Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.     

Dental health service utilization by children seen at the University College Hospital-an update.

Asymptomatic hospital visits have been generally accepted as health behaviour that should be encouraged, although some factors have been identified as factors affecting compliance and attendance. A three years prospective study of the pattern of dental clinic attendance of children seen at the University college Hospital Ibadan was carried out between January 2001-December 2003. A total of 875 children comprising of 421 (48.1%) males and 454 (51.89%) females formed subjects for the study. Results showed that the modal age of presentation was 6-10yers. 88.8% of the children had symptomatic visits while 11.2% had asymptomatic visits and dental caries and its sequel were the frequently diagnosed symptoms. 67.8% of the symptomatic cases required extraction of their badly broken down teeth due to their late presentations at the clinic. Over 80% of the children with asymptomatic visits required only oral prophylaxis. In conclusion, an early age at presentation and asymptomatic visits are health behaviours that should be encouraged through regular dental health education to parents especially mothers.     

Combined volvulus of the sigmoid and the small intestine (physiopathology)

The physiopathology of combined volvulus of sigmoid and small intestine is discussed. In many cases a half-knot is involved, that is to say a "key" between the two ileal and sigmoid loops, difficult to describe with words but easy to understand by the use of a diagram and radiologic and intraoperative images of lesions, of possible assistance when releasing the loops or determining site of section of foot of occluded loops. Of 116 cases of sigmoid volvulus treated in the Treihville hospital, Abidjan between 1972 and 1983, eleven were associated with small intestine volvulus. Of these 11 cases, 9 were treated by emergency ideal colectomy and small intestine resection, with 3 deaths, and 2 by emergency ideal colectomy and small intestine reintegration, with 2 deaths. Operative mortality was therefore high (45%), global mortality being 24%. This is inherent in underdeveloped surgical units and will certainly improve greatly as hospital standing improves.     

Neural and behavioural changes in male periadolescent mice after prolonged nicotine-MDMA treatment

The interaction between MDMA and Nicotine affects multiple brain centres and neurotransmitter systems (serotonin, dopamine and glutamate) involved in motor coordination and cognition. In this study, we have elucidated the effect of prolonged (10 days) MDMA, Nicotine and a combined Nicotine-MDMA treatment on motor-cognitive neural functions. In addition, we have shown the correlation between the observed behavioural change and neural structural changes induced by these treatments in BALB/c mice. We observed that MDMA (2 mg/Kg body weight; subcutaneous) induced a decline in motor function, while Nicotine (2 mg/Kg body weight; subcutaneous) improved motor function in male periadolescent mice. In combined treatment, Nicotine reduced the motor function decline observed in MDMA treatment, thus no significant change in motor function for the combined treatment versus the control. Nicotine or MDMA treatment reduced memory function and altered hippocampal structure. Similarly, a combined Nicotine-MDMA treatment reduced memory function when compared with the control. Ultimately, the metabolic and structural changes in these neural systems were seen to vary for the various forms of treatment. It is noteworthy to mention that a combined treatment increased the rate of lipid peroxidation in brain tissue.     

Abundance and diversity of Anopheles species (Diptera: Culicidae) associated with malaria transmission in human dwellings in rural and urban communities in Oyo State, Southwestern Nigeria

Mosquito samples were collected from rural and urban communities in three selected major towns in Southwestern Nigeria to determine the impact of urbanization on the diversity and abundance of Anopheles species associated with malaria transmission in human habitations. A total of ten Anopheles species were identified in the rural communities, while eight Anopheles species were identified in the urban communities. Out of the ten Anopheles species identified, only four species, Anopheles gambiae (Giles), Anopheles funestus (Giles), Anopheles moucheti (Evans), and Anopheles nili (Theobald), were established to be vectors of malaria occurring in greater than 50 % of the rural communities. Only A. gambiae occurred in all the urban communities, while the other three major vectors occurred in not more than 20 % of the urban communities. Margalef's and Shannon–Wiener indices showed that diversity and species richness were higher in the rural compared to the urban. Comprehensive information on malaria vector abundance and diversity in rapidly changing communities is an important tool in planning and implementing successful vector control programs.     

Ovarian tuberculosis mimicking a malignant tumour

There has been reported increased incidence of ovarian tuberculosis in the tropics since the advent of HIV/AIDS disease. We report a case of bilateral ovarian tuberculosis associated with a single right kidney of uncertain origin in an immunocompetent 15-year-old generally healthy-looking girl. Abdominopelvic scan was equivocal about the diagnosis of the lesion as it failed to differentiate it from malignancy. Tuberculin and histopathology were necessary to confirm the diagnosis of ovarian tuberculosis. Antituberculous medical therapy successfully resolved the disease.Key words: Child, extra-pulmonary, ovaries, ovaries, tuberculosis     

In vivo anti-plasmodial activities and toxic impacts of lime extract of a combination of Picralima nitida,Alstonia boonei and Gongronema latifolium in mice infected with Chloroquine-sensitive Plasmodium berghei

Background

Lime extracts of powdered combination of seeds of Picralima nitida, stem bark of Alstonia boonei and leaves of Gongronema latifolium is a common remedy used in the treatment of malaria in South Western Nigeria.

Objective

To determine the antiplasmodial activities of the combined herbal extracts and its impact on the haematological, hepatological and renological parameters in mice.

Methods

The 4-day suppressive and curative tests were used to assess the antiplasmodial activities of the extract in mice infected with chloroquine-sensitive Plasmodium berghei at concentration of 200mg/kg, 400mg/kg and 800mg/kg body weight. The haematological parameters including red blood cells, white blood cells, packed cell volume and haemoglobin count were analysed with an auto analyser. The activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were determined, while urea, protein and creatinine were analysed by standard procedural methods.

Results

The 4-day suppressive test revealed that the test extract achieved percentage suppression of 39.0%, 41.6% and 54.68% for the 200mg/kg, 400mg/kg and 800mg/kg concentration respectively. Additionally, the curative test achieved a high percentage suppression of 80.97%, 83.84% and 86.16% at the 200mg/kg, 400mg/kg and 800mg/kg concentration respectively. The extracts did not induce significant change on haematological parameters (P>0.05), while significant elevation in the values of the ALT and AST (P<0.05) was observed and elevation of creatinine (P<0.05) at 800mg/kg.

Conclusions

The results support the traditional use of the herbal combination in the treatment of malaria, however the liver cells were impacted by the extracts in bioassay conducted with mice.