One week stenting after pediatric laparoscopic pyeloplasty; is it enough?

INTRODUCTION: The use of ureteric stents for urinary diversion after pediatric dismembered pyeloplasty and its duration remain debatable. Classically, an indwelling Double J ureteric stent has to be left for 4-6 weeks. However, such a duration is not free of stent-related complications, in addition to the need to remove it under general anesthesia in the pediatric age group. OBJECTIVES: This study aims to evaluate the outcome of short-term stenting after laparoscopic pyeloplasty in pediatric sector. METHODS: A prospective randomized study of 37 children (less than 16 years-old) with pelvi-ureteric junction obstruction (PUJO) were managed by laparoscopic pyeloplasty by the same surgeon in the period between April 2015 and September 2017. In group A (18 patients), the DJ was removed after 4 weeks under general anesthesia, while in group B (19 patients), the DJ was fixed to the urethral catheter by a stitch, and it was removed with the urethral catheter after one week in the outpatient office. All patients were followed regularly for symptomatic improvement. Urine culture and sensitivity was done 1 month postoperatively. Abdominal ultrasound was done at 3, 6, 12 months and annually thereafter, while renal isotope scanning was done after 6 months. RESULTS: There were no significant differences between both groups regarding operative duration, postoperative leakage, hospital stay, early postoperative complications. Both groups improved after pyeloplasty with no significant differences regarding symptoms, follow-up ultrasound, and renal scanning. The incidence of irritative symptoms and need for anticholinergics after catheter removal as well as urinary tract infection after 1 month were significantly higher in group A (P-value: 0.004 and 0.029, respectively) (Table). DISCUSSION: To the authors knowledge, this is the first prospective controlled randomized study comparing short-term stenting with the classic 4 weeks stenting after laparoscopic pyeloplasty in the pediatric age group. In addition, the used technique of stenting not only allows stent removal on outpatient basis without anesthesia but also benefits from the pre-operative retrograde study so as not to miss any associated pathology in the ureter. CONCLUSION: Short-term ureteric stenting after laparoscopic pyeloplasty in pediatric age group is safe and not inferior to the standard 4-week stenting. It also avoids the stent-related complications.

Comprehensive evaluation of grafting the preservable narrow plates with consideration of native plate width at primary hypospadias surgery.

INTRODUCTION: Dorsal inlay graft urethroplasty using inner-face preputial graft was described as an adjunct method to the classic tubularized incised plate (TIP) urethroplasty, aiming at reducing the risk of neourethral stenosis. OBJECTIVES: To evaluate the impact of dorsal inlay grafting of preservable narrow plates, in relation to native plate width. METHODS: Consecutive children with penile hypospadias with narrow plate (width < 8 mm) were evaluated prospectively between Jan 2014 and Jun 2018. Included cases were stratified into two groups: group A (plate width: 4 to <8 mm) and group B (plate width: < 4 mm). All cases were approached by TIP urethroplasty, with dorsal inlay grafting (inner-face prepuce). Cases with significant chordee (non-preservable plates), circumcised cases, and redo cases were excluded. RESULTS: A total of 104 hypospadias cases with narrow plates were included in this study. Among group A (n = 81), the need for postrepair urethral dilations was reported in two cases (2.5%) vs seven cases (30%) in group B (n = 23) (P-value < 0.001). Another two cases (2.5%) in group A developed urethrocutaneous fistulae vs three cases (13%) in group B (P-value = 0.0624). Surgical repair of the reported five cases with fistulae, revealed an ample neourethral wall; disclosing well-taken grafts in both groups. DISCUSSION: Few published studies evaluated grafting the incised plate in penile hypospadias. To the authors knowledge, this is the first study that selectively evaluated the impact of grafting narrow plates in relation to its native pre-incision width. CONCLUSIONS: According to the presented authors' experience, 4 mm width is the border line of clinical relevance that defines poor urethral plate. Grafting that plate failed to compensate for its native poor characteristics; however, it offered a valuable neourethral wall that proved indispensable when redo surgery deemed necessary, without adding grafting-related problems. Nevertheless, further extended comparative studies came across as a necessity to verify the long-term outcomes of grafting the incised poor plates.

Use of holmium laser for urethral strictures in pediatrics: A prospective study.

INTRODUCTION: The management of urethral strictures is very challenging and requires the wide expertise of different treatment modalities ranging from endoscopic procedures to open surgical interventions. OBJECTIVE: To assess the effectiveness and complications of retrograde endoscopic holmium: yttrium-aluminum-garnet laser (Ho: YAG) urethrotomy (HLU) for the treatment of pediatric urethral strictures. PATIENTS AND METHODS: From January 2010 to January 2013, 29 male pediatric patients with a mean age of 5.9 years and primary urethral strictures 0.5-2 cm long were treated using HLU. The stricture length was <1 cm in 16 (55%) patients and >1 cm in 13 (45%). Fifteen (51.7%) patients had an anterior urethral stricture, while 14 (48.3%) had a posterior urethral stricture. No positive history was found in 14 (48.3%) patients for the stricture disease, while six (20.7%) had straddle trauma and nine (31%) had an iatrogenic stricture. All of the patients were pre-operatively investigated and at 3 and 6 months postoperation by uroflowmetry and voiding cystourethrography (VCUG). If there were suspicious voiding symptoms, selective uroflowmetry and VCUG were performed at 12 months postoperation. RESULTS: The mean operation time was 31.7 min (20-45 min). Twenty-three (79.3%) and 18 (62.1%) patients showed normal urethra on VCUG with improvement of symptoms at 3 and 6 months, respectively. Thus, recurrence was 37.9% after 6 months of follow-up. The mean pre-operative peak urinary flow rate (Qmax) was 6.47 ml/s. The mean postoperative Qmax at 3 and 6 months was 17.17 ml/s and 15.35 ml/s, respectively. The success rate and flowmetry results did not show any statistical significance in relation to site, length and cause of the strictures. The other 11 patients who failed to improve underwent repeated HLU sessions: 4/11 (36.3%) achieved successful outcomes. Among the seven patients with failed HLU for the second time, a third session was conducted. However, only one patient (14.2%) was cured, while open repair was needed for the remaining six. DISCUSSION: One study has previously been published on the management of pediatric urethral strictures using HLU. The present results are similar to short-term studies after a single session of visual internal urethrotomy using cold knife (VIU). In the present study, the length, location and cause of strictures did not significantly affect the results. However, the outcomes with strictures <1 cm were better than strictures >1 cm, although patients with strictures >2 cm were excluded. In the present study, the success rates among patients with second and third sessions of HLU were 36.3% and 14.2%, respectively. This was similar to other studies, which reported low success rate with the second session of VIU. The present study was limited by the relatively short period of follow-up and the small number of patients. However, it was the first prospective study evaluating HLU for pediatric strictures. The use of flowmetry and VCUG for evaluation of all patients added to the strength of the study. CONCLUSION: HLU can be safely used with good success rates for the treatment of primary urethral strictures (<2 cm) in children. Repeat HLU (more than twice) adds little to success.

Irrigation with industrial wastewater activates antioxidant system and osmoprotectant accumulation in lettuce, turnip and tomato plants.

We focused on the impact of industrial wastes on the water quality of the El-Amia drain in Egypt and the effect of irrigation with industrial wastewater on the growth, cell membranes, photosynthetic pigment content, the antioxidant system and selected osmoprotectants (proline, total amino nitrogen and soluble sugars) in three crop plants: turnip, tomato and lettuce. Furthermore, the present work focused on the analysis of the heavy metal content and its accumulation in the studied plants. For this purpose, water samples were collected 1, 10 and 19 km from the beginning of the drain and used for irrigation, with fresh water as a control. We found that industrial wastewater contained significant amounts of heavy metals (Cd, Ni and Co) warranted a pollution problem as their amounts exceed the maximum recommended concentrations according to FAO guidelines for trace metals in irrigation water. The three crop plants accumulate significant amounts of heavy metals in their shoots and roots and showed a significant decrease in leaf area, fresh weight and dry weight of shoots and roots, accompanied by a marked reduction in photosynthetic pigment content and damage to cell membranes, as indicated by increased electrolyte leakage and a lower membrane stability index. Significant increases in the activities of antioxidant enzymes and in the glutathione, proline, soluble sugar and total amino nitrogen content in response to irrigation with wastewater may be defense mechanisms induced in response to heavy metal stress.

Predictors of treatment failure among tuberculosis patients under DOTS strategy in Egypt.

Treatment failure is a serious problem facing some national tuberculosis (TB) control programmes. Irregularity of treatment is a factor that can lead to treatment failure. A case-control study was carried out in TB centres in Egypt during April 2001-December 2002 aimed at investigating the predictors of treatment failure. We interviewed 119 people with treatment failure and an equal number of cured cases (controls) and their families regarding sociodemographic characteristics, information about TB, information about drugs, treatment compliance, family support and patient-family interaction. Significant risk factors for treatment failure were non-compliance to treatment, deficient health education to the patient, poor patient knowledge regarding the disease and diabetes mellitus as co-morbid condition.

Predictors of treatment failure among tuberculosis patients under DOTS strategy in Egypt

Treatment failure is a serious problem facing some national tuberculosis [TB] control programmes. Irregularity of treatment is a factor that can lead to treatment failure. A case-control study was carried out in TB centres in Egypt during April 2001-December 2002 aimed at investigating the predictors of treatment failure. We interviewed 119 people with treatment failure and an equal number of cured cases [controls] and their families regarding sociodemographic characteristics, information about TB, information about drugs, treatment compliance, family support and patient-family interaction. Significant risk factors for treatment failure were non-compliance to treatment, deficient health education to the patient, poor patient knowledge regarding the disease and diabetes mellitus as co-morbid condition

Accident prevention program in a glass factory in Shoubra El Khema district.

BACKGROUND: An accident can be defined as an unplanned event that results in or suggests the possibility of personal injury, property damage production interruption diminished health or environmental damage. The accidents have a cost impact on the employees and the company itself. OBJECTIVE: This intervention study was carried out to decrease the accident rate in a glass factory in Shoubra El-Khema district. METHODS: A glass factory in Shoubra El-Khema was selected to implement an intervention program. The program was done through three phases. 1. A preliminary interview questionnaire. 2. Seminars of health education were done to all workers and managers with availability of health education posters, establishment of accident committee and a new reporting system, contract with a housekeeping company was done and also training of some leaders. 3. Concurrent and final evaluation of the program was done. RESULTS: The incidence rate, frequency and severity rate of accidents were decreased at the end of the year after the intervention program. The differences were statistically significant. The opinions of the workers and managers about the different causes of accidents were changed. The belief of the workers and managers about efficiency of health educatio program was changed. Some leaders were trained on skills of health education. Modification of reporting and notification system was done. CONCLUSION: This intervention study succeeded in decreasing accidents rates and increasing the awareness of the managers to decrease accident rates. The beliefs and thoughts o both workers and managers became near to each other. The production loss due to days lost by accidents was reduced. RECOMMENDATIONS: Upgrading process in the factory are recommended to eliminate the hazards at source. Sustaining and continuation of the established preventive program should be done. Trying to apply the program in similar factories is also recommended.

Hepatitis c and cirrhotic liver disease in the Nile delta of Egypt: a community-based study.

Residents of Egypt's Nile river delta have among the world's highest seroprevalence of hepatitis C virus (HCV) infection. To assess the impact of HCV on chronic liver disease, we studied the association between HCV, other hepatitis viruses, and cirrhotic liver disease in a cross-sectional, community-based survey of 801 persons aged > or = 10 years living in a semi-urban, Nile delta village. Residents were systematically sampled using questionnaires, physical examination, abdominal ultrasonography and serologically for antibodies to HCV (confirmed by a third-generation immunoblot assay) and to hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis E virus (HEV). The seroprevalence of HCV increased with age from 19% in persons 10-19 years old to about 60% in persons 30 years and older. Although no practices that might facilitate HCV transmission were discovered, the seroprevalence of HCV was significantly associated with remote (> 1 year) histories of schistosomiasis. Sonographic evidence of cirrhosis was present in 3% (95% CI: 1%, 4%) of the population (0.7% of persons under 30 years of age and in 5% of older persons), and was significantly associated with HCV seroreactivity. Our findings are consistent with the hypothesis that past mass parenteral chemotherapy campaigns for schistosomiasis facilitated HCV transmission, and that HCV may be a major cause of the high prevalence of liver cirrhosis in this Nile village.

Effect of occupational lead-exposure on blood pressure, serum aldosterone level and plasma renin activity.

Numerous observations have indicated a relationship between lead exposure and elevated blood pressure. The present study aims to investigate the association between occupational lead-exposure and elevated blood pressure as well as serum aldosterone level and plasma renin activity as parameters affecting blood pressure. Fifty occupationally lead-exposed (16 males and 34 females) and 50 non-exposed (15 males and 34 females) workers were selected after application of certain exclusion criteria. All workers were admitted to complete clinical examination, including standard blood pressure measurement. Also, blood lead level, serum aldosterone concentration and plasma renin activity were estimated. The results of both occupationally lead-exposed males and females demonstrated no significant differences regarding age, work duration, systolic and diastolic blood pressures when compared to occupationally non-exposed males and females; respectively. In addition, occupationally lead-exposed males and females revealed a significant increase in blood lead level and serum aldosterone concentration in comparison to their controls. Moreover, plasma renin activity is significantly decreased among the lead-exposed male workers while it is significantly increased among the lead-exposed female workers in comparison to their controls. It is concluded that serum aldosterone level and plasma renin activity are affected by occupationally low-level of lead exposure, and the present study provide further support for the association between blood lead exposure and blood pressure related hormones.

Chromium induced contact dermatitis and indices for diagnosis.

Chromium exposure plays an important role in development of contact dermatitis. The prevalence of contact dermatitis among tannery workers and cement-exposed workers is high. This study was designed to determine the prevalence of contact dermatitis among some Egyptian workers exposed to chromium and to investigate the role of patch test and IgE immunoassay in diagnosis of contact dermatitis. Eighty-three male workers who were exposed to chromium were selected after application of certain exclusion criteria to be the target population of this study. Forty male workers away from exposure to chromium were taken to be the controls. All the exposed and non exposed workers were investigated through an interview questionnaire, clinical examination, patch test and determination of blood and urine chromium levels, absolute eosinophilic count and total IgE level. The results showed that there was no significant difference between exposed workers with clinically diagnosed contact dermatitis and the clinically free exposed workers regarding age and work duration. 7.7% of exposed workers with positive patch test suffered from contact dermatitis while 31.6% of exposed workers with negative patch test suffered from contact dermatitis. There was no statistically significant difference between clinically diagnosed contact dermatitis workers and clinically free workers regarding blood and urine chromium levels. IgE level and absolute eosinophilic count were statistically higher among exposed workers with contact dermatitis than among clinically free exposed workers. According to the results of this study, it is concluded that the diagnosis of skin hypersensitivity to chromium should depend upon the history of chromium exposure, clinical examination and a battery of investigations including IgE level, eosinophilic count and patch test.

Urinary excretion of copper and zinc among cigarette smokers.

The urinary levels of cadmium (Cd), zinc (Zn) and copper (Cu) were measured among 11 adult male non-smokers and 38 adult male cigarette smokers to investigate the effect of cigarette smoking on the urinary excretion of Zn and Cu in relation to urinary Cd level. The results indicated that among non-smokers, the urinary levels of Cd, Zn, and Cu were: 1.17-5.24 (3.73 +/- 1.23) microg Cd/gm urinary creatinine, 66.73-156.13 (109.28 +/- 30.27) microg Zn/gm urinary creatinine, 83.17-195.65 (126.72 +/- 41.46) microg Cu/gm urinary creatinine, respectively. The cigarette smokers were classified into two groups according to the level of urinary Cd. The first group contains 13 cases with urinary Cd levels within the normal range of non-smokers, and the urinary levels of both Zn and Cu were observed to be also within the normal range of non-smokers (2.14-4.98 (3.85 +/- 0.97) microg Cd/gm urinary creatinine, 69.40-150.59 (97.61 +/- 21.39) microg Zn/gm urinary creatinine, 85.33-137.42 (96.11 +/- 13.60) microg Cu/gm urinary creatinine, respectively]. The second group contains 25 cases with elevated urinary Cd levels (5.44-40.37 (14.08 +/- 9.69 microg Cd/gm urinary creatinine]. The latter group was further subdivided into two subgroups according to the urinary levels of Zn and Cu. The first subgroup contains 15 cases with urinary levels of both Zn and Cu within the normal range of non-smokers [5.44-13.58 (7.74 +/- 2.11) microg Cd/gm urinary creatinine, 69.54-133.46 (96.95 +/- 22.91) microg Zn/gm urinary creatinine, 93.06-191.90 (133.7 +/- 32.80) microg Cu/gm urinary creatinine, respectively]. The second subgroup contains 10 cases with elevated urinary levels of Zn and/or Cu [13.81-40.37 (23.57 +/- 8.74) microg Cd/gm urinary creatinine, 141.53-511.11 (284.76 +/- 132.45) microg Zn/gm urinary creatinine, 193.06-705.48 (388.49 +/- 158.66) microg Cu/gm urinary creatinine, respectively). In the latter subgroup it was noted that only one case showed elevated levels of urinary Cd and Zn but not Cu, while another case showed increased urinary Cd and Cu levels but not Zn. The results of the present investigation suggest that urinary Cd, at a certain level, may be accompanied by increased urinary excretion of both Zn and Cu among cigarette smokers.

Evaluation of the effectiveness of dipstick haematuria and proteinuria in screening Schistosoma haematobium infection among school children in upper Egypt.

This study aimed at evaluation of validity and reliability of dipstick haematuria and proteinuria in screening school children for Schistosoma haematobium infection. It included a random sample of 400 school children aged 6-15 years in rural area of Fayoum Governorate, upper Egypt. Urine samples of the studied children were tested parasitologically by urine filtration technique as a reference test and semiquantitatively for haematuria and proteinuria using urine reagent strips as screening tests. Results of the study revealed that haematuria was a better indicator for Schistosoma haematobium infection than proteinuria, as it was more sensitive (85.5% 73.4%, respectively), specific (94.4% 82.9%, respectively) and reliable (kappa=92% 80%, respectively). Moreover, it had stronger relationship with intensity of infection (r=0.88 & 0.67, respectively). A combination of different grades of haematuria and proteinuria did not significantly increase either sensitivity or specificity. Dipstick haematuria could be a valuable technique in screening rural Egyptian school children who are at risk of urinary schistosmiasis.

Early detection of nephrotoxic effects due to low-dose exposure of cadmium among cigarette smokers.

The effects of low-level exposure to cadmium due to cigarette smoking on renal function were judged by the estimation of urinary levels of total proteins, cadmium, alpha-1-microglobulin (alpha1M) and glutathione S-transferase (GST) activity among 50 males (38 smokers and 12 control non-smokers). Elevated urinary cadmium levels [2.408-28.160; 9.31 +/- 7 .1 microg Cd/gm urine creatinine] were observed among the majority of smokers (24 cases, 63.16%) and these levels showed a positive correlation with age and smoking index. Furthermore, urine total proteins [115.18-652.14; 242.89 +/- 121.88 mg protein/gm urine creatinine) were increased suggesting glomerular involvement among 20 cases (52.63%) of smokers. In addition, urinary alpha1M levels (14.645-86.053; 34.05 +/- 16.83 mg alpha1M/gm urine creatinine) and urinary GST activity [0.0-0.008; 0.00015 +/- 0.0002 micromol/min/100 microl/gm urine creatinine] were elevated among 18 (47.37%) and 20 (52.63%) cases of smokers respectively. Since urinary alpha1M and GST originate from renal proximal tubules, the data of the present investigation could reflect early low-level cadmium exposure nephrotoxic effect on both the glomeruli and tubules.

The impact of health education on the knowledge and attitude of Egyptian nurses towards occupational HIV infection.

There is a phobia about nursing human immunodeficiency virus (HIV) infected patients. This work was carried out to study the impact of health education on the knowledge and attitude of nurses, representing a stratum of health care team, about modes of transmission and prevention of occupational HIV infection. The studied population were students of the High Institute of Nursing, they were subjected to a health education program (HE), and assessment was carried out before and after this intervention. The results revealed that health education is a successful tool in improving the knowledge of the nurses and in minimizing their phobia from occupational HIV infection.

Study of the knowledge, attitude of Egyptian health care workers towards occupational HIV infection.

Acquired immuno-deficiency syndrome (AIDS) was reported for the first time in Egypt in 1986. Up to March 1993, 60 cases were notified to the Ministry of Health and 359 were detected to be infected with human immunodeficiency virus (HIV). Most cases had acquired infection abroad through blood, blood products or sexual contact. The number of cases is continuously increasing. Fear and ignorance about HIV infection causes panic among health care workers (HCWs) whenever a case is discovered and needs medical care. We assessed the knowledge and attitude of 346 HCWs towards the probability of occupational HIV infection using a self administered questionnaire. The sample included physicians, surgeons, nurses, laboratory technicians and ambulance workers. 72.8% of HCWs believed that they are in "great" danger of acquiring AIDS through occupational exposure, whereas 0.6% thought that there was no danger. 67% of HCWs had wrong ideas about transmission of HIV (toilet seats, droplet infection, touching patients). 83.5% mentioned that AIDS patients should be isolated in quarantine. The main source of information about AIDS was the television, radio and ordinary press. 44.8% got their information from textbooks or scientific literature. 95.4% felt the need for more information about infection and disease. The results show an urgent need to start a program of education of HCWs concerning the risk of occupational HIV infection and the measures of its prevention.

PIP: The authors assessed via questionnaire the knowledge and attitude of 346 health care workers toward the probability of occupational HIV infection. The sample included physicians, surgeons, nurses, laboratory technicians, and ambulance workers. 72.8% believe themselves to be in great danger of acquiring AIDS through occupational exposure, while 0.6% thought that there was no danger. 67% were misinformed about the possibility of contracting HIV from toilet seats, droplets, and touching patients, and 83.5% believe that patients with AIDS should be quarantined. Television, radio, and the ordinary press were their main sources of information about AIDS. Only 44.8% received their information on AIDS from textbooks or scientific literature. 95.4% felt the need for more information about infection and disease. These results point to the urgent need to begin educating health care workers about the true risk of occupational HIV infection and how to prevent it.

Workers knowledge of accidents' causes.

Accident constitutes a big problem of occupational health. It causes an economic loss to the work and worker. Six hundred workers were investigated by a well standardized questionnaire through interview. Most workers believed that the most important causes of accidents are those belonging to environment and work pattern. They did not know or denied that there are many important personal factors that are considered to be a corner stone in increasing accident rate. Ninety one percent of the investigated workers believed that the improper guarded machines are one of the most important causes of accidents, only 23% of the involved workers considered the psychological and social disturbance to cause accidents. It is concluded that there should be a well prepared program of health education to learn the workers the different causes of accidents and the methods to prevent and decrease the accident rates.

An experimental study on impact of whole body gamma irradiation on liver function and kidney function.

Five groups of rabbits were used to investigate the effect of increasing doses of radiation on liver and kidney function. One group acted as a control group. The other 4 groups were exposed to increasing doses of whole body gamma radiation. 1-5Gy. The kidney and liver function tests were affected one week after exposure, except bilirubin level that was decreased immediately after exposure within 24 hours.

Epidemiological evaluation of oral polio vaccine efficacy in Cairo.

A case-control study was conducted between November 1992 and May, 1993 to assess the effectiveness of routine oral polio vaccine (OPV) immunization against paralytic poliomyelitis among children aged 1-5 years in Cairo city. Cases of paralytic poliomyelitis at Imbaba Institute of poliomyelitis and Ain-Shams Pediatric Hospital fulfilling the study criteria were obtained. The diagnosis of cases was based on clinical grounds. Age and sex-matched controls were recruited concurrently from patients admitted for reasons other than poliomyelitis. There were 55 cases of poliomyelitis. Vaccination status of cases and controls was ascertained by asking the mothers through interviewing using a questionnaire that had been developed for the purpose of the study. Vaccine efficacy (VE) was 86% (95% CI: 39-97%) and 92% (95% CI: 64-98%) for 3 and 4 doses of OPV respectively. For a vaccine like OPV with the potential of near 100% VE after 3 doses, the estimated level of protection (86%) is considered low especially when we realize the enormous efforts carried out by Ministry of Health and UNICEF in Egypt for upgrading the cold-chain. Higher figures of VE are supposed to be achieved if we are going to meet the challenge of poliomyelitis eradication by the year 1994. Potential biases in study design were also discussed.