Background
In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh ...rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated.
Methods
We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (
n
= 250) and PSR (
n
= 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction.
Results
LVMR was associated with fewer postoperative complications (
p
< 0.001), lower prolapse recurrence (
p
< 0.001), lower Wexner incontinence score (
p
= 0.03), and lower Altomare’s score (
p
= 0.047). Furthermore, LVMR demonstrated a significantly higher surgery–recurrence interval (
p
< 0.001), incontinence improvement (
p
= 0.019), and patient satisfaction (
p
< 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03–0.347,
p
= 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036–1.236,
p
= 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197–1.655,
p
< 0.001).
Conclusions
LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes.
Trial registration
Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.
Rickettsioses have an epidemiological importance that includes pathogens, vectors, and hosts. The dog tick
and the camel tick
play important roles as vectors and reservoirs of Rickettsiae. The aim of ...this study was to determine the prevalence of Rickettsiae in ixodid ticks species infesting dogs and camels in Egypt, in addition to, the morphological and molecular identification of
and
.
A total of 601 and 104 of ticks' specimens were collected from dogs and camels, respectively, in Cairo, Giza and Sinai provinces. Hemolymph staining technique and
and
genes amplification were performed to estimate the prevalence rate of Rickettsiae in ticks. For morphological identification of tick species, light microscope (LM) and scanning electron microscope (SEM) were used. In addition to the phylogenetic analyses of 18S rDNA, Second internal transcript spacer, 12S rDNA, cytochrome c oxidase subunit-1, and 16S rDNA were performed for molecular identification of two tick species.
The prevalence rate of Rickettsiae in ticks was 11.6% using hemolymph staining technique and 6.17% by
and
genes amplification. Morphological identification revealed that 100% of dogs were infested by
while 91.9% of camels had been infested by
. The phylogenetic analyses of five DNA markers confirmed morphological identification by LM and SEM. The two tick species sequences analyses proved 96-100% sequences identities when compared with the reference data in Genbank records.
The present studies confirm the suitability of mitochondrial DNA markers for reliable identification of ticks at both intra- and inter-species level over the nuclear ones. In addition to, the detection of Rickettsiae in both ticks' species and establishment of the phylogenetic status of
and
would be useful in understanding the epidemiology of ticks and tick borne rickettsioses in Egypt.
Tick-borne diseases comprise a complex epidemiological and ecological network that connects the vectors, pathogens, and a group of host species. The aim of this study was to identify bacteria from ...the genus Rickettsia associated with ixodid ticks infesting camels and cows in Egypt. Ticks were collected from 6 different localities: Qina, Giza, Qalet El Nakhl, New Valley, El Arish, and Minufia, from July to October 2008. Species were identified using PCR, followed by sequencing. The gltA and rOmpA genes were used for the initial detection of Rickettsia spp. Further characterization of positive samples utilized primers targeting rOmpB, sca4, and intergenic spacers (mppA-purC, dksA-xerC, and rpmE-tRNA(fMet)). Cows were infested with Hyalomma anatolicum excavatum and Boophilus annulatus. Camels were infested with Hyalomma dromedarii, H. impeltatum, and H. marginatum marginatum. Approximately 57.1% of H. dromedarii ticks collected from Qalet El Nakhl were infected with Rickettsia africae, exhibiting 99.1-100% identity to reference strains. Within H. impeltatum, 26.7% and 73.3% of ticks from El Arish were infected with R. africae and R. aeschlimannii, with 98.3-100% and 97.9-100% identity, respectively. Furthermore, 33.3% of H. marginatum marginatum ticks in Qalet El Nakhl were infected with the same two species as H. impeltatum, demonstrating 99.1-100% and 99.3-100% identity, respectively. By comparing percent identities and phylogenetic relationships, R. africae is identified for the first time in Egypt, in addition to R. aeschlimannii, which exhibits 100% identity with the Stavropol strain in GenBank. In conclusion, the obtained data underscore the medical and veterinary importance of tick-borne rickettsioses, which necessitate further investigation by authorities in Egypt. Moreover, additional characterization of these rickettsial isolates should be performed to designate their strains, using a polyphasic strategy combining genotypic and phenotypic tests, to facilitate their deposition in the rickettsial collection of the WHO and/or ATCC.
It has previously been demonstrated that the risk of hypoglycemia is low among otherwise healthy elderly fasted patients with type 2 diabetes taking oral sulfonylurea medications. Nevertheless, these ...agents do cause hypoglycemia in clinical practice, suggesting that accompanying factors must typically be present for hypoglycemia to occur. Ethanol is one putative risk factor that has not been evaluated as a mechanism for low blood glucose among sulfonylurea users. We hypothesized that low concentrations of ethanol would reduce blood glucose concentrations in elderly type 2 diabetic patients receiving sulfonylureas during a short-term fast.
A total of 10 type 2 diabetic patients, aged 68 +/- 3 years and receiving 20 mg glyburide daily, participated in a prospective double-blind placebo-controlled in-patient study consisting of two 24-h fasts at least 1 week apart. During hours 14 and 15 of the fasting studies, subjects received intravenous infusions of either 4.35 mmol.kg-1.h-1 ethanol (equivalent to one or two alcoholic beverages) or saline placebo in random order. Ethanol, plasma glucose, insulin, and counterregulatory hormones were assessed very 30-60 min during the final 10 h of the fast.
Blood ethanol levels peaked at 17 +/- 2 mmol/l (the lower legal limit of intoxication in New Mexico) during the ethanol study. Plasma glucose concentrations did not differ at baseline (placebo 8.5 +/- 1.8 vs. ethanol 8.7 +/- 1.7 mmol/l; P = 0.50), but nadir plasma glucose was lower after the ethanol infusion compared with placebo (4.4 +/- 1.2 vs. 5.0 +/- 1.4 mmol/l; P = 0.01), and the absolute decline in plasma glucose was also greater during the ethanol study than the placebo study (4.7 +/- 0.9 vs. 3.6 +/- 1.2 mmol/l; P = 0.01). Counterregulatory hormone levels were increased during the ethanol study and nonesterified fatty acid concentrations were suppressed compared with the placebo study.
Low doses of ethanol predispose fasted elderly type 2 diabetic patients to low blood glucose during a short-term fast. This may be one of several mechanisms by which sulfonylurea-induced hypoglycemia occurs in elderly patients.
Apoptosis is a normal physiological process which is very crucial to maintain tissue homeostasis. Dysregulated apoptosis can lead to various diseases as cancer. Thus, evasion of apoptosis stands out ...as a key hallmark of cancer cells. Bcl-2 family of proteins is the key modulator of the mitochondrial apoptotic pathway. Therefore, the balance between the anti-apoptotic (BCL-2, BCL-XL and MCL-1) and pro-apoptotic (BAK, BAX, BAD, PUMA and NOXA) members of this family will govern cell fate. Overexpression of anti-apoptotic BCL-2 members including MCL-1 is implicated in the progression of many human cancers as well as the emerging resistance to various anti-cancer agents including targeted therapies. Indeed, inhibition of the anti-apoptotic BCL-2 members by small molecule BH3 mimetics may provide an excellent approach in cancer therapy. Unfortunately, it was reported that MCL-1 overexpression is linked to Venetoclax, first FDA approved BCL-2 selective inhibitor, resistance in AML. Thus, inhibition of MCL-1 with a selective small molecule inhibitor may provide an attractive strategy in cancer targeted therapy. Recently, several small molecule MCL-1 selective inhibitors have been developed and few are testing in clinical trials. Herein, we will discuss the recent advances in the development of selective small molecule MCL-1 inhibitors.
The genus Hyalomma comprises the most ixodid tick species that parasitize camels in Egypt. Although the immature stages of tick species play an important role in distribution of ticks and tick-borne ...diseases, the identification depends mainly on the adult stage. Therefore, this study tries to identify the specific characteristics of both nymph and larva of Hyalomma rufipes Koch, 1844 using scanning electron microscopy and morphometric analysis in order to differentiate them easily from those of other Hyalomma spp. described before in Egypt. Results showed that the nymph and larva of H. rufipes can be easily identified from those of H. excavatum Koch, 1844, H. dromedarii Koch, 1844 and H. impressum Koch, 1844 but they are strongly close to H. marginatum Koch, 1844. The nymph of H. rufipes can be distinguished from H. marginatum by the number and distribution of dorsal and ventral idiosomal setae and the distribution of sternal setae. All morphological characteristics of H. rufipes larva resemble those of H. marginatum larva. The measurements of nymph and larva structures of H. rufipes are significantly lower than those of H. marginatum.
Hypoglycemia is the principal barrier to achieving target glucose
goals in type 2 diabetes. The effect of short-term improvement in
glycemic control on plasma glucose thresholds for symptomatic and
...hormonal responses to hypoglycemia in type 2 diabetes is not known. We
hypothesized that the thresholds for these events would be increased by
1 wk of improved glycemic control in elderly patients with type 2
diabetes. Ten elderly patients with type 2 diabetes were admitted for
an 8-d inpatient protocol. All subjects underwent insulin-induced
hypoglycemia on days 2 (preglucose control) and 8 (postglucose
control). Between days 2 and 8, subjects received intensive diabetes
management to improve their glycemic control. Timed blood glucose
profiles were obtained daily during the week before and during
admission. Plasma glucose, counterregulatory hormones, and hypoglycemic
symptoms were assessed at baseline and every 10 min during the
hypoglycemic studies. Mean blood glucose concentrations were
significantly reduced by intensive diabetes management from 9.8 ±
3.7 mmol/liter to 7.7 ± 3.3 mmol/liter (P <
0.001). The plasma glucose threshold for epinephrine release during
insulin-induced hypoglycemia was significantly increased by intensive
management from a glucose concentration of 3.7 ± 0.5 mmol/liter
at baseline to 3.1 ± 0.3 mmol/liter after intensive management
(P < 0.05). The plasma glucose threshold for
hypoglycemic symptoms was also increased by intensive therapy from a
glucose concentration of 5.3 ± 1.2 to 3.3 ± 0.6 mmol/liter
(P = 0.003). These rapid changes may increase the
risk for severe hypoglycemia in type 2 diabetes and limit the ability
of physicians to rapidly correct hyperglycemia in elderly type 2
diabetes patients.
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