Does the presence of a percutaneous renal access influence fluoroscopy time during percutaneous nephrolithotomy?

Objective:The aim of this study was to assess whether the presence of a preformed percutaneous renal access(PCA)had any effects on fluoroscopy time(FT)during percutaneous nephrolithotomy(PCNL).Methods:After ethics approval was obtained,medical records of all patients who underwent PCNL between 2009 and 2013 at a tertiary stone referral centre were retrospectively reviewed.Patients with and without pre-formed PCA undergoing PCNL were compared.Patients who underwent second-look PCNL and those who had their access inserted by interventional radiology constituted the group with pre-formed PCA.Results:A total of 185 PCNLs were reviewed.The mean patient age was 55.2±1.0 years with mean body mass index(BMI)of 27.8±0.5 kg/m^2 and male gender of 63.8%.The mean stone size was 618.4±47.0 mm^2 with mean Guy’s grade of 2.3±0.7 and mean S.T.O.N.E.score of 7.6±0.1.The mean operative time was 98.7±2.6 min with mean FT of 113.4±4.5 s.The overall stone-free rate was 71.9%with complication rate of 16.2%.When compared with PCNLs without pre-formed PCA,PCNLs with pre-formed PCA were associated with significantly shorter FT(120.6±5.1 vs.77.5±6.7 s;p<0.001)and significantly lower estimated blood loss(EBL)(p=0.01).On multivariate analysis,PCNLs with pre-formed PCA were associated with significantly shorter FT(B.coefficient=-43.2(95%CI:-66.4 to-20);p<0.001)and lower EBL(p=0.02).Conclusion:PCNLs with pre-formed PCA were associated with significantly lower FT and EBL when compared with PCNLs without pre-formed PCA.

来曲唑诱导对枸橼酸氯米芬抗药性的多囊卵巢综合征女性患者排卵可能不依赖不孕期、体重指数或黄体生成素/卵泡刺激素比值

Letrozole induction of ovulation in clomiphene citrate- resistant women with polycystic ovary syndrome is associated with an ovulation rate of 54.6% and pregnancy rate of 25% . There was no significant difference between letrozole responders and nonresponders in age, period of infertility, body mass index, waist circumference, LH, FSH, or LH/FSH ratio.

Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients

AIM: To study the preoperative and postoperative role of upper esophagogastroduodenoscopy(EGD) in morbidly obese patients. METHODS: This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery(laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August(Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital- Egypt). Patients with age 18-65 years, body mass index(BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients' preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with(group A) or without(group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings. RESULTS: Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery(75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms(group A). EGD was considered normal in 2414(75%) patients(9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings(one or more) were found in 805(25%) patients(19% group A vs 6% group B, P = 0.001). Seven patients had critical events during conscious sedation due to severe hypoxemia(< 60%). Rate of stricture in our study was 2.6%. Success rate of endoscopic dilation was 100%. One point nine percent patients with gastric leak were identified with 75% success rate of endoscopic therapy. Three point seven percent patients developed acute upper bleeding. Seventy-eight point two percent patients were treated by conservative therapy and EGD was performed in 21.8% with 100% success and 0% complications.CONCLUSION: Our results support the performance of EGD only in patients with upper gastrointestinal symptoms. Endoscopy also offers safe effective tool for anastomotic complications after bariatric surgery.

Knowledge, attitude, and practice of house officers towards COVID- 19: A multicentered crosssectional study in Egypt

Objectives:To assess the knowledge,attitude,and practice(KAP)towards COVID-19 and its associated factors among house officers.Methods:A multicentered crosssectional study on house officers was carried out using an online self-administered questionnaire.Sociodemographic data and data related to KAP towards COVID-19 were collected.Besides,KAP level of the house offices was recorded and factors associated with good KAP were determined.Results:This study included 555 house officers from 10 different hospitals with 128 males and 427 females.Almost half of the house officers had good knowledge and a favorable attitude(46.1%and 51%,respectively)on COVID-19.Still,82.5%of them were committed to good practice of preventive measures.Besides,percentages of good knowledge and practice among those with chronic diseases or those who knew someone infected with SARS-CoV-2 were higher,but the differences were not statistically significant(P>0.05).In addition,the percentages of females with good practice were higher than those of males,with no statistical difference(P>0.05).Conclusion:House officers showed a good KAP towards COVID-19.Being aware of gaps in KAP can help to effectively contain the current pandemic.

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.