Giant Prostatic Stones and a Massive Bladder Stone Leading to Obstructive Uropathy: A Rare Case Report

Giant prostatic calculi are rare with less than 20 cases reported in the literature so far. Here, we discuss the presentation, diagnosis, and surgical management of a 25-year-old male patient with giant prostatic stones associated with a large bladder stone resulting from an underlying neurogenic bladder secondary to spina bifida. The patient had a history of congenital spina bifida, hydrocephalus, and non-compliance with clean intermittent self-catheterization. The stones were diagnosed through imaging and cystoscopy, and open cystolithotomy was performed for stone removal. The patient had a successful postoperative recovery with improved renal function. The case highlights the association between prostatic calculi and bladder outlet obstruction, emphasizes the importance of addressing underlying conditions to prevent stone recurrence, and underscores the role of open surgery in managing large bladder stones accompanied by renal impairment.

Giant paratesticular dedifferentiated liposarcoma with intraabdominal extension: a case report

Giant paratesticular liposarcoma is a rare presentation of paratesticular tumor. We present a case of the largest paratesticular liposarcoma described to date with a weight of 4,100 g and measuring 460 × 210 × 130 mm. It was initially mistaken as an inguinoscrotal hernia until a contrast-enhanced computed tomography (CECT) scan of the abdomen and pelvis revealed a huge left paratesticular tumor extending from the scrotum to the mid-abdomen. The challenge was to achieve a tumor-free margin orchidectomy due to the poor fat plane of the tumor to the external iliac artery, psoas muscle, descending colon, and anterior abdominal wall. The surgery was started with laparoscopic dissection for the intraabdominal part of tumor from the vital structure, then followed by inguinal radical orchidectomy and inguinal mesh repair. Postoperative histopathological report revealed a paratesticular dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation with clear margin. The patient had good recovery post operation.

Treatments of Sexual Dysfunction in Opioid Substitution Therapy Patients: A Systematic Review and Meta-Analysis

Sexual dysfunction is a common condition in the opioid substitution therapy (OST) population. We aimed to determine the efficacy and safety of treatment for sexual dysfunction in the OST population. We searched for interventional studies from Medline, PubMed, and Scopus. Three independent authors conducted a risk-of-bias assessment (RoB 2). A total of seven studies (five randomized-controlled trials, two quasi-experimental), including 473 patients with sexual dysfunction, were identified. Among these, three bupropion (n=207), one trazodone (n=75), two rosa Damascena (n=100), and one ginseng (n=91) studies had reported significantly improve various sexual functioning domains in both genders. In a meta-analysis, bupropion significantly increased male sexual function with standardized mean difference of 0.53; 95% confidence interval of 0.19-0.88; P < 0.01; I2=0. The adverse effects were minor for all agents, and no significant difference between treatment and placebo groups in randomized-controlled trials. These agents have a promising future as therapy for sexual dysfunction in the OST population. However, given the limited sample size and number of studies, further studies should be conducted to confirm the use of these agents.

Effect of brown rice flour fortification on the quality of wheat-based dough and flat bread

The objective of present study was to investigate the impact of Brown Rice flour (BR) incorporation, at three different levels of 5, 10 and 15 % to the Wheat Flour (WF) preparations on rheological properties of wheat-based dough and quality of wheat-based flat bread. The BR flour incorporation mainly affected the chemical properties of flours, the rheological characteristics of dough and, quality and shelf life of bread. The protein-related properties of flours principally experienced reduction; however, the ash content had an increase, along with BR flour incorporation. The rheological properties of dough were affected considerably by BR flour substitution, wherein the sample containing 5 % BR flour was closest to BR flour-free dough (control). Regarding the yielded bread, BR flour addition affirmatively affected sensorial properties and firmness quality evaluation, wherein the bread made from dough with composite flour fortified with 5 % BR flour was scored the best. The findings from instrumental firmness quality assessment were confirmed as the bread containing 5 % BR flour remained softer and demanded lowest force to be compressed over the storage period. Overall, results showed that adding BR flour up to 5 % can be used in baking of flat bread since it meets the required criteria.

Ear disorders in scuba divers

History of underwater diving dates back to antiquity. Breath-hold technique in diving was known to the ancient nations. However, deep diving progressed only in the early decades of the 19th century as the result of advancements in efficient underwater technologies which subsequently led to invention of sophisticated sets of scuba diving in the 20th century. Currently, diving is performed for various purposes including commercial, recreational, military, underwater construction, oil industry, underwater archeology and scientific assessment of marine life. By increasing popularity of underwater diving, dive-related medical conditions gradually became more evident and created a new challenge for the health care professionals, so that eventually, a specialty the so-called "diving medicine" was established. Most of the diving-associated disorders appear in the head and neck. The most common of all occupational disorders associated with diving are otologic diseases. External otitis has been reported as the most common otolaryngologic problem in underwater divers. Exostosis of the external ear canal may be formed in divers as the result of prolonged diving in cold waters. Other disorders of the ear and paranasal sinuses in underwater divers are caused by barometric pressure change (i.e., barotraumas), and to a lesser extent by decompression sickness. Barotrauma of the middle ear is the most prevalent barotrauma in divers. The inner ear barotraumas, though important, is less common. The present paper is a brief overview of diving-related ear disorders particularly in scuba divers.

Occupational noise-induced hearing loss

Noise-induced hearing loss (NIHL) is a well-known entity in daily practice of otolaryngology. A wide variety of NIHLs are work-related. Occupational noise is the most common cause of NIHL in adults which is up to now considered incurable and the best approach to it is to utilize maximal protection. An effective noise exposure prevention program consists of identification of sources of noise and implementation of controlling measures and regulations at working environments as well as performing periodic audiologic evaluation of those who are working at noisy environments. The present paper, briefly reviews occupational NIHL mainly based on the related data available on PubMed up to early 2010.

Lead poisoning in the world and Iran

Lead is a relatively ubiquitous heavy metal with particular features such as resistance to corrosion, high malleability and wide variety of industrial applications. In medicine, however, it is considered as a slow-acting toxic substance affecting multiple body systems, specifically functioning as a potent neurotoxin in the central nervous system. Lead poisoning may be acute or chronic and can be due to occupational or environmental exposures. The history of lead poisoning dates back to ancient times. The present paper briefly describes the worldwide historical accounts of lead poisoning with a special focus on Iran.

​​​History of Cholera Outbreaks in Iran during the 19(th) and 20(th) Centuries

Cholera is an acute infectious disease with high mortality if left untreated. Historically, between the 19(th) and 20(th) centuries seven great pandemics of cholera occurred and worldwide, thousands of people died. Based on an old theory, cholera was considered an air-born disease and the emergence of its outbreaks were attributed to bad weather or miasma. However later in the 18(th) century, British physician John Snow (1813-1858) explained the association of a terrible cholera outbreak in London in 1849 to contamination of the drinking water supply with human excreta. Despite his finding, the causative agent of this dreaded illness was unidentified until later in the 19(th) century. In 1854, Filippo Pacini (1812-1883) an anatomist from Italy and then in 1883, Robert Koch (1843-1910) the German bacteriologist, discovered 'vibrio cholerae' as the etiologic agent. During the major pandemics of cholera in 19th and 20th centuries this illness reached Iran and led to vast depopulation and a crucial impact on the country's socioeconomic status. Poor public health conditions, lack of a well-organized public health authority for implementing preventive and quarantine measures as well as Iran's specific geographic location were the main facilitating factors of the emergence of various epidemics, including cholera in Iran. The present paper briefly reviews the cholera outbreaks in Iran during the 19(th) and 20(th) centuries.

Effect of surfactant gels on dough rheological characteristics and quality of bread

Sodium stearoyl-2-lactylate (SSL), diacetyl tartaric acid esters of monoglyceride (DATEM), glycerol monostearate (GMS), and distilled glycerol monostearate (DGMS) surfactant gels were made with water and varying shortening contents. The effect of these gels on dough rheological characteristics and quality of bread was investigated. Overall, the surfactant gels improved the farinograph and extensograph characteristics of wheat flour, but the improvement reduced to some extent with the presence of shortening in the gels. Alveograph data indicated that dough properties improved with the addition of surfactant gels. Shortening in gels showed varying influence on the dough alveograph properties of wheat flour. The results indicated that the surfactant gels changed the rapid visco analyzer characteristics of wheat flour, and the presence of shortening in gels further altered the characteristics. All surfactant gels improved the volume, specific volume, texture, and overall quality scores of bread, but the improvement varied for different surfactants. By increasing the addition of shortening in gels, though the quality characteristics further improved, the response to surfactants reduced by increasing shortening content.