A prospective analysis of thulium laser enucleation in benign prostatic hyperplasia comparing low- and high-power approaches for prostates exceeding 80 g.

INTRODUCTION AND OBJECTIVES: To compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml). PATIENTS AND METHODS: A prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP. All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system. RESULTS: The mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups (p = 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups. CONCLUSION: Low-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.

Clinical and endoscopic characteristics of patients undergoing gastrointestinal endoscopic procedures in Egypt: a nationwide multicenter study.

BACKGROUND: Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt. AIM: We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt. METHODS: This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt. RESULTS: 5910 patients aged 38-63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them. CONCLUSION: This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

MBOAT7 expression is associated with disease progression in COVID-19 patients.

BACKGROUND AND AIM: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 caused a pandemic of acute respiratory disease, named coronavirus disease 2019 (COVID-19). COVID-19 became one of the most challenging health emergencies, hence the necessity to find different prognostic factors for disease progression, and severity. Membrane bound O-acyltransferase domain containing 7 (MBOAT7) demonstrates anti-inflammatory effects through acting as a fine-tune regulator of the amount of cellular free arachidonic acid. We aimed in this study to evaluate MBOAT7 expression in COVID-19 patients and to correlate it with disease severity and outcomes. METHODS: This case-control study included 56 patients with confirmed SARS-CoV-2 diagnosis and 28 control subjects. Patients were further classified into moderate (n = 28) and severe (n = 28) cases. MBOAT7, tumor necrosis factor-α (TNF-α), and interleukin-1ß (IL-1ß) mRNA levels were evaluated in peripheral blood mononuclear cells (PBMC) samples isolated from patients and control subjects by real time quantitative polymerase chain reaction (RT-qPCR). In addition, circulating MBOAT7 protein levels were assayed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Significant lower levels of circulating MBOAT7 mRNA and protein were observed in COVID-19 patients compared to control subjects with severe COVID-19 cases showing significant lower levels compared to moderate cases. Moreover, severe cases showed a significant upregulation of TNF-α and IL-1ß mRNA. MBOAT7 mRNA and protein levels were significantly correlated with inflammatory markers (TNF-α, IL-1ß, C-reactive protein (CRP), and ferritin), liver enzymes, severity, and oxygen saturation levels. CONCLUSION: COVID-19 is associated with downregulation of MBAOT7, which correlates with disease severity.

Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis.

BACKGROUND AND AIM: Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions. METHODS: PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP. RESULTS: Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes. CONCLUSION: Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions. PROSPERO REGISTRATION: CRD42023417362.

Outcomes of Alprostadil As an Adjuvant Therapy with Indirect Angiosomal Revascularization in Patients with Critical Limb Ischemia after Failure of Direct Revascularization.

BACKGROUND: This study was carried out to assess the effectiveness of alprostadil (prostaglandin E1) when used as an adjuvant therapy with indirect revascularization in patients with critical limb ischemia (CLI) after the failure of direct revascularization (DR). METHODS: At our centers, 120 patients suffering from infrainguinal peripheral arterial disease with CLI underwent a failed trial of DR procedure, all revascularization procedures were endovascular. Median follow-up was 2 years and 2.5 years for patients with and without diabetes mellitus (DM). In the alprostadil group, the mean age was 63.41 ± 12.52; 36 (60%) for males and 24 (40%) for females. Post-endovascular intervention alprostadil was administrated immediately postoperatively by intravenous infusion of 40 µg alprostadil diluted in 100 ml of normal saline, over 2 hr every 12 hr for 6 days. RESULTS: In the alprostadil group, the mean ± standard deviation (SD) of the baseline ankle-brachial index (ABI) was 0.45 ± 0.175, while the mean ± SD of ABI at the end of our study was 0.65 ± 0.216 with a difference from the baseline of 0.2 ± 0.041 (P value = 0.08, <0.05 meaning that it is significant). Our 1-month primary patency rate was 93.3%, while our 3- and 6-month patency rate was 92.9%. In the control group, the mean ± SD of the baseline ABI was 0.68 ± 0.22, while the mean ± SD of ABI at the end of our study was 0.69 ± 0.23 with a difference from the baseline of 0.01 ± 0.01 (P value >0.05 meaning that it is nonsignificant) 1-month patency rate was 89%, while 3- and 6-month patency rate was 75%. When we compared the patient's leg vessels before and after our intervention, we found that the percentage of the no-runoff-vessels group decreased from 10 (16.7%) to 4 (6.67%). One-runoff-vessel group percentage dropped from 40 (66.7%) to 36 (60%), whereas, in the two-runoff-vessel group, the percentage increased from 10 (16.7%) to 20 (33.3%). We evaluate leg arteries; we do no pedal arch intervention in the alpostradil group. Out of the total of 60 patients, limb salvage occurred in 58 (96.7%) patients, and 2 (3.3%) patients underwent below-the-knee amputation before the study ended. CONCLUSIONS: Our results show the efficacy and safety of alprostadil as an adjuvant therapy with indirect angiosomal revascularization in patients with tissue loss due to CLI.

Outcomes of Cyanoacrylate Closure Versus Radiofrequency Ablation for the Treatment of Incompetent Great Saphenous Veins.

BACKGROUND: Evaluation of the efficacy and safety of cyanoacrylate closure (CAC) for treating incompetent great saphenous veins (GSVs) compared to radiofrequency ablation (RFA). METHODS: In this prospective, randomized controlled study, 248 symptomatic subjects with incompetent GSVs were assigned to either CAC or RFA. The primary end point, complete closure of the target GSV, was determined using a duplex ultrasound examination. RESULTS: In this study, 248 patients (mean age 33.64 ± 8.06 years including 71% women) were treated with either CAC (n = 128) or RFA (n = 120) between August 2018 to May 2022. As a follow-up, after a 1-month duration, the closure rates were 128/128 at the CAC and 154/158 at the RFA. At month 24, closure rates were 122/128 at CAC and 146/158 at RFA. Apart from phlebitis and pigmentation, the incidences of bruising, skin burn, and paresthesia were lower in the CAC group compared to the RFA group. The mean procedural times were shorter for CAC. The satisfaction level with the treatment was moderately higher among CAC patients than RAF patients. CONCLUSIONS: This study suggests that Cyanoacrylate glue closure of the GSV and RFA are effective techniques for managing primary varicose veins. Cyanoacrylate glue closure of the GSV appears to have a lower rate of complications and higher satisfaction levels, rapid return to normal activities, and improved procedure time without the need for perivenous tumescent anesthesia and postprocedure compression stockings when compared to RFA.

Cognitive behavioral therapy for the treatment of insomnia in patients with cardiovascular diseases: a meta-analysis with GRADE analysis.

Insomnia, as a difficulty in initiating and maintaining sleep, coupled with cardiovascular diseases (CVDs) increase the risk of aggravate daytime symptoms, mortality, and morbidity. Cognitive behavioral therapy (CBT) is thought to have a significant impact on insomnia treatment, but in patients with CVDs, there is a paucity of data. To provide a comprehensive appraisal on the impact of CBT on the treatment of insomnia in patients with CVDs. We searched Ovid, Scopus, Web of science, and Cochrane central, to randomized controlled trials (RCTs) from inception till November 2022. Outcomes of interest were insomnia severity index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep efficiency (SE), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and sleep disorders questionnaire (SDQ). Pooled data were analyzed using mean difference (MD) with its 95% confidence interval (CI) in a random effect model using STATA 17 for Mac. Nine RCTs comprising 365 patients were included in the analysis. CBT significantly reduced scores of ISI (MD = - 3.22, 95%  CI - 4.46 to - 1.98, p < 0.001), PSQI (MD = - 2.33, 95%  CI - 3.23 to - 1.44, p < 0.001), DBAS (MD = - 0.94, 95%  CI - 1.3 to - 0.58, p < 0.001), SDQ (MD = - 0.38, 95%  CI - 0.56 to - 0.2, p < 0.001). Also, it increased the score of SE (MD = 6.65, 95% CI 2.54 to 10.77, p < 0.001). However, there was no difference in terms of ESS. CBT is an easy and feasible intervention with clinically significant improvement in insomnia symptoms. Further large-volume studies are needed to assess sustained efficacy.

Median nerve ultrasonography in Parkinson's disease: a systematic review and meta-analysis.

BACKGROUND: The cross-sectional area (CSA) of the median nerve in Parkinson's disease remains unclear. OBJECTIVES: This meta-analysis assesses median nerve CSA changes in Parkinson's using ultrasonography. METHODS: PubMed, Web of Science, Scopus, and EBSCO were selectively searched for literature on Parkinson's disease, Median nerve, and ultrasonography. Following full-text screening, three studies were included in this meta-analysis with 144 Parkinson's disease patients and 127 controls. The primary outcome was the cross-sectional area of the median nerve; other motor parameters were also evaluated. RESULTS: The cross-sectional area of the median nerve was significantly increased in Parkinson's patients compared to controls (p = 0.007); the standardized mean difference was 0.79 [95% CI (0.21 - 1.37)]. The standardized mean difference of the motor parameters of the median nerve, amplitude, and latency was -0.04 [95% CI (-0.85 to 0.77)] and 0.30 [95% CI (-0.04 to 0.64)], respectively, with statistically insignificant (All p > 0.05). CONCLUSION: This meta-analysis concluded that the cross-sectional area of the median nerve is increased in Parkinson's disease patients. The increase in the CSA of the median nerve might explain the higher prevalence of carpal tunnel syndrome in Parkinson's disease. Further studies are needed to quantify carpal tunnel syndrome prevalence accurately in Parkinson's. LIMITATIONS: Heterogeneity exists due to non-standardized CSA calculation methods and varied disease stages. Finger movement during ultrasound may introduce artifacts, compromising CSA measurement accuracy. Establishing a definitive CSA cut-off for carpal tunnel syndrome in Parkinson's requires further investigation.

The outcome of endovenous intervention for acute iliofemoral deep venous thrombosis with and without inferior vena cava filter.

BACKGROUND: Catheter-directed thrombolysis (CDT) for acute iliofemoral deep venous thrombosis (DVT) is an endovenous interventional therapy that can quickly remove the acute thrombus, thereby improving the clinical outcomes of proximal DVT. However, instrumentation of extensive fresh thrombus may be associated with iatrogenic pulmonary embolism (PE). Therefore, we aimed to compare CDT's safety, complications, and perioperative embolic (PE) insults for acute iliofemoral DVT, with and without an IVC filter. METHODS: One hundred twenty patients having acute proximal DVT for less than 14 days and undergoing endovenous therapy were included and presented to the vascular surgery department of Al-Azhar University Hospitals, Egypt. The patients were randomized into two equal groups, Groups A and B, each having 60 patients. Group A was treated with IVC filter insertion, while Group B was treated without a filter. The anticoagulation and CDT procedures were similar between the two groups. RESULTS: The sample included 96 females (80%) and 24 males (20%), with a mean age of 32.6 ± 7.2 years. Clinically no clinical PE occurred in both groups. However, radiologically, new lesions in multislice CT pulmonary angiogram and V/Q scan were noted in two of 60 patients (3.33%) of the IVC filter group, compared with three patients (5 %) in the non-filtered group. CONCLUSION: Endovenous intervention in the form of CDT for acute iliofemoral DVT without an IVC filter is safe and not associated with an increased risk of pulmonary embolization than filter usage. The routine use of IVC filters should not be used mandatorily during CDT.

Precision Agriculture Applied to Harvesting Operations through the Exploitation of Numerical Simulation.

When it comes to harvesting operations, precision agriculture needs to consider both combine harvester technology and the precise execution of the process to eliminate harvest losses and minimize out-of-work time. This work aims to propose a complete control framework defined by a two-layer-based algorithm and a simulation environment suitable for quantitative harvest loss, time, and consumption analyses. In detail, the path-planning layer shows suitable harvesting techniques considering field boundaries and irregularities, while the path-tracking layer presents a vision-guided Stanley Lateral Controller. In order to validate the developed control framework, challenging driving scenarios were created using IPG-CarMaker software to emulate wheat harvesting operations. Results showed the effectiveness of the designed controller to follow the reference trajectory under regular field conditions with zero harvest waste and minimum out-of-work time. Whereas, in presence of harsh road irregularities, the reference trajectory should be re-planned by either selecting an alternative harvesting method or overlapping the harvester header by some distance to avoid missing crops. Quantitative and qualitative comparisons between the two harvesting techniques as well as a relationship between the level of irregularities and the required overlap will be presented. Eventually, a Driver-in-the-loop (DIL) framework is proposed as a methodology to compare human and autonomous driving.

Unravelling the Antimicrobial, Antibiofilm, Suppressing Fibronectin Binding Protein A (fnba) and cna Virulence Genes, Anti-Inflammatory and Antioxidant Potential of Biosynthesized Solanum lycopersicum Silver Nanoparticles.

Background and Objectives: Urinary tract infections [UTIs] are considered the third most known risk of infection in human health around the world. There is increasing appreciation for the pathogenicity of Gram-positive and Gram-negative strains in UTIs, aside from fungal infection, as they have numerous virulence factors. Materials and Methods: In this study, fifty urine samples were collected from patients suffering from UTI. Among the isolates of UTI microbes, six isolates were described as MDR isolates after an antibiotic susceptibility test carried out using ten different antibiotics. An alternative treatment for microbial elimination involved the use of biosynthesized silver nanoparticles (AgNPs) derived from Solanum lycopersicum [S. cumin]. Results: The sizes and shapes of AgNPs were characterized through TEM imaging, which showed spherical particles in a size range of 35-80 nm, of which the average size was 53 nm. Additionally, the silver nanoparticles (AgNPs) demonstrated inhibitory activity against Staphylococcus aureus (OR648079), exhibiting a 31 mm zone of inhibition at a minimum inhibitory concentration (MIC) of 4 mg/mL and a minimum bactericidal concentration (MBC) of 8 mg/mL. This was followed by Aspergillus niger (OR648075), which showed a 30 mm inhibition zone at an MIC of 16 mg/mL and a minimum fungicidal concentration (MFC) of 32 mg/mL. Then, Enterococcus faecalis (OR648078), Klebsiella pneumoniae (OR648081), and Acinetobacter baumannii (OR648080) each displayed a 29 mm zone of inhibition at an MIC of 8 mg/mL and an MBC of 16 mg/mL. The least inhibition was observed against Candida auris (OR648076), with a 25 mm inhibition zone at an MIC of 16 mg/mL and an MFC of 32 mg/mL. Furthermore, AgNPs at different concentrations removed DPPH and H2O2 at an IC50 value of 13.54 µg/mL. Also, AgNPs at 3 mg/mL showed remarkable DNA fragmentation in all bacterial strains except Enterococcus faecalis. The phytochemical analysis showed the presence of different active organic components in the plant extract, which concluded that rutin was 88.3 mg/g, garlic acid was 70.4 mg/g, and tannic acid was 23.7 mg/g. Finally, AgNPs concentrations in the range of 3-6 mg/mL showed decreased expression of two of the fundamental genes necessary for biofilm formation within Staphylococcus aureus, fnbA (6 folds), and Cna (12.5 folds) when compared with the RecA gene, which decreased by one-fold when compared with the control sample. These two genes were submitted with NCBI accession numbers [OR682119] and [OR682118], respectively. Conclusions: The findings from this study indicate that biosynthesized AgNPs from Solanum lycopersicum exhibit promising antimicrobial and antioxidant properties against UTI pathogens, including strains resistant to multiple antibiotics. This suggests their potential as an effective alternative treatment for UTIs. Further research is warranted to fully understand the mechanisms of action and to explore the therapeutic applications of these nanoparticles in combating UTIs.

Analgesic Efficacy of Ropivacaine Infiltration on Early Post-Tonsillectomy Pain in Pediatrics.

OBJECTIVE: To assess the analgesic efficacy of ropivacaine infiltration in the tonsillar fossa among pediatric patients undergoing tonsillectomy. DATA SOURCES: PubMed, Scopus, Web of Science, and CENTRAL. REVIEW METHODS: Eligible randomized controlled trials (RCTs) were assessed for bias using Cochrane's risk of bias tool (version 2). Our primary outcome was postoperative pain within 24 h, and secondary outcomes included operative time, intraoperative blood loss, time to first analgesia, bleeding, and nausea/vomiting. Data were pooled as mean difference, standardized mean difference, and risk ratio with a 95% confidence interval. RESULTS: Our review included 11 RCTs, with a total of 712 patients. The quality of studies varied and included low risk (n = 8 RCTs), some concerns (n = 2 RCTs), and high risk (n = 1 RCT) of bias. The primary endpoint of postoperative pain across all time points was significantly reduced in the ropivacaine group compared with the placebo group. Trial sequential analysis (TSA) of the postoperative pain depicted conclusive evidence and unnecessity for further RCTs. The mean operative time was significantly reduced in the ropivacaine group compared with the placebo group. However, there was no significant difference between both groups regarding additional clinical (i.e., mean intraoperative blood loss and mean time to first analgesia) and safety (i.e., rates of bleeding and nausea/vomiting) outcomes. CONCLUSION: This systematic review and meta-analysis demonstrated the safety and postoperative analgesic efficacy of ropivacaine versus placebo among pediatric patients undergoing tonsillectomy. There was no significant difference between both groups regarding intraoperative blood loss, time to first analgesia, and rate of postoperative bleeding. LEVEL OF EVIDENCE: 1 Laryngoscope, 134:3018-3029, 2024.

Pharmaceutical Drug Promotion and Rational Drug Use: Assessment of Healthcare Workers Perspective.

Background: Pharmaceutical drug promotion has the potential to improve rational drug use by creating awareness among healthcare workers and patients as well as increasing access to life-saving medicines. This study aimed to determine whether pharmaceutical drug promotion can improve rational drug use among healthcare workers. Methods: Semi-structured questionnaires were filled by selected dispensers and prescribers in central Uganda. Forms of pharmaceutical drug promotion, sources of drug information, and views on the influence of drug promotion on rational drug use were investigated. Associations amongst selected variables were tested at bivariate and multivariate levels. Results: Of the 383 participants enrolled in the study, 49.6% were dispensers. More dispensers (49.0%, 92/188) favored 1 on 1 discussion whereas prescribers (32.0%, 61/191) preferred continuous medical education. Most dispensers (85.6%, 161/188) and prescribers (68.6%, 131/191) reported that drug promotion influences their choice of drug use, with most (dispensers: 85.1%, 160/188 vs prescribers: 72.3%, 1/191) admittedly relying on drug promotion as their primary source of drug information. Conclusion: Pharmaceutical drug promotion influences prescription and dispensing practices among health workers, and it should be strictly regulated to ensure accurate and essential information for health workers while prioritizing rational use of medicines.

Retraction: Pediatric Acute Dacryocystitis and Orbital Cellulitis With Concurrent COVID-19 Infection: A Case Report.

[This retracts the article DOI: 10.7759/cureus.46559.].

An update on the access to inpatient rehabilitation facilities across Tunisia in 2023.

INTRODUCTION: Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated. AIM: To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023. METHODS: Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites. RESULTS: The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia. CONCLUSION: This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.

Does local vaginal estrogen after tension-free transobturator vaginal tape reduce overactive bladder symptoms in postmenopausal women? A prospective randomized, controlled study.

Objective: We aimed to evaluate the efficacy of topical estrogen after transvaginal tension-free vaginal tape-obturator (TVT-O) in the treatment of de novo overactive bladder symptoms that appear after surgery. Methods: This is a prospective randomized controlled study performed in the Urology and Gynecology Departments, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt. Two hundred and ten postmenopausal females presenting during the period between January 2017 and November 2020 with stress urinary incontinence were included in the study. Patients were divided into two groups, 105 patients in Group A (treatment group) and 105 patients in Group B (control group). Patients in Group A underwent transvaginal TVT-O followed by local vaginal estrogen treatment for 6 months, while patients in Group B underwent transvaginal TVT-O only. The study included any postmenopausal female with urodynamic stress urinary incontinence. All patients had to fulfill a 3-day bladder diary, overactive bladder symptoms score, urine analysis, urodynamic study, and post-voiding residual urine measurement by abdominal ultrasound preoperatively and at 3-month and 6-month follow-ups. Results: At 6-month follow-up, daytime frequency was reduced to 8% in Group A (increased to 21% in Group B) with a statistically significant difference between both groups (p=0.009). At 6-month follow-up, nocturia was 8% in Group A (11% in Group B) with no statistically significant difference between both groups (p=0.469). There was a statistically significant difference between both groups as regards to urinary urgency at 6-month follow-up (p=0.024). There was a statistically significant difference in postoperative wound healing events as regards to cure, hyperemia, gapping, and wound infection 1 week after intervention between both groups (p=0.008). No local or systemic side-effects were reported from local estrogen use. Conclusion: Local vaginal estrogen treatment given to postmenopausal patients after midurethral sling procedures can reduce the symptoms of daytime frequency and urinary urgency. Long-term follow-up is needed.

Biocontrol of multidrug resistant pathogens isolated from fish farms using silver nanoparticles combined with hydrogen peroxide insight to its modulatory effect.

This study was divided into two parts. The first part involved the isolation, and detection of the prevalence and antimicrobial resistance profile of Aeromonas hydrophila, Pseudomonas aeruginosa, and Vibrio species from Nile tilapia fish and marine aquatic water. One hundred freshly dead Nile tilapia fish were collected from freshwater aquaculture fish farms located in Al-Abbassah district, Sharkia Governorate, and 100 samples of marine aquatic water were collected from fish farms in Port Said. The second part of the study focused on determining the in vitro inhibitory effect of dual-combination of AgNPs-H2O2 on bacterial growth and its down regulatory effect on crucial virulence factors using RT-PCR. The highest levels of A. hydrophila and P. aeruginosa were detected in 43%, and 34% of Nile tilapia fish samples, respectively. Meanwhile, the highest level of Vibrio species was found in 37% of marine water samples. Additionally, most of the isolated A. hydrophila, P. aeruginosa and Vibrio species exhibited a multi-drug resistance profile. The MIC and MBC results indicated a bactericidal effect of AgNPs-H2O2. Furthermore, a transcriptional modulation effect of AgNPs-H2O2 on the virulence-associated genes resulted in a significant down-regulation of aerA, exoU, and trh genes in A. hydrophila, P. aeruginosa, and Vibrio spp., respectively. The findings of this study suggest the effectiveness of AgNPs-H2O2 against drug resistant pathogens related to aquaculture.

Major mistakes in scientific medical writing based on manuscripts' reviews.

INTRODUCTION: Peer review is a crucial process in ensuring the quality and accuracy of scientific research. It allows experts in the field to assess manuscripts submitted for publication and provide feedback to authors to improve their work. AIM: To describe mistakes encountered while peer reviewing scientific manuscripts submitted to "La Tunisie Médicale" journal. METHOD: This was a bibliometric study of research manuscripts submitted to "La Tunisie Médicale" and reviewed during 2022. The data collected included the type of the manuscripts and the number of reviews conducted per manuscript. The study also identified variables related to writing mistakes encountered during the peer review process. RESULTS: A total of 155 manuscripts (68% original articles) were peer reviewed and 245 reviews were delivered, by two reviewers. Out of 62 mistakes detected, 21% concerned the results section. In 60% of the manuscripts, the keywords used were not MeSH (Medical Subject Headings) terms. The introduction lacked in-text citations in 30% of the reviewed manuscripts, while the method section did not have a clear study framework (27%). The two major mistakes detected in the results section were the misuse of abbreviations in tables/figures, and the non-respect of the scientific nomenclature of tables/figures with respectively 39% and 19% of manuscripts. CONCLUSION: This study identified 62 mistakes while reviewing scientific manuscripts submitted to "La Tunisie Médicale" journal. Scholars can benefit from participation in scientific writing seminars and the use of a safety checklist for scientific medical writing to avoid basic mistakes.