Reliability of prostate imaging reporting and data system version 2.1 for excluding clinically significant prostate cancer using a 1.5 tesla scanner.

INTRODUCTION: Multiparametric magnetic resonance imaging (mpMRI) of the prostate gland is now the recommended initial investigation of choice for the detection of Prostate cancer (PCa). It effectively identifies patients who require prostate biopsies due to the risk of clinically significant PCa. It helps patients with clinically insignificant PCa avoid the invasive biopsies and possible accompanying complications. Large clinical trials have investigated the accuracy of mpMRI in detecting PCa. We performed a local review to examine the reliability of omitting tissue sampling in men with a negative (PIRADS 2 (P2) or less) mpMRI in the primary diagnostic setting. METHODS: This was a retrospective study of patients with clinical suspicion of PCa within a 2-year period. Patients had a mpMRI prior to having trans-perineal prostate gland biopsies. Clinically significant disease was defined as Gleason 7 and above. The descriptive data was analysed using contingency table methods. A p-value less than 0.05 was statistically significant. RESULTS: Out of 700 patients 90 had an mpMRI score of PIRADS 2. Seventy-seven (85.5%) of these patients had a negative biopsy, 9(10%) showed Gleason 6, 4 patients showed Gleason 7 or above. 78 patients with PIRADS 2 had a PSA density of < 0.15, none of which had a clinically significant biopsy result. The negative predictive value of mpMRI from this study is 95%. CONCLUSION: Our results are in line with negative predictive values demonstrated in the current literature. This local study, likely applicable to other district general hospitals, shows that mpMRI is a safe and reliable initial investigation to aid decisions on which patients require biopsies.

Efficacy of Platelet-Rich Plasma Versus Autologous Fat Transfer With Nanofat in the Treatment of Infraorbital Dark Circles: A Single-Blinded Randomized Comparative Clinical Trial.

BACKGROUND: Treating infraorbital dark circles is one of the commonest aesthetic demands worldwide. Autologous fat transfer is commonly used to treat dark circles by filling the grooves, without effect on skin quality. Platelet-rich plasma has been reported to improve skin quality. Autologous fat can be emulsified and filtered to produce nanofat, which is then injected superficially in the dark circles to improve skin quality and discoloration. OBJECTIVE: To compare the efficacy of platelet-rich plasma versus combined fat transfer and nanofat in treating infraorbital dark circles. MATERIALS AND METHODS: 30 patients with infraorbital dark circles of combined etiological factors were randomized into 2 equal groups: Group A treated with platelet-rich plasma and Group B treated with autologous fat transfer with emulsified fat injection. RESULTS: Excellent and moderate responses were observed in 3 (20%) and 2 (13%) patients in group A versus 7 (46.7%) and 4 (27%) in group B, respectively. Nonresponders were 8 (53.3%) in group A and only 1 patient (6.7%) in group B. The difference was statistically significant regarding improvement ( p = .048) and patient satisfaction ( p = .032). CONCLUSION: Autologous fat transfer with nanofat is significantly superior to platelet-rich plasma in improvement and satisfaction.

Optimization of the outcome of percutaneous nephrolithotomy regarding urinary leakage, what should we do?

To evaluate the factors affecting urinary leakage post percutaneous nephrolithotomy. To define those at high risk in whom a double J stent for 4 weeks or external ureteral catheter fixation for at least 3 days is indicated at the end of procedure. A total of 140 patients who underwent single-stage Percutaneous Nephrolithotomy (PCNL) with single or multiple accesses were included between February 2014 and March 2019. A detailed history, laboratory and radiological investigations were performed on all patients. All patients were classified according to postoperative urinary leakage into three groups. We defined leakage as a leakage from percutaneous puncture site. Group 1 (90 patients), No leakage was defined as leakage < 12 hours. In group 2 (32 patients), short-term leakage was defined as leakage 12-48 hours, and in Group 3 (18 patients), prolonged urinary leakage > 48 hours. Patients with short-term and prolonged urinary leakage had a significantly shorter access tract. Most patients (93.8%) with short-term leakage had an access tract of 71-90 mm, while > 50% of patients (55.6) with prolonged leakage had an access tract of 51-70 mm (p <0.001). Multivariate ordinal regression revealed that Operative time, length of the access tract and parenchymal thicknesses significantly predict short-term and prolonged leakage. For predicting the prolonged urinary leakage, the length of access tract and parenchymalthickness showed significant areas under the curve (AUC); 78% (95% CI: 69 - 85, p = 0.002) and 94% (95% CI: 87 - 97, p <0.001), respectively. Operative time, length of the access tract and parenchymal thickness significantly predict short-term and prolonged leakage.

Rhino-orbito-cerebral mucormycosis infection in a 4-year-old Egyptian girl.

Rhino-orbital cerebral mucormycosis is a rare, potentially fatal fungal infection that usually affects diabetic and immunocompromised adults. Recently, an increase in the frequency of this infection in children has been reported, especially in neutropenic patients and premature babies. In this article, we are reporting a case of rhino-orbital cerebral mucormycosis in a 4-year-old girl with a newly diagnosed diabetes mellitus. Tissue biopsy, fungal culture, and imaging were used to confirm the diagnosis. The infection was successfully treated with combined surgical debridement and antifungals.

The Mycobiome: Cancer Pathogenesis, Diagnosis, and Therapy.

Cancer is among the leading causes of death globally. Despite advances in cancer research, a full understanding of the exact cause has not been established. Recent data have shown that the microbiome has an important relationship with cancer on various levels, including cancer pathogenesis, diagnosis and prognosis, and treatment. Since most studies have focused only on the role of bacteria in this process, in this article we review the role of fungi-another important group of the microbiome, the totality of which is referred to as the "mycobiome"-in the development of cancer and how it can impact responses to anticancer medications. Furthermore, we provide recent evidence that shows how the different microbial communities interact and affect each other at gastrointestinal and non-gastrointestinal sites, including the skin, thereby emphasizing the importance of investigating the microbiome beyond bacteria.

Effect of High-Power Laser Therapy Versus Shock Wave Therapy on Pain and Function in Knee Osteoarthritis Patients: A Randomized Controlled Trial.

Objective: The aim of this study was to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and high-intensity laser therapy (HILT), as outpatient physical therapy modalities, on knee osteoarthritis (KOA) patients. Materials and methods: The treatment program was completed by 40 individuals with stage II KOA (according to Kellgren and Lawrence) who were randomly allocated to one of two groups. They have had more than grade 3 pain on the visual analog scale (VAS) during activities for the last 3 months, with body-mass index less than 30 and no history of knee operation, fracture, cancer, or other neuromuscular or musculoskeletal diseases that may affect study results. The ESWT group (n = 20, mean age = 40.12 ± 9.45 years) received ESWT, 0.05 mJ/mm2, one session/week for 4 weeks, and the HILT group (n = 20, mean age = 46.62 ± 8.68 years) received HILT, 1500 mJ/cm2 in each session, three sessions/week for 4 weeks. Both groups received conservative physical therapy programs. Before and after 4 weeks of intervention, pain, physical function, and disability were assessed using a VAS, 6-min walking test, and the Western Ontario and McMaster Universities Osteoarthritis Index. Results: When the pre- and post-treatment mean values of dependent variables of both groups were compared, there were statistically significant improvements in both groups. Significant differences in the measured variables were also discovered in favor of the HILT group compared with the ESWT group. Conclusions: HILT showed a superior effect compared with ESWT on pain, physical function, and disability in chronic KOA patients. Pan African Clinical Trials Registry number: PACTR202007638955907.