Woman with bacterial vaginosis and with a decreased vaginal concentration of hydrogen peroxide-producing lactobacilli may have decreased conception rates and increased rates of failed pregnancy. A larger prospective treatment trial designed to evaluate the impact on ICSI outcomes of optimizing the vaginal flora prior to ICSI may be warranted.

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Background: Fournier’s gangrene (FG) is an acute progressive necrotizing fasciitis of the genital area and perineum with possible extension to the abdominal wall. Surgical debridement is the gold standard management modality of established patients. Equivocal (early) FG represents a challenge in diagnosis. The objective of this study was to compare conservative management and early exploration in cases of equivocal (early) FG. Methods: This was an observational study where data of all patients diagnosed as early FG in our departments over 4 years (2011–2015) were enrolled. Patients were divided into two groups: group 1 with conservative treatment, and group 2 managed with urgent exploration with longitudinal hemiscrotal incision starting from external inguinal ring. All patients’ demographics, vital signs, laboratory finding and clinical findings were reported. Results: A total of 28 patients were enrolled in the study. Group 1 was managed with conservative treatment (17 patients) and group 2 underwent urgent exploration (11 patients). Overall, four patients (23.5%) out of 17 patients of group 1 showed a good response to conservative management without any surgical debridement. A total of 13 patients (76.5%) developed gangrenous discoloration and needed surgical debridement later. In group 2, four patients (36.4%) underwent scrotal exploration and release incision only without debridement and showed an excellent clinical outcome. A total of four patients (36.4%) underwent debridement with excision of doubtful deep subcutaneous and fascial tissues. The remaining three patients (27.2%) underwent debridement of necrotic fascia. The hospital stay was significantly shorter in group 2 patients than group 1 (7.5 ± 3.75 versus 13.4 ± 5.19 days p < 0.05). The mean number of debridement sessions was 3.74 ± 0.69 in group 1 versus 1.82 ± 0.34 in group 2. Conclusions: Early exploration and debridement in equivocal (early) FG has a better clinical outcome with reduced hospital stay and number of debridement sessions than conservative treatment with delayed debridement.

We detected activation of NF-κB in the endothelium and perivascular infiltrating inflammatory cells within the cerebral AVM nidus, suggesting a role in the pathophysiology of cerebral AVM.

Materials and methods Using Survey Monkey, a web-based survey (Supplementary Data; available online at www. surveymonkey.com) was created and administered via blast e-mails to members of the Endourological Society. The survey questionnaire covered demographic data, number of cases performed annually and details pertaining to technique of PCNL

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AIM: To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups. MATERIAL and METHODS: We prospectively followed up a cohort of 34 patients with fractures over dural venous sinuses from January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compound depressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively. RESULTS: The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospital arrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common mode of injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%). Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was five days, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery. CONCLUSION: The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgical intervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant in neurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose including a funduscopic examination and venogram as parts of the initial trauma work-up for these patients.

Context:Lower urinary tract symptoms (LUTSs) in elderly males are usually related to benign prostatic hyperplasia (BPH) in the majority of cases. It is estimated that BPH affects half of men above the age of 50 years. Recently, a relationship between Vitamin D deficiency and LUTS in elderly males has been reported.Aims:The aim of this study was to analyze Vitamin D levels in males aged above 50 years presenting with LUTS.Settings and Design:This is a prospective case–control study.Patients and Methods:This was a case–control study in which males above 50 years of age who presented with LUTS (Group A) were compared with a control group (Group B) without LUTS. Both groups were investigated regarding Vitamin D level, prostate-specific antigen (PSA), International Prostatic Symptoms Score (IPSS), prostate size, flow rate, serum calcium levels, and abdominal ultrasonography.Statistical Analysis Used:Statistical software package (SPSS Inc., Chicago, IL, USA) was used for the statistical analyses, performing t-test for quantitative data to compare between the two groups. Pearson's correlation coefficient “r” test was calculated between two quantitative, continuous variables in Group A. P <0.05 was considered statistically significant.Results:A total of 150 patients were studied. There were 70 and 80 patients in Groups A and B, respectively. The mean age of Group A patients was 60.32 ± 11.93 years versus 58.12 ± 10.55 years for Group B patients (P > 0.05). The mean value of Vitamin D level was 40.82 ± 29.46 nmol/L in Group A and 70.25 ± 22.42 nmol/L in Group B (P < 0.001). The mean value of prostate size was 50.12 ± 23.24 g in Group A and 30.68 ± 4.90 g in Group B (P < 0.001). The mean serum calcium level was 2.4 ± 0.14 mmol/L and 2.50 ± 0.15 mmol/L in Groups A and B, respectively (P < 0.001). The mean value of PSA in Group A was 2.24 ± 1.95 ng/ml versus 2.11 ± 0.45 ng/ml in Group B (P < 0.001). The mean value of IPSS in Group A was 13.38 ± 5.32 ml/s versus 3.41 ± 2.42 ml/s in Group B. The mean value of Q max in uroflowmetry in Group A was 11.5 ± 2 ml/s versus 15.4 ± 1 ml/s in Group B.Conclusions:Men older than 50 years of age with LUTS have lower levels of Vitamin D compared to men without LUTS.