Evaluation of Adding Desmopressin to Alpha Blockers in Treatment of Nocturia in Cases of Benign Prostatic Hyperplasia: A Prospective Randomized Clinical Study

Background: Nocturia is one of the most bothersome symptom of lower urinary tract symptoms in males with Benign Prostatic Hyperplasia (BPH). Alpha blockers has good effect in relieving bladder outlet obstruction.Objective: The aim of the present study was to provide best available medical treatment for nocturia in patients of BPH.Patients and methods: This prospective study was carried out on 44 male patients complaining of lower urinary tract symptoms (LUTS) of BPH with nocturia, were enrolled in this prospective randomized study for 12 weeks. They were divided randomly into 2 groups, each group included 22 patients. Group A: the patient received oral desmopressin added to tamsulosin once daily. Group B, the patient received oral tamsulosin daily.Results: The mean serum Na of patients at group A was 142.35. No significant difference regarding in-between groups before treatment but at after  12 week of treatment; group A was (mean of Na=137.68±2.033) significantly lower than  group B and significantly decreased from before to after treatment. There was no significant difference between groups in both nocturnal void and nocturnal volume before treatment and after treatment as group A was significantly lower and both groups significantly changed and improved from before to after treatment. No significant difference was found at before treatment regarding total International Prostate Symptom Score (IPSS) but group A was significantly lower regarding total IPSS after treatment and both groups significantly decreased after treatment (6.36±2.59 in group A and 10.55±4.13 in group B).Conclusion: Addition of desmopressin to α-blockers is an active therapy for men with BPH and suffering nocturia and is preferred than α-blockers therapy alone

Value of dimeglio scoring system during ponseti correction of congenital talipes equinovarus deformity

Background: When it comes to assessing the severity of an isolated clubfoot deformity and its response to therapy, the Dimeglio scoring system is universally accepted.Objective: The aim of the current work was to increase the knowledge about application of dimeglio scoring system during Ponseti correction of clubfoot.Patients and Methods: On the basis of a Randomized clinical research, at Zagazig University Hospital Orthopedic Department, and Alhawary general hospital, Benghazi, Libya, we recruited 12 patients aged lower than 1 year having idiopathic clubfoot treated using ponseti technique in duration from January 2021 to October 2021.Results: There was a statistically significant decreases in Demiglio score among cases did not need tenotomy compared to cases needed it at all times of follow up. Also, there was a statistically significant decrease in score when comparing 1st & last read in cases needed tenotomy by 89.03% and in cases did not need by 94.26 percent. The different readings of Demiglio score had accuracy 100%, 100%. 91%, 83.3% & 100% respectively in prediction of not needing tenotomy among the studied cases.Conclusion: It could be concluded that in terms of dependability, the Dimeglio scoring system is clinically relevant and may be simply used in clinical practice. The Dimeglio score is practical, easy to use, and applicable in children also above the age of 1.5 years old

Surgical management of fracture both bone forearm in pediatric using elastic stable intramedullary nail

Background: In children, forearm fractures are among the most prevalent types of fractures Operative procedures such as, pinning with K-wires, plate osteosynthesis as well as elastic-stable intramedullary nailing (ESIN) are necessary for these fractures.Objective: This study aimed to assess treating and outcomes of pediatric forearm fractures with elastic stable intramedullary nailing (ESIN).Patients and methods: At Orthopedic Departments of Zagazig University Hospital and Tripoli University Hospital, 8 skeletally immature patients with diaphyseal forearm fractures were studied in prospective cohort research. The study was carried out from November 2020 to May 2021. Pre-operative X-ray and CT were done and the patient was prepared for surgery. Elastic-stable intramedullary nailing technique was done to all patients, all patients were regularly followed clinically and radiographically for 1 week and then 2, 4, 6, 12 week after end of surgery.Results: we found that all patients progressed to union without the need for any further surgical intervention with good functional outcome as regards forearm rotation. One case had residual radius angulation more than 20 degree, no case had residual ulna angulation, 2 cases had superficial infection, 1 case had superficial radial nerve palsy and 1 case had elbow joint stiffness.Conclusion: Intramedullary fixation by flexible intramedullary nails (ESIN) is successful treatment option and recommended for pediatric patients with 4-14 years of age or older because it is simple safe and minimally invasive procedure and effective method of treatment that provides many biological and mechanical advantages

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

A Review of Coformer Utilization in Multicomponent Crystal Formation

Most recently discovered active pharmaceutical molecules and market-approved medicines are poorly soluble in water, resulting in limited drug bioavailability and therapeutic effectiveness. The application of coformers in a multicomponent crystal method is one possible strategy to modulate a drug’s solubility. A multicomponent crystal is a solid phase formed when several molecules of different substances crystallize in a crystal lattice with a certain stoichiometric ratio. The goal of this review paper is to comprehensively describe the application of coformers in the formation of multicomponent crystals as solutions for pharmaceutically active ingredients with limited solubility. Owing to their benefits including improved physicochemical profile of pharmaceutically active ingredients, multicomponent crystal methods are predicted to become increasingly prevalent in the development of active drug ingredients in the futur

α-Mangostin/γ-Cyclodextrin Inclusion Complex: Formation and Thermodynamic Study

α-Mangostin (α-M) has various biological activities, such as anti-cancer, antibacterial, anti-fungal, anti-tyrosin, anti-tuberculosis, anti-inflammatory, and antioxidant. However, it has very low solubility in water. The formulation of this compound requires high amounts of solubilizers, which limits its clinical application. In addition, its low solubility in water is a barrier to the distribution of this drug, thus affecting its potency. Cyclodextrin (CD) is widely used as a solubility enhancer of poorly soluble drugs. This study aimed to increase the solubility of α-M in water through complex formation with CD. The complex of α-Mangostin and γ-Cyclodextrin (α-M/γ-CD CX) was prepared by the solubilization method, resulting in a solubility improvement of α-M in water. Characterization of α-M/γ-CD CX by using FTIR-Spectrometry, XRD, H-, C-, and HMBC-NMR showed that α-M was able to form an inclusion complex with γ-CD. The complex yielded an entrapment efficiency of 84.25 and the thermodynamic study showed that the α-M/γ-CD CX was formed spontaneously, based on the negative values of Gibbs energy and ΔH. Interestingly, the solubility of α-M/γ-CD CX significantly increased by 31.74-fold compared with α-M. These results suggest that α-M/γ-CD CX has the potential in the formulation of water-based preparation for clinical applications

Ulvan/Silver nanoparticle hydrogel films for burn wound dressing

Ulvan is a polysaccharide from green algae that shows good hydrogel film dressing characteristics. Silver nanoparticles (AgNP) can be incorporated into the hydrogel film to improve antibacterial properties and provide a potential burn treatment. In this study, we developed a novel hydrogel film wound dressing composed of ulvan and silver nanoparticles. Two concentrations (0.5 mM and 1 mM) of silver nitrate were used to produce ulvan-silver nanoparticles hydrogel film (UHF–AgNP0.5 and UHF–AgNP1), respectively. The physicochemical characteristics of the hydrogel films were evaluated, including particle size, zeta potential, Fourier transform infrared (FTIR), X-ray diffractometry (XRD), scanning electron microscope and energy-dispersive X-ray (SEM-EDX). Furthermore, the in vitro antimicrobial activity, and second-degree burn wound healing test were evaluated. The UHF–AgNP0.5 showed the highest antimicrobial activity compared to UHF–AgNP1 and UHF film. Meanwhile, an in vivo study using Wistar rats induced second-degree burns showed that UHF–AgNP0.5 significantly accelerated the healing process by regulating the inflammatory process, increasing re-epithelialization, and improving the vascularization process. Ulvan-silver nanoparticle hydrogel films have the ability to accelerate the healing of second-degree burns and are potential candidates for wound dressings