Voiding efficiency in children is significantly impaired by the presence of the urethral catheter during pressure-flow studies.

BACKGROUND: Little is known about the effect of catheterization during pressure-flow studies (PFS) on voiding efficiency in children. Our objective was to determine the effect of urethral catheterization on Qmax and flow index (FI) during PFS compared to the free flow of uroflowmetry (UF). METHODS: We retrospectively reviewed 63 consecutive children who underwent UF and PFS at our center on the same day (2019-2022). Voiding data was available for 46 patients. Patients first underwent a UF with full bladder, then PFS after urethral catheter insertion. Patients with urethral pathologies (n = 6), on clean intermittent catheterization (CIC) (n = 2) and with major comorbidities (n = 2) were excluded. Indications for UF/PFS were LUTS, recurrent UTIs, incontinence or neurosurgical pre-operative evaluation. Data was collected from the UF and the PFS and compared using paired t-test. The idealized Qmax and flow index (FI) were calculated for UF and PFS using the formulas described by Franco et al.: Male Qmax = 11.26 + 0.0701(TBC [total bladder capacity]) - 0.0000513(TBC); Female Qmax = 10.723 + 0.073(TBC) - 0.0000423(TBC), FI = Actual Qmax/Expected Qmax (Franco and et al., 2016; Franco et al., 2018; Franco and et al., 2016). RESULTS: Median age was 7 years old (IQR 5-11). Twenty-one (40%) patients were male and 32 (60%) patients were female. Of the 53 patients, 3 boys and 4 girls (n = 7; 13%) were unable to void with the catheter in place during PFS but able to void after its removal. Of the remaining 46 cases, the Qmax during PFS was 5 mL/s slower than the Qmax recorded on the UF without catheter, representing a decrease of 29% (12.3 vs 17.3 mL/s; p < 0.0001). The impact of urethral catheter during PFS was more important in males vs females (Qmax decreased by 7.7 vs 3.3 mL/s, or 45 vs 19%). The mean FI during PFS was 44%, which was a 30% reduction compared to the 74% FI obtained with UF (p < 0.00001). In males, the FI decreased by 37% on PFS, whereas it decreased 26% in females, similar to the Qmax decrease. CONCLUSIONS: Voiding efficiency, as assessed by Qmax and FI, is decreased during PFS compared to uroflow studies. Our data documents for the first time the impact of urethral catheterization on pediatric voiding efficiency. Abnormal flow rates and elevated PVRs should be used to guide patient management only if obtained by uroflow. Prospective validation comparing free flow with PFS studies will help characterize the impact of urethral catheter relative to bladder pathology, age, gender and catheter size used.

Investigation of Structural, Physical, and Attenuation Parameters of Glass: TeO2-Bi2O3-B2O3-TiO2-RE2O3 (RE: La, Ce, Sm, Er, and Yb), and Applications Thereof.

A novel series of glass, consisting of B2O3, Bi2O3, TeO2, and TiO2 (BBTT) containing rare earth oxide RE2O3, where RE is La, Ce, Sm, Er, and Yb, was prepared. We investigated the structural, optical, and gamma attenuation properties of the resultant glass. The optical energy bands, the linear refractive indices, the molar refractions, the metallization criteria, and the optical basicity were all determined for the prepared glass. Furthermore, physical parameters such as the density, the molar volume, the oxygen molar volume, and the oxygen packing density of the prepared glass, were computed. Both the values of density and optical energy of the prepared glass increased in the order of La2O3, Ce2O3, Sm2O3, Er2O3, and then Yb2O3. In addition, the glass doped with Yb2O3 had the lowest refractive index, electronic polarizability, and optical basicity values compared with the other prepared glass. The structures of the prepared glass were investigated by the deconvolution of infrared spectroscopy, which determined that TeO4, TeO3, BO4, BO3, BiO6, and TiO4 units had formed. Furthermore, the structural changes in glass are related to the ratio of the intensity of TeO4/TeO3, depending on the type of rare earth. It is also clarified that the resultant glass samples are good attenuators against low-energy radiation, especially those that modified by Yb2O3, which exhibited superior shielding efficiency at energies of 622, 1170, and 1330 keV. The optical and gamma ray spectroscopy results of the prepared glass show that it is a good candidate for nonlinear optical fibers, laser solid material, and optical shielding protection.

Peroral endoscopic myotomy (POEM) for the treatment of achalasia: A multicenter Middle Eastern experience.

BACKGROUND: Peroral endoscopic myotomy (POEM) was proposed in 2010 as a minimally invasive procedure for the treatment of achalasia. In this article, we describe the Middle Eastern experience with the procedure in terms of efficacy, length of admission, and short- and long-term complications. METHODS: A retrospective analysis of our prospectively collected data on patients who underwent a POEM procedure was conducted between March 2019 and May 2020. The primary outcome was clinical success rate, defined as a postprocedure Eckardt score ≤3 at ≥3 months. Secondary outcomes included the length of hospital stay, presence of reflux symptoms or need for proton pump inhibitors (PPIs) ≥3 months, and adverse events. RESULTS: During the study period, 67 patients (35 females) underwent the procedure for achalasia. The participants' ages ranged from 11 to 80 years (mean 41 ± 18 years). Eckardt scores before the treatment ranged between 4 and 12 (mean 8.85 ± 1.75). Sixty-four patients (95.5%) achieved Eckardt scores of ≤3 at ≥3 months after the procedure (95% confidence interval [CI]: 91%-100%). The difference between pre- and post-procedural Eckardt scores averaged around -8 points (95% CI: -7.5 to -8.5 P < 0.0001). Adverse events were reported in 24 patients (35.8%) and included pneumoperitoneum (32.8%), reflux symptoms at 3 months (29.9%), and surgical emphysema (3%). Six patients had adverse events that led to prolongation of admission; 3% of whom had aspiration pneumonia, 3% had pneumoperitoneum, 1.5% had both, and 1.5% had an esophageal tear. CONCLUSIONS: POEM is a promising procedure for the treatment of achalasia with a high clinical success rate, short hospital admission, and a reassuring safety profile.

Sequential E2 levels not ovarian maximal diameter estimates were correlated with outcome of cetrotide therapy for management of women at high-risk of ovarian hyperstimulation syndrome: a randomized controlled study.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is an important condition with considerable morbidity and a small risk of mortality and most commonly results as an iatrogenic condition following follicular stimulation of the ovaries. We aimed to evaluate safety and efficacy of 3-day cetrotide therapy started on day of oocyte retrieval (Day-0) in women at high-risk for development of ovarian hyperstimulation syndrome (OHSS) after GnRH agonist induction protocol. METHODS: Forty-eight women fulfilling inclusion criteria underwent ultrasound scanning for maximal ovarian diameter (MOD) estimation and ascites grading. Patients underwent embryo freezing, but the study group received 3-day Cetrotide sc injection (0.25 mg/day) started on Day-0. Serum E2, pain scores and MOD were checked daily. Hematocrite value (Ht%), total leucocytic count (TLC), gastrointestinal (GI) manifestations and ascites grading were re-evaluated on Day-3, 6 and 8. RESULTS: Sequential serum E2 levels decreased significantly in both groups with significantly lower levels in the study group. Sequential MOD estimates showed non-significant difference between the two groups and versus Day-0 estimates. On Day-2, pain scores showed progressive significant decrease compared to Day-0 scores in both groups with significantly lower scores in the study group. On Day-3; four control patients still had vomiting and by Day-6, 6 of the control patients still had GI manifestations with significant difference versus the study group. Compared to Day-0 estimates, Ht% and TLC were significantly lower on Day-3, 6 and 8 in the study group, but only on Day-8 in the control group. Day-3 and Day-8 ascites grading in both groups was significantly lower compared to respective Day-0 grading with significant difference in favor of the study group. Six patients required hospitalization, but without mortalities. Day-3 E2 levels in the study group showed positive significant correlation with clinical and other laboratory data and ascites grading, while the correlation was non-significant with MOD. CONCLUSION: The 3-day cetrotide therapy starting after oocyte retrieval with embryo transfer freezing could be an appropriate management policy for women received GnHR-agonist induction protocol and were at high-risk for OHSS. Sequential E2 serum levels could predict outcome more perfectly than sequential MOD estimates. TRIAL REGISTRATION: Trial registration ( clinicaltrial.gov registration) NCT02823080 (retrospective) Initial Release 21-6-2016 Last Release 3-1-2017 Unique Protocol ID: Benha U Secondary IDs: kmsalama.

Three-dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding.

AIM: The aim of this study was to evaluate the efficacy of 3D power Doppler angiography (3D-PDA) for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding (PMB). MATERIAL AND METHODS: One-hundred and fifty women with PMB and an endometrial thickness (ET) of ≥4 mm on 2D sonography were assessed by 3D-PDA before endometrial sampling to obtain definitive histological diagnosis of endometrial pathology. Endometrial volume (EV), vascularity index (VI), flow index (FI) and vascularity-flow index (VFI) were calculated by computer-aided analysis. RESULTS: Of the 150 women, 114 (76%) had benign endometrial lesions and 36 (24%) had endometrial carcinoma. Patients with endometrial carcinoma had significantly thicker endometrium (15.8 ± 7.7 vs 9.9 ± 5.9 mm; P < 0.001), larger EV (9.1 ± 4.7 vs 2.6 ± 3.5 mL, P < 0.001) and higher 3D-PDA indices (P < 0.001) than patients with benign endometrial lesions. The best variable for distinguishing between benign and malignant endometrium was VI, with an area under the receiver operating characteristic curve (AUC) of 0.86. In contrast, the ET had an AUC of only 0.62. The best-fit logistic regression model for the diagnosis malignancy contained only VI as an independent factor (P = 0.002). CONCLUSION: 3D-PDA measurements may be useful for distinguishing between benign endometrial lesions and endometrial carcinoma in patients with postmenopausal bleeding.

Gartner duct cyst simplified treatment approach.

We present two patients with Gartner's duct cyst managed with simple marsupialization and successful long-term follow up.

Anaerobic biodegradability and treatment of Egyptian domestic sewage.

The anaerobic biodegradability of domestic sewage for four Egyptian villages and four Egyptian cities was determined in batch experiments. The results showed that the biodegradability of the Egyptian-villages sewage (73%) was higher than that of the cities (66%). The higher biodegradability of the soluble COD of village sewage (69%) as compared to that of the cities (46%) was the reason for the higher biodegradability of the total COD of the villages sewage. The biodegradability of suspended COD was similar for the sewage of both villages and cities (73-74%). The results of a mathematical-model. developed based on anaerobic digestion model number 1, indicate that at applying a UASB reactor for the treatment of Egyptian villages and cities sewage, an optimum HRT of, respectively. 16 and 8 h is required. At these HRTs, a total COD removal and a conversion to methane of, respectively, 62-70% and 59-64% can be achieved for the sewage of cities and, respectively, 71-77% and 67-69% for the villages sewage. The model results also show that in the treatment of villages sewage in a two-step (anaerobic filter + UASB reactor) system a higher total COD removal can be obtained (77-81%) at a short HRT of 10 h (4 + 6 h). However, the excess sludge from the first-step of the two-step system will be less stabilized.