Decision-making challenges in children with congenital and acquired monorchism : a critical literature review

Monorchism in children can be caused by congenital and acquired conditions, and can potentially influence the hormonal and reproductive function of an individual in the long term. Depending on the etiology, different approaches to the solitary testis have been suggested; however, studies on this topic are scarce. Prevention of anorchia is the main goal in the management of a child with monarchism. The risk of bilateral testicular loss must be weighed against the risk of performing surgery on a healthy gonad. Little is known about the long-term consequences of the various methods for fixation of the testis. This paper provides an up-to-date summary of the current literature on congenital and acquired monarchism in childhood

Scrotal Pain After Varicocelectomy Causes and Management: A Retrospective Study

Inactive males have a frequency of varicocele, a common urological condition that ranges from 8 to 15%. In male patients with primary or secondary infertility, the prevalence is higher; in fact, this demographic accounts for 35 to 80% of varicocele occurrences. The Varicocele usually presents itself clinically as an asymptomatic mass resembling a "bag of worms," along with infertility, chronic scrotal pain, and the appearance of an apparent lump. Conservative therapies for varicocele often fail before the patient is considered for varicocele. Unfortunately, nutcracker syndrome, referred pain, neuralgia, ureteral lesions, recurrence of varicocele, hydrocele, or neuralgia can all lead to prolonged scrotal pain in some people. As a result, doctors should consider these issues as possible causes of scrotal pain after surgery and treat them accordingly. By considering a number of variables, we can better predict the success rate of varicocele surgery. Clinicians should take these considerations into account when determining the need for surgery and the best course of intervention. There will be less chance of problems like postoperative scrotal soreness and more chance of a favorable surgical outcome if they do this.Material and methods 212 patients received a varicocele diagnosis between July 2021 and July 2023. By surgeons from baquba teaching hospital\u27s urology department performed the varicocelectomy. In order to conduct a retrospective study .Aim to show prevalense of Scrotal Pain after Varicocelectom

Recognise, raise the alarm, react. The process and factors that delay adolescent presentation with testicular pain

Background Adolescent males have high rates of testicular loss after testicular torsion (TT) due to a delay in presentation to hospital after the onset of symptoms. I aim to investigate the issue two-fold: 1. to confirm the scientific basis and ongoing relevance of the need to investigate the phenomena; 2. to investigate the knowledge, views and experiences of young men regarding testicular health to understand the phenomena using qualitative methodology. Methods Meta-analysis following PRISMA guidelines was undertaken with a primary outcome of long-term (>12 months) testicular loss following adolescent TT, in combination with a systematic review investigating predictors of testicular loss. Two regional retrospective audits were undertaken with primary outcomes of immediate testicular loss and time to presentation to hospital after onset of scrotal pain. One-to-one semi-structured interviews were undertaken with young men 11-19 years old with a chaperone, recruited from naturalist environments such as youth clubs. Thematic analysis was undertaken, and data was managed using framework methodology. Recruitment continued until data saturation. Validity was ensured by meticulous study design, high levels of reflexivity and regular supervision. Findings Meta-analysis confirmed a 39% early and 50% long term testicular loss or atrophy rate, with systematic review confirming delay to presentation to predict poor outcomes. Regional audit confirmed ongoing relevancy of the project with early testicular loss of 30% and 50% in Glasgow and Sheffield respectively. Median time from onset of pain to presentation at hospital in Sheffield was 6.25 hours(range 40 minutes to 170 hours) and 24 hours in Glasgow. Qualitative investigation revealed adolescent males are dependent on their parents for all aspects of health, including advice, access and attitudes. The process whereby an adolescent male affects their acute healthcare needs has been revealed. The adolescent recognises there is a problem and raises the alarm by telling their parents. Their parents then synthesise the symptom information and seek help, often after a ‘watch and wait policy’, making an appointment with their general practitioner as the first point of health contact. This process acts as a barrier to young people gaining timely hospital assessment of painful testes. Other factors delaying this process are: poor knowledge of adolescent testicular problems; lack of education and age appropriate information resources; concern from the young people about getting it wrong and raising a false alarm; poor confidence; young peoples’ fear of disrupting the family routine and disincentivisation of hospital attendance confounding concerns about burdening the NHS. Recommendations Recommendations from this study would be to introduce nationalised teaching on testicular health problems in schools, and for parents to receive education of the health conditions whereby a ‘watch and wait’ process is inappropriate and where children and adolescents should be taken directly to hospital

The nomadic bug: a case report of salmonella septic arthritis of the sternoclavicular joint

Septic arthritis of the sternoclavicular joint is extremely rare in an otherwise healthy adult. It is reported to affect less than 0.5 % of all bone and joint infections. It usually affects immunocompromised patients or patients with a history of intravenous drug abuse. Septic arthritis of the sternoclavicular joint requires immediate treatment to prevent morbidity and mortality. Serious complications from this condition include osteomyelitis, chest wall abscess and mediastinitis. We present a rare case of sternoclavicular septic arthritis caused by Salmonella sp. in a healthy 49-year-old lady complicated with lung empyema and mediastinitis. With early detection, her condition improved with antibiotics and aspiration of the lung empyema. To our knowledge, only two previous cases of Salmonella septic arthritis of the sternoclavicular joint were reported in the literature

Unilateral branch retinal artery occlusion due to internal carotid artery occlusive disease in a young adult: a rare case report

Branch retinal artery occlusion occurs when an artery in the branch retina is blocked, most commonly due to emboli. The sensitive neural tissue of the retina is highly dependent on adequate blood flow and hypoperfusion of retinal tissue can cause visual field loss. We report a case of a 23-year-old librarian presented to us with the complaint of sudden onset painless inferior visual field loss in the right eye for three days. She had no other co-morbidities, was a non-smoker and denied any history of head and neck trauma. Clinical examination revealed vision in the right eye was 6/6 and no Marcus Gunn Pupil with Humphrey Visual Field showed hemifield respecting the vertical meridian at inferior part. IOP was 13 mmHg. Fundoscopy revealed a retinal whitening on the superior part with minimal cotton wool spots and Hollen haurst plaque at end of vessels. Left eye examination was unremarkable, with 6/6 vision. Systemic examination revealed a BP of 121/88 mmHg, no cardiac murmurs and absent carotid bruit. Blood and imaging studies were performed to determine the underlying cause of Branch Retinal Artery Occlusion. These include screening for diabetes, dyslipidemia, valvular or cardiac wall abnormalities, vasculitis, coagulopathies and carotid artery stenosis. The blood investigation results revealed that the patient was dyslipidemic. The Carotid Doppler demonstrated proximal right internal carotid artery thrombosis causing significant Internal Carotid stenosis. An urgent vascular, cardiology & haematology referral was done. Endarterectomy was not required and she was treated conservatively with aspirin and statins

Unilateral ischemic central retinal vein occlusion in a young healthy adult: a case report

Central retinal vein occlusion (CRVO) is an obstruction of central retinal vein due to the impingement from the fellow central retinal artery. It is the second most common retinal vascular disease after diabetic retinopathy. Risk factor of CRVO includes diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, male gender and age above 50 years; with 90% of the cases occurred in individual aged 55 years and above. We report a rare case of left eye ischemic CRVO in a 24-year-old healthy gentleman who later on found out to have hypercholesterolemia. He presented with a sudden onset of reduced vision of his left eye. Examination revealed visual acuity (VA) of the left eye was 6/120. Fundus examination showed marked papilloedema with dilated and tortuous blood vessels and extensive flame-shaped hemorrhages with cotton wool spots in all four retinal quadrants. There was a presence of macular edema as well. The ancillary tests confirmed the diagnosis of left eye ischemic CRVO with significant macular edema. The blood investigation revealed elevated cholesterol levels. For treatment, 6 times of monthly intravitreal Ranibizumab injections were planned for the macular edema and oral Atorvastatin 40 milligrams daily was started. Following the intravitreal Ranibizumab injection, his VA has significantly improved with a reduction of macular edema. This report highlights the importance of prompt diagnosis and investigation of CRVO, especially in the younger age group. Early treatment of macular edema secondary to CRVO is able to reduce the edema thus leads to VA improvement

A disastrous complication of colonephrocutaneous fistula: brain abscess

A rare case of colonephrocutaneous fistula complicated with a brain abscess is a lifethreatening clinical condition. We report a case of a 35-year-old lady with a history of partial left nephrectomy complicated with left colonic injury who presented with persistent vomiting associated with headache and blurry vision for 5 days. Clinically, she was confused and restless with Glasgow Coma Scale (GCS) of 12/15, however her pupils were equal and reactive bilaterally. Other neurological examinations were unremarkable. Abdominal examination noted functioning ileostomy with a skin opening at left lumbar with pus discharge. Diagnosis of brain abscess was made after contrasted computed tomography (CT) scan of brain. Urgent open drainage surgery was done followed by long course of antibiotic. Contrasted CT abdomen and fistulogram revealed a left colo-psoas and left nephrocutaneous fistula, hence, she was subjected for surgery. Intraoperatively, there was a fistula tract connecting the descending colon, remaining of left kidney, and the skin. Thus, left hemicolectomy, completion of left nephrectomy, and fistulectomy was done. The long-standing infective foci can lead to septic emboli and causes formation of abscess at distant site. Its management is challenging involving both medical and surgical therapy

The impact of covid-19 lockdown on glycemic control and lifestyle changes in children and adolescent with type 1 diabetes mellitus: a systematic review

Background: The World Health Organization has declared the SARS-CoV-2 outbreak as a pandemic on 11th March 2020. As a measure to prevent the spread of COVID-19, many countries have implemented a lockdown order. The restriction led to lifestyle changes and further affected glycaemic control in children and adolescents with type 1 diabetes mellitus. Thus, this systematic review aims to evaluate the impact of COVID-19 lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 diabetes mellitus. Method: We systematically identified studies by searching Scopus, Pubmed Central, Oxford Academy, Google Scholar, JSTOR and included 17 studies. Levels of HbA1c, blood glucose readings, time in range (TIR), time below range (TBR), time above range (TAR) and glucose standard deviation (SD) were our primary outcomes. Result: A total of 17 studies are included in our research. Regarding the glycaemic control, n=7 (41 %) studies showed significant improvement in glycaemic outcomes. However, n=3 (18 %) research noticed a deterioration of glycaemic control during the lockdown. Furthermore, there were some studies, n=7 (41%) showed no significant changes. Most of the children and adolescents with type 1 diabetes mellitus had lifestyle changes during this lockdown. It was observed that different countries demonstrate different findings in which studies from Italy and the UK show improvement while studies from KSA, Japan and Egypt show deterioration of glycaemic outcomes. Conclusion: The number of studies that showed children and adolescents with improved glycaemic control is similar to the number of studies that showed no significant changes. Thus, further research on a broader scale is recommended

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury