Prevalence and risk factors of erectile dysfunction in cirrhotic patients: An observational study.

Background: Erectile dysfunction (ED) is a prevalent complication observed in male patients with liver cirrhosis; however, there is limited understanding of the etiological determinants responsible for its occurrence. The objective of this investigation is to explore potential contributory factors that underlie the development of ED in male patients with liver cirrhosis. Method: A cross-sectional study was conducted on 200 male patients with liver cirrhosis, who were divided into three groups according to the Child score. ED was studied using the International Index of Erectile Function (IIEF-5) Questionnaire and penile Doppler. Results: The prevalence of ED among the cirrhotic patients was 80%, and it was more frequent in patients with advanced liver disease (Child C). Penile venous leakage was observed in 20% of cirrhotic patients, which increased to 28.6% in those with advanced liver cirrhosis. Multivariate logistic regression analysis showed that age, low albumin levels, elevated INR, high hemoglobin levels, and Child C were predictors of ED in cirrhotic patients. Conclusion: Several clinical variables have been identified as potential contributors to the development of erectile dysfunction (ED) in patients with cirrhosis. These variables include advanced age, decreased levels of albumin, elevated INR, increased hemoglobin levels, and Child C classification. Early identification and treatment of these factors could potentially improve the quality of life for cirrhotic patients with ED. Notably, patients with ED in this population were observed to have elevated levels of INR, serum bilirubin, and hemoglobin, as well as reduced levels of serum albumin.

Transient Cortical Blindness After Cardiac Catheterization: A Case Report and Review of Possible Neurological Etiologies.

Cardiac catheterization is a standard procedure performed approximately 1 million times per year. Transient cortical blindness is a rare complication of this procedure. Herein we report a case of complete bilateral vision loss after cardiac catheterization through right radial access, which, to our knowledge, has only been reported once before. Prompt identification of this complication is crucial for patient care. This report provides insight into the diagnostic difficulties, differential diagnosis, imaging findings, and management of transient cortical blindness.

Human actin mutations associated with hypertrophic and dilated cardiomyopathies demonstrate distinct thin filament regulatory properties in vitro.

Two cardiomyopathic mutations were expressed in human cardiac actin, using a Baculovirus/insect cell system; E99K is associated with hypertrophic cardiomyopathy whereas R312H is associated with dilated cardiomyopathy. The hypothesis that the divergent phenotypes of these two cardiomyopathies are associated with fundamental differences in the molecular mechanics and thin filament regulation of the underlying actin mutation was tested using the in vitro motility and laser trap assays. In the presence of troponin (Tn) and tropomyosin (Tm), beta-cardiac myosin moved both E99K and R312H thin filaments at significantly (p<0.05) slower velocities than wild type (WT) at maximal Ca(++). At submaximal Ca(++), R312H thin filaments demonstrated significantly increased Ca(++) sensitivity (pCa(50)) when compared to WT. Velocity as a function of ATP concentration revealed similar ATP binding rates but slowed ADP release rates for the two actin mutants compared to WT. Single molecule laser trap experiments performed using both unregulated (i.e. actin) and regulated thin filaments in the absence of Ca(++) revealed that neither actin mutation significantly affected the myosin's unitary step size (d) or duration of strong actin binding (t(on)) at 20 microM ATP. However, the frequency of individual strong-binding events in the presence of Tn and Tm, was significantly lower for E99K than WT at comparable myosin surface concentrations. The cooperativity of a second myosin head binding to the thin filament was also impaired by E99K. In conclusion, E99K inhibits the activation of the thin filament by myosin strong-binding whereas R312H demonstrates enhanced calcium activation.

Venous Ablation.

Chronic venous insufficiency is a common and a highly prevalent vascular disorder, that occurs as a result of venous reflux owing to defective venous valves, which in turn causes venous hypertension with significant symptom burden that can interfere with quality of life. Therapeutic strategy involves lowering the venous pressure by lifestyle changes, compression therapy, and conventional catheter-based thermal ablation and novel nonthermal, nontumescent techniques of ablating the affected veins.

Cardiac myosin binding protein-C modulates actomyosin binding and kinetics in the in vitro motility assay.

The modulatory role of whole cardiac myosin binding protein-C (cMyBP-C) on myosin force and motion generation was assessed in an in vitro motility assay. The presence of cMyBP-C at an approximate molar ratio of cMyBP-C to whole myosin of 1:2, resulted in a 25% reduction in thin filament velocity (P<0.002) with no effect on relative isometric force under maximally activated conditions (pCa 5). Cardiac MyBP-C was capable of inhibiting actin filament velocity in a concentration-dependent manner using either whole myosin, HMM or S1, indicating that the cMyBP-C does not have to bind to myosin LMM or S2 subdomains to exert its effect. The reduction in velocity by cMyBP-C was independent of changes in ionic strength or excess inorganic phosphate. Co-sedimentation experiments demonstrated S1 binding to actin is reduced as a function of cMyBP-C concentration in the presence of ATP. In contrast, S1 avidly bound to actin in the absence of ATP and limited cMyBP-C binding, indicating that cMyBP-C and S1 compete for actin binding in an ATP-dependent fashion. However, based on the relationship between thin filament velocity and filament length, the cMyBP-C induced reduction in velocity was independent of the number of cross-bridges interacting with the thin filament. In conclusion, the effects of cMyBP-C on velocity and force at both maximal and submaximal activation demonstrate that cMyBP-C does not solely act as a tether between the myosin S2 and LMM subdomains but likely affects both the kinetics and recruitment of myosin cross-bridges through its direct interaction with actin and/or myosin head.

Hysteroscopic tubal electrocoagulation versus laparoscopic tubal ligation for patients with hydrosalpinges undergoing in vitro fertilization.

OBJECTIVE: To investigate the use and success rate of hysteroscopic tubal electrocoagulation for the treatment of hydrosalpinx-related infertility among patients undergoing in vitro fertilization (IVF) who have laparoscopic contraindications. METHODS: A prospective study was conducted among patients who had unilateral or bilateral hydrosalpinges identified on hysterosalpingography and vaginal ultrasonography, and who were undergoing IVF at a center in Cairo, Egypt, between January 1, 2013, and October 30, 2014. All patients who had contraindications for laparoscopy were scheduled for hysteroscopic tubal electrocoagulation (group 1); the other patients underwent laparoscopic tubal ligation (group 2). For all patients, hysterosalpingography was performed 3 months after their procedure to evaluate proximal tubal occlusion. RESULTS: Among 85 enrolled patients, 22 underwent hysteroscopic tubal electrocoagulation and 63 underwent laparoscopic tubal ligation. The procedure was successful in terms of tubal occlusion for 25 (93%) of 27 hydrosalpinges in group 1, and 78 (96%) of 81 hydrosalpinges in group 2 (P=0.597). No intraoperative or postoperative complications were reported. CONCLUSION: Hysteroscopic tubal electrocoagulation was found to be a successful treatment for hydrosalpinges before IVF when laparoscopy is contraindicated.

Impact of antimüllerian hormone assays on the outcomes of in vitro fertilization: a prospective controlled study.

OBJECTIVE: To assess the value of routine antimüllerian hormone (AMH) assays in patients considered high risk for cancellation. DESIGN: Prospective controlled study. SETTING: A private IVF center, Cairo, Egypt. PATIENT(S): In total 4,917 patients received counseling before starting IVF/intracytoplasmic sperm injection (ICSI). They were comprised of group A1 (n = 1,335), who were considered to be at risk for cancellation after ovarian stimulation, and group A2 (n = 3,582), who were considered low risk for cancellation. A control group, B (n = 4,639), included group B1 (n = 1,248) and group B2 (n = 3,391) based on the same criteria as groups A1 and A2. INTERVENTION(S): An AMH assessment was performed for group A1. All of the patients were stimulated using the long GnRH agonist protocol. Patients with low AMH levels received the flare-up protocol. MAIN OUTCOME MEASURE(S): The cancellation of IVF/ICSI cycles before or after stimulation, as well as the pregnancy rates (PR) in relation to AMH levels. RESULT(S): The group A1 patients (6.4%) did not start IVF due to low AMH, and some (6.6%) had their cycles canceled due to poor responses, compared with 2.6% in group A2 and 13.2% in group B1. The clinical PR was 42% in patients with normal AMH and 20% in patients with low AMH. The differences among these three groups were highly significant. CONCLUSION(S): The AMH assays reduced the cancellations, cost, and stress experienced by couples.

Outpatient hysteroscopy: a routine investigation before assisted reproductive techniques?

OBJECTIVE: To evaluate the importance of subjecting the patient to an outpatient (office) hysteroscopy (OH) before assisted reproductive techniques (ART) and patient compliance, possible side effects, and complications of the procedure. DESIGN: Comparative observational cross-sectional study. SETTING: University hospital. PATIENT(S): One hundred fifty-two patients attending the outpatient infertility clinic for pre-ART (IVF/intracytoplasmic sperm injection [ICSI]-ET) investigations, with normal uterine findings on hysterosalpingography (HSG). INTERVENTION(S): Transvaginal sonography (TVS) and OH (using a rigid, 30-degree, 4-mm hysteroscope) by the vaginoscopic "no touch" technique. MAIN OUTCOME MEASURE(S): Diagnostic value and compliance of OH. RESULT(S): The procedure was successful in 145 patients (95.4%); 51 of them (35.2%) had previous ART failures. Abnormal hysteroscopic findings were observed in 48 women (33.1%), in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common findings. The TVS was specific (100%) but not sensitive (41.7%) compared with OH. Abnormal hysteroscopic findings were significantly higher in patients with previous ART failure(s). The procedure was acceptable in almost all patients with no reported complications. CONCLUSION(S): The OH should be part of the infertility workup before ART even in patients with normal HSG and/or TVS. This is especially relevant in cases with prior failed ART cycles.

Effect of intra-abdominal instillation of lidocaine during minor laparoscopic procedures.

OBJECTIVE: To assess the effect of intraperitoneal instillation of lidocaine on postoperative pain after minor gynecological laparoscopic surgery. METHOD: A prospective, double-blind, placebo-controlled clinical trial of 75 patients undergoing gynecological laparoscopy randomized to receive intraperitoneal instillation of either 120 mg of lidocaine (n=60) or normal saline (n=15) at the end of surgery. Postoperative pain was evaluated by Wong-Baker Faces Pain Rating Scale (WBFS) score at 15 minutes and at 1, 2, 4, 12, and 24 hours postoperatively. RESULTS: The WBFS score was lower for the lidocaine group than for the control group at 1, 2, and 4 hours after surgery (P=0.023). There was no difference in WBFS scores between the 2 groups at 15 minutes (P=0.46), 12 hours (P=0.13), and 24 hours (P=0.07) after surgery. CONCLUSION: Intraperitoneal instillation of lidocaine was effective in reducing postoperative pain after minor gynecological laparoscopic procedures.

Does chronic ST segment elevation following Q wave myocardial infarction exclude tissue viability?

PURPOSE: Electrocardiographic (ECG) ST segment elevation lasting 2 or more weeks following Q wave myocardial infarction has been associated with 'ventricular aneurysm' and absence of tissue viability. Regional systolic dysfunction may reflect either viable myocardium or scar. Positron emission-tomographic (PET) imaging can distinguish viable from nonviable tissue. We hypothesized that patients with chronic ST segment elevation after Q wave infarction might demonstrate salvageable myocardium in the infarct region. METHODS: The ECGs of 1,229 sequential patients undergoing PET scans for viability assessment were reviewed by an electrocardiographer to identify individuals with chronic anteroseptal Q wave infarctions with persistent ST segment elevation exceeding 1 mV. Patients with QRS duration longer than 0.14 ms or rhythm other than sinus were excluded. Viability was considered present if either a reversible stress-induced perfusion defect (ischemia) or a resting perfusion-metabolism mismatch (hibernation) was identified. RESULTS: Anteroseptal ECG Q wave infarction was identified in 132 subjects (74% male, age 61 +/- 12 years). Chronic ST segment elevation was present in 84 subjects (64%) and absent in 48. Baseline clinical characteristics and left ventricular systolic function were similar in both groups. 63% of those with and 56% of those without chronic ST elevation had viable myocardium. No relationship was noted between chronic ST segment elevation and the presence or absence of myocardial viability. CONCLUSIONS: Chronic ST segment elevation after anteroseptal Q wave myocardial infarction does not exclude myocardial viability in the 'infarct zone'. Evaluation of residual tissue viability is indicated to assess the benefit of revascularization in patients with Q wave infarction and chronic ST segment elevation.