Subinguinal versus peritesticular diameters of varicocele veins in the supine and standing posture.

OBJECTIVE: To determine the region which should be taken as a standard of measurement for varicocele veins. METHODS: The cross-sectional study was conducted at the Fatima Memorial Hospital, Lahore, Pakistan, from October 2018 to October 2019, and comprised patients aged 20-45 years diagnosed with left-sided varicocele and infertility having varicocele vein diameter >2.5mm on scrotal colour Doppler ultrasound. The parameters were determined at subinguinal and peritesticular region in the patients. Data was anaylsed using SPSS 23. RESULTS: There were 35 male patients with a mean age of 32.83±5.91 years. In both supine and standing positions, the mean diameters of varicocele vein at the peritesticular region were significantly greater than the mean values at the subinguinal region (p<0.01). All the 35(100%) patients had semen abnormalities, but the diameter of varicocele veins had no significant correlation with such abnormalities (p>0.05). CONCLUSIONS: Varicocele vein diameter at the peritesticular region was found to be significantly greater than the subinguinal diameter in both lying and standing position.

Communicating seminal vesicles leading to indirect vasal communication: A case report.

We are presenting a case of 42 year old male, suffering from secondary infertility. Nine years ago he developed bilateral scrotal pain followed by azoospermia and infertility. At our center during vasography we found that the dye was not seen in bladder or prostatic urethra. But interestingly a direct communication was observed between both seminal vesicles, and through that channel an indirect communication was observed between both vas deferens. It is suggested that the patient developed obstructive azoospermia as a sequel of epididymo-orchitis. It is also concluded that seminal vesicle communication was initially not a primary problem for patient's fertility.

Assessment of Psycho-Education of Carers Questionnaire: APEC-U" translation and cross cultural adaptation of an Urdu Version.

BACKGROUND AND OBJECTIVE: Psycho-education of carers is a part of good mental health practice. Our objective was to translate and validate the English questionnaire "Assessment of Psycho-Education of Carers" (APEC) into Urdu (APEC-U), for use in Pakistan. METHODS: Following development and validation of APEC, it was translated into Urdu after consultation with experts and translators. After pretesting, one hundred and twenty bilingual male 67(55.8%) and female 53(44.2%) primary carers, who could understand both Urdu and English, and were carers for more than three months, were asked to fill in the self reporting Urdu questionnaire at the Fatima Memorial Hospital Psychiatry Out-Patient Department. The data were collected over a period of three months from September, 2018 to November, 2018. MAIN OUTCOME MEASURES: Responses were analyzed for internal consistency, reliability, Intraclass correlation coefficients and kappa statistics. RESULTS: APEC-U was understandable and capable of assessing psycho-education in Urdu. High internal consistency was demonstrated on the full scale as 0.859. Degree of agreement (<0.001) between the Urdu and the originally developed English version was evaluated by Cohen's Kappa, and a high degree of agreement was demonstrated. CONCLUSION: The Urdu questionnaire can adequately assess psycho-education of carers in psychiatric settings.

Correlation between Testicular Hemodynamic and Semen Quality Indices in Clinical Varicocele Patients in Pakistan.

Varicocele, a vascular event, is associated with infertility due to testicular damage that causes abnormal spermatogenesis in males. The goal of this study is to ascertain the diagnostic significance of scrotal color Doppler ultrasonography (CDUS) by measuring peak systolic value (PSV) and resistive index (RI) of the arteries supplying blood to the testis and their association with semen quality attributes. Sixty prospective patients (age: 20-50 years) undergoing microsurgical varicocelectomy at a teaching hospital were included in the study. Semen parameters and CDUS were recorded and testicular blood flow was determined as PSV and RI of subcapsular artery and intraparenchymal artery of the testes. Nonparametric statistics was applied to test the correlation/association of the semen quality with the PSV, RI, and other variables. Results revealed a significant negative correlation (r = -0.28; p < 0.05) between progressive motility of spermatozoa and resistive index of the intraparenchymal arterial blood flow. Furthermore, it was noticed that the progressive motility of spermatozoa was tended to be negatively correlated (r = -0.236) with resistive index of subcapsular arterial blood flow. In conclusion, this study has revealed that progressive motility of sperms has correlation with the intraparenchymal blood flow of testes. The progressive motility of sperms could be correlated with RI of testicular blood flow. The apparent lack of association between diameter of varicocele vein and semen quality signifies the need of investigating some other factors that may be involved in pathogenicity of varicocele. The diagnostic value of CDUS may be carefully interpreted and clinically correlated in assessment of severity of varicocele.

Pattern of varicocele vein blood gases in patients undergoing microsurgical Varicocelectomy.

BACKGROUND: Varicocele is known to be associated with infertility and sperm disorders. The exact cause of this ailment is not fully understood. There are limited numbers of studies where venous blood gases (VBGs) of varicocele veins were determined with conflicting results. Therefore, we have investigated the pattern of VBGs in both internal spermatic and external spermatic varicocele veins and correlation with semen quality parameters in infertile individuals who underwent left microsurgical varicocelectomy. METHODS: Patients (n = 27) undergoing left microsurgical varicocelectomy at a tertiary care hospital, were included in the study. Before surgery, semen parameters and scrotal color Doppler ultrasonography was performed. During surgery, blood sample was drawn from varicocele veins (internal spermatic and external spermatic veins) and a peripheral arm vein of the same patient as a control. The VBGs of all veins under study were estimated and compared with each other. The VBGs were also correlated with various semen quality parameters. Data, expressed as Mean ± SD, regarding VBGs in three veins were analyzed using one-way ANOVA. The correlation between VBGs and semen quality parameters was determined using Pearson's correlation. Differences were considered significant at p < 0.05. RESULTS: The pH was found to be higher (p < 0.01) in the internal spermatic vein compared with the external spermatic and the peripheral veins. Partial pressure of oxygen (pO2) and oxygen saturation (sO2) were higher (p < 0.01) in the internal spermatic vein compared with the peripheral vein. However, concentration of bicarbonate (HCO3) was lower (p < 0.01) in both veins compared with the peripheral vein. Partial pressure of carbon dioxide (pCO2) was also lower (p < 0.01) in the varicocele veins compared with the control vein. CONCLUSION: The internal spermatic veins had higher pH and oxygen tension, but lower HCO3 and pCO2 levels compared with the control peripheral veins. External spermatic veins had lower pCO2 and HCO3 but other VBGs were similar to the peripheral veins. The shift of VBGs of internal spermatic vein toward arterial blood pattern may be a missing link to understand the pathophysiology of varicocele.

Doppler ultrasound findings in a patient with primary infertility and triorchidism.

Polyorchidism, presence of more than two testes in a scrotum, is a rare clinical entity. To date, about 200 cases have been reported in the literature. We report a case of triorchidism in a patient presenting with a 7-year history of primary infertility. Clinical examination revealed two completely separate testes with two separate epididymides and single vas suggesting a complete division of the genital ridge and partial duplication of the vas deferens. In our patient, the clinical picture together with ultrasound findings were characteristic enough to exclude other diagnoses, allowing conservative management. We also present the Doppler ultrasound findings of this rare condition, which may be helpful for comparison in patients with triorchidism who present with testicular torsion.

The Female Sexual Function Index (FSFI): Translation, Validation, and Cross-Cultural Adaptation of an Urdu Version "FSFI-U".

INTRODUCTION: Female sexual dysfunction (FSD) is a common problem, and many self-report questionnaires are available for its evaluation. Pakistani women with sexual problems feel shy to consult with their physician. A validated self-report questionnaire, in the local language with modest expressions is required for these women. AIM: The aim of this study was to translate, cross-culturally adapt, and perform a psychometric validation of an Urdu translation of the Female Sexual Function Index (FSFI). METHODS: The FSFI was translated in Urdu, and its precision was ascertained through reverse translation. It was pretested on 22 bilingual women and refined again to reach at a reliable Urdu version of the questionnaire FSFI-U. One hundred sixteen bilingual women, in a stable sexual relationship over the previous 6 months were finally asked to fill out the FSFI and FSFI-U. Their sexual function was then clinically evaluated and responses were compared with the clinical assessment as well as with each other. MAIN OUTCOME MEASURES: The responses were analyzed through descriptive statistics for reliability, face validity, agreement between the responses to the original English version and to the FSFI-U, and also for test-retest consistency. The data were analyzed statistically using Cronbach's alpha analysis, Intraclass correlation coefficients, Pearson correlation, and Student's t-test. RESULTS: FSFI was found to be easily understandable and capable of adequately evaluating and measuring various aspects of female sexual function. A high degree of internal consistency was demonstrated on Cronbach's alpha analysis. Cronbach's α coefficient for various domains was sufficiently high ranging from 0.84 to 0.97. The clinical assessment of the presence and severity of FSD also matched with the self-report questionnaire. Similarly, various domains of FSFI had high degree of correlation in the Urdu version of FSFI (P < 0.001). CONCLUSION: The Urdu translation version of FSFI is valid and reliable for use in the literate population of Pakistan. Rehman KU, Asif Mahmood M, Sheikh SS, Sultan T, Khan MA. The Female Sexual Function Index (FSFI): Translation, Validation, and Cross-Cultural Adaptation of an Urdu Version "FSFI-U". Sex Med 2015;3:244-250.

Translation, cross-cultural adaptation, and psychometric validation of the 5-item International Index of Erectile Function (IIEF-5) into Urdu.

INTRODUCTION: Patients suffering from erectile dysfunction (ED) feel shy to discuss this issue with their physician. Self-report questionnaires are a key instrument to break this barrier. Most of these questionnaires are in English, and their validated translations in Urdu, the official language of Pakistan, are not available. AIM: The aim of our study is to translate, cross-culturally adapt, and perform psychometric validation of an Urdu translation of the 5-item international index of erectile function (IIEF-5). METHODS: The translation of IIEF-5 was done in Urdu and was refined through reverse translation and expert committee reviews. It was then pretested on 20 bilingual men and reviewed again to develop a final Urdu version of the questionnaire. We selected 47 patients who had been in a stable sexual relationship over the past 6 months and asked them to fill out the IIEF-5 questionnaire in both languages (Urdu and English), followed by evaluation of ED by a clinician, who was blinded to the responses of the patient to the questionnaire. MAIN OUTCOME MEASURES: The self-report to questionnaire and independent clinical assessment were compared. Patients refilled out the questionnaire again at the end of the interview to assess test-retest consistency. These data were now analyzed statistically using descriptive statistics, Cohen's kappa, and Cronbach's alpha analysis. RESULTS: The Cohen's kappa showed a very high degree of agreement between the two versions (P < 0.0001), and a high degree of internal consistency was demonstrated on Cronbach's alpha analysis ([0.882] with 95% confidence interval [0.839-0.916]). The clinical assessment of the presence and severity of ED also matched with the self-report questionnaire. CONCLUSION: We can safely conclude that this Urdu version of IIEF-5 is a valid instrument for use in the literate population of Pakistan.

Management of the giant frontal sinus--a simple method to improve cosmesis.

Frontal bossing can be caused by many craniofacial syndromes, however an enlarged frontal sinus is a rare cause. Because of this the management of this condition is variable. One option is to remove the anterior wall of the frontal sinus and dividing this into segments which are then fixed in the desired position using miniplates.This however may prove difficult in thin bone and in these cases the periosteum can be left intact to splint the fragments which are then repositioned using resorbable sutures.