Non-invasive predictors of response to tamsulosin for benign prostatic obstruction

Objectives: To identify non-invasive predictors of response to tamsulosin 0.4 mg in patients with benign prostatic obstruction (BPO).Methods: Males ≥ 50 years of age with lower urinary tract symptoms (LUTS) suggestive of BPO for over three months were included in the study. We assessed change in the mean International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) after six weeks of medical therapy. Clinical and uroflowmetry parameters were compared between two groups of patients with \u3e25% vs. \u3c25% change in the IPSS after treatment. Pre- and post-treatment post-void residue (PVR), Qmax, and IPSS were compared by independent t-test, univariate/multivariate regression analysis.Results: A total of 121 patients were included. At presentation, the mean prostate size was 35.7±12.2 grams and the mean IPSS was 16.3 ± 4.8. Improvement in the mean IPSS was 7.83, with more marked improvement in storage compared to voiding LUTS (5.26 vs. 2.57). Majority (58%) had a quality of life (QoL) score of 4-5 at presentation whereas after 6-weeks of medication (83.5%) had a QoL score of 0-2. Treatment failure was noted in 11 (9.1%) patients. IPSS was higher and Qmax was lower at the time of presentation in patients who had \u3c25% improvement. However, the two groups were identical on the basis of demographic and other factors (BMI, age, prostate size, PVR).Conclusion: Moderate LUTS secondary to BPO responds favourably to alpha-blocker (tamsulosin 0.4 mg) treatment. Uroflowmetry (UFM) parameters, that is, Qmax and IPSS are important factors in predicting short-term response to medical therapy

Urdu translation and validation of premature ejaculation diagnostic tool (PEDT)

Objective: To validate an Urdu translation of premature ejaculation diagnostic tool (PEDT) by analyzing the association of this diagnostic tool with the clinical diagnosis of premature ejaculation (PE) and intravaginal ejaculatory latency time (IELT).Methods: This cross-sectional study was conducted at the urology section of the Aga Khan University Hospital, Karachi, for six months duration, from July 2018 to December 2018. In our study 108 subjects, aged 20 to 50 years, who were in a stable sexual relationship (heterosexual) for a minimum duration of six months, were asked to fill the Urdu version of PEDT, 61 with PE and 47 without PE.Results: The two groups matched for mean age, duration of relationship and education level. The duration of 1.2 (±0.5) minutes was the mean self-estimated IELT in the PE group and 3.7±0.9 minutes in patients without PE. There was a significant negative correlation of 0.6 (p-value \u3c0.001) between the PEDT score and self-estimated IELT. The test-retest reliability for each item was found to be significant for each individual item (≥ 0.84, p-value \u3c0.001) and 0.94 was the correlation coefficients of the total score, showing an excellent test-retest reliability. 0.93 was the Cronbach\u27s alpha score (95% Confidence interval = 0.905 - 0.948) indicating a significant internal consistency in the Urdu version of PEDT.Conclusions: The Urdu version of PEDT is a valid tool to define and quantify PE objectively, with adequate internal consistency. This version of PEDT has a good negative correlation with self-estimated IELT and excellent correlation with clinical PE

The correlation between stone nephrolithometry score and hemoglobin drop in patients undergoing percutaneous nephrolithotomy

Objective: In this study, we aimed to determine the correlation between the STONE score [(S)ize of the stone, (T)opography or location, degree of (O)bstruction of the urinary system, (N)umber of stones, and (E)valuation of Hounsfield units] and postoperative hemoglobin drop in patients undergoing percutaneous nephrolithotomy (PCNL).Methods: This was a prospective observational study and all adult patients aged 18-65 years undergoing unilateral, single-tract PCNL using 26 Ch. Amplatz sheath for renal calculi were included. The five variables of the STONE nephrolithometry score were calculated prior to the procedure. The stone-free rates were assessed on imaging at four weeks and complications were graded using the modified Clavien system.Results: Of the 142 patients included, 75% were below 55 years of age. More than half of our patients were diabetic with more than 60% having a body mass index (BMI) above 25 kg/m2. The mean STONE score was 7 with 33% having a high (\u3e9) STONE score. The mean hemoglobin drop was 1.15 +0.92 g/dL with eight patients (5.63%) requiring transfusion and one (0.7%) requiring angioembolization; one patient required readmission for observation. Complete STONE clearance was achieved with PCNL alone in 78.2% of the patients. There was a significant correlation of hemoglobin drop with the STONE score, stone size, and preoperative creatinine clearance. Patients with a hemoglobin drop of \u3e1 g/dL had a higher STONE score and mean stone size. The overall complication rate was significantly higher (10.5%) in patients with a hemoglobin drop of \u3e1 g/dL as compared to those with a hemoglobin drop of \u3c1 g\u3e/dL (2.8%).Conclusion: Stone complexity as measured by the STONE score correlates with post-PCNL hemoglobin drop, stone clearance, and complication rates. The STONE score may be used for preoperative counseling and to evaluate the potential need for transfusion

Financing agricultural activities in Afghanistan: a proposed salam-based crowdfunding structure

>Purpose - This study aims to explore the potentials of adopting salam-based crowdfunding for financing the agricultural sector in Afghanistan. Design/methodology/approach - It adopts a triangulation approach, consisting of a number of methods used in gathering relevant information about Afghanistan’s agricultural sector, the concept of crowdfunding and salam (forward sale) contract. These methods include library research, reviewing documents provided by Afghanistan’s banks and semi-structured interviews with Islamic finance experts. Findings - This study finds that salam-based crowdfunding is a viable Sharīʿah-compliant investment platform, which may offer some advantages for both potential investors and farmers or entrepreneurs. Originality/value - The novelty of this paper lies in the proposed structure of salam-based crowdfunding

Intravital Microscopy for Imaging Subcellular Structures in Live Mice Expressing Fluorescent Proteins

Here we describe a procedure to image subcellular structures in live rodents that is based on the use of confocal intravital microscopy. As a model organ, we use the salivary glands of live mice since they provide several advantages. First, they can be easily exposed to enable access to the optics, and stabilized to facilitate the reduction of the motion artifacts due to heartbeat and respiration. This significantly facilitates imaging and tracking small subcellular structures. Second, most of the cell populations of the salivary glands are accessible from the surface of the organ. This permits the use of confocal microscopy that has a higher spatial resolution than other techniques that have been used for in vivo imaging, such as two-photon microscopy. Finally, salivary glands can be easily manipulated pharmacologically and genetically, thus providing a robust system to investigate biological processes at a molecular level

Effects of corporate governance on banking performance of commercial banks in Bangladesh

Corporate governance is the system by which organizations are directed, monitored and controlled. It is an oversight mechanism to ensure the management team efficiently allocates the organizational resources, so as to protect the interest of shareholders and stakeholders. There is a need for good corporate governance practice to stabilize the performance of financial institutions. This study investigated the influence of corporate governance in banking performance. Panel data analysis has been conducted for the top nine public and private commercial banks operating in Bangladesh for a period of 2009 to 2017. Board size, structure of internal audit committee and capital adequacy ratio were being taken as independent variables to measure the effects of corporate governance whereas return on asset, return on equity and earnings per share were being taken as dimensions for measuring bank performance. Correlation and regression analysis techniques were being used to examine the relationships between corporate governance practices and bank performance. The results indicated that CAR has the greater impact on Bank performance. The information derived from this study can be valuable and will help to enhance the understanding of the governing bodies of financial institutions for accelerating banking performance

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Calcul expérimental d'une stratégie hybride DIC pour l'identification de la loi plastique ductile robuste en 3D

The objective of the thesis is to formulate a strategy that gives a robust identification of constitutive law from full-field measurements taking into account 3D effects. Model validation from global response of samples or structures has shortcomings that can be overcome by the use of full-field measurement techniques. Full-field measurement techniques offer the opportunity to acquire large amount of experimental data that might be useful in the context of identification of constitutive law parameters. Among the full field measurement techniques the most popular is digital and stereo image correlation. The existing strategies to make use of full-field data like the Virtual Field Method, the Equilibrium Gap Method, the Constitutive Equation Gap Method and the Reciprocity Method were limited to 2D applications. However, for a specimen with finite thickness 3D effects must be included. Most importantly, for the case of plasticity, stress triaxiality plays an important role. Its effect must therefore be accounted for in the modelling of the constitutive behaviour of the material. Thus in this thesis we propose a method to identify the parameters of an elasto-plastic constitutive law in which the mechanical model can have 3D kinematics. The strategy has been shown to be noise robust, almost independent of initial parameter guess and mesh refinement and allows differentiating between constitutive models with same global response on the basis of mean correlation error. The identification is shown to be good for both single and multiple cameras. The strategy validation is done for stainless steel. The global identified load displacement response of the strategy for mono and stereo mechanical image correlation is very close to the experiments. Lastly, the material parameters have been identified with very different initial guess but all converge to the same final values which show the robustness of the proposed strategy.La validation du modèle de réponse globale des échantillons ou des structures présente des lacunes qui peuvent être surmontés par l'utilisation de techniques de mesure de plein champ. Les techniques de mesure plein champ offrent la possibilité d'acquérir une quantité importante de données expérimentales qui pourraient être utiles dans le cadre de l'identification des paramètres de la Loi de comportement. Parmi les techniques de mesure de champ complet, le plus populaire est la corrélation d'images mono et stéréo. Les stratégies existantes pour rendre l'utilisation des données de plein champ comme la méthode de champ virtuel, la méthode écart d'équilibre, la méthode de Gap équation Constitutive et la méthode de réciprocité ont été limitées à des applications 2D. Cependant, pour un échantillon d'épaisseur finie, les effets 3D doivent être remplis. Plus important encore, dans le cas de la plasticité, triaxialité du stress joue un rôle important. Son effet doit donc être inscrits dans la modélisation du comportement de la matière. Ainsi, dans cette thèse, nous proposons une méthode pour identifier les paramètres d'une loi de comportement élasto-plastique dans lequel le modèle mécanique peut comporter cinématique 3D. La stratégie s'est avérée être le bruit robuste, presque indépendamment de la conjecture de paramètre initial et de raffinement de maillage et permet de différencier les modèles de comportement avec la même réponse globale sur la base de l'erreur de corrélation moyenne. L'identification est avérée bon pour une ou plusieurs caméras. La validation de la stratégie est faite d'acier inoxydable. La réponse globale du déplacement de charge identifié de la stratégie avec la corrélation d'image mécanique mono et stéréo est très proche des expériences. Enfin, les paramètres du matériau ont été identifiés avec l’estimation initial très différents mais tous convergent vers les mêmes valeurs finales qui montrent la solidité de la stratégie proposée

Development and Characterization of Porcine Models of Glioma

Development and Characterization of Porcine Models of glioma Muhibullah S. Tora 132 pages The development of porcine models of glioma using lentiviral vector mediated gene transfer was proposed. Lentiviral vectors were designed based on commonly implicated genetic pathways in high-grade glioma in the brain and spinal cord. Minipigs underwent either laminectomy or craniotomy with subsequent intraparenchymal administration of lentiviral vectors into respective white matter targets in the spinal cord or brain. Behavioral, motor, and clinical veterinary readouts were evaluated. Animals underwent magnetic resonance imaging and post-mortem tissue analyses including immunohistochemistry of tumor markers, RNA-sequencing, differential expression analysis, and gene set enrichment analysis. It was determined that the use of lentiviral mediated gene transfer in the minipig was a feasible approach to induce de-novo gliomagenesis in both the brain and spinal cord, with histopathologic and transcriptomic confirmation. Findings concerning each of the experimental metrics, implications on translation, limitations of the present models, and future research are discussed.Ph.D