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Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. Treating DO/AO can be challenging due to the lack of standardized FDA-approved pharmacotherapies. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO.

PURPOSE: American Urological Association guidelines recommend testicular prosthesis discussion prior to orchiectomy. Utilization may be low. We compared outcomes and care utilization between concurrent implant (CI) and staged implant (SI) insertion after radical orchiectomy. MATERIALS & METHODS: The MarketScan Commercial claims database (2008-2017) was queried for men ages >18 years who underwent radical orchiectomy for testicular mass, stratified as orchiectomy with no implant, CI, or SI. 90-day outcomes included rate of reoperation, readmission, emergency department (ED) presentation, and outpatient visits. Regression models provided rate ratio comparison. RESULTS: 8803 patients (8564 no implant, 190 CI, 49 SI; 2.7% implant rate) were identified with no difference in age, Charlson Comorbidity Index, insurance plan, additional cancer treatment, or metastasis. Median perioperative cost at orchiectomy (+/- implant) for no implant, CI, and SI were $5682 (3648-8554), $7823 (5403-10973), and $5380 (4130-10521), respectively (p

Background and Aim: Laboratory assessment of sialic acid as a marker of microvascular complications can be a diagnostic tool for diabetes mellitus. Microalbumin is an established predictor of diabetic nephropathy. The study was undertaken to evaluate serum sialic acid and microalbumin levels and to correlate it with glycemic control in diabetic nephropathy patients. Material and Methods: Clinically diagnosed diabetic nephropathy patientsvisiting the medicine OPD (outdoor patient department) and NCD (Non-Communicable Disease) were selected for the study. This study included 75 subjectswith diabetes types 2 of which 44 were males and 31were females. Control includes a total of 75 out of which 49 Males and 26 females. Blood samples were analysed for the glucose, C-reactive protein, and sialic acid. Urine sample was analyzed for microalbumin and sialic acid. Results: The mean value of FBS was 161±53.2 mg/dl which was significantlyhigher than controls 81±5.2. The Sialic acid in subjects was 105±21 mg/dl which is higher than controls 51±6 mg/dl. The urine microalbumin level was found to be 96.5±17.2 in subjects, whereas 6.4±1.6 mg/dl was in controls. Serum Creatinine level in subjects was 8.75±2.05 mg/dl which was higher than subjects 0.8±0.3mg/dl. Serum Urea in diabetic nephropathy subjects was 93.5±15.4 mg/dl, which is positively higher than controls 30.8±7.1 mg/dl. Conclusion: Urine microalbumin is established as a potential marker for diabetic nephropathy. The correlation of serum sialic acid, urine microalbumin and serum creatinine proposed serum sialic acid as an accessory diagnostic marker for diabetic nephropathy. Estimation of sialic acid before microalbumin in diabetic patients helps assess glycemic control and identify the risk for nephropathy and other secondary complications of diabetes mellitus, which are the main causes of mortality and morbidity among type-2 diabetes mellitus patients.

Partial thrombosis of the corpus cavernosum is an extremely rare and likely underdiagnosed urologic condition. We discuss a case of a 25-year-old male who presented with severe perineal pain and was diagnosed with idiopathic proximal partial thrombosis of the corpus cavernosum via ultrasound and MRI. The patient experienced symptom resolution with evidence of disease regression on follow up MRI after treatment with direct oral anticoagulation. Further studies are needed to fully delineate the pathophysiology of this condition to facilitate development of standardized diagnostic and treatment algorithms.

Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits.

Author(s): Darshan B. Patel [sup.1] , Amanda C. Farris [sup.2] , Christian Hanna [sup.3] [sup.4] , Faris Hashim [sup.5] Author Affiliations: (1) grid.412408.b, Department of Pediatrics, Texas A&M Health Science [...]

BackgroundSkin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics.MethodsA retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5-10 days of antibiotics. Data were analyzed and reported using descriptive statistics.ResultsOf the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) in 906 patients (70%) with a nonpurulent SSTI. Additionally, 819 patients (45%) received broad-spectrum Gram-negative coverage, and 860 patients (48%) received an antibiotic duration >10 days.ConclusionsWe identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.

PURPOSE:To assess the functional Queryoutcome of patients with cystoscopic recurrence of stricture post-urethroplasty and to evaluate the role of cystoscopy as initial screening tool to predict future failure. METHODS:Cases with cystoscopy data after anterior urethroplasty in a multi-institutional database were retrospectively studied. Based on cystoscopic evaluation, performed within 3-months post-urethroplasty, patients were categorized as small-caliber (SC) stricture recurrence: stricture unable to be passed by standard cystoscope, large-caliber (LC) stricture accommodating a cystoscope, and no recurrence. We assessed the cumulative probability of intervention and the quality of life scores in association with cystoscopic recurrence 1-year post-urethroplasty. Patients with history of hypospadias, perineal urethrostomy, urethral fistula, and meatal pathology were excluded. RESULTS:From a total of 2630 men in our cohort, 1054 patients met the inclusion criteria: normal (n = 740), LC recurrence (n = 178), and SC recurrence (n = 136) based on the first cystoscopic evaluation performed at median 111 days postoperatively. Median follow-up was 350 days (IQR 121-617) after urethroplasty. Cystoscopic recurrence was significantly associated with secondary interventions (2.7%, 6.2%, 33.8% in normal, LC, and SC groups, respectively). Quality of life variables were not statistically significantly different among the three study groups. CONCLUSIONS:Many patients with cystoscopic recurrence do not need an intervention after initial urethroplasty. Despite good negative predictive value, cystoscopy alone may be a poor screening test for stricture recurrence defined by patient symptoms and need for secondary interventions.

BackgroundExcretory phase computed tomography (CT) scan is used for diagnosis of renal collecting system injuries and accurate grading of high-grade renal trauma. However, optimal timing of the excretory phase is not well established. We hypothesized that there is an association between excretory phase timing and diagnosis of urinary extravasation and aimed to identify the optimal excretory phase timing for diagnosis of urinary extravasation.MethodsThe Genito-Urinary Trauma Study collected data on high-grade renal trauma (grades III-V) from 14 Level I trauma centers between 2014 and 2017. The time between portal venous and excretory phases at initial CT scans was recorded. Poisson regression was used to measure the association between excretory phase timing and diagnosis of urinary extravasation. Predictive receiver operating characteristic analysis was used to identify a cutoff point optimizing detection of urinary extravasation.ResultsOverall, 326 patients were included; 245 (75%) had excretory phase CT scans for review either initially (n = 212) or only at their follow-up (n = 33). At initial CT with excretory phase, 46 (22%) of 212 patients were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (interquartile range, 4-7 minutes). Time of initial excretory phase was significantly greater in those diagnosed with urinary extravasation. Increased time to excretory phase was positively associated with finding urinary extravasation at the initial CT scan after controlling for multiple factors (risk ratio per minute, 1.15; 95% confidence interval, 1.09-1.22; p < 0.001). The optimal delay for detection of urinary extravasation was 9 minutes.ConclusionTiming of the excretory phase is a significant factor in accurate diagnosis of renal collecting system injury. A 9-minute delay between the early and excretory phases optimized detection of urinary extravasation.Level of evidenceDiagnostic tests/criteria study, level III.

PURPOSE:The purpose of this study is to assess the incremental effect of tissue plasminogen activator (t-PA) dose on pulmonary artery pressure (PAP) and bleeding during catheter directed thrombolysis (CDT) of submassive pulmonary embolism (PE). MATERIALS AND METHODS:Records of 46 consecutive patients (25 men, 21 women, mean age 55±14 y) who underwent CDT for submassive PE between September 2009 and February 2017 were retrospectively reviewed. Mean t-PA rate was 0.7±0.3 mg/h. PAP was measured at baseline and daily until CDT termination. Mixed-effects regression modeling was performed of repeated PAP measures in individual patients. Bleeding events were classified by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) and t-PA dose at onset. RESULTS:Mean t-PA dose was 43.0±30.0 mg over 61.9± 28.8 h. Mean systolic PAP decreased from 51.7±15.5 mmHg at baseline to 35.6±12.7 mmHg at CDT termination (p

Purpose- Obesity is a fast growing problem not only in developed countries but also in developing countries like India1 . Obesity is a risk factor in development of short stature, school teasing, precocious puberty, hypertension, diabetes, gall bladder disease and coronary heart disease, certain type of cancers and other comorbidities even at early age than usual² . Understanding the prevalence trend and factors contributing in developing obesity in adolescent children will be helpful in prevention of obesity and developing comorbidities in later life. Methods- A cross sectional analytical study conducted in 6 different schools of identified district of western India from 1st July 2022 to 31st June 2023 including school going adolescent children, of age between 10 to 16 years after taking necessary consent. Information regarding various predictors of obesity were taken by predesigned questionnaire, filled by participant along with his/her parentsand relevant anthropometric measurements were recorded. Detailed analysis of predictors which were present in obese and non- obese group was done and results interpreted. Results-Incidence of obesity in present study is 12.6%. Most common age of obesity is 16 years (46%) and most common age group is mid-adolescent (90.4%). Obesity and overweight is most common in upper middle class and in urbanc area. Positive correlation had been observed between adolescent obesity and parental obesity, calorie intake >2000kcal/day, eating >2 times snacks/day, >2 times junk food/week, sleeping > 8hrs/day and watching TV for >60 min, physical activity <30 min and light grade of physical activity. Conclusion-Restricting the calorie intake, food behavioural changes like restricting junk food and snacks consumption, daily physical activity could limit the development of obesity in adolescent age group. [ABSTRACT FROM AUTHOR]

School psychologists have training and expertise in consultation and evidence-based interventions that position them well to support early career teachers (ECTs). The current study involved iterative development and pilot testing of an intervention to help ECTs become more effective in classroom management and engaging learners, as well as more connected to colleagues. The intervention included group seminars, professional learning communities, and coaching. The sample included 15 ECTs and 57 school personnel in three high-poverty, urban schools. Feasibility and initial promise of the intervention were examined using a mixed-method design, which yielded promising trends in ECTs' effectiveness and connectedness. ECTs described facilitators to effectiveness and connectedness associated with the intervention and barriers associated with the structural realities of schools and gaps in their training. ECTs described effectiveness as neither static nor global and perceived meaningful progress, leveraging individual relationships and group formats to receive instrumental and emotional support.