Seminal plasma features of Prochilodus lineatus and Brycon orbignyanus throughout two consecutives spawning seasons.

This study aims to describe seminal plasma characteristics, detect changes during and between two consecutive spawning seasons (SS), and compare plasma features between two important South American fish species. Prochilodus lineatus and Brycon orbignyanus sperm was collected over two (SS1; SS2). Each season was divided into first and second sampling periods (P1; P2). Thus, the four experimental periods were referred to as SS1P1, SS1P2, SS2P1, and SS2P2. Seminal plasma was analyzed for osmolality, pH, and Na+ , K+ , and Ca2+ concentration. Additionally, sperm concentration, motility rate, and velocities (curvilinear = VCL; straight line = VSL) were determined and correlated with plasma features. In P. lineatus, plasma osmolality was lower in SS1P2, pH was higher in SS2P2, Na+ was higher and K+ and Ca2+ were lower in SS2P1 compared with other experimental periods. Positive correlations were observed between motility and plasma osmolality, motility and Na+ , and VCL and Na+ . In B. orbignyanus, plasma osmolality was higher in SS2P1 and SS2P2 and K+ concentration was higher in SS1P1 compared with other experimental periods; no correlation was observed. Seminal plasma parameters change during SS; therefore, the composition of a sperm extender and artificial fertilization methods should be adapted to maximize fertilization rates.

Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate.

BACKGROUND AND AIM: Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction. METHODS: Children with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X-ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X-rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2-8 sachets (14.7 g/sachet) on days 1-2, reducing to 2-6 sachets on day 3. The SPS dose was 15-20 drops on days 2-3. RESULTS: Eighty-nine children (4-18 years) produced a large volume of soft stool (median/inter-quartile-range: 2.2/1.6-3.1 L) over 7 days. Stool volume on X-rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change. CONCLUSIONS: A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying.

Morte súbita em Doença de Chagas ­conceitos atuais e perspectivas de novos avanços / Sudden cardiac death in Chagas Heart Disease- current concepts and perspectives for new advances

A Doença de Chagas atinge milhões de pessoas na América Latina e a evolução para cardiopatia crônica tem como seu principal desfecho a morte súbita cardíaca (MSC). Neste artigo, revisamos, sob a luz da medicina baseada em evidências, os principais aspectos sobre marcadores prognósticos clínicos e de imagem (especificamente a análise da fibrose em ressonância magnética) e terapêutica existente no tratamento e prevenção da MSC, como terapia farmacológica, evidências sobre dispositivos implantáveis e tratamento invasivo de arritmias ventriculares

Chagas disease affects millions of people in Latin America and its evolution to heart disease has the sudden cardiac death (SCD) as one main outcome. In this article, we sought to review the essential evidence-based aspects about prognostic markers and treatments for SCD, including farmacological treatment, use of implantable devices and invasive treatment of ventricular arrhthymias

Higher environmental temperatures promote acceleration of spermatogenesis in vivo in mice (Mus musculus).

Temperature is considered a crucial modulator of reproductive activity and testis homeostasis. It is well known that elevated temperatures cause several effects on testicular components, particularly on germ cells, which might lead to the impairment of spermatogenesis and loss of male fertility. The present study aimed to evaluate the effects of different environmental temperatures on several morphofunctional testis parameters, with emphasis on duration of spermatogenesis and spermatogenic efficiency. Thirty sexually mature Swiss mice (Mus musculus) were allocated in three different experimental groups, being kept in vivarium for three weeks at 16 °C, 23 °C (control group) and 32 °C. In order to estimate the duration of spermatogenesis, three animals per each group received intraperitoneal injections of tritiated thymidine and the testes were perfused-fixed and routinely processed for histological, morphometrical and immunoperoxidase analyses. Although the lower temperature (16 °C) did not change most of the evaluated testicular parameters, our findings showed that higher environmental temperature (32 °C) is able to alter important testis parameters, resulting for instance in acceleration of spermatogenesis, alterations in the stages frequencies, increased number of germ and Leydig cells apoptosis and reduced Sertoli cell and spermatogenic efficiencies. As in many conditions infertile men exhibit higher mean scrotal temperature, we believe that experimental studies with mice involving temperature might represent an interesting approach to better understand the mechanisms related to human testis function and sperm production.

Morphofunctional evaluation of the testis, duration of spermatogenesis and spermatogenic efficiency in the Japanese fancy mouse (Mus musculus molossinus).

Japanese fancy mouse, mini mouse or pet mouse are common names used to refer to strains of mice that present with different colour varieties and coat types. Although many genetic studies that involve spotting phenotype based on the coat have been performed in these mice, there are no reports of quantitative data in the literature regarding testis structure and spermatogenic efficiency. Hence, in this study we researched testis function and spermatogenesis in the adult Japanese fancy mouse. The following values of 68 ± 6 mg and 0.94 ± 0.1% were obtained as mean testis weight and gonadosomatic index, respectively. In comparison with other investigated mice strains, the fancy mouse Leydig cell individual size was much smaller, resulting in higher numbers of these cells per gram of testis. As found for laboratory mice strains, as a result of the development of the acrosomic system, 12 stages of the seminiferous epithelium cycle have been described in this study. The combined frequencies of pre-meiotic and post-meiotic stages were respectively 24% and 64% and very similar to the laboratory mice. The more differentiated germ cell types marked at 1 h or 9 days after tritiated thymidine administration were preleptotene/leptotene and pachytene spermatocytes at the same stage (VIII). The mean duration of one spermatogenic cycle was 8.8 ± 0.01 days and the total length of spermatogenesis lasted 37.8 ± 0.01 days (4.5 cycles). A high number of germ cell apoptosis was evident during meiosis, resulting in lower Sertoli cell and spermatogenic efficiencies, when compared with laboratory mice strains.

Sperm quality and its freezing ability throughout the spawning season in Prochilodus lineatus and Brycon orbignyanus.

The aim of this study was to determine fresh and frozen sperm quality evaluated over two spawning seasons (2013-2014; 2014-2015) in Prochilodus lineatus and Brycon orbignyanus. The spawning seasons were divided into two sampling periods: November to December and January to February. Males were hand-stripped after carp pituitary treatment. Fresh sperm motility rate, velocities (curvilinear = VCL; straight-line = VSL; average path = VAP), and the beat cross frequency (BCF) were determined using a Computer-Assisted Sperm Analyzer (CASA). Sperm of each species was frozen using methyl glycol as cryoprotectant and a glucose solution for P. lineatus or a NaCl solution for B. orbignyanus as extender. Diluted sperm was loaded into 0.25 mL straws, frozen in a nitrogen vapor vessel (dry shipper) and stored in a liquid nitrogen vessel. Six months later, straws were thawed in a water bath at 60 °C for 3 s and sperm quality was determined, as described for fresh sperm. No significant difference was observed for any of the fresh and frozen sperm features between the two spawning seasons or the two sampling periods in P. lineatus and in B. orbignyanus. Motility rate and velocities, but not BCF, was always higher in fresh sperm when compared with frozen sperm. Comparing both species, higher motility in frozen sperm and higher VCL and VAP in both fresh and frozen sperm were observed for P. lineatus, while higher VSL in fresh sperm and higher BCF in both fresh and frozen sperm were observed for B. orbignyanus. Sperm quality and its freezing ability of both species were sustained over the spawning season and thus fish farmers can reproduce these species and freeze their sperm in any time throughout the spawning season. P. lineatus sperm is more resistant to the cryopreservation process than B. orbignyanus.

Storage and transportation of Prochilodus lineatus (Characiformes) sperm prior to cryopreservation.

In this study we compared post-thaw quality of P. lineatus sperm frozen shortly after collection, with sperm frozen after dilution and transportation, and up to 6h from collection. From each sperm sample (n=10 males) five aliquots were taken. One aliquot was diluted in the freezing medium (1 sperm:8 glucose:1 methyl glycol) and frozen ∼20min after collection in the field (control), while the other four aliquots were transported to the laboratory where freezing took place 3 or 6h after collection. From the transported aliquots, two were diluted 1:4 in glucose solution before transportation (diluted samples), while the other two were kept undiluted until freezing (undiluted samples). Thus the five treatments were: control, undiluted-3h, diluted-3h, undiluted-6h and diluted-6h. Post-thaw sperm was evaluated for membrane integrity, motility rate and velocities (curvilinear=VCL; average path=VAP; straight line=VSL). Post-thaw membrane integrity did not differ among the five treatments (48-60% intact sperm). Sperm motility rate was similar (P>0.05) between control (64%) and undiluted samples (60-62%) and higher (P<0.05) than that in diluted samples (35-45%), regardless the time after collection when freezing took place. Velocities were higher in control and in undiluted-3h samples (VCL of 254-265µm/s, VAP of 219-244µm/s and VSL of 134-147µm/s) than in diluted samples or samples frozen 6h after collection. P. lineatus sperm can be transported/shipped to the laboratory without decreasing its suitability for cryopreservation. Sperm should be kept undiluted during storage and be frozen within 3h.

Osmolality and composition of the activating solution affects motility of fresh and frozen Prochilodus lineatus sperm differently.

Osmolality and composition of the activating solution on motility of fresh and frozen Prochilodus lineatus sperm were evaluated. Sperm was triggered in 11 solutions prepared with reverse osmosis (RO) water (∼0mOsmkg(-1)), and glucose or NaCl adjusted to 50, 100, 150, 200 and 250mOsmkg(-1). Sperm motility rate and velocities (curvilinear=VCL, among others) were evaluated in fresh sperm at 10, 30 and 50s post-activation (spa), and in frozen sperm at 10 spa only. Sperm was frozen under a standardized methodology for this species. Fresh sperm motility was higher in samples triggered in RO (91%), in glucose at all osmolalities (90-92%) and in 50-150mOsmkg(-1) NaCl (88-91%) than that in 200-250mOsmkg(-1) NaCl (74-80%). Motility decreased (P<0.05) as a function of time after activation in samples activated in RO and in NaCl but not in glucose. Samples activated in 100-250mOsmkg(-1) glucose yielded motility above 80%, at 50 spa. Curvilinear velocity was higher (P<0.05) in glucose-activated samples (322-357µms(-1)) compared to that activated in NaCl (192-283µms(-1)) and in RO (298µms(-1)). Frozen sperm motility and velocities were similar when triggered in RO, glucose or NaCl and were higher at 0-150 mOsm kg(-1) (69-78% motility; 163-208µms(-1) VCL) than at 200-250mOsmkg(-1) (34-59% motility; 127-168µms(-1) VCL). High sperm motility with fast velocity for a long period is achieved at 100-150mOsmkg(-1), in glucose solution for fresh sperm and in glucose or NaCl for frozen sperm.

Sperm dilution ratio affects post-thaw motility rate and velocity of Prochilodus lineatus (Characiformes) sperm.

There is a lack of standardization in sperm cryopreservation of aquatic organisms and, thus, a necessity of more accurate investigations in all steps of this process. In this study, the effects of sperm dilution ratio on post-thaw sperm quality of Prochilodus lineatus were evaluated. Sperm was diluted in a standard freezing medium (glucose and methyl glycol) at four different ratios (sperm to final volume = 1:5, 1:10, 1:50 or 1:100), frozen in a nitrogen vapour vessel at -170°C and then stored in liquid nitrogen vessel at -196°C. Post-thaw motility rate and velocities (curvilinear = VCL; average path = VAP; straight line = VSL) were determined using a Computer-Assisted Sperm Analyzer (CASA) at 10 and 40 s post-activation. The highest motility rates were observed when sperm was frozen at a ratio of 1:5 (76%) and 1:10 (75%). The highest VCL (225 µm/s) and VAP (203 µm/s) were observed at a ratio of 1:10, while VSL was similar among samples frozen at 1:5, 1:10 and 1:50 (97-124 µm/s). When those parameters were evaluated again 30 s later, motility decreased significantly in samples frozen at a ratio of 1:5 (57%) and 1:10 (61%), while velocities decreased significantly in all samples regardless of dilution ratio (75-85 µm/s of VCL, 38-53 µm/s of VAP and 25-39 µm/s of VSL). P. lineatus sperm should be frozen at a ratio of 1:10, where both the number of loaded sperm per straw and the post-thaw quality are maximized.

Heparan Sulfate Proteoglycans May Promote or Inhibit Cancer Progression by Interacting with Integrins and Affecting Cell Migration.

The metastatic disease is one of the main consequences of tumor progression, being responsible for most cancer-related deaths worldwide. This review intends to present and discuss data on the relationship between integrins and heparan sulfate proteoglycans in health and cancer progression. Integrins are a family of cell surface transmembrane receptors, responsible for cell-matrix and cell-cell adhesion. Integrins' main functions include cell adhesion, migration, and survival. Heparan sulfate proteoglycans (HSPGs) are cell surface molecules that play important roles as cell receptors, cofactors, and overall direct or indirect contributors to cell organization. Both molecules can act in conjunction to modulate cell behavior and affect malignancy. In this review, we will discuss the different contexts in which various integrins, such as α5, αV, ß1, and ß3, interact with HSPGs species, such as syndecans and perlecans, affecting tissue homeostasis.

Immunoregulatory Role of Myeloid-derived Cells in Inflammatory Bowel Disease.

As the frontiers of immunological research expand, new insights into the pathogenesis of long poorly understood diseases, such as inflammatory bowel disease (IBD), are opening up new possible avenues for treatment. Myeloid-derived cells (i.e., monocytes, macrophages, neutrophils, and dendritic cells), long believed to be effector cells driving the initiation of inflammation, have been increasingly shown to have immunoregulatory effects previously underappreciated. Dysfunction in the immunoregulatory roles of these cells may play a part in the pathogenesis of a subset of patients with IBD. The role of myeloid-derived suppressor cells, initially described in cancer, have been shown to play an important role in the balancing of effector and regulatory T cells in inflammation as well, and their role in IBD is also explored. The potential for future cell-based therapies for IBD is enhanced by the advances being made in the understanding of the innate immune system in the intestine.

Fresh, equilibrated and post-thaw sperm quality of Brycon orbignyanus (Valenciennes, 1850) and Prochilodus lineatus (Valenciennes, 1837) treated with either salmon GnRHa and domperidone or pituitary extract

The effects of reduced doses of Ovaprim™ (GnRHa + domperidone) on sperm release of Brycon orbignyanus and Prochilodus lineatus were evaluated. Furthermore, sperm quality was compared among fresh, equilibrated and post-thaw samples. Males received a single and reduced dose of Ovaprim™ (0.125 or 0.25 ml/kg); control males received pituitary extract (cPE; 3 mg/kg). Fresh sperm was evaluated for volume, concentration, seminal plasma osmolality and seminal plasma pH. Then sperm was diluted in a freezing medium, equilibrated for 15-20 min and frozen in nitrogen vapor vessel (dry-shipper). Sperm motility was analyzed during 60 s post-activation in fresh, equilibrated and post-thaw samples. Sperm quality of males treated with Ovaprim™ (both doses) were not different from that of cPE-treated males, thus these data were pooled. In B. orbignyanus, motility was higher in fresh (99%) than in equilibrated sperm (81%); post-thaw motility dropped to 42%. In P. lineatus, motility was similar in fresh (99%) and equilibrated sperm (92%); post-thaw motility was 73%. Motility decreased as a function of time post-activation, and this decrease was significant after 60 s in fresh and equilibrated sperm, and as soon as 30 s in post-thaw sperm, in both species. Ovaprim™ at 1/4 of the recommended dose can successfully replace cPE.

O efeito de doses reduzidas de Ovaprim® (GnRHa + domperidona) na liberação do sêmen de Brycon orbignyanus e Prochilodus lineatus foi avaliado. Além disso, a qualidade do sêmen foi comparada entre as amostras frescas, equilibradas e descongeladas. Os machos receberam dose única e reduzida de Ovaprim® (0,125 ou 0,25 ml/kg); os machos-controle receberam extrato de hipófise (cPE; 3 mg/kg). O sêmen fresco foi avaliado quanto ao volume, concentração, e osmolalidade e pH do plasma seminal. Em seguida, o sêmen foi diluído num meio de congelamento, equilibrado por 15-20 min e congelado em botijão de vapor de nitrogênio (dry-shipper). A motilidade espermática foi analisada durante 60 s pós-ativação no sêmen fresco, equilibrado e descongelado. A qualidade do sêmen não diferiu entre os machos tratados com Ovaprim® (ambas as doses) ou cPE, assim foi feito um pool desses dados. Em B. orbignyanus, a motilidade foi maior no sêmen fresco (99%) do que no equilibrado (81%); a motilidade do sêmen descongelado caiu para 42%. Em P. lineatus, a motilidade foi semelhante entre o sêmen fresco (99%) e equilibrado (92%); a motilidade do sêmen descongelado foi 73%. A motilidade caiu em função do tempo pós-ativação, e essa queda foi significante após 60 s no sêmen fresco e equilibrado, e tão precoce quanto 30 s no sêmen descongelado, em ambas as espécies. Ovaprim® a 1/4 da dose recomendada pode substituir o cPE com sucesso.

Methyl glycol, methanol and DMSO effects on post-thaw motility, velocities, membrane integrity and mitochondrial function of Brycon orbignyanus and Prochilodus lineatus (Characiformes) sperm.

The aim of this study was to use more accurate techniques to investigate the effects of cryoprotectants (CPAs) and extenders on post-thaw sperm quality of Brycon orbignyanus and Prochilodus lineatus. Six freezing media comprising the combination of three CPAs (DMSO, methanol and methyl glycol) and two extenders (BTS and glucose) were used. Sperm was diluted in each medium, loaded into 0.5-mL straws, frozen in a nitrogen vapor vessel (dry-shipper), and stored in liquid nitrogen at -196 °C. Post-thaw sperm motility rate and velocities (curvilinear = VCL; straight line = VSL; average path = VAP) were evaluated using a computer-assisted sperm analyzer. Membrane integrity and mitochondrial function were determined using fluorochromes. Post-thaw quality was considered high when samples presented the following minimum values: 60 % motile sperm, 140 µm/s of VCL, 50 % intact sperm membrane and 50 % mitochondrial function integrity. High post-thaw quality was observed in B. orbignyanus sperm frozen in BTS-methyl glycol and in P. lineatus sperm frozen in BTS-methyl glycol, glucose-methyl glycol and glucose-methanol. All samples frozen in DMSO yielded low quality. The presence of ions in the BTS extender affected post-thaw sperm quality positively in B. orbignyanus and negatively in P. lineatus. Methyl glycol was the most suitable CPA for both fish species, leading to a good protection of cell membrane, mitochondrial function and motility apparatus during the cryopreservation process. For an improved protection, B. orbignyanus sperm should be frozen in an ionic freezing medium.

Gamete quality of streaked prochilod Prochilodus lineatus (Characiformes) after GnRHa and dopamine antagonist treatment.

The efficiency of Ovaprim™ salmon gonadotropin-releasing hormone agonist (GnRHa) and dopamine antagonist on the induction of spawning and spermiation in Prochilodus lineatus in comparison with the commonly used method using pituitary extract (PE) was evaluated. Females received PE at 0.5 + 5.0 mg/kg and Ovaprim™ at 0.05 + 0.45 ml/kg or at 0.125 + 0.375 ml/kg. All males received a first dose of PE at 0.4 mg/kg and then PE at 4.0 mg/kg or Ovaprim™ at 0.25 ml/kg. Oocyte, egg, larvae and sperm quality were evaluated. All females spawned and oocyte, egg and larvae quality were similar between Ovaprim™-treated (both doses) and PE-treated females. Data from females were pooled and the mean values were: 242 g ova weight, 15% ova index, 1209 oocytes/g ova, 284,539 oocytes/female, 183 oocytes/g body weight, 1.18 mm oocyte diameter, 49% fertilization rate, 43% hatching rate and 89% normal larvae. Sperm quality was similar between Ovaprim™-treated and PE-treated males. Data from males were pooled and the mean values of semen were: volume of 3.0 ml, 14.9 × 109 sperm/ml, osmolality of 283 mOsm/kg, pH of 7.4, 71% motile sperm, 217 µm/s curvilinear velocity, 102 µm/s straight-line velocity and 189 µm/s average path velocity. Ovaprim™ treatment can be used for commercial reproduction of P. lineatus, without any loss of gamete quality in comparison with PE treatment.

Osmolality and composition of the extender during the cold storage of Prochilodus lineatus (Characiformes: Prochilodontidae) sperm

This study evaluates the effects of extender osmolality and composition on the cooling of Prochilodus lineatus sperm. Sperm was diluted in six extenders: two compositions (powdered coconut water(tm) = ACP; Beltsville Thawing Solution(tm) = BTS) x three osmolalities (285, 325, and 365 mOsm/kg) plus an undiluted control, and stored at 6-8°C. Motility rate and velocities (curvilinear, straight line, and average path) were determined every other day. Osmolality did not affect the quality of cooled sperm, thus data were pooled. Motility was higher on d 0 compared to the other days and diluted samples (85-90%) yielded higher motility than control (75%). On d 2, motility was higher in BTS-diluted samples and control, but on d 4 and 6, control yielded the highest motility. Velocities decreased from d 0 to 6 in diluted samples, but not in control. On d 0, velocities were higher in BTS-diluted sperm, but, on d 2, 4, and 6, control yielded higher velocities despite of the large variation among males. Thus P. lineatus sperm should be stored in BTS or without dilution, for a maximum of two days at 6-8°C. Extender osmolality between 285 and 365 mOsm/kg does not affect sperm quality during cold storage...

Neste trabalho avaliou-se os efeitos da osmolalidade e da composição do diluidor no sêmen de Prochilodus lineatus, após o resfriamento. O sêmen foi diluído em seis diluidores: duas composições (água de coco em pó(r) = ACP; Beltsville Thawing Solution(r) = BTS) x três osmolalidades (285, 325 e 365 mOsm/kg) mais uma alíquota sem diluição como controle e armazenadas a 6-8°C. A taxa de motilidade e velocidades (curvilinear, retilinear e média de percurso) foram determinadas a cada dois dias. A osmolalidade não afetou a qualidade do sêmen resfriado, dessa forma foi feito um 'pool' desses dados. A motilidade foi maior no d 0 comparado aos outros dias e as amostras diluídas (85-90%) apresentaram as maiores motilidades do que o controle (75%). No d 2, a motilidade foi maior nas amostras diluídas em BTS e controle, mas nos d 4 e 6, o sêmen controle apresentou as maiores motilidades. As velocidades diminuíram do d 0 para o d 6 nas amostras diluídas, mas não no controle. No d 0, as velocidades foram maiores nas amostras diluídas em BTS, mas, nos d 2, 4 e 6, o controle apresentou as maiores velocidades apesar da grande variação entre os machos. Assim, o sêmen de P. lineatus deve ser resfriado em BTS ou sem diluição (controle), por no máximo dois dias a 6-8°C. A osmolalidade do diluidor entre 285 e 365 mOsm/kg não afeta a qualidade do sêmen durante o resfriamento...

Unusual manifestations of a common gastrointestinal disorder.

We present an instructive case of a 13-year old male who presented with bilateral scrotal redness, swelling and tenderness, but with a normal testicular exam. His scrotal swelling persisted despite treatment with intravenous antibiotics, and on further history he reported 2 years of intermittent upper lip swelling. After a referral to a dermatologist, a lip biopsy showed granulomatous changes and he was referred to the gastroenterology department. A gastroscopy and colonoscopy was performed and histology confirmed non-caseating granulomas consistent with Crohn's disease (CD). Eighteen months after the diagnosis of CD he developed perianal disease with a fistula and distal anal stricture. He was successfully treated with insertion of a seton and escalation of therapy to azathioprine and infliximab. CD is a phenotypically diverse chronic inflammatory condition with an increasing incidence in Australia and other Western countries. Non-typical presentations, such as perianal manifestations or orofacial granulomatosis, can be the only presenting symptom in CD, and this highlights the importance for a high degree of clinical suspicion. Genital involvement is rare, but reported.