Acute prostatitis after transrectal ultrasound-guided prostate biopsy: Comparing two different antibiotic prophylaxis regimen

Transrectal ultrasound-guided prostate biopsies (TRUSBx) are common and increasingly performed procedure. As this procedure can be complicated by infections, antibiotic prophylaxis is widely used around the world to minimize these complications, but there is no consensus on the most appropriate prophylaxis regimen. A total number of 412 patients who were referred fo TRUSBx, was devided randomely into two groups. Group 1 received routine antibiotic prophylaxis and Group 2 did not received Amikacin. Other premedications in both groups include ciprofloxacin, metronidazole, ceftazidime and povodine iodine gel. 2 days after biopsy, all patients were investigated about significant fever(e�38°C). febrile patients were referred to urology clinic for further evaluation about acute prostatitis or septicemia. There was 210 patients in group A and 202 patients in group B. No significant difference was detected in mean age, prostatic volume, serum PSA level, re-biopsy rate and pathology report between two groups. Acute prostatitis was developed in 2 patients (0.9) in group A and 1 patient (0.5) in group B that was not statistically significant.(P>0.05) Removing amikacin from ciprofloxacin-based antibiotic prophylaxis along with local povodine iodine would not put our patients in increased risk for infectious complications after TRUSBx. © 2016, Oriental Scientific Publishing Company. All rights reserved

Comparison of gray-scale sonography with Doppler evaluation in diagnosis of varicocele

Varicocele is cited as one of the most common treatable causes of male factor infertility. Diagnosis of varicocele is based on physical examination and also sonography. The aim of this study was to assess the sensitivity and specifity of gray-scale sonography for diagnosis of varicocele. This cross-sectional study was performed on 92 patients in Hasheminejad kidney center, Tehran, Iran. Patients with suspected varicocele who referred to Radiology Department were included. Gray-scale sonography and Color Doppler Ultrasound were performed on patients at rest and Valsalva maneuver. Mean age of patients was 34/55±9/44. In this study a sensitivity of 71 and specificity of 60.7 in gray-scale sonography during Valsalva maneuver were compared to Doppler sonography at cut point of 3/25 mm, and positive predictive value was 80 and negative predictive value was 48/6 (p<0.000), and also there was a significant relationship between duration of reflux and increasing of venous diameter. A sensitivity of 98/4 and specificity of 71.4 in gray-scale solography (with consideration of differentiation of diameter before and during Valsalva maneuver) were compared to Doppler sonography at cut point of 0.2 mm, and positive predictive value was 85.9 and negative predictive value was 94.7. Based on the results of this study, gray scale ultrasound is a good imaging technique for Diagnosis of varicocele and differentiation of diameter before and after Valsalva maneuver had better sensitivity, specificity, positive predictive value and negative predictive value. © 2016, Oriental Scientific Publishing Company. All rights reserved

How can a radiologist reveal more practical information using dynamic study of cavernosal artery after injection of vasoactive agents?

Background: Erection is a dynamic multi-stage neurovascular phenomenon consisting of 4 phases. Conventional protocol of color Doppler study can easily overlook these ongoing dynamic events. Objectives: Here, we tried to designate patterns for these dynamic spectral waveform changes of cavernosal arteries in patients with erectile dysfunction and subsequently better describe the extent of their underlying problem. Patients and Methods: We evaluated 59 men who were referred for post-intracavernosal injection (ICI) color Doppler investigation of suspected erectile dysfunction (ED). The demographic data and medical history were recorded. Afterwards, first scan injection was done. Then scanning of cavernosal arteries was started about one minute after the injection and was continued thereafter. For better description of temporal changes in the waveform of cavernosal arteries, new patterns were defined and used. Patients were also classified based on previously known etiologic categories (i.e. arterial insufficiency, venous leak, mixed type, and normal response). Results: The mean age was 45.6 ± 13.1 (24 to 74) years. Twenty-two were normal responders considered as non-organic causes (37.3% of all patients), 27 were classified as venous leakage, eight had arterial insufficiency and two were mixed type. Maximum PSV occurred before the fifth minute in 47 patients (92.2%). Eight patients completed all phases of erection in the first 5 minutes. We defined 8 patterns for the temporal changes in cavernosal arterial waveform. Pattern 5 was the most common pattern of venous leak; while, patterns 3 and 4 were considered as the uncommon group. Six patients demonstrated the uncommon patterns of venous leak (22.2%). Hypertension was more prevalent in the uncommon pattern of venous leak. Conclusions: We highlight the considerable role of continuous evaluation starting one minute after intra cavernosal with ICI injection of the vasoactive agent for better description of the underlying pathologies of ED especially in patients with venous leak etiology. © 2015, Tehran University of Medical Sciences and Iranian Society of Radiology

Sonographic evaluation of clinically occult inguinal hernias in patients with scrotal pain and normal scrotal color Doppler sonography

Scrotal pain, whether acute or chronic, is a common clinical presentation that can be caused by a diverse array of disorders involving different anatomic structures. Because of pain and guarding, patients are usually incooprative for physical examination and thus, not be reliable. This makes definitive diagnosis difficult for even the most experienced clinician. Sonography can be invaluable in evaluating of patient with scrotal pain. The aim of this study is to assess the prevalence of accult inguinal hernia in patients with scorotal pain who have normal physical examination and normal scorotal color Doppler sonography to improve the weakness of clinical diagnosis. A total of 101 patients who have scrotal pain, were referred prospectively with clinically normal physical examination and normal scorotal color Doppler sonography for ultrasound examinations of occult inguinal hernia. Also we evaluate prevalence of unilateral or bilateral occult inguinal hernia and direct or indirect occult inguinal hernia. Overall, with mean age of 29.4 ± 7.56 years ,mean wight of 76.5 ±9.52 kilogram and mean symtoms duration of 11.9 ±9.15 days, scans showed 51.5 occult direct inguinal hernia,14 occult indirect inguinal hernia and 35 with no evidence of hernia.11.9 of patients have bilateral hernia, 21.8 have left inguinal hernia and 31.7 have right inguinal hernia. A higher incidence of inguinal hernia was associated with age increasement (p = 0.015) and weight increasement (P= 0.01). In conclusion, with achieved prevalence of occult hernia (65.5), in patients with scorotal pain who have normal physical examination and normal scorotal color Doppler sonography in this study, we recommend ultrasonographic evaluation for these patients, since it's noninvasive and available

Assessment of urinary tract calculi with 16-MDCT: The axial versus coronal plane

The purpose of the current study was to compare the detection rate and size measurements of urinary tract calculi on coronal reformations versus the axial plane using 16-MDCT. In this cross sectional study 100 consecutive renal colic patients were evaluated using16- MDCT with collimation 1/5, axial thickness 2mm and coronal reformat thickness 2mm. Coronal and axial view randomly reported by two radiologist and then total images the other time reported by staff. 178 stones in axial and 168 stones in coronal view were detected but the mean number of detected stones in axial view was not significantly more than coronal view(p<0/05( . In two dimensional evaluation, maximum dimension of stones (kidneys and ureter totally) in coronal view was more than axial, but the difference was not significant (p<0/05). In two dimensional evaluation, maximum dimension of ureter stones the in coronal view was significantly more than axial. In 3D evaluation, stones size craniocaudaly in axial view was significantly more than coronal (0.001). The detection of stones was not improved using coronal view compared to axial view with thin thickness. Maximum size of ureter stones using coronal reformation was better estimated than axial view.Craniocaudal size of stone was overestimated in axial view than coronal probably because of partial volume effect

A new method for venom extraction from venomous fish, green scat

Scatophagus argus argus (Green Scat) is a pretty aquarium fish. Its hard spines are venomous and can cause painful injury. In this study 60 specimens of Green Scat were collected periodically from coastal waters of Boushehr (south of Iran) from May 2011 to April 2012. Anatomical features of venomous spines were investigated. Scat venom was extracted from the spines in a new manner for keeping the specimens alive. The nature of venom was tested by SDS-PAGE. Ethical issues and animal welfare principles such as rapid and instantaneous anesthetizing, post operation disinfection and fast recovery of the specimens was practiced in order to minimize the complications. This method enhanced the purity and quantity of venom as demonstrated by 12 separated proteins in electrophoresis. New ethical issues were developed to surviving the specimens and prolong viability as well

In vitro anti-bacterial effect of nano-polyamidoamine-G5 dendrimer

Introduction: Progress in nanotechnology in the past decayed has created various opportunities for evaluation of biological effects such as anti-bacterial effects of nanoparticles. This study was aimed to examine synthesis and the antibacterial effect of Nano-Polyamidoamine-G5 (NPAMAM-G5) dendrimer on Klebsiella Pneumoniae, Pseudomonas Aeruginosa, Shigella Dysenteriae and Bacillus Subtilis. Materials and Methods: NPAMAM-G5 dendrimers was synthesized by Tomalia�s divergent growth approach. The antibacterial effects of NPAMAM-G5 dendrimer were studied by disc diffusion and micro-dilution method. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against gram-positive and gram-negative bacteria were determined according to Clinical and Laboratory Standards Institute (CLSI) guideline. Transmission electron microscopy (TEM) was used to analyze morphology and size of NPAMAM-G5. Results: Zone of inhibition in concentration 25μg/ml of NPAMAM-G5 dendrimers for Klebsiella Pneumoniae, Pseudomonas Aeruginosa, Shigella Dysenteriae and Bacillus Subtilis were 27, 13, 30 and 18 mm, respectively. There was a significant difference regarding the zone of inhibition between gram-negative and gram-positive bacteria (p<0.05). Remarkably, the MIC for Klebsiella Pneumoniae, Pseudomonas Aeruginosa and Shigella Dysenteriae was 2.5μg/ml and for Bacillus Subtilis was 25μg/ml. The MBC for Shigella Dysenteriae and Pseudomonas aeruginosa were 50 and 200 μg/ml, respectively and for Klebsiella Oxytoca and Bacillus Subtilis was100 μg/ml. It was found that NPAMAM-G5 particles had a spherical shape with a mean diameter size of 10 nm. Conclusion: According to the results, the NPAMAM-G5 dendrimer with end amine groups displayed a positive effect on the removal of standard strains of gram-positive and gram-negative bacteria. © 2019, Semnan University of Medical Sciences. All rights reserved

Phase 1 human trial of autologous bone marrow-hematopoietic stem cell transplantation in patients with decompensated cirrhosis

Aim: To evaluate safety and feasibility of autologous bone marrow-enriched CD34+ hematopoietic stem cell Tx through the hepatic artery in patients with decompensated cirrhosis. Methods: Four patients with decompensated cirrhosis were included. Approximately 200 mL of the bone marrow of the patients was aspirated, and CD34+ stem cells were selected. Between 3 to 10 million CD34+ cells were isolated. The cells were slowly infused through the hepatic artery of the patients. Results: Patient 1 showed marginal improvement in serum albumin and no significant changes in other test results. In patient 2 prothrombin time was decreased; however, her total bilirubin, serum creatinine, and Model of End-Stage Liver Disease (MELD) score worsened at the end of follow up. In patient 3 there was improvement in serum albumin, porthrombin time (PT), and MELD score. Patient 4 developed radiocontrast nephropathy after the procedure, and progressed to type 1 hepatorenal syndrome and died of liver failure a few days later. Because of the major side effects seen in the last patient, the trial was prematurely stopped. Conclusion: Infusion of CD34+ stem cells through the hepatic artery is not safe in decompensated cirrhosis. Radiocontrast nephropathy and hepatorenal syndrome could be major side effects. However, this study does not preclude infusion of CD34+ stem cells through other routes. © 2007 The WJG Press. All rights reserved

Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation

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