Power walking based outpatient cardiac rehabilitation in patients with post-coronary angioplasty: Randomized control trial.

PURPOSE: The purpose of this trial was to compare the effectiveness of standardized outpatient cardiac rehabilitation combined with treadmill power walking versus standardized outpatient cardiac rehabilitation alone on health-related quality of life (HQoL), functional exercise capacity (FEC), left ventricular ejection fraction (LVEF) and metabolic equivalent of tasks (METs) in patients who went post coronary angioplasty (CA). Further this study evaluated the association between average numbers of steps taken with above clinical outcomes. METHODS: In a pragmatic sequential randomized clinical trial, 24 patients were randomized into two groups (n = 12) and participated in a standardized outpatient cardiac rehabilitation program (SOCRP) with treadmill power walking as an intervention group and SOCRP alone in control group. Scores obtained before and after 4 weeks of intervention, that is, after 12 treatment sessions were assessed using a HQoL questionnaire and 6-min walk test (6 MWT). Average number of steps taken throughout the 4 weeks, METs and LVEF values were obtained by pedometer, exercise stress testing and echocardiogram respectively. RESULTS: Significant improvements were found in intergroup and intragroup comparison after 4 weeks of cardiac rehabilitation (p < 0.05). Scores of 6 MWT and LVEF significantly improved in the intervention group (p < 0.003) compared to the control group (p < 0.032). HQoL components that is, global and physical, MET values and average number of steps were significantly higher in the intervention group compared to the control group (p < 0.001). CONCLUSION: SOCRP with power walking was more effective in improving HQoL, FEC, LVEF, METs and average numbers of steps than SOCRP alone although both interventions were significant after 4 weeks in patients underwent CA and completed cardiac rehabilitation program. Positive significant associations were found between the average number of steps taken with scores of METs and scores of global and physical domains of HQoL.

Reconstructive Surgery for Mycetoma: Is There a Need to Establish an Algorithm?

BACKGROUND: Mycetoma is a chronic, progressive, disfiguring, and destructive disease. It caused by a variety of microorganisms including fungi and higher bacteria. It is primarily an infection of the skin and soft tissue, most frequently affecting the lower extremity and the hand and spread through fascial planes and lymphatics. METHODS: Current medical and surgical management are still inadequate and the recurrence rate is high with severe disabilities. RESULTS: This review describes some reconstructive techniques that were performed to address essential aspects with regard to mycetoma surgical management that include coverage of large skin and soft-tissue defects left after local excisions, enhancing the rate of chronic mycetoma wound healing, and preservation or restoration of functional status of the affected limbs. CONCLUSION: These applied techniques-which had acceptable preliminary outcome-have to be considered by the surgeons dealing with mycetoma to improve the functional and cosmetic outcomes and to minimize tremendous morbidities and disabilities that are associated with this neglected disease.

Congenital heart disease in a cohort of Sudanese patients with cleft defects

Background and objectives:Cleft defects are among the most visible congenital defects worldwide and congenital heart disease (CHD)being one of the most common associated anomalies. This study aimed to assess the prevalence of CHD among a cohort of Sudanese patients with cleft lip and/or palate.Patients and Methods:All patients who presented to Soba University Hospital with cleft lip and/or palate from March 2009 toMarch 2015 were included.Results:Out of 381 patients included; 168 patients (44%) had cleft lip and palate (CLP), 156 (41%) had cleft lip (CL)and isolated cleft palate (CP) was found in 57 patients (15%). Facial dysmorphic features were identified in 57 (15%) and cardiac defects in 42 (11%) patients. Ventricular septal defect (VSD) was diagnosed in 16 patients (38%), and ASD in 12 (30.9%). Other macroscopic anomalies were identified in 57 patients (15%)and were associated with CHD (P<0.001). Significant association was found between the type of cleft andCHD (P<0.002), as cardiac defects were maximally observed among CP cases (21%) followed by CLP cases (13%) then CL cases (5.12%). Significant association was also found between facial dysmorphicoccurrence and CHD (P < 0.001).Conclusion:CHD is a common anomaly in cleft population. The pattern of CHD is consistent with the literature withVSD being the most frequent. The cardiac defects are most prevalent in CP group. Echocardiography isjustified for screening of CHD due to the relatively higher incidence of CHD among clefts patients than ingeneral population

Congenital heart disease in a cohort of Sudanese patients with cleft defects

Background and objectives: Cleft defects are among the most visible congenital defects worldwide and congenital heart disease (CHD) being one of the most common associated anomalies. This study aimed to assess the prevalence of CHD among a cohort of Sudanese patients with cleft lip and/or palate. Patients and Methods: All patients who presented to Soba University Hospital with cleft lip and/or palate from March 2009 to March 2015 were included. Results:Out of 381 patients included; 168 patients (44%) had cleft lip and palate (CLP), 156 (41%) had cleft lip (CL) and isolated cleft palate (CP) was found in 57 patients (15%). Facial dysmorphic features were identified in 57 (15%) and cardiac defects in 42 (11%) patients. Ventricular septal defect (VSD) was diagnosed in 16 patients (38%), and ASD in 12 (30.9%). Other macroscopic anomalies were identified in 57 patients (15%) and were associated with CHD (P<0.001). Significant association was found between the type of cleft and CHD (P<0.002), as cardiac defects were maximally observed among CP cases (21%) followed by CLP cases (13%) then CL cases (5.12%). Significant association was also found between facial dysmorphic occurrence and CHD (P < 0.001). Conclusion: CHD is a common anomaly in cleft population. The pattern of CHD is consistent with the literature with VSD being the most frequent. The cardiac defects are most prevalent in CP group. Echocardiography is justified for screening of CHD due to the relatively higher incidence of CHD among clefts patients than in general population

Effect of sperm chromatin condensation on the outcome of intrauterine insemination in patients with male factor infertility.

OBJECTIVE: To study the effect of sperm nuclear chromatin condensation on pregnancy rates and rates of abortion in infertile couples with male factor infertility undergoing intrauterine insemination. STUDY DESIGN: A total of 195 infertile couples with male factor infertility undergoing intrauterine insemination (IUI) were included in this prospective study. They were divided into two groups according to sperm chromatin staining by aniline blue stain. The first group included 109 patients having a positive aniline blue staining in < 30% of sperm. The second group included 86 infertile couples in whom > or = 30% spermatozoa were positively stained. All cases were assessed clinically and underwent semen analysis and assessment of chromatin condensation by aniline blue staining. IUI with the partner's sperm was done after semen processing and induction of ovulation; pregnancy rate and rate of abortion were recorded. RESULTS: The pregnancy rate in the first group was 21.6% (24/111), and abortions occurred in 29.2% (6/24). In the second group the pregnancy rate was 18.6% (16/84) and abortions occurred in 56.3% (9/16). There was no statistically significant difference in pregnancy rate between the two groups, while the rate of abortion increased with increased sperm chromatin decondensation. CONCLUSION: Our study concluded that sperm chromatin condensation has no effect on the pregnancy rate, but it has a profound effect on fertilization failure after IUI, therefore assessment of sperm chromatin condensation may be useful as a predictive test for successful pregnancy after intrauterine insemination.