MORPHOLOGICAL ALTERATIONS OF RED BLOOD CELLS CAUSED BY OVERDOSES OF SILDENAFIL

Objective: The objective of this study was to investigate whether the overdose of sildenafil (Viagra) causes red blood cytotoxicity in rats by seeing the morphological alterations. Methods: Fifteen rats which were randomly divided into four groups of rats were received intraperitoneal injections of sildenafil. The sildenafil was dissolved in sterile saline 45% for three groups except the control group. They were injected for 5 days in three doses as followed (0.3 mg/rat for G1, 0.5 mg/rat for G2, and 1 mg/rat for G3). Blood smears were made to test the alterations in the blood cells after injection. Results: The result indicated the presence of a relationship between sildenafil overdosing and red blood cell morphology. Mild-to-moderate alterations of hematological morphology were observed. The hematologic morphology variation was observed in size, shape, and distribution of hemoglobin using light microscope and confirmed by the scanned electronic microscope. Conclusion: Possible hemotoxicity effects of sildenafil overdosing might be existing, which might be proportional to the duration of usage. However, further studies are recommended properly illustrate the effect of usage duration on sildenafil overdosing toxicity on red blood cells

Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia

Introduction: Tonsillectomy is a common surgical procedure done by  totolaryngologists. Tonsillectomy is a relatively simple procedure. The concept of implementing it as a day case operation has become increasingly popular.Material and Methods: This is a cross sectional study done in Alahsa city, eastern province, Saudi Arabia during the period from January 2014 to March 2015,This study reported the postoperative hemorrhage after Bipolar diathermy and Cold dissection surgical techniques to evaluate the incidence of the hemorrhage and to identify the possible risk factors associated with its occurrence.Results: Postoperative bleeding occurred in 45 (3.6%) out of 1232 patients. Post-tonsillectomy hemorrhage according to operation technique was significantly higher among patients who underwent bipolar diathermy than cold dissection technique (p< 0.05).Conclusion: Bleeding after operation by bipolar diathermy technique was occurring more frequently within the first five days. Hemoglobin level was significantly decreased in posttonsillectomy hemorrhage

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

THE FIBRINOLYTIC ALTERATION ASSOCIATED WITH DAILY ADMINISTRATION OF SILDENAFIL

Objective: The objective of this study was to determine the fibrinolytic alteration associated with daily administration of sildenafil.Methods: A total of 12 adult male rabbits without mortality rate had been fed standard and subdivided into four groups; their average weight was 1.5, 2.5, 1.9, and 2 kg randomly selected during the period of March 2012–July 2013. Depending on weight, the control groups (2.25 mg/1.5 kg day) and sildenafil groups (3 mg/2 kg/day, 2.85 mg/1.9 kg/day, and 1.7 mg/2.5 kg/day) were injected by normal saline and sildenafil concentration, respectively to create four groups, every group was composed of three rabbits; saline rabbit (control group, n=3) and sildenafil rabbits (sildenafil group, n=9). All rabbit's plasma samples have been investigated for prothrombin time, activated partial thromboplastin time, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), prothrombin fragment 1+2, tissues plasminogen activator (tPA), plasmin antiplasmin (PAP), plasminogen, and D-dimer after 24 h of administration.Results: The PAP level was significantly (p<0.05) decreased following sildenafil injection. Sildenafil-injected (3 mg/ml) rabbits had decreased the means of PAI-1 and mean tPA, as early as 1-day post-injection, with a considerable lower PAP first determined 3 days after injection that continued into each rabbit 2 and 3.Conclusion: Better strategies are to initiate and manipulate this drug ought to reduce the chance of each thrombosis and hemorrhage, at the same time as minimizing the need for laboratory monitoring with the aid of the use of PAI-1, tPA, and PAP checks

Haemophilia Laboratory diagnosis training and care in Rural communities in Sudan

Sixty nine per cent of people with hemophilia symptoms in rural areas were accessed to laboratory diagnosis and care support in Sudan, where technical expertise and health care facilities was less than optimal. There were many reasons for the inadequate care of hemophilic patients: the perception of rarity of the disease; lacked of laboratory facilities to diagnose the disorder; lacked of understanding of the disorder by patients, their relatives, and even healthcare providers; poorly developed blood bank facilities; and lacked of adequate factor supply were just some examples. The Sudanese Hemophilia Care Association (SHCA) was attempted to address many of these issues by establishing hemophilia care programs and by educating and training healthcare practitioners so that a healthcare team could be organized that attempts to ameliorate these problems and provides treatment options. However, it was possible to manage hemophiliac’s patients with limited resources. Strategies for conserving factor concentrates were included education of doctors and patients, prenatal diagnosis, increasing the use of anti fibrinolytic agents, physiotherapy, the use of fibrin glue, and simple orthotics and prosthetic measures. An outreach program would be initiated to ensure that hemophilia care and diagnosis was available outside the capital city. Official recognition of hemophilia laboratory diagnosis and treatment centers and designated centers by the government could also be very beneficial in ensuring adequate care in rural areas in Sudan

Direct DNA Sequencing-Based Analysis of Microbiota Associated with Hematological Malignancies in the Eastern Province of Saudi Arabia

Introduction. Bloodstream infections (BSI) among patients with hematological malignancies (HM) could predispose them to higher morbidity and mortality for various underlying conditions. Several microorganisms, either pathogenic or opportunistic normal human flora, could cause severe bacteremia and septicemia. While conventional methods have their own limitations, molecular methods such as next-generation sequencing (NGS) can detect these blood infections with more reliability, specificity, and sensitivity, in addition to information on microbial population landscape. Methodology. Blood samples from HM patients (n=50) and volunteer blood donor control individuals with no HM (n=50) were subjected to 16S rRNA gene amplification using standard PCR protocols. A metagenomic library was prepared, and NGS was run on a MiSeq (Illumina) sequencer. Sequence reads were analyzed using MiSeq Reporter, and microbial taxa were aligned using the Green Genes library. Results. 82% of the patients showed BSI with Gram-negative bacteria as the most predominant group. E. coli comprised a major chunk of the bacterial population (19.51%), followed by K. pneumoniae (17.07%). The CoNS and Viridans Streptococci groups are 17.07% and 14.63%, respectively. Other major species were S. aureus (9.75%), P. aeruginosa (7.31%), A. baumannii (4.87%), E. cloacae (4.87%), and P. mirabilis (4.87%). 34.14% of the cases among patients showed a Gram-positive infection, while 14.63% showed polymicrobial infections. Conclusion. Most of the BSI in patients were characterized by polymicrobial infections, unlike the control samples. Molecular methods like NGS showed robust, fast, and specific identification of infectious agents in BSI in HM, indicating the possibility of its application in routine follow-up of such patients for infections