Intravesical instillation of platelet-rich plasma for treatment of interstitial cystitis/bladder pain syndrome: A pilot study.

Objective: The aim of this study was to evaluate the feasibility of intravesical instillation of platelet-rich plasma (PRP) to treat interstitial cystitis/bladder pain syndrome (IC/BPS). Materials and methods: Twenty PRP samples were tested in vitro for stability after exposure to urine samples with different pH. A pilot study involving 21 female patients with IC/BPS was conducted, and 6 weekly doses of autologous PRP (50 mL) were administered. Patients were followed up at the 2nd, 4th, 8th, and 12th weeks after terminating instillation. The primary endpoint was the visual analog scale (VAS) for pain, and the secondary endpoints included the IC symptom index, IC problem index of the O'Leary-Sant questionnaire and global response assessment, urine culture, and uroflowmetry. Success was defined as a reduction in VAS by 30% or more compared with basal level, and adverse events were recorded. Results: The mean ± SD of VAS was significantly reduced compared with basal level (4.4 ± 2.6 vs. 8.8 ± 1.1, respectively, p = 0.001). Meanwhile, 80% of cases were considered successful, with a 50.1% reduction in the mean score compared with the basal level. The mean ± SD of IC symptom index and IC problem index significantly improved compared with the basal level. Global response assessment was markedly, moderately, and slightly improved in 2 (10%), 10 (50%), and 5 (25%) patients, respectively, and showed no change in 3 (15%). Three patients had positive urine cultures at follow-up, but 1 withdrew after 2 sessions because of a lack of efficacy. Conclusions: Repeated intravesical instillation of PRP could be considered an effective and safe approach for treating IC/BPS.

Pattern of traumatic occupational injuries in Saudi Arabia: A cross-sectional study.

Background: In the Kingdom of Saudi Arabia (KSA), the labor market is thriving, employing a large workforce in occupations that carry a high risk for traumatic injuries such as construction, transportation, and manufacturing. These jobs usually involve physical exertion, power tools, high-voltage electricity, working at heights, and exposure to bad weather conditions that could potentially lead to injury. This study aimed to determine patterns of traumatic occupational injuries in Riyadh, KSA. Methods: A cross-sectional study was conducted at King Khalid Hospital and Prince Sultan Centre for Healthcare, Prince Sattam bin Abdulaziz University Hospital, and the Al-Kharj Military Industries Corporation Hospital in Al-Kharj City in the KSA between July 2021 and 2022. Descriptive analysis elucidated the type, severity, and patterns of management of non-fatal traumatic occupational injuries. A Kaplan-Meier survival curve and Weibull model for length of hospital stay adjusted for age, gender, nationality, cause for injury, and injury severity scale (ISS) scores were constructed. Results: A total of 73 patients with a mean age of 33.8 ± 14.1 years were included in the study. The most common cause of occupational injury was falling from height (87.7%). The median length of hospital stay was 6 days (IQR: 4 - 7), with no mortalities. In the adjusted survival model, compared to migrants, Saudi nationals had a 45% lower median hospital stay (-62 to - 21), P < 0.01, and every 1-point increase in ISS was associated with a 5% increase in median length of hospital stay (CI: 3 - 7, P < 0.01). Conclusion: Being a Saudi national and having lower ISS scores were associated with shorter durations of hospital stay. Our findings indicate the need for improved occupational safety measures, especially among migrant, foreign-born, and ethnic minority workers.

Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: a case-matched multicenter study.

BACKGROUND: The present study aimed to compare the outcome of single anastomosis sleeve ileal (SASI) bypass and sleeve gastrectomy (SG) in regards weight loss, improvement in comorbidities at 12 months of follow-up, and postoperative complications. METHODS: This was a case-matched, multicenter analysis of the outcome of patients who underwent SG or SASI bypass. Patients who underwent SASI bypass were matched with an equal number of patients who underwent SG in terms of age, sex, BMI, and comorbidities. The main outcome measures were excess weight loss (EWL) at 6 and 12 months after surgery, improvement in medical comorbidities, and complications. RESULTS: A total of 116 patients (97 female) of a mean age of 35.8 years were included. Fifty-eight patients underwent SASI bypass and an equal number underwent SG. %EWL at 6 months postoperatively was similar between the two groups. SASI bypass conferred significantly higher %EWL at 12 months than SG (72.6 Vs 60.4, p < 0.0001). Improvement in type 2 diabetes mellitus (T2DM) and gastroesophageal reflux disease (GERD) after SASI bypass was better than SG (95.8% Vs 70% and 85.7% Vs 18.2%, respectively). SASI bypass required longer operation time than SG (108.7 Vs 92.8 min, p < 0.0001). Complications occurred in 12 (20.7%) patients after SG and 4 (6.9%) patients after SASI bypass (p = 0.056). CONCLUSION: The %EWL at 12 months after SASI bypass was significantly higher than after SG. SASI bypass conferred better improvement in T2DM and GERD than SG. Both procedures had similar weight loss at 6 months postoperatively and comparable complication rates.

Short-term Outcome of Single-Anastomosis Plication Ileal Bypass (SAPI) in Treatment of Morbid Obesity.

PURPOSE: This prospective study aimed to report the short-term outcome of the single-anastomosis plication ileal (SAPI) bypass in the treatment of morbid obesity. METHODS: Adult patients with morbid obesity who underwent SAPI procedure were recruited to this prospective study. SAPI procedure involved plication of the greater curvature of the stomach in two rows then performing a stapled side-to-side anastomosis between an ileal loop and the gastric antrum. Body mass index (BMI), percentage excess weight loss (%EWL), percentage total weight loss (%TWL), and improvement in comorbidities were recorded at 6 and 12 months postoperatively. RESULTS: The present study included 56 patients (48 female) of a mean age of 37.3 years. There was a significant decrease in BMI at 6 months (37.2 ± 9.3) and 12 months (31.5 ± 7.8) as compared with the baseline BMI (47.9 ± 5.7). The %EWL at 12 months was 72.5 ± 16.2, significantly higher than its value at 6 months (50.1 ± 15.6). The %TWL at 12 months was 36.4 ± 6.4, significantly higher than its value at 6 months (24.9 ± 6.3). All patients with DM showed remission or improvement in their diabetic state. Improvement in hyperlipidemia and hypertension was recorded in 81.8% and 77.8% of patients, respectively. Postoperative complications were recorded in five (8.9%) patients. CONCLUSION: SAPI procedure achieved significant reduction in body weight and BMI, significant %EWL, and satisfactory improvement in comorbidities at 12 months after surgery. Longer follow-up of patients is needed to reach more solid conclusions on the efficacy and safety of this new technique.

A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection.

BACKGROUND: Surgical site infection (SSI) is one of the most common complications after abdominal surgery. The present trial examined the efficacy of saline irrigation of open appendectomy wound with or without topical antibiotics in prevention of SSI. METHODS: This was a double-blind randomized trial on patients with acute appendicitis who underwent open appendectomy. Patients were randomly allocated to one of three equal groups; group I had layer-by-layer wound irrigation with gentamicin-saline solution, group II had wound irrigation with saline solution, and group III received no irrigation (Control group). The main outcome measures were the incidence of incisional SSI, surgical site occurrence (SSO), other complications, operation time, postoperative pain, and patients' satisfaction. RESULTS: 205 patients (113 female) of a mean age of 27.9 years were included. The average hospital stay and pain scores were similar in the three groups. Groups I and II had significantly lower rates of incisional SSI (4.3% Vs 2.9%; Vs 17.4%, p = 0.005) and SSO (24.6% Vs 13.4% Vs 43.5%; p = 0.0003) as compared to group III. Groups I and II had comparable rates of SSI and SSO. The three groups had similar rates of wound seroma, hematoma, and dehiscence. Groups I and II had significantly higher satisfaction with the procedure than group III. CONCLUSIONS: Layer-by-layer irrigation of open appendectomy wound decreased the rates of incisional SSI and SSO significantly compared to the no-irrigation group. Adding gentamicin to saline solution was useless to improve the outcome and did not decrease rates of SSI or other complications.

Fasting Ghrelin and Postprandial GLP-1 Levels in Patients With Morbid Obesity and Medical Comorbidities After Sleeve Gastrectomy and One-anastomosis Gastric Bypass: A Randomized Clinical Trial.

BACKGROUND: Sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are among the commonly performed bariatric procedures. This randomized study aimed to compare SG and OAGB in terms of weight loss, improvement in comorbidities, and change in serum ghrelin and glucagon-like peptide-1 (GLP-1) levels. PATIENTS AND METHODS: This was a prospective randomized trial on patients with morbid obesity associated with medical comorbidities who were randomly assigned to 1 of 2 equal groups; group I underwent SG and group II underwent OAGB. Outcome measures were percent of excess weight loss (%EWL), improvement in comorbidities, change in the venous levels of fasting ghrelin and postprandial GLP-1 at 12 months after surgery, in addition to operation time and complications. RESULTS: Forty patients (38 female) of a mean age of 33.8 years and mean body mass index of 48.6 kg/m2 were included. Operation time in group II was significantly longer than in group I (86 vs. 52.87 min; P<0.001). There were 6 recorded complications (1 in group I and 5 in group II, P=0.18). The %EWL, %total weight loss, and %excess body mass index loss at 6 and 12 months postoperatively were significantly higher in group II than in group I. Both groups had similar rates of improvement in comorbidities. Group I had significantly lower ghrelin and GLP-1 levels postoperatively at 6 and 12 months, respectively, as compared with group II. CONCLUSIONS: OAGB was associated with significantly higher EWL than SG. The reduction in fasting ghrelin and postprandial GLP-1 serum levels at 12 months after SG was significantly higher than that after OAGB.

Helicobacter pylori, Sleeve Gastrectomy, and Gastroesophageal Reflux Disease; Is there a Relation?

PURPOSE: Sleeve gastrectomy (SG) is an effective bariatric procedure, yet can be associated with complications as gastroesophageal reflux disease (GERD). The present study aimed to investigate the prevalence of Helicobacter pylori (H. pylori) in SG specimens, its relation with GERD, and its impact on postoperative outcomes. METHODS: All SG specimens received in the pathology laboratory were reviewed. The prevalence of H. pylori in SG specimens was recorded. Patients with H. pylori infection who received triple therapy were compared with patients without H pylori in terms of baseline characteristics, preoperative GERD and its outcome postoperatively, development of new-onset GERD, staple line complications, and weight loss. RESULTS: The records of 176 patients were reviewed; 69 (39.2%) were positively tested on H. pylori infection. Patients with H. pylori had higher body mass index (BMI) (RR = 1.51), greater incidence of preoperative GERD (RR = 1.67), and complained more of dyspepsia (RR = 1.87). Eradication of H. pylori was achieved in 67 (97.1%) of 69 patients. Postoperative improvement in GERD symptoms (44.4% Vs 19%, p = 0.036) and dyspepsia (85.7% Vs 51.7%, p = 0.007) was higher in patients with H. pylori with confirmed eradication of infection than patients without H. pylori. Both groups had similar operation time, postoperative BMI, excess weight loss, staple line complications, and new-onset GERD. CONCLUSIONS: More than one-third of patients with morbid obesity had H. pylori infection. Morbidly obese patients with H. pylori infection may be more prone to develop GERD symptoms; yet after eradication of the infection, they may also experience better improvement in symptoms after SG.

Topical 5% minoxidil versus topical 0.2% glyceryl trinitrate in treatment of chronic anal fissure: A randomized clinical trial.

BACKGROUND: Chronic anal fissure (CAF) is a common painful anal condition. Medical treatment of CAF involves the use of agents that induce chemical sphincterotomy. The present trial aimed to compare the efficacy and safety of topical minoxidil and glyceryl trinitrate (GTN) preparations in treatment of CAF. METHODS: Adult patients with CAF were randomly assigned to one of two equal groups; group I received topical 5% minoxidil gel and group II received topical 0.2% GTN cream. The main outcome measures were healing of anal fissure, duration to healing, relief of symptoms, and adverse effects. RESULTS: 62 patients (36 female and 26 male) were included to the study. Group I comprised 30 patients and group II comprised 32 patients. Healing of anal fissure was achieved in 23 (76.7%) patients in group I and 15 (46.9%) patients in group II (p = 0.03). The average duration to healing in group I was significantly shorter than group II (4.1 ± 1.9 vs 5.3 ± 2.7 weeks, p = 0.048). Adverse effects were recorded in 2 (6.6%) patients in group I and 13 (40.6%) patients in group II. The post-treatment pain score in the GTN group was significantly lower than the Minoxidil group. CONCLUSION: Topical 5% minoxidil gel achieved greater and quicker healing of CAF and fewer adverse effects than topical 0.2% GTN cream. Post-treatment pain scores after GTN were significantly lower than minoxidil. TRIAL REGISTRATION NUMBER: NCT03528772.

Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients With Morbid Obesity: Technical Description and Short-term Outcomes.

BACKGROUND: Morbid obesity has been recognized as a public health crisis, particularly in developed countries. Single anastomosis sleeve ileal (SASI) bypass has been introduced as a novel bariatric and metabolic procedure. The present study aimed to describe the technical steps and assess the short-term outcomes of SASI bypass in patients with super morbid obesity. PATIENTS AND METHODS: Adult patients of both sexes with body mass index (BMI) ≥50 kg/m underwent SASI bypass and were followed for 12 months postoperatively. Changes in BMI, excess weight loss (EWL), and improvement in comorbidities were recorded on follow-up. RESULTS: Twenty patients (17 female) of the mean age of 35.4 years were included in the study. The mean preoperative BMI (53.7±5.9) showed a significant decrease at 6 months (39.9±5.2) and then at 12 months (33.6±6) postoperatively. The mean %EWL was 44.3±7.8 at 6 months and 65.2±12.6 at 12 months. All patients with diabetes mellitus, osteoarthritis, and reflux esophagitis showed resolution at 12 months after the SASI bypass. Complications were recorded in 2 patients and no mortality was reported. CONCLUSIONS: SASI bypass is an effective and safe bariatric procedure that confers significant loss of weight and improvement in medical comorbidities. As compared with previous studies on patients with lower BMI, patients with super morbid obesity attained lower %EWL but similar resolution of diabetes mellitus at 12 months after SASI bypass.

Identifying Patients at High Risk of Having Pulmonary Dysfunction Before Laparoscopic Bariatric Surgery and Its Impact on Postoperative Pulmonary Complications.

Background: Morbid obesity is associated with variable degrees of pulmonary dysfunction that may predispose to postoperative complications. This study aimed to identify high risk patients to have pulmonary dysfunction before bariatric surgery in terms of age, sex, and body mass index (BMI) and the impact of pulmonary dysfunction on postoperative pulmonary complications. Methods: Prospective database of patients with morbid obesity who underwent bariatric surgery was reviewed. Data on patients' demographics, parameters of pulmonary function tests, and postoperative pulmonary complications were collected. The correlation between patients' age, sex and BMI, and pulmonary function was investigated using Pearson's correlation coefficient test. Results: Ninety-seven patients (82 female) with morbid obesity were included in the study. Twenty-eight (28.9%) patients had pulmonary dysfunction. Patients >40 years had higher odds of pulmonary dysfunction than patients ≤40 years (odds ratio [OR]: 2.54, P = .05). Male patients had significantly higher odds of pulmonary dysfunction than female patients (OR: 2.5, P = .03). Patients with BMI >50 had significantly higher odds of pulmonary dysfunction than patients with BMI <50 (OR: 4.9, P = .002). Patients with pulmonary dysfunction had significantly higher odds of developing pulmonary complications than patients with normal spirometry (OR: 9.13, P = .009). Conclusion: Around 30% of patients undergoing bariatric surgery had pulmonary dysfunction. Pulmonary dysfunction in preoperative spirometry was able to predict postoperative pulmonary complications. Men, patients older than 40 years, and superobese individuals had higher odds of having pulmonary dysfunction and are at higher risk to develop pulmonary complications after bariatric surgery.

Drainage Seton Versus External Anal Sphincter-Sparing Seton After Rerouting of the Fistula Tract in the Treatment of Complex Anal Fistula: A Randomized Controlled Trial.

BACKGROUND: Complex anal fistula is one of the challenging anorectal conditions. Several treatments have been proposed for complex anal fistula, yet none proved to be ideal. OBJECTIVE: This randomized trial aimed to assess the efficacy of external anal sphincter-sparing seton in comparison with the conventional drainage seton in the treatment of complex anal fistula. DESIGN: This was a prospective, randomized, single-blind controlled study. SETTINGS: The study was conducted at the Colorectal Surgery Unit of Mansoura University Hospitals. PATIENTS: Adult patients of both sexes with complex anal fistula were recruited and evaluated with MRI before surgery. INTERVENTIONS: Patients were randomly divided into 2 groups; group 1 was treated with conventional drainage seton and group 2 was treated with external anal sphincter-sparing seton using a rerouting technique. MAIN OUTCOME MEASURES: The duration of healing, incidence of recurrence or persistence, postoperative pain, and complications including fecal incontinence were measured. RESULTS: Sixty patients (56 men) with a mean age of 43 years were included. Mean operation time in group 1 was significantly shorter than group 2 (29.8 ± 4.3 vs 43.8 ± 4.5 min; p < 0.0001). The mean pain score at 24 hours in group 1 was 8.1 ± 1.6 versus 5.3 ± 1.3 in group 2 (p < 0.0001). Five patients (17%) in group 1 experienced complications versus 2 (7%) in group 2. All of the patients in group 1 required a second-stage fistulotomy versus 2 patients (7%) in group 2 (p < 0.0001). Time to complete healing in group 1 was significantly (p < 0.0001) longer than group 2 (103 ± 47 vs 46 ± 18 d). Four patients (13%) in group 1 and 1 patient (3%) in group 2 experienced persistence or recurrence of anal fistula (p = 0.35). LIMITATIONS: This was a single-center study with relatively small numbers in each group. CONCLUSIONS: Patients treated with external anal sphincter-sparing seton after rerouting of the fistula tract achieved quicker healing and less postoperative pain than those with conventional drainage seton. Postoperative complication and recurrence rates were comparable in both groups. See Video Abstract at http://links.lww.com/DCR/A963. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03636997 (https://clinicaltrials.gov/ct2/show/NCT03636997).

Impact of Pyloric Injection of Magnesium Sulfate-Lidocaine Mixture on Postoperative Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: a Randomized-Controlled Trial.

BACKGROUND: One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG. METHODS: Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24 h postoperatively. RESULTS: Seventy patients (63 female) with a mean age of 34.6 ± 9.9 years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7 mmHg before injection to 13.4 ± 4.1 mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1 mmHg). Of the treatment group patients, 17.1% had significant PONV at 6 h compared to 91.4% of control group patients (p < 0.0001). At 24 h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001). CONCLUSION: Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24 h after LSG without being associated with higher complication rate.

Impact of Ultrasound-Guided Transversus Abdominis Plane Block on Postoperative Pain and Early Outcome After Laparoscopic Bariatric Surgery: a Randomized Double-Blinded Controlled Trial.

BACKGROUND: Based on the promising results of transversus abdominis plane (TAP) block in various abdominal procedures, this study aimed to investigate its effect on postoperative pain and early outcome after laparoscopic bariatric procedures. METHODS: Patients with morbid obesity were randomly assigned to one of two equal groups; group I had US-guided TAP block upon completion of the bariatric procedure and before recovery from general anesthesia and group II did not have TAP block. All procedures were performed laparoscopically with a standardized five-trocar technique. RESULTS: Ninety-two patients of a mean age of 34.7 years and mean BMI of 49.5 kg/m2 were included. The mean pain score in group I was significantly lower than group II at 1 and 6 h postoperatively, whereas no significant differences in pains scores at 12 and 24 h between the two groups were observed. Eight patients in group I required rescue opioid analgesia within the first 24 h postoperatively, compared with 24 patients in group II (P < 0.0001). The postoperative nausea and vomiting (PONV) score at 24 h was significantly lower in group I than group II. Group I required a significantly shorter time to full ambulation and to pass flatus compared with group II. Hospital stay was similar in the two groups. CONCLUSION: Using US-guided TAP block in adjunct with laparoscopic bariatric surgery managed to achieve lower pain scores, lower opioid requirements, lower PONV scores, earlier ambulation, shorter time to pass flatus, and comparable hospital stay and complication rate to the control group.

Outcome of Modified Park's Technique for Treatment of Complex Anal Fistula.

BACKGROUND: Treatment of complex anal fistula (CAF) can be associated with high rates of recurrence and fecal incontinence (FI). Park suggested drainage of the affected intersphincteric anal gland for treatment of cryptoglandular anal fistula; however, recurrence after this technique was high. We modified the original Park's technique by extending the internal sphincterotomy to ensure adequate drainage of the intersphincteric space. The aim of this study was to evaluate the incidence of recurrence and FI after modified Park's technique in treatment of CAF. METHODS: Adult patients of both genders with CAF were evaluated before undergoing modified Park's technique with Wexner continence score, clinical examination, and endoanal ultrasonography or MRI. Postoperatively, patients were examined every 2 wk until complete wound healing. The continence state was evaluated with Wexner continence score, and quality of life was assessed before surgery and at 6 mo postoperatively by Short Form-36 questionnaire. RESULTS: Thirty-two patients (27 male) of a mean age of 38 y were included. Median follow-up was 12 mo. Two patients (6.25%) experienced recurrence and 5 (15.6%) developed complications. One patient (3.1%) developed new-onset FI postoperatively. Twenty-eight (87.5%) patients were completely satisfied with the procedure. Quality of life showed significant improvement at 6 mo postoperatively. CONCLUSIONS: The modified Park's technique is a promising procedure for the treatment of CAF with low recurrence and FI rates, and improved quality of life.

Combined Doppler ultrasound and platelet indices for prediction of preeclampsia in high-risk pregnancies.

Objectives: To evaluate Doppler ultrasound and platelet indices for the prediction of preeclampsia (PE).Design: Prospective observational study.Methods: The study included 270 normal pregnancy primigravida <20 years at 20-24-week gestation. Doppler ultrasound was done to detect uterine artery diastolic notch and to measure the pulsation index (PI) and the resistance index (RI). The platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (Plcr) was measured by automated blood picture.Outcome: Validity of combined tests in prediction of PE.Results: Patients who developed PE had significant higher percentage of diastolic notch, higher mean PI, RI, and significant increase of MPV and PDW than normotensive women (p < .001). Patients with abnormal Doppler and abnormal platelet indices had significant higher incidence of severe PE (p < .001).Conclusion: Abnormal platelet indices combined with abnormal Doppler is a predictor of severity rather than the rate of development of PE.

Single-Anastomosis Plication Ileal Bypass (SAPI) in Treatment of Morbid Obesity.

BACKGROUND: This report aimed to demonstrate the technical steps and preliminary outcome of a novel bariatric procedure, the single-anastomosis plication ileal bypass (SAPI), for the treatment of morbid obesity. MATERIALS AND METHODS: Totally, 5 female patients with morbid obesity underwent SAPI procedure. The procedure consisted of 2 steps; the first step involved greater curvature plication done in a standardized manner, and the second step involved performing a stapled side-to-side anastomosis between an ileal loop 300 cm distal to the duodenojejunal junction and the gastric antrum. Body mass index (BMI) and percentage excess weight loss (%EWL) at 4 months postoperatively were measured. RESULTS: The median age of patients was 38 years. The mean preoperative BMI decreased from 47.3±7.1 kg/m to 36.3±6.1 at 4 months, postoperatively. The mean %EWL at 4 months after SAPI was 51.5±10.8. The mean operation time was 66±5.47 minutes. The median hospital stay was one day. No postoperative complications were recorded. CONCLUSIONS: Despite the small numbers included, the preliminary results of this report show that SAPI is a promising bariatric procedure that achieved significant decrease in BMI and satisfactory excess weight loss. Long-term follow-up of larger number of patients is necessary to reach more firm conclusions on the efficacy and safety of this novel technique.

Demographics and sexual characteristics of sex-enhancing medication users: Study of a web-based cross-sectional sample of sexually active men.

OBJECTIVES: To evaluate the frequency of sex-enhancing medications (S-EM) use and to investigate the demographics and sexual characteristics of the S-EM users amongst a Saudi Arabian male population. SUBJECTS AND METHODS: A cross-sectional sample of 1176 Saudi Arabian men was recruited using a web-based survey between 1 January and 1 April 2015. The survey included multiple open and closed questions to assess the frequency of S-EM use; and demographics, clinical, and sexual characteristics of S-EM users, as well as their perceptions of S-EM. RESULTS: Amongst the participants, 1008 were sexually active and included in the data analysis. Of the sexually active participants, 402 (39.9%) reported S-EM use in the form of herbal or phosphodiesterase type 5 inhibitors at some time in their lives. Comparing S-EM users with S-EM non-users, the S-EM users had a number of demographic and sexual characteristics including: higher education level, higher income, smoking, more than one sexual partner, longer sexual activity duration, higher frequency of sexual intercourse, and lower sexual satisfaction level. Most of the S-EM users (82.1%) bought S-EM without a medical prescription and 62.5% had used them recreationally. In all, 52% of respondents used S-EM to treat ED and 69% of those who used it recreationally reported enhancement of erection with S-EM usage. CONCLUSIONS: Demographic and sexual characteristics of S-EM users and the attitude of the users towards the S-EM were identified amongst a Saudi Arabian male population.

Nitric oxide donors increase the pregnancy rate in patients with unexplained infertility undergoing clomiphene citrate stimulation and intrauterine insemination: a randomized controlled pilot study.

This study evaluated the effects of nitric oxide donor's treatment on the pregnancy rate and uterine blood flow in patients with unexplained infertility undergoing clomiphene citrate stimulation and intrauterine insemination. A total of 120 patients were randomly allocated to a control group who received 100 mg clomiphene citrate daily from day 5 to 9 of cycle plus placebo vaginal tablets, and a study group received clomiphene citrate plus isosorbide mononitrate 10 mg vaginal tablets. Vaginal ultrasound was done before treatment and every other day starting from day 12 of cycle to count mature follicles and ovulation was triggered by IM injection of 10 000 IU hCG when one follicle measured 18 ≥ mm followed by intrauterine insemination after 36 h. The endometrial thickness, uterine arteries resistance and pulsation indices, and endometrial vascular flow and vascular flow indices were measured before treatment and at day of hCG injection. Results were analyzed after one cycle treatment using the Mean ± SD, the Student t test and the Fisher Exact test. Significant result was considered at p values <0.05. The study group had significant higher pregnancy rate/cycle, higher endometrial and lower uterine artery blood flow indices (p < 0.05).

Prophylactic treatment for preeclampsia in high-risk teenage primigravidae with nitric oxide donors: a pilot study.

OBJECTIVES: Preeclampsia is associated with significant morbidity and mortality especially in high-risk groups. Impairment of endogenous nitric oxide has been shown to be associated with the disease and prophylactic therapy may ameliorate this condition and improve pregnancy outcome. This study valuated nitric oxide donors prophylactic treatment for preeclampsia in high-risk teenage primigravidae. METHODS: The study included three hundred primigravidae aged ≤ 20 years with singleton pregnancy. Abdominal pulsed color Doppler ultrasound was done at 24 weeks gestation and pregnancies with uterine artery diastolic notch were randomly allocated to a control group received placebo vaginal tablets and a study group received isosorbid mononitrate 20 mg tablet once daily applied vaginally until delivery. OUTCOMES: Incidence of preeclampsia and maternal, fetal, and neonatal outcome in both groups. RESULTS: The study group had significant lower incidence of preeclampsia, preterm birth, intrauterine growth restriction and of neonatal admission to the intensive care (p < 0.05). CONCLUSIONS: Nitric oxide donors prophylactic treatment for preeclampsia in high-risk teenage pregnancies decrease the incidence of preeclampsia and improve maternal, fetal, and neonatal outcomes. Further studies on larger sample size are required to confirm these results.

The Effects of Nitric Oxide Donors on Uterine Artery and Sub-endometrial Blood Flow in Patients with Unexplained Recurrent Abortion.

BACKGROUND: Nitric oxide plays a major role in increasing uterine blood flow during the luteal phase and early pregnancy. This study was done to compare uterine artery and sub-endometrial blood flow indices during the luteal phase between patients with unexplained recurrent abortion and fertile women and also to evaluate the effects of nitric oxide donors on blood flow indices in the abortion group. METHODS: The study included a control group of 30 primiparae who had normal vaginal delivery and no history of abortion and an abortion group of 30 nulliparous women with history of two or more unexplained recurrent abortions. Transvaginal three-dimensional pulsed color Doppler ultrasound was done on days 21-23 of the cycle to measure uterine artery resistance and pulsation indices and the subendometrial vascular, flow and vascular-flow indices. Isosorbide mononitrate 20 mg tablet was administered vaginally in the abortion group and blood flow indices were measured again after two hours. The Student t-test and the paired t-test were used for analysis of results and a p-value of ≤0.05 was considered significant. RESULTS: Patients with unexplained recurrent abortion had significantly higher uterine artery resistance and pulsation indices and lower sub-endometrial vascular, flow and vascular-flow index (p < 0.01-0.0001). Isosorbide mononitrite significantly decreased uterine artery and increased sub-endometrial blood flow indices (p < 0.001). CONCLUSION: Uterine artery and sub-endometrial blood flow decreased during the luteal phase in patients with unexplained recurrent abortion. Nitric oxide donors increased blood flow and may be of a therapeutic value.