Comparison of high and low pulse energy dusting protocols using holmium: YAG laser in flexible ureteroscopy for treatment of renal stones.

Objectives: The management of renal stones, particularly those less than 2 cm in diameter, has changed with the development of endourological techniques, among which flexible ureteroscopy (FURS) using laser for lithotripsy has become a cornerstone. This study aims to compare the effectiveness of high pulse energy versus low pulse energy laser settings in renal stone dusting by Holmium YAG laser. Patients and Methods: This prospective randomized study was conducted between September 2021 and November 2023 to compare the efficacy and safety of high energy versus low-energy pulse settings using a Holmium: YAG laser dusting of renal stones less than 2 cm in diameter. A total of 174 adult patients were included, divided equally into high- and low-pulse energy groups, based on the energy settings of the laser high energy (ranged from 1.2-2.5 Joules and frequency of 8 hz) and low energy (less than 0.5 Joules and frequency ≥ 15 hz) using the dusting technique with non-touch non-stop approach. The study sought to evaluate the impact of these settings on stone fragmentation efficiency, operative time, laser energy consumption, and postoperative outcomes, including stone-free rates and complications. Results: The study involved 174 patients who underwent renal stone lithotripsy and showed that using high pulse energy laser dusting settings significantly reduced operative times and more rapid dusting compared to low pulse energy settings, without affecting the stone-free rate. The study observed no significant differences in stone size or location between both groups. Minor postoperative complications were similar between both groups, indicating high pulse energy settings for lithotripsy dusting. Conclusion: The efficacy of high pulse energy dusting in enhancing stone removal during surgery, potentially reducing operative time. Further validation through larger-scale studies is needed to solidify these findings. This technique presents a promising solution, particularly in regions with limited resources where acquiring expensive laser equipment is challenging.

Addition of local cryotherapy for treatment of post-mastectomy lymphedema.

Worldwide, lymphedema can present as a significant health issue. Left untreated, it can have long-term medical and psychological consequences for patients. Cryotherapy is a new physical therapy modality used for many purposes including reduction of pain, inflammation, and edema. It is thought to decrease interstitial fluid volume through many mechanisms. Therefore, it is reasonable to think that cryotherapy might have a positive effect in treatment of lymphedema. The goal of this study was to investigate how local cryotherapy in combination with standard therapy affects patient outcomes. Forty post-mastectomy female patients aged 40-60 years old with lymphedema were referred to the outpatient clinics of the Faculty of Physical Therapy at South Valley University for medical treatment and follow-up by the vascular surgery department. Patients were randomly divided into two groups of equal size. Traditional physical therapy programs (manual lymphatic drainage, pneumatic compression, bandaging, breathing exercises, circulatory exercises, shoulder mobilizations, and ROM exercises) were combined with pulsed local cryotherapy three times per week for 12 weeks in Group (A). For 12 weeks, Group (B) received only traditional physical therapy three times per week. Patients were evaluated using circumferential measurement with tape at the wrist, below the elbow, and above the elbow level, as well as ultrasonography to assess skin thickness before the start of physical therapy, 6 weeks later, and at the end of the treatment (after 12 weeks). Results indicate that cryotherapy is an effective adjunct modality for the treatment of secondary lymphedema and should be added to physical therapy protocols for lymphedema rehabilitation.

Insights overview on the possible protective effect of chitosan nanoparticles encapsulation against neurotoxicity induced by carbendazim in rats.

Carbendazim (CBZ) contamination of food and water is a principal factor in many negative impacts on public health. Nanoencapsulation of agrochemicals by nontoxic polymers as chitosan nanoparticles (CS-NPs) is one of the most applications of nanotechnology in agriculture. Despite its many advantages, such as it provides controlled release property, more stability and solubility of the active ingredient, it is not authorized to be used in the market because there are no adequate studies on the nano pesticides induced toxicity on experimental animals. So, we aim to study the possible impacts of CBZ-loading CS-NPs on the whole brain of rats and to explain its mechanism of action. 20 male Wistar rats were partitioned into 4 groups as follows: Group (1), normal saline; group (2), 5 mg/kg CS-NPs; group (3), 300 mg/kg CBZ; group (4) 300 mg/kg CS/CBZ-NCs. After 28 days, some neurobehavioral parameters were assessed to all rats then euthanization was done to collect the brain. Our results revealed that CBZ prompted neurotoxicity manifested by severe neurobehavioral changes and a significant increase of MDA with a decrease of GSH and CAT in brain tissue. In addition, there were severe neuropathological alterations confirmed by immunohistochemistry which showed strong bax, GFAP, and TNF-á½° protein expression in some brain areas. CBZ also induced apoptosis manifested by up-regulation of JNK and P53 with down-regulation of Bcl-2 in brain tissue. Otherwise, encapsulation of CBZ with CS-NPs could reduce CBZ-induced neurotoxicity and improve all studied toxicological parameters. We recommend using CBZ-loading CS-NPs as an alternative approach for fungicide application in agricultural and veterinary practices but further studies are needed to ensure its safety on other organs.

Neurobehavioral Toxicity Induced by Carbendazim in Rats and the Role of iNOS, Cox-2, and NF-κB Signalling Pathway.

Carbendazim (CBZ) is one of the most common fungicides used to fight plant fungal diseases, otherwise, it leaves residue on fruits, vegetables, and soil that contaminate the environment, water, animal, and human causing serious health problems. Several studies have reported the reproductive and endocrine pathological disorders induced by CBZ in several animal models, but little is known about its neurotoxicity. So that, the present study aimed to explain the possible mechanisms of CBZ induced neurotoxicity in rats. Sixty male Wistar rats were divided into 4 groups (n = 15). Group (1) received normal saline and was kept as the negative control group, whereas groups (2, 3, 4) received CBZ at 100, 300, 600 mg/kg b.wt respectively. All rats received the aforementioned materials daily via oral gavage. Brain tissue samples were collected at 7, 14, 28 days from the beginning of the experiment. CBZ induced oxidative stress damage manifested by increasing MDA levels and reducing the levels of TAC, GSH, CAT in some brain areas at 14 and 28 days. There were extensive neuropathological alterations in the cerebrum, hippocampus, and cerebellum with strong caspase-3, iNOS, Cox-2 protein expressions mainly in rats receiving 600 mg/kg CBZ at each time point. Moreover, upregulation of mRNA levels of NF-κB, TNF-α, IL-1B genes and downregulation of the transcript levels of both AchE and MAO genes were recorded in all CBZ receiving groups at 14 and 28 days especially those receiving 600 mg/kg CBZ. Our results concluded that CBZ induced dose- and time-dependent neurotoxicity via disturbance of oxidant/antioxidant balance and activation of NF-κB signaling pathway. We recommend reducing the uses of CBZ in agricultural and veterinary fields or finding other novel formulations to reduce its toxicity on non-target organisms and enhance its efficacy on the target organisms.

The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review.

AIMS: Despite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective is to assist humanitarian actors and agencies in providing culturally relevant Mental Health and Psychosocial Support (MHPSS) for Rohingya refugees displaced to Bangladesh and other neighbouring countries. METHODS: We conducted a systematic search across multiple sources of information with reference to the contextual, social, economic, cultural, mental health and health-related factors amongst Rohingya refugees living in the Asia-Pacific and other regions. The search covered online databases of diverse disciplines (e.g. medicine, psychology, anthropology), grey literature, as well as unpublished reports from non-profit organisations and United Nations agencies published until 2018. RESULTS: The legacy of prolonged exposure to conflict and persecution compounded by protracted conditions of deprivations and displacement is likely to increase the refugees' vulnerability to wide array of mental health problems including posttraumatic stress disorder, anxiety, depression and suicidal ideation. High rates of sexual and gender-based violence, lack of privacy and safe spaces and limited access to integrated psychosocial and mental health support remain issues of concern within the emergency operation in Bangladesh. Another challenge is the limited understanding amongst the MHPSS personnel in Bangladesh and elsewhere of the language, culture and help-seeking behaviour of Rohingya refugees. While the Rohingya language has a considerable vocabulary for emotional and behavioural problems, there is limited correspondence between these Rohingya terms and western concepts of mental disorders. This hampers the provision of culturally sensitive and contextually relevant MHPSS services to these refugees. CONCLUSIONS: The knowledge about the culture, context, migration history, idioms of distress, help-seeking behaviour and traditional healing methods, obtained from diverse sources can be applied in the design and delivery of culturally appropriate interventions. Attention to past exposure to traumatic events and losses need to be paired with attention for ongoing stressors and issues related to worries about the future. It is important to design MHPSS interventions in ways that mobilise the individual and collective strengths of Rohingya refugees and build on their resilience.

SUTURE VERSUS FIBRIN GLUE MICRONEURAL ANASTOMOSIS OF THE FEMORAL NERVE IN SPRAGUE DEWLY RAT MODEL. A COMPARATIVE EXPERIMENTAL ASSESSMENT OF THE CLINICAL, HISTOLOGICAL AND STATISTICAL FEATURES.

INTRODUCTION: Peripheral nerve injury is a frequently encountered clinical problem that leads to functional losses at the long-term. Although microsurgical repair has been introduced to clinical practice in peripheral nerve injuries, unsatisfactory outcomes regarding functional recovery in target organ cause an increasing interest on studies about nerve injury and biology of the recovery in nerve injuries1. MATERIAL AND METHODS: Sciatic nerves of seventy adult Sprague Dewly rats were transected and primary anastomosis was performed. Rats were then divided into three groups: Control group, while 30 rats were repaired with sutures, and the remaining 30 were repaired with fibrin glue. After 30 days the rats were sacrified and the sciatic nerves were investigated histologically with morphometrical and statistical analyses. RESULTS: In microsurgical nerve repair, suture placement has been thought to cause hindrance to the sprouting axons and compress the blood supply to the fascicles, thereby impairing the regeneration of the transected nerve ends after repair, with possible neuroma formation. On the other hand, fibrin glue is a simple, effective technique, less time consuming than suturing. Another advantage of this suture-free technique is that it avoids injuring the axon with needles, and the lack of foreign bodies minimizes the inflammatory reaction. CONCLUSION: We recommend using fibrin glue as it demonstrates less inflammatory reaction, less scar tissue formation, it is less time consuming and provides better outcomes.

The mitigative effect of Raphanus sativus oil on chromium-induced geno- and hepatotoxicity in male rats.

To study the impact of radish oil on the possible genotoxic and hepatotoxic effects of hexavalent chromium, male rats were divided into 4 groups. Group 1 served as control, group 2 received radish oil at the recommended human therapeutic dose (0.07 mL/kg) by gavage, group 3 received sodium dichromate dihydrate (SDD) 520 mg/L in drinking water, and group 4 received both SDD and radish oil as previously mentioned in groups 2 and 3. All treatments were continued for six months. The results revealed that chromium exposure promoted oxidative stress with a consequently marked hepatic histopathological alterations, increased serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities, alfa fetoprotein (AFP) levels, and micronucleated erythrocytes (MNE) % in peripheral blood. Moreover, COMET assay of hepatic DNA revealed that SDD exposure significantly decreased the intact cells %, head diameter, and head DNA % compared to control, indicating DNA damage. However, radish oil co-administration with SDD resulted in marked amendment in the altered parameters as detected by improved liver function markers (ALT and ALP) and AFP level, decreased lipid peroxidation, increased antioxidant markers, inhibited hepatic DNA damage and restored the hepatic histology by preventing the appearance of the altered hepatocytes' foci and decreasing chromium induced histopathological lesions. It could be concluded that radish oil was able to provide a convergent complete protection against the geno- and hepatotoxicity of chromium by its potent antioxidant effect.

Study of prevalence and effects of insulin resistance in patients with chronic hepatitis C genotype 4.

There is strong epidemiological evidence linking hepatitis C virus (HCV) infection and diabetes. Our aim was to evaluate the prevalence of insulin resistance in Egyptian patients with chronic HCV genotype 4 infection, to assess factors associated with insulin resistance and to test the impact of insulin resistance on outcomes of treatment with pegylated interferon/ribavirin. Insulin resistance [homeostasis model assessmentinsulin resistance (HOMA-IR) score > 3.0] was detected in 31 of 100 nondiabetic patients. The relationship between elevated HOMA-IR and baseline viral load and degree of fibrosis was statistically significant (r = 0.218 and r = 0.223). Follow-up of patients with complete early virological response until the end of treatment showed a statistically significant decrease in HOMA-IR score. Out of 29 liver tissue sections examined, 14 had a low level of expression of insulin receptor type 1 by immunohistochemical studies. This study confirms that insulin resistance affects treatment outcome, and thus HOMA-IR testing before initiation of therapy may be a cost-effective tool.

The Remedial Efficacy of Spirulina platensis versus Chromium-Induced Nephrotoxicity in Male Sprague-Dawley Rats.

This study was conducted to investigate the possible protective effect of Spirulina platensis against chromium-induced nephrotoxicity. A total of 36 adult male Sprague-Dawley rats were divided into 4 equal groups (Gps). Gp1 served as control, rats of Gps 2, 3, and 4 were exposed to Spirulina platensis (300 mg/kg b.wt per os) and sodium dichromate dihydrate (SDD) via drinking water at concentration of 520 mg /l respectively. Chromium administration caused alterations in the renal function markers as evidenced by significant increase of blood urea and creatinine levels accompanied with significant increase in kidney's chromium residues and MDA level as well as decreased catalase activity and glutathion content in kidney tissue. Histologically, Cr provoked deleterious changes including: vascular congestion, wide spread tubular epithelium necrobiotic changes, atrophy of glomerular tuft and proliferative hyperplasia. The latter was accompanied with positive PCNA expression in kidney tissues as well as DNA ploidy interpretation of major cellular population of degenerated cells, appearance of tetraploid cells, high proliferation index and high DNA index. Morphometrical measurements revealed marked glomerular and tubular lumen alterations. On contrary, spirulina co-treatment with Cr significantly restored the histopathological changes, antioxidants and renal function markers and all the previously mentioned changes as well.

Intermittent exotropia: relation between age and surgical outcome: a change-point analysis.

PURPOSE: To study the relationship between age and response to surgery in patients with intermittent exotropia and to identify change points in response to surgery. METHODS: A retrospective analysis was conducted on 311 patients with intermittent exotropia who had bilateral lateral rectus recession using standard tables with minimum follow-up of 6 months. Data were analyzed using the change-point analysis software to identify cutoff points. A prospective pilot study was then performed on 171 consecutive patients with intermittent exotropia with the same clinical characteristics, in whom amount of recession was modified according to the identified cutoff points. In angles with two change points, 1-mm recession was reduced from patients younger than the lower change point and 1.5-mm recession was added to those older than the upper change point. In angles with one change point, 1.5-mm recession was added to those older than the change point. Satisfactory alignment was defined as esophoria/tropia ≤ 5Δ to exophoria/tropia ≤ 8Δ. RESULTS: There was a negative correlation (P<0.01) between response to surgery and age at surgery for all angles. In younger patients (<7 years) in whom surgical dose was reduced, there was no significant change in success rate (77%), compared with those who had surgery using standard tables (75%). In older patients (>12 years) in whom surgical dose was increased, there was a statistically significant increase in success rate (80% vs 41%). CONCLUSIONS: Modifying the surgical dose according to age can improve the success in patients with intermittent exotropia.

Endoscopic study of African AIDS patients with upper gastrointestinal symptoms.

This study was carried out to investigate the endoscopic and histopathological findings in AIDS patients in Mulago Hospital, in Uganda who present with upper gastrointestinal symptoms. Any observed morphological changes were biopsied. Duodenal contents were aspirated in each case for microscopic examination. Vomiting was reported in 100% of the patients, dysphagia and epigastric pain were reported in 89%. Other symptoms reported in decreasing frequency were odynophagia 46%, retrosternal chest pain 40%, haematemesis 10%, and hiccough 3%. Up to 74% of the patients had morphological changes in the oesophagus, while 28% showed changes in the stomach. Only 15% demonstrated changes in the duodenum. Duodenal aspirate revealed giardia lamblia 22%, Acid fast bacilli 7% and cryptosporidium 5%. Endoscopic findings were mostly observed in the oesophagus. Candida was the main pathogen detected. Also atrophic gastritis is a recognizable finding in these patients.

PIP: 50-90% of people with AIDS experience disease of the upper gastrointestinal tract during the course of their illness, such as opportunistic infections, cytomegalovirus, Herpes simplex virus, and malignant neoplasms. This paper reports the endoscopic and histopathological findings among 100 AIDS patients in Mulago Hospital, Kampala, Uganda, who presented with upper gastrointestinal symptoms. The diagnosis of AIDS was based upon the World Health Organization clinical definition for AIDS. Observed morphological changes were biopsied, while duodenal contents were aspirated in each case for microscopic examination. Vomiting was reported among all patients, dysphagia and epigastric pain in 89%, odynophagia in 46%, retrosternal chest pain in 40%, haematemesis in 10%, and hiccough in 3%. Up to 74% of the patients had morphological changes in the esophagus, while 28% showed changes in the stomach. Only 15% demonstrated changes in the duodenum. Duodenal aspirate revealed giardia lamblia among 22%, acid fast bacilli in 7%, and cryptosporidium in 5%. Endoscopic findings were mostly observed in the esophagus. Candida was the main pathogen detected. Atrophic gastritis was also a recognizable finding among these patients.