Expression profiles of immunity and reproductive genes during transition period in Holstein cattle.

The transition period is a critical time for dairy cows as the animal is subjected to the physiological stress accompanying parturition. Immunosuppression and health status were examined during this period in 80 Holstein cows. Blood samples were taken from each cow 3, 2 and 1 week before and after calving, and at calving (0 day). RNA was extracted and subjected to real-time PCR to determine mRNA levels for the immune-related genes TLR 2, 4, 6, 7 and ß-defensin 5 in addition to the reproduction-related genes prolactin and IGF-I. Results showed significant up-regulation of pro-inflammatory-selected genes, TLR 4, 6 7 and ß-defensin 5 at the third-week post-calving; however, earlier periods had lower expression of such genes. In contrast, the immunosuppression biomarker TLR2 gene was up-regulated at calving and 1 week after parturition and then down-regulated again at second and third week. Prolactin and IGF-I genes expression levels were significantly and gradually increased mainly post-partum. This research highlights that the expression patterns of TLRs, BNBD5, PRL and IGF-I could be biomarkers to follow up immune and reproductive status of dairy cow at peri-parturient period to predict the most susceptible risk time for disease incidence and to build up management protocol.

[A 22-year-old patient from Ghana with fever and reduced CD4 T-cell count]. / Fieber und erniedrigte CD4-Zellzahl bei einem 22-jährigen Patienten aus Ghana.

A 22-year-old patient from Ghana without relevant co-morbidities was admitted twice with fever of unknown origin and reduced CD4 T-cell count. During the second hospital stay, after prolonged incubation of blood cultures and detection of vegetations on the mitral valve in a transesophageal echocardiogram, infectious endocarditis with Aggregatibacter aphrophilus was diagnosed. Treatment according to European guidelines resulted in resolution of the fever, dissolution of the mitral valve vegetations and recovery of CD4 T-cell count.

An epidemiological study on survival of oropharyngeal cancer cases in Alexandria, Egypt.

A retrospective cohort study was conducted to determine the 5-year survival and prognostic factors for survival for 407 oropharyngeal cancer cases registered in the 3 main hospitals in Alexandria, Egypt, from 1996-2000. Survival analysis was conducted using Kaplan-Meier curves, and multivariate Cox regression analysis. The overall 5-year survival rate was 30.8%. Multivariate analysis showed that significant prognostic factors for survival were tumour stage (hazard ratio = 2.39; 95% CI: 1.41-11.72), tumour site and patient's age. Secondary prevention of oral cancers can be conducted through examination of the oral cavity to find precancerous and early cancerous lesions and hence improve survival.

A pilot study of penile hemodynamics in men with penile curvatures.

Penile curvature (PC) is bothersome to the patient. PC is either congenital or acquired. In most of the circulatory system, blood flows in a laminar profile with minimal energy expenditure. When a fluid passes in a curved tube, the laminar profile is disturbed and changed into a turbulent flow. It increases the energy expenditure and reduces the flow. Turbulent flow may have a role in the development of an atherosclerotic plaque and in localizing its site. The aim of this research was to study penile hemodynamics before and after correction of PC. This prospective study included 20 participants, with PC more than 30°. For each participant, preoperative color duplex doppler ultrasonography (CDDU), correction of the curvature using 16 dot plication technique and post-operative CDDU were done. Furhtermore, arterial systolic velocity was estimated distal to the site of curvature/correction every 5 min for 25 min. The degree of curvature ranged from 30° to 90° with a mean of 55±18.98. Comparative study between the preoperative and post-operative data proved a significantly higher postoperative peak systolic velocity distal to the site of correction, whereas CDDU data had insignificant differences. We concluded that correction of PC is associated with improvement of penile arterial blood flow distal to the site of correction.

Etiological factors of unconsummated marriage.

Normal erectile function is subjected to the influence of psychological, hormonal, neurological, vascular and cavernosal factors. Unconsummated marriage is a common medical and social problem in andrology clinics in conservative communities. However, its etiological factors remain unclear. This work aimed to define the probable etiology of unconsummated marriage. A total of 191 patients were evaluated through history taking, constructed questionnaire, educational settings, clinical examination, lab investigation, imaging procedures and other measures. Psychogenic factors were the cause in 74.4% of the investigated patients. Performance anxiety was the cause in 52.9%, and in 21.5% other psychological distresses were responsible. Organic causes represent 7.3%, vaginismus 8.4%, premature ejaculation 3.1% and cases with undetermined etiology were 6.8%. In conclusion, performance anxiety was revealed to be the main contributor. However, other psychogenic, organic and social factors represent sizable etiological factors.

Short-term use of sildenafil in the treatment of unconsumated marriages.

The aim of this study is to evaluate the effectiveness of short-term sildenafil use in the management of unconsummated marriages diagnosed to be mainly psychogenic in origin. This retrospective study included 35 patients evaluated within an Andrology clinic. Patients underwent a complete medical and sexual history as well as a focused physical examination. Investigations were ordered as necessary following a goal-directed approach. Education about the male and female genital anatomy and the sexual response cycle was carried out, as well as a detailed explanation about the concepts of performance anxiety, vaginismus and the mode of action of sildenafil. Sildenafil on demand therapy was initiated for 1 month and the duration extended as needed. Of 35 patients included in our study, 32 (91%) were able to achieve vaginal intromission and perform sexually. In all, 23 patients needed the sildenafil (66%) for less than 1 month, five (14%) for up to 3 months and four (11%) for more than 3 months. Three patients (9%) were unsuccessful. Treatment failures were managed by intracavernous injection therapy, combined with psychosexual therapy, depending on the cause. We conclude sildenafil use is effective as a short-term treatment option in the management of unconsummated marriages.

Autoantibodies against malondialdehyde-modified LDL are elevated in subjects with an LDL subclass pattern B.

Small low density lipoproteins (LDL) are more susceptible to in vitro oxidation than larger LDL. To study whether this leads to more oxidation of small LDL in vivo, we determined the level of autoantibodies against malondialdehyde-modified LDL (MDA-LDL) in subjects with small or large LDL (LDL subclass pattern B or A) by ELISA. The study group consisted of 92 subjects with coronary heart disease without severe hypercholesterolemia (mean total plasma cholesterol 5.9 +/- 0.8 mM), 46 with an LDL subclass pattern A and 46 with an LDL subclass pattern B. In the subjects with LDL subclass pattern B the titre of autoantibodies of the IgM class against MDA-LDL was 29% higher than in the subjects with LDL subclass pattern A (P < 0.0001). The concentration of the anti-MDA-LDL autoantibodies of the IgM class was 58% higher in the patients with the pattern B than in the patients with the pattern A (P < 0.0001). There was no statistically significant difference in the titre or concentration of autoantibodies of the IgG class between subjects with LDL subclass patterns A and B. Besides plasma triglyceride and HDL cholesterol, the titre and concentration of the IgM autoantibodies were found to be independent predictors of the LDL subclass pattern. These results show that small LDL are associated with higher autoantibody levels than large LDL. Based on the assumption that the level of autoantibodies against MDA-LDL represents the rate of LDL oxidation in vivo, we conclude that in vivo small LDL is more readily oxidised than larger LDL.(ABSTRACT TRUNCATED AT 250 WORDS)

Validity of the Arabic version of the sexual health inventory for men among Egyptians.

The objective of this study is to assess the validity of Arabic version of the abridged International Index of Erectile Function among a sample from the Egyptian populace. Two groups were included in this study. Group A included 68 patients complaining of erectile dysfunction (ED) >1 y, who failed oral treatment and accepted intracavernous self-injection. All patients of group A were previously clinically diagnosed as having ED. Group B included 68 men not complaining of ED and not suffering from any major chronic or acute illness. The mean (s.d.) age of all 136 patients was 52+/-5.7 y. Candidates of both groups were requested to complete the Sexual Health Inventory for Men (SHIM) questionnaire. Cronbach's alpha coefficient was used to assess the internal consistency of the SHIM. The items of maintenance ability, erection confidence, maintenance frequency, erection firmness and intercourse satisfaction showed an overall ICC of 0.92. Internal consistency for the whole scale was 0.91. In conclusion, the Arabic version of the SHIM administered to 136 Egyptian men proved to be reliable and valid. It also showed a high degree of specificity and sensitivity among the Egyptian population.

Infection control in outpatient unicomponent penile prosthesis surgery.

The aim of this work is evaluate the efficacy of infection control measures with unicomponent penile implants in two ambulatory surgery units in Cairo and Jeddah. This was a retrospective study of 117 consecutive cases. A patient selection and infection control protocol was followed to implant 12 hydraulic, 53 mechanical and 52 malleable prostheses under local bupivacaine penile ring anesthesia and intravenous propofol. No infection occurred that required prosthesis removal, none required hospitalization or urinary catheterization, one crural and two septal perforations were managed intraoperatively; one case was reoperated upon for mechanical failure, two for oversizing and one for undersizing the girth. We conclude that implantation of unicomponent penile implants under triple antibiotic coverage in an ambulatory surgery setting, with rigid infection control measures appears to be effective in preventing infection.

Malleable penile implants without plaque surgery in the treatment of Peyronie's disease.

The objective of this retrospective study is to evaluate the surgical outcome with malleable penile implants without plaque surgery in the treatment of impotence associated with Peyronie's disease. This study included 20 men with Peyronie's disease who underwent placement of a malleable penile prosthesis. The surgeries were performed in three day surgery units in Cairo and Jeddah. The implantation of the prosthesis straightened the penile shaft in all cases but a variable degree of deviation of the glans penis persisted in seven cases (35%), and led to dissatisfaction in 2 out of 16 patients followed for one year (12.5%). No operative or postoperative complications occurred and no reoperations were needed. We conclude that malleable penile implants are safe and effective in the treatment of Peyronie's disease associated with impotence.

Corporeal counter incisions: a simplified approach to penile prosthesis implantation in fibrotic cases.

OBJECTIVE: To evaluate the effectiveness of the technique of corporeal counter incisions for penile prosthesis implantation in cases with marked corporeal fibrosis. METHODS: Creating subtunical tunnels that are stretched transversely by the dilamezinsert instrument & Heggars dilators with its tip entering from one side and protruding from the counter incision to avoid urethral or corporeal perforation. PATIENTS: Seventeen patients underwent this technique, mean age 56 y (range 42-71 y); 12 post removal of an infected prosthesis and five post priapism. RESULTS: In all cases, two rods were successfully implanted. In one case, a crural perforation occurred that was repaired intra-operatively. CONCLUSION: Corporeal counter incisions with transverse tissue stretching is a relatively simple technique to implant semirigid implants in fibrosed corpora.

Horizontal plication after vertical tunical incisions for the correction of congenital penile curvature.

The objective of this retrospective study is to evaluate the surgical outcome of correction of congenital penile curvature, via multiple vertical incisions in the tunica albuginea that are sutured horizontally using simple inverted 2-0 PDS sutures. The study included 22 men with congenital penile curvature. The surgeries were performed in three general hospitals. The procedures straightened the penile shaft in all cases but a degree of curvature recurred in three cases. No operative or postoperative complications occurred and no reoperations were needed. Four patients complained of penile shortening. We conclude that horizontal plication after vertical corporal incisions is safe and effective in the treatment for congenital penile curvature without hypospadius.

Short term use of intracavernous vasoactive drugs in the treatment of persistent psychogenic erectile dysfunction.

The objective of this retrospective study is to evaluate the effectiveness of short term intracavernous pharmacotherapy in the treatment of persistent psychogenic impotence. The study included 153 patients evaluated within an Andrology clinic in a general hospital working in close relation to three psychiatry clinics in three hospitals. Patients underwent an average of two office sessions of intracavernous injections for the selection of the appropriate intracavernous agent and dose, and for self injection training. Of the 153 patients included in our study 98 (64%) needed the injection for less than three months, only 18 (12%) patients needed the injections up to one year. We concluded that intracavernous self injection of vasoactive drugs is an effective alternative in the treatment of men with persistent psychogenic impotence when sex therapy is unsuccessful.

The value of penile duplex in the prediction of intracavernous drug-induced priapism.

The aim of this work is to assess the value of penile duplex in the prediction of intracavernous drug-induced ischemic priapism. A total of 400 patients with erectile dysfunction were evaluated before and after diagnostic intracavernous injection of a trimix solution (papaverine+phentolamine+PGE1) using color Doppler sonography. In all, 29 patients experienced sustained rigid erections for more than an hour. Patients were further divided into two groups. Group A included patients with spontaneous resolution of their rigid erection within 3 h (10/29) and group B included patients with priapism (19/29) that did not resolve within 3 h. In group A, patients had minimal cavernous artery blood flow within the first hour postinjection, that increased with relief of their erection. Group B patients had no blood flow in their cavernous artery an hour after intracavernous injection and for 6 h later. The disappearance of blood flow in the cavernous artery after an hour of sustained rigid erection predicted priapism with 100% specificity and sensitivity. The persistent absence of cavernous artery blood flow for more than an hour, as detected by color Doppler ultrasound, is an objective predictor of priapism. This may guide early intervention to resolve the prolonged erection.

Correlation between penile duplex findings and stress electrocardiography in men with erectile dysfunction.

The aim of this work is to assess the association between vasculogenic erectile dysfunction (ED) and coronary artery disease in men above the age of 40 y. The study included 40 patients above 40 y of age with vasculogenic ED of more than 3 months duration. A dynamic duplex study after intracavernosal injection of a bimix solution (60 mg papaverine + 2 mg phentolamine mesylate) was carried out using a color ultrasound machine. The patients underwent a stress ECG test, carried out on a motor-driven treadmill according to the 'Bruce Protocol'. A total of 12 patients were diagnosed with positive ischemic heart disease (IHD). Their mean peak systolic velocity (PSV) was PSV = 19.58 cm/s. In all, patients were diagnosed with negative IHD; their mean PSV was 36.21 cm/s. A statistically significant difference was observed between patients with positive IHD and patients with negative IHD regarding PSV (P = 0.003). The sensitivity of a PSV of less than 35 cm/s in predicting IHD was 50% with a specificity of 100%. Positive predictive value for abnormal stress ECG to predict a PSV of less than 35 cm/s was 100%. In conclusion, the PSV of cavernosal arteries is a reliable measure for predicting IHD in patients with vasculogenic ED. Patients with a PSV of less than 35 cm/s should be referred for cardiologic assessment as they carry a real risk of having silent IHD.

Clinical and sonographic assessment of the side effects of intracavernous injection of vasoactive substances.

The objective of this study is to evaluate the side effects of intracavernous vasoactive agents on clinical and sonographic basis. Two groups of patients were included, group I included 168 ED patients trained on self-injection therapy using one of the three protocols. Protocol A: papaverine; protocol B: PGE1; and protocol C: trimix (papaverine, phentolamine and PGE1). Patients were followed up clinically, sonographically and by laboratory investigations for 6 months to evaluate the occurrence of side effects. Group II included 21 patients presenting to our department for the first time with a complication of intracavernous injection pharmacotherapy (ICI) initiated elsewhere. In all, 168 patients of group I completed the study. Patients on papaverine had the highest incidence of complications concerning prolonged erection, subcutaneous hematoma and penile fibrosis. Postinjection penile pain was observed more with groups B and C than group A. No systemic side effects were reported. Duplex ultrasound was beneficial in detecting mild clinically impalpable fibrosis. In total, 10 patients of group II presented with prolonged erection, seven with penile fibrosis, three with cavernositis and one with intracavernous needle breakage. We conclude that although ICI therapy is an effective second-line treatment option, patients on a self-injection program should be followed up both clinically and sonographically both at the initiation phase and on regular follow-up visits.

[Mother-child transmission of hepatitis B virus in the Tunisian Sahel]. / Etude de la transmission mère-enfant du virus de l'hépatite B dans le Sahel tunisien.

In order to assess the importance of mother-child transmission of the hepatitis B virus (HBV) in the Tunisian Sahel, 81 HBsAg-positive mothers have been selected at delivery in a representative sample of 1940 who delivered in maternities of this region. Each HBsAg-positive mother was matched for age and parity particularly with two HBsAg-negative mothers. Children born to these 66 HBsAg+ and 120 HBsAg- mothers were traced at 28 months and tested by ELISA for HBV serologic markers (HBsAg, anti-HBs and anti-HBc). The distribution of these markers was significantly different according to the maternal status for HBsAg. The overall prevalence rate of HBV markers was higher in children born to HBsAg+ mothers as compared to children born to HBsAg- mothers (33.3% vs 13.3%, OR = 2.5, 95% CI:1.4-4.2). For HBsAg, the figures were 27.3% and 9.2% respectively (OR = 2.9, 95% CI: 1.5-5.9). Given the prevalence rate of HBsAg in mothers (4.2%), the role of mother-child transmission in the spread of HBV infection and the intensity and precocity of horizontal transmission, systemic vaccination against HBV at birth should be recommended in the Tunisian Sahel in the context of the EPI. However this decision should take into account, in terms of cost/efficacy ratio, the other public health problems concerning this area.

Pattern of erectile dysfunction in Jeddah city.

OBJECTIVE: The aim of this study was to determine the demographic features of erectile dysfunction patients attending different specialized clinics in Jeddah city, and to identify possible risk factors associated with erectile dysfunction problem. METHODS: All newly erectile dysfunction patients (n=388) who attended 6 andrology and urology clinics within a period of 3 months were subjected to a modified structural interview questionnaire to collect demographic data and risk factors for erectile dysfunction. RESULTS: The study revealed the following results among erectile dysfunction patients; Saudi patients constituted (81%). The age ranged from 20-86 years with mean age of 43.23+12.56 years, 73% were married with one wife, 23.5% married with two wives, and 8% were single. About one-half (43%) were less than secondary education level. Retired patients constituted (13%) of all patients. Lack of exercise was the most frequent risk factor among 82% of patients, followed by smoking (56%), use of regular medication (44%), diabetes (30%), hypertension (15%), history of pelvic surgery (14%) alcoholism (13%), and drug addict (8%). CONCLUSION: Erectile dysfunction is a problem of not only old age but also of middle and young age. This might be attributed to the high frequency of some risk factors such as diabetes mellitus, hypertension, smoking, alcohol consumption, and drug addiction. This finding may reflect the necessity for construction of prevention strategies.

[Antibiotic prophylaxis in a priori cesarean sections without a high risk of infection. Experiences of a Tunisian maternity department]. / L'antibioprophylaxie dans les césariennes a priori sans "haut risque infectieux". Expérience d'une maternité tunisienne.

OBJECTIVE: This study was conducted to evaluate the effect of antibiotic prophylaxy on decreasing the frequency of postoperative infections after cesarean sections performed in cases with no prior indication of a high risk of infection. METHODS: A prospective randomized study included 269 cesarean sections without a high risk of infection performed in the Maternity and Neonatology Ward of the Sousse Hospital from February 1991 to July 1991. The patients were randomly divided into two groups. One group received an antibiotic prophylactic treatment including cephapirine, gentamicin and metronidazole) and the second group was given no treatment. RESULTS: Antibiotic prophylactic therapy led to a reduction of infectious morbidity after cesarean section in patients without high risk o infection from 33% to 11%. A 66% rate of efficacy was observed. In addition, antibiotics given in this context led to substantial cost reduction both by reducing the cost of antibiotics prescribed in the postoperative period and by reducing the number of days of hospitalization, and thus total cost. CONCLUSION: This study demonstrated the effectiveness of antibiotic prophylaxy for cesarean sections in patients without a high risk of infection. Nevertheless, a reevaluation of the antibiotic protocols and a rigorous operative procedure are essential.

Ovarian cancer in Alexandria from 1988 to 1997: trends and survival.

The trend of incidence of ovarian cancer was studied, the 5-year survival rate calculated and prognostic factors for survival determined. Data were collected from the Alexandria Cancer Registry and medical records in various hospitals. A total of 358 cases of ovarian cancer were diagnosed from 1988 to 1997. A significant increasing trend in incidence of ovarian cancer from 1.23/100,000 in 1988 to 3.16/100,000 in 1997 was found. The overall 5-year survival rate was 46%. The 5-year survival rates for tumour stages I to IV were 85%, 71%, 41% and 22% respectively, which was statistically significant. Survival rates with poorly differentiated tumours were significantly worse than with moderate or well differentiated tumours.