Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the US Preventive Service Taskforce recommendations against PSA screening

ABSTRACT Objective: In the following years after the United States Preventive Service Task Force (USPSTF) recommendation against prostate cancer screening with PSA in 2012, several authors worldwide described an increase in higher grades and aggressive prostate tumors. In this scenario, we aim to evaluate the potential impacts of USPSTF recommendations on the functional and oncological outcomes in patients undergoing robotic-assisted radical prostatectomy (RARP) in a referral center. Material and Methods: We included 11396 patients who underwent RARP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups based on an inflection point in the outcomes at the end of 2012 and the beginning of 2013. The inflection point period was detected by Bayesian regression with multiple change points and regression with unknown breakpoints. We reported continuous variables as median and interquartile range (IQR) and categorical variables as absolute and relative percent frequencies. Results: Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. In the final pathology, Group 2 had 9.5% increase in tumor volume, 24% increase on Gleason ≥ 4+3 (ISUP 3), and 18% increase on ≥ pT3. This translated to a 6% increase in positive surgical margins and 24% reduction in full nerve sparing in response to the worsening pathology. There was a significant decline in post-operative outcomes in Group 2, including a 12-month continence reduction of 9%, reduction in potency by 27%, and reduction of trifecta by 22%. Conclusions: The increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. Among some historical changes in prostate cancer diagnosis and management in the period of our study, the USPSTF recommendation coincided with worse outcomes of prostate cancer treatment in a population who could benefit from PSA screening at the appropriate time.

The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study

Abstract Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. Methodology Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. Results Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. Conclusion RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.

[ effectiveness of a training program for improving language impairment among a sample of children suffering from developmental learning disabilities in preschool stage]

Aim: This study drives at identifying the effectiveness of a training program for improving language impairment of preschool children with developmental learning disabilities

Methods: The study counts on the experimental method with two equal groups

Sample: The research sample consist of 30 male/ female preschool children aged [4-6] years old who are suffering from language development impairment

Tool: The researcher uses a Checklist of Developmental Learning Disabilities for Kindergarten Children [by Adel Abd Allah, 2006]- Stanford Binet Intelligence Test for measuring intelligence- IV Edition- Test of Development of Language Functions [Revised by Nahla Abdel Aziz El-Refae, 2009]- Scale of the Family Socio-Economic Level [by Abdel Aziz El-Shakhs, 2013] Primary Data Form [by the researcher]- A Training Program for Improving Language Impairment, in a sample of children with developmental learning disabilities [by researcher]

Results: The study results indicate that there are significant statistical differences between average scores of the experimental and the control group post application of the training program for improving language for developing vocabulary on the pictured test, in favor of the experimental group at significance level 0.01. There are also significant statistical differences between average scores of the experimental group pre/post application of the training program for improving language impairment for developing vocabulary on the pictured test for development of language functions, in favor of the post-application at significance level 0.01. There are no significant statistical differences between average scores of the experimental/follow up group on use of a program for improving language impairment for developing vocabulary on development of language functions test

[ effectiveness of the counseling program to improve the quality of life in a sample of children renal failure]

Aims: This study aims to develop a pilot program to try to improve the quality of life in a sample of children patients with renal failure

Methodology: The study is based on the experimental method is Altsmaimin pre and post

Sample: A sample of 12 children divided into two groups and a control group experimental group ranged in age from [12-15] years

Tools: Study used researcher in this study the quality of life scale [setup researcher] and Indicative Programme [setup researcher], and using the Mann-Whitney test and test and W.Coxon

Results: Study found that there are significant differences between the experimental group arranged in two measurements before and after the application of the program measures the quality of life scale in the direction of the post-test measurement. That there is no statistically significant differences between the control group arranged in two measurements before and after the application of the program measures the quality life scale, that there are significant differences between the mean scores of the two groups experimental and control on the quality of life scale after application of the program procedures in the direction of the experimental group, and that there are significant differences between the experimental group arranged in two measurements dimensional and iterative program on quality of life scale

[Locus of control and its relationship to quality of life in a sample of adolescents dependent on psychological materials]

Problem: The problem of study to know the locus of control and its relationship to quality of life in a sample of adolescents dependent on psychological materials

Aims: The study aims to achieve several goals can be summarized as following, Test the sign of the differences between adolescents who are dependent on psychological materials and non-dependent ones locus of control

Sample: A sample 200 of adolescents that dependent and non-dependent on psychological materials, were selected from one of hospital, Sample dependent on the psychological material: 100 of adolescent substance- dependent and are chosen from applicants for the treatment of adolescents who are dependent on psychological materials in one of the clinics for the first time, Sample non-dependent: 100 is selected from a teenage high school students and university requires non-dependent ones on any type of drug is determined by the sample that meet the requirement of equivalence

Tools: Interview codified from prepared by the researcher, Locus of control scale [a measure of Rutter translation and legalization of Aladdin Kafafy 1982], and Quality of Life Scale IHO [1996]. Statistical methods: Description of the sample through the averages and standard deviations. Using the equation of differences between the two groups T-test

Results: There are differences between adolescents who are dependent on psychological materials and non-dependent ones locus of control and quality of Life, There is a correlation between locus of control and quality of life in adolescents who are dependent on psychological materials. There is a correlation between locus of control and quality of life in adolescents who are non-dependent on psychological materials

[Self-concept and its relationship to future anxiety for a sample of children who suffer from nocturnal enuresis]

Introduction: Nocturnal enuresis considers one of the most common and a critical psychological that affects a child's personality and requires more focus and concern to identify its impact on children

Problem: The current study problem could be crystallized in the following questions: Is there any relationship between self-concept and future anxiety in a sample of children who suffer from nocturnal enuresis and normal children? And are there any differences between the two sample of nocturnal enuresis and normal children?

Objectives: The current study drives at defining and exploring the relationship between self-concept and future anxiety in a sample of children who suffer from nocturnal enuresis

Instruments: Scale of Self- Concept for Children [Adel Ezz El-Din, 2015], Asuit University Scale for Non- Verbal Intelligence[ Taha El- Mestekawy, 2000], Scale of the Socio- Economic and Cultural Level [Mohamed El- Behairy, 2002], Scale of Future Anxiety for Children [researcher]

Sample: It is consistent of 120 Male/ Females children aged [9-12] year olds

Results: There is a significant statistical correlation between average scores of the study sample on scales of self-concept and future anxiety. There are significant statistical differences between the average score of children who suffer from nocturnal enuresis and normal children on scales of future anxiety and self- concept; while there are significant statistical differences between average scores of normal male and female children on scale of future anxiety. There are no significant statistical differences between males and females of children who suffer from nocturnal enuresis and normal children on scale of future anxiety

Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome

Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008. Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients. During the study period, 287 thyroidectomies were performed and 47 [16.4%] patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy [P=.0001], Hashimoto thyroiditis [P=.004], and extrathyroidal spread [P=.0003]. Postoperative hypocalcemia occurred in 18 [38.3%] of the patients in whom the parathyroid gland was removed inadvertently and in 48 [20%] of the rest of the patients [P=.0123]. The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy

Leprosy [part 2]: treatment and disease control

Although, leprosy is a very variable disease, affecting different people in different ways according to their immune response, it is no longer an incurable disease. In areas, where leprosy is less common, the ability to suspect leprosy and refer the patient to the specialist is the most important skill required for junior doctors working in dermatology, general practitioner and other specialities. The Multi-drug therapy "MDT" has been a continuing process and neither relapse nor drug resistance are significant problems. In the present we will review the treatment of leprosy and disease control and recent WHO recommendations

Endometriosis of the appendix: a trap for the unwarey

The anatomic variations of the appendix along with a wide spectrum of appendiceal affections frustrate the accurate diagnosis of appendicitis. Isolated endometriosis of the appendix is rare and its presentation as acute appendicitis is even uncommon[1] Endometriosis affects the intestinal tract in 15-30% of patients with pelvic endometriosis[2]. The correct diagnosis is often delayed because intestinal endometriosis may masquerade clinically as regional enteritis, ischemic enteritis or colitis, diverticulitis or neoplasm[3,4]. The incidence of endometriosis of the appendix is reported to be just under 1% of the total endometriosis cases[5,6] but because of its propensity to manifest with a wide spectrum of sitespecific presentations, appendiceal endometriosis should be a diagnostic consideration in the evaluation of pre menopausal women with gastrointestinal complaints[7]. This case report presents a lady with vague abdominal pain and ultimately was found to have endometriosis of the appendix at King Khalid University Hospital Riyadh, Kingdom of Saudi Arabia [K.S.A]

Unilateral humeral lengthening in children and adolescents

This study evaluated the early experience with unilateral humeral lengthening in children and adolescents. Sixteen cases with unilateral humeral shortening ranged from 5.5-15 cm were studied. The etiology was Erb's palsy in eight cases, epiphyseal injury in five cases and infection in three cases. Hybrid fixation using wires and half pins was applied to all cases to minimize the risk of operative neurovascular complications. Osteotomy was performed in the middle 1/3 of the humerus through a posterior approach. After a latent period of 5-7 days, lengthening started at a rate of 1/3 mm every 8 hours. At an average follow up of 3 years and 2 months, ten excellent and six good results were achieved. The average healing index was 28 days/cm. The complications included pin tract infection in all cases, radial nerve palsy in one case and fracture of the regenerate in two cases

Treatment for reducing use of water in white clond cauliflower Brassica oleracea Varbotrytis and improving its growth and yield through "Mechanically induced stress" MIS and chemical fertilization

An experiment was conducted in season 1999/2000 in private orchid at Baghdad, white cloud cauliflower cultivar was used in a factorial experiment adopted in Randomized Complete Block Design [RCBD] with three replicates. The first factor "Mechanically induced stress "MIS" included seedling brushing for 1.5 min/day and no brushed, the second factor "Seeding fertilization" by two doses of NPK at a ration of 18:46:0, respectively, with the amount of 50 and 100/m 2. Beside, the control. Results indicated that [MIS] and seedling fertilization resulted in a significant increase in the weight and leaf number; total leaf area, leaf, root and curd dry weights for plant. In addition to increase resistance external conditions when culture it. [Reduction of supply water for plant, lowering in temperature]. The increase in each parameter was positively correlated with the increase in the fertilizer levels. MIS and seedling fertilization with 100g/m 2 produced and increase in curd diameter; curd weight; protein percentage and total plant weight compared to the other treatments. The heaviest curd fresh weight [2195.00g] obtain from adopting MIS and high level of fertilization on seedling at propagating period compared to that seedlings came from control treatment [no MIS and without fertilization]

Forearm lengthening

In this study, 11 cases of forearm shortening underwent lengthening using Ilizarov principles. The etiology was hereditary multiple exostosis in six cases, radial club hand in two cases and traumatic in three cases. The average age at operation was 15.5 years [range 9-40 years]. The average follow up period was 3.5 years [range 2-6 years]. Eight good results, two fair results and one poor result were obtained. The area of lengthening achieved ranged from 2-11 cm of the original bone length. The average healing index was 40 days/cm. There were no neurovascular problems. Complications comprised some sort of pin tract infection in all cases, fracture of the regenerate in one case, breakage of a half pin in one case and increased carpal subluxation in another case. The combination of Ilizarov method and hybrid fixation provides a relatively safe method of forearm lengthening with the possibility of deformity correction and gradual reduction of chronic dislocations

Gallbladder carcinoma: is it a rare disease in our community?

Gallbladder carcinoma has an unusual geographic and demographic distribution. It is more common in certain geographic areas and its incidence varies in different ethnic groups even within the same country. The aim of our study was to gauge the magnitude of the problem in a group of our patients. The hospital and histopathological records of 549 patients who underwent cholecystectomy in our institute in the period from January 1996 to December 2001 were retrospectively reviewed. There was a predominance of female patients undergoing cholecyslectomy [male to female ratio 1:4]. The mean age was 38.2 years. The histological results did not show any evidence of malignancy of the gallbladder in the patients studied. The incidence of gallbladder carcinoma in patients undergoing cholecystectomy in King Khalid University Hospital, Saudi Arabia, is low. Possible explanations are absence of industrial carcinogens, low incidence of smoking among women and relatively younger age of the group of patients who underwent cholecystectomy

Laparoscopic cholecystectomy: the outcome with minimal conversion rate: Experience in a district hospital

Since introducing laparoscopic cholecystectomy [LC] different centres have reported different conversion rate [CR] to open cholecystectomy [OC] and different reasons for conversion. To evaluate the role of LC in the treatment of symptomatic gallstones and establish the outcomes of this treatment modality in general, looking especially into the rate of conversion to OC, at a district hospital. Patients and methods: From July 1992-July 1998, 751 patients who underwent LC were retrospectively reviewed. All patients with symptomatic gallstones were offered LC with no exclusion criteria apart from anaesthetic opinion. No attempts were made at selection of patients for LC There were 751 patients with symptomatic gallstones [617 females, 134 males] underwent LC. Chronic cholecystitis represented the majority of cases [83%]. The mean operative time was 65.52 minutes; pre-operation and main hospital stay was 2.46 days. our total conversion rate was 0.9% and 0.4% if malignancy of the gallbladder is excluded. In comparison to the published data, there was obvious lower conversion, rate, which was neither associated with increased morbidity nor mortality Laparsocopic cholecystectomy is a reliable, safe and cost effective treatment modality for symptomatic gallstones. With growing experience in laparoscopic technique, proper settings and harmony of the operating team, it is possible to bring the conversion rate to OC to the minimum without any increment in mortality or morbidity

Prevalence and predictors of renal artery stenosis detected by renal duplex sonography in type 2 diapetes mellitus

Diabetes mellitus [DM] is a risk factor for atherosclerosis that may lead to renal artery stenosis [RAS]. This study aimed to screen type 2 diabetic patients for presence of RAS and to identify the main predictors of its presence. The study included 473 patients [204 males and 269 females], aged 40 years or more with a well established DM of more than 5 years duration. Data about smoking, hypertension, diabetic retinopathy, ischemic heart, cercbrovascular and peripheral vascular diseases, macro and microalbuminuria, impaired kidney function and dyslipidemia were collected using history taking, physical examination and appropriate laboratory investigations. Renal ultrasonography and duplex renal scans were obtained for each patient under standardized conditions to determine the size and volume of the kidneys and to evaluate dynamics of the renal blood flow to diagnose RAS. The prevalence of RAS among all patients was 5.9%, and was 11.7% in those with hypertension. Logistic regression analysis was performed to examine and control for the joint effect of multiple factors potentially predicting presence of RAS. The odds ratio [OR] of RAS for the hypothesized predictors were determined to assess the significance of the association. There was a significant association between RAS and presence of abdominal bruit [OR=11.3], difference of length between the two kidneys [OR=3.4], age of patients [OR= 1.6] and duration of DM [OR= 1.1]. RAS is a common complication in type 2 DM. Type 2 DM patients should be scheduled for regular renal duplex check up and this may be done more frequently in patients with certain features that predict presence of RAS

Serum transferrin receptors/ferritin index, a discriminative parameter for iron deficiency anemia versus anemia of chronic disorder and B-thalassemia minor

Differentiation between iron deficiency anemia [IDA], anemia of chronic disorders [ACD] and beta-thalassemia minor is usually made definite by examining the bone marrow for iron stores. The aim of this study was to evaluate a new noninvasive parameter, serum transferrin receptors [TfR], in discriminating IDA versus ACD and beta-thalassemia minor. The subjects involved in this study consisted of IDA group [65 cases], ACD group [64 cases] and beta-thalassemia minor group [61 cases]. For the three groups, complete blood count [CBC], serum iron, total iron binding capacity [TIBC], iron stain for bone marrow smears, hemoglobin electrophoresis, serum transferrin, ferritin and transferrin receptors were assayed in addition to the calculation of the TfR/ferritin index. The results of this study showed that transferrin ferritin and TfR had better sensitivity and specificity when compared with serum iron, MCV and TIBC. However, the best sensitivity and specificity were encountered with TfR/ferritin index. Receiver operating characteristics [ROC] analysis for the different studied parameters revealed similar findings. It may be concluded that the combination between TfR and ferritin in one index can maximize the sensitivity and the specificity in the recognition of IDA