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.

Body Mass Index as a Major Prognostic Contributing Factor in COVID-19: A Multicentral Egyptian Study.

Background: Extreme body mass index (BMI) is an influential pathophysiological risk factor for serious illnesses following lower respiratory tract infection. The purpose of the current study was to examine how the BMI of Coronavirus disease-19 (COVID-19) patients affects their prognosis. Methods: Two hundred patients with COVID-19 admitted to Al-Azhar, Qena, Aswan, and Sohag University hospitals in Egypt were included and categorized into four groups according to their BMI. The diagnosis was made according to a real-time reverse transcription-polymerase chain reaction (rRT-PCR) positive result for the SARS-CoV-2 nucleic acid in swabs from upper respiratory tract. A detailed history, clinical examination, and outcomes (disease severity and complications, hospital stay, ICU admission, mortality) were recorded for all patients. SPSS version 24 software was used for data analysis. Results: Average age of participants (19-90 years old), 92 (46%) males and 108 females (54%). ICU admission was significantly higher among underweight patients (75%) and obese patients (78.6%). The majority of underweight (62.5%) and obese (57.1%) patients had critical disease. Invasive mechanical ventilation (MV) is frequently used in underweight (50%) and obese patients (42.9%) patients. Adult respiratory distress syndrome (ARDS), cardiac, neurological, and hematological complications, and incidence of myalgia and bed sores were most frequent among obese and overweight patients. Acute kidney injury was significantly higher among underweight patients (37.5%) and obese patients (28.6%) than among other classes (p=0.004). Frequency of endocrine complications was significantly higher in underweight patients than that in other classes (p=0.01). The majority of underweight (75%) and obese patients (50%) deteriorated and died, whereas the majority of normal-weight patients (90.3%) and overweight patients (75.8%) improved and were discharged (p< 0.001). Conclusion: Body mass index is a major contributing factor to the outcome of patients with COVID-19, and patients with extreme of body mass index were associated with the worst prognosis.

Association Between Vitamin D Receptor Polymorphism and the Response to Helicobacter Pylori Treatment.

Background & Aims: This research aimed to determine how variations in the vitamin D receptor gene affected the response of H. pylori infections to eradication therapy. Patients and Methods: On 105 adult H. Pylori-positive patients, a prospective cohort study was carried out. PCR was used to genotype all patients' VDR gene polymorphisms. The patients in the study received standard triple eradication medication (clarithromycin 500 mg, amoxicillin 1000 mg, and omeprazole 20 mg) twice daily for 14 days. A stool test for H. pylori Ag was conducted 4 weeks following the end of treatment. Results: In our study, the usual triple therapy's H. pylori eradication rate was 75.2%. The successful eradication of H. pylori and VDR rs 2228570 gene polymorphisms was more prevalent in CT gene polymorphism (64.6%) compared to non-responders (19.2%), while treatment failure was more prevalent in CC gene polymorphism (73.1% in non-responders compared to responders 24.1%), which is statistically significant. In regards to the eradication of H. pylori and VDR rs7975232 gene polymorphisms, the success of eradication was more prevalent in AC gene polymorphism (54.4%) vs non-responders (30.4%), while all patients (14) with gene AA (17.7%) are responders to standard treatment, while the failure of treatment was more prevalent in CC gene polymorphism (69.2% in non-responder vs 27.8% in responders) which is statistically significant. Our findings demonstrated a strong correlation between patients' responses to H. pylori treatment and polymorphisms in the VDR gene (ApaI and TaqI) (P 0.05). Conclusion: As far as we are aware, this is the first study to identify a potential link between the FokI and Apal VDR polymorphism and treatment response in H pylori-positive patients. To evaluate the findings, more research with larger number of patients and different population is required.

Endoscopic papillary large balloon dilatation for the extraction of common bile duct stones

Background and aim: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. Patients and methods: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3). All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) with limited sphincterotomy and large balloon dilatation followed by stone extraction using an extraction balloon or dormia basket, without lithotripsy, stenting or further ERCP sessions. Results: successful stone extraction was achieved in 34 patients (85%) and stone extraction failure occurred in six patients (15%). Complications included minimal pancreatitis in four cases (10%), mild pancreatitis in two cases (5%), cholangitis in two cases (5%) and bleeding in two cases (5%). There were no recorded cases of perforation or mortality subsequent to the procedure. Conclusion: EPLBD is a safe and efficient procedure for the extraction of difficult CBDS and may be advisable in patients with a bleeding risk or abnormal papillary anatomy

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Endoscopic papillary large balloon dilatation for the extraction of common bile duct stones.

BACKGROUND AND AIM: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. PATIENTS AND METHODS: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3). All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) with limited sphincterotomy and large balloon dilatation followed by stone extraction using an extraction balloon or dormia basket, without lithotripsy, stenting or further ERCP sessions. RESULTS: successful stone extraction was achieved in 34 patients (85%) and stone extraction failure occurred in six patients (15%). Complications included minimal pancreatitis in four cases (10%), mild pancreatitis in two cases (5%), cholangitis in two cases (5%) and bleeding in two cases (5%). There were no recorded cases of perforation or mortality subsequent to the procedure. CONCLUSION: EPLBD is a safe and efficient procedure for the extraction of difficult CBDS and may be advisable in patients with a bleeding risk or abnormal papillary anatomy.

The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room.

In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.

Detection of risky esophageal varices by two-dimensional ultrasound: when to perform endoscopy.

OBJECTIVE: Esophageal varices are a consequence of portal hypertension in cirrhotic patients. Current guidelines recommend that all cirrhotic patients undergo screening endoscopy at diagnosis to identify patients with varices at high risk of bleeding who will benefit from primary prophylaxis. This practice increases costs, involves a degree of invasiveness and discomfort and places a heavy burden on endoscopy units. Several studies have evaluated possible noninvasive predictors of esophageal varices, but most of these studies remain controversial. METHODS: The intra-abdominal portion of the esophagus in 673 patients who presented with liver cirrhosis and portal hypertension was examined using standard 2-dimensional (2D) ultrasound. A direct relationship between the degree of varices observed on upper endoscopy and the intra-abdominal esophageal wall thickness was detected using 2D ultrasound. RESULTS: The mean thicknesses of the esophageal wall were 3.7 ± 0.5 mm (mean ± standard deviation) in normal individuals, 7.3 ± 3.3 mm in those with esophageal varices and 8.65 ± 1.98 mm in those with risky esophageal varices. The overall accuracy of 2D ultrasound was 95%. CONCLUSIONS: The intra-abdominal esophagus should be observed during abdominal ultrasound examination in patients with liver cirrhosis. Two-dimensional ultrasound can play an important role in screening for esophageal varices.

Changes in binocular function in anisometropic nonstrabismic children with optical correction and occlusion therapy.

PURPOSE: To identify factors that influence binocular function in anisometropic, nonstrabismic children before and after optical correction and amblyopia therapy. METHODS: This was a prospective observational study of consecutive patients with nonstrabismic anisometropia. Visual acuity and responses to the 4(Δ) base-out prism test, the Worth 4-dot test, and the TNO test were recorded after spectacle correction and every 3 months for 1 year. Factors affecting visual acuity and binocular function were analyzed using univariate and multiple stepwise regression analysis. RESULTS: A total of 118 subjects were enrolled. At the end of the first year, the mean improvement in visual acuity was 2.6 ± 2.3 lines. The percentage of patients showing a positive response to the 4(Δ) base-out prism test increased from 47% to 79%; fusion in the Worth 4-dot test, from 37% to 66%; and measurable stereopsis on TNO testing, from 59% to 80%. Better initial visual acuity and better final visual acuity were associated with better binocular function. Interocular refractive error difference was a predictor of poor binocular function in multiple regression analysis if the difference in spherical error exceeded 4 D. Patients with amblyopia showed significantly worse binocular function compared to those with no amblyopia. CONCLUSIONS: Binocular function of anisometropic children can be improved with refractive correction and amblyopia therapy.

Evaluation of intralesional propranolol for periocular capillary hemangioma.

BACKGROUND: The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of periocular capillary hemangioma. METHODS: A prospective study was performed in 22 consecutive patients with periocular hemangioma. Twelve patients underwent intralesional propranolol injection and ten patients underwent intralesional triamcinolone injection. The size of the lesion was measured serially every week during the first month, every 2 weeks for the second month, and then monthly for another 2 months. The refractive error and degree of ptosis if present were measured before injection and at the end of the study. RESULTS: There was reduction in the size of hemangioma, astigmatic error, and degree of ptosis in both groups. The difference in outcome between both groups was not statistically significant. Rebound growth occurred in 25% of the propranolol group and 30% of the steroid group but responded to reinjection. No adverse effects were reported during or after intralesional propranolol injection. CONCLUSION: Intralesional propranolol injection is an alternative and effective method for treatment of infantile periocular hemangioma.

Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract.

PURPOSE: To compare torsional versus combined torsional and conventional ultrasound modes in hard cataract surgery regarding ultrasound energy and time and effect on corneal endothelium. SETTINGS: Kasr El Aini hospital, Cairo University, and International Eye Hospital, Cairo, Egypt. METHODOLOGY: Ninety-eight eyes of 63 patients were enrolled in this prospective comparative randomized masked clinical study. All eyes had nuclear cataracts of grades III and IV using the Lens Opacities Classification System III (LOCS III). Two groups were included, each having an equal number of eyes (49). The treatment for group A was combined torsional and conventional US mode phacoemulsification, and for group B torsional US mode phacoemulsification only. Pre- and post-operative assessments included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp evaluation, and fundoscopic evaluation. Endothelial cell density (ECD) and central corneal thickness (CCT) were measured preoperatively, 1 day, 7 days, and 1 month postoperatively. All eyes were operated on using the Alcon Infiniti System (Alcon, Fort Worth, TX) with the quick chop technique. All eyes were implanted with AcrySof SA60AT (Alcon) intraocular lens (IOL). The main phaco outcome parameters included the mean ultrasound time (UST), the mean cumulative dissipated energy (CDE), and the percent of average torsional amplitude in position 3 (%TUSiP3). RESULTS: Improvement in BCVA was statistically significant in both groups (P < 0.001). Comparing UST and CDE for both groups revealed results favoring the pure torsional group (P = 0.002 and P < 0.001 for UST; P = 0.058 and P = 0.009 for CDE). As for %TUSiP3, readings were higher for the pure torsional group (P = 0.03 and P = 0.01). All changes of CCT, and ECD over time were found statistically significant using one-way ANOVA testing (P < 0.001). CONCLUSION: Both modes are safe in hard cataract surgery, however the pure torsional mode showed less US energy used.

The use of mitomycin C with autologous limbal-conjunctival autograft transplantation for management of recurrent pterygium.

PURPOSE: The purpose of this study is to evaluate and compare recurrence rates upon using mitomycin C (MMC) with limbal-conjunctival autograft for treating recurrent pterygia. METHODOLOGY: An interventional, prospective, comparative clinical study was performed in 30 eyes (26 patients) with recurrent pterygia, allocated into two groups: Group A (19 eyes) operated by pterygium excision and limbal-conjunctival autograft transplantation (L-CAT) without MMC and Group B (20 eyes) operated with injection of 0.1 mL of MMC 0.15 mg/mL 1 month before L-CAT surgery. Exclusion criteria included patients with symblepharon, cicatricial conjunctival diseases, limbal stem cell deficiency, and other intraocular diseases. RESULTS: A total of four cases of recurrences for Group A (P = 0.012) and one case of recurrence for Group B (P < 0.001) were recorded. CONCLUSIONS: Preoperative injection of MMC in low dose and concentration improves the results of L-CAT in recurrent pterygium.

Comparative performance of intraocular lenses in eyes with cataract and uveitis.

PURPOSE: To evaluate the postoperative outcomes in uveitic eyes after phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter (19) international study. METHODS: This prospective randomized comparative interventional case series comprised 140 eyes of 140 patients who had phacoemulsification and implantation of IOLs of various materials: hydrophobic acrylic (n = 48), silicone (n = 44), poly(methyl methacrylate) (PMMA) (n = 26), or heparin-surface-modified PMMA (HSM PMMA) (n = 22). Preoperative and postoperative grading and control of intraocular inflammation were performed. Clinically significant observations, visual outcomes, and the incidence of postoperative complications were recorded. RESULTS: At the final follow-up, 64 eyes (46.3%) had a best corrected visual acuity of 20/40 or better, an improvement that was highly significant (P <.0001). One day after surgery, the acrylic group had the lowest inflammation values and the silicone group the highest (P =.02). The acrylic group continued to have the lowest inflammation grade values until the 3-month follow-up. The acrylic and HSM PMMA groups had the lowest incidence of relapses. Posterior capsule opacification developed in 48 eyes (34.2%), with the highest incidence in the silicone group. CONCLUSIONS: Phacoemulsification with IOL implantation in selected uveitic eyes was safe and effective. Acrylic IOLs provided a better visual outcome and lower complication rate than IOLs of other materials.

Comparison of corneal pachymetry using ultrasound and Orbscan II.

PURPOSE: To compare Orbscan II pachymetry with ultrasonic pachymetry in eyes having corneal refractive surgery. SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: In this comparative prospective study, 72 eyes (36 patients) were divided into 4 groups: Group 1, 16 eyes with haze after photorefractive keratectomy (PRK); Group 2, 12 eyes with no haze after PRK; Group 3, 24 eyes that had uneventful laser in situ keratomileusis; Group 4, 20 normal eyes. The corneal thickness was measured in all eyes by the Orbscan II (version 3.27.10, Orbtek Inc.) and then by ultrasonic pachymetry (DHC 500, Technology Inc.). RESULTS: The results between the 2 systems of pachymetry were significant in Group 1 (P < .0001) and not significant in Groups 2, 3, and 4 (P = .056, P = .051, and P = .68, respectively). A statistically significant correlation existed between the grade of haze and the decrease in Orbscan readings (C = -0.821, P < .0001). CONCLUSION: The Orbscan II pachymetry measurements correlated with the ultrasound measurements in eyes with clear corneas. Haze after PRK decreased the Orbscan pachymetry.