Knowledge, attitudes and practices with regard to prophetic medicine during the COVID-19 pandemic in Saudi Arabia.

OBJECTIVE: The current study explores the impact of Prophetic medicine's knowledge, attitudes, and practices on the Saudi population during the COVID-19 pandemic. SUBJECTS AND METHODS: This study used a web-based cross-sectional design. A self-selected nonprobability sampling technique was utilized to recruit social media users in Saudi Arabia aged ≥18. RESULTS: Four statements were used to evaluate participants' knowledge of the role of prophetic medicine in preventing and treating COVID-19. The participants had significant levels of knowledge, with an average of 90.3% correct answers. They strongly agreed with prophetic advice, including quarantine, travel bans and hand washing to prevent COVID-19 infection, with a mean of 4.3. In addition, the participants followed prophetic advice, including walking for half an hour, keeping social distance, wearing masks, and taking vaccines to prevent COVID-19 infection, with a mean of 4.2. CONCLUSIONS: The current study was conducted to evaluate the knowledge, attitudes, and practices of Muslim residents of Saudi Arabia concerning prophetic medicine during the COVID-19 pandemic. The study revealed that participants had good knowledge of prophetic medicine, including the use of natural products such as honey, ginger, garlic, and olive oil, as well as herbal products such as black seeds, and practices such as cupping. The study also showed that participants strongly believed that COVID-19 preventative measures - including quarantine, travel bans, and handwashing - were introduced by prophetic medicine. Practices including self-isolation, hand washing, and travel bans help prevent, treat and control diseases. They assist in maintaining good health and developing resistance to diseases.

Aquatic disaster activation plan and tactic: The natural history and management conceptual framework of aquatic disasters.

INTRODUCTION: In the past decades, water-related disasters had been accounted for about three-quarters of all-natural disasters worldwide. Asia is the most affected region with more than 45% of fatalities and more than 90% of the victims affected by aquatic disasters. Aquatic events progress differently and rapidly as compared to inland disasters. Thus, apart from additional equipments and trained aquatic rescuers, aquatic disaster operation requires specific strategies and tactics. MATERIALS AND METHODS: This qualitative study was conducted using mixed methods involving the Delphi method and decision-conferencing approach. Two rounds of open-ended questionnaires were sent to subject matter experts from rescue agencies that involved in aquatic disaster rescue and management. Feedback from the panel was reviewed, the natural history of different aquatic disasters was appraised, and the decision-analysis model on the command, control and management of aquatic disaster was developed. The model was then reassessed through an iteration process at decision-conferencing among the expert panel until the final framework was accepted by all members of the panel. RESULTS: The fast progression of aquatic disasters with multiple hazards on the scene and unique technical challenges of the operation increase the risk of rescuers to become victims themselves. The developed conceptual framework, namely Aquatic Disaster Activation Plan and Tactic (ADAPT), was found able to guide rescuers in risk assessment, judgment, and response in aquatic disasters based on strategies and tactics for different phases along the natural history of aquatic disasters. CONCLUSION: With realistic scenario-based training and drills, ADAPT can be the blueprint in aquatic disaster management. It is designed to facilitate rescue agencies and organizations in preparing and executing the technical aquatic rescue operations safely, according to the resources available and the capability of the respective rescue organization.

Exogenous Ca/Mg quotient reduces the inhibitory effects of PEG induced osmotic stress on Avena sativa L.

Drought is one of the most damaging abiotic stress that hinder plant growth and development. The present study aimed to determine the effects of various Ca/Mg quotients under polyethylene glycol (PEG)-induced osmotic stress on growth, uptake and translocation of Ca and Mg in Avena sativa (L). Plants were grown in nutrient solution supplemented with three different Ca/Mg molar quotients (0.18, 2, and 4). After 30 days plants were exposed to two different PEG (Polyethylene glycol) concentrations (0.6 MPa & 0.2 MPa) for 8 days, and solutions were renewed after 4 days. A solution containing Ca and Mg nutrients has mitigated the negative impact caused via osmotic stress on relative growth rate (RGR), absolute growth rate (AGR), crop growth rate (CGR), leaf area ratio (LAR), Leaf index ratio (LAI), root-shoot ratio (RSR), water use efficiency (WUE) and net assimilation rate (NAR). In addition, it adversely affected germination parameters, including final emergence percentage (FEP), mean germination time (MGT), Timson germination Index (TGI), germination rate index (GRI) and percent field capacity (%FC), of oat (Avena sativa L.). Mg and Ca in shoot and root and Ca translocation factor decreased with increasing Ca in solution, while Mg translocation factor increased with increasing Ca in nutrient solution. In this work, the combined effects of various Ca/Mg quotients and osmotic stress produced by polyethylene glycol (PEG) in different concentrations (0.6 MPa, 0.2 MPa) on the growth and element uptake of Avena sativa L. are examined. As a result, the Ca/Mg Quotient may naturally combat the moderate drought stress experienced by field crops.

Vismodegib and Sonidegib in Locally Advanced and Metastatic Basal Cell Carcinoma: Update on Hedgehog Pathway Inhibitors. / Vismodegib y sonidegib en el carcinoma de células basales localmente avanzado y metastásico: actualización acerca de los inhibidores de la vía de Hedgehog.

As one of the most common malignancies, basal cell carcinoma (BCC) has evolved as a global burden with incidence annually rising, especially in the older population. Even though the condition is mostly localized, the nature of the disease is destructive and can evolve as either locally advanced BCC (laBCC) or even more rarely as metastatic BCC (mBCC). There are well-established conventional treatment options for these cases, including surgeries and radiotherapy. However, not all cases are eligible for conventional treatments. Recently, biologic treatment has gained a lot of attention and research. This has led to the development of targeted treatment involving the hedgehog pathway inhibitor (HPI), a key pathogenesis in laBCC and mBCC. There are currently two approved HPIs, vismodegib and sonidegib to treat inoperable laBCC and mBCC. This review seeks to explore the pathophysiology of hedgehog pathway behind the development of BCC, and the current update of the efficacy as well as pharmacokinetics properties of HPIs that led to the ideal treatment for laBCC or mBCC, either as monotherapy or in combination with other conventional therapies.

Vismodegib y sonidegib en el carcinoma de células basales localmente avanzado y metastásico: actualización acerca de los inhibidores de la vía de Hedgehog / Vismodegib and Sonidegib in Locally Advanced and Metastatic Basal Cell Carcinoma: Update on Hedgehog Pathway Inhibitors

El carcinoma de células basales (CBC) es una de las neoplasias malignas más frecuentes, por lo que se ha convertido en una importante carga asistencial. Su incidencia se incrementa anualmente, especialmente en la población con mayor edad. A pesar de que generalmente está bien localizado, el CBC tiene la capacidad de destruir tejidos y evolucionar a un CBC localmente avanzado (CBCla) o incluso, aunque de forma más rara, a un CBC metastásico (CBCm). Las opciones terapéuticas convencionales en estos casos están bien establecidas, entre las cuales se incluyen la cirugía y la radioterapia. Sin embargo, no todos los casos son elegibles para realizar un tratamiento de tipo convencional. Recientemente, los tratamientos biológicos vienen ganando una mayor atención y son objeto de diversos estudios de investigación. De este modo se ha desarrollado una terapia dirigida utilizando los inhibidores de la vía de Hedgehog (IVH), teniendo en cuenta que se trata de una vía patogénica clave tanto en el CBCla como en el CBCm. En la actualidad, para poder tratar el CBCla y el CBCm no operables existen dos IVH aprobados: el vismodegib y el sonidegib. Esta revisión busca explorar la fisiopatología de la vía del Hedgehog responsable del desarrollo del CBC y hacer una actualización en cuanto a la eficacia, así como de las propiedades farmacocinéticas de los IVH, características que los convirtieron en la opción terapéutica ideal en el CBCla o en el CBCm, ya sea en forma de monoterapia o en combinación con alguno de los tratamientos convencionales (AU)

As one of the most common malignancies, basal cell carcinoma (BCC) has evolved as a global burden with incidence annually rising, especially in the older population. Even though the condition is mostly localized, the nature of the disease is destructive and can evolve as either locally advanced BCC (laBCC) or even more rarely as metastatic BCC (mBCC). There are well-established conventional treatment options for these cases, including surgeries and radiotherapy. However, not all cases are eligible for conventional treatments. Recently, biologic treatment has gained a lot of attention and research. This has led to the development of targeted treatment involving the hedgehog pathway inhibitor (HPI), a key pathogenesis in laBCC and mBCC. There are currently two approved HPIs, vismodegib and sonidegib to treat inoperable laBCC and mBCC. This review seeks to explore the pathophysiology of hedgehog pathway behind the development of BCC, and the current update of the efficacy as well as pharmacokinetics properties of HPIs that led to the ideal treatment for laBCC or mBCC, either as monotherapy or in combination with other conventional therapies (AU)

[Translated article] Vismodegib and Sonidegib in Locally Advanced and Metastatic Basal Cell Carcinoma: Update on Hedgehog Pathway Inhibitors / Vismodegib y sonidegib en el carcinoma de células basales localmente avanzado y metastásico: actualización acerca de los inhibidores de la vía de Hedgehog

As one of the most common malignancies, basal cell carcinoma (BCC) has evolved as a global burden with incidence annually rising, especially in the older population. Even though the condition is mostly localized, the nature of the disease is destructive and can evolve as either locally advanced BCC (laBCC) or even more rarely as metastatic BCC (mBCC). There are well-established conventional treatment options for these cases, including surgeries and radiotherapy. However, not all cases are eligible for conventional treatments. Recently, biologic treatment has gained a lot of attention and research. This has led to the development of targeted treatment involving the hedgehog pathway inhibitor (HPI), a key pathogenesis in laBCC and mBCC. There are currently two approved HPIs, vismodegib and sonidegib to treat inoperable laBCC and mBCC. This review seeks to explore the pathophysiology of hedgehog pathway behind the development of BCC, and the current update of the efficacy as well as pharmacokinetics properties of HPIs that led to the ideal treatment for laBCC or mBCC, either as monotherapy or in combination with other conventional therapies (AU)

El carcinoma de células basales (CBC) es una de las neoplasias malignas más frecuentes, por lo que se ha convertido en una importante carga asistencial. Su incidencia se incrementa anualmente, especialmente en la población con mayor edad. A pesar de que generalmente está bien localizado, el CBC tiene la capacidad de destruir tejidos y evolucionar a un CBC localmente avanzado (CBCla) o incluso, aunque de forma más rara, a un CBC metastásico (CBCm). Las opciones terapéuticas convencionales en estos casos están bien establecidas, entre las cuales se incluyen la cirugía y la radioterapia. Sin embargo, no todos los casos son elegibles para realizar un tratamiento de tipo convencional. Recientemente, los tratamientos biológicos vienen ganando una mayor atención y son objeto de diversos estudios de investigación. De este modo se ha desarrollado una terapia dirigida utilizando los inhibidores de la vía de Hedgehog (IVH), teniendo en cuenta que se trata de una vía patogénica clave tanto en el CBCla como en el CBCm. En la actualidad, para poder tratar el CBCla y el CBCm no operables existen dos IVH aprobados: el vismodegib y el sonidegib. Esta revisión busca explorar la fisiopatología de la vía del Hedgehog responsable del desarrollo del CBC y hacer una actualización en cuanto a la eficacia, así como de las propiedades farmacocinéticas de los IVH, características que los convirtieron en la opción terapéutica ideal en el CBCla o en el CBCm, ya sea en forma de monoterapia o en combinación con alguno de los tratamientos convencionales (AU)

Natural DENV-2 NS2B/NS3 protease inhibitors from Myristica cinnamomea King.

The NS2B/NS3 protease is crucial for the pathogenesis of the DENV. Therefore, the inhibition of this protease is considered to be the key strategy for the development of new antiviral drugs. In the present study, malabaricones C (3) and E (4), acylphenols from the fruits of Myristica cinnamomea King, have been respectively identified as moderate (27.33 ± 5.45 µM) and potent (7.55 ± 1.64 µM) DENV-2 NS2B/NS3 protease inhibitors, thus making this the first report on the DENV-2 NS2B/NS3 protease inhibitory activity of acylphenols. Based on the molecular docking studies, compounds 3 and 4 both have π-π interactions with Tyr161. While compound 3 has hydrogen bonding interactions with Gly151, Gly153 and Tyr161, compound 4 however, forms hydrogen bonds with Ser135, Asp129, Phe130 and Ile86 instead. The results from the present study suggests that malabaricones C (3) and E (4) could be employed as lead compounds for the development of new dengue antivirals from natural origin.

Natural DENV-2 NS2B/NS3 protease inhibitors from Myristica cinnamomea King

@#The NS2B/NS3 protease is crucial for the pathogenesis of the DENV. Therefore, the inhibition of this protease is considered to be the key strategy for the development of new antiviral drugs. In the present study, malabaricones C (3) and E (4), acylphenols from the fruits of Myristica cinnamomea King, have been respectively identified as moderate (27.33 ± 5.45 μM) and potent (7.55 ± 1.64 μM) DENV-2 NS2B/NS3 protease inhibitors, thus making this the first report on the DENV-2 NS2B/NS3 protease inhibitory activity of acylphenols. Based on the molecular docking studies, compounds 3 and 4 both have π-π interactions with Tyr161. While compound 3 has hydrogen bonding interactions with Gly151, Gly153 and Tyr161, compound 4 however, forms hydrogen bonds with Ser135, Asp129, Phe130 and Ile86 instead. The results from the present study suggests that malabaricones C (3) and E (4) could be employed as lead compounds for the development of new dengue antivirals from natural origin.

Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study.

BACKGROUND: Ambulatory surgery has recently gain popularity, as it is a good method of optimizinghospital resources utilization. To support ambulatory surgery, anaesthetic goals nowrevolve around patients' early recovery with minimal pain and nausea, expedientdischarge home and prompt resumption of activities of daily living. In this study, weevaluated the effect of a single pre-induction dose of dexmedetomidine on anaestheticrequirements, postoperative pain and clinical recovery after ambulatory ureteroscopy andureteric stenting under general anaesthesia. METHODS: Sixty patients were randomised to receive IV dexmedetomidine 0.5 µg.kg-1 (Group DEX, n = 30) or IV saline (Group P, n = 30). General anaesthesia was maintained with Sevoflurane: oxygen: air, titrated to BIS 40-60. Pain intensity, sedation, rescue analgesics, nausea/vomiting and resumption of daily activities were recorded at 1 h, and postoperative day (POD) 1-5. RESULTS: Group DEX patients had significant reduction in sevoflurane minimum alveolar concentration (MAC), mean (SD) DEX vs. Placebo 0.6 (0.2) vs. 0.9 (0.1), p = 0.037; reduced postoperative resting pain at 1 h (VAS 0-10) (mean (SD) 1.00 (1.84) vs. 2.63 (2.78), p = 0.004), POD 1 (mean (SD) 1.50 (1.48) vs. 2.87 (2.72), p = 0.002), POD 2 (0.53 (0.97) vs. 1.73 (1.96), p = 0.001) and POD 3 (0.30 (0.75) vs. 0.89 (1.49), p = 0.001). DEX patients also had less pain on movement POD 1 (3.00 (2.12) vs. 4.30 (3.10), p = 0.043) and POD 2 (2.10 (1.98) vs. 3.10 (2.46), p = 0.040), with higher resumption of daily activities by 48 h compared to placebo, 87% vs. 63%, p = 0.04. CONCLUSIONS: We conclude that a single dose of dexmedetomidine was a useful adjuvant in reducing MAC and postoperative pain (at 1 h and POD 1-3), facilitating faster return to daily activities by 48 h. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001120369 , 31st July 2017, retrospectively registered.

The Identifications and Clinical Implications of Cancer Stem Cells in Colorectal Cancer.

Cancer stem cells (CSCs) are cancer cells that are responsible for initiation, progression, metastasis, and recurrence in cancer. The aim of this review was to analyze the markers for identifying of CSCs in colorectal carcinoma, as well as the prognostic and therapeutic implications of these markers in the cancer. CSCs are insensitive to the current drug regimens. In colorectal carcinoma, markers, including Nanog, Oct-4, SOX-2, Lgr-5, CD133, CD24, CD29, ALDH1, EpCAM, CD44, CD166, and CD26, are commonly used for the identification and isolation of CSCs. In addition, ALDH1, CD24, CD44, CD133, CD166, EpCAM, Lgr-5, Nanog, and SOX-2 could have clinical roles in predicting pathological stages, cancer recurrence, therapy resistance, and patients' survival in patients with colorectal carcinoma. In light of the current knowledge of CSCs in colorectal carcinoma, novel potential therapeutic strategies, such as development of monoclonal antibodies or immunotoxins and targeting various cell surface molecules in colorectal CSCs and/or components of signaling pathways, have been developed. This could open new opportunities for the better management of patients with colorectal carcinoma.

Patterns of practice in palliative radiotherapy in Africa - case revisited.

AIMS: To investigate patterns of practice in palliative radiotherapy in Africa. MATERIALS AND METHODS: Fifteen centres in Africa provided detailed information about radiotherapy in both metastatic and locally advanced disease via a questionnaire. Information included general information (institution status, equipment, staff, patient number), radiotherapy and other treatment characteristics in bone metastasis, brain metastasis, metastatic spinal cord compression, lung and liver metastasis, as well as locally advanced tumours. RESULTS: The number of patients annually seen/treated ranged from 285 to 5000. Breast, cervix, head and neck, gastrointestinal and prostate cancer were the top five cancers overall. Eight (53%) institutions were without linear accelerators, four (27%) had a single one, whereas one institution each had two, three and four linear accelerators. The number of cobalt machines ranged from 0 to 2 (median 1). Most centres still prefer to use fractionated radiotherapy regimens over single-fraction regimens in bone metastasis, although most centres are now using single-fraction radiotherapy in retreatments. Radiotherapy in brain metastasis and metastatic spinal cord compression mostly conform to worldwide standards. Lung and liver metastases are rarely irradiated, largely as a consequence of the lack of modern radiotherapy technology. Locally advanced disease in various tumour sites was mostly palliated, in agreement with current evidence-based practices. CONCLUSIONS: African countries still lack adequate staffing and equipment to adequately address their clinical burden, being palliative in most cases. Emphasis should also be made on more rationally using existing capacities by using more of the single-fraction radiotherapy regimens, especially in bone metastasis.

Using grouper fish as bio-indicator of Cd, Cu, Pb and V in the vicinity of a single buoy mooring (SBM3) at Mina Al Fahal in the Sultanate of Oman.

This paper investigated metal contamination in muscle tissue of the grouper (Epinephelus coioides) in the vicinity of a single buoy mooring (SBM3) at the Sultanate of Oman. The fish samples were analyzed for cadmium (Cd), copper (Cu), lead (Pb) and vanadium (V). The mean concentrations of Cd, Cu, Pb and V in the fish samples were 0.05 ± 0.004, 0.34 ± 0.013, 0.20 ± 0.018 and 0.03 ± 0.006 mg/kg, respectively. The results were compared with the corresponding permissible concentration limits according to the Sultanate of Oman (0.05, 3.28, 0.3 and 1.4 mg/kg for Cd, Cu, Pb and V, respectively) and the European Commission (0.05 mg/kg for Cd and 0.3 mg/kg for Pb). It was found that none of the overall mean metal concentrations exceeded the corresponding Omani legislation or European Commission limits. However, the overall mean concentration of Cd was identical to the maximum permissible limit of 0.05 mg/kg that has been established by both Commissions, and the limits were exceeded for mean Cd levels in fish at two of the six sampling stations at SBM3. In general, this study indicated that the fishes at SBM3 were not highly contaminated with these metals.

Task dependent muscular volume in unilateral edentulous patientsby magnetic resonance imaging (MRI) / Volume muscular função-dependente em pacientes desdentadosunilaterais por ressonância magnética (RM)

Objective: To assess the sequelae of unilateral chewing on muscles of mastication via comparing the approximatemuscular volume (AMV) of the masseter (MM), medial pterygoid (MPM), temporalis (TM),superior and inferior lateral pterygoid muscles (SLPM/ILPM) bilaterally using MRI. Materials and methods:Twenty patients (16 females and 4 males) were selected from outpatient dental clinics of Kaser AlAini Hospitals, Cairo University, complaining from being unilaterally edentulous for one year or more. Alsosix fully dentate individuals (2 males and 4 females) were selected as control group. Magnetic ResonanceImaging (MRI) of the masticatory muscles was performed followed by measuring the approximate musclevolume (AMV) for each muscle bilaterally using the planimetry method. Results: Showed increase in theapproximate muscular volume (AMV) of the dentate side in both right side and left side edentulous patients.Conclusion: Our study shows the effect of long term unilateral chewing on decreasing the AMV in the nonfunctioningside, suggesting that measuring the approximate masticatory muscle volume using MRI couldbe helpful in detection of long-term functional disability of each muscle in comparison to adjacent muscles.

Objetivo: Avaliar as sequelas da mastigação unilateral sobre os músculos da mastigação por meio da comparaçãodo volume aproximado muscular (AMV) do músculo masseter (MM), pterigóideo medial (MPM), temporal(TM), músculos pterigóideos laterais superior e inferior (SLPM/ILPM) bilateralmente usando ressonânciamagnética. Materiais e métodos: Vinte pacientes (16 mulheres e 4 homens) foram selecionados a partir deambulatórios odontológicos do Hospital Kaser Al Aini, Universidade do Cairo; todos os participantes eram unilateralmentedesdentados há um ano ou mais. Também, seis indivíduos totalmente dentados (2 homens e 4mulheres) foram selecionados como grupo controle. Imagem por Ressonância Magnética (RM) dos músculosmastigatórios foi realizada seguido pela medição do volume muscular aproximada (AMV) para cada músculobilateral utilizando o método de planimetria. Resultados: Foi observado aumento no volume aproximadomuscular (AMV) do lado dentado em ambos os lados direito e esquerdo de desdentados laterais. Conclusão:Este estudo mostra o efeito em longo prazo da mastigação unilateral na diminuição da AMV no lado nãofuncional, o que sugere que a medição do volume muscular mastigatório aproximado usando ressonânciamagnética pode ser útil na detecção de deficiência funcional de cada músculo em comparação com músculosadjacentes em longo prazo.

Tob1 induces apoptosis and inhibits proliferation, migration and invasion of gastric cancer cells by activating Smad4 and inhibiting ß­catenin signaling.

Transducer of ErbB-2.1 (Tob1), a tumor suppressor protein, is inactivated in a variety of cancers including stomach cancer. However, the role of Tob1 in gastric carcinogenesis remains elusive. The present study aimed to investigate whether Tob1 could inhibit gastric cancer progression in vitro, and to elucidate its underlying molecular mechanisms. We found differential expression of Tob1 in human gastric cancer (MKN28, AGS and MKN1) cells. The overexpression of Tob1 induced apoptosis in MKN28 and AGS cells, which was associated with sub-G1 arrest, activation of caspase-3, induction of Bax, inhibition of Bcl-2 and cleavage of poly (ADP-ribose) polymerase (PARP). In addition, Tob1 inhibited proliferation, migration and invasion, which were reversed in MKN1 and AGS cells transfected with Tob1 siRNA. Overexpression of Tob1 in MKN28 and AGS cells induced the expression of Smad4, leading to the increased expression and the promoter activity of p15, which was diminished by silencing of Tob1 using specific siRNA. Tob1 decreased the phosphorylation of Akt and glycogen synthase kinase-3ß (GSK3ß) in MKN28 and AGS cells, resulting in the reduced protein expression and the transcriptional activity of ß­catenin, which in turn decreased the expression of cyclin D1, cyclin-dependent kinase-4 (CDK4), urokinase plasminogen activator receptor (uPAR) and peroxisome proliferator and activator receptor-δ (PPARδ). Conversely, silencing of Tob1 induced the phosphorylation of Akt and GSK-3ß, and increased the expression of ß­catenin and its target genes. Collectively, our study demonstrates that the overexpression of Tob1 inhibits gastric cancer progression by activating Smad4- and inhibiting ß­catenin-mediated signaling pathways.

Patient experience and satisfaction with awake craniotomy for brain tumours.

Awake craniotomy is increasingly used to facilitate safe maximal resection of brain tumours. Very little published data is available to determine patient experiences and satisfaction. This knowledge may lead to improvement in technique and enhance future patient care. In 2006, we began to use conscious sedation ('full awake technique') for craniotomies for tumour resection. A questionnaire designed with reference to Royal College of Surgeons (RCS) guidelines was sent out to 60 consecutive patients. Four areas of care were explored. These included the out-patient consultation with the neurosurgeon, anaesthetic consultation, operation and the post-operative period. Fourty-five responses were received. Ninety-three percent of the patients in our study felt involved sufficiently in the decision for awake surgery and felt they were given enough information when seen in the surgical consultation. However, only 64% of patients received written information in advance of their surgical date. Ninety-one percent of patients were confident that they would be looked after during surgery following their anaesthetic consultation. Eighty-seven percent of patients felt at ease during surgery. Twenty-four percent experienced some discomfort during surgery, some of which was related to positioning of the patient rather than surgical technique. Fifty-six percent of our patients reported no post-operative pain. Eighty-four percent of patients were happy with timing of their discharge. Eighty percent felt well supported post-discharge. This study demonstrates high levels of patient satisfaction and provides surgeons with useful data for consenting patients. We identified no difference in levels of patient satisfaction comparing day-case patients with those admitted. We identified areas for improvement including provision of written information, enhancing post-discharge support and allowing more time for anaesthetic discussion before surgery.

Left-sided strangulated Amyand's hernia presenting as testicular torsion in an infant.

The finding of an appendix in the hernial sac is termed Amyand's hernia. There have been a few reports of perforated appendix in the hernial sac (right-sided) mimicking testicular torsion. We report an extremely rare case of a left-sided inguinal hernial containing sac containing perforated appendix which was never thought of in the preoperative assessment.

Correlation between penile cavernosal artery blood flow and retinal vascular findings in arteriogenic erectile dysfunction.

OBJECTIVES: Arteriogenic erectile dysfunction (ED) is a target organ disease of atherosclerosis, and therefore might be a predictor of systemic atherosclerosis. Being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. We investigated the possible correlation between penile cavernosal artery blood flow and retinal vascular findings in patients with arteriogenic ED. PATIENTS AND METHODS: Sixty patients with ED were divided according to the peak systolic velocity (PSV) in their penile cavernosal arteries into two groups; Group A included 30 patients with PSV less than 25 cm/sec, and Group B included 30 patients with PSV more than 35 cm/sec. Blood flow in the penile cavernosal artery was measured with color Doppler ultrasonography. All patients were assessed by ocular fundus examination under amydriatic conditions to evaluate retinal vascular atherosclerotic changes using Hyman's classification. RESULTS: Evidence of retinal vascular atherosclerotic changes was found in 19 patients (63.3%) in Group A and in 10 patients (33.3%) in Group B. CONCLUSIONS: Our study confirms the possibility of predicting penile arterial vascular status in patients with ED from their retinal vascular findings by using amydriatic simple, practical funduscopy.

Clinics in diagnostic imaging (130). Congenital megalourethra.

A 35-day-old boy presented with complaints of an enlarged deformed penis and a history of difficulty in micturition. Haematological and biochemical analyses as well as renal tract sonography were normal. Retrograde urethrography revealed congenital megalourethra which was confirmed on cystourethroscopy. The literature pertaining to the types, aetiology, associated abnormalities, differential diagnosis, imaging and management of megalourethra is discussed.

Changes in central retinal artery blood flow after ocular warming and cooling in healthy subjects.

CONTEXT: Retinal perfusion variability impacts ocular disease and physiology. AIM: To evaluate the response of central retinal artery (CRA) blood flow to temperature alterations in 20 healthy volunteers. SETTING AND DESIGN: Non-interventional experimental human study. MATERIALS AND METHODS: Baseline data recorded: Ocular surface temperature (OST) in degrees C (thermo-anemometer), CRA peak systolic velocity (PSV) and end diastolic velocity (EDV) in cm/s using Color Doppler. Ocular laterality and temperature alteration (warming by electric lamp/cooling by ice-gel pack) were randomly assigned. Primary outcomes recorded were: OST and intraocular pressure (IOP) immediately after warming or cooling and ten minutes later; CRA-PSV and EDV at three, six and nine minutes warming or cooling. STATISTICAL ANALYSIS: Repeated measures ANOVA. RESULTS: (n = 20; mu+/-SD): Pre-warming values were; OST: 34.5+/-1.02 degrees C, CRA-PSV: 9.3+/-2.33 cm/s, CRA-EDV: 4.6+/-1.27 cm/s. OST significantly increased by 1.96 degrees C (95% CI: 1.54 to 2.37) after warming, but returned to baseline ten minutes later. Only at three minutes, the PSV significantly rose by 1.21 cm/s (95% CI: 0.51 to 1.91). Pre-cooling values were: OST: 34.5+/-0.96 degrees C, CRA-PSV: 9.7+/-2.45 cm/s, CRA-EDV: 4.7+/-1.12 cm/s. OST significantly decreased by 2.81 degrees C (95% CI: -2.30 to -3.37) after cooling, and returned to baseline at ten minutes. There was a significant drop in CRA-PSV by 1.10 cm/s (95% CI: -2.05 to -0.15) and CRA-EDV by 0.81 (95% CI: -1.47 to -0.14) at three minutes. At six minutes both PSV (95% CI: -1.38 to -0.03) and EDV (95% CI: -1.26 to -0.02) were significantly lower. All values at ten minutes were comparable to baseline. The IOP showed insignificant alteration on warming (95% CI of difference: -0.17 to 1.57 mmHg), but was significantly lower after cooling (95% CI: -2.95 to -4.30 mm Hg). After ten minutes, IOP had returned to baseline. CONCLUSION: This study confirms that CRA flow significantly increases on warming and decreases on cooling, the latter despite a significant lowering of IOP.