Periodontal inflammatory and microbial profiles in healthy young African Americans and Caucasians.

AIM: This study aimed to compare microbial and inflammatory profiles in periodontally/systemically healthy African American (AA) and Caucasian (C) individuals. MATERIALS AND METHODS: Thirty-seven C and 46 AA aged from 5 to 25 years were evaluated regarding periodontal disease, caries, microbial subgingival profile via 16-s sequencing, as well as salivary and gingival crevicular fluid (GCF) inflammatory profile via multiplex assay. RESULTS: Greater probing depth percentage was detected in AA (p = .0075), while a higher percentage of caries index (p = .0069) and decayed, missing, filled teeth (DMFT) index (p = .0089) was observed in C, after adjusting for number of teeth, sex and age. Salivary levels of IL-6, IL-8 and TNFα were higher for C, whereas GCF levels of eotaxin, IL-12p40, IL-12p70, IL-2 and MIP-1α were higher in AA (p < .05). Different microbial profiles were observed between the races (p = .02). AA presented higher abundance of periodontopathogens (such as Tanerella forsythia, Treponema denticola, Filifactor alocis, among others), and C presented more caries-associated bacteria (such as Streptococcus mutans and Prevotella species). Bacillaceae and Lactobacillus species were associated with higher DMFT index, whereas Fusobacterium and Tanerella species with periodontal disease parameters. CONCLUSIONS: A different inflammatory and bacterial profile was observed between healthy AA and C, which may predispose these races to higher susceptibility to specific oral diseases.

Hematuria and dietary supplements - A case report on pronounced bleeding following a minimally invasive urological intervention in a patient on long term garlic supplements.

This report focuses on a patient encounter with suspected significant hematuria post operation occurring primarily due to garlic supplementation. A 65-year-old male underwent day case PVP. He had significant hematuria post operation requiring added use of bipolar coagulation. He was fit and well with no other past medical or drug history apart from dietary supplementation of garlic extracts. There are various mechanisms that components of garlic like allicin can produce antiplatelet effect on blood. This represents a novel case of unexpected bleeding in patient strongly attributed to dietary supplements for a less invasive technique with better hemostatic profile like PVP.

Predictors for adverse events following intravesical botulinum toxin injections in men.

INTRODUCTION: Intravesical botulinum toxin A (BTX-A) has been long established as treatment for overactive bladder and neurogenic bladder dysfunction. However, most published data are reported among a female cohort. Adverse events such as intermittent self-catheterization (ISC) and urinary tract infections (UTIs) play a large role in discontinuation of therapy. There is currently limited information regarding predictive factors to appropriately counsel male patients. MATERIALS AND METHODS: We retrospectively collected data on male patients undergoing their first intravesical BTX-A therapy from January 2016 to July 2021 in two high-volume centers. Data included demographics, past medical and surgical history, and urodynamic parameters. Patients were excluded if they had a long-term catheter or ISC before initiation of therapy. RESULTS: A total of 69 men were included in the study with a median age of 66 years. There were 18 patients with neurogenic bladder dysfunction. Thirty men had urge incontinence secondary to radical prostatectomy or bladder outflow surgery. Overall rates of ISC were 43.5%. Predictors for ISC included a baseline postvoid residual (PVR) ≥ 50 mL (odds ratio [OR]: 4.2, 95% confidence interval [CI]: 1.36-13.03, p = 0.01), BTX-A dose >100 units (OR: 4.2, 95% CI: 1.36-13.0, p = 0.01). Stress urinary incontinence was protective against ISC (OR: 0.20, 95% CI: 0.04-1.00, p = 0.049) as well as history of prostatectomy/bladder outflow obstruction (BOO) surgery (OR: 0.16, 95% CI: 0.05-0.47, p < 0.001). A multivariable logistic regression model with these factors yielded a c-statistic of 0.80 (optimism-adjusted = 0.75). An enlarged prostate was the only predictor for UTI among our male cohort (OR: 8.0, 95% CI: 2.03-31.5, p = 0.003). CONCLUSIONS: This is the first study assessing risk factors of adverse events among men following BTX-A injection. High PVR and BTX-A dose of >100U were predictors of requiring ISC after BTX-A. Stress incontinence, previous radical prostatectomy, and BOO surgery were all protective against needing ISC post-BTX-A. An enlarged prostate was associated with development of UTI. These factors can be used to assist in counseling male patients regarding their risk of ISC and UTI.

Can surgical treatment for benign prostatic hyperplasia improve sexual function? A systematic review.

INTRODUCTION: Erectile dysfunction is an established, well known risk of any operative management of benign prostatic hyperplasia (BPH). However, there are some cases reported in which surgical treatment has paradoxically improved erectile function. Here, we present a systematic review of the literature pertaining to the effect of surgery on sexual function, focusing on reports of improvement in erectile function following surgery. MATERIALS AND METHODS: We searched PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases for the following keywords: (("sexual function" OR "erectile function") AND "improvement" AND "benign prostatic hyperplasia" AND "surgery"). RESULTS: Sixteen studies (total n = 2087) were reviewed which reported a significant improvement in any aspect of erectile function. Ten of these studies had a follow-up period of 12 months or more while five had a follow up less than 12 months. Various surgical methods were included in the 16 studies; however, five reported TURP outcomes specifically. Eleven studies reported outcomes using the International Index of Erectile Function (IIEF). Overall, a further 87 studies showed no significant change and 8 studies showed a significant reduction. CONCLUSIONS: The majority of studies report no change in erectile function following surgical intervention for BPH. There seems to be no obvious correlating factor between the studies reporting an improvement in erectile function. Further research is needed to guide us in how to consent our patients for erectile function outcomes for BPH surgery.

Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM).

BACKGROUND: Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). OBJECTIVE: To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. DESIGN, SETTING, AND PARTICIPANTS: A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. INTERVENTION: Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. RESULTS AND LIMITATIONS: Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. CONCLUSIONS: Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. PATIENT SUMMARY: We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics.

Testicular Rupture or Testicular Fracture? A Case Report and Literature Review.

Testicular trauma is relatively uncommon. However, severe injuries can result in many complications and should be carefully diagnosed and managed. We present a case of testicular fracture diagnosis made by ultrasonography. The surgical exploration revealed the fracture as well as complete rupture of the tunica albuginea. Testicular rupture is the disruption of the tunica albuginea, while testicular fracture is a "break" in the testicular parenchyma. Management could be conservative in mild fracture cases without rupture while suspected or confirmed fracture should be treated by surgical exploration.

Subclinical hypothyroidism or central hypothyroidism-The danger of thyroid function misinterpretation.

Correct interpretation of thyroid function tests is critical to providing appropriate care to patients with suspected thyroid disease. It is particularly important to distinguish central hypothyroidism from other types due to the potential of concurrent secondary adrenal insufficiency and thus the need for immediate steroid replacement prior to commencing thyroxine.

DEDICATED BREAST CANCER MANAGEMENT CENTRES WITH. FACILITIES FOR FULL IMAGE-GUIDED ASSESSMENT AND IMAGE-GUIDED SURGERY IN THE DEVELOPING AREAS OF PAKISTAN--A LONG OVERDUE NECESSITY.

BACKGROUND: Dedicated centres to manage breast cancers are important to combat this menace. An example of practice in the U.K. Hospitals is given with an attempt to explain reasons for an urgent need of dedicated breast cancer centres in developing areas of Pakistan. METHODS: The rates of breast conservation, mastectomy, and immediate breast reconstruction are compared between a centre in the U.K. and a secondary radiotherapy facility in developing areas in Pakistan for 2011. RESULTS: At Kettering General Hospital, 152 patients (71%) had breast conservation therapy including image-guided surgery, 45 (29%) had mastectomy and 15 (33.3%) had immediate breast reconstruction. All the 263 patients who had adjuvant therapy with surgery, has had mastectomy at the institute of radiotherapy and nuclear medicine (IRNUM) in Peshawar, and no patient had immediate reconstruction. CONCLUSION: The availability of mammogram in individual clinics in Peshawar, without the back up of dedicated breast cancer centre fails to materialize the dream of provision of whole spectrum of breast cancer care. Government and international donor organisations may need to be approached for. investment in technology and training of personnel.

A seven-day diabetes service for inpatients and the emergency department in an acute hospital setting - the East and North Herts Diabetes Outreach Team (DOT).

There is evidence that all hospital-based care needs to improve across 7 days. Inpatients with diabetes require better specialist attention and improved clinical outcomes. The East and North Herts inpatient diabetes service has responded to this challenge with care now delivered by consultants and diabetes nurses, 365 days per year. We set out to provide a prospectively measurable improvement in ascertainment of appropriate patients alongside a 'care bundle' to ensure they receive a better quality experience. We also set out to document quantifiable changes in clinical data. A seven-day service is now in place and provides a variety of benefits to both professionals and patients alike.

Management of encrusted ureteric stent and impacted stone in pregnancy - a challenging dilemma.

We are presenting an interesting case of impacted stone and stent in a pregnant patient. We have proved safe use of ureteroscopy and laser in pregnancy with minimal x-ray exposure.

Impact of colour blindness on recognition of haematuria in bladder cancer patients.

OBJECTIVE: Colour blindness might lead to failure in recognizing frank haematuria. Our aim is to investigate as to whether colour-blind males who develop bladder cancer present later with less favourable histology. PATIENTS AND METHODS: Two hundred male patients with bladder cancer were assessed using Ishihara plate test for colour deficiency. Degree of haematuria, method of presentation and initial histologic findings were also determined. RESULTS: Colour-blind patients who develop bladder cancer present with less favourable histology compared with non-colour-blind (p = 0.01). CONCLUSION: Colour blindness was associated with presentation with more advanced bladder tumours.