACT Introduction: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. Objective: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. Results: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. Conclusion: Due to the large number of sexual and urinary disorders found, we recommend the improvement in health conditions, promoting a better quality of life in the elderly.
Subject(s)
Humans , Male , Female , Aged , Lower Urinary Tract Symptoms , Quality of Life , Urination Disorders , Sexual Partners , Surveys and Questionnaires , Premature Ejaculation , Erectile Dysfunction , Middle AgedABSTRACT
Aim: the aim of the study was to assess the prevalence of impacted teeth and its association with sex and age among a sample of the Yemeni population. Materials and Methods: A cross sectional study design was employed. The study included 999 radiographical records of patients who had panoramic X- rays previously done. All radiographs were assessed for the number and type of impacted teeth, pathology-associated impaction, sex, age and location (mandible and/or maxilla). The collected data was analyzed using SPSS®version21 software. Results: The study sample comprised digital panoramic radiographs of Yemeni patients aged 17 to 54 years (mean 26.6 years). The present study found 542 patients (54.3%) presented with at least one impacted tooth. The 17 to 25 years age group of the study sample had the highest prevalence of tooth impaction (28.6%). Only 10 (1.0%) case presented pathologies associated with the impacted teeth. There was a significant difference in the number of male 203 (20.3%) and female 339 (33.9%) patients with impacted teeth (p=0.031). Impacted teeth occurred slightly more often in the mandible (42.8%) compared to the maxilla (42.4%). Conclusion: The prevalence of impacted teeth among a sample of Yemeni population was high. Third molars and canines were the most common impacted teeth. The prevalence of impacted teeth in females was higher than in males and it was higher in the mandible than in the maxilla, with the younger patients with a higher prevalence of impaction.
Objetivo: el objetivo del estudio fue evaluar la prevalencia de dientes impactados y su asociación con el sexo y la edad en una muestra de la población yemení. Material y Métodos: se empleó un diseño de estudio transversal. El estudio incluyó 999 registros radiográficos de pacientes con radiografías panorámicas realizadas previamente. Todas las radiografías fueron evaluadas en relación al número y tipo de dientes impactados, patología asociada a la impactación, sexo, edad y ubicación (mandíbula y/o maxilar). Los datos recopilados se analizaron utilizando el software SPSS® version 21. Resultados: La muestra del estudio comprendió radiografías panorámicas digitales de pacientes yemeníes entre 17 a 54 años (media 26,6 años). El presente estudio encontró que 542 pacientes (54,3%) presentaron al menos un diente impactado. El grupo de edad de 17 a 25 años de la muestra de estudio tuvo la mayor prevalencia de impactación dental (28,6%). Solo 10 casos (1,0%) presentaron patologías asociadas a los dientes impactados. Hubo una diferencia significativa en el número de pacientes masculinos 203 (20.3%) y femeninos 339 (33.9%) con dientes impactados (p=0.031). Los dientes impactados ocurrieron con un poco más de frecuencia en la mandíbula (42.8%) en comparación con el maxilar (42.4%). Conclusión: La prevalencia de dientes impactados entre una muestra de población yemení fue alta. Los terceros molares y caninos fueron los dientes más comúnmente impactados. La prevalencia de dientes impactados en las mujeres fue mayor que en los hombres y fue mayor en la mandíbula que en el maxilar, y los pacientes más jóvenes mostraron una mayor prevalencia de impactación.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Tooth, Impacted , Yemen , Radiography, Panoramic , Prevalence , Cross-Sectional Studies , Age and Sex Distribution , Mandible , Molar, ThirdABSTRACT
Background: Obstructive uropathy is a group of different pathologies. Congenital obstructive uropathy represents a major cause of renal failure in infants and children. Urinary tract obstruction is defined as any condition that impairs urinary drainage from the pelvicalyceal system and leads to increased pressure and reduced urine flow rate
Objective: The aim of this study was to assess the role of combined static and dynamic Magnetic Resonance Urography in the management of pediatric obstructive uropathy and to compare it with our basic investigations
Patients and Methods: This study was conducted on the pediatric patients presented to Pediatric Surgery Department in cooperation with Radiology Department, Ain Shams University Hospitals, presented with upper urinary tract dilatation detected by ultrasonograghy
Results: There was a high agreement between MRU and our standard imaging data as regard detection of urinary tract obstruction giving the MRU no superiority to the basic imaging in this field. Combined MRU showed the highest accuracy among other investigations in identification of the level of obstruction. Dynamic MRU and renal scintigraphy in our study yielded similar results for identification of split renal function
Conclusion: This study provides evidence that combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys to be used as a single modality for the comprehensive evaluation of urinary tract obstruction
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OBJECTIVE@#To investigate the pharmacological basis of its uses of Phyla nodiflora (P. nodiflora) for the treatment of anomalies predominantly by smooth muscle containing tissues such as gastrointestinal/vascular/broncho spasm and cardiovascular modulation.@*METHODS@#The crude hydroalcoholic extract of P. nodiflora (Pn.Cr) and its fractions were evaluated on isolated rabbit jejunum, rat trachea, aorta and atrium. To access the contractile or relaxant effects of testing materials, the tissues were mounted in isolated organ bath and responses were recorded with transducers coupled with data acquisition system. BALB/c mice were challenged with castor oil for the assessment of in-vivo antidiarrheal activity. Normotensive rats were used for in-vivo hypotensive study.@*RESULTS@#Hydroalcoholic extract of Pn.Cr at variable concentrations inhibited the natural spontaneous rhythm and 80 mmol/L K mediated contractions in isolated segment of jejunum with EC values of 3.18 and 1.91 mg/mL respectively. Verapamil, a Ca channel blocker, demonstrated akin pattern in jejunum and therefore possibly suggesting calcium blocking activity. On isolated rat tracheal tissue, Pn.Cr showed relaxation of high-K and carbachol mediated contractions (EC values: 1.24 and 2.42 mg/mL). Pn.Cr treatment relaxed the rat aortic ring in a cumulative doses with high-K and phenylephrine-induced contractions (EC values 0.25 and 0.92 mg/mL). Activity based fractionation of Pn.Cr showed that dichloromethane fraction was more potent for relaxing the tissues spasm compared to aqueous fraction. In-vivo experiments, significant protection by Pn.Cr (P < 0.05) was observed in castor oil-induced diarrhea (50-500 mg/kg) whereas hypotensive effect in anesthetized rats was seen at the dose range of 1-10 mg/kg of Pn.Cr (P < 0.05).@*CONCLUSION@#This study suggests the blockage of calcium channel in the smooth muscles as a pharmacological application to make usage of P. nodiflora in the management of diarrhea, asthma and hypotensive effect.
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@#Khat leaves chewing/use, which imparts amphetamine like effects on the user, is widely practiced in parts of Africa, the Arabian Peninsula, and among the diaspora communities from these regions. Basic clinical and epidemiological studies from different settings have reported associations of acute coronary syndrome, heart failure, and cardiomyopathy, with khat chewing /use. This review aims to analyse the current evidence of the impact that khat, or its active constituent, cathinone, has on the cardiovascular system (CVS), particularly in two parameters, heart rate (HR) and blood pressure (BP). Subsequently, the possible mechanism of actions of how khat impacts these cardiovascular parameters is discussed, and different studies’ findings are summarised appropriately. The analysis of literature suggests that khat could influence HR and BP by most likely causing tachycardia and hypertension and the impacts might be dose-dependent and time-dependent. However, most of the studies involved different species and study designs, and had different limitations. Additionally, the underlying mechanisms of khat effects on these CVS parameters remain unclear. Therefore, more studies are needed to further support the current evidence of the impacts that khat has on the CVS parameters of HR and BP.
Subject(s)
Heart Rate , Blood Pressure , ReviewABSTRACT
Objective To investigate the pharmacological basis of its uses of Phyla nodiflora (P. nodiflora) for the treatment of anomalies predominantly by smooth muscle containing tissues such as gastrointestinal/vascular/broncho spasm and cardiovascular modulation. Methods The crude hydroalcoholic extract of P. nodiflora (Pn.Cr) and its fractions were evaluated on isolated rabbit jejunum, rat trachea, aorta and atrium. To access the contractile or relaxant effects of testing materials, the tissues were mounted in isolated organ bath and responses were recorded with transducers coupled with data acquisition system. BALB/c mice were challenged with castor oil for the assessment of in-vivo antidiarrheal activity. Normotensive rats were used for in-vivo hypotensive study. Results Hydroalcoholic extract of Pn.Cr at variable concentrations inhibited the natural spontaneous rhythm and 80 mmol/L K
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The primary objective of this research was to systematize the existing studies done on the commonly used intravenous [IV] fluids, electrolytes and trace elements in the fluid replacement postoperative procedure. This particular meta-analysis was done in place of the traditional use of literature review, and for this reason, this research paper has compared opinions from various existing studies done by different scholars on synthesis. Also, this analysis has explored the best-identified guidelines that should be applied to postoperative patients. Although this analysis would give various advisories on the type of fluids and electrolytes used for replacement in postoperative patients, the primary emphasis would be to highlight the advantages and disadvantages of each identified replacement fluid. This also included the surgical and anesthetic techniques that should apply in the best practice guideline used, when dealing with postoperative patients
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A 47-year-old male presented to emergency department with dislocation of hallucal interphalangeal joint of the left great toe. A trial of closed reduction under local anesthesia was attempted but failed. An emergency open reduction of the irreducible dislocation of hallucal interphalangeal joint was done with stabilization by K-wire. We report this unusual case of rare injury and review the relevant literature
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Objective: Analysis of renal excretory system integrity and efficacy of radiofrequency ablation with and without irrigation with saline at 2 o C (SF2). Materials and Methods: The median third of sixteen kidneys were submitted to radiofrequency (exposition of 1 cm) controlled by intra-surgical ultrasound, with eight minutes cycles and median temperature of 90 o C in eight female pigs. One excretory renal system was cooled with SF2, at a 30ml/min rate, and the other kidney was not. After 14 days of post-operatory, the biggest diameters of the lesions and the radiological aspects of the excretory system were compared by bilateral ascending pyelogram and the animals were sacrificed in order to perform histological analysis. Results: There were no significant differences between the diameters of the kidney lesions whether or not exposed to cooling of the excretory system. Median diameter of the cooled kidneys and not cooled kidneys were respectively (in mm): anteroposterior: 11.46 vs. 12.5 (p = 0.23); longitudinal: 17.94 vs. 18.84 (p = 0.62); depth: 11.38 vs. 12.25 (p = 0.47). There was no lesion of the excretory system or signs of leakage of contrast media or hydronephrosis at ascending pyelogram. Conclusion: Cooling of excretory system during radiofrequency ablation does not significantly alter generated coagulation necrosis or affect the integrity of the excretory system in the studied model. .
Subject(s)
Animals , Female , Cold Temperature , Catheter Ablation/methods , Kidney/surgery , Models, Animal , Saline Solution, Hypertonic/pharmacology , Kidney/pathology , Necrosis , Organ Size , Reference Values , Reproducibility of Results , Swine , Therapeutic Irrigation , Time Factors , Ultrasonography, Interventional/methods , Urothelium/injuriesABSTRACT
Uma grande revolução no tratamento da disfunção erétil, especialmente após o desenvolvimento dos primeiros inibidores da 5-fosfodiesterase (5-PDE), no final dos anos 90, marcou profundamente a história da sexualidade humana, repercutindo sobretudo na população de difícil tratamento (diabetes mellitus, prostatectomizados por câncer e outros casos de disfunção orgânica). Respeitando a estratégia de tratamento de cada urologista, os pacientes devem ser estimulados a experimentar todos os tipos de inibidores da 5-PDE disponíveis. Na falha da farmacoterapia oral, ou quando houver contraindicação para ela, dever-se-á considerar a injeção intracavernosa e, finalmente, implante cirúrgico de prótese peniana.
Subject(s)
Humans , Male , Adult , Middle Aged , Erectile Dysfunction/diagnosis , Erectile Dysfunction/therapyABSTRACT
In this work the effect of excess body weight on house works and some physiological parameters were conducted on twelve females' university students. The students were divided into a control [normal weight] group and experimental [overweight] group. The weakly cleaning of the living room was chosen as house work. A room was prepared as a living room with some furniture like tables, chairs, a sofa and cupboard in addition to a carpet on the ground and curtains on the walls. Observation of complexion, tremors, behavior reflecting boredom , level and time of performance as well as any complaint as tiredness, back pain, leg pain. Some physiological parameters as pulse, blood pressure, respiratory rate forced respiratory capacity and expiratory time were measured. The results showed that overweight has passive effect on time and level of performance; also it affects the circulatory functions more than the respiratory functions. So house works are not considered as hard work and not sufficient to reduce body weight in overweight women. Also house works can be tolerated and there is no need to restrict activity to guard against respiratory distress
Subject(s)
Humans , Female , Adolescent , Young Adult , Work , Students , Pulse , Blood Pressure , Respiratory Rate , TremorABSTRACT
Objective: To evaluate the effects of tissue-specific tibolone and continuous combined hormone replacement therapy [ccHRT] on mammographic parenchymal density and plasma lipoprotein profile in healthy postmenopausal women
Design and Setting: This was a prospective double-blind, randomised placebo-controlled study conducted at Al-Azhar University Hospitals in Damietta and Cairo
Subjects and Methods: 90 healthy postmenopausal women aged 48 to 55 years with a normal mammogram and lipid profile at baseline were equally randomized to receive one of three treatment arms: [1] tibolone 2.5 mg [group I. n=30]; [2] continuous combined 17-beta estradiol 2 mg plus norethisterone acetate 1 mg [E2/NETA] [group II, n=30]; [3] placebo [group III, n=30]. Mammograms were performed at baseline and after 12 months of treatment. Mammographic density was quantified according to the Wolfe classification and by the percentage area of the breast that had a dense pattern. Plasma levels of total cholesterol, low-density lipoprotein [LDL-C], high- density lipoprotein [HDL-C] cholesterol; triglycerides [TG]; lipoprotein [a] [Lp[a]]; apolipoprotein A [apoLpA] and apolipoprotein B [apoLpB] were determined on four occasions [i.e., baseline. 3-, 6- and 12-month visits]
Results: An increase in mammographic density was much more common among women receiving continuous combined hormone replacement therapy [43% - 50%] than among those receiving tibolone [3% - 6%] and placebo [0%] treatment. The difference between E2 /NETA and placebo was highly significant [p[c]<0.001]. Treatment with tibolone did not differ from that with placebo. In the tibolone group, 6% 13% of the women showed an involutionary change in breast density in the 12-month reevaluation. In contrast, none of the women receiving E2/NETA or placebo showed an involutionary changes in breast density. Considering the effects of treatment regimens on lipids profile, it was found that tibolone therapy was associated with a statistically significant reduction in serum triglycerides, HDL-C, apolipoprotein A and lipoprotein [a] by [22%, 20%. 10%. 20%, respectively] [p[a] <0.05], whilst no significant changes were seen in LDL-C and apolipoprotein B levels. In E2/NETA-group, there was a significant reduction of total cholesterol, LDL-C ,apolipoprotein B. HDL-C and lipoprotein [a] by [9%. 11%. 10.7%. 7.4%. 18%. respectively] [p[a] <0.05], whilst no significant changes were seen in triglycerides levels [p[a] >0.05]. Decrements were observed within 3 months of active treatments and maintained thereafter. Group I showed a more pronounced reduction of HDL-C, apolipoprotein A and triglycerides than Group II and Group III. The levels of LDL-C and apolipoprotein B declined significantly only in Group II [P[a] <0.05], while LDL-C/HDL-C ratio increased significantly in Group I by 23% when compared with GII [2.3%] and GIII [10.2%] after 12 months of treatment [P[b] and P[c]<0.05]
Conclusion: An increase in mammographic parenchymal density should be regarded as an unwanted side effect of HRT. In contrast to conventional estrogen/progestogen treatment, tissue-specific tibolone seems to exert little stimulation of breast tissue with no impairment of mammogram interpretation. Both tibolone and continuous combined HRT induced a favorable plasma lipid response. These therapeutic effects may contribute to the reduction or prevention of atherogenesis in postmenopausal women. Larger longterm studies are needed to confirm the impact of prolonged tibolone or continuous combined HRT administration on mammography and plasma lipoproteins
ABSTRACT
Background: surgery is the treatment of choice for malignant thymoma whenever a complete resection can be accomplished. For locally advanced [LA] and unresectable stage III and IVa thymoma, the therapeutic outcome has been poor
Purpose: to assess tumor response, respectability, event-free survival and, overall survival of multimodality approach in therapy of LA stage III and IVa malignant invasive thymoma
Patients and Methods: fourteen patients [7 males and 7 females] with histologically confirmed invasive thymoma were treated. The median age was 48 years [range: 24-64 years]. Six patients [42.9%] were in clinical stage III disease and, 8 patients [57.1%] had stage IVa disease. The most common histological type was lymphoepithelial [57.1%]. The treatment protocol consisted of 3 courses of induction cisplatin-based chemotherapy [PAC with corticostreoids: cisplatin: 50 mg/m[2] IV DI, doxorubicin: 50 mg/m[2] IV DI, cyclophosphamide: 50 mg/m2 IV DI and, prednisolone: 60 mg/m[2] PO D1-5], then surgery followed by postoperative radiotherapy and completion consolidation chemotherapy; another 3 courses of PAC plus corticosteroids
Results: fourteen patients were enrolled and assessed for response. After induction chemotherapy, complete response encountered in four patients [28.6%], partial response in 7 patients [50%], stable disease in 1 patient [7.1%] and progressive disease in 2 patients [14.3%]. Ten patients [71.4%] performed surgical resection: total resection in 8 patients [57.1%] and, subtotal in 2 patients [14.3%]. 1 refused surgery, 1 patient died with stable disease [7.1%], and 2 patients [lied with progressive disease [14.3%]. At the end of the study and after a median follow-up of 18 months. 11 patients were alive [78.6 %] and 9 patients are event-free [64.3%]. The 3-year calculated actuarial overall and event-free survival of studied patients was 71.3% and 57.1% respectively
Conclusion: Combined treatment approach in management of LA and unresectable invasive thymema is encouraging and demonstrated high objective overall response rates with increased respectability rate and, improvement of overall survival. Preoperative induction chemotherapy followed by surgical resection, postoperative radiotherapy and consolidation chemotherapy may become the standard treatment of LA and unresectable invasive thymoma