Background The aim of this magnetic resonance imaging (MRI) study was to investigate controversial sexual dimorphism of the posterior condylar ofset of the femur (the ofset) and the posterior slope of the tibia (the slope) in non-arthritic knees of Egyptian adults. Methods On 100 male and 100 female MRIs of non-arthritic knees, linear measurements of the distal part of the femur (the ofset) and the angular measurements of the proximal part of the tibia (the slope) were performed and compared regarding sex and ethnicity. The intraclass correlation coefcient (ICC) was used to test the interrater agreement. Results Both ofsets and the lateral ofset ratio were larger in males (p0.8 proved MRI’s precision was high. Conclusion There was a sexual dimorphism of both the ofset and the medial slope in non-arthritic knees of Egyptian adults. We believe future designs of knee implants should consider these diferences in order to improve postoperative range of motion and patients’ satisfaction after total knee arthroplasty. Level of evidence Level III Retrospective Cohort Study. Trial registration ClinicalTrials.gov identifer: NCT03622034, registered on July 28, 2018.

Background & objective: Hyponatremia is the most common electrolyte disorder and is a predictor of osteoporosis, inflammation and cognitive dysfunction leading to falls in the elderly patients. We compared glutamate levels in normonatremic elderly patients with those with hyponatremia, admitted with osteoarthritis, to find correlation between the cognitive status with cerebrospinal fluid (CSF) glutamate as a biomarker for hyponatremia.

Methodology: In an observational prospective study; 70 patients, more than 70 y of age, admitted to trauma unit of Assiut University Hospital with fractures around the hip, were investigated for the frequency of on-admission hyponatremia. The CSF glutamate level was determined using radio-immune assay. We compared glutamate level in 18 hyponatremic patients with 10 normonatremic elderly patients admitted with osteoarthritis for elective joint replacement (control group) to find correlation between the cognitive status assessed by Modified Mini-Mental State (3MS) examination and CSF glutamate as a biomarker for hyponatremia.

Results: Hyponatremia is highly prevalent in elderly with fractures around the hip; we recorded it in 41.4% of the study sample. Most patients were females (62.86%). CSF glutamate was significantly increased in hyponatremic patients than the controls (P< 0.001).

Conclusion: Prevalence of hyponatremia is high in old aged patients probably due to due to prevalent hot weather in the south of Egypt. CSF glutamate level can be a marker for mild cognitive impairment caused by hyponatremia.

Abbreviations: 3MS: Modified Mini-Mental State examination; CSF: cerebrospinal fluid; RPM …

Antibiotic combinations remain the frontline therapy for severe infections to reduce mortality. However, conventional antibiotic combinations have some limitations such as the low bioavailability and the rise of resistant strains. Nanoparticles are increasingly used as antibiotic delivery systems to promote bioavailability and hence improve efficacy of antibiotics. In this work, we hypothesize that the simultaneous delivery of two antibiotic-loaded nanoparticles will improve the intracellular bioavailability and thus inhibit emergence of resistance. Accordingly, Chitosan–pluronic nanoparticles were used to construct nanosized ciprofloxacin and meropenem and the antibacterial activity of nanosized combined antibiotics were compared versus unloaded single, unloaded combined, and nanosized single antibiotics. Thirty-six stepwise mutants were selected by exposing two E. coli strains to increasing concentrations of free-unloaded and nanosized antibiotics, and mutants were tested for antimicrobial susceptibilities using broth microdilution and disc diffusion methods. The change in expression levels of acrB efflux pump and porins (ompC and ompF) was assessed by real-time reverse transcription–PCR. The in vitro evaluation of combined ciprofloxacin and meropenem-loaded nanoparticles demonstrated that this nanosystem exhibited enhanced antibacterial effect. Step mutants selected with nanosized combined antibiotics showed higher sensitivity to both drugs, exhibited lower mutation frequencies, and less cross-resistance to other antimicrobial classes. Moreover, for all steps of selection, nanosized combined antibiotic mutants expressed significantly lower levels of acrB as well as higher levels of ompC and ompF (p-value <0.01). In view of these results, the use of nanosized combined antibiotics may be considered among the new promising strategies to combat infections through their potential efficacy in reducing microorganisms' ability to form resistant mutants

Purpose: To evaluate the incidence and type of microbial colonization of the pseudo-capsule (PC) that forms around sacral nerve stimulators (SNS) and consequently the significance of surgical excision of this PC at time of SNS revision or removal.

Materials and Methods: A cohort of 31 patients who underwent SNS revision or removal from January 2018 to June 2021 were retrospectively reviewed. The baseline demographics, rate and type of PC microbial colonization and development of SNS insertion site infection were reported.

Results: A cohort of 31 patients who underwent “InterStim device (Medtronic)” revision or removal were included. The majority were females (93.5%). The most common indication for SNS insertion was refractory overactive bladder (67.7%). Nine patients (29.0%) underwent SNS revision due to malfunctional device, and 9 patients had SNS removal for the need of MRI procedures. Four patients (12.9%) had positive tissue culture growing Coryneform bacillus (50.0%), Cutibacterium acnes (25.0%) and Pseudomonas aeruginosa (25.0%).

Conclusions: PC colonization was uncommon at the time of SNS explant. However, more research is needed to better understand the role of PC-positive culture in increasing the risk of SNS device infections if strict adherence to sterile techniques is adopted.

Purpose of Review: We performed recent literature review with the aim to address the updates in diagnosis and management of sexually transmitted urethro-cystitis.

Recent Findings: There are multiple, recently published studies that collectively lead to an organized stepwise plan for diagnosis and management of sexually transmitted urethro-cystitis.

Summary: Sexually transmitted urethro-cystitis is a common health condition that can be managed efficiently if the appropriate steps are taken in diagnosis and management.

Background: We sought to evaluate rural–urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression.

Methods: Using 2007–2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors’ first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures.

Results: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = −2.0; p = 0.022), specialist rating (ß = −2.5; p = 0.008), and overall care rating (ß = −2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = −7.0; p = 0.017) and a lower health plan rating (ß = −7.9; p = 0.003) compared to their respective counterparts in large metro areas.

Conclusions: Rural PCa survivors are less likely to receive treatment. Rural–urban differences in PCEs varied by treatment status.

Background: One of the commonest pediatric surgeries is hydrocele. There are suggestions to wait for spontane- ous resolution than to operate these cases without harmful adverse events. Herein, we evaluated the outcome of the watchfulness of these cases over 18 months.

Methods: The study included 93 infants with communicating hydrocele for the Pediatric Surgery Department, Fac- ulty of Medicine (Assiut, Egypt). They were planned to be followed up for 18 months, and indications for intervention included hernia, increasing in size, being tense, and completion of 18 months of follow-up without improvement.

Results: The gestational age of the included patients was 38.5 ± 2.2 weeks and the age at the time of presentation was 50 (7, 495) days. Most cases were bilateral, reducible, and had an intermittent course. After 18 months of follow- up, 60.2% of the patients resolved spontaneously and 39.8% were surgically treated. Age at the time of presentation was higher among operated patients. Patients with reducibility criteria on clinical examination and lack of intermittent course had higher frequency among operated patients (89.2%).

Conclusions: It is safe to wait and not to operate on infants with hydrocele up to 18 months as long as there was no hernia. Higher age at presentation and reducibility on examination are indicators that favor the need for surgery.

Introduction: Near-infrared (NIR) fluorescent cholangiography (FC) using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) has been used as a technique for real-time visualiza- tion of bile ducts for approximately ten years; however, no standard protocol has been deter- mined. This study aimed to determine the optimal time of administration of ICG.

Material and methods: In this prospective study, patients (n1⁄430) indicated for LC were div- ided into two groups. The first group received ICG 1 h before anesthesia at a dose of 0.1 mg/kg (1h group), whereas the other group received ICG immediately after anesthesia with the same dose (0 h group).

Results: The rates of identification of the cystic duct (CD) and common bile duct (CBD) using NIR FC before and after dissection of Calot’s triangle were comparable between the two groups. The fluorescence intensity ratios of CD/Liver and CBD/Liver were significantly higher in the 1h group (2.2 vs. 0.49 and 2.1 vs. 0.38, respectively, p < .001) with minimal background liver fluores- cence interference in the 1 h group.

Conclusions: The study illustrates that administration of ICG 1 h before surgery with a dose of 0.1 mg/kg allows superior visualization of the extrahepatic bile ducts with minimal fluorescence interference from the background liver.

Abbreviations: BDI: bile duct injury; BMI: body mass index; CBD: common bile duct; CD: cystic duct; CHD: common hepatic duct; CVS: critical view of safety; FC: fluorescent cholangiography; FI: fluorescence intensity; GB: gallbladder; ICG: indocyanine green; IOC: intraoperative cholangi- ography; LC: laparoscopic cholecystectomy; NIR: Near-infrared; WL: white light