Megameatus intact prepuce variety of hypospadias: tips for repair using the modified glanular approximation procedure

Background/purpose Megameatus and intact prepuce (MIP) is an unusual, anterior hypospadias variant. Cosmetic remodeling is usually carried out to avoid disturbing the child’s psychological state. Several approaches are used for MIP repair. The purpose of this study was to present a single institution’s experience with the modified glanular approximation procedure (GAP) in the treatment of the MIP variant of hypospadias and the tips needed to obtain the best outcome.Patients and methods Seventeen patients with MIP were repaired between May 2004 and May 2009 by the modified GAP technique. The technique was used to achieve a conical glans with a vertical slit, tip-cited meatus, and a straight urine stream. Patient/parent satisfaction was assessed by a subjective score that ranged between 0 and 3 and complications were reported.Results All patients were repaired using the modified GAP technique. The age of the patients ranged from 6 months to 28 years. Four patients were circumcised with a history of intact prepuce. An intermediate layer was added in seven patients. Excision of a part of the redundant urethral plate was carried out in six cases. Disruption of the repair occurred in one patient as a result of wound infection. Excellent cosmetic results were achieved in 14 patients (10 with a subjective score of 3 and four with a subjective score of 2). Two patients expressed an acceptable score of 1 and one patient was dissatisfied with a subjective score of 0.Conclusion Good cosmetic results, such as achievement of a straight urine stream and patient satisfaction, can be achieved using the modified GAP procedure. The steps should be tailored to individual cases.Keywords: hypospadias, megameatus, modified glanular approximation procedur

Symptomatic Non-parasitic benign hepatic cyst: Evaluation of Management by Deroofing in Ten Consecutive Cases

Background/Purpose: Solitary non-parasitic cysts of the liver are commonly asymptomatic and do not require treatment. Rarely, however, the cysts become symptomatic and are then best treated surgically. The optimal surgical treatment is debatable. The aim of this study was to evaluate the role of deroofing as a safe and effective approach in the management of simple non-parasitic hepatic cysts. Materials & Methods: From January 2002 to October 2008, 10 patients (8 females and 2 males) with histologically proven non-parasitic, benign, simple hepatic cysts underwent deroofing at Tanta University Hospital. Deroofing was achieved by open surgery in 3 cases and by laparoscopic surgery in 7 patients. The principle of both open and laparoscopic approaches was to remove as much as possible of the cyst wall, destroy the endothelial lining and pack the residual cavity with omentum. Results: All of our patients had a solitary cyst with a mean diameter of 12.5 cm (range; 9-18 cm) and all were symptomatic. The most common complaint was upper abdominal pain (n=7, 70%). Age ranged from 1 - 72 year with a median of 15 years. Three patients (30%) were treated with open deroofing while 7 patients (70%) underwent laparoscopic deroofing. One out of these 7 patients was converted to open surgery. Recurrence occurred in 2 patients but was asymptomatic and discovered on follow up because of the small diameter of recurrent cysts (3-4 cm). The follow up period ranged between 12 – 72 months (median 20 months). Conclusion: with proper selection of patients, laparoscopic deroofing of symptomatic, benign, solitary, non-parasitic hepatic cysts is safe, effective and offers all the advantages of minimally invasive surgery. Open deroofing should be reserved for cysts inaccessible by laparoscopy, when the diagnosis is in doubt and for difficulties encountered at laparoscopy.Index Word: hepatic cyst, laparoscopy

Impact of spinal anesthesia on cesarean section outcome in Omdurman maternity hospital - Sudan 2011

Background: The cesarean section is indicated when vaginal delivery is not safe for the mother or the baby.Objective: A descriptive study done in Omdurman maternity hospital–OMH to assess the impact of spinal anesthesia (SA) on cesarean section(C/S), including, intra and post operative maternal complications, neonatal outcome and patients’ satisfaction in 2011.Methodology: Women delivered by C/S under SA were included in the study after an informed consent. All women in the study were operated on by trained registrars or obstetricians, under SA given, either by anesthetist or assistant anesthetist under supervision with similar conditions andwere followed till discharge from hospital.Results: Total number of deliveries at OMH in 2011 were 30397, 21677 (71.3%) delivered vaginally, 8720 (28.7%) delivered by C/S, only 24 women (0.3%) delivered under general anaethesia- GA. Women included in the study were 1029, 517 (50.2%) were elective and 512 (49.8%) were emergency C/S. Intra- operatively, 79 women (7.7%) developed hypotension, their BP dropped by more than 30 mmHg, four women developed severe shivering for which they received intravenous 25 mg pethedine, and 44 neonates received oxygen by mask and only oneneeded endotranchial intubation. Post operatively, only two women had disabling headache, 24 women (2.4%) had episodes of vomiting and 199 (19.3%) had pain in their lower limbs, buttock and thigh, it disappeared completely before discharge. In this study, 880 women (85.5%) weresatisfied with SA, while 149 (14.5%) were not satisfied due to pain at the time of puncture, headache, or transient lower limb pain after operation.Conclusion:Spinal anesthesia is increasingly used for C/S in this hospital, with excellent patients’ satisfaction, without increase in maternal and neonatal mortality or morbidity.Key words: spinal anesthesia, Cesarean section, Suda

Evaluation Of The Essential Oil Of Foeniculum Vulgare Mill (Fennel) Fruits Extracted By Three Different Extraction Methods By Gc/Ms

Background: Hydrodistillation (HD) and steam-distillation, or solvent extraction methods of essential oils have some disadvantages like thermal decomposition of extracts, its contamination with solvent or solvent residues and the pollution of residual vegetal material with solvent which can be also an environmental problem. Thus, new green techniques, such as supercritical fluid extraction and microwave assisted techniques, are potential solutions to overcome these disadvantages.Materials and Methods: The aim of this study was to evaluate the essential oil of Foeniculum vulgare subsp. Piperitum fruits extracted by three different extraction methods viz. Supercritical fluid extraction (SFE) using CO2, microwave-assisted extraction (MAE) and hydro-distillation (HD) using gas chromatography-mass spectrometry (GC/MS).Results: The results revealed that both MAE and SFE enhanced the extraction efficiency of the interested components. MAE gave the highest yield of oil as well as higher percentage of Fenchone (28%), whereas SFE gave the highest percentage of anethol (72%).Conclusion: Microwave-assisted extraction (MAE) and supercritical fluid extraction (SFE) not only enhanced the essential oil extraction but also saved time, reduced the solvents use and produced, ecologically, green technologies.Keywords: Foeniculum vulgare subsp. Piperitum, microwave-assisted extraction (MAE), Supercritical fluid extraction (SFE), Essential Oils,Anethol, Fenchone, Limonene, Pinene, GC/MS

Neutrophil-Associated Central Nervous System Inflammation in Tuberculous Meningitis Immune Reconstitution Inflammatory Syndrome.

Background. The immunopathogenesis of tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS) remains incompletely understood, and we know of only 1 disease site-specific study of the underlying immunology; we recently showed that Mycobacterium tuberculosis culture positivity and increased neutrophils in the cerebrospinal fluid (CSF) of patients with tuberculous meningitis (TBM) are associated with TBM-IRIS. In this study we investigated inflammatory mediators at the disease site in patients with TBM-IRIS. Methods. We performed lumbar puncture at 3–5 time points in human immunodeficiency virus (HIV)–infected patients with TBM (n = 34), including at TBM diagnosis, at initiation of antiretroviral therapy (ART) (day 14), 14 days after ART initiation, at presentation of TBM-IRIS, and 14 days thereafter. We determined the concentrations of 40 mediators in CSF (33 paired with blood) with Luminex or enzyme-linked immunosorbent assays. Findings were compared between patients who developed TBM-IRIS (n = 16) and those who did not (TBM-non-IRIS; n = 18). Results. At TBM diagnosis and 2 weeks after ART initiation, TBM-IRIS was associated with severe, compartmentalized inflammation in the CSF, with elevated concentrations of cytokines, chemokines, neutrophil-associated mediators, and matrix metalloproteinases, compared with TBM-non-IRIS. Patients with TBM-non-IRIS whose CSF cultures were positive for M. tuberculosis at TBM diagnosis (n = 6) showed inflammatory responses similar to those seen in patients with TBM-IRIS at both time points. However, at 2 weeks after ART initiation, S100A8/A9 was significantly increased in patients with TBM-IRIS, compared with patients with TBM-non-IRIS whose cultures were positive at baseline. Conclusions. A high baseline M. tuberculosis antigen load drives an inflammatory response that manifests clinically as TBM-IRIS in most, but not all, patients with TBM. Neutrophils and their mediators, especially S100A8/A9, are closely associated with the central nervous system inflammation that characterizes TBM-IRIS

Vascular access in Senegalese patients starting chronic haemodialysis

Introduction: It is recommended that patients should start chronic haemodialysis using an arteriovenous fistula (AVF). We aimed to determine the proportion of Senegalese patients who used an AVF at the start of  haemodialysis and examined the factors associated with its use. Methods: We conducted a cross-sectional study from 1 June 2021 to 2 October 2021 among patients on chronic haemodialysis in 10 centres in the Dakar and Thiès regions. Clinical and laboratory data were collected from medical records and also via patient interviews. Results: The patients (n = 543) had a median age of 50 years [interquartile range (IQR) 40–62 years] and 50.6% were male. The socio-economic level was low in two-thirds of cases. The median duration of haemodialysis was 40 (IQR 17–76) months. Hypertension was noted in 92% and diabetes in 13%. Hypertensive kidney disease was the cause of kidney failure in 33%. Only 47 patients (9%) had started dialysis using an arteriovenous fistula. Factors associated with its use at haemodialysis initiation were socio-economic level (OR 0.48; 95% confidence interval (CI) 0.25–0.94 for low socio-economic level) and duration of pre-dialysis follow-up by a nephrologist for >4 months (OR 7.82; 95% CI 3.05–26.50). In 65% of prevalent patients, the vascular access used was an AVF, a tunnelled central venous catheter in 28%, an arteriovenous graft in 2% and a temporary central venous catheter in 4.4%. Conclusions: The proportion of Senegalese patients with an AVF at the start of haemodialysis was low. AVF use was associated with socio-economic level and pre-dialysis follow-up by a nephrologist for >4 months

Mild Behavioral Impairment as a Marker of Cognitive Decline in Cognitively Normal Older Adults

This is the author accepted manuscript. the final version is available from Elsevier via the DOI in this recordObjective: Mild Behavioral Impairment (MBI) is a neurobehavioural syndrome characterized by later life emergent neuropsychiatric symptoms (NPS) which represent an at-risk state for incident cognitive decline and dementia in people with Mild Cognitive Impairment. We undertook a study to determine whether MBI was associated with progressive changes in neuropsychological performance in people without significant cognitive impairment. Methods: 9,931 older adults enrolled in the PROTECT study who did not have MCI or dementia undertook a comprehensive neuropsychological battery measuring attention, reasoning, executive function and working memory at baseline and one year. MBI was ascertained using self-administration of the MBI-C at one year, and participants grouped according to MBI status: no symptoms, intermediate neuropsychiatric symptoms and MBI. All assessments were completed online and data analyzed using MMRM ANOVA. Results: 949 (10%) people had MBI. These individuals had significantly worse cognitive performance at baseline and significantly greater decline over one year in the four composites cognitive scores measuring attentional intensity (F(2,8578)=3.97,p=0.019), sustained attention (F(2,8578)=18.63, p<.0001), attentional fluctuation (F(2,8578)=10.13, p=<.0001) and working memory F(2,9895)=13.1, p<.0001. Conclusions: Our novel findings show that MBI is associated with faster decline in attention and working memory in this cognitively normal sample. MBI may be an earlier marker of neurodegenerative disease than MCI, captured at the stage of SCD or before, raising the possibility that MBI represents a novel target for dementia clinical trials or prevention strategies.National Institute for Health Research (NIHR

Rare recurrence of a rare ovarian stromal tumor with luteinized cells: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sex cord-stromal tumors of the ovary are uncommon. They behave unpredictably and often have a late recurrence, making counseling, management, and prediction of prognosis challenging.</p> <p>Case presentation</p> <p>A 52-year-old Moroccan woman with an sex cord-stromal tumors underwent a bilateral oophorectomy. The histology was unusual but was likely to be a luteinized thecoma with suspicious features for invasion. Seven years later, after a gastrointestinal bleed, a metastasis within the small bowel mucosa was detected. This represents probable isolated hematogenous or lymphatic spread, which is highly unusual, especially in the absence of concurrent peritoneal disease.</p> <p>Conclusions</p> <p>To the best of our knowledge, this is the second reported case of an sex cord-stromal tumors recurring in small bowel mucosa and mimicking a primary colorectal tumor. This highlights the diverse nature and behavior of these tumors.</p

Relationship between parental locus of control and caries experience in preschool children – cross-sectional survey

Background: Due to high prevalence and serious impacts, childhood caries represents a public health issue. Behavioural risk factors such as locus of health control have been implicated in the development of the disease; however their association with childhood caries has not been thoroughly studied. The aim of this cross-sectional survey was to assess the relationship between parental locus of health control and caries experience and untreated caries of their preschool children in a representative sample in Czech Republic, adjusting for relevant sociodemographic characteristics. Methods: A representative sample of 285 preschool children and their parents was recruited. Study data included children's dental status recorded in nurseries and parental questionnaires with 13 attitudinal items regarding locus of control (LoC) in caries prevention. The association between parental locus of control and children's caries experience and level of untreated caries was analysed using logistic regression, adjusting for the effect of key sociodemographic variables. Results: There was a statistically highly significant linear trend between increased parental LoC and higher probability of the children to be free from untreated caries, independent from the effect of sociodemographic variables of children and parents. A similar highly statistically significant trend, although not entirely linear, and independent from sociodemographic variables was observed with respect to the chance of the children to be free from caries experience with increasing strength of parental LoC. After full adjustment, children in the strongest parental LoC quintile were 2.81 (1.23–6.42, p< 0.05) times more likely to be free from untreated caries in comparison to the weakest parental LoC quintile and 2.32 (1.02–5.25, p< 0.05) times more likely to be free from caries experience in comparison to the weakest parental LoC quintile. Conclusion: The findings support the hypothesis that higher internal parental LoC is associated with better control of both untreated caries and caries experience in their preschool children and highlight that a more internal LoC within the family is advantageous in the prevention of dental caries