Embryonal rhabdomyosarcoma of the testis in a 17-year-old male.

Primary rhabdomyosarcoma of the testis is an exceptionally rare and highly malignant sarcoma. To date, there are only 23 reported cases in the literature. We report a 17-year-old male patient presented with massive scrotal swelling that had been progressively enlarging over seven-months. Scrotal ultrasound and contrast-enhanced CT revealed a 10 × 10cm left testicular heterogeneously enhancing mass that extends into the spermatic cord. A left inguinal orchiectomy was performed, and histopathological examinations showed findings consistent with Rhabdomyosarcoma, Embryonic-type. Primary embryonal testicular rhabdomyosarcoma has poor prognosis, particularly for adolescents, and tumour size greater than 10cm. Early diagnosis and radical orchiectomy improve the prognosis.

Comparative analysis of Super-mini percutaneous Nephrolithotomy (SMP) and Retrograde Intrarenal Surgery (RIRS) for the Management of Renal Calculi ≤ 2 cm among Somali Population.

Background Limited data have explored the efficacy of Super-Mini Percutaneous Nephrolithotomy (SMP) and Retrograde intrarenal Surgery (RIRS) in managing≤ 2 cm renal calculi. This study aims to comprehensively evaluate the safety and effectiveness of SMP compared to RIRS. Method This prospective cohort study investigated 210 patients with renal calculi (≤ 2 cm) undergoing SMP or RIRS, randomly recruited over four years. 51.4% underwent SMP and 48.6% underwent RIRS. Results: The mean patient age was 31.3±14.7 years; 56.7% were men, mean stone size of 1.3±0.28 cm, and stone hardness of 1190.1±352.83 HU. Pearson's correlation indicated negative correlations for SMP with hospital stays (r=-0.138, p=0.046), operating time (r=-0.519, p<0.001), stone-free rate (SFR) (r=-0.161, p=0.020); and a positive correlation with a postoperative ureteral catheter (r=+0.389, p<0.001). In regards to RIRS, the study shows a positive correlation with hospital stay (r=+0.138, p=0.046), operating time (r=+0.519, p<0.001), and SFR (r=+0.161, p=0.020); and a negative correlation with postoperative ureteral catheter (r=-0.389, p<0.001). Logistic regression, using SMP as the reference, RIRS was associated with ß=+0.31, and 1.20(95% CI,1.14-1.27, p=<0.001) risk of operation duration and ß=+0.37, 1.44(95% CI,1.00-2.07, p=0.047) risk of longer hospital stay. Conclusion This study investigates the suitability of SMP and RIRS for treating renal calculi ≤2 cm. SMP demonstrated superior efficacy with significantly shorter operating times and reduced hospital stays, suggesting potential advantages for managing lower-volume renal stones.

Prevalence and associated factors of sexual dysfunction in female hemodialysis patients: first report from Somalia.

BACKGROUND: Sexual dysfunction is frequent in female hemodialysis patients and is related to poorer quality of life. It is often a neglected topic associated with marked distress and interpersonal difficulties. OBJECTIVE: Few studies are reported from Sub-Saharan African Countries (SSA) regarding female sexual dysfunction (FSD) in (HD) patients. The study aims to explore the prevalence and associated factors of FSD in female HD at a sole dialysis centre in Somalia. METHOD: Over a one-month period, a cross-sectional study was conducted among women with end-stage renal disease aged 18-50 years who were undergoing a dialysis program for at least three months at the dialysis center of our hospital. The participants were married, and they were living with their partners. Data regarding the sociodemographic features, clinical characteristics, frequency of sexual intercourse per week, and the Female Sexual Function Index (FSFI) scores were collected using a standard face-to-face interview questionnaire. RESULTS: During the study period, a total of 115 participants were eligible for the study's inclusion criteria. The mean patient age was 38.5 ± 9.3 years. The most common cause of ESRD was diabetes, which accounted for 53%, followed by hypertension (26.1%) and glomerulonephritis (9.6%). The mean duration of dialysis was 2.9 ± 1.4 years, and approximately two-thirds of the participants (62.5%) were in the program for more than three years. Regarding the frequency of sexual intercourse, 61.7% of female participants performed sexual intercourse less than once time/a week. The prevalence of FSD was 92.2% (n = 106) of all participants. The mean FSFI score of the participants was 16.05 ± 4.48. Longer duration of dialysis program (i.e., more than four years), increasing age (i.e., > 35 years), those with diabetes had scored lower overall FSFI scores. CONCLUSION: The prevalence of female sexual dysfunction among Somali female hemodialysis patients was very high, representing a significant problem in end-stage renal disease (ESRD). Our study findings revealed that increasing age, diabetes, and duration of dialysis negatively impact female sexual function and are significantly associated with FSD.

Traumatic renal artery occlusion secondary to blunt trauma in a second-trimester pregnant woman who managed successfully with non-operative management: A rare case report.

Blunt renal injuries in pregnancy are seldom isolated, with resultant renal vascular injury following this type of injury being extremely rare. We present a rare case of complete blockage of the left renal artery about 1 cm from the aortic opening in a second-trimester pregnant woman after she sustained a motor-vehicle-accident. She was managed successfully with NOM. Traumatic renal artery blockage is a rare condition with devastating consequences if missed on imaging. Although blunt renal trauma during pregnancy is a rare condition, NOM has become increasingly popular to reduce morbidity associated with nephrectomy resulting in higher rates of renal salvage.

A 12-year-old Somalian girl presented with chronic kidney disease and died as a result of female genital mutilation- A case report.

The tradition of female genital mutilation (FGM) is practiced in many African countries, including Somalia. FGM is responsible for several short and long-term complications that can negatively influence vital and functional prognosis. We present a case of a 12-year-old girl subjected to FGM who developed urethral meatus stenosis, exacerbated by chronic renal failure and urine infection, leading to her death from a combination of complications. FGM complications, sometimes fatal, remain in developing nations. The fight against these practices must be stepped up, supported by public awareness, education, and communication efforts.

Extensive penile glans and corpus spongiosum necrosis due to catheter traction following laparoscopic radical cystoprostatectomy: a rare case report and literature review.

BACKGROUND: Penile glans and corpus spongiosum necrosis is an extremely rare urologic condition associated with substantial morbidity. CASE PRESENTATION: We report a rare case presenting extensive penile glans and corpus spongiosum necrosis following catheter traction in a 71-year-old male patient who had a laparoscopic radical cystoprostatectomy for muscle-invasive bladder cancer. The patient has no preexisting diabetes mellitus or chronic renal failure. The case was successfully managed with penile preservation. During the procedure, it was observed that the necrosis was not limited to the glans. The necrosis had spread to the entire penile urethra and corpus spongiosum, and an excision of approximately 14 cm of corpus spongiosum was performed. CONCLUSION: This is the first case presenting extensive length of penile glans and corpus spongiosum necrosis managed successfully with penile preservation, enabling reaching the best functional and esthetic results reported in the literature. Early detection and urgent imaging with a high index of suspicion ensure a favorable outcome. The main treatment steps are careful evaluation, appropriate therapy, and prompt intervention depending on the severity.

Incidence and associated factors for incidental prostate cancer among patients who underwent surgery for benign prostatic hyperplasia: first report from Somalia.

BACKGROUND: The incidence rate of incidental prostate cancer (IPC) differs significantly among the reported studies in the relevant literature. There is a scarcity of studies regarding IPC reported from Sub-Saharan African Countries, including Somalia. The present is the first study that evaluates the incidence and associated factors for IPC among patients who had surgery for benign prostatic hyperplasia at a tertiary hospital in Somalia. METHOD: This retrospective study reviewed the data of 538 patients with benign prostate hyperplasia, 464 patients who underwent transurethral resection of the prostate (TURP), and 74 patients with open prostatectomy (OP) over 5 years. A binary logistic regression model was used to investigate the association between perioperative factors such as age, prostate volume, total prostate-specific antigen (TPSA) levels, type of surgery, specimen weight, and the finding of IPC. RESULTS: IPC was detected in 17.6%, 18.3% of TURP, and 13.5% of OP patients (p = 0.002). The mean age of the patients was 71.82 ± 7.4; IPC patients had a significantly higher mean age than the BPH group (74 ± 10.9 vs. 71.3 ± 10.8, p < 0.001). Sixty-two percent of the patients were T1b, while 57.8% had ISUP grade groups 1 and 2. Patients with T1a had significantly higher International Society of Urological Pathology (ISUP) grades 1 and 2 than those with T1b (69.4% in T1a vs. 50.8% in T1b, p < 0.001). Increased age, higher TPSA levels, low prostate volume, and specimen weight were independently associated with the finding of incidental prostate carcinoma (OR 1.978, 95% CI 0.95-1.60, P < 0.04; OR 1.839, 95% CI 0.99-2.02, P < 0.001; OR 1.457, 95% CI 0.7102.99, P < 0.001, OR 0.989, 95% CI 1.07-2.94, P = 0.01). IPC was most commonly managed by active surveillance (54.7%), followed by androgen deprivation therapy in 28.4%. The overall survival rate for a 5-year follow-up in the entire cohort was 79%. The cancer-specific mortality was 8.4%. CONCLUSION: The study findings revealed a higher incidence and cancer-specific mortality rate of incidental prostate carcinoma. T1b stage, higher ISUP grade, older age, and higher preoperative TPSA were significantly associated with the overall mortality and cancer-specific mortality rate. More than half of the cases were managed by active surveillance, and it is a safe management strategy, particularly in low-income countries like Somalia.

A presentation of iatrogenic hypospadias after traditional circumcision: A case report.

Introduction and Importance: Traditional circumcisions may cause complications such as hemorrhage, infection, amputations of the penis, meatal stenosis, and urethro-cutaneous fistula. In addition to all these complications, iatrogenic hypospadias, as in our case, is a rare condition. In general, complications are mild and preventable, especially in children, but when the procedure is carried out by unskilled providers, in unsterile conditions, or with inadequate equipment and supplies, severe complications are more likely to occur. Several degrees of urethral erosion, including iatrogenic hypospadias, might result from further injury. Particularly in intensive care facilities, the ventral male urethra can undergo this kind of trauma. Case presentation: A 4-year-old child was circumcised at the age of 3 years, and after that, he bled profusely. His parents brought him to the hospital after 4 months. On physical examination of the patient, the glans was normal but there was an opening near the glans in the distal urethra at the subcoronal level. After the pre-operative check-up, the patient was prepared for elective surgery. An incision and dissection were performed to reveal the fistula tract all around by placing marker sutures from the edges of the fistula. The fistula opening was repaired with 6/0 PDS (polydioxanone) and a second layer was created over the urethral fistula repair, and then the skin was closed with 4/0 Vicryl (polyglactin). Clinical discussion: Around the world, circumcision continues to be the most common procedure done on children. Injuries to the penis may actually happen with a 1% complication incidence. A poorly placed suture at the frenulum in an effort to achieve hemostasis is the most frequent cause of the fistula. This causes strangulation and necrosis of a portion of the urethral wall, which leads to the creation of a sub glandular fistula. It is important to properly identify and treat any life-threatening injuries to the urethra as soon as possible. Conclusion: Considered a medical procedure that necessitates great care, circumcision should only be carried out by qualified surgeons under sterile hospital circumstances. Most circumcision-related injuries result from clamp circumcisions (such as Mogen or Gomco), and they can range from minor loss of penile skin to more serious glans, distal urethral, and penile shaft injuries.

Terror-related injuries in Somalia: a retrospective cohort of 2426 hospitalized cases along 7 years.

Terrorism-related injuries and deaths have become a major threat to the Somalian population, as in the rest of the world. We aimed to characterize and compare firearm and explosion injuries caused by terrorist acts. This retrospective study reviewed the data of all patients injured by explosions and firearm attacks over seven years. Epidemiological characteristics, injury pattern, severity scores, hospital resource utilization parameters, length of stay, and death rates were evaluated. A total of 2426 patients were injured by 359 explosions and firearm attacks during the study period. Eighty-one percent of the patients (n = 1974) were male, while 19% of the cases were female. Multiple body site injuries occurred more frequently in explosion injuries (75%) than firearm wounds (48%) (P < 0.001). The relative frequency of internal injuries in explosion injuries was higher than in firearm wounds (46.7% vs. 36.2%). Patients injured due to the explosion have a greater rate of severe and critical injuries than those injured by firearms (30.2% vs. 21.2%, P < 0.001). About a quarter (24%) of the patients were hospitalized in the intensive care unit. The inpatient mortality rate was 11.6%. The findings of the study revealed that suicide bombings explosions are associated with multiple body site injuries, a greater rate of severe and critical internal injuries, and a higher mortality rate.

An isolated traumatic renal artery pseudoaneurysm treated by renal artery stent insertion: a case report presenting a nephron-sparing approach.

Penetrating or blunt traumas can rarely lead to renal artery pseudoaneurysms (RAPs). Renal parenchymal lacerations usually accompany them, and nephrectomy is performed in these cases. Although angioembolization of the renal artery can negate the need for nephrectomy while treating the RAP, it is not a nephron-sparing procedure. Herein, we present a case of isolated (i.e. without accompanying renal laceration) left RAP. During conservative follow-up, the RAP enlarged, and subsequently, it was treated by renal artery stent insertion. An expandable covered stent was used during this procedure. The renal function was preserved without experiencing any complications.

Somalian women with female genital mutilation had increased risk of female sexual dysfunction: a cross-sectional observational study.

Studies regarding the impact of female genital mutilation/cutting (FGM/C) on sexual function are scarce. This study is the first to explore the rate of female sexual dysfunction (FSD) among Somalian women who underwent FGM and its association with different FGM types. This study was carried out among women with a history of FGM who visited our clinic for a medical check-up. It relied on data including socio-demographic features, type of FGM determined by an examination, and the Female Sexual Function Index (FSFI) scores. Overall, 255 women were included. While 43.9% (n = 112) of the respondents had a history of Type 3 FGM, 32.2% had Type 2 (n = 82), and 23.9% had Type 1 (n = 61) FGM. Among all patients, 223 had FSD (87.6%). There was a significant association between the FGM type and FSD (p < 0.001). The mean total FSFI score for the patients with Type 1, 2, and 3 FGM was 22.5, 19.7, and 17.3, respectively, all indicating FSD. The FSD is prevalent among mutilated Somalian women. Patients with Type 3 FGM had the lowest mean total FSFI scores indicating that the impact on sexual function was correlated with the extent of tissue damage during FGM.

Epidemiology of End-Stage Renal Disease in Mogadishu, Somalia: First Report at a Tertiary Care Hospital.

Background: End-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis. Patients and methods: This cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed. Results: The mean age of the patients was 52.7±15.0 years, 43.3% were >60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825-5.357, OR: 3.017, p<0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p<0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507-13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%. Conclusion: The prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.

Clinical Features and Surgical Outcomes of the Children With Urolithiasis at a Tertiary Care Hospital: First Report From Somalia.

Introduction: There are very few studies regarding pediatric urolithiasis (PU) reported from Africa, and to date, no data have been presented from Somalia. This study evaluated the sociodemographic and radiological characteristics, treatment, and outcome data of the PU patients treated at Somalia's only tertiary care center. Method: The data of all patients diagnosed with urolithiasis during a 6-year period were reviewed. Only pediatric (age <18) urolithiasis patients were included. Demographic parameters, radiological features, stone characteristics, treatment, and outcome data were collected and analyzed. Results: Overall, 227 (127 male, 100 female) patients were included. The rate of PU was 8.1%. The mean patient age was 12.7 ± 3.2. More than two-thirds of the patients (n = 161, 70.9%) were adolescents. The stones were located in the kidney in 50.7%, the ureter in 33%, and the bladder in 14.5%. Distal ureteral stones (36%) accounted for the majority of ureteral stones, followed by the ureterovesical junction (26.7%) and proximal ureteral (24%) stones. The mean stone size was 16.2 mm. Most (42.3%) stones had a 10-20 mm diameter, while 23.3% were sized between 6 and 10 mm. Renal insufficiency was present in 5.3%. Among 227 patients, 101 (44.5%) underwent minimally invasive procedures including ureterorenoscopic lithotripsy (n = 40, 18%), retrograde intrarenal surgery (n = 30, 13.2%) and percutaneous nephrolithotomy (n = 31, 14%). Open pyelolithotomy was the most common surgery performed (n = 53, 22.3%). Surgical site infection developed following 3.5% of the open surgery cases. The stone-free rate was 91.3%. It was significantly higher in open cases (98%) compared to the cases performed via a minimally invasive approach (83%) (p = 0.02). Conclusion: In Somalia, PU is more common than in many other countries. Open surgery continues to be the primary treatment modality for children with urolithiasis due to the restricted endourology resources. However, minimally invasive approaches have evolved over the last years.

Epidemiological and Histopathological Characteristics of Renal Cell Carcinoma in Somalia.

Background: There is a scarcity of studies regarding renal cell carcinoma (RCC) reported from Sub-Saharan Africa. Objective: The present study is the first report evaluating the prevalence and clinical and histopathological features of RCC at a tertiary hospital in Somalia. Methods: This retrospective study included 84 patients with histologically confirmed RCC over 5-years. The investigated parameters were sociodemographic features, radiological and histopathological characteristics, mortality, and overall 5-year survival rate. Results: The prevalence of RCC in our study was 0.7%. The mean age of the patients was 53.74±5.5 years, 67.9% were male, and 32.1% were female, with a 2:1 male-to-female ratio. The mean tumor size was 6.38±2.4 cm. Clear cell RCC was the most common histological type in 67.8%, followed by papillary RCC (15.6%), unclassified RCC (9.5%), and chromophobe RCC was the least common in 7.1% of the cases. About one-third of the case had locally advanced RCC with positive nodal involvement, 26.2% of the patients had metastatic disease, and a further 6% progressed to metastatic cancer despite surgical resection. Eight percent of our cases returned with local recurrence. The mortality rate was 37.2%. More than eighty percent of females had a low-stage and a low-grade RCC, while males held higher stages and higher grades RCC in 37% and 63%, respectively (p<0.001). Smokers were male-only, while obesity was common in female patients (p=0.02). Conclusion: The study findings showed a satisfactory outcome, 71.4% of our patients presented with localized RCC, the five-year survival rate of the patients was 62.8%, and the mortality rate was substantially higher for patients with a higher stage, a higher grade tumor, and metastatic disease at the time of diagnosis.

Sonographically diagnosed and conservatively managed case of polyorchidism: A case report.

Polyorchidism is a congenital abnormality with distinct sonographic characteristics. In most cases, sonography is sufficient for diagnosis. In instances of complicated polyorchidism, an MRI may provide further information. Conservative treatment with sonographic follow-up is the best management option in uncomplicated cases. We present a rare case of polyorchidism with no associated complications that were managed conservatively with periodic follow-up imaging.

Management of a patient with a double J stent knotted at the mid-portion.

Ureteral stents are safe, and because of their widespread usage, complications associated with stenting increased. The knotting of the ureteral stent is an uncommon complication. Until today, only three cases of knotting at the mid-portion and distal ends of the ureteral stents were reported. Herein, we report a rare case of a downward migrated ureteral stent with a knot in its middle portion at the level of the distal ureter in a 25-year-old female patient. Her knotted stent was successfully removed by guidewire insertion and ureteroscopy under fluoroscopic guidance.

Antimicrobial Resistance and Predisposing Factors Associated with Catheter-Associated UTI Caused by Uropathogens Exhibiting Multidrug-Resistant Patterns: A 3-Year Retrospective Study at a Tertiary Hospital in Mogadishu, Somalia.

Background: Widespread and rapidly emerging multidrug-resistant uropathogens, particularly carbapenem-resistant pathogens, are a public health concern that impairs the determination of empirical therapy. This study aims to evaluate the antimicrobial susceptibility profile and factors associated with catheter-associated urinary tract infection (CA-UTI). Method: This retrospective study was carried out on a total of 779 urine cultures over a 3-year period. Antimicrobial sensitivity tests were performed using the standard Kirby−Bauer disk diffusion method. Results: The prevalence of CA-UTI in our study was 12.7%; a total of 47% of cultures had multi-drug-resistant (MDR) uropathogens, and 13% of the cultures showed extended-spectrum beta-lactamase (ESBL)-producing pathogens. Elderly patients, intensive care unit admissions, and associated comorbidities were correlated with higher rates of CA-UTI caused by multidrug-resistant uropathogens (p < 0.021, 95% CI: 0.893−2.010), (p < 0.008, 95% CI: 1.124−5.600), (p < 0.006, 95% CI: 0.953−2.617). Latex catheters and prolonged catheterization time were associated with increased risk of CA-UTI (p < 0.0001, 95% CI: 0.743−1.929, p = 0.012, 95% CI: 0.644−4.195). Patients with MDR uropathogens had prolonged hospital stays, i.e., 49% in more than 2 weeks (p < 0.04, 95% CI: 0.117−3.084). E. coli was the most common pathogen (26.3%), followed by Acinetobacter baumannii (24.3%). Acinetobacter baumannii showed the highest MDR pattern (88.5%), followed by Pseudomonas aeruginosa (68%). Acinetobacter baumannii and Klebsiella pneumoniae were associated with prolonged hospital stays (>2 w at 73.1 and 69%, respectively). Higher antimicrobial resistance against ceftriaxone (85.7%), meropenem (54.3%), ertapenem (50%), ciprofloxacin (58.5%), amikacin (27%), tigecycline (7.6%), and colistin (4.6%), was revealed in the study. Conclusion: Aside from the higher antimicrobial resistance against cephalosporins and fluoroquinolones, the findings of this study revealed that carbapenems are facing increased rates of antimicrobial resistance and are associated with substantial morbidity, prolonged hospitalization times, and increased healthcare expenses.

The prevalence of premature ejaculation and its relationship with polygamous men: a cross-sectional observational study at a tertiary hospital in Somalia.

BACKGROUND: Premature ejaculation (PE) is the most common and prevalent sexual disorder among men. To the best of our knowledge, this is the first study aimed at evaluating the relationship of PE among polygamous men. METHOD: Over a 1-year period, a cross-sectional observational study was carried out among 202 married men who visited the urology polyclinic due to different clinical conditions and contributed by completing a standardized structured questionnaire regarding their sociodemographic data, as well as sexual and past medical history. RESULTS: In our study, the prevalence of PE was 37.1%; half of the monogamous men (50%) complained of PE, while 22% of men with two wives, 20% of men with three wives, and 12% of men with four wives complained of PE (p < 0.0001, 95% CI 0.122-1.920). Seventy percent of erectile dysfunction (ED) patients had PE concurrence (p < 0.0001, 95% CI 0.057-5.543). Regarding frequency of sexual intercourse, 48% of patients who complained of PE performed sexual intercourse less than two times/week, while two-thirds of the participants who did not complain of PE had sexual intercourse two to four times/week (p < 0.0001, 95% CI 0.203-0.568). Among the men who reported ED, 42% had one wife, 21.5% had two wives, 40% had three wives, and 12.5% had four wives (p < 0.029, 95% CI 0.417-0.962). CONCLUSIONS: We report that polygamous men have a lower incidence of premature ejaculation and higher sexual satisfaction than monogamous men. There is a significant association between ED and PE, showing a complex and bidirectional relationship between the two conditions. The new taxonomic entity called loss of control of erection and ejaculation (LCEE) views the two sexual symptoms as deeply interrelated. The study results indicate that a sexual intercourse frequency of two or more times per week significantly lowers the risk of PE.

Epidemiological Characteristics and Predisposing Factors for Surgical Site Infections Caused by Bacterial Pathogens Exhibiting Multidrug-Resistant Patterns.

BACKGROUND: Surgical site infection is the most common kind of nosocomial infection in developed and developing countries. OBJECTIVES: Our aim was to identify the prevalence of factors predisposing to multidrug resistance and the antimicrobial susceptibility profile of pathogens. METHOD: This retrospective study enrolled 10,878 patients who underwent operations in 2018-2020. Pathogens were identified using eosin methylene blue agar. Mueller-Hinton agar was used to assess antimicrobial sensitivity and resistance. In total, 382 patients with confirmed surgical site infection (SSI), whose culture showed growth, were included in the study. RESULTS: The prevalence of SSI in the current study was 3.5%. Escherichia coli was the predominant pathogen (35.8%), followed by Staphylococcus aureus (21.8%). Antibiotic use, chronic renal failure, diabetes, and emergency operations were found to increase the likelihood of multidrug resistance (OR = 6.23, CI = 1.443-26.881, p = 0.014; OR = 5.67, CI = 1.837-19.64, p = 0.02; OR = 2.54, CI = 1.46-7.35, p = 0.03; OR = 1.885, CI = 1.067-3.332, p = 0.002, respectively). The pathogens showed different levels of antimicrobial resistance against ceftriaxone (72.7%), ciprofloxacin (46.6%), and gentamicin (34%). Antimicrobial resistance of about 1-3.4% was exhibited by linezolid, tigecycline, and teicoplanin. CONCLUSION: The study presented significantly increased multidrug-resistant (MDR) Enterobacteriaceae pathogens isolated from surgical sites. They involve significant morbidity and mortality rates and increased health-related costs.

Giant bladder stone of 152g in an 11-year child with recurrent urinary tract infections: A rare case report and review of the literature.

In the literature, there are few case reports regarding pediatric giant bladder stones, although they are more common in children living in low-income countries due to low socioeconomic status, a diet with low protein, animal milk (goat milk), and dehydration. Herein, we report a child with a giant bladder stone of 72 × 42 × 44 mm in dimension and 152 gm in weight successfully managed with open cystolithotomy. Early diagnosis and management of bladder stones in the pediatric age group are crucial to prevent subsequent complications including recurrent urinary tract infections, excessive antimicrobial use and dissemination of antimicrobial resistance, and consequent renal insufficiency.