Effect of spinal cord stimulation on quality of life and opioid consumption in patients with failed back surgery syndrome.

BACKGROUND: Failed back surgery syndrome (FBSS) is a constellation of conditions occurring after spine surgeries, characterized by the presence of persistent or recurring low back pain that has a significant impact on patients' quality of life. Neuromodulation in the form of Spinal Cord Stimulation (SCS) is considered an indispensable treatment modality in the management of certain chronic pain conditions and it is showing good results for improvement in pain scores and functional capacity of the FBSS patients. OBJECTIVES: To assess the change in pain scores, quality of life, and opioid medication intake as an outcome of neuromodulation procedures performed on patients diagnosed with failed back surgery syndrome, and to detect the post-procedure complications. METHODS: A prospective observational study was conducted at two university hospitals in Egypt and the U.S.A. during the period from September 2019 to August 2021 for patients who underwent spinal cord stimulation procedures for FBSS with follow-up period of at least 1 year. Patients who are 18 years old or older diagnosed with FBSS for more than 6 months and treated with spinal cord stimulation with successful trials during this time frame were included in the study. RESULTS: Thirty-four patients were included in this study who had successful SCS trials and underwent permanent implantation of SCS devices with post-procedure follow-up period of 12 months. Patients showed a median pain numerical rating scale (NRS) of 7/10 at baseline with a median NRS of 4/10 through the follow-up period. Basic mobility and daily activity scores assessed by activity measure of post-acute care (AM-PAC) showed significant improvement from the mean of 16.87 ± 2.74 at baseline to a mean of 19.97 ± 2.93 through follow-up. In addition, there was a reduction in opioid medication usage. Post-procedure complications was of low percentage with the most detected were battery dysfunction in 7 patients and pocket pain in 6 patients. Reoperation was needed in 13 patients with 4 needed just revision and 9 patients required a complete removal of the device. CONCLUSION: Spinal cord stimulation is an effective modality of treatment for cases of failed back surgery syndrome with a statistically significant reduction in pain scores and a significant improvement in quality of life. Also, it achieves a recognizable reduction in opioid analgesic medications, with a reliable safety profile as detected with the recorded post-procedure complications. However, randomized controlled trials with more patients and long-term follow-up are highly recommended.

Sofosbuvir-/Daclatasvir-based therapy for chronic HCV and HCV/hepatitis B virus coinfected patients in Egypt.

BACKGROUND: Dramatic advances in hepatitis C virus (HCV) treatment were witnessed with the introduction of direct-acting antivirals (DAAs). Generic DAAs with remarkable efficacy and good safety profiles are currently manufactured by local pharmaceutical companies in Egypt. METHODS: In the real-world setting, of a total of 367 patients chronically infected with HCV, 289 (277 treatment-naïve and 12 treatment-experienced) patients were enrolled. Approximately 15% of the patients were coinfected with hepatitis B virus (HBV). Patients were treated with sofosbuvir+daclatasvir with or without ribavirin for 12 or 24 wk as the standard of care. HBV DNA levels were monitored throughout the study. RESULTS: A sustained virologic response at 12 wk (SVR12) was achieved in 98.3% of the patients. All non-responders were treatment-naïve and the response rate among treatment-experienced patients was 100.0%. Elevated α-fetoprotein and treatment with sofosbuvir+daclatasvir+ribavirin for 6 mo were predictors of non-response (OR [95% CI] = 1.06 [1.02 to 1.1] and 15.9 [1.8 to 136.2]; p<0.05, respectively). No HBV reactivation was noticed throughout the treatment and follow-up periods in HCV/HBV coinfected patients. CONCLUSION: The present real-world findings add to the evidence for the efficacy of generic DAAs for the treatment of patients infected with HCV. HBV reactivation is unlikely to occur in those coinfected with HBV. Although liver cirrhosis affected the outcome, pretreatment liver chemistry did not seem to correlate with the results of treatment.

Real-life results of sofosbuvir based therapy in chronic hepatitis C -naïve and -experienced patients in Egypt.

BACKGROUND: More than ten million Egyptians are infected with HCV. Every one of them is going to infect about three to four persons every year. Treating those patients is a matter of national security. A dramatic improvement in hepatitis C virus (HCV) infection treatment was achieved in the last five years. A new era of direct-acting antivirals is now dawning in Egypt. OBJECTIVE(S): We share in this report our clinical experience in treating chronic HCV Egyptian patients with Sofosbuvir based regimens to evaluate its safety and efficacy on real life practical ground. METHODS: A total of 205 chronic HCV patients (195 naive and 15 experienced) were enrolled in the study. Patient were treated with Sofosbuvir+Ribavirin 24 weeks as standard of care. Two interferon eligible patients were treated with PEG-INF+ Sofosbuvir+Ribavirin for 12 weeks. The primary efficacy endpoint was the proportion of patients with sustained virologic response at 24 weeks after cessation of therapy. RESULTS: The overall response rate was 97.1%. Sustained virological response rate did not differ among treatment-naive patients and patients with previous history of IFN-based therapy. Portal hypertension, prediabetes, and lack of early virologic response were predictors of non response. No clinically significant treatment-emergent adverse effects were noted. No treatment discontinuation was encountered. CONCLUSION: In the real-life setting, Sofosbuvir based regimens for 24 weeks has established an efficacious and well tolerated treatment in naïve and experienced patients with chronic HCV genotype 4 infection; although shorter treatment durations may be possible. However, patient follow up should extent to at least 6 months post-treatment and verifying viral load on yearly basis is warranted to track any late relapse.

Comparative study between abdominal versus laparoscopic sacral colpopexy / Estudio comparativo entre sacrocolpopexia laparoscópica y abierta en prolapso uterino grave

This study was undertaken to compare laparoscopic and open sacral colpopexies for efficacy and safety. This prospective randomized controlled study was conducted in the Gynecologic Department of El-Shatby Maternity Hospital, University of Alexandria in Egypt. It involved 30 women selected after fulfilling the criteria of inclusion into the study with informed consent to participate in the study. All patients in this study were randomly allocated into one of the two following groups: Group A (15 patients) where laparoscopic sacrocolpopexy was done. Group B (15 patients) where abdominal (open) sacrocolpopexy was done. Demographic and hospital data, complications, and follow-up visits were reviewed. Median follow-up was 12 months in the laparoscopic and open groups. Mean operating time was significantly greater in the laparoscopic versus open group, 90 min and 70 min, respectively. Estimated blood loss (84 mL vs 156 mL) and hospital stay duration (1 vs 2 days) were significantly less in the laparoscopic group than the open group. Demographic data, other perioperative data, quality of life assessment, subjective, objective cure rates, complications and reoperation rates were non-significant. As a conclusion, laparoscopic and open sacral colpopexies have comparable clinical outcomes. Although laparoscopic sacral colpopexy requires longer operating time, hospital stay and blood loss are significantly decreased. Postoperatively overall quality of life and sexual quality showed significant improvement. The subjective cure rate was 90%, the objective cure rate (no prolapse in any compartment) was 100%. The procedure is recommended for experienced laparoscopic surgeons because of severe intraoperative complications like bladder or rectal injuries (AU)

El presente estudio se llevó a cabo para comparar la eficacia y seguridad de las sacrocolpopexias laparoscópicas y de las abiertas. Este ensayo prospectivo, comparativo y aleatorizado se realizó en el Departamento de Ginecología del Hospital de Maternidad El-Shatby, Universidad de Alejandría en Egipto. Se seleccionaron 30 mujeres que cumplieron con los criterios de inclusión y firmaron un consentimiento para participar en la investigación. Las pacientes se dividieron de manera aleatoria en dos grupos: en el Grupo A (15 pacientes) fueron intervenidas mediante colpopexia sacra laparoscópica. En el Grupo B (15 pacientes), mediante colpopexia sacra abdominal (abierta). Se revisaron los datos demográficos y del hospital, las complicaciones y las visitas de seguimiento. La mediana de seguimiento fue a los 12 meses en los grupos laparoscópicos y abiertos. La duración media de la intervención fue significativamente mayor en el grupo laparoscópico frente al grupo abierto, 90 minutos y 70 minutos respectivamente. La pérdida de sangre (84 ml frente a 156 ml) y la estancia en el hospital (1 frente a 2 días) fueron significativamente menores en el grupo laparoscópico que en el abierto. Los datos demográficos y otra información perioperatoria, la valoración de la calidad de vida, las tasas de curación subjetivas y objetivas, las complicaciones y la tasa de reintervención no fueron significativos. En conclusión, los resultados de las colpopexias sacras laparoscópicas y abiertas son comparables. Si bien la colpopexia sacra laparoscópica precisa un mayor tiempo operatorio, la duración del ingreso y la pérdida de sangre son significativamente menores. La calidad de vida y la calidad sexual postoperatorias mejoraron significativamente. La tasa de curación subjetiva fue de un 90%, la tasa de curación objetiva (sin prolapso en ningún compartimento) fue de un 100%. La técnica quirúrgica se recomienda a cirujanos con experiencia en laparoscopias debido a sus graves complicaciones intraoperatorias, como lesiones vesicales o rectales (AU)

Folic acid supplementation may cure hot flushes in postmenopausal women: a prospective cohort study.

BACKGROUND: Neurotransmitter norepinephrine seems to be involved in the pathophysiology of hot flushes in postmenopausal women, and folic acid was found to interact with its receptors. OBJECTIVES: To examine the effect of folic acid supplementation on the occurrence of hot flushes and the plasma level of 3-methoxy 4-hydroxy phenyl glycol (MHPG, the main metabolite of brain norepinephrine). METHOD: Forty-six postmenopausal women were allocated (by alternation) into 2 groups (n = 23 each); Group 1 received folic acid 5mg tablets daily for 4 weeks and group 2 received placebo tablets. Four women in group 2 discontinued the study. RESULTS: The number of women who reported improvement in hot flushes was significantly higher in the treatment group. On comparing the mean plasma levels of MHPG before and after treatment, a significant lowering was found in the treatment group (mean % change = -24.1 +/- 17.9, p < 0.001) when compared with the placebo-control group (mean % change = -5.59 +/- 16.4, p = 0.10). In the treatment group, there was a significant negative correlation between improvement in hot flushes and the plasma level of MHPG (r = -0.453, p = 0.03). CONCLUSION: Folic acid supplementation may cause subjective improvement of hot flushes by lowering the increased central noradrenergic activity.