Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: outcome analysis.

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The advantages of the microscopic approach to varicocele repairs are detailed identification and preservation of the vascular structures. In this study, our purpose is to review the outcome of all patients that underwent microscopic subinguinal varicocelectomy with the video telescopic operating microscope (VITOM). Hence, a retrospective review of 23 varicocele patients who underwent microscopic subinguinal varicocelectomy at the center from the year 2019 until 2021 was done. They, ranging between 18 to 58 years of age, comprising one case of right varicocele, fifteen cases of left varicocele, and seven cases of bilateral varicocele, were all having symptoms (pain and swelling) and clinically palpable varicocele. Ultrasounds were done to confirm the diagnosis and measure the testicular size. The surgery was performed by a single surgeon, under spinal anesthesia. The operation was performed using the VITOM telescope system, with an average operative time of one hour. The patients were followed-up at one month postoperatively to review the wound and symptoms. Phone call evaluations of all 23 patients were done to detect any recurrence or complications. All patients were discharged one day after surgery. Post-operative, all of them have a well-formed scar at the previous subinguinal region incision wound during the clinic visits. None of the 23 patients reported with varicocele recurrence, testicular pain, hydrocele formation or sexual dysfunction. The previous testicular pain or discomfort they encountered prior to the surgery was resolved as well. In conclusion, microscopic subinguinal varicocelectomy using the VITOM telescope is feasible and could achieve good outcomes.

Gut microbiota and their derivatives in the progression of colorectal cancer: Mechanisms of action, genome and epigenome contributions.

Gut microbiota interacts with host epithelial cells and regulates many physiological functions such as genetics, epigenetics, metabolism of nutrients, and immune functions. Dietary factors may also be involved in the etiology of colorectal cancer (CRC), especially when an unhealthy diet is consumed with excess calorie intake and bad practices like smoking or consuming a great deal of alcohol. Bacteria including Fusobacterium nucleatum, Enterotoxigenic Bacteroides fragilis (ETBF), and Escherichia coli (E. coli) actively participate in the carcinogenesis of CRC. Gastrointestinal tract with chronic inflammation and immunocompromised patients are at high risk for CRC progression. Further, the gut microbiota is also involved in Geno-toxicity by producing toxins like colibactin and cytolethal distending toxin (CDT) which cause damage to double-stranded DNA. Specific microRNAs can act as either tumor suppressors or oncogenes depending on the cellular environment in which they are expressed. The current review mainly highlights the role of gut microbiota in CRC, the mechanisms of several factors in carcinogenesis, and the role of particular microbes in colorectal neoplasia.

An overview of the ameliorative efficacy of Catharanthus roseus extract against Cd2+ toxicity: implications for human health and remediation strategies.

Rapid industrialization has led to an increase in cadmium pollution, a dangerously toxic heavy metal. Cadmium (Cd) is released into the environment through industrial processes and can contaminate air, water, and soil. This pollution poses a significant risk to human health and has become a pressing concern in many industrialized areas. Due to its extended half-life, it leads to a range of health problems, including hepato-nephritic toxicity, brain damage, and degenerative bone disorders. Intoxication alters various intracellular parameters, leading to inflammation, tissue injury, and oxidative stress within cells, which disrupts normal cellular functions and can eventually result in cell death. It has also been linked to the development of bone diseases such as osteoporosis. These adverse effects highlight the urgent need to address cadmium pollution and find effective solutions to mitigate its impact on human health. This article highlights the Cd-induced risks and the role of Catharanthus roseus (C. roseus) extract as a source of alternative medicine in alleviating the symptoms. Numerous herbal remedies often contain certain bioactive substances, such as polyphenols and alkaloids, which have the power to mitigate these adverse effects by acting as antioxidants and lowering oxidative cell damage. Research conducted in the field of alternative medicine has revealed its enormous potential to meet demands that may be effectively used in safeguarding humans and their environment. The point of this review is to investigate whether C. roseus extract, known for its bioactive substances, is being investigated for its potential to mitigate the harmful effects of cadmium on health. Further investigation is needed to fully understand its effectiveness. Moreover, it is important to explore the potential environmental benefits of using C. roseus extract to reduce the negative effects of Cd. This review conducted in the field of alternative medicine has revealed its enormous potential to meet demands that could have significant implications for both human health and environmental sustainability.

Association of Childhood Emotional Maltreatment with Adolescents' Psychopathology: A Systematic Review and Meta-Analysis.

Childhood Emotional Maltreatment (CEM) is a significant but under-studied risk factor for impaired mental health, with adolescents being particularly susceptible. This systematic review and meta-analysis, prospectively registered in PROSPERO as CRD42022383005, aims to synthesize the findings of studies investigating the association between CEM and adolescent psychopathology, making it the first attempt to the best of our knowledge. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a comprehensive search (PubMed, Scopus, PsycINFO, Science Direct, Embase, and ProQuest) yielded 12,224 studies, from which 72 were included in the qualitative synthesis. The meta-analysis was conducted on 76 effect sizes (ranging from 0.01 to 0.57) extracted from 56 studies. The assessment of publication bias utilized funnel plots, Egger's regression test, and the trim and fill method, if required. Additionally, a predictor analysis investigated the influence of study-level variables on the CEM-psychopathology association. Results revealed a significant positive correlation between CEM and adolescent psychopathology (Pooled association: 0.24-0.41) Furthermore, assessment of publication bias indicated no significant bias. The predictor analysis suggested minimal influence of study-level variables. The study underscores the urgent need to address CEM as a crucial risk factor for adolescent psychopathology. The significant positive correlation between CEM and psychopathological outcomes highlights the detrimental effects of CEM on adolescents. Awareness, prevention efforts, and targeted interventions are essential to mitigate these effects. Further studies with culturally diverse and larger sample sizes are required, with emphasis on methodological rigor, given that most of the identified studies showed a high risk of bias.

Giant Prostatic Stones and a Massive Bladder Stone Leading to Obstructive Uropathy: A Rare Case Report.

Giant prostatic calculi are rare with less than 20 cases reported in the literature so far. Here, we discuss the presentation, diagnosis, and surgical management of a 25-year-old male patient with giant prostatic stones associated with a large bladder stone resulting from an underlying neurogenic bladder secondary to spina bifida. The patient had a history of congenital spina bifida, hydrocephalus, and non-compliance with clean intermittent self-catheterization. The stones were diagnosed through imaging and cystoscopy, and open cystolithotomy was performed for stone removal. The patient had a successful postoperative recovery with improved renal function. The case highlights the association between prostatic calculi and bladder outlet obstruction, emphasizes the importance of addressing underlying conditions to prevent stone recurrence, and underscores the role of open surgery in managing large bladder stones accompanied by renal impairment.

Systemic Interleukin-6 Response after Intravesical Instillation of Bacillus Calmette-Guérin and Mitomycin C in Superficial Bladder Cancer.

Interleukin-6 (IL-6) is proposed to play a significant role in pathogenesis of urinary bladder cancer (UBC). This role may be influenced by chemotherapy (mitomycin C; MMC) or immunotherapy (Bacillus Calmette-Guérin; BCG). A case-control study was conducted to determine IL-6 levels in serum of newly diagnosed cases (NDC) of superficial UBC, as well as in patients treated with MMC or BCG intravesical instillation. A total sample of 111 patients (36 NDC, 45 MMC and 30 BCG) was included, as well as a control group of 107 healthy controls (HC). IL-6 was detected by enzyme-linked immunosorbent assay. Results revealed that median levels of IL-6 were significantly elevated in NDC group (15.8 pg/mL; P<0.001) compared to MMC and BCG groups (7.5 and 5.3 pg/mL, respectively) or HC (4.4 pg/mL); while, there were no significant differences between the latter three groups (MMC, BCG and HC). Receiver operating characteristic curve analysis revealed that IL-6 is a very good predictor of UBC in NDC group versus HC (area under the curve=0.885; 95% confidence interval=0.828-0.942; P<0.001; cut-off value=10.5 pg/mL; Youden index=0.62; sensitivity=80.6%; specificity=81.3%). Logistic regression analysis confirmed this significance and IL-6 was associated with a higher risk of UBC (odds ratio=1.18; 95% confidence interval=1.11-1.26; P<0.001). In conclusion, this study indicated that IL-6 level was upregulated in serum of NDC of UBC. Further, IL-6 level was restored to normal levels after intravesical instillation of MMC or BCG.

Protective Effect of Catharanthus roseus Extract on Cadmium-Induced Toxicity in Albino Rats: A Putative Mechanism of Detoxification.

Globally, people are highly affected by Cadmium (Cd), the most hazardous heavy metal. It has been implicated in various pathogeneses. Oxidative stress may be one the main reasons for Cd-induced disorders in the body. This article investigates the protective ability of Catharanthus roseus (CR) extract on oxidative stress in the kidney and liver of rats exposed to Cd. After 21 days, a significant increase in MDA concentration (6.81 ± 0.05), (6.64 ± 0.03) was observed in Cd-treated groups compared to the control (5.54 ± 0.02), (5.39 ± 0.04) for the kidney and liver, respectively, while significant changes were observed in the haematological parameters. Antioxidant enzymes, GPx, CAT, and SOD showed a significant decrease in their activity. We established that increasing the concentration of Cd in the presence of H2O2 was able to cause stand scission in pBR322 plasmid DNA, which may be due to the mediation of ROS generated in the process. The antioxidant ability of CR extract was tested in DPPH and H2O2 scavenging assay, depicted by the increase in the percentage inhibition. Upon treatment of CR extract to rats, MDA concentration was decreased for the kidney and liver compared to the Cd-treated groups. This was again confirmed by comet assay of both tissues, where the degree of cellular DNA breakage caused by Cd toxicity decreased significantly upon treatment with CR extract. Overall, the results suggest that Cd plays a major role as an effector metal ion, causing a decrease in the concentration and activity of AO enzymes and enhanced lipid peroxidation. ROS production resulted in oxidative DNA damage within the cell, whereas CR extract showed potential antioxidant activity against ROS-mediated DNA damage induced by Cd poisoning.

The Utilization of a Fiberglass Mesh-Reinforced Foamcrete Jacketing System to Enhance Mechanical Properties.

Foamcrete is fabricated by combining mortar slurry and constant foam. Owing to the existence of air entrained in its cementitious matrix, foamcrete is tremendously brittle compared to normal-strength concrete. The addition of synthetic and natural plant fibers demonstrates an enhancement to foamcrete's mechanical performance yet exerts a harmful effect on long-term performance. Depreciation of natural plant fibers and corrosion of synthetic fibers impact the lifespan and durability properties of foamcrete. Hence, this study aims to investigate the mechanical properties and mode of failures of foamcrete reinforced with fiberglass mesh (FM). The parameters assessed were the compression, flexural, and splitting tensile strengths of 1100 kg/m3 density foamcrete confined with various layers of 145 g/m2 of FM. The optimal foamcrete mechanical properties enhancement was attained with three-layer jacketing. Notable augmentations of 108% in the compressive strength, 254% in flexural strength, and 349% in splitting tensile strength were achieved in comparison to the control specimens at day 28. The control foamcrete samples under compressive, flexural, and tensile loads encountered brittle failure in comparison to the confined foamcrete. The mode of failure under the tensile load indicates that only a slight crack occurred at the upper side and a perpendicular mark at the lateral section of the foamcrete with one to three layers of FM jacketing. Thus, the jacketing system of foamcrete with FM enhances the behavior and load carrying capacity of foamcrete to the extent of preventing the propagation of cracks.

Interaction of Geopolymer Filler and Alkali Molarity Concentration towards the Fire Properties of Glass-Reinforced Epoxy Composites Fabricated Using Filament Winding Technique.

This paper aims to find out the effect of different weight percentages of geopolymer filler in glass-reinforced epoxy pipe, and which can achieve the best mechanical properties and adhesion between high calcium pozzolanic-based geopolymer matrices. Different weight percentages and molarities of epoxy hardener resin and high calcium pozzolanic-based geopolymer were injected into the glass fiber. By manually winding filaments, composite samples were produced, and they were then allowed to cure at room temperature. To determine how well the geopolymer matrices adhere to the fiber reinforcement, the microstructure of the composites' surfaces and perpendicular sections were examined. Maximum values of compressive strength and compressive modulus were 94.64 MPa and 2373.58 MPa, respectively, for the sample with a weight percentage of filler loading of 30 wt% for an alkali concentration of 12 M. This is a relatively wide range of geopolymer weight percentage of filler loading from 10 wt% to 40 wt%, at which we can obtain high compressive properties. By referring to microstructural analysis, adhesion, and interaction of the geopolymer matrix to glass fiber, it shows that the filler is well-dispersed and embedded at the fiber glass, and it was difficult to determine the differences within the range of optimal geopolymer filler content. By determining the optimum weight percent of 30 wt% of geopolymer filler and microstructural analysis, the maximum parameter has been achieved via analysis of high calcium pozzolanic-based geopolymer filler. Fire or elevated temperature represents one of the extreme ambient conditions that any structure may be exposed to during its service life. The heat resistance or thermal analysis between glass-reinforced epoxy (GRE) pipe and glass-reinforced epoxy pipe filled with high calcium pozzolanic-based geopolymer filler was studied by investigating burning tests on the samples, which shows that the addition of high calcium pozzolanic-based geopolymer filler results in a significant reduction of the melted epoxy.

Comparison of Hook and Straight Steel Fibers Addition on Malaysian Fly Ash-Based Geopolymer Concrete on the Slump, Density, Water Absorption and Mechanical Properties.

Geopolymer concrete has the potential to replace ordinary Portland cement which can reduce carbon dioxide emission to the environment. The addition of different amounts of steel fibers, as well as different types of end-shape fibers, could alter the performance of geopolymer concrete. The source of aluminosilicate (fly ash) used in the production of geopolymer concrete may lead to a different result. This study focuses on the comparison between Malaysian fly ash geopolymer concrete with the addition of hooked steel fibers and geopolymer concrete with the addition of straight-end steel fibers to the physical and mechanical properties. Malaysian fly ash was first characterized by X-ray fluorescence (XRF) to identify the chemical composition. The sample of steel fiber reinforced geopolymer concrete was produced by mixing fly ash, alkali activators, aggregates, and specific amounts of hook or straight steel fibers. The steel fibers addition for both types of fibers are 0%, 0.5%, 1.0%, 1.5%, and 2.0% by volume percentage. The samples were cured at room temperature. The physical properties (slump, density, and water absorption) of reinforced geopolymer concrete were studied. Meanwhile, a mechanical performance which is compressive, as well as the flexural strength was studied. The results show that the pattern in physical properties of geopolymer concrete for both types of fibers addition is almost similar where the slump is decreased with density and water absorption is increased with the increasing amount of fibers addition. However, the addition of hook steel fiber to the geopolymer concrete produced a lower slump than the addition of straight steel fibers. Meanwhile, the addition of hook steel fiber to the geopolymer concrete shows a higher density and water absorption compared to the sample with the addition of straight steel fibers. However, the difference is not significant. Besides, samples with the addition of hook steel fibers give better performance for compressive and flexural strength compared to the samples with the addition of straight steel fibers where the highest is at 1.0% of fibers addition.

Attitudes of Irish patients with chronic pain towards medicinal cannabis.

BACKGROUND: Medicinal cannabis use is topical in the media in Ireland. A recent Health Products Regulatory Authority review, however, has recommended against its use for patients with chronic pain. This is despite evidence for its effectiveness in this patient's cohort and the inadequate pain management of these patients. AIM: The aim of this study was to evaluate the attitudes of Irish patients with chronic pain towards medicinal cannabis. METHODS: After institutional ethics committee approval, a 12-item questionnaire (excluding demographics) was randomly assigned to patients attending a chronic pain clinic (University Hospital Limerick). The questionnaire was designed to incorporate patient's attitudes on a variety of medicinal cannabis related topics. RESULTS: Ninety-six adult patients were surveyed. 88.54% agreed that cannabis should be legalised for chronic pain medicinal purposes. 80.21% believed it would have health benefits for them and 73.96% agreed it would be socially acceptable to use cannabis for this purpose. 33.33% perceived cannabis to be addictive while 68.75% would be willing to try it if prescribed by a medical professional. CONCLUSIONS: The study highlights the attitudes of chronic pain patients in Ireland towards medicinal cannabis. It shows their desire to have medical cannabis legalised for chronic pain and that they view it as a reasonable pain management option.

Groundwater contamination with cadmium concentrations in some West U.P. Regions, India.

Water is considered a vital resource because it is necessary for all aspects of human and ecosystem survival. However, due to natural processes and anthropogenic activities, various pollutants have been added to the ground water system. Among these, heavy metals are some of the most serious pollutants. Cd, a toxic heavy metal used in Ni-Cd batteries, the colouration of plastic and various discarded electronic products released into the water system causes serious health issues. The chronic exposure to Cd produces a wide variety of acute and chronic effects in humans. Cd accumulates in the human body, especially in the kidneys, resulting in kidney damage (renal tubular damage), which is a critical health effect. Other effects of Cd exposure are disturbances in calcium metabolism, hypercalciuria and the formation of kidney stones. High exposure to Cd can lead to lung cancer and prostate cancer; hence, poor quality water that may result in Cd toxicity has become a global concern. Thus, the aim of this study is to determine the concentration of Cd in underground water sources in western U.P. regions. Water samples were acidified to 1% with nitric acid and then stored in double-capped polyethylene bottles for further analysis by an atomic absorption spectrophotometer. After comparing the data to the WHO (2011) permissible limit, the study revealed that the concentration of Cd was higher than the regulatory threshold; therefore, the underground water system is seriously affected by Cd toxicity.

Bioremediation of cadmium induced renal toxicity in Rattus norvegicus by medicinal plant Catharanthus roseus.

Cadmium is the second most hazardous metals with bio-concentration factor (BCF) > 100 Although WHO permitted cadmium concentration in drinking water is 0.005 mg/L, yet the reality is far above to this limit because of industrial utility of this metal. Oral exposure of cadmium to human results in dreadful symptoms of metabolic disorders especially in liver and kidneys. Endogenous protection could be supported by some exogenous herbal supplement (viz., Catharanthus roseus in this case) to overcome the toxic effects. Present Study has been designed to find out the functional renal changes under the effect of cadmium and Catharanthus roseus in the model organism albino rats. Cadmium significantly (p > 0.01) increases the level of nitrogenous waste (Urea, BUN, Uric Acid and Creatinin), while decreases the serum protein profile in acute and sub-acute sets. Urea concentration of control ranged from 16.56 to 17.72 mg/dl while that of Group-B and D were 19.84 to 20.87 mg/dl and 17.56 to 17.59 mg/dl respectively. Similarly uric acid concentration ranged in control form 6.98 to 8.01 mg/dl in group-B from 7.58 to 10.25 mg/dl, in Group-D 8.02 to 8.59 mg/dl respectively. Creatinin concentration ranged in control 0.57 to 0.65 mg/dl, in group-B 0.97 to 1.02 mg/dl, in group-D - 0.95 to 0.98 mg/dl respectively. These results might be due to altered filtration rate of kidney because of protein disruption. The studies conclude the efficient nephro-protection offered by Catharanthus roseus extract against Cadmium toxicity.

Difficult Airway in a Case of Gross Hydrocephalus for Shunt Surgery.

Children with gross hydrocephalus for emergency ventriculoperitoneal (VP) shunt present challenges to anesthesiologist due to increase in circumference of head, associated congenital anomalies. Here is a case report of child with gross hydrocephalus with Type 2 Arnold chiari malformation posted for emergency VP shunt placement possessed a difficult airway.