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Objective: The study extract the fundamental elements needed for sustainable design considering fourteen (14) countries. Methods/Statistical Analysis: The study examined the elements used in different assessment tools for 14 countries, and found out the most used elements which almost all the assessment tools used them based on critical analysis. Findings: From the assessment tools five (5) most used elements were identified which are very important to sustainable design. Application/Improvement: In conclusion sustainable design will not be effective if any of the five (5) elements is eliminated, because it shows that for design to be effectively sustainable the 5 elements need to be included.

This paper examined the influence of parental level of education and occupation on truant behaviour among primary school pupils in Jalingo metropolis. In the study, 150 truants and 150 non-truants were selected from primary schools. Truant Behaviour Questionnaire was developed to measure the variables under study. Based on the analysis, it was concluded that parental level of education and occupation influence truant behaviour among primary school pupils in Jalingo metropolis. The study recommended that Parents Teachers Association, in collaboration with school counsellors, should regularly organise meetings with parents who belong to certain occupations and level of education to encourage their children towards good school attendance and inform them about the dangers of truant behaviour. State ministries of education, in collaboration with school proprietors and school counsellors, should organise workshops for parents with certain occupation and level of education to help them keep their children in school, through behaviour modification intervention.

The prevalence of varicocele is 7% and 10–25% in pre pubertal and post pubertal males, respectively [1]. Varicoceles are found in 21–41% of men with primary infertility and 75–81% of those with secondary infertility. Physical examination of varicocele has a sensitivity and specificity of around 70%. The Color Doppler ultrasound (7MHz) has sensitivity of 50% and specificity of 90%. A pencil probe of 9 MHz is good in detecting subclinical varicocele. This has advantage when bilateral varicoceles are suspected [2]. The effect of varicocele on the testis is due to stasis of blood, increased testicular temperature, and reflux of toxic metabolites from the kidney and adrenal gland. This leads to oxidative stress, apoptosis, a deleterious effect on DNA integrity, and the OAT syndrome [3]. The indications for varicocele treatment are pain, arrest of testicular growth, and infertility. Varicoceles in early adolescence should be followed up and treated if there is persistent discrepancy of testicular size by >20% or >2 cm. However, this should be taken in to consideration together with the peak retrograde flow. A peak retrograde flow of 38cm/s or more may indicate that the arrest of testicular growth is likely to worsen [4]. Research by Goldstein's group in 2011 showed that men with varicoceles have lower testosterone than a comparison group (men without varicoceles presenting for reversal of vasectomy). There was a 70% improvement in testosterone levels of men who had varicocelectomy. The mean increase was 178 ng/dl [5]. Controversies have dominated research on varicocelectomy as a treatment for infertility in the last decade, but research in the last couple of years tends to favor treatment of varicoceles in the presence of abnormal semen parameters and infertility. A prospective randomized trial by Abdel Meguid et al. in which 150 men were randomized to either observation or a microscopic subinguinal varicocelectomy revealed an overall improvement in the odds of achieving pregnancy with varicocelectomy. After 12 mos. of follow–up, 13.9% of the observation group and 32.9% of the treatment group had achieved pregnancy (odds ratio [OR]: 3.04; 95% confidence interval [CI], 1.33–6.95). The authors found a number needed to treat of 5.27 (95% CI, 1.55–8.99), which suggests that 5.27 men need to undergo varicocelectomy to achieve one spontaneous pregnancy [6]. A meta–analysis of outcomes of varicocelectomy in the treatment of infertility in oligospermic men in 2011 by Bazeem and coexperts in the field revealed that combined odds ratio was 2.23 (95% CI, 0.86–5.78; p = 0.091), showing varicocelectomy is moderately superior to observation, but the effect is not statistically significant. They concluded that there is no evidence that a varicocele repair improves spontaneous pregnancy rates. They had observed that varicocelectomy improves sperm parameters (count, total, and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology [7]. An updated Cochrane systemic review in 2012 involving 894 men from 10 studies found out that the combined fixed–effect odds ratio (OR) of the 10 studies for the outcome of pregnancy was 1.47 (95% CI 1.05 to 2.05). The number needed to treat for an additional beneficial outcome was 17. A sub analysis of five studies in which patients had normal semen analysis, but were subfertile also favored treatment with a combined OR 2.39 (95% CI 1.56 to 3.66). The number needed to treat for an additional beneficial outcome was seven. The authors concluded that treatment of varicocele in men from couples with otherwise unexplained subfertility may improve a couple's chance of pregnancy. However, the findings are inconclusive as the quality of the available evidence is very low and more research is needed with live birth or pregnancy rate as the primary outcome [8]. Analyzing the different meta–analyses, the European Association of Urology guidelines recommended varicocele repair in cases of infertility with clinical varicocele and oligospermia, as well as in adolescents with progressive failure of testicular development (Grade B). It recommended against treatment of varicocele in infertile men with normal semen parameters and subclinical varicocele (Grade A) [9]. The current popular methods of varicocele treatment are microsurgical lymphatic and arterial sparing, subinguinal varicocelectomy, and radiological embolization. The authors, with over one thousand patients in their study, have added one of the largest series of clinical and laboratory profiles on men with varicoceles to the literature on the subject. Their finding of slightly higher level of testosterone in men with grade 3 varicocele compared to grade 1 and 2 has defied most studies as discussed above, but their explanation is plausible though more research is needed on it. However, it is a known fact that precision and standardization of testosterone assay is a challenge in itself [10].

A 31-year-old man with recurrent testicular torsion and infertility was found to have a fusional anomaly of the epididymis on scrotal exploration in which only the head of epididymis was attached to the testis, while the body and tail were completely free. He had bilateral orchidopexy, which relieved pain and recurrent torsion. He was then referred for fertility treatment. Literature search has shown that infertility is more associated with congenital anomalies of the epididymis and not with recurrent torsions.

A 58-year-old man presented with a large left scrotal swelling suspected to be a large hydrocele, both, clinically and on initial ultrasound. However, at operation, a large tunica albuginea cyst was found arising from the mid anterior wall of the tunica albuginea. It was dissected, excised and edges under run. Further review of the ultrasound scan revealed a unique feature of large tunica albuginea cyst simulating a hydrocele.

A 39-year-old man presented with penile swelling, pain and hematoma associated with sexual intercourse. On exploration, he was found to have ruptured the superficial dorsal vein of penis, which was ligated. He had an uneventful postoperative recovery and has resumed normal sexual life. A rectangular-shaped suprapubic and distal penile hematoma with sparing of the proximal penile skin was observed. We believe that this physical sign could aid clinical diagnosis of a ruptured superficial dorsal vein of penis.