Succinylcholine is a preferred muscle relaxant for rapid sequence intubation. Postoperative myalgia (POM) is one of its commonest adverse effects with unknown pathogenesis. Various modalities were examined to reduce POM. We hypothesized that duloxetine may reduce incidence and severity of fasciculation or succinylcholine‐induced POM in outpatient surgeries.

METHODS

This randomized double‐blinded trial involved controlled 70 adult participants scheduled for elective direct microlaryngoscopic surgeries. Before induction of general anesthesia by 2 hours, 35 patients received duloxetine 30mg orally (Group‐D) and 35 patients received similar oral starch placebo capsules (Group‐C). Fasciculations, POM, sedation score, time to first rescue analgesia, total analgesic consumption 24 hours after surgery, patients’ satisfaction, and adverse effects were recorded.

Background

Laparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces the quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.

Methods

Ninety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (group B, n = 30), or dexmedetomidine (group D, n = 30) or clonidine (group C, n = 30). Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score and complications …

Background and objectives: IL27 and IL35 are regulatory T cells (T-regs) related cytokines; they were accused in eukemogenesis of acute myeloid leukemia (AML). This study aimed to assess the expression of these cytokines in de novo AML and investigate their role as biomarkers.
Subjects and methods: Seventy newly diagnosed patients with primary AML and 30 matched healthy volunteers were recruited. AML diagnosis was confirmed with flowcytometric and immunophenotypic analyses, while ELISA was used to assess serum levels of IL27 and IL35 in patients and controls. Receiver operating characteristic curve analysis was used to estimate IL27 and IL35 optimum cutoff values for predicting AML.
Results: Serum levels of both cytokines were significantly higher in AML patients than controls (P<0.001), with no effect of gender or French-American-British subtypes. Significant correlations of IL27 and IL35 with poor prognostic factors and with each other were detected in patients only. IL27 optimum cutoff for predicting AML was >43, AUC (0.926) with a sensitivity 74% and specificity 96.6% (P<0.001), while for IL35>27.8, AUC (0.972) with 88% and 98% sensitivity and specificity, respectively (P<0.001).
Conclusion: Conclusively, this study proved that IL27and IL35 could identify AML patients from healthy subjects, and their overexpression denotes poor prognosis. Based on the simplicity and wide availability of their detection technique we recommend the inclusion of IL27 and IL35 in the diagnostic/prognostic workup of AML; however, further longitudinal research is needed to prove their exact prognostic value.
 

Background and objectives

Myeloid leukemias (MLs) are clonal stem cell disorders affecting myeloid lineage cells. Advances in cytogenetic and molecular studies partially disclosed the mystery about risk factors and pathophysiology of MLs. Regarding incidence, risk factors, response to treatment, and overall survival of patients, research showed differences among different countries. However, the Western registry data are the basis for the documented description of MLs in medical textbooks. This research aimed to study MLs in Middle Eastern health centers. Egypt has the highest population in the Middle East; furthermore, 96.6% of the population is native Egyptians; accordingly the study focused on Egypt.

Patients and methods

Data of 468 patients with MLs were collected from hospital records at two big tertiary health centers. They were grouped into group 1 (chronic myeloid leukemia, CML) and group 2 (acute myeloid leukemia, AML); the latter was subgrouped into 2a (primary AML) and 2b (secondary AML).

Results and conclusions

The median age of patients was 43 years; males predominate in group 2a and females in groups 1 and 2b. 37.2% of group 1 patients were treated with Gleevec. Hematopoietic stem cell transplantation was planned for only 5% of group 2 and 18% relapsed. Of groups 1 and 2 patients, 25% and 12%, respectively, stopped follow up, and 15% and 35% died. ORR and overall survival were 53%, 27% and 7%, 0.4% for groups 1 and 2, respectively. Conclusively, this study showed a young age of ML patients, with female predominance in CML, and poor outcome. This reflected racial, ethnic and risk factor differences in incidence of MLs.

Background: The distress thermometer (DT) is an effective tool for identifying distress among cancer patients
worldwide. However, DT has not been studied in Egyptian patients. We aimed to study the prevalence of distress
among Egyptian patients with different types of cancers using DT.
Methods: A total of 550 patients with newly diagnosed hematological and solid cancers who were followed up at
3 Oncology Centers in Egypt were enrolled. They completed a sociodemographic and clinical status questionnaire,
the DT and the Problem List (PL) scale.
Results: At a DT cut-off score of ≥4, 46% of patients had significant distress, which was related to the tumor site
and stage. The most frequent problems reported were treatment decision (64.4%), worry (47%), and fears (44.5%). In
univariate logistic regression analysis, participants who had significant distress described 23 out of 36 problems in
the practical, family, emotional, and physical areas. After adjustment to sociodemographic and clinical
characteristics, multivariable analysis confirmed that insurance, depression, fear, sadness, worry, loss of interest in
usual activity, and sleep were independent factors associated with significant distress in cancer patients.
Conclusions: Almost half of Egyptian patients newly diagnosed with cancer reported significant distress. Those
who had significant distress described extra problems in the practical, family, emotional, and physical areas. We
recommend the routine use of DT for screening Egyptian patients with cancer, as well as the involvement of the
psycho-oncology and social services, at the time of their initial diagnosis.

Objective: To assess the volume and temporal trends in utilization of gynecologic surgery codes between 2010 and 2015.

Study design: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to determine the frequency of individual gynecologic surgical procedures from 2010 to 2015. The National Inpatient Sample was used to further define the frequency of minimally invasive hysterectomies from 2012 to 2016. Data were analyzed using linear regression and chi-squared tests.

Results: Gynecologic procedures represented 6.8% (95% confidence interval 6.8–6.9) of all surgical procedures included in the NSQIP database from 2010 through 2015 and this percentage was stable during the study period. The top 10% of procedures make up ∼70% (66.5%–71.2%) of all procedures performed. The top 40% of procedures make up ∼97% (96.8%–97.5%) of all procedures. Although hysterectomy codes were consistently among the top 10 most utilized codes, significant trends were observed in utilization related to the route of hysterectomy with rise of total laparoscopic hysterectomy (TLH). This was correlated with increasing adoption of robotic-assisted laparoscopy and decline of total vaginal hysterectomy (TVH) and abdominal hysterectomy (p < 0.001). There was also a large increase in concomitant adnexal surgery at the time of TLH, which potentially mirrors the recent rise in opportunistic salpingectomy.

Conclusion: In this analysis, we highlight changes in the utilization of different gynecologic procedures to inform policy makers of challenges to appropriate reimbursement for laparoscopic procedures and a potential skills loss in open and vaginal procedures.

Introduction and hypothesis

While approximately 225,000 pelvic organ prolapse (POP) surgeries are performed annually in the US, there is no consensus on the optimal route for pelvic support for the initial treatment of uterovaginal prolapse (UVP). Our objective is to compare the outcomes of abdominal sacrocolpopexy (ASC) to vaginal pelvic support (VPS) with either uterosacral ligament suspension (USLS) or sacrospinous ligament fixation (SSF) in combination with hysterectomy for treating apical prolapse.

Methods

A systematic search was performed through March 2021. Studies comparing ASC with VPS for treatment of UVP were included in the review. The primary outcome was the rate of overall anatomic prolapse failure per studies' definition. Secondary outcomes included evaluating isolated recurrent vaginal wall prolapse, postoperative POP-Q points, total vaginal length (TVL), and Pelvic Floor Distress Inventory (PFDI-20) scores. Random effect analyses were generated utilizing R 4.0.2.

Results

Out of 4225 total studies, 4 met our inclusion criteria, including 226 patients in the ASC group and 199 patients in the VPS group. ASC was not found to be associated with a higher rate of vaginal wall prolapse recurrence (OR = 0.6; 95% CI = 0.2–2.4; P = 0.33). There was no significant difference between groups for anterior or apical vaginal wall prolapse recurrence (P = 0.58 and P = 0.97, respectively). ASC was associated with significantly longer TVL (mean difference [MD]: 1.01; 95% CI = 0.33–1.70; P = 0.02) and better POP-Q Ba scores [MD = −0.23; 95% CI = −0.37; −0.10; P = 0.01].

Conclusions

ASC and vaginal pelvic support (either USLS or SSF) have comparable anatomical outcomes. However, weak evidence of a difference in TVL and Ba was found. The strength of the evidence in this study is based on the small number of observational studies. A large, randomized trial is highly warranted.

Introduction and hypothesis

Sacral neuromodulation (SNM) is gaining popularity as a treatment option for chronic pelvic pain (CPP). Our hypothesis is that SNM is effective in improving CPP.

Methods

A systematic search was conducted through September 2018. Peer-reviewed studies using pre- and postpain intensity scores were selected. The primary outcome was pain improvement on a 10-point visual analog scale (VAS) (adjusted or de novo) in patients with CPP. Secondary outcomes included comparing SNM approaches and etiologies and evaluating lower urinary tract symptoms (LUTS).

Results

Fourteen of 2175 studies, evaluating 210 patients, were eligible for further analysis. The overall VAS pain score improvement was significant [weighted mean difference (WMD) −4.34, 95% confidence interval (CI) = −5.22, to−3.64, p < 0.0001)]. Regarding SNM approach, both standard and caudal approaches had significant reduction in pain scores: WMD −4.32, CI 95% = −5.32, to −3.31 (p < 0.001) for the standard approach, compared with WMD −4.63, 95% CI = −6.57 to −2.69 (P < 0.001), for the caudal approach (p = 0.75). While significant improvement in pain was observed both in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS), the observed improvement was lower in patients with (WMD −4.13, CI 95% −5.36 to −2.90 versus without (WMD −5.72, CI 95% = −6.18, to−5.27) IC/BPS (p = 0.02). SNM was effective in treating voiding symptoms (frequency, urgency, nocturia) associated with IC/BPS (all p < 0.01).

Conclusions

SNM is an effective therapy for CPP in both IC/BSP and non-IC/BSP patients, with better results in non-IC/BSP patients. Outcomes of the antegrade caudal approach were comparable with the standard retrograde approach.

Aplastic anemia (AA) is a type of anemia that is caused by an intrinsic defect of hematopoietic progenitors or an extrinsic immune mediated destruction of stem cells. Patients commonly presented with pancytopenia, particularly leukopenia that renders patient susceptible to various infections. COVID-19 is one of these infections that could be life threatening and highly contagious. Infection with COVID-19 is expected in a patient who developed fever, respiratory manifestations, leukopenia and lymphopenia together with history suggestive of exposure to infection. Furthermore COVID-19 was found associated with thrombocytopenia, agranulocytosis and monocytopenia in severe cases. Thus the relationship between COVID-19 infection and AA would be a vicious circle as both cause leukopenia and lymphopenia. This study aimed to break this circle, through proposing risk stratification of vulnerability to COVID-19 in AA patients who were admitted in our institution in the period from Mar. 2018 to Mar. 2020 followed by a strict preventive plan tailored for each risk group. 79% of AA patients were at high risk of acquiring COVID-19 infection if exposed. This group of patients have to be targeted with more aggressive preventive plan than normal healthy persons. In conclusion this study proposed next step in combating COVID-19 infection through mass survey of high risk people then application of specific precautions to them, perhaps they could be candidate for future vaccine or prophylactic treatment.

Background
Bladder stones in children represent up to 15% of all pediatric urolithiasis. Variant methods of managing vesical stones in children are available now with comparable success rates. Percutaneous cystolithotripsy (PCCL) was introduced to our department to be offered for male children on a routine basis.
Aim
To evaluate our experience in managing bladder stones in male children less than 14 years of age via PCCL regarding safety and efficacy.
Patients and methods
A total of 37 children underwent PCCL for their bladder stones in the period between November 2016 and November 2017 in Assiut Urology and Nephrology Hospital. Their median age was 36 (12–144) months and median stone size was 11 (7–26) mm. Initial diagnosis was urethral stones in 26 (70.3%) patients and bladder stones in 11 (29.7%) patients. Patients were followed up for periods ranging from 5 to 33 months (median 18 months).
Results
The median operative time was 14 (5–45) min. Twenty-one (56.8%) patients underwent direct stone extraction without disintegration of their bladder stones. Sixteen (43.2%) patients needed disintegration of their stones, of which 13 (81.25%) had pneumatic disintegration of their stones, whereas three (18.75%) had laser disintegration. Success was achieved in 36 (97.3%) patients. Complications were reported in three (8.1%) cases, and prolonged catheterization was reported in two (5.4%) patients.
Conclusion
PCCL is a safe and effective minimally invasive method for treating bladder stones in children.