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International Journal of Molecular... Nov 2023Polyarteritis nodosa (PAN), also known as panarteritis nodosa, represents a form of necrotizing vasculitis that predominantly affects medium-sized vessels, although it... (Review)
Review
Polyarteritis nodosa (PAN), also known as panarteritis nodosa, represents a form of necrotizing vasculitis that predominantly affects medium-sized vessels, although it is not restricted to them and can also involve smaller vessels. The clinical presentation is heterogeneous and characterized by a significant number of patients exhibiting general symptoms, including asthenia, fever, and unintended weight loss. Although PAN can involve virtually any organ, it preferentially affects the skin, nervous system, and the gastrointestinal tract. Orchitis is a rare but specific manifestation of PAN. The absence of granulomas, glomerulonephritis, and anti-neutrophil cytoplasmic antibodies serves to distinguish PAN from other types of vasculitis. Major complications consist of hemorrhagic and thrombotic events occurring in mesenteric, cardiac, cerebral, and renal systems. Historically, PAN was frequently linked to hepatitis B virus (HBV) infection, but this association has dramatically changed in recent years due to declining HBV prevalence. Current epidemiological research often identifies a connection between PAN and genetic syndromes as well as neoplasia. This article provides a comprehensive review of PAN, specifically focusing on the progression of its clinical manifestations over time.
Topics: Male; Humans; Polyarteritis Nodosa; Vasculitis; Hepatitis B; Hepatitis B virus; Gastrointestinal Tract
PubMed: 38068989
DOI: 10.3390/ijms242316668 -
Progres En Urologie : Journal de... Nov 2023The role of urogenital infections in male infertility has long been the subject of debate. (Review)
Review
BACKGROUND
The role of urogenital infections in male infertility has long been the subject of debate.
METHODS
A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles.
RESULTS
Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved.
CONCLUSION
This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.
Topics: Humans; Male; Semen; Infertility, Male; Inflammation; Spermatozoa; Testis; Urinary Tract Infections; Bacterial Infections
PubMed: 38012909
DOI: 10.1016/j.purol.2023.09.015 -
Antibiotics (Basel, Switzerland) Nov 2023Antimicrobial resistance is a major global problem that is primarily driven by the excessive and inappropriate utilization of antibiotics. Urinary tract infections...
Antimicrobial resistance is a major global problem that is primarily driven by the excessive and inappropriate utilization of antibiotics. Urinary tract infections (UTIs) are frequent in primary health care (PHC) and are typically treated with antibiotics. There is ample evidence on the management of this condition in women but not in men. The aim of this study was to describe the epidemiology of UTIs in men in Catalonia, Spain. We conducted a population-based observational cohort study that included male patients diagnosed with UTI within our SIDIAP and CMBD database during the period from 2012 to 2021. UTI diagnoses were grouped into five main groups (cystitis, prostatitis, orchitis and epididymitis, urethritis, and pyelonephritis). Of the 316,762 men with at least one recorded UTI episode, the majority were registered with a diagnosis of cystitis in PHC (212,958 patients). Quinolones were the most commonly recorded treatment for UTIs (between 18.3% and 38.6%, depending on the group), except for urethritis in which a combination of antibiotics (36.7%) was most frequently used. The treatment duration period was between 9 days and 18 days, except for the prostatitis group, in which treatment was extended to 21 days. Urine cultures were documented in up to 30% in the cystitis group. Pyelonephritis was the category linked to most septicemia cases (3.0%). Conclusions: This is the first study to assess UTIs in men using a large PHC database in Spain. The sociodemographic characteristics of our sample are similar to other studies in the literature. In our setting, the use of quinolones for the treatment of UTIs is the most registered, and its duration was between 9 days and 18 days, despite the fact that resistance to quinolones exceeds 20% of the strains in our area.
PubMed: 37998813
DOI: 10.3390/antibiotics12111611 -
Translational Andrology and Urology Oct 2023Testicular torsion (TT) is a urological emergency that needs early diagnosis and intervention to prevent testicular death and necrosis. This study aimed to determine the...
BACKGROUND
Testicular torsion (TT) is a urological emergency that needs early diagnosis and intervention to prevent testicular death and necrosis. This study aimed to determine the efficacy of testicular scintigraphy (TS) in confirming the clinical diagnosis of TT and how this imaging method correlates with the surgical findings.
METHODS
A retrospective cohort review of clinical data was performed for 68 patients referred for TS from January 2016 to December 2021 to rule out possible TT. The final diagnosis was confirmed at surgery for all those with TS positive for TT.
RESULTS
The median age of the patients was 18.5 years, interquartile range of 15-31 years. Commonly presenting symptoms were pain (99%) and swelling (68%). Only 6% had history of trauma. TT was diagnosed by technetium-99m (Tc)-pertechnetate in 35 (51%) patients all of whom underwent surgical exploration. Of this group, 7 (20%) had manual detorsion intraoperatively (intermittent torsion), in 20 (57%) missed (complete) torsion was confirmed and 8 (23%) had a necrotic testis. Of the remaining 33 patients with results negative for torsion, 10 were normal and 23 were diagnosed with either epididymitis 13/23 (57%), orchitis 3/23 (13%) or 7/23 (30%) with epididymo-orchitis. TT was more common in patients under 15 and 15-19 years (P<0.05). The mean presentation time was 5 days with a range of 1-30 days.
CONCLUSIONS
The Tc-pertechnetate scan remains an effective investigation in the diagnosis of TT and may serve as a gate-keeper for surgery even in patients who present late for treatment.
PubMed: 37969780
DOI: 10.21037/tau-23-116 -
Postgraduate Medicine Nov 2023Sexually transmitted infection (STI) diagnosis is complicated as these infections can present with lower genitourinary tract symptoms (LGUTS) that overlap with other...
OBJECTIVES
Sexually transmitted infection (STI) diagnosis is complicated as these infections can present with lower genitourinary tract symptoms (LGUTS) that overlap with other disorders, i.e. urinary tract infections (UTIs). The study's objective was to determine potential missed STI diagnoses from patients presenting with LGUTS in the US between January 2010 and December 2019.
METHODS
The de-identified insurance claims data from the IBM® MarketScan® Research Databases were collected from patients (14-64 years old) who presented with LGUTS, which could be caused by an STI. A 'GAP' cohort was created, consisting of episodes with potentially delayed STI ( [CT]/ [NG]) treatment. The intention was to capture episodes where an STI was not initially suspected. Four subgroups were defined depending on the treatment received (fluoroquinolone; azithromycin and/or doxycycline; cephalosporins; gentamicin and azithromycin).
RESULTS
The GAP cohort consisted of 833,574 LGUTS episodes from the original cohort (23,537,812 episodes). Post-index CT/NG testing was carried out for 4.6% and 5.4% of the episodes from men and women, respectively. There were ≥2 return visits for 16.1% and 15.8% of the episodes from men and women, respectively. A substantial percentage of episodes from men (52.1%) and women (68.3%) were diagnosed with a UTI and/or acute cystitis at the index prior to receiving post-index STI treatment. Other top conditions diagnosed at index for men were dysuria (25.8% of the episodes), orchitis/epididymitis (14.3% of the episodes), and acute prostatitis (10.1% of the episodes), and for women were dysuria (24.2% of the episodes), vaginitis/vulvitis/vulvovaginitis (11.7% of the episodes), and cervicitis (3.3% of the episodes).
CONCLUSION
These findings highlight delayed STI antibiotic treatment and low rates of CT/NG testing, suggesting late STI consideration and suboptimal diagnosis. Additionally, our study illustrates the importance of accurately diagnosing and treating STIs in patients with LGUTS and associated conditions, to avoid antibiotic misuse and complications from delayed administration of appropriate treatment.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Azithromycin; Outpatients; Dysuria; Chlamydia Infections; Chlamydia trachomatis; Sexually Transmitted Diseases; Anti-Bacterial Agents; Urinary Tract Infections; Vulvovaginitis; Prevalence
PubMed: 37961909
DOI: 10.1080/00325481.2023.2280439 -
Tierarztliche Praxis. Ausgabe K,... Oct 2023The autoimmune polyendocrine syndrome (APS) refers to a combination of autoimmune endocrine disorders. It is rarely described in dogs. The most common combinations are...
The autoimmune polyendocrine syndrome (APS) refers to a combination of autoimmune endocrine disorders. It is rarely described in dogs. The most common combinations are hypoadrenocorticism and hypothyroidism, followed by diabetes mellitus, and less often hypoparathyroidism and orchitis. The diagnosis of the APS is based on the diagnosis of each endocrinopathy, as is the therapy, which involves the substitution of deficient hormones. If a patient was previously stable under treatment and is showing further signs (e.g. polyuria, polydipsia, or weight loss), the development of additional endocrinopathies like hypoadrenocorticism or diabetes mellitus should be considered. The diagnosis of the initially diagnosed endocrinopathy should also be critically questioned. This article summarizes some cases of our own animal hospital and selected cases published in the available literature.
Topics: Male; Dogs; Animals; Diabetes Mellitus, Type 1; Polyendocrinopathies, Autoimmune; Syndrome; Hypoparathyroidism; Dog Diseases
PubMed: 37956663
DOI: 10.1055/a-2183-0654 -
Journal of Agricultural and Food... Nov 2023Furan is a heat-induced food contaminant, and it causes damage to visceral organs, including the testis. To determine the mechanism of the damage to the testis, a mouse...
Furan is a heat-induced food contaminant, and it causes damage to visceral organs, including the testis. To determine the mechanism of the damage to the testis, a mouse model treated with furan (8 mg/kg bw/day) and salidroside (SAL, 10/20/40 mg/kg bw/day) was established, and levels of testicular functional markers and changes of morphology were investigated in furan-induced mice treated with SAL. The change in related proteins and genes suggested that SAL restored the furan-mediated leaky tight junction and triggered the TLR4/MyD88/NF-κB pathway and NLRP3 inflammasome together with inflammation. To find out the gut-testis axis, microbiota PICRUSt analysis and correlation analysis were conducted to investigate the core microbiota and metabolites. The endoplasmic reticulum stress (ERS)-related key protein levels and the result of transmission electron microscopy suggested that SAL inhibited the furan-induced intestinal ERS. The result of TUNEL and levels of apoptosis-related proteins suggested that furan-induced intestinal apoptosis was alleviated by SAL. Collectively, SAL inhibited furan-induced ERS-mediated intestinal apoptosis through modulation of intestinal flora and metabolites, thus strengthening the gut barrier. It inhibited LPS from entering the circulatory system and suppressed the testicular TLR4/MyD88/NF-κB pathway and NLRP3 inflammasome, which alleviated testicular inflammation.
Topics: Male; Humans; Mice; Animals; NF-kappa B; Inflammasomes; NLR Family, Pyrin Domain-Containing 3 Protein; Myeloid Differentiation Factor 88; Toll-Like Receptor 4; Apoptosis; Inflammation; Orchitis; Furans
PubMed: 37943949
DOI: 10.1021/acs.jafc.3c06587 -
Cureus Oct 2023Tuberculosis is an infectious disease with broad pulmonary and extrapulmonary clinical manifestations. Central nervous system tuberculosis (CNS-TB) is a complex...
Tuberculosis is an infectious disease with broad pulmonary and extrapulmonary clinical manifestations. Central nervous system tuberculosis (CNS-TB) is a complex extrapulmonary infection known for its diverse clinical features including meningitis, tuberculoma, and spinal arachnoiditis. Particularly, tuberculosis meningitis can further lead to complications such as ischemic stroke. This article presents a challenging case of a 35-year-old male patient initially diagnosed with epididymo-orchitis, followed by viral-like central nervous system symptoms, ultimately complicated by tuberculosis meningitis and basal ganglia ischemic stroke. This case presentation underscores the diagnostic complexities associated with CNS-TB and emphasizes on the critical need for heightened awareness of the wide-ranging clinical presentations that can potentially delay early disease recognition and management.
PubMed: 37937015
DOI: 10.7759/cureus.46640 -
Research and Reports in Urology 2023Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis in developing countries. Isolated genital TB is rare, but testicular infarction...
BACKGROUND
Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis in developing countries. Isolated genital TB is rare, but testicular infarction is an unusual complication of delayed management, in which surgical intervention is warranted.
CASE PRESENTATION
A 29-year-old male non-smoker presents with painful left scrotal pain of 21 days. Initially managed with intravenous antibiotics, the disease progressed and resulted in testicular infarction. Left orchiectomy was performed, and the specimen was sent for histopathological examination, which revealed features consistent with a testicular tuberculous abscess.
CONCLUSION
Tuberculous epididymo-orchitis (TBEO) with testicular infarction was unusual. It is prudent to consider this in patients presenting with long-standing urinary symptoms, particularly in those unresponsive to the initial antibiotic therapy. It requires a high index of suspicion, especially in TB endemic areas.
PubMed: 37920685
DOI: 10.2147/RRU.S434046 -
Clinical Imaging Dec 2023Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory... (Review)
Review
Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.
Topics: Male; Humans; Inflammation; Urogenital System; Pyelonephritis; Urinary Tract Infections; Kidney Diseases; Cystitis
PubMed: 37918136
DOI: 10.1016/j.clinimag.2023.110013