Tailored metabolic workup for urolithiasis: the debate continues

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks to years, depending upon the composition and attending risk factor. They should be targeted with concentric and tailored prevention protocols. The major urological guidelines [EAU and AUA] recommend basic stone workup for all patients. However, indication for detailed workup are less well documented, so one potential solution is to tailor metaphylaxis strategies for individual patient

In vitro and in vivo evaluation of the antiangiogenic activities of Trigonella foenum-graecum extracts

Objective To assess the antiangiogenic activity of fenugreek. Methods Different fractions of fenugreek crude extracts were prepared and their antiangiogenic properties were assessed using the ex vivo rat aortic ring assay and in vivo chicken embryo chorioallantoic membrane (CAM) assay. They were investigated for their direct cytotoxic activity in the MCF7 cells using the MTT assay. Results The ethanol extract showed 100% inhibition of blood vessel outgrowth from primary tissue explants in the rat aortic ring assay at a concentration of 100 μg/mL while the other extracts did not show significant antiangiogenic activity. The ethanol extract was therefore investigated at varying concentrations and exhibited a significant dose dependent effect. The CAM assay coincided with the results of the aortic ring assay as ethanol extract showed a significant inhibition of formation of new blood vessels. The extracts only showed anti-proliferative activity at the highest concentration of 400 μg/mL towards MCF7 breast cancer cell lines in the MTT assay. Conclusions Findings of the both assays confirmed that the ethanol extract inhibited vascularization significantly. Further studies on the ethanol extract would be beneficial in isolating the active ingredient responsible for the inhibition.

Relationship between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with urinary tract symptoms

ABSTRACT Objective: To evaluate correlation between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with lower urinary tract symptoms. Material and Methods: This is a cross sectional study conducted at a university Hospital. Sixty-seven adult male patients>50 years of age were enrolled in the study after signing an informed consent. Qmax and voided volume recorded at uroflowmetry graph and at the same time VPSS were assessed. The education level was assessed in various defined groups. Pearson correlation coefficient was computed for VPSS and Qmax. Results: Mean age was 66.1±10.1 years (median 68). The mean voided volume on uroflowmetry was 268±160mL (median 208) and the mean Qmax was 9.6±4.96mLs/sec (median 9.0). The mean VPSS score was 11.4±2.72 (11.0). In the univariate linear regression analysis there was strong negative (Pearson's) correlation between VPSS and Qmax (r=848, p<0.001). In the multiple linear regression analyses there was a significant correlation between VPSS and Qmax (β-http://www.blogapaixonadosporviagens.com.br/p/caribe.html after adjusting the effect of age, voided volume (V.V) and level of education. Multiple linear regression analysis done for independent variables and results showed that there was no significant correlation between the VPSS and independent factors including age (p=0.27), LOE (p=0.941) and V.V (p=0.082). Conclusion: There is a significant negative correlation between VPSS and Qmax. The VPSS can be used in lieu of IPSS score. Men even with limited educational background can complete VPSS without assistance.

Antimicrobial activity for excretion and secretion of the greenbottle fly larvae lucilia sericata [meigen] [diptera: calliphoridae]

Sterile larval excretion/secretion [ES] exhibited antibacterial activity against some species of bacteria. They were shown to inhibit the growth of Gram-positive bacteria Staphylococcus aureus and Bacillus subtilis Gram-negative bacteria Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae and Fungi Geotricum candidum and Aspergillus fumigatus thus exhibited limited inhibitory effect towards Gram-positive bacteria Streptococcus pyogenes and Staphylococcus epidermidis and Gram-negative Proteous vulgaris and Fungi Syncephalastrum racemosum, Candida albicans, that effect was slowed down when challenged with secretion on a solid media but no zone of complete inhibition was detected. Growth inhibiting activity was determined in liquid growth media using the Gram-positive, Gram-negative bacterial and fungal strains as indicator organisms

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

New and contemporary markers of prognosis in nonmuscle invasive urothelial cancer

Nonmuscle invasive (NMI) urothelial cancer (UC) is associated with varied biological potential. It is characterized by frequent recurrence and progression, which thus worsens the oncological outcome. Nearly three-quarters of NMI UCs recur within 5 years, whereas half can progress during follow-up. Progression is particularly seen in T1 and carcinoma in situ (CIS). Undoubtedly, NMI UC is one of the most expensive cancers to manage. The European Organisation for Research and Treatment of Cancer (EORTC) risk calculator is a commonly used tool for assessing the recurrence and progression potential of a newly diagnosed cancer. The parameters used in the assessment are tumor size and number, pathological stage and grade of the cancer, presence of CIS, and prior recurrence rate. The main advantages of the EORTC tool are its ease of use and the lack of need to run expensive molecular tests. However, reproducibility of pathologic stage and grade is modest, which is a concern to clinicians. Molecular markers have potential for predicting the clinical outcome of NMI UC, given that clinico-pathologic variables are not sufficient for prediction of prognosis in an individual. Significant work has been done in the past 2 decades in understanding the molecular biology of bladder cancer; however, the translational value of this knowledge remains poor. The role for molecular markers in predicting recurrence seems limited because multifocal disease and incomplete treatment are probably more important for recurrence than the molecular features of a resected tumor. Urinary markers have very limited value in prognostication of bladder cancer and are used (mainly as an adjunct to cytology) for detection and surveillance of urothelial cell cancer recurrence. Prediction of progression with molecular markers holds considerable promise. Nevertheless, the contemporary value of molecular markers over clinico-pathologic indexes is limited.

Prevalence and severity of plaque-induced gingivitis in a Saudi adult population

To evaluate the prevalence and severity of plaque-induced gingivitis among a Saudi adult population in Riyadh region. Three hundred and eighty-five eligible participants in this cross-sectional study were recruited from routine dental patients attending the oral diagnosis clinic at Al-Farabi College in Riyadh, Saudi Arabia from June 2013 to December 2013. A clinical examination was performed by 2 dentists to measure the gingival and plaque indices of Loe and Silness for each participant. The prevalence of gingivitis was 100% among adult subjects aged between 18-40 years old. Moreover, the mean gingival index was 1.68 +/- 0.31, which indicates a moderate gingival inflammation. In fact, males showed more severe signs of gingival inflammation compared with females [p=0.001]. In addition, the mean plaque index was 0.875 +/- 0.49, which indicates a good plaque status of the participants. Interestingly, the age was not related either to the gingival inflammation [p=0.13], or to the amount of plaque accumulation [p=0.17]. However, males were more affected than females [p=0.005]. The results of this study show that plaque accumulation is strongly associated with high prevalence of moderate to severe gingivitis among Saudi subjects

Functional and clinical outcome of ileal [studer] neo-bladder reconstruction: single centre experience from Pakistan

To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal [Studer] neo-bladder following radical cystectomy. Case series. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010. Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder [Studer type] reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients. A total of 29 patients [23 males and 6 females] with mean age of 59 +/- 12 years were included for the final analysis. The mean duration of surgery [both radical cystectomy and urinary diversion] was 520 +/- 70 minutes. Perioperative complication rate was 24% [n=7] with surgical site infection in 4 patients, sepsis in 1 patient and 2 had ureteroileal leak. At 6 months follow-up, 22 patients were fully continent while 7 patients had minimal stress / nocturnal incontinence. The continence rate was 93% [n=27] at one year follow-up. The mean capacity of neo-bladder at 6 months was 384 +/- 66 mLs. The late complication rate was 17% [n=5]. Three patients developed anastomotic stricture requiring transurethral incision of neo bladder neck, one formed stone in neo-bladder and one developed incision hernia. All patients had preserved renal functions on follow-up. The survival rate was 80% [n=23] at a median follow-up of 66.4 +/- 36 months. Two patients developed local recurrence and four developed distant metastasis. Studer ileal neo-bladder is a safe and effective option for urinary diversion in select patients with good oncological and functional outcomes comparable to contemporary literature, even in a low volume center

using of lucilia cuprina maggots in the treatment of diabetic foot wounds

In the present study, Lucilia cuprina maggots were used for the treatment of diabetic foot wounds. An artificial wound was made in diabetic foot of rabbit. The maggots were sterilized arid put directly on the wound after dressing the wound without using any antibiotics. Several cycles of maggots were put on the wound. The present results showed that the treatment of the diabetic foot was observed after 13 days. After this period the wound was completely healed and become free of microbial contamination. The new tissues were observed to close the wound

Repellent effect of lagenaria siceraria extracts against culex pipiens

Ethanolic, acetone and petroleum ether extracts from leaves and stems of Lagenaria siceraria [Cucurbitaceae] were screened for their repellency effect against Culex pipiens L. mosquito. The repellent action of the present plant extracts were varied depending on the plant parts and the dose of extract. The petroleum ether extract of leaves showed the same repellency percent [100%] of commercial formulation, N. N.'diethyl toulamide [DEBT] at the higher dose [3.33 mg/cm[2]], while petroleum ether extract from stems exhibiting the repellent action [89.6%] at the same dose, respectively. Ethanolic extracts of leaves and stems exhibited the lowest repellent activity as it recorded [81.3% and 69.1%] at [6.67 mg/cm[2]], respectively. Results of this study may contribute to design an alternative way to control mosquitoes currently based on applications of synthetic insecticides. These extracts could be developed commercially as an effective personal protection measure against mosquito bites and thus to control diseases caused by mosquito-borne pathogens

Impact of Histopathological Variant on the Outcome of Patients Treated by Radical Cystectomy

PURPOSE: It is well established that muscle-invasive urothelial carcinoma (UC) has a marked propensity for divergent differentiation, a fact that has significant diagnostic, prognostic, and therapeutic implications. This work is designed to assess the impact of different histopathologic variants of bladder cancer on morbidity and mortality in patients undergoing radical cystectomy (RC) as compared to the impact in patients with conventional UC. MATERIALS AND METHODS: We reviewed records of 201 patients treated with RC and pelvic lymph node dissections. Demographics as well as clinico-pathologic parameters, including histopathological variant, tumor stage, and nodal status, were reviewed. Multivariate analyses were used to evaluate these parameters for overall survival (OS). Kaplan-Meier curves for overall and cancer-specific survival were plotted. RESULTS: The majority of patients were male (84%), and the mean age was 61+/-13.1 years (range, 27-87 years). The mean follow-up was 67 months (range, 6-132 months). A histological variant of UC tumor was found in 19 patients (11%). The OS was 55%, and the cancer-specific survival was 35%. The histopathologic variance showed significant impact on morbidity and mortality (p=0.02 and p=0.05, respectively). Patients with divergent histopathology of bladder tumor have poorer survival than do those with UC in a multivariate analysis. CONCLUSIONS: The pathologic stages at RC and lymph node involvement are predictors for OS. Because of its aggressive nature, histopathologic variance is an independent risk factor determining the outcome in terms of both morbidity and mortality.

Effects of midgut bacteria and two protease inhibitors on the reproductive potential and midgut enzymes of culex pipiens infected with wuchereria bancrofti

Laboratory investigations were carried out to asses the effect of some proteases inhibitors on the reproductive potential of Culex pipiens females resulted from larvae treated with different protease inhibitors. The fecundity and engorgement of symbiotic and aposymbiotic C. pipiens females were significantly reduced. The blood meal digestion period increased significantly. On the other hand, enzyme band with molecular weight of 40 KDa which may be cysteine protease was detected in untreated symbiotic and aposymbiotic female midguts. The results may explain that the absence of this enzyme bands in treated female midguts may be due to the inhibition caused by [E-64] a cysteine protease inhibitor

Effects of midgut bacteria and two protease inhibitors on the transmission of wuchereria bancrofti by the mosquito vector, culex pipiens

Laboratory investigations were carried out to study the effect of two protease inhibitors on the transmission of W. bancrofti filarial by Culex pipiens and to study the susceptibility interaction between filaria and protease inhibitors. The results obtained revealed that, infection rates were variable among untreated and treated symbiotic and aposymbiotic Cx. pipiens females resulted from third instar larvae treated with E-64 and EDTA. The survival rate was variable among untreated and treated symbiotic and aposymbiotic females resulted from third instar larvae treated with E-64 and EDTA. Protease inhibitor [E-64] caused inhibition of the parasite development and transmission by means of ceasing catalytic activity- responsible for parasite migration-caused by parasitic larval stages inside the mosquito vector

Optimal Management of Lower Polar Calyceal Stone 15 to 20 mm

PURPOSE: To compare the stone clearance rate, efficiency quotient (EQ), and early complications of shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for solitary lower-pole renal stones measuring 15 to 20 mm. MATERIALS AND METHODS: This was a retrospective matched-pair analysis of 142 patients (78 in the SWL and 64 in the PCNL group). Preoperative imaging was done by use of noncontrast computed tomography (CT kidney, ureter, and bladder [KUB]), intravenous urogram, or plain X-ray and ultrasound KUB to assess the largest dimension of the stones. Only patients with radiopaque stones were included. The stone-free rates were assessed with plain X-ray and ultrasound at 4 weeks. Data were analyzed by use of SPSS ver. 19. RESULTS: The patients' demographic profiles (age, body mass index) and the stone sizes were comparable in the two groups. The mean stone size was 17.4+/-2.12 in the PCNL group compared with 17.67+/-2.04 in the SWL group (p=0.45). At 4 weeks, 83% of patients undergoing PCNL were stone-free compared with 51% in the SWL group (p<0.001). The EQ for the PCNL group was 76% compared with 44% for the SWL group (p<0.001). Ancillary procedures were required by 9% of patients in the PCNL group compared with 15% in the SWL group. The complication rate was 19% in both groups. The SWL complications were minor. CONCLUSIONS: Stone clearance from the lower pole of solitary stones sized 15 to 20 mm at the greatest diameter following SWL is poorer. These calculi can be better managed with percutaneous surgery owing to its higher efficacy and acceptably low morbidity.

Grading complication following radical cystectomy and ileal conduit for bladder cancer using clavien grading system

To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system. An analytical descriptive study. The Aga Khan University Hospital, Karachi, from 1990 to 2010. Patients who had undergone ileal conduit [IC] formation, following radical cystectomy [RC] for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system [CG]. Results were presented using descriptive statistics. Of all the RC performed at this hospital 89 patients received IC. Of them 75 were male and 14 female. Mean age was 60 years. Mean duration of hospital stay was 14 days. Ten patients each received pre-operative chemotherapy and radiotherapy, respectively. Mean duration of surgery was 8.2 hours, with mean estimated blood loss of 1334 ml. Preoperative radiotherapy was associated with more complications. No other factor like ASA, co-morbidities, blood loss or duration of stay influenced the complications. Fifty patients [56.2%] did not have any complications. Most common complication of wound infection was seen in 7 patients [CG-2], followed by uretero-ileal leakage in 5, requiring percutaneous intervention under local anaesthesia [GC-3a]. Mortality rate was 4.5%, classified as CG-V. Radical cystectomy with Ileal conduit is a major procedure with a good safety profile at this institute. Longterm follow up is still needed to evaluate delayed complications and quality of life

Life quality after video-assisted thoracoscopic thoracic sympathetic chain clipping for patients with isolated primary palmar hyperhidrosis

Video-assisted thoracic sympathectomy [VATs] is the most frequently used procedure in the treatment of primary hyperhidrosis. The objective of the present study was to assess the life quality of patients before and after VATs clipping using a specific questionnaire. Between February 2009 and September 2012, 45 patients with primary palmar hyperhidrosis admitted to King Abdulaziz University Hospital were administered a disease-specific questionnaire preoperatively and 6 months after VATs clipping of the third and fourth sympathetic chain thoracic segment [T3, 4] under general anesthesia. The mean age of the patients was 27.8 years [range 19-35]. Thirty [66.67%] patients were female, with a mean age of 27 years [range 19-35]. Fifteen [33.33%] patients were male, with a mean age of 29.3 years [range 25-34]. Six [13.33%] patients were obese and consisted of one [2.22%] male and five [11.11%] female patients. All patients were discharged on the second day, except for one who had pneumothorax [fifth day]. There was another patient with pneumothorax [2.22%], two patients with VATs port infection [4.44%], and 17 patients with compensatory hyperhidrosis [37.78%]. All domains of the specific questionnaire reported a statistically significant improvement in each domain separately [P<0.001] and in the total test score [P<0.001]. Preoperatively, 15 [33.33%] patients were in very poor [VP] health and 30 [66.67%] were in poor [P] health. Postoperatively, the condition of 17 [37.8%] patients improved considerably [of whom 12 were VP and five were P] and that of 28 [62.2%] improved but to a less extent [three were VP and 25 were P]. VATs is a straightforward, effectual, safe, and sound method for relieving the symptoms of primary palmar hyperhidrosis and improving the quality of life

Body mass index [BMI] and some hormonal changes in epileptic children receiving antiepileptic therapy

Epilepsy is a common neurological problem. It's treatment is often for years or even lifelong. The primary treatment of choice is the use of the antiepileptic drugs [AEDs]. Endocrine disorders are of major concern for clinicians who treat patients with epilepsy. This prospective hospital based study was conducted during the period from March 2008 till November 2010 at Assiut Children University Hospital. The aim of the study was to assess the effect of some antiepileptic drugs is Valproic acid, Carbmazepine or Topirmate, either monotherapy in combination on body weight and some endocrine aspects in epileptic children. The study included 62 epileptic children and 25 age and sex matched normal children as control. The cases were divided into 4 groups: [Group 1] included 22 cases on Valproic acid alone, [Group 2] included 19 cases on Valproic acid and Carbmazepine, [Group 3] included 21 cases on Valproic acid and Topirmate and control cases [Group 4]. All children were subjected to detailed medical history, full neurological examination, measurement of height, weight and body mass index [BMI], in addition to estimation of serum levels of leptin, insulin and fasting blood glucose levels. Patients treated with Valproic acid alone [group1] had significantly increased BMI and serum levels of leptin and insulin when compared with either [group3] or [group 4]. Cases on both Valproic acid and Carbmazepine [group 2] had significantly higher serum level of leptin, insulin and BMI when compared with control group [group 4].Cases on both Valproic acid and Topiramate had significantly higher serum level of insulin when compared with control group [group 4].Serum level of leptin in cases treated with Valproic acid had positive correlation with age, BMl,insulin, dose and treatment duration. Cases of obese parents had increased BMI, serum leptin and insulin when compared with cases of non obese parents. The study concluded that children receiving antiepileptic medications especially valoproic acid are at a great risk for development of obesity especially if associated with other risk factors as female sex and obese parents. Leptin and insulin serum levels should be checked regularly during treatment with antiepileptic drug therapy especially Valproic acid

Sucralfate versus omeprazole as a prophylaxis of upper gastro intestinal tract bleeding in ventilated and in critically III non-ventilated children

Upper gastrointestinal bleeding [UGITB] complications in the form of mucosal congestion, ulceration and bleeding related to stress-related mucosal disease [SRMD] will lengthen hospitalization and increase mortality intensive care unit [ICU]. Several medications were tried to prevent SRMD. to compare the efficacy of oral Sucralfate [OS] versus IV omeprazole [IVO] for prophylaxis of UGITB in mechanically ventilated and in critically ill non-ventilated patients. 10-months observational controlled study. Setting: Pediatric ICU, Pediatric Department, Tanta University Hospital Patients and Methods: 60 pediatric patients were included 30 males and 30 females. In every patient; SOFA scoring, Gastric juice aspirate samples were examined for occult blood and aspirate pH bypH meter. In 40 patients either OS or IVO was started by 3 day of admission and continued for 4 days. No UGITB prophylactic therapy was given to 20 patients [controls]. In patients receiving OS: There was insignificant decrease in gastric bleeding [GB] and increase in gastric pH in comparison to controls; and in patients after OS than before. In patients receiving IVO the unventilated patients showed significant decrease in GB cases and increase in gastric pH in comparison to controls; and in patients after IVO than before. The ventilated patients showed insignificant decrease in GB cases in comparison to controls; and in patients after IVO than before. Also, there was significant increase in pH in unventilated and ventilated IVO group in comparison to controls, and in after IVO than before. Conclusions: OS may not be the appropriate choice for SUP due to its limited effects on UGITB and gastric pH. Meanwhile, IVO reduce UGITB in a higher proportion of patients and increase gastric pH to higher levels. So, it may be the SUP drug of choice in high-risk patients

Mosquito species diversity and abundance in relation to riceland agroecosystem and filarial infection in Kafr El-Sheikh Governorate, Egypt

The present work studied the mosquitoes abundance, identification, distribution and density in three villages [rural area] and one city [urban area] in Kafr El-Sheikh Governorate namely; Kebreet, Minyat Al-Ashraaf, El-Salmia and Fowa city, respectively during the rice cultivation season in relation to filaria from June to Oct. 2009. A total of 11381 mosquitoes larvae belonging to four genera and 8 species were collected. Of which 3525 [31.0%] in Minyat Al-Ashraaf followed by 3339 [29.3%] in Kebreet, 3331 [29.3%] in El-Salmia villages compared with 1186 [10.4%] in Fowa city. The five most common species collected during this study were Culex pipiens [39.2%], Cx. antennatus [27.3%], Cx. univittatus [15.8%], Anopheles pharoensis [10.4%], and An. coustani[3.8%]. The mosquito species diversity [H] and evenness [EH] in the [rice cultivated areas] Minyat Al-Ashraf, Kebreet and El-Salmia villages [H = 1.286, EH= 0.829; H= 1.227, EH= 0.742; H= 1.110, EH=0.882; respectively] were much higher than in the Fowa city [non rice cultivated area] [H= 0.718, EH= 0.608]. On the other hand, the highest diversity and density of adult mosquitoes species obtained from Minyat Al-Ashraaf were 5 species and [33.8%], followed by Kebreet 5 species and [31.6%], El-Salmia 4 species and [24.5%], respectively compared with 3 species and [10.1%] in Fowa city. Cx. pipiens adults were the predominant species, in all filarial indicator areas [68.1, 53.4, 40.8 and 20.8 mosquitoes/room] in Minyat Al-Ashraaf, Kebreet, El-Salmia villages and Fowa city, respectively. Cx. pipiens was the only species to cany infective larvae as well as other stages, while Cx. antennatus carried immature stages only [not infective]. Filarial larvae in Cx. pipiens and Cx. antennatus were found only in Minyat Al-Ashraaf and Kebreet villages. It is inferred from the data that different levels of habitat with regard to rice cultivation have different effects on mosquito diversity and abundance. Also, our study revealed that filarial vectors Cx pipiens and Cx. antennatus had a wide distribution and high relative density especially in irrigated rice regions and hence its role in disease transmission in Kafr El-Sheikh region needs further investigation