Comparison between the Regenerative and Therapeutic Impacts of Bone Marrow Mesenchymal Stem Cells and Adipose Mesenchymal Stem Cells Pre-Treated with Melatonin on Liver Fibrosis.

BACKGROUND: The distinctive feature of liver fibrosis is the progressive replacement of healthy hepatic cells by the extracellular matrix protein, which is abundant in collagen I and III, with impaired matrix remodeling. The activation of myofibroblastic cells enhances the fibrogenic response of complex interactions of hepatic stellate cells, fibroblasts, and inflammatory cells to produce the excessive deposition of the extracellular protein matrix. This process is activated by multiple fibrogenic mediators and cytokines, such as TNF-α and IL-1ß, accompanied with a decrease in the anti-fibrogenic factor NF-κß. Mesenchymal stem cells (MSCs) represent a promising therapy for liver fibrosis, allowing for a more advanced regenerative influence when cultured with extrinsic or intrinsic proliferative factors, cytokines, antioxidants, growth factors, and hormones such as melatonin (MT). However, previous studies showed conflicting findings concerning the therapeutic effects of adipose (AD) and bone marrow (BM) MSCs; therefore, the present work aimed to conduct a comparative and comprehensive study investigating the impact of MT pre-treatment on the immunomodulatory, anti-inflammatory, and anti-apoptotic effects of AD- and BM-MSCs and to critically analyze whether MT-pre-treated AD-MSCs and BM-MSCs reveal equal or different therapeutic and regenerative potentials in a CCl4-injured liver experimental rat model. MATERIALS AND METHODS: Six groups of experimental rats were used, with ten rats in each group: group I (control group), group II (CCl4-treated group), group III (CCl4- and BM-MSC-treated group), group IV (CCl4 and MT-pre-treated BM-MSC group), group V (CCl4- and AD-MSC-treated group), and group VI (CCl4 and MT-pre-treated AD-MSC group). Liver function tests and the gene expression of inflammatory, fibrogenic, apoptotic, and proliferative factors were analyzed. Histological and immunohistochemical changes were assessed. RESULTS: The present study compared the ability of AD- and BM-MSCs, with and without MT pre-treatment, to reduce hepatic fibrosis. Both types of MSCs improved hepatocyte function by reducing the serum levels of ALT, aspartate aminotransferase (AST), alkaline phosphatase (AKP), and total bilirubin (TBIL). In addition, the changes in the hepatocellular architecture, including the hepatocytes, liver sinusoids, central veins, portal veins, biliary ducts, and hepatic arteries, showed a decrease in hepatocyte injury and cholestasis with a reduction in inflammation, apoptosis, and necrosis of the hepatic cells, together with an inhibition of liver tissue fibrosis. These results were augmented by an analysis of the expression of the pro-inflammatory cytokines TNFα and IL-1ß, the anti-fibrogenic factor NF-κß, the apoptotic factor caspase-3, and the proliferative indicators antigen Ki-67 and proliferating cell nuclear antigen (PCNA). These findings were found to be statistically significant, with the restoration of normal parameters in the rats that received AD-MSCs pre-treated with MT, denoting optimal regenerative and therapeutic effects. CONCLUSIONS: AD-MSCs pre-treated with MT are the preferred choice in improving hepatic fibrosis and promoting the therapeutic and regenerative ability of liver tissue. They represent a very significant tool for future stem cell use in the tissue regeneration strategy for the treatment of liver diseases.

Novel adaptations in percutaneous right transaxillary access for transcatheter aortic valve implantation using the sapien ultra valve.

BACKGROUND: Percutaneous transaxillary access is used as an alternative to the transfemoral approach for transcatheter aortic valve implantation in patients with severe peripheral vascular disease. The left transaxillary approach is usually preferred due to ease of valve alignment with the aortic annulus. Some patients have anatomical and physiological factors which preclude this approach. Moreover, most catheterization lab layouts make left-sided approaches to the heart awkward for imaging, visualization, procedural ease, and radiation protection. AIMS: The authors describe novel adaptations to allow successful right transaxillary access for implantation of the transcatheter heart valve using the Edwards Sapien 3 system (Edwards Lifesciences). METHODS: We searched our local structural heart database for all patients who underwent transcatheter aortic valve implantation via axillary access, from January 2021 to January 2022. Patients with left axillary access were excluded. RESULTS: We report 6 percutaneous right transaxillary cases performed in the last year using steps which allow smooth delivery of the SAPIEN 3 Ultra valve down the greater curvature of the aorta and providing co-axial alignment of the valve. Only one patient had a vascular complication with arterial dissection at the closure point managed with 8 mm x 37 mm Bentley uncovered stent at the access site. CONCLUSION: With the modifications described in our article, the right transaxillary approach has now become our preferred secondary access route for TAVI.

Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan.

Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient's medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization's Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications.

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

Evaluation of Knowledge, Attitudes, and Practices about Pharmacovigilance among Community Pharmacists in Qassim, Saudi Arabia.

BACKGROUND: Pharmacovigilance (PV) is an essential activity to detect adverse drug reactions (ADRs) and ensure patient safety. Hence, we aimed to evaluate knowledge, attitudes, and practices (KAP) regarding PV among community pharmacists in Qassim, Saudi Arabia. METHODS: A cross-sectional study was conducted by using a validated questionnaire after obtaining ethical approval from the Deanship of Scientific Research, Qassim University. The sample size was calculated based on the total number of pharmacists in the Qassim area by using Raosoft, Inc. Statistical Package for the Social Sciences version 20 was used for data entry and analysis. Ordinal logistic regression was performed to identify the predictors of KAP. A p-value of <0.05 was considered statistically significant. RESULTS: A total of 209 community pharmacists participated in the study; 62.9% of them defined the PV correctly, and 59% of them defined ADRs correctly. However, only 17.2% knew where to report ADRs. Interestingly, the majority of participants (92.9%) reported that it is necessary to report ADRs, and 73.8% of them were willing to report ADRs. A total of 53.8% of the participants identified ADRs during their careers; however, only 21.9% reported ADRs. Barriers discourage ADR reporting; the majority of the participants (85.6%) do not know how to report ADRs. CONCLUSION: Community pharmacists who participated in the study were knowledgeable about PV, and their attitude towards reporting ADRs was highly positive. However, the number of reported ADRs was low because of the lack of knowledge on how and where to report ADRs. Continuous education and motivation about ADRs reporting and PV are warranted among community pharmacists for the rational use of medications.

Synergism of CD28 Immune Molecule in Late Immunosuppressive Phase of COVID-19: Effectiveness in Vaccinated Individuals.

Context: Lymphopenia has been frequently documented and linked to coronavirus disease 2019 (COVID-19) in a severe acute respiratory syndrome (SARS)-coronavirus 2 (CoV-2) attack. A decrease in the T-lymphocyte count has shown promise as a clinical indicator and predictor of COVID-19 severity. Objective: The review intended to examine the relationship of COVID-19 infections in individuals to lost expression of CD28 on naive CD4+/CD8+-mediated, vaccine-specific, neutralizing antibody responses. Design: The research team performed a narrative review by searching eight databases: Medline, Elsevier, Cochrane, PubMed, Google Scholar, Mendeley, and Springer Nature. The search used the following key terms: SARS CoV-2, clinical aspects and pathology of SARS CoV-2, involvement of viral spike (S) protein in SARS CoV-2, immunological changes in COVID-19 infection, basic overview of CD28 immuno-molecule ligand, reduction of vaccine therapeutic efficacy in COVID-19 infection, and immunomodulatory response of lost CD28 ligand. Setting: This study was done in a Maharishi Arvind College of Pharmacy, Jaipur, India. Results: In COVID-19 patients, particularly those with severe disease, had increased levels of IL-2 or IL-2R. Given IL-2's supportive role in the expansion and differentiation of T cells, the authors exhibiting that lymphopenia, particularly in severe COVID-19, could be attributed to nonfunctional and dysfunctional differentiation of CD4+ and CD8+ T cells as a result of low CD28 immuno-molecule expression on naive T cells. Conclusions: The literature review found that independent, early immunological prognostic markers for a poor prognosis, in addition to higher levels of IL-6, include a substantial proportion of large inflammatory monocytes and a small proportion of chronic CD28+ CD4+T cells. The current findings suggest that a combination of COVID-19 vaccination with SARS CoV-2-reactive naive T cells with the CD28 immune-molecule may be a viable method for establishing T-cell-based, adaptive cellular immunotherapy against COVID-19 infection. Further research is needed, especially larger studies to confirm the current findings, to improve early clinical treatment.

Pharmacy education in Saudi Arabia: Achievements and challenges during the last two decades with a focus on Taif University as a case study.

Basic expectation from graduates of any pharmacy program is to be able to provide pharmaceutical care at both patients and community levels, be able to solve problems arising during practice, be able to improve quality and outcomes of the services provided continuously and be able to respond effectively to patients and community changing needs. Pharmacy education in Saudi Arabia established in 1959 by founding the first college in Riyadh (King Saud University) followed by establishing two pharmacy colleges in Jeddah (King Abdulaziz University, 2001) and Abha (King Khalid University, 2001), then a college in Al Ahsa (King Faisal University, 2002), followed by four colleges three-years later in each of Buraydah (Qassim University, 2005), Madinah (Taibah University, 2005), Taif (Taif University, 2005) and Makkah (Umm Al-Qura University, 2005). Up to date the number of pharmacy colleges offering basic degrees in pharmacy are 21 governmental and eight privates. This review describes pharmacy education in Saudi Arabia, the historical perspective, current situation, and the important features. The report focuses on the changes during the last two decades covering three main aspects (1) Clinical education and training, (2) Research output, and (3) Quality and accreditation.

A cross-sectional survey: knowledge, attitudes, and practices of self-medication in medical and pharmacy students.

BACKGROUND: Self-Medication is common practice worldwide in both developed and developing countries. Self-Medication is referred as self consumption of medication without consulting a physician for either diagnosis or treatment. This study aimed to assess the knowledge, attitudes and practices toward self-medication among medical and pharmacy students. METHODS: This cross-sectional study was conducted among medical and pharmacy students in Qassim university, Buraydah, Saudi Arabia, during the period 2020-2021. Multistage random sampling technique was used to recruit students. The data were collected through questionnaire. RESULTS: Three hundred and sixteen of 316 students were recruited. This study showed that the majority (94.6%) of students had good knowledge of self-medication. Additionally, the following characteristics were significantly associated with good knowledge: being female, and Pharmacy students. Overall mean score for the attitudes towards self-medication shows that 58.4% of the total sample had high agreements towards the questions of the attitudes toward self-medication. More than half (63.9%) of the students reported that they practice self- medication in the last 6 months. Pain killers was the most common medication used for self- medication by the majority of the students (88.29%). CONCLUSIONS: In conclusion, students' knowledge of self-medication appears to be good and significantly high among pharmacy students in comparison to medical students. As well self-medication was highly practiced among the students. Therefor, medical and pharmacy students should be viewed as important contributors to the public health care system, and future health professionals should be properly educated on good pharmacy practice and responsible self-medication. TRIAL REGISTRATION: Not applicable.

Simvastatin mitigates streptozotocin-induced type 1 diabetes in mice through downregulation of ADAM10 and ADAM17.

BACKGROUND: T cell mediates immune response in type 1 diabetes mellitus (T1DM) through its trafficking into pancreatic islets. The role of A Disintigrin And Metalloproteinase 10 (ADAM10) and 17 (ADAM17) in pancreatic T-cells recruitment into the pancreatic islets during T1DM is not known. AIM: Explore the role of ADAM10 and ADAM17 in the processing of CXCL16 in T1DM and possible protective effect of simvastatin (SIM) in streptozotocin (STZ)-induced T1DM. MAIN METHODS: Balb/c mice were classified into 4 groups, 10 each. Control group received buffer while SIM group received 50 mg/kg, i.p daily for 12 days starting from day 4 of the experiment. Diabetic group; received STZ (55 mg/kg, i.p.) for 5 consecutive days starting from day 1 of the experiment. SIM + STZ group; received SIM (50 mg/kg, i.p.) daily for 12 days and STZ (55 mg/kg, i.p.) for 5 consecutive days. Biochemical, inflammatory and apoptotic markers as well as expression of CXCL16, ADAM10, NF-κB and pancreatic T-cells expression were analyzed. KEY FINDINGS: Significant increase in biochemical, inflammatory, apoptotic parameters, expression of ADAM10, ADAM17, CXCL16, NF-κB, and infiltrated T-cells to the pancreatic islets were found in STZ group. SIM treatment in the presence of STZ improved biochemical and inflammatory parameters as well as it reduced the expression of CXCL16, ADAM10, ADAM17, NF-κΒ, T-cells migration and apoptosis in the pancreatic islets. SIGNIFICANCE: SIM mitigated pancreatic ß-cell death induced by STZ through down regulation of ADAM10, ADAM17and CXCL16. Therefore, ADAM10/ADAM17 and CXCL16 may serve as novel therapeutic targets for T1DM.

Dabigatran mitigates cisplatin-mediated nephrotoxicity through down regulation of thrombin pathway.

INTRODUCTION: Cisplatin (CDDP) nephrotoxicity is one of the most significant complications limiting its use in cancer therapy. OBJECTIVES: This study investigated the pivotal role played by thrombin in CDDP-mediated nephrotoxicity. This work also aimed to clarify the possible preventive effect of Dabigatran (Dab), a direct thrombin inhibitor, on CDDP nephrotoxicity. METHODS: Animals were grouped as follow; normal control group, CDDP nephrotoxicity group, CDDP + Dab 15, and CDDP + Dab 25 groups. Four days following CDDP administration, blood and urine samples were collected to evaluate renal function. Moreover, tissue samples were collected from the kidney to determine apoptosis markers, oxidative stress and histopathological evaluation. An immunofluorescence analysis of tissue factor (TF), thrombin, protease-activated receptor-2 (PAR2), fibrin, pERK1/2 and P53 proteins expression was also performed. RESULTS: Thrombin, pERK, cleaved caspase-3, and oxidative stress markers were significantly elevated in CDDP-treated group. However, pretreatment of animals with either low or high doses of Dab significantly improved kidney function and decreased oxidative stress and apoptotic markers. CONCLUSION: We conclude that thrombin is an important factor in the pathogenesis of CDDP kidney toxicity via activation of ERK1/2, P53 and caspase-3 pathway, which can be effectively blocked by Dab.

Clinical Significance of Helicobacter pylori Infection on Psoriasis Severity.

The aim of the study was to appraise the link between psoriasis and Helicobacter pylori, investigate the influence of H. pylori treatment on psoriasis severity, determine the cutoff value of haptoglobin as a psoriatic biomarker, and determine the most reliable predictor for psoriasis in patients with H. pylori. This study was carried out on 100 adult Saudi participants from the Security Forces Hospital (Riyadh, Kingdom of Saudi Arabia). All participants were allocated into 5 groups (20/group): controls (G1), psoriatic patients (G2), patients with H. pylori (G3), psoriatic patients with untreated H. pylori (G4), and psoriatic patients with treated H. pylori (G5). The study was approved by the ethics committee of Security Forces Hospital, Riyadh, Saudi Arabia. The psoriasis area and severity index (PASI) score, 13C-urea breath test (13C-UBT), C-reactive protein (CRP), haptoglobin, platelet P-selectin, cluster of differentiation 4/cluster of differentiation 8 (CD4/CD8) ratio, and lymphocyte percentages were recorded. The haptoglobin level was significantly elevated in psoriatic patients compared with G1. In G5, there was significant attenuation in the PASI score, P-selectin, CRP, CD4/CD8 ratio, and lymphocyte percentage compared with G4. There was a significant positive correlation between psoriasis severity and 13C-UBT. In addition, 13C-UBT and PASI scores were significantly positively correlated with CRP, platelet P-selectin, and percentage of lymphocytes. H. pylori plays a potential role in psoriasis pathogenesis. H. pylori treatment attenuates psoriasis severity. Haptoglobin could be utilized as a psoriatic biomarker with 1.95 g/L as the cutoff value. The most reliable predictor for psoriasis in infected patients with H. pylori is 13C-UBT.

Dementia: The Toll on Caregivers and the Role of the Pharmacist.

Millions of Americans provide help to family members with dementia; most often, this becomes the responsibility of the affected individual's spouse. Studies indicate that female caregivers report higher levels of depression and anxiety and lower levels of life satisfaction than males as a result of their caregiving responsibilities. Spouses of people with dementia also experience considerable strain as they observe their life partners' deterioration. In addition, this stress may increase the risk of negative cognitive outcomes in the cognitively healthier spouse. One possible mechanism of this detrimental effect may be chronic stress on the hippocampus, a brain region responsible for memory. Caregivers may be at greater risk of cognitive problems because of years of shared lifestyle with a spouse who then develops dementia as well as greater burdens of psychosocial, behavioral, and physiological dysregulation. Caregivers may put off their own wellbeing and health while taking care of a loved one. A number of interventions that improve health habits and provide support can decrease caregiver burden and reduce their risk of developing dementia as well.

Patient outcomes related to the daytime versus after-hours surgery: A meta-analysis.

BACKGROUND: It has been investigated in multiple subspecialties that surgery timing may have an impact on patient outcomes, yet no definitive evidence is reached. OBJECTIVES: To analyze current literature on this topic and investigate whether day versus after-hours surgery may have an effect on postoperative outcomes. DATA SOURCES: MEDLINE, EMBASE and Cochrane Library. STUDY ELIGIBILITY CRITERIA: Studies reporting on the surgery timing as well as postoperative mortality and morbidity were included. PARTICIPANTS AND INTERVENTIONS: There were 119,213 and 46,196 surgery cases that occurred during daytime and after-hours shifts, respectively. STUDY APPRAISAL AND SYNTHESIS METHODS: Thirteen studies (12 retrospective case controls and 1 prospective study) published in English between February 2003 and May 2018 were scrutinized by two reviewers. The odds ratio (OR) for each clinical outcome data was presented with a 95% confidence interval (CI). Pooled estimates of effects were calculated using random-effect models. RESULTS: Among the included studies, 10 reported morbidities and 10 reported death rates. The pooled OR was 0.67 (95% CI: 0.51-0.89; p = 0.005) for postoperative mortality and 0.71 (95% CI: 0.53-0.94; p = 0.02) for overall postoperative complications in patients who underwent daytime versus after-hours surgery. CONCLUSION: After-hours surgery was associated with significantly increased postoperative mortality and morbidity, which might be related to state of urgency, availability of resource and/or fatigue factor of the personnel.

Cellular and molecular approaches to enhance myocardial recovery after myocardial infarction.

Reperfusion therapy has resulted in significant improvement in post-myocardial infarction morbidity and mortality in over the last 4 decades. Nonetheless, it is well recognized that simply restoring patency of the epicardial artery may not stop or reverse damage at microvascular level, and myocardial salvage is often suboptimal. Numerous efforts have been undertaken to elucidate the mechanisms underlying extensive myonecrosis to facilitate the discovery of therapies to provide additional and incremental benefits over current therapeutic pathways. To date, conclusively effective strategies to promote myocardial recovery have not yet been established. Novel approaches are investigating the foundational cellular and molecular bases of myocardial ischemia and irreversible injury. Herein, we review the emerging concepts and proposed therapies that may improve myocardial protection and reduce infarct size. We examine the preclinical and clinical evidence for reduced infarct size with these strategies, including anti-inflammatory agents, intracellular ion channel modulators, agents affecting the reperfusion injury salvage kinase (RISK) and nitric oxide signaling pathways, modulators of mitochondrial function, anti-apoptotic agents, and stem cell and gene therapy. We review the potential reasons of failures to date and the potential for new strategies to further promote myocardial recovery and improve prognosis.

Outcome of anastomotic posterior urethroplasty with various ancillary maneuvers for post-traumatic urethral injury. Does prior urethral manipulation affect the outcome of urethroplasty?

PURPOSE: We present our success rate and complications of delayed anastomotic urethroplasty (DAU) in patients with post-traumatic posterior urethral injury. MATERIALS AND METHODS: This was a retrospective study of patients aged ≥17 years that underwent DAU for post-traumatic posterior urethral injury during 2010-2014. Stricture length was measured by ascending and descending urethrogram. Success of procedure was considered when the patient was free of stricture-ralated obstruction and needed no further intervention. Primary group includes patients who underwent first time delayed urethroplasty while secondary group included patients who had some sort of urethral manipulation in local hospital. Results were analyzed using unpaired t-test, Chi-square test, binary logistic regression, Kaplan-Meier curves, and log-rank test. RESULTS: Of the 80 male patients, 73 (91.25%) patients underwent primary DAU while 7 (8.75%) patients had secondary DAU. Median age, stricture length, and follow-up were 27.0 ± 12.7, 1.6 ± 0.9, and 3.2 ± 0.9, respectively. Overall, success rate was 83.75% while success rate in primary group was 89.04% and secondary group was only 28.57% (P = 0.0059). Regarding ancillary maneuvers, urethral mobilization alone was done in 29 (36.25%) patients with success rate (72.41%), corporeal body separation in 36 (45%) patients with success rate (91.66%), inferior wedge pubectomy in 13 (16.25%) with success rate (84.61%), supracrural rerouting in 1 (1.25%) with success rate (100%), and abdominoperineal approach in 1 (1.25%) with success rate of 100% (P = 0.193). Patients who had prior urethral manipulation affect the outcome of definitive anastomotic urethroplasty. CONCLUSION: DAU has durable success rate with less morbidity. Ancillary elaborated maneuvers are frequently needed in patients with complex and elongated post-traumatic posterior urethral defect with successful outcome.

Long-term outcome of sacral neuromodulation in patients with idiopathic nonobstructive urinary retention: Single-center experience.

OBJECTIVE: The objective of this study was to determine the safety and efficacy of sacral neuromodulation (SNM) in patients with idiopathic nonobstructive urinary retention. MATERIALS AND METHODS: We retrospectively reviewed the files of patients who underwent staged neuromodulation for idiopathic nonobstructive urinary retention from 2004 to 2016 at our hospital. Patients who had a 50% improvement in symptoms after 1 week of stage 1 procedure were qualified for permanent device implantation. Patient data were assessed on efficacy and need for intermittent self-catheterization, complications, and operative revision rates. RESULTS: Twenty-seven female patients who underwent SNM therapy were analyzed. The mean age of the patients was 32.5 ± 10.8 years. The mean duration of urinary retention was 3.2 ± 1.7 years. All patients were doing intermittent self-catheterization, but few were able to void <100 ml. Twenty-four (88.8%) of the 27 patients demonstrated a >50% improvement in symptoms and underwent permanent device placement. At a median follow-up of 5.7 ± 3.2 years, 20 (83.3%) of the 24 patients demonstrated sustained improvement rates of >50%. Seventeen (70.83%) of 24 patients could void spontaneously with a mean residual urine of 28.1 ± 24.4 ml (P < 0.001). Three (12.5%) were voiding with significant mean decreasing number of catheterizations from 5.6 ± 2.4 to 1.4 ± 2.1 (P < 0.001). Four (16.6%) had their device explanted. Ten (41.6%) of the 24 patients underwent surgical revision. Most of the adverse events were managed by device reprograming. CONCLUSION: SNM is a highly effective and safe procedure in this subset of the female population with idiopathic refractory nonobstructive urinary retention.

Knowledge around back pain and spinal disorders among Saudi patients: A cross-sectional study.

OBJECTIVE: To assess the knowledge of patients about low back pain and spinal disorders. METHODS: This cross-sectional study was conducted at King Saud University, Riyadh, Saudi Arabia, from December 2015 to February 2016, and comprised patients presenting with lower back pain. The low back pain knowledge questionnaire was translated to Arabic and distributed, after adding more questions, among patients. The scores were calculated as per the published guidelines. SPSS 21 was used for data analysis. RESULTS: There were 153 patients in the study. The reliability test revealed a Cronbach's alpha score of 0.834 for all items. The overall mean age was 40.2±19.3 years (range: 15-76 years). Besides, 61(39.9%) participants were males and 92(60.1%) were females. The overall median score was 9 (interquartile range: 0-19) out of 24 points. Both educational level and monthly income were found to be dependent variables (p<0.001; p=0.007). . CONCLUSIONS: The majority of patients with lower back pain had limited knowledge about their condition and the related complications.

Factors Predicting Renal Function Outcome after Augmentation Cystoplasty.

We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was 7.0 ± 2.6 years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median 114 ± 53.6 to 342.1 ± 68.3 ml (p = .0001), 68.5 ± 19.9 to 28.2 ± 6.9 cm H2O (p = .0001), and 3.0 ± 2.1 to 12.8 ± 3.9 (p = .0001), respectively. Renal function remained stable and improved in 22 (76%) patients from median eGFR 135 ± 81.98 to 142.82 ± 94.4 ml/min/1.73 m2 (p = .160). Significant deterioration was found in 7 (24%) patients from median eGFR 68.25 ± 42 to 36.57 ± 35.33 (p = .001). The causes of renal deterioration were noncompliance to self-catheterization (2 patients), posterior urethral valve/dysplastic kidneys (2 patients), and reflux/infection (2 patients). On multivariate analysis, recurrent pyelonephritis (OR 3.87, p = 0.0155) and noncompliance (OR 30.78, p = 0.0156) were significant. We concluded that AC is not the cause of progression to end-stage renal disease in patients with renal insufficiency.

The validity and reliability of the Arabic version of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire: Can we implement it in Saudi Arabia?

BACKGROUND: The Japanese Orthopedic Association designed their back pain evaluation questionnaire (JOABPEQ) which was proven to be feasible, reliable and valid. The questionnaire's validity and reliability were confirmed when it was implemented in patients with different cultural background. Since the JOABPEQ still has not been utilized in any of the Arabic countries, we present the Arabic version with its validity and reliability. METHODS: After ensuring an optimal forward-backward translation of the JOABPEQ, the Arabic version was distributed among 151 patients visiting our clinics from December 2015 to February 2016. The reliability was tested using Cronbach's alpha. The convergent validity was assessed through aggregating and correlating the questionnaire's items with their previously designed and validated subscales described in the JOABPEQ validity study by Fukui et al. (four items for social function, seven for mental health, six for lumbar function, five for walking ability and four for low back pain); Spearman's correlation matrix was used. The correlation coefficient had to be greater than 0.40 for each item with its corresponding subscale to be satisfactory. Scores underwent descriptive analysis, and Mann-Whitney u test was performed to compare between categorical subgroups. RESULTS: 151 spine patients completed the questionnaire. The mean age (range) was 34.9 (10-72) years. The male respondents were 61 (40.4%) and the females were 90 (59.6%). The result of Cronbach's alpha for internal consistency (reliability) was 0.87 for the 25 items. The validity was confirmed since the correlation coefficient was greater than 0.4 for each item with only its relevant subscale. CONCLUSION: the Arabic version of the JOABPEQ is valid, reliable and feasible in assessing patients with spine disorders. We believe the JOABPEQ with its different versions are suitable questionnaires to be used across nations and can serve as a unified tool in conducting research and exchanging information in the future.

Coccygodynia review: coccygectomy case series.

BACKGROUND: Coccygodynia is a pain of the coccyx that is typically exaggerated by pressure. Management includes anti-inflammatory medications, physiotherapy, and coccyx manipulation. Coccygectomy is the surgical approach for treating coccygodynia when the conservative management fails. Generally, coccygectomy yields good results. Its most common complication is wound infection. OBJECTIVE: To determine the effectiveness of coccygectomy in patients with coccygodynia. METHODS: A retrospective review of 70 patients (52 females and 18 males) with coccygodynia at King Khalid University Hospital in Riyadh was carried out, and the outcomes were studied. Twenty patients did not respond to conservative management; therefore, bimanual coccyx manipulation was done. Eleven were identified with instability and did not respond to coccygeal manipulation. Coccygectomy was performed on 8 patients while 3 declined. RESULTS: All patients who underwent coccygectomy showed improvement of their symptoms. One case of superficial wound infection and delayed wound healing was encountered. CONCLUSION: Coccygectomy provides effective pain relief to patients not responding to conservative therapies.