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Hypospadias is a developmental defect of male urethra characterized by absence of meatal opening at the tip of glans but is present at the ventral surface of penis anywhere along the shaft, even in the perineum. Usually this defect is associated with ventrally curved penis. Surgery is the single option to correct this birth defect. More than 300 techniques have been developed but none is universally acceptable as because, surgery is usually associated with fistula. Rate of fistula formation varies from technique to technique. Now a day, Snodgrass technique is widely practiced because of its low rate of fistula formation. Many factors are responsible for this post-operative complication. Most important one is developmentally defective ventral penile skin where some local factors like vascular and collagen tissues are insufficient. This observational study was performed to evaluate the role of dorsal vascular flap over the neourethra following urethroplasty by Snodgrass technique in terms of post-operative fistula formation in the Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2018 to March 2020. A total of 39 patients with distal penile hypospadias were included in this study. All underwent Snodgrass urethroplasty with additional dorsal vascular flap over the neourethra to support this ventrally deficient local factor. The outcome in terms of post operative urethrocutaneous fistula was evaluated. Only two patients (5.15%) developed urethrocutaneous fistula. In conclusion, addition of dorsal vascular flap over the neourethra by Snodgrass technique reduces the rate of the fistula formation.

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BACKGROUND: Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. METHODS: Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. RESULTS: 200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p = 0.11 and p = 0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). CONCLUSION: HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials

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BACKGROUND: Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. METHODS: Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. RESULTS: 200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p=0.11 and p=0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). CONCLUSION: HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials.

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Inflammation is a double-edged sword with both detrimental and beneficial consequences. Understanding of the mechanisms of crosstalk between the inflammatory milieu and human adult mesenchymal stem cells is an important basis for clinical efforts. Here, we investigate changes in the transcriptional response of human adipose-derived stem cells to physiologically relevant levels of IL-2 (IL-2 priming) upon replicative senescence. Our data suggest that replicative senescence might dramatically impede human mesenchymal stem cell (MSC) function via global transcriptional deregulation in response to IL-2. We uncovered a novel senescence-associated transcriptional signature in human adipose-derived MSCs hADSCs after exposure to pro-inflammatory environment: significant enhancement of the expression of the genes encoding potent growth factors and cytokines with anti-inflammatory and migration-promoting properties, as well as genes encoding angiogenic and anti-apoptotic promoting factors, all of which could participate in the establishment of a unique microenvironment. We observed transcriptional up-regulation of critical components of the nitric oxide synthase pathway (iNOS) in hADSCs upon replicative senescence suggesting, that senescent stem cells can acquire metastasis-promoting properties via stem cell-mediated immunosuppression. Our study highlights the importance of age as a factor when designing cell-based or pharmacological therapies for older patients and predicts measurable biomarkers characteristic of an environment that is conducive to cancer cells invasiveness and metastasis.

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BACKGROUND: The 2014 Ebola Virus Disease (EVD) outbreak was characterised by fear, misconceptions and irrational behaviours. We conducted a knowledge attitude and practice survey of EVD in Nigeria to inform implementation of effective control measures. METHODS: Between July 30th and September 30th 2014, we undertook a cross sectional study on knowledge, attitude and practice (KAP) of Ebola Virus Disease (EVD) among adults of the general population and healthcare workers (HCW) in three states of Nigeria, namely Bayelsa, Cross River and Kano states. Demographic information and data on KAP were obtained using a self-administered standardized questionnaire. The percentage KAP scores were categorised as good and poor. Independent predictors of good knowledge of EVD were ascertained using a binary logistic regression model. RESULTS: Out of 1035 study participants with median age of 32 years, 648 (62.6%) were males, 846 (81.7%) had tertiary education and 441 (42.6%) were HCW. There were 218, 239 and 578 respondents from Bayelsa, Cross River and Kano states respectively. The overall median percentage KAP scores and interquartile ranges (IQR) were 79.46% (15.07%), 95.0% (33.33%) and 49.95% (37.50%) respectively. Out of the 1035 respondents, 470 (45.4%), 544(52.56%) and 252 (24.35%) had good KAP of EVD defined using 80%, 90% and 70% score cut-offs respectively. Independent predictors of good knowledge of EVD were being a HCW (Odds Ratio-OR-2.89, 95% Confidence interval-CI of 1.41-5.90), reporting 'moderate to high fear of EVD' (OR-2.15, 95% CI-(1.47-3.13) and 'willingness to modify habit' (OR-1.68, 95% CI-1.23-2.30). CONCLUSION: Our results reveal suboptimal EVD-related knowledge, attitude and practice among adults in Nigeria. To effectively control future outbreaks of EVD in Nigeria, there is a need to implement public sensitization programmes that improve understanding of EVD and address EVD-related myths and misconceptions, especially among the general population.

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AIM: About 1/10 of the patients apply to breast clinics with the complaint of nipple discharge (ND). Surgery is the most frequently preferred treatment method in case of suspicious ND. The contribution of ductoscopy to identify the patients who are candidates for surgery was evaluated and its role to limit the surgery was assessed. METHODS: From November 2005 to December 2010 430 patients with ND were assessed by 456 ductoscopic investigations and the results were analyzed. Complete ductoscopic evaluation was achieved in 84% of cases and 28 patients were offered surgery but did not accept (N.=355). Patients with bloody or serous discharges from a single duct were investigated by ductoscopy under local anesthesia as an office procedure. The patients were grouped according to discharge characteristics and the ductoscopic diagnoses. RESULTS: A total of 223 patients had all three criteria of pathologic ND (PND: single duct, spontaneous and bloody/serous discharge). Twenty-two potential neoplastic or malignant lesion (PNML) and 79 papillomatous lesion (solitary or multiple papilloma) were identified. In 132 patients with just two of the PND criteria, 5 PNML and 18 papillomatous lesions were identified. Twenty-three patients with solitary papilloma that were removed by ductoscopic papillomectomy (DP) are followed up without surgery. CONCLUSION: Ductoscopy helped to identify the patients who required surgical treatment and decreased the number of operations. DP was successfully performed in select group of patients who otherwise would have required surgical resection. Patients with normal ductoscopy findings and patients who were treated with DP successfully can be followed up without the need of surgery.

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Computer-aided detection systems can help radiologists to detect pulmonary nodules at an early stage. In this paper, a novel Computer-Aided Diagnosis system (CAD) is proposed for the classification of pulmonary nodules as malignant and benign. The proposed CAD system using ensemble learning classifiers, provides an important support to radiologists at the diagnosis process of the disease, achieves high classification performance. The proposed approach with bagging classifier results in 94.7 %, 90.0 % and 77.8 % classification sensitivities for benign, malignant and undetermined classes (89.5 % accuracy), respectively.

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A computer-aided detection (CAD) can help radiologists in diagnosing of lung diseases at an early level. In this study, a new CAD system for pulmonary nodule detection from CT imagery is presented by using morphological features and patient information properties. Decision trees are utilized for classification and overall detection performance is evaluated. Results are compared to similar techniques in the literature by using standard measures. Proposed CAD system with random forest classifier result in 90.5 % sensitivity and 87.6 % specificity of detection performance.

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BACKGROUND: Contact dermatitis (CD) is a significant problem among nurses. Although there are reports about the prevalence of CD from different parts of the world, data about its frequency in Turkey and about allergic contact sensitization among nurses is insufficient. OBJECTIVE: To define the frequency and patterns of allergic contact sensitization and related symptoms in practicing and student nurses. METHODS: There were 123 nurses in our hospital practicing in the in-patient clinics. All were invited to participate in the study. 69 working-in nurses and 79 student nurses participated in the study. The main reason for refusal of nurses was that they were usually having a shower daily after a hard working day and they had to postpone having a bath for 3 days if they had a patch test on their back. A ready-to-use patch test system (TRUE test(R)) with 29 standardized test substances was applied to all of the participants. History about symptoms of CD and allergic diseases was investigated by questionnaire. RESULTS: While 34.8% (24/69) of practicing nurses had symptoms of CD, 19% (15/79) of student nurses reported the symptoms (p = 0.039). The most prevalent positive reaction was to nickel sulfate followed by thimerosal. There was no difference for positive reaction rates between practicing and student nurses. Nurses who had symptoms of CD were older than those without symptoms (p = 0.003). The participants with symptoms of CD were more frequently from practicing nurses (p = 0.047). CONCLUSION: CD is more frequent in practicing nurses than student nurses; allergic contact sensitization is not. This may be attributed to the length of occupation that is also correlated well with the length of exposure to the occupational irritants.

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AIM: Patients undergoing excision for breast lumps prefer general anesthesia or local anesthesia plus sedation, because of the fear of pain for local anesthesia alone. The aim of this study is to show the efficacy of an eutectic mixture of local anesthetic lignocaine and prilocaine (EMLA®) in these patients. METHODS: This study has been designed randomized, placebo-controlled. Forty five patients undergoing excision for breast lumps were divided into three groups. The first group was administered local EMLA cream preoperatively (Group I, N.=15), the second group (Group II, N.=15) had no preoperative preparation and the third group was placebo group (Group III, N.=15). All groups underwent the operation under local anesthesia. Pain during the local anesthesia and three hours after the operation were assessed using the visual analog scale. The amount of local anesthetic used during the operation and the anesthetic need of patients after the operation were assessed. RESULTS: When the three groups were compared, it was found that the intensity of pain in the group with EMLA was considerably lower during and after the operation (P<0.05). The amount of local anesthetic used during the operation was lower (P<0.05) and the need for post-operative analgesic was also less than the usual (P<0.05). CONCLUSION: Topical EMLA use decreases the pain, provides per-operative and postoperative patient and physician comfort, improved patient's compliance, and simplifies the surgical procedure. This is the first study demonstrating that a topical anesthetic provides a non-invasive analgesia during benign breast mass excision.

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