Prognostic factors and outcome of management of ischemic priapism in Zaria, Nigeria

Objectives: The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Patients and Methods: We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006­2015). The data extracted included patients' age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20. Results: The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8­53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors. Conclusion: Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention

Evaluation of the microleakage of different class V cavities prepared by using Er: YAG laser, ultrasonic device and conventional rotary instruments with two dentin bonding systems: an in vitro study

The aim of this study was to evaluate the extent of microleakage in class V cavities prepared with bur, Er: YAG laser and ultrasonic, hybridized with two different bonding agents ["Single bonding", a solvent-free bonding agent, and "Swiss TEC SL bond", an alcohol-based solvent]. Thirty freshly extracted human premolars were divided into three groups of ten teeth each according to the device used in cavity preparation: Group 1] Er:YAG laser [500 mJ, 10 Hz, 63.69J/cm 2]; group 2] ultrasonic device and group 3] diamond burs. On each tooth, two cavities were prepared, one on the buccal surface and one on the lingual surface. Each group was subdivided into two subgroups of 5 teeth each according to the bonding system used: subgroup a] "Single bonding" and subgroup b] "Swiss TEC SL bond]. Cavities were restored with a micro-hybrid composite resin. After thermocycling, the specimens were immersed in 2% methylene blue solution for four hours and then sectioned in the buccolingual direction. Dye penetration was scored using a stereomicroscope. The two-way ANOVA test and paired t-test revealed no statistically significant differences among the methods of preparation [conventional, laser and ultrasonic]. However, statistical differences were found between the adhesive tested; the "Single bonding" had lower microleakage values than "Swiss TEC SL bond". Based on the results of this study it can be concluded that the Er: YAG laser and ultrasonic device are as effective as the conventional method in preparing cavities. The extent of microleakage depends on the type of the bonding agents

Iraqi children with acute bacterial meningitis... who may need ventilatory support?

Acute bacterial meningitis [ABM] is one of the most potentially serious infections occurring in infants and older children. Indications for PICU admission are shock, markedly elevated intracranial pressure [ICP], coma, and refractory seizures. [1] This cross sectional study enrolled children 2 months-12 years of age presented with [ABM] who were admitted to Children Welfare Teaching Hospital [CWTH] -Medical City- Baghdad, including those who needed Pediatric Intensive Care Units [PICUs] admission in CWTH Unit and Surgical Specialty Hospital [SSH] Unit in the period from the 1[st] of Feb 2004 to the 1[st] of Feb 2006. The diagnostic inclusion criteria of [ABM] were clinical symptoms and signs of meningitis plus a CSF neutrophilic pleocytosis with a CSF cells count of more than 5 cells/mm[3]. [1] Data included history, clinical examination, investigations, complications, PICU management, and outcome. Statistical analysis was done by using SPSS version 13.0 computer facility, Chi-square test and T test were used when needed and a P.value < 0.05 was considered significant. In the present study [ABM] in children 2 months -12 years constituted 7% of cases admitted to PICUs. The majority of cases [77.2%] were below 2 years of age. The mean age of children with [ABM] was 18.3 +/- 6.80 months. The PICU cases of [ABM] differed from the neurological ward cases in their more acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium and longer duration of stay and all these characteristics showed highly significant differences The case fatality rate of children with [ABM] is 13.3%. The study concluded the need for PICU admission in children with [ABM] with acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium, and recommended laboratory and PICU service expansion