Urethral Polyembolokoilamania: An Unusual Manifestation of Behavioral and Psychological Symptoms of Dementia (BPSD)

Behavioral and psychological symptoms of dementia (BPSD) have varied presentations and frequently occur throughout the trajectory of dementia. Hypersexuality and general disinhibition of societal and cultural norms are commonly documented in all types of dementia. However, sparse literature exists on polyembolokoilamania (insertion of foreign objects in bodily orifices) without a sexual component as a dementia-related symptom. We review an unusual case of a 94-year-old man who presented with urethral polyembolokoilamania without hypersexuality or other behavioral disinhibition. We highlight clinical considerations of managing urethral polyembolokoilamania in an elderly patient without a previous neurocognitive disorder diagnosis. A multidisciplinary team approach with input from Internal Medicine, Urology, Psychiatry, and Neurology lead to a comprehensive assessment of a patient that could have been managed solely as a surgical case. This spearheaded a formal diagnosis of neurocognitive disorder—guiding successful management, follow-up, caregiver education, and reduction of further harm

Impacts of Supplementing Broiler Diets with Biological Curcumin, Zinc Nanoparticles and Bacillus licheniformis on Growth, Carcass Traits, Blood Indices, Meat Quality and Cecal Microbial Load

The current study aimed to investigate the influence of dietary zinc nanoparticles (ZnNPs), curcumin nanoparticles (CurNPs), and Bacillus licheniformis (Bl) on the growth, carcass, blood metabolites, and the count of some cecal microorganisms of Indian River (IR) broilers. Chicks were allotted into seven experimental groups: control group, 1st, 2nd and 3rd groups were given diets enriched with ZnNPs, CurNPs and Bl (3.0, 5.0 and 2.0 cm3/kg diet, respectively). The 4th, 5th and 6th groups were given diets supplemented with ZnNPs (3.0) + Bl (2.0) (ZP); ZnNPs (3.0) + CurNPs (5.0) (ZC) and ZnNPs (3.0) + CurNPs (5.0) + Bl (2.0) (ZCP) cm3/kg diet, respectively. The results revealed that ZnNPs and CurNPs exhibited a considerable antimicrobial activity against pathogenic bacteria and fungi. They also inhibited the growth of microbes in a range of 50–95 µg/mL. The diet supplemented with ZnNPs, CurNPs, and Bl increased the body weight compared to the control after five weeks of age. Additionally, values of daily feed intake increased in these groups; however, the feed conversion ratio decreased. All values of carcass traits were better than that of the control. The treatments led to decreased abdominal lipids compared to the control. The activity of liver enzymes and malondialdehyde (MDA) activity decreased in the treated groups. In a converse trend, the levels of oxidative enzymes, amylase, protease, lipase and immunoglobulin were higher than that of the control. Meat quality properties were improved and cecal microbial counts were decreased. In conclusion, the ZnNPs, CurNPs, and Bl improved the broiler’s weights, carcass traits, meat quality traits, as well as some blood indices and cecal microbial load. Therefore, the inclusion of ZnNPs, CurNPs, or Bl is recommended for broiler feeding regimens to improve the performance and health status

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies