A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.

Sciatic neuropathy is caused by a wide spectrum of etiologies including trauma, compression, metabolic, infectious, and inflammatory conditions. Diabetic mononeuropathy remains one of the more elusive disease manifestations due to lack of large-scale prevalence studies and varied classification schemes. In this study, we present the case of a 48-year-old female diagnosed with diabetic mononeuropathy involving the sciatic nerve. Electromyography and nerve condition studies showed left sciatic neuropathy, and magnetic resonance imaging of the pelvis revealed an elarged left sciatic nerve. The patient was managed by controlling the blood glucose level and by therapeutic exercise. This case aims to achieve a better understanding of mononeuropathies occuring in diabetes.

Human ; Female ; Middle Aged ; Diabetes Mellitus ; Blood Glucose ; Cross-sectional Studies ; Diabetic Neuropathies ; Electromyography ; Magnetic Resonance Imaging ; Mononeuropathies ; Pelvis ; Sciatic Nerve ; Sciatic Neuropathy

No abstract available.
Urinary Bladder, Overactive* ; Duloxetine Hydrochloride

Japanese encephalitis (JE) virus activity is an important cause of viral encephalitis in Southeast Asia. In Malaysia, JEV activity has been first detected in Culex gelidus in 1976. Since then, no study has fully addressed the seasonal dynamics of this mosquito. As irrigated rice production expands, the incidence of JEV vectors, particularly Cx. gelidus is expected to increase. We surveyed Penang Island to determine the breeding patterns of Cx. gelidus and their potential insect predators, in relation to habitat/niche and rice growing period. Six rice fields proper (RFP) and related drainage canals (DC) were visited through three cultivation cycles (CCs) over 17 months. Weekly visits were performed to each of the 36 sites and mosquito larvae and aquatic insects were sampled from RFP and DCs using dippers. Culex gelidus was abundant in RFP and almost absent in DCs. Its densities usually were high during the first and 3rd CC and when the RFs were in Fp, Pp and Gp. In DCs, the mosquito was abundant during Mp, e.g., 2nd CC. Predators, especially those belonging to the families Corixidae, Coenagrionidae and Dytiscidae, were more present in RFP. Predator numbers usually were high during the first CC; in some cases predator abundance peaked during other CCs, e.g., corixids and dysticids. In RFP, neither corixids nor coenagrionids showed any positive correlation with densities of Cx. gelidus. However, dytiscids' population peaked when the mosquito densities were on the rise. These observations suggest that Cx. gelidus is active during the period of rice cultivation. Operational vector control through bio-control or with insecticides near the end of the rice cultivation season in RFP may prove beneficial in reducing the density of Cx. gelidus, but also the amount of bio-agent or insecticide applied on riceland.

BACKGROUND:Emergency physicians (EPs) often care for patients with acute small bowel obstruction. While some patients require exploratory laparotomy, others are managed successfully with supportive care. We aimed to determine features that predict the need for operative management in emergency department (ED) patients with small bowel obstruction (SBO). METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period. We evaluated demographic characters (prior SBO, prior abdominal surgery, active malignancy) and clinical findings (leukocytosis and lactic acid) to determine features associated with the need for urgent operative intervention. RESULTS:Patients with a prior SBO were less likely to undergo operative intervention [20.3％ (42/207)] compared to those without a prior SBO [35.2％ (57/162)]. Abnormal bloodwork was not associated with need for operative intervention. 68％ of patients with CT scan findings of both an SBO and a hernia, however, were operatively managed. CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization. Abnormal bloodwork was not associated with operative intervention. The CT finding of a hernia, however, predicted the need for operative intervention, while other findings (ascites, duodenal thickening) did not. Further research would be helpful to construct a prediction rule, which could help community EPs determine which patients may benefit from expedited transfer for operative management, and which patients could be safely managed conservatively as an initial treatment strategy.

BACKGROUND:The purpose of this study was to document the correlation between medical and wilderness training with levels of preparedness for acute mountain sickness (AMS), illness, and injury among backcountry hikers. METHODS:We conducted a cross-sectional, convenience survey in Rocky Mountain National Park in July and August 2015. The study group consisted of 380 hikers who completed a written survey that collected information about demographics, wilderness experience, altitude experience, hiking equipment, communications devices, and trip planning. RESULTS:Factors such as wilderness training (wilderness first aid [WFA], wilderness first responder [WFR], or wilderness emergency medical technician [WEMT]), wilderness experience, and altitude experience all affected hikers' emergency preparedness. Respondents with medical training were more prepared to avoid or respond to AMS (62.3％ vs. 34.3％ [P<0.001]). They were also more prepared to avoid or manage injury/illness than hikers without medical training (37.7％vs. 20.7％ [P=0.003]). Participants with wilderness training were more likely to be prepared to avoid or respond to AMS (52.3％ vs. 36.8％ [P=0.025]) but not significantly more likely to be prepared to manage illness/injury (31.8％ vs. 22.0％ [P<0.11]). Adjusting for experience, wilderness training, age, and gender, we found that medical training was associated with increased preparedness for AMS (OR 2.72; 95％ CI 1.51–4.91) and injury/illness (OR 2.71; 95％ CI 1.5–4.89). CONCLUSION:Medically trained hikers were more likely to be prepared to avoid or manage AMS, medical emergencies, and injuries than their non-medically trained counterparts. Wilderness training increased hikers' preparedness for AMS but did not significantly alter preparedness for illness/injury.

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.
Colon ; Colonoscopy ; Diagnosis ; Endoscopy, Gastrointestinal ; Humans ; Polyps

The strategy of fortifying food grade salt with iodine has been globally successful in increasing iodine intake and significantly reducing the prevalence of iodine deficiency. In addition, the consumption of salt through processed foods is increasing in many countries. The major objectives of the current study were to assess the iodine nutritional status among school children, the availability and awareness of iodized salt, the use of salty condiments and flavorings in households in a remote Zia community. This was a school and community based prospective cross-sectional study carried out in February 2020. The study population included 6 to 12 years old school children in five schools in Zia. Simple random sampling was used to select the children. Salt samples were collected from randomly selected households in the community. Discretionary salt intake was also assessed in a sub-set of households. The size of the thyroid gland of the children was assessed by a single specialist endocrinologist using the standardized procedure for palpation and grading, after which a single urine sample was collected from the children after obtaining informed consent from their parents. A pre-tested questionnaire was used to assess the awareness and use of iodized salt in the households. The iodine content in salt samples was measured using the single wavelength semi-automated WYD Iodine Checker Photometer. The urinary iodine concentration (UIC) was measured by isotopic dilution, using 129I as a spike. The 127I/129I ratio was measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS) (quadrupole ICP-MS iCap). The volume of urine required per run was 0.3ml. The mean iodine content of the salt samples from the Households was 31.7 ± 5.9mg/kg. The daily per capita discretionary intake of salt was 5.7 ± 2.2g. The calculated per capita discretionary intake of iodine was 126.5 ± 48.8μg per day. The Median UIC among the children was 147.5μg/L, which indicates normal iodine status at the time of this study. A total of 44.5% of all the children had palpable goiter (grade 1). This may indicate long-standing prevalence of mild status of iodine deficiency. Majority of the households (93.9%) used Maggi Kakaruk stock cubes to make their food salty compared to 90.9% that used salt. Instant noodles/2-minute noodles are the best wheat based alternative processed foods that should be fortified with iodine. Salt and Maggi Kakaruk stock cubes are the two optimal food vehicles for fortification with iodine in this remote community.

Introduction: Spirituality was defined as a way individual seek and express meaning and purpose and the way they experience their connectedness to the moment. Studies showed that spiritual beliefs provided comfort to cancer patients and that different dimensions were related with the different aspects of health. Objectives: The aim of the study is to determine the correlation on effects of spirituality and the quality of life among patients enrolled in the outpatient chemotherapy clinic. Methodology: An analytical cross-sectional study using a non-probability convenience sampling was done of which validated questionnaires on the Spirituality and Quality of Life were the research instruments of the study. The Pearson’s correlation coefficient/Spearman rho computed on the relationship between the dimensions of spirituality and subscales of the quality of life among cancer patients. Chi Square/Fisher’s test was used to determine the correlation among the types and stages of cancer with the quality of life and spirituality of the respondents. Results: A total of 105 cancer patients participated in this study, with ages ranging from 21 to 76 years and a mean age of 51 +/- 11 years, 2/5 were married females and 4/5 were Roman Catholic. Fifty-six percent of the cancer patients have Invasive Ductal Carcinoma (Breast Cancer). Most of the respondents are at stages 2 and 3 with equal percentages of 41%. This study revealed that most of the cancer patients enrolled in the outpatient chemotherapy clinic had a mean score of 3.56 + 0.35 indicating moderate to high level of spirituality. It also showed a mean score of 5.41 +.53 indicating high QOLs. Dimensions of spirituality which were found to have significant association with QOL domains (p < 0.05) were Mindfulness and Feeling of Security which were both found to have positive correlation with Emotional Wellbeing and Social Status. Conclusion Spiritual care should be included as one of the non-pharmacological modalities in the comprehensive management and palliative care for the Filipino cancer patients in order to improve the over-all well-being, healthcare outcomes and quality of life of patients and their families.
Neoplasms ; Patients ; Quality of Life

No abstract available.