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Background: Premature ejaculation (PE) is a significant and common medical problem affecting many men worldwide. While PE is not a life- threatening disorder, its effect on quality-of-life (QoL) issues is significant. Objective: To evaluate the feasibility, safety and efficacy of pulse radiofrequency (PRF) of dorsal nerve of the penis in lifelong premature ejaculation refractory to conventional treatment. Patients and Methods: In this prospective study, all adult males complaining from lifelong PE resistant to conventional treatment, and seeking treatment of PE, at Al-Azhar University Hospitals [Al-Hussein and Sayed Galal]; Cairo; Egypt during the period from December 2019 to July 2020 were studied. Detailed history, physical examination, serum testosterone, serum prolactin were obtained. Patients underwent ultrasound guided pulsed radiofrequency of dorsal nerve of the penis. Any operative complications were recorded. To assess the efficacy of the procedure, patients were evaluated by intra vaginal ejaculatory latency time (IELT) and sex satisfaction scale (SSS). Results: As regard SSS, 3 weeks before intervention, all the subjects (20 subjects) were unsatisfied. Three weeks post intervention, 9 (45%) of subjects were satisfied, while 11 (55%) were unsatisfied. Four months post intervention, 8 (40%) subjects were satisfied, and 12 (60%) were unsatisfied SSS 3 weeks post intervention was significantly different from SSS 3 weeks before intervention and 4 months post intervention (p < 0.001). The mean of IELT was 33.4±19, 188.4±154.9, and 141.5±129.7 seconds at 3 weeks before PRF, 3 weeks after PRF, and 4 months after PRF, respectively. A significant difference was found between IELT pre intervention, 3 weeks and 4 months post intervention (p < 0.001). A strong positive correlation was found between IELT and SSS at 3 weeks and 4 months post intervention (p < 0.001& r = 0.78) and (p < 0.001& r = 0.91) respectively. In our study, 4 (20%) patients had pain that relieved by analgesic and 2 (10%) patients had minimal bleeding at site of needle insertion & resolved by compression. No subjects complained of erectile dysfunction nor loss of sensation, while 2 (10%) patients reported superficial infection in first week post intervention which may contribute to uncontrolled DM, 4 (20%) patients had tingling within the first 3 weeks, and 2 (10%) had numbness within the first 3 weeks. All these complications resolved with conservative treatment. Conclusion: PRF is a hopeful treatments in life long PE. Objective data on change in sensation (biothesiometry) and the short term of objective follow-up data are the significant limitations of this study.

Background: Brachial plexus block is frequently used for ambulatory upper limb surgery. It can significantly reduce pain and nausea, allowing for faster discharge from hospital when compared with general anesthesia (GA). Doing this block through ultrasound has higher index of safety, allowing providers to identify the appropriate point of injection and performing this block with greater accuracy under direct visualization. Objective: the aim of the study was to compare the efficacy of bupivacaine plus dexamethasone versus bupivacaine plus dexmedetomidine as adjuvants on block characteristics including onset and duration of sensory and motor blockade, duration of postoperative analgesia, post-operative pain score and sedation score. Patients and Methods: This prospective double – blinded, randomized controlled trial included a total of 60 patients divided to two groups, each group contained 30 patients. Group 1 (dexmedetomidine group) had received 1μg/kg of dexmedetomidine + 20 ml bupivacaine 5%. Group 2 (dexamethasone group) had received dexamethasone + 20 ml of bupivacaine5%. Results: In this study the onset and duration of sensory and motor blockade was statistically shorter in dexamethasone group when compared to dexmedetomidine group. Conclusion: It could be concluded that addition of dexmedetomidine to bupivacaine prolongs the time of block and analgesia duration longer than dexamethasone, but the onset of block was shorter when dexamethasone was added to bupivacaine.

Background Volunteers play a significant role in supporting hospice and palliative care in Africa, but little is known about the types of volunteers, their motivations and roles in service delivery. Methods Palliative care experts from 30 African countries were invited to participate in an online survey, conducted in English and French, that consisted of 58 questions on: socio-demographics, the activities, motivation and coordination of volunteers, and an appraisal of recent developments in volunteering. The questionnaire was pre-tested in Uganda. Quantitative data was analysed descriptively with SPSS v22; answers on open-ended questions were analysed using content analysis. Results Twenty-five respondents from 21 countries replied to the questionnaire. The typical volunteer was reported to be a female aged between 30 and 50 years. Volunteer roles included, among others: direct patient assistance, providing psychosocial / spiritual support, and assisting patients’ families. Respondents considered altruism, civic engagement and personal gain (for a professional career) as volunteers’ most significant motivational drivers. One in two respondents noted that recruiting volunteers is easy, and cooperation with the communities was often mentioned as helpful. Trainings mostly occurred before the first assignment, with topics covering the palliative care concept, care, psychosocial support and team work. Half of respondents described recent overall volunteering developments as positive, while the other half described problems primarily with financing and motivation. Most volunteers received transportation allowances or bicycles; some received monetary compensation. Conclusions The findings show a wide range of volunteering in palliative care. We identified volunteers as typically 30–50 years old, non-professional females, motivated by altruism, a sense of civic engagement and personal gain. Palliative care services benefit from volunteers who take on high workloads and are close to the patients. The main challenges for volunteer programmes are funding and the long-term motivation of volunteers.