[Adhesion of urologists to the recommendations of the French Urological Association Cancer Committee (CCAFU) in the imaging work-up of localized prostate cancer]. / L'adhésion des urologues aux recommandations du comité de cancérologie de l'association Française d'urologie (CCAFU) dans le bilan d'imagerie du cancer localisé de la prostate.

OBJECTIVES: The literature review shows a low adhesion of urologists to the recommendations of learned societies in the imaging work-up of localized prostate cancer (CaP), especially for low and intermediate risks of the D'Amico classification. We analyzed the adhesion of urologists in the Hérault region (France) to the CCAFU 2016/2018, 2018/2020 recommendations. MATERIAL AND METHODS: From the Hérault Onco Urology Registry (RHESOU) database, we identified localized CaP diagnosed between 01/01/2017 and 31/12/2019, and then classified them into 3 distinct risk groups according to the D'Amico classification. We compared the imaging workup performed by each patient to the CCAFU 2016/2018, 2018/2020 recommendations, according to the risk group. RESULTS: Of the 2,049 localized CaPs included in our study, 591 belonged to the low-risk group, 1059 to the intermediate-risk group, and 399 to the high-risk group. In the low-risk group 45.2% of the cases did not follow the CCAFU 2016/2018, 2018/2020 recommendations in the imaging workup, 77.3% in the intermediate-risk group and 80.9% in the high-risk group. For our entire study, 1,408 patients (68.7%) had an imaging workup that did not follow the CCAFU recommendations. CONCLUSION: Our results show a low adhesion of urologists to the CCAFU recommendations in the imaging assessment of localized CaP. The causes of this non-adhesion are multifactorial and difficult to analyze.

[RHESOU (Registry in HErault Specialized in Onco-Urology) : the first French Registry specialized in Onco-Urology. One-year experience]. / RHESOU (Registre de l'Hérault spécialisé en onco-urologie) : le premier registre français spécialisé en onco-urologie. Un outil méthodologique de recueil de données en onco-urologie. Bilan de faisabilité sur un an d'expérience.

PURPOSE: In 2016, the Herault tumor registry collected 1961cancers in urology (21.4 % from all Herault cancers this year). RHESOU was created to complete RTH' data with specific parameters in onco-urology. The aim of this study is to describe RHESOU and to give some examples with our first results. MATERIAL AND METHODS: In November 2018, RHESOU (Registry HErault Specialised in Onco-Urology) was founded with the same registry recommendations. It collects specific oncologic parameters and also complete RTH's data. For each urological cancer, a specific survey with different choices was performed to collect a maximum of data which could be present in patients' file. These surveys were used for urological cancers cases that live in Herault in 2017. RESULTS: In 2017, we collected 970 prostate cancers, 581 bladder cancers, 212 kidney cancers, 51 upper excretory tract cancers, 28 testicle cancers and 9 penil cancers. Our urological data collection gives many possibilities to create many requests for detailed analysis in urological cancers. In this article, we reported data from kidney, bladder and prostate cancers. CONCLUSIONS: RHESOU is a new tool opened to the different urologic corporations (urologists, pathologists, oncologists, radiotherapists, radiologists) that permits an overview in urological cancers in Herault. Finally, one important aim is that this tool will be adapted when new treatments or new important parameters appear in the years ahead. LEVEL OF EVIDENCE: 3.

Catastrophic health expenditure among ex-Gazan families in Jerash camp, Jordan.

OBJECTIVES: This study investigated the magnitude of catastrophic health expenditure (CHE) among ex-Gazan households in Jerash camp in Jordan. STUDY DESIGN: This retrospective survey used a systematic sample. METHODS: A systematic sample was used wherein every fifth house in Jerash camp was invited to participate in the study. The camp represents the largest community of ex-Gazan refugees in Jerash camp. Of the 1038 households who were invited, 976 households agreed to participate (response rate = 94%) and filled the pilot-structured questionnaire with information related to their socio-economic characteristics, health status, and their healthcare and total household expenditures. van Doorslaer's method was used to calculate the frequency of CHE, wherein the expenditure on health care was considered catastrophic if it exceeded 10% of a household's total expenditure. RESULTS: Of the sample, 41.8% suffered from CHE. Moreover, we calculated the frequency of CHE using 15%, 20%, 30%, and 40% as threshold values, and the total rates were 14.7, 6.3, 1, and 0.3%, respectively. In addition, the statistical analysis of the results showed higher frequencies of CHE in households with larger number of dependents, those headed by widowed women, and those with history of hospitalizations. CONCLUSIONS: The study shows that the rate of CHE in Jerash camp is very high and mainly due to the cost of hospitalization. Special attention should be paid for the residents of that area.

Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors.

Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.

[Results of surgical revisions for ureteral complications after renal transplantation]. / Résultats des reprises chirurgicales pour complications urétérales après transplantation rénale.

OBJECTIVE: To analyze the results of surgical revision for ureteral complication (ureteric stenosis or urinary leakage) after renal transplantation over a period of 10 years. MATERIALS AND METHODS: We performed a retrospective study on 1313 consecutive kidney transplantations carried out in a University Hospital Center between 2005 and 2014. The data of the patients who developed a ureteral stenosis or a urinary leakage secondary to a renal transplantation were analyzed. Combined organ transplantations (kidney-liver and kidney-pancreas), as well as pediatric transplantations were excluded. RESULTS: Seventy-six patients (5.8%) had ureteric stenosis or urinary leakage after renal transplantation. Forty-six patients (3.5%) underwent surgical revision: 27 for ureteral stenosis, 19 for urinary leakage. Early success was achieved in 26 patients (56.5%), including 14 ureteric stenosis (51.9%) and 12 urinary leakage (63.2%) (P=0.45). After a complementary endoscopic or surgical treatment, the final success rate was increased to 73.1% (34 patients): 20 ureteric stenosis (74.1%) and 14 urinary leakage (73.7%) (P=0.98). There were 2 graft losses (4.3%) and one death (2.2%). The mean glomerular filtration rate estimated by the MDRD was 44.58mL/min/1.73m2 (±14.7) before surgery and 45.37mL/min/1.73m2 (±16.5) 6 months after surgery (P=0.92). CONCLUSION: Although frequently challenging, surgical revisions for ureteral complications after renal transplantation give good results, with a low rate of graft loss and mortality. LEVEL OF EVIDENCE: 4.

Effect of lead on the physiological, biochemical and ultrastructural properties of Leucaena leucocephala.

Heavy metals are characterised by a relatively high density and cause genotoxic, cytotoxic and mutagenic effects on plants, animals and humans. Lead (Pb) is one of the heavy metals that causes toxicity to plants and animals. This experiment was conducted using a hydroponic technique to study the effects of Pb(NO3 )2 on physiological, biochemical and ultrastructural characteristics in Leucaena leucocephala seedlings. Plants were grown in a growth chamber for 21 days in Hoagland's solution supplemented with 0 (control), 25, 50, 100, 300, 500 and 700 µm Pb(NO3 )2 . Shoot heights as well as root lengths decreased significantly in Pb-treated plants with 300, 500 and 700 µm. In Pb-treated plants with high Pb concentrations, photosynthesis rate (PN ), stomatal conductance (gs ) and transpiration rate (E) decreased. Total protein and carbohydrate content in Pb-treated plants with 300, 500 and 700 µm increased significantly in leaves. Moreover, in Pb-treated plants with 300, 500 and 700 µm Pb(NO3 )2 , mesophyll cells had enlarged chloroplasts with disrupted thylakoid membranes associated with large starch grains. In contrast, Pb treatments with 25, 50 µm and 100 µm were not toxic to the plants. Thick sections of roots of Pb-treated plants with 300, 500 and 700 µm Pb showed distinct changes in structure of epidermal and cortical cells. Moreover, thin sections of roots of Pb-treated plants with 300, 500 and 700 µm Pb had thickened walls of xylem cells. These results will shed more light in understanding the effects of heavy metal stress on plants.

Time trends in diabetes mellitus in Jordan between 1994 and 2017.

AIM: The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan. METHODS: Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates. RESULTS: The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of < 59 mmol/mol (7.5%) was observed in 41.4% of participants with known diabetes. CONCLUSION: The results showed a high prevalence of diabetes in Jordan among people aged ≥ 25 years. Prevalence increased from 1994 to 2009, but slowed thereafter. The increase was greater in men than in women. Previously diagnosed diabetes accounted for a high percentage of people with diabetes in all surveys and was highest in 2017 survey, suggesting that the national strategy against diabetes has brought some benefits. Efforts should be made to improve glycaemic control in people with diabetes.

Effect of Thickness on Light Transmission and Vickers Hardness of Five Bulk-fill Resin-based Composites Using Polywave and Single-peak Light-emitting Diode Curing Lights.

OBJECTIVES:: This study compared light transmission through different thicknesses of bulk-fill resin-based composites (RBCs) using a polywave and a single-peak light-emitting diode light-curing unit (LCU). The effect on the surface hardness was also evaluated. METHODS:: Five bulk-fill RBCs were tested. Specimens (n=5) of 1-, 2-, 4-, or 6-mm thickness were photopolymerized for 10 seconds from the top using a polywave (Bluephase Style) or single-peak (Elipar S10) LCU, while a spectrophotometer monitored in real time the transmitted irradiance and radiant exposure reaching the bottom of the specimen. After 24 hours of storage in distilled water at 37°C, the Vickers microhardness (VH) was measured at top and bottom. Results were analyzed using multiple-way analysis of variance, Tukey post hoc tests, and multivariate analysis (α=0.05). RESULTS:: The choice of LCU had no significant effect on the total amount of light transmitted through the five bulk-fill RBCs at each thickness. There was a significant decrease in the amount of light transmitted as the thickness increased for all RBCs tested with both LCUs ( p<0.001). Effect of LCU on VH was minimal (ηp2=0.010). The 1-, 2-, and 4-mm-thick specimens of SDR, X-tra Fill, and Filtek Bulk Restorative achieved a VHbottom/top ratio of approximately 80% when either LCU was used. CONCLUSIONS:: The total amount of light transmitted through the five bulk-fill RBCs was similar at the different thicknesses using either LCU. The polywave LCU used in this study did not enhance the polymerization of the tested bulk-fill RBCs when compared with the single-peak LCU.

Preparation, characterization and in vitro thrombolytic activity of a novel streptokinase foam.

Vascular thrombosis is a potentially fatal disease. Thrombolysis represents an efficient therapeutic option, although it still presents intrinsic bleeding risks. In order to minimize this problem, intra-thrombus injections, alone or associated with some kind of mechanical thrombectomy, have been used. In this work, a new approach to thrombolysis is presented, where the preparation, characterization and in vitro thrombolytic activity of a novel streptokinase foam are reported. Foams were prepared by mixing albumin solution with CO2 at different volume ratios. Foam stability and apparent viscosity were the parameters used to characterize the foams. The volume ratio between CO2 and albumin solution that yielded the samples with the best properties was used to prepare the thrombolytic foams, where streptokinase was used as the thrombolytic agent. The thrombolytic effect of this foam was assessed in vitro by delivering it intra-thrombus and the results were compared with those of the foam without streptokinase as well as those of a regular streptokinase solution. Both foam stability and viscosity increased as the ratio of CO2:albumin solution increased and the 3:1 ratio was used to incorporate streptokinase. The in vitro thrombolytic activity study revealed that the streptokinase foam caused a 46.6 % of thrombus lysis after 30 min of experiment against 21 and 31 % of those of the foam without streptokinase and the regular streptokinase liquid solution, respectively. Thus, the use of CO2:albumin foam enhanced the in vitro thrombolytic effect of streptokinase, which indicates its potential as a novel vehicle for carrying and delivering streptokinase to targeted thrombi.

New additions to the scorpion fauna of Riyadh region, Saudi Arabia

In this work, we present additional morphological data about the scorpion fauna of Saudi Arabia. This investigation was carried out in the central region (Riyadh) of the country and identified existing and newly discovered scorpion species for taxonomic documentation while determining the medically important ones. The survey covered the entire Riyadh region, including all major districts, and collected a total of 4,164 specimens. Morphological identification of collected animals was based on identification keys. There were two species (one with a subspecies) that belonged to the family Scorpionidae, namely Scorpio maurus kruglovi (0.02 percent) and Hemiscorpius arabicus (0.05 percent). The latter, currently, is part of the Hemiscorpiidae family that had been upgraded from a subfamily. Eight more species from the Buthidae family were found: Leiurus quinquestriatus (7.20 percent), Androctonus crassicauda (17.24 percent), Androctonus bicolor (64.60 percent), Compsobuthus arabicus (3.84 percent), Compsobuthus werneri (0.94 percent), Buthacusyotvatensis nigroaculeatus (2.31 percent), Buthacusleptochelys (3.24 percent) and Orthochirus innesi (0.55 percent). The major locations of collection were the outskirts of Riyadh city and the airport vicinity. The specimens were transported from all central region areas in 124 short trips.(AU)

Efficacy of interferon plus ribavirin in the treatment of hepatitis C virus genotype 5.

Hepatitis C virus (HCV) genotype 5 has only been reported in a few countries and treatment response has not been well characterized. Our aim is to present the treatment outcome for HCV genotype 5 patients evaluated at three medical centres in Syria between January 2004 and June 2007. Medical records were reviewed retrospectively. Treatment consisted of ribavirin 1 000-1 200 mg daily plus interferon alpha-2a, 3 MU x 3/week or pegylated-interferon alpha-2a, 180 mug/week. Patients were treated for 24 or 48 weeks. Sustained viral response (SVR) was assessed at the end of a 6-month follow-up period. Twenty-six treatment-naïve patients with HCV genotype 5 have completed the course of anti-HCV therapy and a 6-month follow-up. An SVR was achieved in 54% (47% with standard interferon and 67% with pegylated interferon, P = 0.43). A trend towards better results was observed for younger patients, low viremia and mild fibrosis. SVR was similar for treatment course of 24 or 48 weeks. In summary, treatment of HCV genotype 5 with combination therapy resulted in SVR in 54% of patients. Twenty-four weeks of treatment might be adequate. Further research should evaluate the ideal duration of treatment.

Morphological identification of scorpion species from Jazan and Al-Medina Al-Munawara regions, Saudi Arabia

The present work is a complementary contribution to the comprehensive study of the scorpion sting syndrome in Saudi Arabia. It deals with the identification and determination of medically important scorpions and the other ones, which were collected from two regions (Jazan and Al-Medina Al-Munawara), based on their morphology (the molecular phylogeny and venom characteristics will appear in subsequent publications). The specimens collected from those two regions were brought to the Research Center laboratories in several batches. Morphological identification of the collected specimens was done employing identification keys. There were 646 specimens collected from Jazan Region. A single species, Nebo hierichonticus (Family Diplocentridae), and five genera with four identified species, Parabuthus liosoma, Hottentotta jayakari (salei?), Compsobuthus werneri, Leiurus quinquestriatus (Vachoniolus globimanus?), Vachoniolus spp. (other species) and Orthochirus innesi (Family Buthidae), were classified as extant scorpions in the region. Three hundred and ninety-six specimens from Al-Medina Al-Munawara Region were categorized into eight groups; four of them were identified. Three buthids, Leiurus quinquestriatus, Androctonus crassicauda, Orthochirus innesi and one scorpion specimen, Scorpio maurus, were identified and classified as extant scorpions in this region. The other four species are still not completely identified. They are Vachoniolus (Buthacus minipectinibus?) globimanus? (Unidentified-1), Compsobuthus spp (arabicus?) (Unidentified-2), Compsobuthus spp (werneri?) (Unidentified-3) and a single specimen of Androctonus spp (australis?) (Unidentified-4), all of which belong to the family Buthidae.(AU)

Morphological identification of scorpion species from Jazan and Al-Medina Al-Munawara regions, Saudi Arabia

The present work is a complementary contribution to the comprehensive study of the scorpion sting syndrome in Saudi Arabia. It deals with the identification and determination of medically important scorpions and the other ones, which were collected from two regions (Jazan and Al-Medina Al-Munawara), based on their morphology (the molecular phylogeny and venom characteristics will appear in subsequent publications). The specimens collected from those two regions were brought to the Research Center laboratories in several batches. Morphological identification of the collected specimens was done employing identification keys. There were 646 specimens collected from Jazan Region. A single species, Nebo hierichonticus (Family Diplocentridae), and five genera with four identified species, Parabuthus liosoma, Hottentotta jayakari (salei?), Compsobuthus werneri, Leiurus quinquestriatus (Vachoniolus globimanus?), Vachoniolus spp. (other species) and Orthochirus innesi (Family Buthidae), were classified as extant scorpions in the region. Three hundred and ninety-six specimens from Al-Medina Al-Munawara Region were categorized into eight groups; four of them were identified. Three buthids, Leiurus quinquestriatus, Androctonus crassicauda, Orthochirus innesi and one scorpion specimen, Scorpio maurus, were identified and classified as extant scorpions in this region. The other four species are still not completely identified. They are Vachoniolus (Buthacus minipectinibus?) globimanus? (Unidentified-1), Compsobuthus spp (arabicus?) (Unidentified-2), Compsobuthus spp (werneri?) (Unidentified-3) and a single specimen of Androctonus spp (australis?) (Unidentified-4), all of which belong to the family Buthidae.

Pharmacological characterization of rat paw edema induced by Cerastes gasperettii (cerastes) venom

Inflammatory response induced by the venom of the Arabian sand viper Cerastes gasperettii was studied by measuring rat hind-paw edema. Cerastes gasperettii venom (CgV, 3.75-240 µg/paw), heated for 30s at 97°C, caused a marked dose and time-dependent edema in rat paw. Response was maximal 2h after venom administration and ceased within 24h. Heated CgV was routinely used in our experiments at the dose of 120 µg/paw. Among all the drugs and antivenoms tested, cyproheptadine and 5-nitroindazole were the most effective in inhibiting edema formation. Aprotinin, mepyramine, dexamethasone, diclofenac, dipyridamole, Nomega-nitro-L-arginine, quinacrine, and nordihydroguaiaretic acid showed statistically (p 0.001) significant inhibitory effect, but with variations in their inhibition degree. Equine polyspecific and rabbit monospecific antivenoms significantly (p 0.001) reduced edema when locally administered (subplantar) but were ineffective when intravenously injected. We can conclude that the principal inflammatory mediators were serotonin, histamine, adenosine transport factors, phosphodiesterase (PDE), cyclooxygenase, lipoxygenase and phospholipase A2 (PLA2), in addition to other prostaglandins and cytokines.

Ataxia-oculomotor apraxia syndrome.

Ataxia-oculomotor apraxia is a distinct entity first comprehensively described in 1988. The features include early childhood onset of ataxia and oculomotor apraxia, mimicking ataxia telangiectasia but without the extraneurologic findings of ataxia telangiectasia. We add to the clinical description of the ataxia-oculomotor apraxia syndrome by reporting eight patients, ages 2 to 15 years, from four families, suggesting autosomal recessive inheritance, with the longest follow-up over 6 years. After initial gait deterioration, all had a nonprogressive course. We have postulated that ataxia-oculomotor apraxia should be established as a separate disease from ataxia telangiectasia or its variants not only by clinical history, examination findings, and course, but primarily by the biologic markers of normal chromosome breakage and radiation sensitivity studies. We found no increased chromosome breakage in the four patients studied and intermediate sensitivity to chronic ionizing radiation of cultured skin fibroblasts on the three patients studied. Family studies revealed an intermediate radiosensitivity from two patients, their asymptomatic parents, and a sister. The lack of chromosome breakage strongly separates ataxia-oculomotor apraxia from ataxia telangiectasia. The radiation sensitivity studies are compatible with two possibilities: (1) symptomatic ataxia telangiectasia heterozygotes, but this would be highly unusual because the degree of clinical involvement in the ataxia-oculomotor apraxia patients is not mild, as would be expected if they were heterozygotes and (2) a separable disease entity, which is the interpretation we favor.

Neurophysiologic correlates of organic acidemias: a survey of 107 patients.

The files of 107 patients with 19 different types of organic acidemia were reviewed retrospectively. Approximately 50% of the patients had abnormal electroencephalogram (EEG) at the time of initial study. In patients who had serial studies, the EEG deteriorated in 38% and improved in 15%. The predominant EEG abnormality encountered was slowing of the background activity in various degrees. Focal or generalized paroxysmal activity occurring in conjunction with slow background activity indicated a poor prognosis. Brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP), and somatosensory evoked potentials (SEP) were analyzed. The VEP was abnormal in 44%, BAEP in 39%, and SEP in 29% of the patients. Given the magnitude and frequency by which neurophysiological abnormalities occur in organic acidemias, neurophysiology testing provides complementary functional information and has an important place in the clinical work-up of these diseases.

Effect of gonadal steroid hormones on the metabolic rate of the cold-acclimated gonadectomized male and female Chalcides ocellatus (Forskal).

Male and female Chalcides ocellatus were gonadectomized and cold acclimated at 15 degrees for 1 week. Lizards were injected with testosterone and estradiol, and their oxygen consumption was determined at 15 degrees. Testosterone and estradiol caused a significant increase in the whole body rate of oxygen consumption in male and female lizards, respectively.