The Era of Coronavirus: Assess the Impact of Distance Learning Course on the Levels of Hand Hygiene Knowledge, Attitude and Practice of Students in Low Resources Country

@#Introduction: Hand Hygiene is an essential method to preclude infections in all healthcare environments. Education is essential to advance hand hygiene performance amongst nurses and nursing students. The aim is to find out the usefulness of a self-paced online hand hygiene course on the knowledge, attitude and practice of nursing students by evaluating student performance in post-tests. Methods: The study employed a quasi-experimental design in which data were collected using two questionnaires from undergraduate nursing students and they were exposed to interactive lectures and online activities related to risks, benefits, and key recommendations for hand hygiene. The following two surveys were used, Hand Hygiene Knowledge Questionnaire for Health-Care Workers; and Handwashing Assessment Inventory. Data were collected through pre-post tests. Results: Nurses reported a significant change for the better in hand hygiene comprehension, attitude, and performance of hand hygiene behaviours. The present study revealed a significant increase in hand hygiene knowledge belief, attitude, and outcomes among university students after participating in the training intervention. The majority of participants in the pretest rated their knowledge level as poor. Conclusion: Interactive training and online learning courses on hand hygiene could be used to influence the beliefs, attitudes and behaviours of students to bring about the desired change in hand hygiene practice.

Improved dentin disinfection by combining different-geometry rotary nickel-titanium files in preparing root canals

OBJECTIVES: This study was to evaluate the antibacterial effect of different instrumentation and irrigation techniques using confocal laser scanning microscopy (CLSM) after root canal inoculation with Enterococcus faecalis (E. faecalis). MATERIALS AND METHODS: Mesiobuccal and mesiolingual canals of extracted mandibular molars were apically enlarged up to a size 25 hand K-file, then autoclaved and inoculated with E. faecalis. The samples were randomly divided into 4 main groups according to the system of instrumentation and irrigation: an XP-endo Shaper (XPS) combined with conventional irrigation (XPS/C) or an XP-endo Finisher (XPF) (XPS/XPF), and iRaCe combined with conventional irrigation (iRaCe/C) or combined with an XPF (iRaCe/XPF). A middle-third sample was taken from each group, and then the bacterial reduction was evaluated using CLSM at a depth of 50 µm inside the dentinal tubules. The ratio of red fluorescence (dead cells) to green-and-red fluorescence (live and dead cells) represented the percentage of bacterial reduction. The data were then statistically analyzed using the Kruskal-Wallis test for comparisons across the groups and the Dunn test was used for pairwise comparisons. RESULTS: The instrumentation and irrigation techniques had a significant effect on bacterial reduction (p < 0.05). The iRaCe/XPF group showed the strongest effect, followed by the XPS/XPF and XPS/C group, while the iRaCe/C group had the weakest effect. CONCLUSIONS: Combining iRaCe with XPF improved its bacterial reduction effect, while combining XPS with XPF did not yield a significant improvement in its ability to reduce bacteria at a depth of 50 µm in the dentinal tubules.

Amoxicillin–clavulanic acid induced sperm abnormalities and histopathological changes in mice

Objective To explore the genotoxic potential and histopathological changes induced in liver, kidney, testis, brain and heart after using the antibiotic drug amoxicillin/clavulanic acid (4:1). Methods The study included chromosomal aberration analysis in bone-marrow and mouse spermatocytes, induction of sperm morphological abnormalities and histopathological changes in different body organs. The drug was administrated orally at a dose of 81 mg/kg body weight twice daily (Total = 162 mg/kg/day) for various periods of time equivalent to 625 mg/men (twice daily). Results The results revealed non-significant chromosomal aberrations induced after treatment with amoxicillin/clavulanic acid (AC) in both bone marrow and mouse spermatocytes after 7 and 10 days treatment. On the other hand, statistically significant percentages of sperm morphological abnormalities were recorded. Such percentage reached 8.10 ± 0.55, 9.86 ± 0.63 and 12.12 ± 0.58 at the three time intervals tested (7, 14 and 35 days after the 1st treatment respectively) (treatment performed for 5 successive days) compared with 2.78 ± 0.48 for the control. The results also revealed histopathological changes in different body organs after AC treatment which increased with the prolongation of the period of therapy. Congestion of central vain, liver hemorrhage and hydropic changes in hepatocytes were noticed in the liver. Degenerative changes were found in kidney glomerulus and tubules while testis showed atrophy of seminiferous tubules, and reduction of spermatogenesis. AC also induced neurotoxicity and altered brain neurotransmitter levels. Hemorrhage in the myocardium, disruption of cardiac muscle fibers and pyknotic nuclei in cardiomyocytes were recorded as side effects of AC in heart tissue. Conclusions The results concluded that AC treatment induced sperm morphological abnormalities and histopathological changes in different body organs. Clinicians must be aware of such results while describing the drug.

Surveillance of communicable diseases for decision-making in Egypt: 2006–2013

The Egyptian Ministry of Health and Population surveillance system provides data about notifiable communicable diseases. This study aimed to provide information for decision-making to reduce the burden of communicable diseases in Egypt by analysis of the surveillance data for 2006–2013 to identify trends in the incidence of the diseases by governorate, season, age and sex. Composite risk-index scores were estimated to rank the 27 Egyptian governorates into 3 groups: high, medium and low risk. The 15 diseases with the highest incidence were food and waterborne diseases [5 diseases], vaccine-preventable diseases [7 diseases] and others, e.g. hepatitis C infection. Bloody diarrhoea and typhoid had the high incidence for 2006–2013. There were 11 high-risk governorates; Ismailia had the highest risk-index score. The findings suggest the need for specific interventions related to environmental sanitation and improving the childhood immunization programme, particularly in the high-risk governorates

Amoxicillin-clavulanic acid induced sperm abnormalities and histopathological changes in mice

Objective:To explore the genotoxic potential and histopathological changes induced in liver,kidney,testis,brain and heart after using the antibiotic drug amoxicillin/clavulanic acid (4∶1).Methods:The study included chromosomal aberration analysis in bone-marrow and mouse spermatocytes,induction of sperm morphological abnormalities and histopathological changes in different body organs.The drug was administrated orally at a dose of 81 mg/kg body weight twice daily (Total =162 mg/kg/day) for various periods of time equivalent to 625 mg/men (twice daily).Results:The results revealed non-significant chromosomal aberrations induced after treatment with amoxicillin/clavulanic acid (AC) in both bone marrow and mouse spermatocytes after 7 and 10 days treatment.On the other hand,statistically significant percentages of sperm morphological abnormalities were recorded.Such percentage reached 8.10 ± 0.55,9.86 ± 0.63 and 12.12 ± 0.58 at the three time intervals tested (7,14and 35 days after the 1st treatment respectively) (treatment performed for 5 successive days) compared with 2.78 ± 0.48 for the control.The results also revealed histopathological changes in different body organs after AC treatment which increased with the prolongation of the period of therapy.Congestion of central vain,liver hemorrhage and hydropic changes in hepatocytes were noticed in the liver.Degenerative changes were found in kidney glomerulus and tubules while testis showed atrophy of seminiferous tubules,and reduction of spermatogenesis.AC also induced neurotoxicity and altered brain neurotransmitter levels.Hemorrhage in the myocardium,disruption of cardiac muscle fibers and pyknotic nuclei in cardiomyocytes were recorded as side effects of AC in heart tissue.Contusions:The results concluded that AC treatment induced sperm morphological abnormalities and histopathological changes in different body organs.Clinicians must be aware of such results while describing the drug.

Evaluating the effect of midodrine on renal resistance index in patients with liver cirrhosis and ascites

Background: Portal hypertension, which occurs as a consequence of liver cirrhosis, leads to splenic vasodilatation and alterations in the systemic circulation. Arterial vasodilatation in the splanchnic circulation appears to play a central role in hemodynamic changes and in the decline in renalfunction in cirrhosis. Peripheral vasodilatation, which occurs as a part of alterations in the systemic circulation, may decrease the renal blood flow and subsequently raise plasma renin activity. Midodrine is a agonist and acts as a peripheral vasoconstrictor; therefore, it may reduce plasma renin activity and improve renal function

Aim of the work: The aim of the study was to evaluate the relationship between renal resistive indices [RIs]in cirrhotic patients before and after oral administration of 7.5 mg midodrine three times dailyfor 3 days

Patients and methods:The study was conducted on 40 patients with liver cirrhosis and ascites and on 40 healthy controls from October 2014 to March 2015 at Al Azhar University Hospital, Assiut, where allpatients were subjected to history and clinical examination as well as to routine investigations such as total bilirubin, albumin, international normalized ratio, and serum creatinine. Patients underwent an abdominal ultrasound with duplex Doppler examination of the kidneys, and RIwas calculated before and 3 days after oral intake of midodrine

Results: Patients with liver cirrhosis and ascites had significantly higher RI in the right kidney[0.69 +/- 0.101 vs. 0.57 +/- 0.055, P < 0.001] and in the left kidney [0.69 +/- 0.097 vs. 0.59 +/- 0.047,P < 0.001] compared with healthy controls. After oral administration of midodrine for 3 days,RI showed significant improvement [RI = 0.928, P < 0.001] in the right kidney and in theleft kidney [R = 0.993, P < 0.001]. RI had significant positive correlation with Child-Pughscore [R = 0.75, P < 0.001, in the right kidney and R = 0.75, P < 0.001, in the left kidney] and significant positive correlation with Model for End Stage Liver Disease score [R = 0.536,P < 0.008, in the right kidney and R = 0.487, P < 0.005, in the left kidney]

Conclusion: Oral midodrine improved renal hemodynamics as assessed by RI in cirrhotic patients. RI is correlated with severity of liver disease as assessed by Child-Pugh and Model for End StageLiver Disease scores

Incidence of influenza virus-associated severe acute respiratory infection in Damanhour district, Egypt, 2013

The epidemiology, seasonality and risk factors for influenza virus infection remains poorly defined in countries such as Egypt. Between 1 January and 31 December 2013, we used surveillance data on patients hospitalized with severe acute respiratory infection in three Egyptian government hospitals in Damanhour district to estimate the incidence rate of laboratory-confirmed seasonal influenza. Samples were taken from 1727 of 1856 patients; of these, 19% were influenza virus positive. The overall incidence of influenza virus-associated SARI during the study period was estimated to be 44 cases per 100 000 person-years [95% CI: 39-48]. The highest incidence of 166 cases per 100 000 person year [95% CI: 125-220] was observed in children aged 2 to 4 years. The incidence of influenza-virus associated SARI cases in pregnant women was estimated to be 17.3 cases per 100 000 person-years [95% CI: 6-54]. Majority of influenza virus-associated SARI occurred in autumn and early winter, and influenza A[H3N2] virus predominated. This was the first ever description of the epidemiology of seasonal influenza in Egypt. However, additional works are needed for greater understanding of influenza burden in Egypt

Comparative analysis of CD4+ and CD8+ T Cells in tumor tissues, lymph nodes and the peripheral blood from patients with breast cancer

CD4+ and CD8+ T cells are the main types of lymphocytes in cell-mediated immunity and play a central role in the induction of efficient immune responses against tumors. The frequencies of T cell subtypes in the peripheral blood and tumor tissues, and draining lymph nodes [dLN] can be considered as useful markers for evaluation of the immune system in cancers. In this study, the frequencies of CD4+ and CD8+ T cells in blood, tumor tissues, and dLN samples of breast cancer patients were compared with each other and with similar tissues from normal individuals. Immunophenotyping was carried out by flow cytometry and the expression levels of CXCL10, granzyme B, and mammaglobin were evaluated by real-time PCR In the peripheral blood, there were no differences in the T cell subsets between the patients and the normal individuals. The frequency of CD8+ T cells was significantly higher in tumor tissue than normal breast tissues while granzyme B expression was similar. Based on mammaglobin expression levels, dLN have been classified into micro- and macro-metastatic dLN. We found significantly lower frequency of CD4+ in macro-metastatic dLN than micro-metastatic dLN. CD8+ frequency was similar in both dLN; however, granzyme B expression was higher in micro-metastatic ones. There was not any significant difference in CXCL10 expression between the two types of dLN. Based on our results, although the tumor does not affect the systemic immunity, tumoral cells affect the local immune system in the tumoral tissues and the metastatic dLN.

Various fractions of Hypericum x moserianum and Hypericum ericoides possess antiglycation, anti-lipid peroxidation, antioxidative activities and non-toxic effects in vitro

In the present study, two species Hypericum x moserianum and Hypericum ericoides which belong to genus Hypericum were evaluated for their potential antiglycation, antioxidant, anti lipid peroxidation and cytotoxic activities. These species are widely used in folk medicine and to the best of our knowledge there were no previous reports regarding antioxidant, anti-glycation and cytotoxicity studies of these species. Among the crude methanol extracts and fractions of both the species, the ethyl acetate fraction of H. x moserianum exhibited promising antioxidant activity against 1, 1-diphenyl-2-picrylhydrazyl [DPPH] with IC50 129.084+/-1.215µg/ml, followed by methanol extract [IC50=232.083+/-1.215µg/ml] and aqueous fraction [IC50=266.962+/-2.213µg/ml]. The ethyl acetate fraction of Hericoides exhibited IC50 value of 295.088+/-2.320µg/ml. In antiglycation assay, the ethyl acetate fraction of H.x moserianum showed 52.096% inhibition at 500µg/ml. For lipid peroxidation assay, the dichloromethane, aqueous and n-hexane fractions of H. x moserianum showed 67.241, 66.147 and 64.213% inhibition respectively, while aqueous fraction of H. ericoides exhibited 67.404% inhibition at 500µg/ml. In cytotoxicity assay, all fractions of both the species were found to be non-toxic on mouse fibroblast 3T3 cells with IC50 value greater than 30µg/ml as compared to cycloheximide with IC50 value 0.073+/-0.1µg/ml used as a st and ard. It was concluded from the study that among the two species, crude methanolic and ethyl acetate fractions were more active regarding the antioxidant, anti-glycation activities while dichloromethane, aqueous and n-hexane fractions possessed anti-lipid peroxidation activity

Risk factors and effects of infestation with Pediculosis Capitis and Scabies among primary school students in Cairo, Egypt

Background: Pediculosis capitis [PC] and scabies are an important public health problem in childhood. They have a worldwide distribution. Also, they have many effects on the infested students

Objectives: To define the prevalence of PC and scabies, to find out the socio-demographic, environment, and health care behavior risk factors, and to determine the effects on the studied students in Cairo, Egypt

Subjects and Methods: A cross-section, analytical study design was chosen to conduct this work. Three primary schools were the field of this study. Total number of the students was 1987. The students were clinically examined; for each infested case with PC and/ or scabies a control student was chosen

Results: Prevalence of PC and scabies was 10.2% and 3.4%, respectively. These infestations were more common significantly among students in the public school. Significant social risk factors of infested students were the low level of head of the family education, occupation, and social status. Also, significant personal hygiene risk factors were poor hair, body, and environment hygiene. While significant health care behavior risk factors were student never received skin examination, no early consultation for skin diseases, and no compliance with therapy. Also; female gender, the last birth order child, had previous infestation with PC, had sibling[s] with PC, and had parents with history of infestation with PC were significant risk factors. On the other hand; male gender, the last birth order child, had previous infestation with scabies, had sibling[s] with scabies, and had parents with history of infestation with scabies were significant risk factors. Further, the PC cases with crowding index >1, had no sun access, had shared water supply and bathing facilities, co-sleeping, had no short cut hair, and sharing hair brushes were significant risk factors. On the other hand, the scabitcs with crowding index >1, had no sun access, had shared water supply and bathing facilities, and co-sleeping were significant risk factors. Lastly, presences of psychiatric, sleep, and peers' relations disturbances were significantly more common among the infested students

Conclusions: Many risk factors of PC and scabies can be manipulated, so these infestations can be prevented, so many health hazards on the students could be prevented

Recommendations: Improving students' hygiene, health education, and regular dermatological screening and treatment of students are important essentiality. Also, dermatological health component should be integrated in school health program. Lastly, further studies in different rural and urban areas in Egypt are recommended

Drug interactions between phenytoin and rosuvastatin on lipid profile, liver functions and oxidative stress biomarkers in irradiated rats

Phenytoin is one of the most commonly used anticonvulsants for treating generalized tonic-clonic seizures and status epileptics. Rosuvastatin is a new generation HMG-CoA reductase inhibitor. This enzyme converts HMG-CoA to mevalonic acid in the cholesterol biosynthetic pathway which is the rate limiting step in cholesterol synthesis. This study was aimed to investigate the possible interactions between phenytoin and rosuvastatin when used together in irradiated rats. The experiments were carried out to investigate the acute effect of each drug individually and in combination with radiation on lipid profile [Total cholesterol, Triacylglycerols, High density lipoproteins, Low density lipoproteins and Very low density lipoproteins, Risk factor, Atherogenic Index], liver function tests [AST and ALT] and oxidative stress biomarkers [MDA, NO and SOD]. Data revealed that, phenytoin in irradiated rats significantly increased serum total cholesterol compared to normal control. Rosuvastatin significantly decreased serum total cholesterol compared to irradiated control. Combination of two drugs significantly increased serum total cholesterol; triacylglycerols and serum VLDL-c levels compared to normal and irradiated rats and significantly increased Atherogenic Index and Risk factor compared to normal control. Phenytoin significantly increased serum ALT level compared to normal and irradiated rats and significantly increased serum MDA and serum NO levels compared to normal rats. But phenytoin significantly decreased MDA and NO levels and significantly increased SOD activity compared to irradiated rats. Rosuvastatin significantly increased serum ALT level compared to normal control but it significantly decreased MDA and significantly increased SOD activity compared to irradiated rats. Combination phenytoin and rosuvastatin in irradiated rats significantly increased serum ALT level compared to normal and irradiated rats and it significantly increased MDA, NO levels but it significantly decreased SOD activity compared to normal control. It could be concluded that administration of phenytoin concurrently with rosuvastatin not recommended in patients receiving radiotherapy as dangerous side effects may be occurred

Detection of chlamydia trachomatis in patients with unexplained infertility: a case control study

Is to detect Chlamydia Trachomatis organism in cervical swabs obtained from patients with unexplained infertility [UI] and to compare its incidence in infertile compared to fertile females in reproductive age. The study design was a case control observational study, done in Cairo University Hospitals. One hundred females diagnosed as unexplained infertility and 100 normal fertile females were included in the study for detection of Chlamydia trachomatis by using polymerase chain reaction [PCR] of cervical swab samples. Fifteen females were positive for Chlamydia trachomatis in infertile group while only 2were positive in healthy fertile group with p value of 0.002. The Incidence of Chlamydia trachomatis in cervical swabs was significantly higher in unexplained infertile females compared with the control group

Epidemiology of rabies in Oman: a retrospective study [1991-2013]

Animal bites and rabies are under-reported in many developing countries and there is poor understanding of the disease burden. The aim of this study was to map the epidemiology of animal bites and rabies in Oman over the period 1991-2013. In a cross-sectional, descriptive, surveillance-based study, all data about animal bites and rabies from the national communicable disease surveillance system were analysed. A total of 22 788 cases of animal bites were reported. Most bites were to males [70%] and the 10-19 year age group [26%]. Cats were the most common animal and upper extremities were the most common bite site. There were 8 rabies cases reported during the study period, mostly due to bites from wild animals, with 100% mortality. Of 758 suspected animals tested, 56.1% were positive for rabies; foxes had the highest positivity rate [70.1%]. The high incidence of animal bites in Oman emphasizes the importance of a rabies prevention and control programme

Predictors of adherence to antihypertensive medication in northern United Arab Emirates

This study aimed to assess the predictors of non-adherence to antihypertensive medications in northern United Arab Emirates. In a cross-sectional, multicentre study in Ajman Emirate, 250 patients with hypertension were randomly selected from outpatient clinics. Participants answered an interview questionnaire about sociodemographic and clinical data and completed the Morisky medication adherence scale. Non-adherence to antihypertensive medication was reported by 45.6% of patients. Sociodemographic predictors of non-adherence were sex and number of children. Therapy-related predictors of adherence were hospital admissions, number and cost of medications, medication perceived effectiveness and use of traditional remedies. Patient-related predictors of non-adherence were forgetfulness, method of identifying medication and poor awareness of hypertension complications. Health-care-related predictors were regular follow up at clinics, education and counselling, frequency of changing medication by physicians and awareness of physicians' instructions

[Role of Re-resection of non-muscle invasive bladder cancer T1 in treatment and prognosis]

Bladder cancer is the most common malignancy of the urinary tract. Approximately 75% of patients present with a non-muscle-invasive bladder tumors. It is recommended to perform a second resection [Re-TURBT] of T1, and high grade tumors after 2-6 weeks from the initial TURBT. This retrospective study was performed to determine the role of re-resection [Re-TURBT] of non-muscle invasive T1 bladder cancer after 4-6 weeks from the first resection. From January 2011 to December 2013, we retrospectively evaluated 108 patients with primary T1 TCC [transitional cell carcinoma] bladder cancer. Re-TURBT was performed in 70 patients [group A] after 4-6 weeks from initial TURBT, 38 underwent regular follow up without re-resection [group B]. A cystoscopy was performed every 3 months for 1 year in all patients. Both groups [A+B] received 6 doses course of BCG as an adjuvant therapy. Residual disease at the second TURBT was detected in 41 patient [58.5%].Understaging in initial TURBT was found in 11 patients [15.7%], 6 [8.5%] of them were T2 and underwent cystectomy. Recurrence happened in 21 [32.8%] patients of group A [64 patients] and in 25 patients [65.7%] of group B. Progression to muscle invasive tumors in 4 [6%] in group A, in 6 [15%] in group B. Recurrence was reduced from 65.7% in group B to 32.8% in group A [p=0.001] and progression reduced from 15% to 6%, [p=0.11]. Re-TURBT has an important role in correcting understaging in initial TURBT, and it reduces recurrence and progression in patients with T1 bladder tumors. We recommend re-TURBT in T1 bladder tumor patients

Immunohistochemical and light and electron microscopic study of the basement membrane in photoaged skin

The basement membrane plays an important role in maintaining a healthy epidermis and dermis, and repeated damage destabilizes the skin and accelerates the aging process. This study was carried out to detect the changes in human skin basement membrane in sun-exposed skin compared with sun-protected skin. Skin biopsies were taken from sun-exposed and sun-protected skin of 10 male individuals aged between 50 and 60 years and processed for light and electron microscopic examination of the changes of the basement membrane. Immunohistochemical assessment of laminin and matrix metalloproteinase-1 [MMP-1] expression in skin biopsies was also carried out. Histological examination of sections of sun-exposed skin revealed that the basement membrane was discontinuous and the collagenous fibers of the underlying connective tissue were discrete in comparison with sun-protected skin. Immunoreactivity for laminin was decreased, whereas that for MMP-1 was markedly increased in sun-exposed skin as compared with sun-protected skin. The results of the current study revealed that the structure of the basement membrane was affected in sun-exposed skin as regards thickness, continuity, and structure. Increased activity of MMP-1 accounts at least in part for the disruption of the basal lamina and degradation of collagenous fibers of the dermis

Artemisinin as a Chinese medicine, selectively induces apoptosis in pancreatic tumor cell line / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the possible mechanism through which Artemisinin induced apoptosis in pancreatic cell line.</p><p><b>METHODS</b>Column chromatography, thin layer chromatography (TLC) and proton NMR spectroscopy were used to purify Artemisinin. The flowcytometry was employed to detect apoptosis and reactive oxygen species (ROS).</p><p><b>RESULTS</b>The results indicated that 50% inhibiting concentration (IC50 value) for pancreatic cell line (RIN) was 45 μmol/L of Artemisinin. Artemisinin had no cytotoxic effect on the growth of peripheral blood lymphocytes. The mechanism of apoptosis was evaluated by measuring intracellular ROS. It was shown that Artemisinin-induced apoptosis occurred independently of the binding of CD95L to CD95 receptor in the RIN cells. Moreover, Artemisinin, in a dose-dependent manner, could significantly increase the level of ROS.</p><p><b>CONCLUSION</b>Artemisinin can induce apoptosis in the RIN cells via the generation of ROS and triggering the intrinsic pathway of cell death.</p>

Evaluation of the effect of sildenafil and/or doxazosin on Benign prostatic hyperplasia-related lower urinary tract symptoms and erectile dysfunction

To verify the association between lower urinary tract symptoms [LUTS] and erectile dysfunction [ED] and evaluate the influence of sildenafil and doxazosin either as single agents or combined on both symptoms. A prospective randomized study including 150 patients presented with LUTS caused by BPH in association with clinically diagnosed ED, with age equal or more than 45 years from April 2010 to April 20011. They were categorized into three comparative groups each one containing 50 patients. These groups were comparable regarding pretreatment international prostate symptoms score [IPSS] and international index of erectile function [IIEF]. The patients of the first group were given sildenafil 50 mg as monotherapy, those of the second group were given doxazosin 2 mg and those of the third group were given combination of both drugs for 4 months for each group. The main post-treatment parameters for assessment and comparison include assessment of patient's symptoms by repeated IPSS and IIEF, uroflowmetry and assessment of PVR. The statistics was done by use of the chi-square test Pre-treatment parameters were assessed and compared between the three groups. After 4 months of treatment, the comparative parameters were applied to all groups and the differences were measured post-treatment regarding IPSS, erectile function score, uroflowmetry, and post-void residual [PVR] urine. Sildenafil alone caused mild improvement in IPSS, more improvement in IIEF score, and little effect on flow rate and PVR urine. Doxazosin alone caused more improvement in IPSS, flow rate and PVR urine and less improvement in IIEF score. A combination of both sildenafil and doxazosin caused more improvement in all of the comparative parameters than when each drug was given alone. There is a strong relationship between LUTS and ED. Doxazosin or sidenafil as a single drug could be used in treating mild or mild to moderate symptoms but more severe symptoms may usually need a combination of both drugs

[Evaluation of pneumothorax risk factors in mechanically ventilated neonates admitted to neonatal intensive care unit]

Pneumothorax is the most common pulmonary air leak syndrome which occurs more frequently in the neonatal period than any other time of life. Mechanical ventilation with positive pressure is one of the most common causes of this condition. The aim of this study was to evaluate pneumothorax risk factors in mechanically ventilated neonates admitted to neonatal intensive care unit [NICU] of Besat Hospital in Sanandaj This was a nested case-control study. Case group were neonates under ventilation with pneumothorax admitted to NICU between April 2012 and March 2013. Control group included neonates under ventilation without pneumothorax whose admission times followed in the immediate chronology to the case group. 31 cases and 62 controls were selected. Data collection was performed by use of medical records and ventilator memory in the last 24 hours. The data were introduced into SPSS software. Analysis of qualitative variables was performed by chi-squared and Fisher test. We used Mann Whitney U test for analysis of quantitative variables and logistic regression in order to control confounders. 61.3% of newborns with pneumothorax were male and 38.7% female. 61.3% of these neonates were born by Cesarean section and 38.7% by vaginal delivery. Their mean gestational age was 32 weeks and the mean birth weight was 1819 g. 74% of cases had pneumothorax in the right side, 13% left side and 13% bilaterally. Hyaline membrane disease [HMD] was the most common underlying disease [74.2%] in the newborns with pneumothorax. 38% of neonates under pressure controlled ventilation developed pneumothorax compared to 7.1% of neonates under synchronized intermittent mandatory ventilation [SIMV], which showed a significant difference [p=0.03]. Ventilator parameters associated with higher risk of pneumothorax were more episodes of ventilator adjustments [P<0.001], high peak inspiratory pressure [p<0.001], high positive end expiratory pressure [p=0.029] and high mean airway pressure [p<0.001]. In general pneumothorax risk factors in mechanically ventilated neonates in our investigation were similar to those of other studies. Our findings indicated that pressure controlled ventilation more episodes of ventilator adjustments, increased peak inspiratory pressure, positive end expiratory pressure and mean airway pressure are major pneumothorax risk factors in the mechanically ventilated newborns. To prevent pneumothorax, it is necessary to avoid frequent changes of ventilator adjustments and decrease in the above mentioned parameters to the levels enough to supply lung oxygenation