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Background: overactive bladder [OAB] also referred to as the urgency-frequency syndrome, with or without urge urinary incontinence can considerably impair the patient's quality of life. It is widely accepted that diet and life style modifications, behavioral therapy and medication belong to the standard conservative therapeutic options and considered as the first-line measures. The International Consultation on Incontinence [ICI] guidelines reported that when the first line approach is not fully satisfactory or fails after 8-12 weeks, alternative therapies should be sought out. It is worthwhile and justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the treatment is contraindicated. Second-line of therapies include less-invasive measures such as percutaneous posterior tibial neve stimulation, sacral neuromodulation, detrusor injections with botulinum toxin [BTX] and whereas more-invasive measures constitute surgical techniques e.g. bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today an established treatment option for patients refractory to or intolerant of conservative treatments
Objective: this study aimed to compare between the efficacy of continuous anticholinergic therapy and intermitted anticholinergic therapy for treatment of the overactive bladder
Patients and Methods: our study included 60 patients categorized into two groups: continuous anticholinergic therapy group and intermitted anticholinergic therapy. By using 12 weekly intermitted anticholinergic therapies, remarkable clinical results were obtained. Percent of the patients who complained OAB in the intermitted anticholinergic group reported a statistically significant subjective success. These patients chose to continue treatment to maintain the response
Results: patients in the intermitted anticholinergic therapy group showed significant improvement of frequency [31%] urgency [50%] urge incontinence [50%] and nocturia [53%] compared to propiverine group frequency [50%] urgency [60%] urge incontinence [67%] and nocturia [67%]. No serious side effects were reported, in group A 8 patients had horm of dry mouth in 5 cases [16.7%], constipation in 2 cases [67%] 8 blurred vision in one case [33%]. In group B, there were 5 patients [16.7%] in the horm of dry mouth in 3 cases [10% constipation in one case [3.3] and blurred vision in one case [3.3%]
Conclusion: our study concluded that intermittent anticholinergic therapy induced improvement of bladder over activity symptoms and less side effects than continuous anticholinergic group
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Background: worldwide, breast cancer is the most common malignancy among women and there is a deep need for precise novel methodologies for breast cancer [BC] diagnosis. Major advances in cancer control will be successfully achieved with early cancer detection. So, recent trends are going toward using circulating non-coding RNA as diagnostic tool for their critical role in cancer detection
Aim: retrieve non coding RNA that is mechanistically linked to breast cancer stem cell with validation of the results in a group of breast cancer patients versus control groups to evaluate their usefulness as a potential biomarker in breast cancer diagnosis
Patients and Methods: we retrieved LncRNA that is linked to stem cell differentiation and specific to BC utilizing bioinformatics tools. Then we validated this biomarker in serum of 30 patients with BC, 12 patients with benign breast lesion and 12 healthy volunteers using RT-qPCR. We evaluate the power of diagnosis of the serum profiling system using ROC curve analysis
Results: hoxd antisense growth-associated long non coding RNA [HAGLR] had great sensitivity and specificity for differentiating BC from patients with benign breast lesion and also from healthy controls
Conclusion: the chosen circulatory RNA based biomarker can be used as a potential diagnostic biomarker for BC. In addition it could be therapeutic target
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Background: Doppler ultrasound velocimetry foetal vessels have become established method of antenatal monitoring, allowing non-invasive assessment of foetal circulation
Aims: To determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio [C/U] evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies from 36 to 40 weeks
Subjects and Methods: this is prospective study include 300 uncomplicated pregnant women, age ranged from 17 to 45 years, with gestational age 36 to 40 weeks
Results: there was significant relation between CPR and adverse neonatal outcome p-value <0.001 with sensitivity, specificity and PPV, NPPV of CPR in detecting neonatal adverse outcome 100%
Conclusion: better prediction of neonatal outcome can be done by C/U ratio
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Background: Endotracheal intubation is the prominent cause of airway mucosal injury which results in postoperative sore throat [POST], with an incidence of 21%65%. Although this complication is minor, if left unresolved, it produces significant agony and annoyance to the patient
Aim of the Work: to compare efficacy of magnesium/ nebulizer versus ketamine nebulizer in decreasing postoperative sore throat incidence, severity and duration with fixed endotracheal tube intra cuff pressure at or below 20 cm H2O using handheld tracheal cuff pressure monitor in adults ASA [American Society of Anesthesiologists] I-II in 20-60 years age group of either sex in operations less than 2 hours
Methodology: our study included 90 adult patients, status I-II [ASA I-II] in the age group 20-60 years, of either sex undergoing operation under general anesthesia [GA] scheduled for a day case surgery and operation time less than 2 hours with fixation of endotracheal tube cuff at 20 cm H2O using hand held tracheal cuff pressure monitor [Pressure Gauge] and checked every half hour till end of surgery and maintained at or below 20 cm H2O
Results: Our study showed reduction in POST incidence and severity after preoperative magnesium sulfate nebulization in all time points 0, 2, 4, 8, 12 and 24 hours postoperative, so it was proved that magnesium nebulizer has great role in reduction of incidence, severity and duration of POST
Conclusion: we concluded that preoperative magnesium sulfate nebulization reduce incidence and severity of POST and it is more effective than preoperative ketamine nebulization
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Background: the provision of obstetric and neonatal care, as well as the public health monitoring of pregnancy outcomes, relies upon the accurate determination of gestational age. Uncertain gestational age has been associated with adverse pregnancy outcomes including low birth weight, preterm delivery and perinatal mortality, independent of maternal characteristics. Many patients in Egypt due to socio-economic reasons come for their first antenatal visit in the third trimester. Most of them are uneducated and come from remote areas. Also, many being lactating mothers are unsure of their LMP or have irregular cycles. Because of non availability of any dating scans or earlier ultrasound and uncertainty in LMP, it becomes very difficult to calculate their due dates, so many pregnancies considered to be preterm or posterm were wrongly classified. The use of ultrasonography has significantly improved evaluation of fetal growth and development and had permitted prenatal diagnosis of a variety of congenital malformations. Ultrasonographic fetal biometry is highly reliable in the first and second trimester of pregnancy, but reliability of any ultrasound method greatly diminishes as gestational age advances, in the third trimester, reliability of any single ultrasound parameter alone is poor without correlation with other parameters
Objective: in our study, TCD was compared to FL and BPD in accuracy of assessment of gestational age in the third trimester of pregnancy. We correlated between the three parameters, Transcerebellar [TCD] and Biparietal diameter [BPD] and Femur length [FL], for accurate determination of gestational age in third trimester of pregnancy
Methods: a total of 200 pregnant women in the third trimester pregnancy was assessed in this observational study in Department of Obstetrics and Gynecology, Damietta Hospital, Al-Azhar University [Outpatient] by two-dimensional ultrasound to assess the accurate method for assessment of gestational age in the third trimester of pregnancy. Examinations were performed after a verbal consent from the patient with the patient lying in the dorsal supine position. Two dimensional ultrasounds were carried out. Fetal biometry and amniotic fluid volume were assessed. All women included in this study were subjected to history taking and clinical examination
Results: we found that out of 200 patients, TCD gave correct assessment of gestational age within 3 days in 118 patients [59%] and within 1 week in 180 patients [90%]. While, FL gave correct assessment of gestational age within 3 days in 92 patients [46%] and within 1 week in 160 patients [80%]. The least accurate was BPD that gave correct assessment of gestational age within 3 days in 59 patients [29.5%] and within 1 week in 120 patients [60%]
Conclusion: from this study, we concluded that TCD was the most accurate method for assessment of gestational age in the third trimester followed by FL and the least accurate was the BPD. Also, by combining accuracy of TCD [90%] and that of FL [80%] we can be near certain of gestational age in most of our patients even if they are unsure of their dates
Recommendations: measuring TCD as routine in the third trimester as it has the same accuracy as the current fetal biometry [BPD and FL]
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Background: IL-17 plays a major protective role against fungal infection in mice and humans. Genetic defects involving IL-17 increase the susceptibility to candidiasis
Objective: This study aimed at assessing the association between serum Interleukin-17A [IL17A] and candida infection in Intensive Care Unit patients with candidemia versus non-candidemic patients
Methodology: 90 individuals were included; 60 ICU patients, divided into 2 groups; group1: 30 patients with Candidemia, group 2: 30 patients with Candida in sputum and/or urine samples and 30 apparently healthy as a control group. All enrolled individuals underwent history taking, physical examination, laboratory assessment for Candida albicans infection and serum IL-17A
Results: IL17A level was significantly high among candidemia group [0.24 +/-0.10 pg/ml] followed by group of candida in urine and sputum [0.08 +/- 0.02 pg/ml] [P-value <0.001]
Conclusion:There was an association between IL-17A levels and candidemia suggesting its predictive value for a forthcoming invasive candidiasis
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Background: Bacterial vaginosis [BV] is a relatively complex yet extremely common condition characterized by alteration of the vaginal ecology in which the normal flora, dominated by lactobacilli, is replaced by a mixed bacterial flora. BV is associated with adverse pregnancy outcome, increased risk for pelvic inflammatory disease and abnormal cervical cytology. BV can be treated with antibiotics such as metronidazole or clindamycin, either orally or vaginally. However, there is usually a high rate of recurrence. Probiotics are defined as live micro-organisms which, when administered in an adequate amount, confer a health benefit on the host. The aim of this study was to investigate the efficacy of vaginally administered Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 as probiotics in comparison to the standard oral metronidazole therapy in the treatment of symptomatic bacterial vaginosis
Patients and Methods: The study enrolled 60 women with BV. They were divided into two groups: Group [1] included 30 patients who received oral metronidazole tablets 500mg twice daily for one week and placebo vaginal capsules twice daily for five days. Group [II]: included 30 patients who received oral placebo tablets twice daily for one week and vaginal capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14] twice daily for five days. All participants were evaluated before initiation of treatment then 1 and 4 weeks thereafter. Follow up was based on clinical improvement, pH of vagina, whiff test, absence of clue cells in vaginal smears and Nugent score which is considered the standard for research
Results: After 4 weeks of follow up, the probiotic group had a significantly higher cure rate of BV [88%] than the metronidazole group [51%] [p = 0.01]. In addition, according to the Gram-stain Nugent score more women were assessed with "normal: vaginal micrbiota in the Probiotic group both after 1 week [p=0.05] and after 4 weeks [p=0.01]. Relapse was higher in the metronidazole treated group [4 out of 29 cases, who completed the study accounting for 13.8%] while there was no relapse in the probiotic treated group. Failure of cure was higher in metronidazole treated group [10 cases accounting for 34.4%] than probiotic treated group [3 cases accounting for 12%]
Conclusion: The results of the present study showed that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, taken vaginally, were effective in treatment, relapse prevention and normalization of the vaginal flora in women with bacterial vaginosis for which we recommend the use of Probiotics as an effective treatment option. Furthermore, testing sensitivity of isolates of BV for metronidazole resistance is recommended to find reasons of less efficacious metronidazole treatment
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Nitric oxide was recognized as a key signaling molecule in a wide variety of biological functions, and NO research affects all branches of medicine. In the lung, NO acts as a vasodilator, bronchodilator and non-adrenergic non-cholinergic [NANC] neurotransmitter and is an important mediator of the inflammatory response. Nitric oxide is formed in the lungs and the presence of NO has been detected in the exhaled air of several species, including humans. The aim of the present work to evaluate the validity of exhaled nitrite and nitrate level in exhaled breath condensate in evaluating cases of controlled asthma. The study included 61 subjects: 49 controlled asthmatic patients and 12 control subjects All subjects in the present study were subjected to spirometric study, collection of exhaled breath condensate, breath condensate analysis using nitrite assays, pH measurement. The asthmatic group was further subdivided into two groups: [group I a] including 34 patients receiving anti inflammatory treatment [inhaled corticosteroid] and [group I b] including 15 patients receiving bronchodilators [Beta 2 agonist or theophylline]. Exhaled nitric oxide end product level was significantly higher in asthmatic patients than in control subjects. Asthmatic patients receiving inhaled corticosteroid therapy had a significantly lower exhaled nitric oxide end product level than the others .Breath condensate pH was significantly lower in asthmatic patients than in control subjects. Asthmatic patients receiving inhaled corticosteroid therapy had a significantly higher breath condensate pH than the other patients. Exhaled nitric oxide end product and breath condensate pH reflect the degree of airway inflammation and airway obstruction in stable asthmatic patients. Hence, they could both provide a valuable tool for early disease management and prevention
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Humanos , Masculino , Feminino , Expiração , Óxido Nítrico , Testes de Função Respiratória , Estudo de ValidaçãoRESUMO
Training needs assessment is essential for planning educational activities for head nurses. This study aim was to identify managerial training needs assessment for head nurses working at ministry of health hospital. This was to be achieved through assessment of the points of view of head nurses. The study was conducted on 139 head nurses working in l4 general hospitals affiliated to the ministry of health in 14 govemorates in Egypt. Data collection was done through a self-administered questionnaire to assess training needs in administrative and managerial tasks, as well as their preferences for training. The results demonstrated that only 39.6% of the head nurses attended training courses in administration. There was a high agreement upon all head nurses tasks proposed. The training topics mostly needed were time management [65.5%] and informatics [64.0%]. Half or more of the head nurses preferred five courses per year, with seven days duration, five daily working hours, during work time, and out side the workplace, with pre-post testing, and nomination for courses to be based on pre-set criteria, and the lecture was the most preferred teaching method. These preferences differ among different governorates and according to head nurse qualification. Therefore it is recommended to develop a plan for training nurse managers in administration and management, taking into account their expressed needs and preferences. Periodic assessment of training needs should be conducted to update needs and preferences
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Humanos , Feminino , Supervisão de Enfermagem/organização & administração , Hospitais Públicos , Avaliação das Necessidades , Inquéritos e QuestionáriosRESUMO
The present study was conducted to sixty children [38 male and 22 female] with an average age eight years. Hemoglobin [Hb] was used to assess anemia. Iron deficiency anemic children were determined in a convenience sample of children aged 12-36 month from low-income families who were attending the out-patient clinic of Kasr Al-Aini hospital with iron deficiency anemia [IDA]. Twenty normal children were chosen as a control group. This study aimed to evaluate the changes induced in the electrical and magnetic properties of Hb in IDA. Oscillator strength, magnetic susceptibility, electrical conductivity, concentrations of some trace elements [Zn, Cu, Fe, Pb and Ph], serum ferritin, transferrin and adcnosine triphosphate [ATP] as well as superoxide dismutase [SOD] activity were measured. Results showed increase in hemoglobin electrical conductivity, serum ferritin either in male or female and concentrations of cupper and phosphorus. An increase in the molar magnetic susceptibility of Hb of the IDA patients was observed, when compared to control subjects. ATP, serum transferrin and iron concentrations were decreased in IDA patients. It was concluded that iron deficiency anemia affect the spin state of heme iron and the tertiary structure of hemoglobin and altering the hydrophobic/hydrophilic ratio on the hemoglobin molecule surface
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Humanos , Masculino , Feminino , Hemoglobinas , Oligoelementos , Ferritinas/sangue , Transferrina , Trifosfato de Adenosina , Superóxido Dismutase , Condutividade Elétrica , MagnetismoRESUMO
Background and Purpose: Clostridium difficile [C. difficile] is the most common cause of nosocomial acquired, antibiotic-associated diarrhea [AAD], that's called Clostridium difficile associated disease [CDAD]. This organism causes about 20% of the cases of AAD, up to 75% of the cases of antibiotic-associated colitis, and virtually all the cases of pseudomembranous colitis [PMC]
Patients and Methods: Sixty isolates were collected; all had been obtained from hospitalized patients under antibiotic therapy. Clostridium difficile associated diarrhea was defined as the presence of diarrhea >/=6 watery stools in a 36 hours period in a patient with a positive stool culture or a positive cytotoxin assay. Primary cultures were done on selective medium for C. difficile, cefoxitin-cycloserine fructose agar [CCFA]. C. difficile isolates were presumptively identified by their colony morphology. Additional biochemical tests were also used. API A TB 32A Rapid ID Anaerobe Identification Kit was also used for confirmation of the biological identification. Gas liquid chromatography [GLC] was used to detennine the volatile fatty acids produced by the growth of the organisms. Production of C. difficile toxin A [TcdA] is determined by the ToxA TEST immuno assay. The presence of C. difficile toxin B was determined by demonstrating a specific cytopathic effect on MRC-5 cells. Using HindIII restriction endonuclease did DNA extraction, PCR amplification and restriction endonuclease analysis. The pattern of each isolate was visually compared with the patterns of the previously identified REA groups in a well-characterized REA patterns library. Most patients were treated for respiratory tract infections [48% of cases] either lower [17 = 28%] or upper [12 = 20%]
Results: Patients treated by a combination of antibiotics formed 35% [25/60] of cases, 2 or 3 or 4 antibiotics. Cephalexin was associated with the highest incidence of CDAD [12=20%]. Clindamycin and amoxicillin formed 11 cases [= 18%]. The majority of COAD cases developed after 6-9 days use of antibiotics [45 patients = 75%]. Screening the isolates for sensitivity to metronidazole using E-test showed that, MIC50 [= 0.125 micro g/mL] and MIC90 [= 1 micro g/mL]. Only 2 isolates [= 3.033%] were inhibited at MIC = 16 micro g/mL and these isolates are identified as resistant strains [MIC >/=16 micro g/mL]
Conclusion: From this study we can ensure that CDAD is a serious problem caused by the use of broad-spectrum antibiotics for long periods especially in old age group of patients. Also we can conclude the high sensitivity of C. difficile to metronidazole; in spite of the recently emerging and rapidly expanding problem of resistance, which is still in need for further research work to be justified
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The present study was performed to investigate the possible correlation between the effects of candesartan cilexetil [3 mg/kg b.w.] and garlic; allium sativum [100 mg/kg b.w.] alone and in combination on high cholesterol diet [HCD] male mice. Candesartan cilexetil alone and their combination with garlic were given orally to animals fed on hypercholesterolemic diet by gavage for 12 weeks . Results of this investigation showed that animals under high cholesterol diet exhibited some sort of changes in the blood, plasma and tissue levels of leukocytes,cholesterol, triglyceride and enzymes where they increased significantly while some decrease exhibited in heart weight, LDH-cholesterol and testosterone hormone compared with that of the normal diet animals. Candesartan cilexetil garlic or their combination significantly decreased the plasma and tissue levels of total cholesterol [TC], triglyceride [TG], while they increased significantly the levels of high density lipoprotein cholesterol [HDL-C]. On the contrary, candesartan and candesartan in combination with garlic decrease WBCs, neutrophils and platelets significantly in compared with that of the [HCD] animals. This study included the total body and heart weights. Heart weight increased significantly in candesartan, garlic and their combination treated group. On the other hand, there were significantly decreases in body weight in candesartan, garlic and their combination compared with that of the high cholesterol diet treated animals. The effect of candesartan, garlic and their combination upon serum and liver levels of ALP, AST, ALT and ChE enzymes were investigated. Serum and liver ALP, AST, ALT and ChE were increased significantly in candesartan treated group but they decreased markedly in garlic and its combination with candesartan in serum and liver respectively compared with that of the high cholesterol diet animals. Candesartan decreased plasma level of testosterone while garlic and its combination with candesartan increased the testosterone hormone significantly compared with that of the high cholesterol diet animals. In conclusion, animals given garlic have improved physiological functions and induced significant causes of antiatherosclerosis effect. Also, these observations show that garlic is efficacious in lowering blood lipid profiles and thereby could maintain protection with hypertensive drugs
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The purpose of this study was to characterize intestinal permeability changes over a range of physiologically relevant intestinal injury. The experiments were performed in 80 rats subdivided into four groups as aspirin [400 mg/kg b.w.], gum Acacia [1g./day] and aspirin with gum Acacia groups for 21 days compared with control group. Relative reabsorption of L- Histidine was greater [p<0.001] in the aspirin in 10 min of incubation compared with that of the control rats. In aspirin in combination with gum Acacia, the relative reabsorption were significantly [p<0.001] decrease in 10, 20 and 30 min. of incubation compared with that of the control rats. Moreover, the relative reabsorption of L-histidine was significantly [p<0.01] reduced by the aspirin at 45 min of time of the incubation buffer compared with that of the control. However, gum acacia treatment was increased at 10 min [p<0.01], 30 min [p<0.01] and 45 min [p<0.001] respectively compared with that of the control rats. Relative reabsorption of L-histidine record a nonsignificant increase of aspirin at 20 min and 30 min of incubation compared with that of the control. Gum and aspirin with gum at 20min and 45min of incubation resulted an increase and decrease in relative reabsorption of L-histidine respectively compared with that of the control. Aspirin and aspirin in combination with gum acacia treatment increased body, intestinal weights and mucosal total protein significantly with percent changes ranged from 8% to 40% compared with that of the control. On the other hand, gum treatment decreased body, intestinal weights and mucosal total protein significantly with percent changes ranged from 8% to 35% compared with that of the control. These results demonstrated that L-histidine is actively taken up by a gum Acacia system in intestinal everted sac mechanism of rat with energy supplied by glucose and Na+in incubation buffer. Moreover, aspirin system had an inhibitory effect on L-histidine uptake in 45 min of incubation, indicating the saturation by L-histidine in first ten minuts of incubation. Also, these results provide evidence the uptake of L-histidine into rat intestine was not reduced at all by the treatment of aspirin. These results suggest that the uptake of L-histidine by intestinal everted sac of rat has different characteristics of aspirin with gum compared with that of the control in respect to relative reabsorption of L- histidine
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Dynamic balance, which is vital for all dynamic activities, could be affected by various parameters of back dysfunction. To find if there is a difference in dynamic balance responses between chronic mechanical low back pain [CMLBP] patients and normal subjects. Twenty normal volunteers and twenty CMLI3P patients of moderate disability participated in this study. Medio-lateral [ML] and antero-posterior [AP] stability indices were measured in five dynamic balance conditions using Biodex stability system designed to qualify dynamic balance. AP stability indices were significantly greater in all the five tested conditions in the CMLBP patients as compared to healthy subjects. ML stability indices were significantly greater in CMLBP patients in all the tested conditions except with single foot. Patients with CMLBP, in contrast to healthy subjects, demonstrated a significantly reduced dynamic balance measurements in nearly all the five tested conditions. These impaired balance responses may constitute a predisposing factor to low back injuries and recurrent pain episodes