Scoping review of the recommendations and guidance for improving the quality of rare disease registries.

BACKGROUND: Rare disease registries (RDRs) are valuable tools for improving clinical care and advancing research. However, they often vary qualitatively, structurally, and operationally in ways that can determine their potential utility as a source of evidence to support decision-making regarding the approval and funding of new treatments for rare diseases. OBJECTIVES: The goal of this research project was to review the literature on rare disease registries and identify best practices to improve the quality of RDRs. METHODS: In this scoping review, we searched MEDLINE and EMBASE as well as the websites of regulatory bodies and health technology assessment agencies from 2010 to April 2023 for literature offering guidance or recommendations to ensure, improve, or maintain quality RDRs. RESULTS: The search yielded 1,175 unique references, of which 64 met the inclusion criteria. The characteristics of RDRs deemed to be relevant to their quality align with three main domains and several sub-domains considered to be best practices for quality RDRs: (1) governance (registry purpose and description; governance structure; stakeholder engagement; sustainability; ethics/legal/privacy; data governance; documentation; and training and support); (2) data (standardized disease classification; common data elements; data dictionary; data collection; data quality and assurance; and data analysis and reporting); and (3) information technology (IT) infrastructure (physical and virtual infrastructure; and software infrastructure guided by FAIR principles (Findability; Accessibility; Interoperability; and Reusability). CONCLUSIONS: Although RDRs face numerous challenges due to their small and dispersed populations, RDRs can generate quality data to support healthcare decision-making through the use of standards and principles on strong governance, quality data practices, and IT infrastructure.

Prevalence and Distribution of Postvoid Residual Urine Volume in a Hospital-Based Sample of Men with Symptomatic Benign Prostatic Hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a known cause of bladder outlet obstruction (BOO) in aging men. Patients present with lower urinary tract symptoms (LUTS), elevated postvoid residual urine (PVR), and reduced peak flow rate of urine. Although urodynamic study is the gold standard for diagnosing and quantifying BOO, it is invasive and as such urologists in their routine practice frequently rely on less invasive methods like PVR estimation to objectively assess BOO. AIM: To study the prevalence and distribution of PVR in a hospital-based population of men with symptomatic BPH. MATERIALS AND METHODS: Patients aged 40 years and above were enrolled for the study. History was taken from each of the 170 participants recruited, and physical examination was done including digital rectal examination. Every one of them completed the International Prostate Symptom Score (IPSS) questionnaire and also had ultrasonography assessment of PVR. Relevant laboratory investigations (PSA, renal function test, full blood count, urinalysis, and urine culture) and uroflowmetry to determine the peak flow rate of urine (Qmax) were done. RESULTS: A total of 170 subjects who met the inclusion criteria were enrolled for this study. The mean age of the subjects was 63.70 ± 9.92 years with a range of 42-88 years. The subjects had a mean PSA of 2.68 ± 0.91 ng/ml and a mean prostate volume of 70.8 ± 39.5 ml. The prevalence of significant PVR was 57.06%. The distribution of PVR was skewed with values ranging from 4.0 ml to 382.9 ml, a median value of 60.5 ml (interquartile range, IQR, =25.0-100.76), and a mean value of 77.70 ± 69.30 ml. An IPSS range of 8 to 23 with a mean value of 13.64 ± 4.14 and a median value of 13 (interquartile range = 10.0-16.0) was observed. The Qmax range was from 5 ml/s to 50 ml/s with a mean value of 20.25 ± 9.70 ml/s, and a median value of 18.0 ml/s (interquartile range = 14.0-24.0). CONCLUSION: This study showed that the prevalence of significant PVR volume among men with symptomatic BPH in our environment is high. There was also a high variation in the distribution of PVR among the subjects. Therefore, it is essential to create more public awareness especially among men in their fourth decade of life and above to visit a urologist whenever they have BPH symptoms so as to avoid impairment in quality of life and renal function associated with neglected significant PVR.

Carbapenem resistance associated with coliuria among outpatient and hospitalised urology patients.

The World Health Organization in 2017 listed carbapenem resistant Enterobacteriaceae (CRE) with critical priority for research. A research to assess carbapenem resistant Escherichia coli (CREc) in coliuria among the outpatients and inpatients of a tertiary health institution was carried out using conventional methods, polymerase chain reaction, Sanger sequencing, and bioinformatics. There were 39 positive coliuria cases from the urine samples collected from a total of 126 patients with various genitourinary diseases. The E. coli enumeration (log10 CFU/mL) revealed that 82.1% (n = 32) of the samples showed significant coliuria, 12.8% (n = 5) showed non-significant coliuria while 5.1% (n = 2) showed indeterminate coliuria even when repeated. Significantly higher numbers (p > 0.05) of the sampled inpatients yielded positive coliuria (57.9%) than the outpatients. Though there were significantly more (P > 0.05) urology female patients (n = 77) than male (n = 49), coliuria was more prevalent in sampled male patients (34.9%) than female (28.6%). Highest prevalence of coliuria was observed among the age range (18-30) years. Selected CREc that was sequenced and the sequences submitted to GenBank of National Center for Biotechnological Information (NCBI) were Escherichia coli AYO-WINI111 and Escherichia coli AYO-WINI112 with accession number MT735391 and MT735392, respectively. High resistance was observed against ertapenem (53%), imipenem (62%), meropenem (48%), and doripenem (47%), while 7%-22% of the isolates showed phenotypic intermediate carbapenem resistance. Critically dangerous CREc are harboured by large number urology patients in the study area, depicting the need for more attention in the management of the condition, as CREc are close to achieving totally antibiotic resistance.

Global research trends on bioflocculant potentials in wastewater remediation from 1990 to 2019 using a bibliometric approach.

The preference of biofloculants over chemical flocculants in water and wastewater remediation systems has gained wider attention due to their biodegradability, innocuousness, safety to human and environmental friendliness. The present study aimed to evaluate research outputs on bioflocculant potentials in wastewater remediation from 1990 to 2019 using bibliometric analyses. To the best of our knowledge, this is the first bibliometric report in bioflocculant research. The subject bibliometric dataset was extracted from the Web of Science Core Collection (WoSCC) and Scopus using the Boolean, 'bioflocculant* and waste*' and analysed for indicators such as a yearly trend, productivity (authors, articles, country, institution and journal source), conceptual framework and collaboration network. We found 119 documents with 347 authors from 78 journal sources on the subject, an annual growth rate of 12·1%, and average citations/document of 15·08. Guo J. and Wang Y. were the top researchers with 15 and 12 outputs respectively. China (42%) and South Africa (9·24%) ranked the top two dominant countries in the field. The top journals were Bioresource Technology (9 papers, 506 citations), Applied Microbiology and Biotechnology (5 papers, 268 citations), whereas, the top institution was Chengdu University of Information and Technology (n = 9 documents) followed by Sichuan Univ. Sci. & Engn, China (n = 8 documents). This study found that lack of intercountry collaboration and research funding adversely affects research participants in the field.

Seasonal Shift in Physicochemical Factors Revealed the Ecological Variables that Modulate the Density of Acinetobacter Species in Freshwater Resources.

Certain environmental variables are responsible for the survival of microorganisms in aquatic environments. The influence of these environmental factors in each season (winter, autumn, spring and summer) of the year can be used to track changes in a microbial population in freshwater resources. In this study, we assessed the effect of seasonal shifts in environmental variables including temperature, pH, total dissolved solids (TDS), total suspended solids (TSS), biochemical oxygen demand (BOD) and turbidity (TBS) among others on the density of Acinetobacter species in the Great Fish, Keiskamma and Tyhume rivers in the Eastern Cape Province, South Africa. Water samples and values of the environmental factors were taken from the rivers for 12 months. The density of presumptive Acinetobacter species was estimated from the culture of water samples on a CHROMagar selective medium, while the Acinetobacter-specific recA gene was targeted for the identification of Acinetobacter species using PCR assay. The multivariate relationship between seasons and changes in variables was created using PCA, while the effect of seasonal shifts in the environmental variables on the density of Acinetobacter species was evaluated using correlation test and topological graphs. Positive association patterns were observed between the seasons, environmental factors and the bacterial density in the rivers. In addition, temperature, TBS, TSS and BOD tended to influence the bacterial density more than other physicochemical factors in the rivers across the seasons. Of the total 1107 presumptive Acinetobacter species, 844 were confirmed as Acinetobacter species. Therefore, these findings suggested that the rivers contain Acinetobacter species that could be useful for basic and applied study in ecology or biotechnology, while their clinical relevance in causing diseases cannot be underestimated.

Detection of antibiotic resistance and virulence genes of Vibrio strains isolated from ready-to-eat shrimps in Delta and Edo States, Nigeria.

AIM: The current study was conducted to determine the incidence, antibiotic resistance and virulence genes of Vibrio strains isolated from ready-to-eat shrimps in Edo and Delta States, Nigeria. METHODS AND RESULTS: A total of 1440 ready-to-eat shrimp samples were obtained from open markets from November 2016 to October 2017 and analysed using standard culture-based procedures. Overall, our result showed that the ready-to-eat shrimp samples had high mean aerobic mesophilic bacterial count between 3·543 and 7·489 log10 CFU per gram. Vibrio cell densities ranged between 0·663 and 6·761 log10 CFU per gram. From the total samples, 1343/1440 (93·3%) were positive for Vibrio species where 120 Vibrio isolates were randomly selected and confirmed using genus- and species-specific PCR approach. The PCR identification revealed the presence of Vibrio parahaemolyticus 46 (38·33%), Vibrio vulnificus 14 (11·67%), Vibrio fluvialis 12 (10%), Vibrio alginolyticus 8 (6·67%), Vibrio cholerae 2 (1·67%), Vibrio mimicus 10 (8·33%), Vibrio harveyi 3 (2·5%) and other Vibrio sp. 25 (20·83%). All Vibrio isolates were sensitive to colistin and gentamycin with varying percentage of resistance to other antibiotics used in the study. Multiple antibiotic-resistant (MAR) index ranged from 0·08 to 0·83. The tcp, tdh and trl virulence genes were identified in 95 (79·2%), 92 (76·7%) and 95 (79·2%) of the examined isolates respectively. Antibiotic-resistant genes also revealed the presence of class 1 integrase 75 (62·5%), sul2 87 (72·5%), strB 94 (78·3%) and catB3 68 (56·7%). CONCLUSION: Our findings revealed that the ready-to-eat shrimps may serve as potential reservoirs and medium in the dissemination of prospective MAR pathogens to the consumers and thus constitute a potential risk to public health. SIGNIFICANCE AND IMPACT OF THE STUDY: The findings from this study represent the first comprehensive report of Vibrio isolates from ready-to-eat shrimps in Edo and Delta States, Nigeria. Incessant monitoring of Vibrio strains and their predisposition to antimicrobials is a necessity to guarantee seafood safety and guarantee the best treatment regimen for patients with gastroenteritis.

Distribution and Chemical Analysis of Pharmaceuticals and Personal Care Products (PPCPs) in the Environmental Systems: A Review.

PPCPs are found almost everywhere in the environment especially at an alarming rate and at very low concentration in the aquatic systems. Many methods-including pressurized hot water extraction (PHWE), pressurized liquid extraction (PLE), ultrasound-assisted extraction (UAE), and micro-assisted extraction (MAE)-have been employed for their extraction from both surface waters and biota. Solid-phase extraction (SPE) proved to be the best extraction method for these polar, non-volatile, and thermally unstable compounds in water. However, ultrasonic extraction works better for their isolation from sediment because it is cheap and consumes less solvent, even though SPE is preferred as a clean-up method for sediment samples. PPCPs are in groups of-acidic (e.g., diclofenac, ibuprofen, naproxen), neutral (e.g., caffeine, carbamazepine, fluoxetine), and basic pharmaceuticals, as well as antibiotics and estrogens amongst others. PPCPs which are present in trace levels (ng/L) are more often determined by liquid chromatography-mass spectrometry (LC-MS), gas chromatography-mass spectrometry (GC-MS), and high-performance liquid chromatography-ultraviolent (HPLC-UV). Of these, LC-MS and LC-MS-MS are mostly employed for the analysis of this class of compounds, though not without a draw-back of matrix effect. GC-MS and GC-MS-MS are considered as alternative cost-effective methods that can also give better results after derivatization.

Production of polyextremotolerant laccase by Achromobacter xylosoxidans HWN16 and Citrobacter freundii LLJ16.

Given the upwelling of a variety of potential applications laccases could participate in, it would be fitting to equally make available laccases that are well suited for the aforementioned. Therefore historian understanding of the catalytic and physicochemical properties is desirable. Owing to this, the biochemical properties of the crude laccases from Achromobacter xylosoxidans HWN16 (Hb9c) and Citrobacter freundii LLJ 16 (Ie1c) were assessed. Furthermore, a hint of the molecular basis for their production from respective organisms was presented. Results showed that both laccases were tolerant, and sometimes had their activities improved by the set of parameters tested. They were active at broad range of temperature (0-90 °C), pH (3-11), and were equally thermo- and pH-stable. Their activities were either improved, or left unabated by cations, detergents, and chloride (5-40%), however, the highlight of the study was their augmented activity, when they were incubated with certain concentrations of fluoride (2-20%), a potent inhibitor. They were depicted to have multiple homologous laccase encoding genes, on molecular evaluation, which may be responsible the conferral of these remarkable qualities they possess. Therefore, the laccases might be beneficial, if employed in formulations for a wide range of environmental and biotechnological applications. Moreover, the molecular machinery of their production be exploited for economical benefits in the immediate future.

National Trends and Outcomes of Patients Bridged to Transplant With Continuous Flow Left Ventricular Assist Devices.

BACKGROUND: Continuous flow left ventricular assist devices (CF-LVAD) are widely used as a bridge to transplantation (BTT) among patients with advanced heart failure. The primary outcome of the current study was to study the incidence of waitlist mortality and morbidity of CF-LVAD patients bridged to heart transplantation in the current BTT era and to determine the factors that increased their risk of delisting. METHODS: Patients who were bridged to heart transplant with a CF-LVAD between April 2008 and September 2015 were identified from the United Network for Organ Sharing heart transplant registry. They were then categorized based on the development of complications. Cox proportional hazards and Kaplan-Meier survival curves were used for time-to-event analysis for the primary outcome. RESULTS: Out of 7070 patients who were bridged to heart transplant, 2510 (36%) developed device-related complications. The primary outcome was present in 1631 of 7070 patients (23%). Independent predictors of primary outcome were age, ABO blood group, etiology of cardiomyopathy, and history of diabetes mellitus. Developing one device-related complication was associated with a hazard ratio (HR) of 2.59 of having the primary outcome. The HR increased to 3.45 when ≥2 of the defined complications occurred. In patients who developed the primary outcome, they most likely had a device infection (odds ratio 2.51). CONCLUSION: Findings from the current study add to the existing literature about the incidence of morbidity and mortality in the current BTT era. Development of one device-related complication increases the risk of death or delisting among patients on the heart transplant waitlist; however, this risk almost doubles when 2 or more complications occur.

Impact of Baseline Mitral Regurgitation on Postoperative Outcomes After Left Ventricular Assist Device Implantation as Destination Therapy.

BACKGROUND: Currently, there are no guidelines for management of moderate to severe mitral regurgitation (MR) in patients undergoing left ventricular assist device (LVAD) implantation. The present study aimed to investigate the impact of baseline MR on short and midterm survival in patients who had LVAD as destination therapy (DT). METHODS: The DT-LVAD patients were classified into 2 groups based on baseline MR status: ≥ moderate MR and < moderate MR. Baseline clinical characteristics and post-LVAD implant adverse events were compared. Unadjusted mortality rates at 30 days, 1 year, and 2 years were analyzed. RESULTS: Of 91 patients studied, 62 (68%) had ≥ moderate MR before LVAD implantation; ≥ moderate MR patients had a higher incidence of concomitant pulmonary disease (11% vs 0%; P = .001) and ≥ moderate tricuspid regurgitation (55% vs 23%, P = .004) than < moderate MR patients. Other baseline clinical characteristics were similar in both groups. Post-LVAD adverse events did not differ between the 2 groups. Survival rates at 30 days, 1 year, and 2 years for both groups (≥ moderate MR vs < moderate MR) were 90% vs 100% (P = .03), 63% vs 90% (P = .001), and 52% vs 83% (P = .002), respectively. On multivariable analysis, age, female sex, ≥ moderate tricuspid regurgitation, and ≥ moderate MR at baseline were found to be independent predictors of overall all-cause mortality. Overall survival was significantly lower in the ≥ moderate MR group than the < moderate MR group (log-rank test, P = .03). CONCLUSION: In DT LVAD patients, ≥ moderate MR is common and is associated with worse survival at both short and midterm follow-up.

Levels of Polycyclic Aromatic Hydrocarbons in the Water and Sediment of Buffalo River Estuary, South Africa and Their Health Risk Assessment.

The incidence and spatial distribution of polycyclic aromatic hydrocarbons (PAHs) in the Buffalo River Estuary in the Eastern Cape Province of South Africa were assessed in this study. A total of 60 surface water and 19 sediment samples were collected from 5 sites of the estuary over a period of 6 months (December 2015 to May 2016). Extraction of PAHs from the water and sediment samples was achieved by using liquid-liquid and soxhlet extraction methods respectively, followed by column clean up with silica gel and quantification by gas chromatography-flame ionization detection. Individual PAH levels in the water and sediment samples ranged from not detected (ND) to 24.91 µg/L and ND to 7792 µg/kg, respectively. Total concentrations of the PAHs in the water and sediment samples varied as 14.91-206 µg/L and 1107-22,310 µg/kg in that order. Total levels of the contaminants were above the target values in the two matrices and were higher in summer than autumn. Although the noncarcinogenic risk of PAHs estimated in the water column through dermal absorption was very low compared with the target value, the carcinogenic risk determined was high for both adults and children. Similarly, benzo(a)pyrene and dibenzo(a,h)anthracene were found to be of higher carcinogenic and mutagenic risks in the sediments collected from the study area. Diagnostic ratios suggest that the target hydrocarbons are predominantly from pyrolytic sources. It therefore could be inferred that the water body is conspicuously polluted; hence, efforts should be made to control all the activities contributing to such magnitude of pollution at the sites.

Distribution pattern and health risk assessment of polycyclic aromatic hydrocarbons in the water and sediment of Algoa Bay, South Africa.

Polycyclic aromatic hydrocarbons are amongst the pollutants of major concern in the terrestrial and aquatic habitats. They are mostly characterised by carcinogenic and non-carcinogenic effects. Distribution and potential health risks of sixteen priority PAHs in the water and sediment samples collected between December 2015 and June 2016 from Algoa Bay, South Africa, were evaluated. Water and sediment samples collected were extracted with liquid-liquid and soxhlet extraction methods, respectively, and then cleaned up using glass column loaded with silica gel. Final concentrations of the target PAHs were determined by gas chromatography interfaced with flame ionization detector. Results indicated that individual PAH concentrations in surface water, bottom water and sediment samples ranged from not detected (ND) to 24.66 µg/L, ND to 22.81 µg/L and ND to 5.23 mg/kg correspondingly. Total PAHs concentrations varied as 12.78-78.94 µg/L, 1.20-90.51 µg/L and 1.17-10.47 mg/kg in the three environmental matrices in that order. The non-carcinogenic risk was generally below 1, whereas risk indices (dermal contact) were above the acceptable limit of 1 × 10-4 in the water column, suggesting possible carcinogenic effects to humans, with adults being the most vulnerable. Similarly, highest contributions to TEQs and MEQs in the sediments were made by benzo(a)pyrene and dibenzo(a,h)anthracene, the two most toxic congeners, signifying the possibility of carcinogenicity and mutagenicity in humans. Diagnostic ratios of PAHs reflect a prevailing pyrogenic input all through. The pollution was albeit moderate, yet regular check is recommended to ensure safe and healthy environment for human and aquatic lives.

Petroleum Hydrocarbon Fingerprints of Water and Sediment Samples of Buffalo River Estuary in the Eastern Cape Province, South Africa.

Petroleum hydrocarbon status of the Buffalo River Estuary in East London, South Africa, was evaluated from January to May, 2016. Surface water and sediment samples were collected from five points in the estuary and extracted using standard methods. The extracts were subsequently analyzed by gas chromatography-flame ionization detection. Results showed that total petroleum hydrocarbon (TPH) varied from 7.65 to 477 µg/L in the water and 12.59 to 1,100 mg/kg in the sediments, with mean values of 146.50 ± 27.96 µg/L and 209.81 ± 63.82 mg/kg, respectively. Concentrations of TPH in the sediments correlated significantly with organic carbon (OC) in both seasons. TPH and OC levels were slightly lower in summer than in autumn in the two environmental matrices, and the average amount of TPH in the water samples collected from all the sampling stations was generally lower than the EU standard limit of 300 µg/L. However, the levels in the sediments exceeded the EGASPIN target value (50 mg/kg) for mineral oil but were below the intervention value (5,000 mg/kg), indicating a serious impact of industrial growth and urbanization on the area, although the n-alkane ratios and indexes used for source tracking revealed excessive flow from both natural and anthropogenic sources.

Triclosan in water, implications for human and environmental health.

Triclosan (TCS) is a broad spectrum antibacterial agent present as an active ingredient in some personal care products such as soaps, toothpastes and sterilizers. It is an endocrine disrupting compound and its increasing presence in water resources as well as in biosolid-amended soils used in farming, its potential for bioaccumulation in fatty tissues and toxicity in aquatic organisms are a cause for concern to human and environmental health. TCS has also been detected in blood, breast milk, urine and nails of humans. The significance of this is not precisely understood. Data on its bioaccumulation in humans are also lacking. Cell based studies however showed that TCS is a pro-oxidant and may be cytotoxic via a number of mechanisms. Uncoupling of oxidative phosphorylation appears to be prevailing as a toxicity mechanism though the compound's role in apoptosis has been cited. TCS is not known to be carcinogenic per se in vitro but has been reported to promote tumourigenesis in the presence of a carcinogen, in mice. Recent laboratory reports appear to support the view that TCS oestrogenicity as well as its anti-oestrogenicity play significant role in cancer progression. Results from epidemiological studies on the effect of TCS on human health have implicated the compound as responsible for certain allergies and reproductive defects. Its presence in chlorinated water also raises toxicity concern for humans as carcinogenic metabolites such as chlorophenols may be generated in the presence of the residual chlorine. In this paper, we carried out a detailed overview of TCS pollution and the implications for human and environmental health.

Acute and intermittent testicular torsion: Analysis of presentation, management, and outcome in South East, Nigeria.

BACKGROUND: Testicular torsion compromises the blood supply to the testes and may result in testicular loss or damage if not dealt with promptly. It can occur either as acute testicular torsion (ATT) or intermittent testicular torsion (ITT). This study examines the presentation, management, and outcome of adult testicular torsion. PATIENTS AND METHODS: During the period January 1999 and December 2009, 34 out of 59 patients treated for testicular torsion, who had complete records, were evaluated. Operating theater and urology ward admission registers were used to identify patients. RESULTS: Age range was 16-50 years. Of the 34 patients, 11 (32.4%) were between 26 and 30 years old, while 16 (47.1%) were between 16 and 25 years old. Mean age was 27 years. Scrotal pain of varying severity was noted in all patients; there was associated vomiting in 21% of cases and abdominal pain in 38% of cases. Clinical diagnosis was ATT in 12 (35.3%) patients and ITT in 22 (64.7%) patients. In the ATT group, only one patient (8.3%) presented within 6 h of onset of symptoms. In the ITT group, 3 patients (13.6%) presented within 1 month of onset of symptoms while 7 (31.8%) of patients presented between 1 and 6 months after the onset of symptoms. Testicular salvage rate was 58.3% for ATT. Surgical intervention occurred within 3 h in the ATT group in 7 patients (58.3%) and in 5 patients (41.7%) within 3-6 h of onset of symptoms. In the patients with ITT, 12 patients (54.5%) were operated upon within 1 month of presentation. Preoperative external manual detorsion was performed in 1 patient. CONCLUSION: Late presentation was observed, especially in the intermittent variety. Delay occurred both at pre- and intra-hospital phases. Testicular salvage rate may be improved by physician/health worker and community enlightenment. Adoption of local anesthetic may reduce intrahospital delay.

Ischemic priapism in South-East Nigeria: Presentation, management challenges, and aftermath issues.

CONTEXT: Ischemic priapism is the more common variety of priapism and often presents late. Outcome is largely dependent on the duration of ischemia. AIMS: To determine the etiology, presentation, management, and outcome of ischemic priapism. SETTINGS AND DESIGN: Retrospective analysis of consecutive cases presenting to three hospitals offering specialist urological services in South-East Nigeria from January 2000 to December 2010. PATIENTS AND METHODS: Fifteen patients were assessed for clinical data and outcome. STATISTICAL ANALYSIS USED: The data were analyzed descriptively and inferentially using Statistical Package for Social Sciences (SPSS version 16, SPSS Inc., Chicago IL, USA) with P < 0.05. RESULTS: Mean age was 30.5 years (standard deviation [SD] =1.63), range: 14-79 years. Onset to presentation interval ranged from 6 h to 28 days. Eight patients (53.3%) had sickle cell disease (SCD). Four patients (26.7%) had unidentified causes. The 8 SCD patients had stuttering priapism on several occasions previously. Six patients (40%) had taken oral herbal medications as treatment prior to presentation. Initial resuscitative measures were intravenous hydration, aspiration, and irrigation with normal saline in 13 patients. Glanulo-cavernous shunt (Al-Ghorab) was performed in all the patients. Detumescence was immediate in 14 and delayed in 1 patient. Three patients had transient recurrence of tumescence, while one had to be reshunted. Erectile dysfunction (ED) occurred in 7 patients (46.7%). Occurrence of ED increased significantly in patients presenting 24 h after onset of symptoms ([P = 0.032] Fishers exact test). Mean duration of follow-up was 21.9 weeks (SD = 4.1), range: 3-156 weeks. CONCLUSIONS: Low flow priapism is common in our environment, and approximately half will occur in SCD patients who have had stuttering priapism previously. Timely diagnosis and treatment will reduce the probability of severe ED. In our experience, the Al-Ghorab shunt provides rapid relief. Enlightenment is vital in reducing ischemia time. Emphasis on preventive measures in SCD patients is vital.

Ischemic Priapism in South-East Nigeria: Presentation; Management Challenges; and Aftermath Issues

Context: Ischemic priapism is the more common variety of priapism and often presents late. Outcome is largely dependent on the duration of ischemia. Aims: To determine the etiology; presentation; management; and outcome of ischemic priapism. Settings and Design: Retrospective analysis of consecutive cases presenting to three hospitals offering specialist urological services in South-East Nigeria from January 2000 to December 2010. Patients and Methods: Fifteen patients were assessed for clinical data and outcome. Statistical Analysis Used: The data were analyzed descriptively and inferentially using Statistical Package for Social Sciences (SPSS version 16; SPSS Inc.; Chicago IL; USA) with P 0.05. Results: Mean age was 30.5 years (standard deviation [SD]

Antiviral Combination Therapy With Low-Dose Hepatitis B Immunoglobulin for the Prevention of Hepatitis B Virus Recurrence in Liver Transplant Recipients: A Single-Center Experience.

OBJECTIVES: This study presents the overall long-term hepatitis B virus (HBV) recurrence rate with possible associated factors after hepatitis B immunoglobulin (HBIG) was given in combination with 4 different antiviral (lamivudine, adefovir, entecavir, and tenofovir) drugs. PATIENTS AND METHODS: Between September 2000 and October 2013, the medical records of 42 adult patients who underwent liver transplantation at the Cukurova University Medical Hospital for chronic liver failure or hepatocellular carcinoma (HCC) secondary to chronic HBV were reviewed retrospectively. The analyses of risk factors for recurrence were performed based on the efficacy of hepatitis B envelope antigen (HBeAg), hepatitis B core antibody (anti-HBc), HBV DNA, preoperative prophylaxis, and the presence of HCC. Posttransplantation HBV recurrence was defined as persistence of hepatitis B surface antigen (HBsAg) positivity after orthotopic liver transplantation, or the reappearance of HBsAg and HBV DNA after initial HBsAg undetectability despite prophylaxis. RESULTS: The mean follow-up of 28 patients having HBIG and lamivudine prophylaxis was 73.25 ± 37.5 months with a recurrence rate of 3.5%. The mean follow-up of 2 patients having HBIG and adefovir prophylaxis was 90 ± 46.6 months with a 50% recurrence rate. The mean follow-up of each 6 patients who received prophylaxis with entecavir and tenofovir groups were 27.5 ± 16.1 and 16.17 ± 5.3 respectively, with no posttransplantation recurrence for both groups. On univariate analysis, preoperative factors such as anti-HBc, HBV DNA, preoperative prophylaxis, and the presence of HCC did not show any correlation with recurrence. However, HBeAg showed statistical significance for recurrence. CONCLUSIONS: Low-dose HBIG in combination with antiviral agents (lamivudine, entecavir, and tenofovir) is efficacious in preventing recurrence of HBV in posttransplantation patients.

Transvesical prostatectomy in the management of benign prostatic hyperplasia in a developing country.

CONTEXT: The surgical management of benign prostatic hyperplasia (BPH) is evolving away from open surgery. In developing countries however majority of cases are managed by transvesical prostatectomy (TP). AIMS: This study aims to describe our experience regarding the efficacy, complication profile and outcome of TP in the management of BPH in Nigeria. SETTINGS AND DESIGN: A descriptive, retrospective study carried out in three tertiary centers. SUBJECTS AND METHODS: Two hundred and ninety-seven patients were studied. Parameters examined included age, clinical features, investigations, type of postoperative bladder irrigation, prostate gland volume, duration of hospital stay, complications and outcome. STATISTICAL ANALYSIS USED: Simple means and percentages with SPSS 16. RESULTS: Mean age was 65.2 ± 6.8 years (range 47-93 years). Presentation with severe lower urinary tract symptoms only occurred in 76 patients (25.7%); acute urinary retention was seen in 106 patients (35.7%). Chronic urinary retention, impaired renal function and haematuria occurred in 47 (15.8%), 37 (12.5%), and 31 patients (10.4%) respectively. On comorbidity, 63 patients (21.2%) were hypertensive and 24 patients (8.1%) had diabetes mellitus. Two hundred and twenty three patients (75%) had indwelling catheters at the time of surgery. Preoperative urinary catheter duration was 1 week-35 months. Mean duration of hospital stay was 8.8 days. Complications were transient urinary incontinence 33 patients (11.1%), urinary tract infection 38 patients (12.7%), and acute epididymoorchitis 15 patients (5.1%). Clot retention occurred in 40 patients (13.5%). Mortality rate was 1%. CONCLUSIONS: TP remains useful in developing climes. There is a need to emphasize effective preoperative workup so as to limit morbidity. Emphasis on variety of techniques for hemostasis is necessary.

Bioflocculant production by Bacillus sp. Gilbert isolated from a marine environment in South Africa.

In our previous study we reported on the bioflocculant production by a Bacillus species isolated from sediment samples of Algoa Bay in the Eastern Cape Province of South Africa. In current study we carried out further evaluation on the effect of different culture conditions on the bioflocculant production, as well as characterised the bioflocculant produced in detail. The bacteria produced bioflocculant optimally under the following conditions: using sodium carbonate (95.2% flocculating activity) and potassium nitrate (76.6% flocculating activity) as carbon and nitrogen sources, respectively; inoculum size of 3% (v/v); initial pH 9.0; and Al3+ as coagulant aid. The crude bioflocculant retained 44.2% residual flocculating activity after heating at 100 degrees C for 15 min. Chemical analysis of the Bacillus sp. Gilbert purified bioflocculant demonstrated that it was composed mainly of polysaccharide. Fourier transform infrared spectroscopy analysis revealed the presence of hydroxyl, carboxyl and methylene groups in the bioflocculant and energy-dispersive X-ray analysis detected the elemental composition in mass proportion (% w/w) of C, N, O, S and P as 4.12 : 7.40: 39.92: 3.00: 13.91. Scanning electron micrograph image of the bioflocculant revealed an amorphous compound.