Primary metastatic prostate cancer between prognosis or adequate/proper medical therapy.

PURPOSE: To define the efficacy of standard androgen deprivation therapy (ADT) in the treatment of metastatic prostate cancer (PCa). MATERIALS AND METHODS: Fifty patients with mean age of 70.48 ± 9.95 years old (range 52-87) who had metastatic PCa and received ADT between 2014 and 2019 were retrospectively evaluated. Median values of pre-therapeutic PSA and Gleason scores were 50 ng/ml (range 8-1201) and 8 (range 6-9), respectively. All patients received luteinizing hormone-releasing hormone (LHRH) analogue and anti-androgen. The patients were evaluated in terms of age, pre-therapeutic PSA serum levels, Gleason scores, presence of metastasis, number and percentage of cores involved, nadir PSA, time to nadir PSA, duration of ADT, and PSA at last follow-up. Multivariate analysis was used to define the factors which have impact on ADT response. The mean follow-up period was 13.87 ± 7.78 months, (range 2-32). RESULTS: All patients showed reduction in serum PSA level after initiation of ADT, and the median value of nadir PSA was 1.12 ng/ml (range 0.02-50). The mean value of time to nadir PSA was 3.85 ± 1.57 months (range 2-7). The median value of PSA at last follow-up was 2 ng/ml (range 0.02-50.21). Multi-variant analysis showed that nadir PSA have a significant correlation with pre-therapeutic PSA, PSA at last follow-up, age, and Gleason scores (p < .05). CONCLUSION: Standard ADT is a feasible option in the treatment of metastatic PCa. Gleason scores, age, pre-therapeutic PSA, and PSA at last follow-up have significant impact on outcomes of ADT. Further studies of high number of patients with long-term follow-up including other chemo-hormonal therapy and androgen receptor blockers should be carried out to confirm and improve efficacy of ADT.

The efficacy of green light laser prostatectomy in the management of urinary retention due to prostate hyperplasia.

To evaluate the efficacy and safety of 120 W potassium titanyl phosphate (KTP) in the treatment of urinary retention (UR) due to benign prostate hyperplasia in high-risk patients. Forty-six male patients with mean age of 73.78 ± 9.82 years who اhad UR and underwent 120 W KTP laser vaporization of the prostate between January 2015 and June 2017 were included. We evaluated perioperative parameters including serum prostate specific antigen, prostate volume, period of postoperative catheterization, vaporization time, delivered energy, hospitalization period, as well as intraoperative and postoperative complications. In the follow-up protocols, International Prostate Symptom Score and quality-of-life questionnaire (IPPS-QoL) and postvoid residual volume (PVR) were also assessed. The mean follow-up period was 15.57 ± 9.26 (1-42) months. All patients get rid of UR, except 1 patient (2.1%) remained on Foley catheter and standard TURP was done. Mean vaporization time was 8.57 ± 4.19 min, and mean energy delivered was 51.7 ± 29.9 kJ. No intraoperative complications were observed and no blood transfusion was done. The mean postoperative IPSS at the last follow-up was 9.64 ± 6.65 and the QoL score was 1.61 ± 1.31. Green light laser prostatectomy is a safe, simple, and effective procedure for the treatment of UR secondary to BPH in high-risk patients. Short hospitalization, low rate of intra operative and postoperative complications with rapid improvements in the objective, and subjective voiding parameters are important considerations of this procedure.

Ethnopharmacological survey of medicinal plants practiced by traditional healers and herbalists for treatment of some urological diseases in the West Bank/Palestine.

BACKGROUND: Throughout history, every civilization in the world used plants or their derivatives for treatment or prevention of diseases. In Palestine as in many other countries, herbal medicines are broadly used in the treatment of wide range of diseases including urological diseases. The main objective of this research is to study the use of herbal remedies by herbalists and traditional healers for treatment of various urological diseases in the West Bank regions of Palestine and to assess their efficacy and safety through the literature review of the most cited plants. METHOD: The study included a survey part, plant identification and a review study. The first part was a cross-sectional descriptive study. Face to face questionnaires were distributed to 150 traditional healers and herbalist in all regions of the West Bank of Palestine. The literature review part was to assess the most cited plants for their efficacy and toxicity. RESULTS: One hundred forty four herbalists and traditional healers accepted to participate in this study which was conducted between March and April, 2016. The results showed that 57 plant species belonging to 30 families were used by herbalists and traditional healers for treatment of various urinary tract diseases in Palestine. Of these, Apiaceae family was the most prevalent. Paronychia argentea, Plantago ovata, Punica granatum, Taraxacum syriacum, Morus alba and Foeniculum vulgare were the most commonly used plant species in the treatment of kidney stones, while Capsella bursa-pastoris, Ammi visnaga and Ammi majus were the most recommended species for treatment of urinary tract infections and Portulaca oleracea used for renal failure. In addition Curcuma longa and Crocus sativus were used for enuresis while Juglans regia, Quercus infectoria, Sambucus ebulus and Zea mays were used for treatment symptoms of benign prostate hyperplasia. Fruits were the most common parts used, and a decoction was the most commonly used method of preparation. Through literature review, it was found that Paronychia argentea has a low hemolytic effect and contains oxalic acid and nitrate. Therefore, it could be harmful to renal failure patients, also Juglans regia, Quercus infectoria and, Sambucus ebulus are harmful plants and cannot be used for treatment of any disease. CONCLUSIONS: Our data provided that ethnopharmacological flora in the West Bank regions of Palestine can be quite wealthy and diverse in the treatments of urinary tract diseases. Clinical trials and pharmacological tests are required evaluate safety and efficacy of these herbal remedies.

Robotic-assisted laparoscopic versus open salvage radical prostatectomy following radiotherapy.

INTRODUCTION: To describe immediate perioperative outcomes of robot-assisted laparoscopic salvage radical prostatectomy for recurrent cancer following radiation therapy, and compare outcomes to a contemporary open surgical cohort. MATERIALS AND METHODS: A total of 39 patients underwent salvage radical prostatectomy with pelvic lymphadenectomy (20 robotic, 19 open) for local recurrence following radiation therapy at a single institution between 2007 and 2011. Intraoperative parameters, postoperative complications, and oncological outcomes, were recorded. Wilcoxon rank-sum test and Fisher's exact test were used for comparison of continuous and categorical variables respectively. Mean values of numeric variables are reported with standard deviation. RESULTS: The cohorts were similar with respect to age, ethnicity, and American Society of Anesthesiologists Score classification. Estimated blood loss was lower in the robotic group versus the open group (381.3 mL versus 865.0 mL, p = 0.001). There was no difference in the rate of intraoperative complications, postoperative Clavien = 3 complications (30% versus 15.7%), anastomotic leak (40% versus 42.1%), or wound infection (0% versus 15.7%) in the robotic and open groups. Mean node yield (10.4 versus 11.8), positive surgical margins (15.0% versus 15.7%), and undetectable prostate-specific antigen rate (78% versus 60%) were also similar between the robotic and open groups. CONCLUSIONS: Robotic salvage prostatectomy appears to have no significant difference to the open approach with respect to safety and surgical quality as measured by complications, node yield and surgical margins in this retrospective single-institution series.

Comparison of caudal bupivacaine alone with bupivacaine plus two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infra-umbilical surgery: a randomized controlled double-blinded study.

BACKGROUND: Data are still insufficient about the effects of different concentrations of caudal dexmedetomidine when used to prolong postoperative analgesia in children. The aim of this study was to assess the analgesic efficacy and side effects of two doses of caudal dexmedetomidine (1 and 2 µg·kg(-1)) co-administered with bupivacaine in terms of postoperative pain scores and requirement of postoperative analgesia over 24 h in children undergoing infra-umbilical surgery. METHODS: Ninety-one children, aged 1-6 years, undergoing infra-umbilical surgery were included and randomly allocated into three groups of caudal block. Group B received 0.25% bupivacaine 2 mg·kg(-1) (0.8 ml·kg(-1)). Groups BD1 and BD2 received dexmedetomidine 1 and 2 µg·kg(-1), respectively along with bupivacaine 2 mg·kg(-1) in a total volume of 0.8 ml·kg(-1). Anesthesia was induced and maintained with sevoflurane in 100% oxygen. Hemodynamic and other routine intraoperative monitoring was carried out in addition to endtidal sevoflurane concentration. Time to spontaneous eye opening and postoperative pain and sedation scores were recorded in addition to time to first analgesia, paracetamol analgesic requirements, and any side effects during the first 24 postoperative hours. RESULTS: Time to first analgesia requirement was significantly longer in BD1 and BD2 groups compared to B group with mean values (95% CI) of 809 min (652-965), 880 (733-1026), and 396 (343-448), respectively, P < 0.001. Postoperative paracetamol analgesic requirements over 24 h were higher in group B compared to BD1 and BD2 groups (Mean (95% CI): 3.2 (2.9-3.5) doses, 1.9 (1.5-2.3), and 1.6 (1.3-1.9), respectively), P < 0.001. The dexmedetomidine groups had significantly higher postoperative sedation scores compared to plain bupivacaine group that were dose dependent and for longer time in BD2 group. Two patients in BD2 group developed bradycardia and hypotension, and one developed urine retention compared to none in other groups. CONCLUSION: A 1 µg·kg(-1) dose of caudal dexmedetomidine achieved comparable prolongation of postoperative analgesia to 2 µg·kg(-1) dose, with shorter duration of postoperative sedation and lower incidence of other side effects.

The feasibility and safety of repeat cryosurgical ablation of localized prostate cancer.

BACKGROUND: The aim of the study was to assess the morbidity and efficacy of repeat cryoablation (CA) in the treatment of localized prostate cancer. METHODS: Twenty-seven patients with median age of 71 years (range 48-80) who underwent repeat CA between April 2003 and April 2011 at a single institution were included. The median initial prostate-specific antigens (PSA) and Gleason values were 6.2 ng/ml (range 4-23.6) and 7 (range 6-9), respectively. Twenty-four patients underwent two CA treatments, and three patients underwent three CA treatments. Pre- and perioperative parameters and oncological and functional outcomes were evaluated. RESULTS: No intraoperative complications occurred. After the first CA, PSA was undetectable in 10 patients, and the median nadir PSA value was 0.65 ng/ml (range 0.1-4.9). After the second CA, 4 patients had undetectable PSA, and the median nadir PSA value was 1.25 ng/ml (range 0.2-7.9). For patients who underwent a third CA treatment, no patients had undetectable PSA, and the subsequent median nadir PSA value was 1.6 ng/ml (range 0.4-4.5). Two patients had incontinence (1 pad per day) following repeat CA. One patient had urinary retention after the third CA treatment, and one had urethral stricture. The mean hospitalization and follow-up periods were 1 day (range 0-2) and 51.5 months (range 11-96), respectively. CONCLUSIONS: Repeat CA successfully reduced PSA levels, and complications were modest. We conclude that repeat CA is a feasible, safe, and effective treatment option for localized prostate cancer.

The efficacy and safety of retrograde ureteral stenting in the management of complicated cases of ureteral obstruction caused by urolithiasis.

PURPOSE: To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. PATIENTS AND METHODS: An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. RESULTS: A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. CONCLUSION: Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis.

Intrarenal neurofibroma: unveiling a diagnostic challenge-a case report and literature review.

A 53-year-old male patient presented with an incidental finding of a left kidney mass after being evaluated for elevated serum creatinine without having any symptoms. The left kidney mass was confirmed by ultrasound, computed tomography 'CT' scan and magnetic resonance imaging 'MRI'. A left radical nephrectomy was done, and histopathology confirmed the presence of intrarenal neurofibroma with no evidence of malignancy.

Self-filling of male urethra with silicon jell to achieve erection: A case report.

Self-insertion of foreign body into male urethra represents heterogeneous group of cases in terms of causes, symptoms and management. We reported a case of 60-year old male patient filled his urethra with silicone-jell. Patient had severe penile pain and difficult urination. Physical examination revealed palpable hard mass starting from distal part of prostatic urethra to midpenile urethra. Rigid cystoscopy showed complete occlusion of urethra. Laser fragmentation and mechanic extraction failed. Open surgery was decided. Midline incision was performed at the distal end of foreign body in the penile urethra. The foreign material was extracted successfully.

Endoscopic Management of Upper and Lower Ureteric Stones Using Pneumatic Lithotripter: A Retrospective Medical Records Review.

Background: In this study we aimed to assess and compare the rate of sem-irigid ureterorenoscope in the treatment of upper and lower ureter stones through pneumatic lithotripsy (PL). Materials and Methods: Ninety-two patients with a mean age±SD of 45±15years who had had a surgical procedure performed by the same experienced surgeon between January 2013 and July 2015 were included in the study. The mean±SD stone size was 8.8±2.6 mm. Forty-two of the patients (45.7%) had upper ureter stones and 50 (54.3%) had lower ureter stones in order to increase the success rate and avoid stone migration. The medical files of the patients were reviewed regarding age, sex, stone size, stone location, success rate, complications, and presence of hydronephrosis. Success was operationally defined as the complete fragmentation of stone to very small parts that could pass or complete extraction of the stone. Results: Eighty-four of the patients were stone free (91%). The success rates for patients with upper or lower ureteric stones were 93% and 90%, respectively (P=0.63). There were no complications during the operation. However, 4 patients (4.4%) had postoperative complications in terms of urinary tract infection or urosepsis. Those were accurately managed by the suitable medical treatment. Conclusion: Semi-rigid ureterorenoscopy by using PL was a safe and practical treatment option for managing the upper and lower ureter stones. Performing the tips and tricks of ureterorenoscopy by an experienced surgeon seems to enhance the success rate, especially in upper ureter stones.

Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC.

Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide.

Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL).

We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

Scientific Appraisal and Therapeutic Properties of Plants Utilized for Veterinary Care in Poonch District of Jammu and Kashmir, India.

The importance of traditional and indigenous knowledge is acknowledged on a worldwide scale for its coexistence principles and sustainable use techniques. In view of this, the present study is an attempt to document the ethno-veterinary plants used by the tribal communities of Western Himalaya. This study also provides the scientific validation of herbal medicines used in ethno-veterinary practices through a reverse pharmacological approach. A total of 59 informants were selected through a non-probability sampling method. Detailed information on the medicinal plants used in ethno-veterinary practices along with their habits and habitats, part/s used, remedy preparation methods, additives/ingredients used during preparation and administration, dosages administered, and route of administration was collected. Data was analyzed for the Relative Frequency of Citations (RFC), Use Values (UV), Informant Consensus Factor (ICF), and Jaccard Index (JI). Further, a reverse pharmacological approach was used for scientific validations of the documented herbal knowledge of plant species. During the study, 56 plant species belonging to 54 genera and 39 families were documented. Asteraceae was the dominant family followed by Lamiaceae, Amaranthaceae and Fabaceae. Life forms were dominated by herbaceous species and leaves were the most common plant parts used. The highest Relative Frequency of Citations (RFC) and Use Values (UV) were recorded for Brassica rapa L. (Brassicaceae). The Pearson correlation coefficient between RFC and UV shows a strong positive correlation between the proportion of uses of a plant species within a sample of informants and the number of times that a particular use of a plant species was mentioned by the informant. Studies of the biological activity of ethno-veterinary plants can provide clues of promising leads for the isolation and identification of useful compounds that may be developed into pharmaceuticals for human welfare.

Combining Stellate ganglion block and intravenous regional anesthesia to treat complex regional pain syndrome: A 19-years' experience in a tertiary center.

OBJECTIVES: To study reduction in pain score after treatment with intravenous regional anesthesia (IVRA) and Stellate ganglion block (SGB) combination on complex regional pain syndrome (CPRS) patients and to quantify patients' satisfaction with treatment and occurrence of complications. METHODS: This is a record-based retrospective review carried out in 2020, targeting patients treated in the University of Jordan Hospital, Amman, Jordan, over the years 2002-2020. RESULTS: Among 99 patients, a significant drop in pain scores occurred in 88% of the patients' sample. Gender, age, type of CRPS, and duration of symptoms didn't affect statistical results. An average of 8.6 sessions needed to achieve 50% drop in pain score, and 2-3 sessions for first clinical improvement. Patients with previous application of plaster of Paris had increased success rates. CONCLUSION: We find it practical, inexpensive, safe, and straightforward to combine SGB with IVRA for CRPS patients.

Development and Implementation of the AIDA International Registry for Patients With Still's Disease.

Objective: Aim of this paper is to present the design, construction, and modalities of dissemination of the AutoInflammatory Disease Alliance (AIDA) International Registry for patients with systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD), which are the pediatric and adult forms of the same autoinflammatory disorder. Methods: This Registry is a clinical, physician-driven, population- and electronic-based instrument implemented for the retrospective and prospective collection of real-world data. The collection of data is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain evidence drawn from routine patients' management. The collection of standardized data is thought to bring knowledge about real-life clinical research and potentially communicate with other existing and future Registries dedicated to Still's disease. Moreover, it has been conceived to be flexible enough to easily change according to future scientific acquisitions. Results: Starting from June 30th to February 7th, 2022, 110 Centers from 23 Countries in 4 continents have been involved. Fifty-four of these have already obtained the approval from their local Ethics Committees. Currently, the platform counts 290 users (111 Principal Investigators, 175 Site Investigators, 2 Lead Investigators, and 2 data managers). The Registry collects baseline and follow-up data using 4449 fields organized into 14 instruments, including patient's demographics, history, clinical manifestations and symptoms, trigger/risk factors, therapies and healthcare access. Conclusions: This international Registry for patients with Still's disease will allow a robust clinical research through collection of standardized data, international consultation, dissemination of knowledge, and implementation of observational studies based on wide cohorts of patients followed-up for very long periods. Solid evidence drawn from "real-life" data represents the ultimate goal of this Registry, which has been implemented to significantly improve the overall management of patients with Still's disease. NCT05200715 available at https://clinicaltrials.gov/.

Urine cytology to evaluate urinary urothelial damage of shock-wave lithotripsy.

Our aim is to study the prospective trial where urine cytology was used to detect the acute urothelial mucosal damage in patients who undergo extracorporeal shock waves lithotripsy (SWL). The study included 48 consecutive patients (28 male, 20 female) with mean age of 49.02 years (range 18-66) who were treated with SWL due to renal stones (30 patients) or upper ureter stones (18 patients). The mean calculi diameter was 12.44 mm (range 5-20). Urinary cytologic examinations were done for all patients immediately before and after SWL therapy and 10 days latter. The average numbers of transitional cells, red blood cells and myocytes were counted under 40 × magnification. In overall patients the average numbers of transitional cells at the cytologic examinations done immediately before and after SWL therapy were 1.6 and 7.53 cell/field, respectively (p = 0.001). The increment in transitional cells at cytologic examination after SWL was significantly influenced only by number of shock waves applied (p = 0.003). No muscle cell was detected in all cytologic examinations. The cytologic examinations which were done after 10 days of SWL therapy showed recovery from all cytologic abnormalities. The acute increment in number of transitional cells after the SWL is not clinically important and it is a temporary change. Urothelial lesion is limited to mucosal layer and there is no evidence of damage to basal membrane or deeper muscle layer. SWL safety on urothelial and muscular layer was demonstrated. However, evaluation of larger series with use of other lithotripters is necessary before reaching any definitive conclusions.

A new framework for warehouse assessment using a Genetic-Algorithm driven analytic network process.

A novel way of integrating the genetic algorithm (GA) and the analytic network process (ANP) is presented in this paper in order to develop a new warehouse assessment scheme, which is developed through various stages. First, we define the main criteria that influence a warehouse performance. The proposed algorithm that integrates the GA with the ANP is then utilized to determine the relative importance values of the defined criteria and sub-criteria by considering the interrelationships among them, and assign strength values for such interrelationships. Such an algorithm is also employed to linguistically present the relative importance and the strength of the interrelationships in a way that can circumvent the use of pairwise comparisons. Finally, the audit checklist that consists of questions related to the criteria is integrated with the proposed algorithm for the development of the warehouse assessment scheme. Validated on 45 warehouses, the proposed scheme has been shown to be able to identify the warehouse competitive advantages and the areas where more improvements can be achieved.

Favipiravir versus standard of care in patients with severe COVID-19 infections: A retrospective comparative study.

OBJECTIVE: To assess the efficacy of Favipiravir compared to the standard therapy in treating patients with severe COVID-19 infection. METHODS: This is a retrospective cohort of patients with COVID-19 pneumonia who were treated with favipiravir, versus comparison group that received the standard of care. RESULTS: A total of 226 patients were included; 110 patients received favipiravir and 116 patients received standard of care. Patients who received favipiravir had longer time to recovery (14.2 ± 8.8 versus 12.8 ± 5.2, p = 0.17). Favipiravir was associated with an improved early day 14 mortality (4 [3.6%] versus 11 [9.5%]), p = 0.008), but was associated with a higher day 28 mortality (26 [23.6%] versus 11 [9.5%], p = 0.02). The overall mortality was higher in the favipiravir versus the standard of care group but difference was not statistically significant (33 [30.0%] versus 24 [20.7%], p = 0.10). CONCLUSION: The addition of favipiravir to standard of care was not associated with any improvement in clinical outcomes or mortality. Larger randomized controlled clinical trials are needed to further assess the efficacy of favipiravir.

Cancer immunotherapy from biology to nanomedicine.

With the significant drawbacks of conventional cancer chemotherapeutics, cancer immunotherapy has demonstrated the ability to eradicate cancer cells and circumvent multidrug resistance (MDR) with fewer side effects than traditional cytotoxic therapies. Various immunotherapeutic agents have been investigated for that purpose including checkpoint inhibitors, cytokines, monoclonal antibodies and cancer vaccines. All these agents aid immune cells to recognize and engage tumor cells by acting on tumor-specific pathways, antigens or cellular targets. However, immunotherapeutics are still associated with some concerns such as off-target side effects and poor pharmacokinetics. Nanomedicine may resolve some limitations of current immunotherapeutics such as localizing delivery, controlling release and enhancing the pharmacokinetic profile. Herein, we discuss recent advances of immunotherapeutic agents with respect to their development and biological mechanisms of action, along with the advantages that nanomedicine strategies lend to immunotherapeutics by possibly improving therapeutic outcomes and minimizing side effects.

Intraoperative administration of dexmedetomidine reduces the analgesic requirements for children undergoing hypospadius surgery.

BACKGROUND: The present study was designed to assess whether an intraoperative administration of dexmedetomidine would decrease the intraoperative and postoperative analgesic requirements for paediatric patients undergoing hypospadius surgery. METHODS: Forty-eight children (American Society of Anesthesiologists-1) aged 1-12 years undergoing hypospadius repair under general anaesthesia were randomly assigned into dexmedetomidine or placebo groups, D and P, respectively. Group D received a loading dose of dexmedetomidine 1 microg kg(-1) after induction of anaesthesia, followed by a continuous infusion at a rate of 0.7 microg kg(-1) h(-1). Group P received a volume-matched 0.9% saline. Both groups received fentanyl for intraoperative analgesia and intravenous morphine and oral paracetamol for postoperative analgesia. For both groups, heart rate, blood pressure and fentanyl requirements were recorded intraoperatively. During their stay for 2 h in the recovery room, heart rate, blood pressure, pain scores, behaviour scores and total morphine requirements were recorded. After discharge from postanaesthesia care unit, paracetamol requirements over 24 h were also recorded. RESULTS: Intraoperatively, the dexmedetomidine-treated group had significantly fewer fentanyl requirements, slower heart rate and lower mean arterial blood pressure (P < 0.001). In the postanaesthesia care unit, this group also consumed significantly less morphine, had lower pain scores, lower behaviour score in the immediate postoperative period, lower heart rates and mean arterial blood pressures when compared with the placebo group (P < 0.001). Group D consumed significantly less paracetamol than group P in the ward over 24 h. CONCLUSION: Intravenous administration of dexmedetomidine intraoperatively during hypospadius repair in children reduces intraoperative and postoperative analgesic requirements and lowers heart rate and blood pressure.