Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices

ABSTRACT Objectives: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. Patients and Methods: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. Results: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. Conclusion: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices.

OBJECTIVES: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. PATIENTS AND METHODS: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. RESULTS: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. CONCLUSION: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Risk of vasectomy failure by ligation and excision with fascial interposition: A prospective descriptive study.

OBJECTIVE: To evaluate the occlusive failure risk of ligation and excision with fascial interposition vasectomy technique. There are doubts about the effectiveness of this technique largely used in Asia and Latin America. STUDY DESIGN: We conducted a prospective longitudinal observational descriptive study among men who underwent a vasectomy performed under local anesthesia in a clinic specializing in sexual and reproductive health services in Bogotá, Colombia. Three urologists used the Percutaneous No-Scalpel Vasectomy technique to isolate the vas deferens. They then ligated the vas, excised a 1 cm segment between ligations, and ligated the fascia on the prostatic end to cover the testicular end. We requested all patients to submit a semen sample three months after the vasectomy. We defined probable and confirmed vasectomy failure as 1-4.9 million sperm/ml and 5 million sperm/ml or more or any number of motile sperm observed on the last semen sample available, respectively. RESULTS: Among 1149 participants, 581 (51%) had at least one post-vasectomy semen analysis. The overall failure risk was 5.2% (30/581; 95% confidence interval [CI] 3.6%-7.3%) with probable and confirmed failure risk of 1.9% (11/581; 95% CI 1.1%-3.4%) and 3.3% (19/581; 95% CI 2.1%-5.1%), respectively. Older men and one urologist had statistically significant higher risk of overall failure. CONCLUSION: Our study confirmed that the ligation and excision with fascial interposition vasectomy technique is associated with an unacceptable risk of failure. IMPLICATIONS: Surgeons who use the ligation and excision with fascial interposition vasectomy technique and countries with large vasectomy programs in Asia and Latin America that still recommend this technique should consider adopting alternatives to reduce the failure risk to below 1% as recommended by the American Urological Association.

Environmental risks associated with trace elements in sediments from Cartagena Bay, an industrialized site at the Caribbean.

Cartagena Bay (CB) is an industrialized site in the Caribbean. The aim of this study was to evaluate contamination patterns by trace elements in sediments from CB. Sediment samples from twelve sites in CB, and three at the Grand Marsh of Santa Marta (GMSM), a reference site, were collected during dry and rainy seasons. Forty-four trace elements were evaluated employing ICP-MS, and mercury (Hg) was measured using a Hg analyzer. Most contaminated sites corresponded to stations related to repair and maintenance of ships, with high concentrations of Cr, Cu, As and Cd; as well as in areas where cargo transshipment centers and cruise ship terminals operate, which showed elevated levels of Ba. Stations receiving inputs from petrochemical and fertilizer plants displayed high content of Pb. At the station where an extinct chlor-alkali plant was located, a high total Hg level was found, highlighting its persistence. At least 70% of the samples presented Cr, Cu, and As concentrations that were ≥ Threshold Effect Level, < Probable Effect Level, ≥ Effects Range Low and < Effects Range Medium, suggesting adverse biological effects could occur occasionally. Potential Ecological risk values revealed that only Hg and Cd may generate deleterious effects to the aquatic life. However, with few exceptions, sediment samples from CB can be considered as moderately to heavily contaminated, as shown by the Igeo. In short, the principles of ecosystem-based management should be implemented along Cartagena Bay to guarantee safe levels of trace elements in sediments and a better quality of this estuary.

The Cultural Importance of Plants in Western African Religions.

This paper explores the importance of elements of the natural world, and particularly plants, among people of different religious affiliations in western Africa. Plants play an overriding role in African folk religions, which in turn are closely associated with health practices and influence management decisions concerning natural resources. In spite of the extensive literature documenting ritual plant use, the cultural importance of plants in this context has not been systematically assessed. Our objective was to see whether the importance of plants was reflected in people's conceptions of global (i.e., Christianity, Islam) and folk religions (i.e., Vodoun and Bwiti) in Benin (West Africa) and Gabon (Central Africa). By performing a cultural domain analysis (CDA) with 96 individuals, we found that, regardless of the religious affiliation of informants, plants and other elements of the natural world were more present in people's notions of folk religions than in global religions. We conclude by reflecting on the potentials and limitations of the data presented here as a starting point to explore the topic of cultural keystone species.

Why ritual plant use has ethnopharmacological relevance.

ETHNOPHARMACOLOGICAL RELEVANCE: Although ritual plant use is now recognised both for its socio-cultural importance and for its contribution to nature conservation, its potential pharmacological effects remain overlooked. AIM OF THE STUDY: Our objective was to see whether ritual plant use could have ethnopharmacological relevance through practices that involve direct physical contact with the human body. We hypothesise that ritual practices reflect traditional knowledge on biological activities of plant species, even if plants are used in a symbolic way. MATERIALS AND METHODS: Data were collected in collaboration with traditional healers and ritual plant vendors and harvesters in Benin (West Africa) and Gabon (Central Africa). Both ritual and medicinal uses of plants were recorded. Voucher specimens were collected and identified. We documented different administration routes of ritual plants and selected those whose uses involved direct contact with the human body. Based on our quantitative market surveys and field inventories, we identified 24 commercially or otherwise culturally important species and compared their ritual uses with proven biological activity from the literature. RESULTS: We recorded 573 plant species with 667 ritual uses, of which ca. 75% (442 species and 499 uses) implied direct contact with the human body. The most common route of administration for ritual treatments was baths, followed by oral ingestion and skin rubbing. One third (186 species) of all ritual plants doubled as medicine for physical ailments. In contrast to previous research that explained the effectiveness of ritual plant use to be a matter of belief, our results hint at the potential medicinal properties of these plants. Ritual treatment of madness caused by evil spirits by the consumption of Rauvolfia vomitoria roots, for example, may be based on the species' proven anticonvulsant properties. DISCUSSION AND CONCLUSION: We discuss some of the possible implications of ritual plant use for public health and conclude by suggesting that ritual plant uses that do not involve contact with the human body may also be vehicles for the transmission of traditional medicinal knowledge.

"The medicine from behind": The frequent use of enemas in western African traditional medicine.

ETHNOPHARMACOLOGICAL RELEVANCE: Purgative enemas form an integral part of African traditional medicine. Besides possible benefits, serious health risks of rectal herbal therapy have been described in literature. To design appropriate health education programs, it is essential to understand traditional herbal practices and local perceptions of health and illness. Little is known about the herbal ingredients of enemas in Sub-Saharan Africa and consumers' personal reasons to use them. AIM OF THE STUDY: To analyze the importance of enema use with regard to plant species used and illnesses treated in West and Central Africa, to understand the local health beliefs that underlie frequent enema use and to evaluate which recipes and practices could be beneficial or harmful. MATERIALS AND METHODS: We extracted data from 266 ethnobotanical questionnaires on medicinal (in particular women's health and childcare) and ritual plant use in Ghana, Benin and Gabon. Plants mentioned during interviews were vouchered and identified in herbaria. Health issues treated by means of enemas were ranked according to the number of plant species used for a specific illness. We compared our results with findings of medical research on benefits and risks of enema use in Sub-Saharan Africa. RESULTS: We recorded ca. 213 different plant species used in hundreds of recipes for rectal insertions, mostly in Ghana and Gabon. Stomachache, abdominal pain, female infertility and birth facilitation were treated with the highest number of plants species. Cleansing the intestines of young children to promote their health by getting rid of 'dirt', instead of treating constipation, was an important cultural practice that required the rectal application of herbal medicine, as well as other cultural bound health issues like stimulating children to walk at an early age. Tradition, the bitter taste of herbal medicine and the rapid effect of enemas were frequently mentioned reasons for enema use. DISCUSSION AND CONCLUSIONS: Literature indicates that although enemas can help to improve the hygienic conditions of a household with young infants, frequent enema use can pose serious risks like direct toxicity caused by harmful ingredients, mechanical injury and infections. In Africa, enemas containing herbal medicine are common methods of administering herbal medicine for a variety of diseases, rather than just medicinal treatments for constipation as previously thought. Health professionals should be aware of the extent of, and motivation behind enema use to develop culturally appropriate education programs, especially targeted at vulnerable groups such as elderly people, parents of young infants and pregnant women.

Evidence of a link between taboos and sacrifices and resource scarcity of ritual plants.

BACKGROUND: One of the main obstacles for the mainstreaming of religious traditions as tools for the conservation of nature is the limited applicability of research results in this field. We documented two different restrictions implemented by local people (taboos and sacrifices) related to the use of ritual plants in Benin (West Africa) and Gabon (Central Africa). METHODS: To see whether these restrictions reflected plant scarcity from an etic perspective (official threat status) and an emic viewpoint (perceived scarcity by local people), we conducted 102 interviews with traditional healers and adepts of traditional faiths. RESULTS: We documented a total of 618 ritual plants, from which 52 species were used in both countries. In Benin, the use of 63 of the 414 ritual plant species was restricted; while in Gabon 23 of the 256 ritual plants were associated with taboos and sacrifices. In Benin, restricted plants were significantly more often officially threatened, perceived as scarce, and actively protected than non-restricted plants. In the more forested and less densely populated Gabon, plants that were perceived as scarce were more often associated to local restrictions than officially threatened species. CONCLUSIONS: These results prove the presence of a form of adaptive management where restrictions are related to resource scarcity and protection of ritual plant species. By providing baseline data on possibly endangered species, we demonstrate how plant use in the context of religious traditions can yield important information for conservation planning.

Local plant names reveal that enslaved Africans recognized substantial parts of the New World flora.

How did the forced migration of nearly 11 million enslaved Africans to the Americas influence their knowledge of plants? Vernacular plant names give insight into the process of species recognition, acquisition of new knowledge, and replacement of African species with American ones. This study traces the origin of 2,350 Afro-Surinamese (Sranantongo and Maroon) plant names to those plant names used by local Amerindians, Europeans, and related groups in West and Central Africa. We compared vernacular names from herbarium collections, literature, and recent ethnobotanical fieldwork in Suriname, Ghana, Benin, and Gabon. A strong correspondence in sound, structure, and meaning among Afro-Surinamese vernaculars and their equivalents in other languages for botanically related taxa was considered as evidence for a shared origin. Although 65% of the Afro-Surinamese plant names contained European lexical items, enslaved Africans have recognized a substantial part of the neotropical flora. Twenty percent of the Sranantongo and 43% of the Maroon plant names strongly resemble names currently used in diverse African languages for related taxa, represent translations of African ones, or directly refer to an Old World origin. The acquisition of new ethnobotanical knowledge is captured in vernaculars derived from Amerindian languages and the invention of new names for neotropical plants from African lexical terms. Plant names that combine African, Amerindian, and European words reflect a creolization process that merged ethnobotanical skills from diverse geographical and cultural sources into new Afro-American knowledge systems. Our study confirms the role of Africans as significant agents of environmental knowledge in the New World.

Consequences of the trans-Atlantic slave trade on medicinal plant selection: plant use for cultural bound syndromes affecting children in Suriname and Western Africa.

Folk perceptions of health and illness include cultural bound syndromes (CBS), ailments generally confined to certain cultural groups or geographic regions and often treated with medicinal plants. Our aim was to compare definitions and plant use for CBS regarding child health in the context of the largest migration in recent human history: the trans-Atlantic slave trade. We compared definitions of four CBS (walk early, evil eye, atita and fontanels) and associated plant use among three Afro-Surinamese populations and their African ancestor groups in Ghana, Bénin and Gabon. We expected plant use to be similar on species level, and assumed the majority to be weedy or domesticated species, as these occur on both continents and were probably recognized by enslaved Africans. Data were obtained by identifying plants mentioned during interviews with local women from the six different populations. To analyse differences and similarities in plant use we used Detrended Component Analysis (DCA) and a Wald Chi-square test. Definitions of the four cultural bound syndromes were roughly the same on both continents. In total, 324 plant species were used. There was little overlap between Suriname and Africa: 15 species were used on two continents, of which seven species were used for the same CBS. Correspondence on family level was much higher. Surinamese populations used significantly more weedy species than Africans, but equal percentages of domesticated plants. Our data indicate that Afro-Surinamers have searched for similar plants to treat their CBS as they remembered from Africa. In some cases, they have found the same species, but they had to reinvent the largest part of their herbal pharmacopeia to treat their CBS using known plant families or trying out new species. Ideas on health and illness appear to be more resilient than the use of plants to treat them.

Volume, value and floristic diversity of Gabon׳s medicinal plant markets.

ETHNOPHARMACOLOGICAL RELEVANCE: African medicinal plant markets offer insight into commercially important species, salient health concerns in the region, and possible conservation priorities. Still, little quantitative data is available on the trade in herbal medicine in Central Africa. The aim of this study was to identify the species, volume, and value of medicinal plant products sold on the major domestic markets in Gabon, Central Africa. MATERIALS AND METHODS: We surveyed 21 herbal market stalls across 14 of the major herbal medicine markets in Gabon, collected vouchers of medicinal plants and documented uses, vernacular names, prices, weight, vendor information and weekly sales. From these quantitative data, we extrapolated volumes and values for the entire herbal medicine market. RESULTS: We encountered 263 medicinal plant products corresponding with at least 217 species. Thirteen species were encountered on one-third of the surveyed stalls and 18 species made up almost 50% of the total volume of products available daily, including the fruits of Tetrapleura tetraptera and seeds of Monodora myristica. Although bark comprised the majority of the floristic diversity (22%) and the highest percentage of daily stock (30%), the resin of IUCN red-listed species Aucoumea klaineana represented 20% of the estimated daily volume of the entire herbal market. Plants sold at the market were mainly used for ritual purposes (32%), followed by women׳s health (13%), and childcare (10%). The presence of migrant herbal vendors selling imported species, especially from Benin, was a prominent feature of the Gabonese markets. CONCLUSION: An estimated volume of 27 t of medicinal plant products worth US$ 1.5 million is sold annually on the main Gabonese markets. Aucoumea klaineana and Garcinia kola are highlighted as frequently sold species with conservation priorities. The herbal market in Gabon is slightly higher in species diversity but lower in volume and value than recently surveyed sub-Saharan African markets.

Quantifying the domestic market in herbal medicine in Benin, West Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: Herbal medicine markets are essential in understanding the importance of medicinal plants amongst a country's inhabitants. They are also instrumental in identifying plant species with resource management priorities. To document the diversity of the medicinal plant market in Benin (West Africa), to quantify the weight of traded species in order to evaluate their economic value, and to make a first assessment of their vulnerability for commercial extraction. MATERIALS AND METHODS: We quantitatively surveyed 22 market stalls of 16 markets in the country's eight largest urban areas. We collected all plant (parts) following standard botanical methods and recorded uses, prices and local names, and weighed and counted the numbers of sales units. RESULTS: We recorded 307 medicinal products corresponding to ca. 283 species. Thirty-five species were encountered in at least 25% of the surveyed stalls, from which ten are locally endangered or red-listed by the IUCN. Examples of vulnerable species included Caesalpinia bonduc, which has been declared extinct in the wild but is largely cultivated in home gardens, and was exploited for its seeds, roots, and leaves, and Zanthoxylum zanthoxyloides which was harvested for its bark, roots, and leaves. Other top-selling fruits and seeds included red-listed species: Monodora myristica, Xylopia aethiopica, and Schrebera arborea. Top-selling woody plant parts included the roots of Sarcocephalus latifolius, Mondia whitei, and the barks of Khaya senegalensis and Pteleopsis suberosa. All but Sarcocephalus latifolius and Pteleopsis subersosa were species with some threat status. Plants sold at the market were mainly used for ritual purposes, women's health, and to treat malaria and its symptoms. CONCLUSION: Our results suggest that the domestic medicinal plant market in Benin is of substantial economic importance. A volume of approximately 655 metric tons worth 2.7 million USD is offered for sale annually. Traditional spiritual beliefs seem to be a major driving force behind the trade in herbal medicine.

Hemangioma capilar intramedular / Intramedullary capillary hemangioma

Los hemangiomas capilares son lesiones tumorales benignas comunes en diferentes localizaciones. Sin embargo la afección del sistema central es extremadamente inusual. En la literatura tan solo han sido reportados 7 casos de hemangiomas capilares de localización exclusiva intramedular y poco más de 20 casos con compromiso extramedular adicional. Reportamos un paciente adolescente alteración motora y sensitiva progresivo del miembro superior izquierdo asociado a cervicalgia y espasmos musculares cervicales. La resonancia magnética reveló la presencia de una lesión medular cervical sugestiva de neoplasia con un importante componente vascular. Durante la resección no se observó compromiso extra-medular. Los exámenes histopatológico e inmunohistoquímico confirmaron el diagnostico de hemangioma capilar. Si bien, se han publicado muy pocos casos de hemangiomas capilares intramedulares, se cree que puede existir un importante subregistro. En general constituyen una patología benigna de buen pronóstico y que no requiere de manejos adyuvantes como quimio o radioterapia, pero si de un seguimiento neurológico.

Fiabilidad del CSV 1000 para evaluar la función de sensibilidad al contraste en infantes entre los siete y diez años / Reliability of CSV 1000 to evaluate the role of contrast sensitivity in children between seven and ten years

Objetivo: determinar la concordancia entre observadores para medir la función de sensibilidad al contraste empleando el test CSV 1000E en un grupo de infantes entre los siete a diez años. Metodología: fueron evaluados cincuenta niños (cien ojos) visualmente sanos empleando el CSV 1000E. Cada infante fue evaluado por dos evaluadores el mismo día con una diferencia de 30 minutos entre evaluaciones. Resultados: la curva de sensibilidad al contraste promedio fue normal, aunque superior hacia las frecuencias espaciales altas, al ser comparada con un estudio similar (López, 2003). La concordancia obtenida fue muy pobre –coeficiente de correlación concordancia de Lin (pc<0.90)– para todas las frecuencias espaciales, debido a la falta de precisión del test; los límites de acuerdo fueron más amplios a los publicados en otra investigación (Pomerance & Evans, 1994). Conclusiones: los resultados encontrados muestran que el test tiene una baja concordancia, lo que indicaría una pobre validez para medir la función de sensibilidad al contraste en niños.

The purpose of this trial was determinate the test retest reliability between evaluators to measurement contrast sensitivity function using the CSV 1000E test in children between 7-10 years. Methods: fifty visually-healthy children were tested using the CSV1000E. Each children was seen by 2 evaluators the same day, thirty minutes apart from each evaluations. Results: the contrast sensitivity curve function was normal, although it was higher for high spatial frequencies when compared to that was it found in another trial (López, 2003). test retest reliability was poor (pc<0.90) for all spatial frequencies because the CSV 1000 precision was low, 95 por ciento limits of agreement were wider than found in another research project (Pomerance y Evans, 1994). Conclusions: the results have shown that CSV 1000 had low agreement, means this test has poor reliability to assess contrast sensitivity function in children.