Prognostic Factors for the Development of Biochemical Recurrence after Radical Prostatectomy

Prostate cancer is one of the most common cancers in Western countries and is associated with a considerable risk of mortality. Biochemical recurrence following radical prostatectomy is a relatively common finding, affecting approximately 25% of cases. The aim of our paper was to identify factors that can predict the occurrence of biochemical recurrence, so the patient can be properly counselled pre- and postoperatively. Medline review of the literatures was done followed by a group discussion on the chosen publications and their valuable influence. Preoperative serum total PSA and clinical stage, together with prostatectomy Gleason grade, tumour volume, and perineural and vascular invasions, were the most important variables found to influence outcome

Child Abuse and Aggressive Behavior among Primary School Children

Context: Child abuse considered all forms of physical, emotional, sexual abuse, and neglect. Child abuse is identified to threaten development, health, dignity, or even survival. Many abused children have ongoing troubles with relationships, trust in others, difficulties at school, and exhibiting aggressive behavior or act nasty towards other children and animals.Aim: This study aimed to investigate the relationship between child abuse and aggressive behavior among primary school children. Subjects and methods: A descriptive correlational research design was utilized to achieve the aim of this study. This research was carried out in four schools from an urban and rural area in Minia city. A stratified sample of 150 children in grade six in primary school was recruited in the current study. This study's three tools to collect data include the Socio-demographic Questionnaire, Child Abuse Scale, and Children Aggressive Behavior Scale. Results: The current study revealed that about two-thirds of the sample were girls 65.3%, and more than half of them had high levels of child abuse and aggression at 63.3% & 58.7%, respectively. There was a significant positive correlation between child abuse and aggression among primary school children.Conclusion: The current study concluded that primary school children have a positive connection between child abuse and their aggressive behavior. The study recommended a counseling program for parents and teachers about the negative impact of child abuse and how to deal effectively with child aggression. Teaching parenting strategies such as alternatives to physical punishment is essential in reducing the recurrence of physical abuse, and that this may enhance parental self-management

Value of non-contrast CT examination of the urinary tract (stone protocol) in the detection of incidental findings and its impact upon the management

AbstractBackgroundUrolithiasis is one of the most common urinary tract diseases worldwide, with a wide range of affected age groups. Non-contrast CT examination of the urinary tract is the gold-standard examination for detection and characterization of urinary tract stones, with great impact upon the choice of method of management. Aside from detection of stones, non-contrast CT examination of the abdomen and pelvis also offers a valuable overlook upon the other abdominal organs, pathologies of which may simulate a stone disease, or accompany stone disease and can be detected incidentally, which may shift management plan dramatically.Aim of workTo demonstrate the use of non-contrast CT examinations (stone protocol) in the detection of abdominal pathologies other than stones, whether or not simulating the clinical picture of urolithiasis, and its impact upon patient management.Patients and methodsAssessment of the non-contrast examinations of the urinary tract of patients referred for suspected stone urolithiasis recording any incidental finding and follow-up of the impact of these incidental findings upon the management delivered to the patient.ResultsA total of 719 examinations were performed, of which 334 had urinary tract stones only, 211 had incidental finding beside urinary tract stones, 170 had an incidental finding with no urinary tract stones, and four patients had neither stones nor incidental findings. A total number of 381 patients had incidental findings, 198 (47%) of which had an impact upon the management.ConclusionNon-contrast CT examination of the urinary tract (stone protocol) is a valuable tool in the detection of incidental findings which may simulate, or coincide with urolithiasis and it has a significant impact upon the management of the patients

Management of Early Osteoarthritis

Osteoarthritis (OA) is a chronic degenerative joint disease of dynamic pathology with multiple etiologies. It involves progressive process of softening, loss of articular cartilage, subchondral bone sclerosis, development of osteophytes, and cyst formation. OA usually contributes to decreased activity associated with aging, secondary to diminished function and pain, thus consequently impairing quality of life. It is well established that pain due to OA, swelling, or stiffness can make it difficult for individuals to perform simple daily living activities. Although OA is not curable, a variety of treatment modalities are available to improve symptoms. Main elements include pain management maneuvers, education, changing lifestyle physical activity (PA), and weight reduction in case of overweight. Although total joint arthroplasty (TJA) is considered a cost-effective treatment for people with OA, TJA should only be considered after failure of conservative treatments. Symptoms of OA are usually managed by either pharmachological or nonpharmachological protocols; joint replacement surgeries are considered in advanced cases. Analgesics remain the keystone of pharmacological treatment for OA symptoms, including paracetamol, topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. However, benefits from paracetamol and opioids are minimal, and NSAIDs are not ideal for many patients because they have many side-effects. Intra-articular therapies such as corticosteroids are also commonly used, though usually with short-term benefits

Beating-heart versus conventional mitral valve replacement; a randomized clinical trial

Background: Various methods have been developed to overcome the deleterious effects of ischemia/ reperfusion injury that occurs after cardioplegic arrest. The aim of the study was to assess the safety, efficacy, and applicability of the beating-heart mitral valve replacement (MVR) compared to the conventional MVR. Methods: Forty patients scheduled for mitral valve replacement were randomly assigned into two groups, conventional MVR as the control group (n= 20) and beating-heart MVR with continuous antegrade coronary perfusion as the study group (n=20). Three patients in the beating-heart group were converted to the conventional technique because of the blood-flooded field and excluded from the analysis. Results: The preoperative clinical and echocardiographic variables were comparable between both groups. There was no significant difference between both groups regarding cardiopulmonary bypass time (79.4± 14 vs. 75.7± 10.9 minutes; p= 0.398) and total operative time (200± 55.6 vs. 183.9± 67.5 min; p= 0.458) in the conventional and beating-heart group, respectively. Serum troponin I level was significantly higher in the conventional MVR group 6 hours postoperatively (4.9±4 vs. 2.7±1.2 ng/ml; p= 0.036), while there was no significant difference between both groups regarding total CK and CK-MB (p= 0.565 & 0.597 respectively).  Eight patients (44%) in the conventional MVR group needed inotropic support compared to 3 patients (19%) in the beating-heart MVR group (P = 0.11). There was no operative mortality or major morbidity in both groups. At 6-months follow-up, there was no difference in NYHA class (1.3±0.3 vs. 1.2±0.3; p= 0.336) and the ejection fraction (60.0±6.3 vs. 63.2±6 %; p= 0.139) in the conventional vs. beating-heart group.  Conclusion: Beating-heart MVR is a safe alternative to the conventional method with comparable outcomes. There is a relatively blood-filled field compared to the conventional technique

Spontaneous Retroperitoneal Hemorrhage in a Patient with Acquired Cystic Kidney Disease

Spontaneous retroperitoneal hemorrhage (SRH) is a rare emergency. It is usually encountered in patients on hemodialysis and is associated with high rate of morbidity and mortality. This is a case from the emergency department. The patient had unstable vitals with SRH following dialysis. Immediate exploration and nephrectomy using transverse lateral lumbotomy incision were done. Patients on hemodialysis are at a risk of SRH and frequent surveillance is recommended. Acquired cystic kidney disease (ACKD) can develop in hemodialysis patients and put them at risk for bleeding. Transverse lateral lumbotomy may be a safe option for direct access to the kidney in emergency kidney surger

Successful Surgical Management of Locally Advanced Renal Cell Carcinoma Invading Spleen and Pancreas

Over the last two decades, the treatment of metastatic RCC has changed significantly, and the role of surgery is being debated. A 50-year-old man presented with pain in his left loin. An ultrasound, followed by a CT scan, revealed a 17.5 cm left renal mass invading the left suprarenal gland, spleen, and pancreatic tail. Radical nephrectomy through chevron incision under epidural block with general anesthesia was performed. The entire mass was removed en bloc. The estimated blood loss was 300 mL, and no blood transfusions were performed. The operation took approximately 2 h. Histological examination revealed clear cell renal carcinoma with extension into the spleen, pancreatic tail, and diaphragmatic fibers with negative resection margin. The patient discharged after a 3-day uneventful hospital stay. Aggressive surgical removal of a locally invasive renal cell carcinoma is feasible and should be considered in patients with good performance status and no or minimal distant metastases

Capability of the Invasive Tree Prosopis glandulosa Torr. to Remediate Soil Treated with Sewage Sludge

Sewage sludge improves agricultural soil and plant growth, but there are hazards associated with its use, including high metal(loid) contents. An experimental study was conducted under greenhouse conditions to examine the effects of sewage sludge on growth of the invasive tree Prosopis glandulosa, as well as to determine its phytoremediation capacity. Plants were established and grown for seven months along a gradient of sewage sludge content. Plant traits, soil properties, and plant and soil concentrations of N, P, K, Cd, Pb, Cu, Ni, Zn, Cr, Co, As, and Fe were recorded. The addition of sewage sludge led to a significant decrease in soil pH, and Ni, Co, and As concentrations, as well as an increase in soil organic matter and the concentrations of N, P, Cu, Zn, and Cr. Increasing sewage sludge content in the growth medium raised the total uptake of most metals by P. glandulosa plants due to higher biomass accumulation (taller plants with more leaves) and higher metal concentrations in the plant tissues. P. glandulosa concentrated more Cd, Pb, Cu, Zn, and Fe in its below-ground biomass (BGB) than in its above-ground biomass (AGB). P. glandulosa concentrated Ni, Co, and As in both BGB and AGB. P. glandulosa has potential as a biotool for the phytoremediation of sewage sludges and sewage-amended soils in arid and semi-arid environments, with a potential accumulation capability for As in plant leaves