Clinical outcome of pediatric and young adult subclinical varicoceles: a single-institution experience / 亚洲男科学杂志(英文版)

Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. As there is limited information on long-term outcome of subclinical varicoceles due to challenges in diagnosis and management, we performed a single-institution, retrospective review of patients from October 1999 to October 2014 with subclinical varicocele and with available US studies reviewed by a single radiologist. Subclinical varicocele was defined as dilation of the pampiniform venous plexus on US involving ≥2 vessels with diameter >2.5 mm, without clinical varicocele on physical examination or prior inguinal surgery. Thirty-six of 98 patients identified were confirmed as having a subclinical varicocele and analyzed. The mean age at initial visit was 15.5 years, with a mean follow-up of 26.5 months. The majority were right-sided (69.4%, n = 25), usually with a contralateral clinical varicocele. Testicular asymmetry (>20% volume difference of the affected side by testicular atrophy index formula) was assessed in 9 patients with unilateral subclinical varicocele without contralateral clinical or subclinical varicocele and observed in 1 patient. Of 17 patients with follow-up, 3 (17.6%) progressed to clinical varicocele without asymmetric testicular volume, as most remained subclinical or resolved without surgery. In our experience, subclinical varicoceles appeared unlikely to progress to clinical varicoceles, to affect testicular volume, or to lead to surgery. Although our study is limited in numbers and follow-up, this information may aid clinical management strategies and guide future prospective studies.

Seroprevalence of chikungunya virus infection in five hospitals within Anyigba, Kogi State of Nigeria

ABSTRACT Febrile illnesses in developing countries are often misdiagnosed as malaria or typhoid fever. Although arboviral infections have similar clinical symptoms, they are usually not screened because of limited resources and the fact that there are several viruses in this group. Chikungunya virus (CHIKV) has been isolated in parts of Nigeria, but there is no documented evidence of the infection in Kogi State. This study determined seroprevalence of active and past CHIKV infection among febrile patients who tested negative for malaria and typhoid fever. Sera from 243 febrile patients were screened for CHIKV IgG and IgM using an immunochromatographic test kit. Clinical and socio-demographic variables were collected using a structured questionnaire. Recent CHIKV infection was observed in 5.8% of the study participants while 25.1% had IgG antibodies demonstrating previous infection. Significant associations were observed between seropositivity and age of participants (p < 0.001), sex (p = 0.044), marital status (p = 0.002), and occupation (p < 0.001). Clinical symptoms such as fever, joint pain, and headache were significantly associated with seropositivity. This study identified recent CHIKV infection in Anyigba. Therefore, there is need for routine screening of febrile patients and molecular characterization to determine the nature of circulating strains.

Associations of Perirenal Fat Thickness with Renal and Systemic Calcified Atherosclerosis

BACKGROUND@#We investigated associations between perirenal fat thickness and atherosclerotic calcification in six different vascular beds.@*METHODS@#Using a community-based cohort (n=3,919), perirenal fat thickness was estimated from computed tomography scans. It was classified as Q1 (the lowest quartile) to Q4 (the highest quartile) in each sex. Calcification in the carotid arteries, coronary arteries, thoracic aorta, abdominal aorta, iliac arteries, and renal arteries was evaluated.@*RESULTS@#Perirenal fat thickness was associated with older age (P<0.01) and a higher prevalence of obesity, hypertension, and dyslipidemia (P<0.01 for all). Perirenal fat thickness was independently associated with renal arterial calcification even after adjustment for age, sex, body mass index, hypertension, dyslipidemia, smoking history, and family history of heart diseases in first-degree relatives (odds ratio [OR] per quartile of perirenal fat thickness, 1.25; 95% confidence interval [CI], 1.09 to 1.44). Compared to Q1, the odds of renal arterial calcification in Q4 was about two times higher (OR, 2.05; 95% CI, 1.29 to 3.25). After adjustment for renal arterial calcification and atherosclerotic risk factors, the only other vascular bed where perirenal fat thickness showed a significant association with calcification was the abdominal aorta (OR, 1.11; 95% CI, 1.00 to 1.23; P=0.045).@*CONCLUSION@#Perirenal fat thickness was independently associated with vascular calcification in the renal artery and abdominal aorta.

Aberrant anatomy in endodontically treated teeth in a Nigerian Teaching Hospital

Objective: The anatomical features of teeth show wide morphological variations. These variations include coronal and radicular aberrations. They are thought to be influenced by age, gender, race and evaluation methods. Therefore, an in-depth knowledge of both normal and unusual dental morphology is vital in the practice of endodontics. The objective of the study was to investigate the incidence of aberrant root anatomy in endodontically treated teeth among adult patients attending the Endodontic unit of a tertiary hospital in Southern Nigeria. Methods: A retrospective review of all clinical records of adult patients who attended the Endodontic unit of the Department of Restorative Dentistry, University of Benin Teaching Hospital (UBTH) Edo State, Nigeria from January 2013 to January 2018 for root canal treatment (RCT). The demographic and clinical data were retrieved from the patients' records and analyzed using IBM SPSS version 20. Results: A total of 927 patients, comprising445 (48.0%) males and 482 (52.0%) females (a ratio of 1:1.1) underwent endodontic treatment during the study period. The age range of patients was 18-80 years. The total number of teeth treated was 1016. Aberrant root anatomy was observed in 161 (15.8%) of the studied sample. It was more frequently seen in mandibular 118 (29.9%) than maxillary 43 (6.9%) teeth. Aberrant root anatomy occurred most frequently in mandibular second molars 42 (38.9%) followed by the maxillary first molars 32 (38.1%). These aberrations were observed in the roots and canal numbers of treated teeth while the occurrence of aberrant anatomy was higher in females (9.9%) than males (5.9%). Conclusion: In this study, aberrant root anatomies were mostly observed in mandibular teeth and among female patients. Clinicians should be aware of the existence of wide variations in root form and canal morphology during endodontic procedures. The alertness is helped by the use of Dental operating microscopes or other magnification devices, multiple periapical radiographs with angular cone shift or other contemporary imaging modalities in revealing tooth anatomy that would otherwise be missed

Shade selection practices amongst clinical dental students in South Western Nigeria

Objective: Shade selection is crucial in satisfying aesthetic demands of patients during cosmetic dental treatment. It is important to nurture and evaluate this act in students as future dental professionals. This study aimed to evaluate the understanding and practice of tooth shade matching amongst dental students. Methods: A descriptive cross-sectional study was carried out in South-Western Nigeria. A structured, self-administered questionnaire was given to clinical dental students to garner information on socio-demographics, knowledge and practice of shade selection. The resulting data were statistically tested using chi-square with p-value ≤ 0.05 indicating significant level. Results: There was 76.5% response rate to the questionnaires with the male subjects accounting for 52.3%. The mean age of participants was 24.2 ± 2.4 years. Majority (40.9%) did not know the ideal time required for shade selection. Most (57.9%) students used visual/manual method in shade selection but 63.6% of these did not know the name of the shade guide used. Majority (80.8%) select the shade before commencing restorative procedure. Less than half (36.4%) of participants performed tooth shade matching in 3 segments (from incisal-third to cervical-third) while 54.5% considered tooth shade as a single uniform colour. Most students, 67.4% had a fair knowledge of shade matching while 13.6% practiced good shade matching technique for restorations/prosthesis. There was a statistically significant difference (p=0.022) between shade selection practice and the clinical training levels of students. Conclusion: The dental students had a fair knowledge about the principles of shade selection but lack the clinical know-how

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients / 대한소아소화기영양학회지

Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.

Endodontic treatment: an analysis of demand by adult patients in a tertiary hospital in Southern Nigeria

Objective: An increase in dental awareness and need to maintain good oral health, in a growing population will necessitate an increased demand for root canal treatment (endodontic treatment). In emerging economies like Nigeria, the trend appears similar to what obtains in more developed economies where patients are keen on retaining their teeth. The objective was to determine the reasons for endodontic treatment and pattern of demand for treatment among adult patients attending the Endodontic unit of a tertiary hospital in Southern Nigeria.Methods: A retrospective review of all clinical records of adult patients who attended the Endodontic unit of the Department of Restorative Dentistry, University of Benin Teaching Hospital (UBTH) Edo State, Nigeria from January 2012 to December 2014 for root canal treatment (RCT). The demographic and clinical data were retrieved from the patients' records and analyzed using Results: A total of 485 patients, comprising 226(46.6%) males and 259(53.4%) females (a ratio of 1:1.4) underwent endodontic treatment during the study period. The age range of patients was 18-68 years. In the studied population, the highest demand for endodontic treatment 219(45.2%) was among the 20-29 years age range. The commonest indication for RCT was irreversible pulpitis (48.4%). The total number of teeth treated was 522. More posterior teeth 338(64.8%) were treated than anteriors 184(35.2%). The mandibular first molar 96(18.4%) was the most frequently treated tooth. More maxillary teeth 332(63.6%) underwent RCT than mandibular teeth 190(36.4%).Endodontic treatment was mostly completed in multiple visits 439(84.1%). A total of 279 (57.5%) patients had their treatments covered by the National Health Insurance Scheme (NHIS). Out of pocket payments accounted for 40.2% of patients who had endodontic treatment.Conclusion: There was a greater demand for root canal treatment among female and young adult patients. Most of the procedures were performed on maxillary teeth while the mandibular first molar was the most frequently treated tooth

Andodontic treatment: an analysis of demand by adult patients in a tertiary hospital in southern nigeria

Objective: An increase in dental awareness and need to maintain good oral health, in a growing population will necessitate an increased demand for root canal treatment (endodontic treatment). In emerging economies like Nigeria, the trend appears similar to what obtains in more developed economies where patients are keen on retaining their teeth. The objective was to determine the reasons for endodontic treatment and pattern of demand for treatment among adult patients attending the Endodontic unit of a tertiary hospital in Southern Nigeria. Methods: A retrospective review of all clinical records of adult patients who attended the Endodontic unit of the Department of Restorative Dentistry, University of Benin Teaching Hospital (UBTH) Edo State, Nigeria from January 2012 to December 2014 for root canal treatment (RCT). The demographic and clinical data were retrieved from the patients' records and analysed using SPSS version 20. Results: A total of 485 patients, comprising 226(46.6%) males and 259(53.4%) females (a ratio of 1:1.4) underwent endodontic treatment during the study period. The age range of patients was 18-68 years. In the studied population, the highest demand for endodontic treatment 219(45.2%) was among the 20-29 years' age range. The commonest indication for RCT was irreversible pulpitis (48.4%). The total number of teeth treated was 522. More posterior teeth 338(64.8%) were treated than anterior 184(35.2%). The mandibular first molar 96(18.4%) was the most frequently treated tooth. More maxillary teeth 332(63.6%) underwent RCT than mandibular teeth 190(36. 4%).Endodontic treatment was mostly completed in multiple visits 439(84.1%). A total of 279 (57.5%) patients had their treatments covered by the National Health Insurance Scheme (NHIS). Out of pocket payments accounted for 40.2% of patients who had endodontic treatment. Conclusion: There was a greater demand for root canal treatment among female and young adult patients. Most of the procedures were performed on maxillary teeth while the mandibular first molar was the most frequently treated tooth

DNA barcoding reveals the diversity of sharks in Guyana coastal markets

A fundamental challenge for both sustainable fisheries and biodiversity protection in the Neotropics is the accurate determination of species identity. The biodiversity of the coastal sharks of Guyana is poorly understood, but these species are subject to both artisanal fishing as well as harvesting by industrialized offshore fleets. To determine what species of sharks are frequently caught and consumed along the coastline of Guyana, we used DNA barcoding to identify market specimens. We sequenced the mitochondrial co1 gene for 132 samples collected from six markets, and compared our sequences to those available in the Barcode of Life Database (BOLD) and GenBank. Nearly 30% of the total sample diversity was represented by two species of Hammerhead Sharks (Sphyrna mokarran and S. lewini), both listed as Endangered by the International Union for Conservation of Nature (IUCN). Other significant portions of the samples included Sharpnose Sharks (23% - Rhizoprionodon spp.), considered Vulnerable in Brazilian waters due to unregulated gillnet fisheries, and the Smalltail Shark (17% - Carcharhinus porosus). We found that barcoding provides efficient and accurate identification of market specimens in Guyana, making this study the first in over thirty years to address Guyana's coastal shark biodiversity.(AU)

Um desafio fundamental para a pesca sustentável e a proteção da biodiversidade nos neotrópicos é a identificação precisa das espécies. A biodiversidade dos tubarões costeiros da Guiana é pouco compreendida, porém essas espécies estão sujeitas tanto à pesca artesanal quanto à pesca industrializada não costeira. Para determinar quais espécies de tubarões são frequentemente capturadas e consumidas ao longo do litoral da Guiana, utilizamos DNA barcoding para identificar espécimes comumente encontrados e adquiridos em mercados. Nós sequenciamos o gene mitocondrial coI para 132 espécimes adquiridos de seis mercados e comparamos estas sequências com as disponíveis no Barcode of Life Database (BOLD) e GenBank. Quase 30% da diversidade total amostrada foi constituída por duas espécies de tubarões martelo (Sphyrna mokarran e S. lewini), ambas listadas como espécies ameaçadas pela UICN. Outras porções significativas da amostragem incluem Cações-Frango (23% - Rhizoprionodon spp.), considerados vulneráveis em águas brasileiras, devido a pesca de arrasto não regulamentada, e o Cação-azeiteiro (17% - Carcharhinus porosus). Descobrimos que o barcoding é uma forma identificação eficiente e precisa para espécimes de mercado na Guiana, tornando este estudo o pioneiro na documentação da biodiversidade dos tubarões costeiros da Guiana.(AU)

Comparison of Vertebroplasty, Kyphoplasty, and Nonsurgical Management of Vertebral Compression Fractures and Impact on US Healthcare Resource Utilization

STUDY DESIGN: Retrospective propensity score-matched cohort analysis of the Thomson Reuters MarketScan database. PURPOSE: To compare the outcomes of vertebral compression fracture (VCF) treatment options, with an emphasis on reoperation, complications, costand overall healthcare resource use between 2005 and 2009 in the United States. OVERVIEW OF LITERATURE: Options for the treatment of VCFs include conservative management, kyphoplasty, and vertebroplasty. The cost-effectiveness of surgical intervention for VCF has been criticized, and some suggest their outcomes to be similar to placebo. METHODS: Patients 18 years of age and older who developed a VCF were identified and separated into three treatment cohorts: vertebroplasty, kyphoplasty, and non-surgical. Propensity score matching was performed to match patients between cohorts. Main outcomes assessed included reoperation, complications, healthcare resource use and associated cost. Outcomes were compared at three separate time intervals (patients at index hospitalization; patients with at least 2-year follow-up data; and those with at least 4-year follow-up data). RESULTS: Twenty thousand seven hundred forty patients were identified with VCFs, yielding 7,290 after propensity score matching. The mean age of the patients was 78+/-12 years; and 5,507 (75.5%) were female. All reoperation rates ranged from 6%-17%, while complication rates ranged from 7%-10%, which did not differ significantly among the three cohorts at all follow-up periods. Overall costs were noted to be significantly greater in both the kyphoplasty and vertebroplasty groups at 1-year follow-up, not at 2-year and 4-year follow-up. CONCLUSIONS: Our data suggests that the treatment of a VCF patient will likely be associated with similar long-term operative and complication rates regardless of treatment modality.

Relationship between left ventricular diastolic function and geometric patterns in Nigerians with newly diagnosed systemic hypertension

Background: It is not known whether abnormalities of left ventricular diastolic function are influenced by the various cardiac geometric patterns in Nigerians with newly diagnosed systemic hypertension. Objective: To evaluate the relationship between the parameters of left ventricular diastolic function and the geometric patterns in this group of patients. Methods: Two-dimensional; guided M-mode echocardiography including Doppler was performed in 150 consecutive; newly diagnosed hypertensive individuals and normotensive controls aged between 35 and 74 years. Left ventricular mass index and relative wall thickness were used to classify the hypertensive individuals into four geometric patterns; and the pulsed-wave Doppler parameters obtained were used to categorise the abnormalities of diastolic function. Results: Four left ventricular geometric patterns were identified : 23 (15.3) had normal left ventricle geometry; 33 (22) had concentric remodelling; 37 (24.7) were found to have eccentric hypertrophy; and concentric hypertrophy occurred in 57 (38) of the hypertensive individuals. Left ventricular diastolic dysfunction occurred more in hypertensives with concentric left ventricular geometric pattern.Increased left ventricular mass index and relative wall thickness were found to be associated with the mitral E-wave; E/A ratio and pulmonary venous flow S-wave in the hypertensives (p 0.001). Conclusion: In newly diagnosed Nigerian hypertensives; the abnormalities in left ventricular diastolic function varied between the different left ventricular geometric patterns; being worst in those with concentric geometry

Ca2+ entry, efflux and release in smooth muscle

Control of smooth muscle is vital for health. The major route to contraction is a rise in intracellular [Ca2+], determined by the entry and efflux of Ca2+ and release and re-uptake into the sarcoplasmic reticulum (SR). We review these processes in myometrium, to better understand excitation-contraction coupling and develop strategies for preventing problematic labours. The main mechanism of elevating [Ca2+] is voltage-gated L-type channels, due to pacemaker activity, which can be modulated by agonists. The rise of [Ca2+] produces Ca-calmodulin and activates MLCK. This phosphorylates myosin and force results. Without Ca2+ entry uterine contraction fails. The Na/Ca exchanger (NCX) and plasma membrane Ca-ATPase (PMCA) remove Ca2+, with contributions of 30 percet and 70 percet respectively. Studies with PMCA-4 knockout mice show that it contributes to reducing [Ca2+] and relaxation. The SR contributes to relaxation by vectorially releasing Ca2+ to the efflux pathways, and thereby increasing their rates. Agonists binding produces IP3 which can release Ca from the SR but inhibition of SR Ca2+ release increases contractions and Ca2+ transients. It is suggested that SR Ca2+ targets K+ channels on the surface membrane and thereby feedback to inhibit excitability and contraction.