3D visualization of perianal fistulas using parametric models.

BACKGROUND: Magnetic resonance imaging (MRI) is used as a standard for assessment of complex perianal fistulas. Apart from textual description of the case, 3D reconstructed models from MRI further aid in understanding the entire anatomy of the fistula tract and its relation to the pelvic floor. This information is crucial as it helps surgeons to understand the extent and complexity of the disease before surgical treatment. However, 3D model generation from MRI is a time-consuming step for a radiologist as it requires tedious manual delineations to be performed on every slice of the images. The aim of this study was to develop a method that could enable radiologists to present enhanced information to surgeons for treatment of complex perianal fistulas while simultaneously reducing the manual efforts and time required to generate the information. METHODS: A method was proposed to depict relevant anatomies of complex perianal fistula as parametric models in three-dimensional (3D) space. A plugin inside 3D Slicer software was developed for the generation of the parametric models from MRI. The levator ani muscle, internal sphincter, and external sphincter are represented as tubular structures, whereas fistula tracks and abscess are presented as splines. RESULTS: Parametric models were generated to depict three cases of complex perianal fistulas and similarity measures were computed for ten cases. Visual comparison of the parametric models was made with the 3D models generated by the standard approach. The parametric models took less time to create and were able to visually present enriched information as compared to the 3D models generated by the standard approach. CONCLUSIONS: The proposed method, using parametric models, shows potential for faster generation and better visualization of the 3D information required for the treatment of complex perianal fistula cases.

Therapeutic efficacy of the root tubers of Aconitum heterophyllum and its substitute Cyperus rotundus in the amelioration of pylorus ligation induced ulcerogenic and oxidative damage in rats.

The phenomenal increase in the demand of herbal drugs, leads to over exploitation of medicinal plants which ultimately resulted in the scarcity and endangerment of many valuable plant species. On observing the difficulties in procuring genuine herbal drugs arose the concept of substitution which was documented in many classical Ayurvedic texts. The present study made a comparative evaluation of the gastroprotective potential of hydroalcoholic extracts of an original drug Aconitum heterophyllum (HAAH) and its substitute Cyperus rotundus (HACR) in the treatment of gastric ulcer under in vivo experimental conditions. The anti-ulcer property of the plant extracts was investigated against pylorus ligation induced ulcer in Wistar albino rats. The results confirmed that both A. heterophyllum and C. rotundus deliver comparable significant protection against gastric ulcer, indicated by a decrease in the free and total acidity, volume of gastric content, total proteins and increase in pH of gastric content, total carbohydrates and total carbohydrates to total proteins ratio. The observed anti-ulcer potential of both the drugs is attributed mainly to prevention of the generation of damaging free radical cascades and oxidant radical release.

Testosterone, testosterone therapy and prostate cancer.

With prostate cancer not observed in eunuchs and total androgen suppression by castration an effective first-line treatment for advanced prostate cancer, the dramatic regression seen in tumour symptoms after castration, lead to the theory that high levels of circulating androgens were a risk factor for prostate cancer. This theory however, ignored the effects testosterone variations within a physiologic range could have on early tumour events and since the early 2000s, clinical evidence discounting testosterone as a linear mechanistic cause of prostate cancer growth mounted, with alternative mechanistic hypotheses such as the saturation model being proposed. Together with a growing understanding of the negative health effects and decreased quality of life in men with testosterone deficiency or hypogonadism, a paradigm shift away from testosterone as a prostate cancer inducer occurred allowing clinicians to use testosterone therapy as potential treatment for men with difficult and symptomatic hypogonadism that had been previously treated for prostate cancer. In this review we contextualise the idea of testosterone as a risk factor for prostate cancer inducement and compile the most current literature with regards to the influence of testosterone and testosterone therapy in prostate cancer.

Testosterone therapy has positive effects on anthropometric measures, metabolic syndrome components (obesity, lipid profile, Diabetes Mellitus control), blood indices, liver enzymes, and prostate health indicators in elderly hypogonadal men.

To alleviate late-onset hypogonadism, testosterone treatment is offered to suitable patients. Although testosterone treatment is commonly given to late-onset hypogonadism patients, there remains uncertainty about the metabolic effects during follow-ups. We assessed the associations between testosterone treatment and wide range of characteristics that included hormonal, anthropometric, biochemical features. Patients received intramuscular 1,000 mg testosterone undecanoate for 1 year. Patient anthropometric measurements were undertaken at baseline and at each visit, and blood samples were drawn at each visit, prior to the next testosterone undecanoate. Eighty-eight patients (51.1 ± 13.0 years) completed the follow-up period. Testosterone treatment was associated with significant increase in serum testosterone levels and significant stepladder decrease in body mass index, total cholesterol, triglycerides and glycated haemoglobin from baseline values among all patients. There was no significant increase in liver enzymes. There was an increase in haemoglobin and haematocrit, as well as in prostate-specific antigen and prostate volume, but no prostate biopsy intervention was needed for study patients during 1-year testosterone treatment follow-up. Testosterone treatment with long-acting testosterone undecanoate improved the constituents of metabolic syndrome and improved glycated haemoglobin in a stepladder fashion, with no adverse effects.

Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? a randomized controlled trial.

Patient concerns about penile length after penile prosthesis (PP) implantation for erectile dysfunction (ED) have significant impact on patients and their partners. In addition, corporal fibrosis is associated with difficult PP implantation. The preoperative use of vacuum erectile devices (VED) is an uncommon physical treatment for such concerns. Therefore, the current randomized controlled study assessed two outcomes: whether pre-operative VED use for a month before surgery would significantly increase flaccid stretched penile length (SPL) on the day of surgery, and facilitate easier corporal dilatation intraoperatively. Fifty-one patients scheduled for PP implantation for ED were randomized to either intervention group (pre-operative VED use; 10-15 min/day for ≥30 days; Group A; n = 25), or control group (no intervention; Group B; n = 26). A research assistant (blinded to the treatment assignments) recorded SPL at baseline (initial consultation) and on day of surgery. The surgeons performing the PP implantation (also blinded to the treatment assignments) provided subjective assessments of the ease of corporal dilatation. Baseline patient characteristics, demographics, and comorbidities were the same in both groups. Baseline measurements (SPL-1) were 10.71 ± 1.28 and 10.87 ± 1.26 cm in Group A and Group B, respectively; and the day of surgery measurements (SPL-2) were 11.50 ± 1.33 and 11.06 ± 1.34 cm in Group A and Group B, respectively. In terms of outcomes: mean SPL increase in Group A was significantly more by a mean of 0.80 ± 0.38 cm (p < 0.05) compared to Group B; and surgeons' subjective report of surgical ease indicated smoother corporal dilatation for Group A compared to Group B. VED use (10-15 min/day during the month prior to PP implantation) was associated with significantly increased SPL on day of surgery, and facilitated easier corporal dilatation intraoperatively. Future studies should examine the long-term outcomes of penile prosthesis implantation after pre-operative use of vacuum erectile devices.

Association between oral health knowledge and practices of Saudi pregnant women in Dammam, Saudi Arabia.

This study assessed the association between oral health knowledge and practices of pregnant Saudi women selected from visitors to a government hospital in Dammam, Saudi Arabia in 2014. Women answered questions on oral health knowledge during pregnancy and knowledge of infant oral health. Most women (> 70%) knew that dental caries in children can be prevented, that pregnancy affects oral health and that dental treatment during pregnancy can negatively affect infants. Most women (> 80%) performed oral hygiene procedures but only 18% regularly visited the dentist. In a regression analysis, oral health knowledge was not significantly associated with reported oral hygiene practices. Women who visited the dentist regularly were more likely to know how to prevent caries in children, and that dental treatment during pregnancy and infant health were associated.

Association between oral health knowledge and practices of Saudi pregnant women in Dammam, Saudi Arabia

This study assessed the association between oral health knowledge and practices of pregnant Saudi women selected from visitors to a government hospital in Dammam, Saudi Arabia in 2014. Women answered questions on oral health knowledge during pregnancy and knowledge of infant oral health. Most women [> 70%] knew that dental caries in children can be prevented, that pregnancy affects oral health and that dental treatment during pregnancy can negatively affect infants. Most women [> 80%] performed oral hygiene procedures but only 18% regularly visited the dentist. In a regression analysis, oral health knowledge was not significantly associated with reported oral hygiene practices. Women who visited the dentist regularly were more likely to know how to prevent caries in children, and that dental treatment during pregnancy and infant health were associated

La présente étude avait pour objectif d'étudier l'association entre les connaissances et les pratiques en matière de santé bucco-dentaire de femmes enceintes saoudiennes sélectionnées dans un hôpital public à Dammam, Arabie saoudite, en 2014. Les femmes interrogées ont répondu à des questions concernant leurs connaissances sur la santé bucco-dentaire pendant la grossesse et la santé bucco-dentaire du nourrisson. La plupart des femmes [plus de 70%] avaient connaissance du fait que les caries dentaires chez l'enfant peuvent être évitées, que la grossesse a une influence sur la santé bucco-dentaire, et que les traitements dentaires pendant la grossesse peuvent avoir un impact négatif sur le nourrisson. La plupart des femmes [plus de 80%] appliquaient des pratiques d'hygiène buccale, mais seulement 18% se rendaient régulièrement chez un dentiste. Une analyse de régression a montré que les connaissances en matière de santé bucco-dentaire n'étaient pas associées de façon significative à l'application de pratiques d'hygiène buccale. Les femmes consultant régulièrement un dentiste étaient plus susceptibles de savoir comment prévenir les caries chez l'enfant, et qu'un traitement dentaire pendant la grossesse et la santé du nourrisson étaient corrélées

Evaluating the English language scientific writing skills of Saudi dental students at entry level.

Better knowledge is needed about the effectiveness of preparatory English language courses for the health professions. This study evaluated the scientific writing skills of students finishing their preparatory year of a bachelor of dentistry programme in Saudi Arabia. A cross-sectional study was conducted in 2014-15 among first-year dental students at the University of Dammam. Students were asked to write a 150-word English language assignment that was analysed for writing statistics and problems using Microsoft Word and plagiarism detection software. Of the 89 respondents, female students used a significantly greater number of words than did male students and their assignments had significantly lower Flesch reading ease scores. Male students had significantly lower odds of using references (OR 0.04) and higher odds of making punctuation and grammar mistakes (OR 2.63 and 3.91 respectively). One course of scientific writing in the preparatory year may not be enough to develop adequate writing skills among undergraduate dental students.

New generic and species records for the flora of Saudi Arabia.

Recent field works in the central and southern regions of Saudi Arabia including agricultural centers have managed to collect four vascular plants new to terrestrial and wetland flora of the country. These new additions include one new genus Malvastrum A. Gray (M. coromandelianum) subsp. capitato-spicatum (O. Kuntze) S.R. Hill, Potamogeton perfoliatus L. (Potamogetonaceae), Euphorbia tirucalli L. (Euphorbiaceae) and Sesuvium portulacastrum (L.) L. (Aizoaceae). Detailed morphological description, distribution and habitat of each of these species are provided along with illustrations and photographs. The report of new additions to the flora of Saudi Arabia indicated that the country needs thorough botanical explorations.

Epidemiology of autistic disorder in Bahrain: prevalence and obstetric and familial characteristics.

European and North American studies show that the prevalence of autistic disorder is inccreasing. This study was performed to identify the prevalence of autistic disorder in Bahrain, and determine some of the demographic and family characteristics. Using a case-control design, 100 children who received a diagnosis of autistic disorder according to DSM-IV-TR during the period 2000-2010 were selected. An equal numberofcontrols who had received a diagnosis of nocturnal enuresis and no psychopathology were selected, matched for sex and age group. The prevalence of autistic disorder was estimated as 4.3 per 10,000 population, with a male:female sex ratio of 4:1. Significantly more cases than controls were delivered by caesarean section and had mothers who suffered prenatal complications. The prevalence estimate in Bahrain is comparable to previous reports using similar methods. Obstetric complications and caesarean section delivery may be associated with autistic disorder.

BRCA1 gene Molecular Alterations in Omani Breast Cancer Patients.

BACKGROUND: Breast cancer (BC) is the most common cancer reported in females in Oman and usually occurs at a relatively younger age, presents at an advanced stage and behaves aggressively. BC occurs in hereditary and sporadic forms. Although germ-line mutations in BRCA1 and BRCA2 genes are rare in sporadic cases compared with hereditary cases, molecular alterations, such as loss of heterozygosity, and CpG methylation, are common. In this study, we investigated the types of molecular alterations associated with hereditary and sporadic BRCA1-associated BC in Omani patients. METHODS: We obtained clinical data and samples from 43 sporadic BC patients. The selection of cases was made based on the following criteria: aged ≤ 40 years, or bilateral breast cancer, or estrogen and progesterone receptor negative status, and HER-2/neu negative (Triple Negative phenotype) status. Screening for molecular alterations was performed by direct sequencing, multiplex ligation-dependent probe amplification (MLPA). RESULTS: Genomic deletions and duplication in the BRCA1 gene were identified in four female patients. Two patients carried exon 1 and 2 deletions and two showed exon 1 and 2 duplication. Screening for mutation by direct sequencing revealed three polymorphisms in exon 11. Two of these polymorphisms are nonsynonymous (rs1800704, rs799917) and one is synonymous (rs1800740). CONCLUSION: The current pilot study detected previously described gene rearrangements and polymorphisms involving the BRCA1 gene and no seemingly pathogenic missense mutations were elucidated. KEYWORDS: BRCA1, breast cancer, mutation, polymorphism, Omani, Arab.

Which is guilty in self-induced penile fractures: marital status, culture or geographic region? A case series and literature review.

Penile fracture is a well-recognized and relatively uncommon clinical entity. It was previously reported that the incidence of penile fracture varies according to various geographic regions. In order to determine whether marital status or culture other than geographic region is involved in the etiology of penile fracture in our country, the charts of 122 men diagnosed with penile fracture were retrospectively reviewed. Detailed history including cause, symptoms, country of origin and a single-question self-report of erectile dysfunction was used for all cases. Diagnosis of our cases was mainly based on history and physical examination and ultrasonography. Immediate or delayed surgical repair of penile fracture included a degloving circumferential, and an additional direct incision, if the site of the tear could not be reached via degloving, was performed. The patients were evaluated after 1 week and 1, 3, and 6 months follow-up by penile examination, recording complications, and with a single-question self-report questionnaire after 3 and 6 months. The most common cause of penile fracture was manual bending of the erected penis in 66 out of 122 (54.1%) of our study patients. In our study, we believe that the prime causes of bending the penis are single status and culture, which are influencing factors irrespective of the geographic distribution.

Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature.

A cohort of 20 patients with delayed priapism who underwent treatment at the Emergency Department of our academic referral centers between January 2002 and April 2010 was studied. Of these, 16 cases suffered from a low-flow priapism. A total of 6 cases were managed non-surgically, 10 required shunt surgery, and of these 5 were treated by early penile prosthesis surgery. Prostheses were easily implanted in all patients with a mean operative time of 94 min. No intraoperative complications and no infection were registered. All patients with an inflatable prosthesis complained a reduction in penile sensibility that lasted 3 months. All patients were satisfied with the results of surgery (International Index of Erectile Function Questionnaire-5, Q5 mean value 4), and all were successfully engaging in satisfactory sexual intercourses. No significant loss of penile length, neither apical erosion nor extrusion was recorded. Early insertion of a penile prosthesis is a simple and safe procedure in patients with ischemic priapism, which failed to respond to conservative management. Early insertion of a prosthesis helps to maintain adequate penile length, resolve priapism and, in the long term, it results in high satisfaction rates.