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Introduction: Colorectal Cancer (CRC) has been primarily considered a disease of the elderly, but recent data have shown an alarming rise among young people. It has also been suggested that young age is associated with aggressive histopathological characteristics and advanced stages of the disease at diagnosis. Aim: To assess and compare the clinical and pathological characteristics of patients with rectal cancer diagnosed at ages over and below 45 years. Materials and Method: This prospective cross-sectional study was conducted between January 2020 and August 2022 in the Departments of Surgical, Medical, Radiation Oncology, Surgical Gastroenterology, and General Surgery at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakand, India. All patients underwent a biopsy from the representative site for histological documentation of the disease. They then underwent treatment (surgery/chemotherapy/radiotherapy) as required. All the data were categorised into two groups: an early-onset group (age

Prostatic adenocarcinoma is the most common type of cancer in men, with subsequent lesions most commonly occurring in the lymph nodes, bones, and lungs.1,2 We discuss the clinical case of a 59-year-old man who presented after radical prostatectomy for prostate cancer with a unilateral metastasis in the right testis. Metastases to the testis are uncommon, occurring in less than 4% of cases.2,3 This kind of metastasis is usually unilateral, manifesting as a palpable testicular mass, and rarely involves both the testis and the epididymis.1,2 Secondary neoplasms of the testis are found in around 2.5% of autopsies, including nonneoplastic fatalities.2 Most secondary testicular metastases develop from distant primary locations, the most prevalent of which are the lung, prostate, and gastrointestinal tract.2 Testicular metastases can occur in up to 4% of all prostate cancer cases and are frequently discovered by chance following orchiectomy therapy for advanced disease.4 In general, advanced prostate cancer metastases to the pelvic lymph nodes, bones, lungs, and liver are common; however, few of these patients have clinically evident testicular metastasis.4,5 Secondary neoplasms of the testis are uncommon, with a reported rate of 0.02-2.5%, except leukemia and lymphoma infiltration.2,3 The prostate is the most common site of testicular metastases (15%), followed by the lung, melanomas, skin, colon, and kidney.1,2 However, most testicular metastases of prostate cancer were discovered after examining a significant number of testes from patients who had tumors removed during therapeutic orchiectomies.2,4 Lung cancer (43%), malignant melanoma (20%), pancreatic cancer (10%), and prostate cancer (10%) are among cancers that can spread to the testes.4,5 However, the great majority of metastases are lesions detected by chance following an autopsy or bilateral orchiectomy for Prostatic Cancer hormonal treatment.3 A testicular tumor revealing clinical recurrence is highly unusual. Bubendorf et al.1 discovered testicular metastases in just 0.5% of 1,589 prostate carcinoma autopsy reports. He also suggests a backward metastatic channel through prostate veins in addition to the typical hematogenous tumor spread via the vena cava. Overall, four routes have been hypothesized for the propagation of the lesions to the testis: retrograde venous extension, retrograde lymphatic extension, arterial embolism, and through the lumen of the vas deferens.1 Patients with symptomatic isolated post-prostatectomy testicular metastases can live for a surprisingly long time after orchidectomy without further development. This phenomenon may be linked to cytoreduction.1,2 The ability to manage the malignant process locally is an undeniable clinical benefit for patients undergoing orchiectomy. Given that this method of treatment is easy, safe, and associated with few problems, all patients with isolated prostatic cancer testicular metastases should be considered candidates for metastasectomy.4,5 The histological features of prostate cancer testicular metastases are similar to those of original prostate tumors; however, histology may show a more aggressive phenotype with a significant probability of future disease spreading and, thus, worse survival.3,4 Weitzner4 found that patients with newly diagnosed testicular metastases from prostate cancer had a median survival of roughly 12 months.1,2 Other studies, on the other hand, have documented survival of more than two years without biochemical relapses. As a result, the predictive impact of testicular metastases from prostate cancer is yet unknown, owing to the rarity of the incidence.2 Testicular metastasis from prostate carcinoma is an uncommon manifestation of advanced disease.2 It often presents with testicular pain, swelling, or a palpable mass and can mimic primary testicular neoplasms. Clinicians should maintain a high index of suspicion, especially in patients with a history of prostate carcinoma. Prompt diagnosis through imaging studies and histopathological confirmation is essential for appropriate management and prognosis.3,4 This case underscores the importance of considering testicular metastasis in the differential diagnosis of testicular masses, particularly in patients with a history of prostate carcinoma. A multidisciplinary approach is crucial for optimal management and improving patient outcomes. Early recognition and timely intervention are paramount in managing metastatic disease and improving quality of life. Figure 1 refers to a 59-year-old male patient presented to our hospital with an elevated serum prostate-specific antigen (PSA) level of >100 ng/ml. He had been on regular follow-up with urology for surveillance of prostate cancer recurrence. He had undergone a radical prostatectomy two years ago with Gleason grade group 5. Scrotal ultrasound showed a hypoechoic mass involving the right testicle with increased vascularity, suggesting a neoplastic lesion. Hence, the patient was planned for a bilateral orchidectomy. The patient underwent bilateral inguinal orchiectomy without any complications. Macroscopic examination of the right resected testis revealed a solid yellowish-white tumor of 0.5 × 0.5 cm. Histopathological analysis showed that the right testis was infiltrated by metastatic adenocarcinoma. Immunohistochemical examination revealed that tumor cells were diffusely positive for PSA and Alpha (α)-methylacyl-CoA racemase (AMACR). The patient was diagnosed with right testicular metastasis of Prostatic Carcinoma. The patient had an uneventful postoperative recovery. The patient was scheduled for regular follow-up appointments to monitor disease progression. Serial PSA levels and imaging studies were planned to look for disease status. Figure 1 A – Gross view of the right orchidectomy showing a small nodular metastatic deposit in tunica albuginea from the prostate cancer; B, C and D are photomicrographs of the tumor and testicle parenchyma; B – shows normal testicular seminiferous tubules along with presence of metastatic tumor deposit in the wall of testis (Tunica albuginea) (H&E x100); C – These tumor cells are immunopositive for prostate specific antigen (PSA 40X); D – The tumor cells are also positive for Alpha-methylacyl-CoA racemase (AMACR 200X).:

Abstract Gallbladder cancer (GBC) is a lethal disease with surgical resection as the only curative treatment. However, many patients are ineligible for surgery, and current adjuvant treatments exhibit limited effectiveness. Next-generation sequencing has improved our understanding of molecular pathways in cancer, sparking interest in microRNA-based gene regulation. The aim of the study is to identify dysregulated miRNAs in GBC and investigate their potential as therapeutic tools for effective and targeted treatment strategies. GBC and control tissue samples were sequenced for miRNA expression using the Illumina HiSeq platform. Biological processes and related pathways were determined using the Panther and Gene Ontology databases. 439 significantly differentially expressed miRNAs were identified; 19 of them were upregulated and 29 were downregulated. Key enriched biological processes included immune cell apoptosis, endoplasmic reticulum (ER) overload response, and negative regulation of the androgen receptor (AR) signaling pathway. Panther analysis revealed the insulin-like growth factor (IGF)-mitogen activated protein kinases (MAPK) cascade, p38 MAPK pathway, p53 pathway, and FAS (a subgroup of the tumor necrosis factor receptor) signaling pathway as highly enriched among dysregulated miRNAs. Kirsten rat sarcoma virus (KRAS), AR, and interferon gamma (IFN-γ) pathways were identified among the key pathways potentially amenable to targeted therapy. We concluded that a combination approach involving miRNA-based interventions could enhance therapeutic outcomes. Our research emphasizes the importance of precision medicine, targeting pathways using sense and anti-sense miRNAs as potential therapies in GBC.

We analyzed the risk factors and outcomes of antenatally diagnosed congenital diaphragmatic hernia (CDH) from a tertiary-care children’s hospital following in-utero transfer. A total of 41 antenatally detected cases of CDH were included; 30 were live-born and 11 were still-born. The primary outcome was postnatal survival. The secondary outcome was the probable factor affecting survival. No medical termination of the pregnancy was done. The mean gestational age at diagnosis was 23 weeks. The diagnostic accuracy of antenatal ultrasonography was 40/41 (97.5%). Lung-to-head ratio (LHR) was 1 in 10 cases (survived 8), and LHR was not recorded in 11 cases (survived 4). Overall survival was 14/41 (34.1%). Survival in fetuses with polyhydramnios was 0% (n=3; survived 0), associated anomalies were 33.3% (n=3; survived 1), and liver herniation was 22.2% (n=9; survived 2). Postnatally, significant risk factors included a low Apgar score, the need for ventilation, and neonatal intensive care unit (NICU) management. Survival in live-born cases was 14/30 (46.6%) and in operated cases was 14/19 (73.6%). We concluded that antenatal ultrasound had a high accuracy rate for detecting CDH. Antenatal risk factors affecting outcomes were low LHR, maternal polyhydramnios, liver herniation, and associated malformations. Postnatal risk factors included a low Apgar score, NICU admission, and a need for ventilation. The overall survival rate, as well as the survival rates for live-borns and those undergoing surgery, were 34.1%, 46.6%, and 73.6%, respectively. This data will guide clinicians in counseling the families of antenatally diagnosed CDH.

Background: Hypertension is a major public health problem in India, affecting a significant proportion of the population. Drug utilization research is important for assessing the rationality of drug treatment and for identifying areas for improvement. This study examined the drug utilization pattern of antihypertensive drugs in hypertensive patients at an Outpatient Department (OPD) in Udaipur, Rajasthan, India, based on JNC-8 classification. Materials and Methods: The observational cross-sectional study included 300 hypertension patients aged above 25 attending the hypertension clinic. Exclusions were made for inpatients, age < 25, uncertain diagnosis, pregnant/lactating mothers, and patients subsequently admitted after OPD visits. Results: The majority of affected patients were above 60 years old, with most having hypertension for 2-5 years, often accompanied by Type II Diabetes Mellitus. Oral administration was the primary drug delivery route. On average, patients received 1.93 antihypertensive drugs per encounter (range: 1 to 4), with an average of 5.82 drugs per encounter (range: 1 to 12). Losartan (72%) and amlodipine (46%) were the most prescribed drugs, with Angiotensin Receptor Blockers (ARBs) being the most prescribed drug class (79.3%), followed by Calcium Channel Blockers (CCBs) at 46.6%. The most common therapy was a two-drug combination (44.6%), followed by single-drug therapy (33%). Approximately 26.3% of prescriptions indicated potential drug interactions. Conclusions: This study provides valuable baseline data on the prescribing pattern of antihypertensive drugs. Rational prescribing practices are being followed, with the majority of patients being prescribed a combination of two or three antihypertensive drugs. However, there is a need to educate patients about the risks associated with uncontrolled high blood pressure and the benefits of lifestyle changes.

Abstract Linear antenna arrays (LAAs) play a critical role in smart system communication applications such as the Internet of Things (IoT), mobile communication and beamforming. However, minimizing secondary lobes while maintaining a low beamwidth remains challenging. This study presents an enhanced synthesis methodology for LAAs using the Adaptive Naked Mole Rat Algorithm (ANMRA). ANMRA, inspired by mole-rat mating habits, improves exploration and exploitation capabilities for directive LAA applications. The performance of ANMRA is assessed using the CEC 2019 benchmark test functions, a widely adopted standard for statistical evaluation in optimization algorithms. The proposed methodology results are also benchmarked against state-of-the-art algorithms, including the Salp Swarm Algorithm (SSA), Cuckoo Search (CS), Artificial Hummingbird Algorithm (AHOA), Chimp Optimization Algorithm (ChOA), and Naked Mole Rat Algorithm (NMRA). The results demonstrate that ANMRA achieves superior performance among the benchmarked algorithms by successfully minimizing secondary lobes and obtaining a narrow beamwidth. The ANMRA controlled design achieves the lowest Side Lobe Level (SLL) of − 37.08 dB and the smallest beamwidth of 74.68°. The statistical assessment using the benchmark test functions further confirms the effectiveness of ANMRA. By optimizing antenna element magnitude and placement control, ANMRA enables precise primary lobe placement, grating lobe elimination, and high directivity in LAAs. This research contributes to advancing smart system communication technologies, particularly in the context of IoT and beamforming applications, by providing an enhanced synthesis methodology for LAAs that offers improved performance in terms of secondary lobe reduction and beamwidth optimization.

Introduction: Cancer impacts not only people living with cancer but also their caregivers. In hospital, caregivers always have pressure on them and their personal and private lives are disrupted during the caring process. Aim: To identify the various factors affecting the Quality Of Life (QOL) among caregivers of cancer patients. Materials and Methods: This quantitative study with an exploratory research design was conducted in oncology Outpatient Department (OPD) of All India Institute of Medical Sciences, Rishikesh, India, from November 2019 to February 2020. A total of 256 caregivers of cancer patients, who were visiting various oncology units were included. Data regarding caregiver’s sample characteristics, clinical variables and caregiver’s Oncology Quality of Life questionnaire (CarGOQoL) were collected. Statistical analysis was done using Chi-square test and Fisher-exact tests were used to study variables. Results: Majority, 94 (37%) belonged to 41-50 years age group, 143 (56%) were females, and 142 (56%) lived in rural areas. Patients’ diagnoses were breast cancer in 94 (37%), Stage-III in 133 (52%), symptoms lasting more than 6-12 months in 103 (40%), and were partial dependent in 172 (67%). A total of 123 (48%) of caregivers scored less in the CarGOQoL questionnaire, so about half of the caregivers had a poor QOL. Caregiver coping (43%) and the private life domain were enormously affected in 193 (37%). Significant relationships with caregivers’ QOL were seen for variables like female gender (p-value=0.037), educational level of patients (p-value=0.018), caregivers with co-morbidities (p-value=0.05), and the number of earning members in the family (p-value=0.022). Conclusion: Care burden always has an impact on the caregiver’s overall QOL. It mainly affected their psychological well-being, burdens, and private lives. Therefore, comprehensive attention should be given to patients as well as caregivers.

BackgroundSplenic artery embolization (SAE) is increasingly favored for adult blunt splenic injury management. We compared SAE to other splenic injury management strategies using robust statistical techniques.Materials and methodsUnivariate analyses of demographics and outcomes were performed for four patient groups: observation, SAE, splenic surgery, splenic surgery + SAE in the American College of Surgeons Trauma Quality Program (TQIP) database. To address nonlinear associations of ED vital signs with mortality, multivariable spline-based logistic regression models with interaction terms between hemodynamic status and management strategy and either splenic Abbreviated Injury Score (AIS) or Injury Severity Score (ISS), were generated.ResultsIn 44,187 splenic injury patients meeting study inclusion criteria, the most common management strategy was observation alone (77.9%). The observation group had median spleen AIS of 2, ISS 20, with 6.3% mortality; SAE (2.6%) had median spleen AIS3, ISS 24, with 6.6% mortality; splenic surgery (22.4%) AIS4, ISS 29, with 15.4% mortality; and splenic surgery + SAE (0.04%) AIS4, ISS 29, with 15.2% mortality. In multivariable models, SAE had lower predicted probability of mortality than surgery over most initial ED systolic blood pressures (SBPs). At all spleen AIS, SAE had lower predicted mortality than surgery. SAE had lower mortality than surgery except at very high ISS, where it was comparable. SAE had lower predicted mortality than observation management at spleen AIS≥3. In subgroup analysis of patients without severe multi-system injuries, predicted mortality did not differ by management strategy.ConclusionsSAE is associated with decreased mortality at spleen AIS 3-5. The benefits of SAE appear to be largely for spleen AIS 3-5 in the setting of severe (AIS≥3) multi-system injuries.

Introduction: Carcinoma esophagus has heterogeneous and changing epidemiology and clinicopathological characteristics. A thorough literature search revealed a knowledge gap regarding esophageal cancers in this sub-Himalayan region. Materials and Methods: This prospective, descriptive, observational study was conducted at a tertiary institute in the sub-Himalayan region, including 119 patients from January 2021 to December 2022. Patients above 18 years of age with histologically proven cancer esophagus and giving their informed consent were recruited. The aim was to study the clinicopathological characteristics of adult patients with carcinoma esophagus. Descriptive data were collected, and statistical analysis was done using the SPSS version 23 software. Results: The mean age of presentation was 58.55 ± 10.76 years, with the male-to-female ratio of 1.70:1 and rural-to-urban distribution of 2.05:1. Distribution was higher at higher altitudes. The majority of patients consumed large amounts of hot beverages on a regular basis (83.2%). The disease was more common in the lower (V) and upper lower (IV) socioeconomic status. Progressive dysphagia (Grade III to V in 96.6%), loss of appetite, and unintentional significant weight loss were the common presenting symptoms. The most common involved subsite was middle thoracic (53.4%), followed by lower thoracic (40.5%), upper thoracic (28.4%), and cervical esophagus (12.1%). Only 12.6% of patients presented as Stage II, the rest were in a higher stage. All patients were having squamous cell carcinoma except one case (0.8%) of adenocarcinoma and small-cell carcinoma and two cases (1.6%) of NET. The mean primary delay was 1.73 ± 0.90 months, and the mean secondary delay was 1.02 ± 0.77 months. Conclusion: Our results align with the published literature with additional observations of changes in disease distribution with altitudes. However, a following study is required for trend analysis and develop policies for the primary prevention and early detection of carcinoma esophagus.

Background and Objective: The ovary is considered one of the complex organs with respect to histology, embryology, steroidogenesis, as well as tumor incidence. In order to attain a better knowledge of the disease mechanism, the current research highlights a correlation between the pathological and clinical features of epithelial ovarian carcinoma. The aim of this research is to evaluate the oncological and clinicopathological results of patients who were diagnosed with ovarian cancer (OC) in a tertiary care center situated in the Sub-Himalayan region. Materials and Methods: Seventy patients with OC registered at the department of surgical oncology, obstetrics and gynecology, and medical oncology between January 2019 and December 2021 had been estimated in this prospective and retrospective observational research. Age, histological type, stage at presentation, and treatment pattern were the characteristics examined in the patients. Results: The patients' average age was 48.18 ± 12.309 years, having a maximum age of 74 years as well as the minimum age of 21 years. The most frequent symptom was abdominal pain (30%). Hypertension was the most commonly seen comorbidity in 7 (10%) patients. Most of the patients had high-grade serous carcinoma in 40 (56.1%) patients. Neoadjuvant chemotherapy and adjuvant type of chemotherapy were given to 30 (42.9%) patients. After 3 months, follow-up imaging showed that there was no residual disease in 51 (72.8%) patients, and the disease progression was seen in 8 (11.4%) patients. Conclusion: Because of their clinical correlation, behavioral predictability, as well as proper management of patient care, the right clinicopathological detection of ovarian tumors is extremely important.

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.Design Population based cohort study.Setting England and Wales, comprising routine data for births and hospital records.Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at

Abstract Background There are many ways that students and trainees learn to talk about patients. The way trainees and physicians use language during clinical care is important, as labeling patients can have adverse effects on patient safety. Communication is considered a core competency by The Accreditation Council on Graduate Medical Education (ACGME). Past research has shown that participants in narrative medicine curricula report developing stronger communication skills however it is not clear how these workshops motivated trainees to use language differently during patient care. To explore this, we interviewed second-year residents in academic year 19–20 about their experiences both in participating in narrative medicine workshops and giving patient care. Methods The framing context for this constructivist thematic analysis is a series of narrative medicine workshops facilitated for interns in an internal medicine residency program at a large academic medical center during the 18–19 academic year. We developed a semi-structured interview study that allowed residents to reflect on their experiences in these workshops. Eighteen out of 60 residents (30%) were interviewed. Results We found that sessions regarding language use in patient care shaped how interns thought about and used language during clinical work, a finding that arose spontaneously during interviews. Conclusions Our research suggests that workshops aimed specifically at addressing the use of language in healthcare can have meaningful impact on trainees. Our study makes a unique contribution to the scholarship by suggesting that training in narrative medicine can lead to a change in the way that trainees use language during their clinical work.

Background: Bone marrow metastasis is an uncommon yet significant presentation of many non haematological malignancies. Aims: The present study was conducted with the aim of analysing the clinical, haematological and biochemical parameters of the patients with bone marrow metastases and determines the parameters which could possibly indicate the presence of bone marrow metastases. Patients and Methods: Bone marrow aspirate, imprint and biopsy slides of 22 cases with bone marrow metastases were reviewed and the haematological and biochemical data of all these cases were compared with that of 20 controls without any evidence of metastases. Results: The mean values of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and serum lactate dehydrogenase (LDH) were found to be significantly different (P < 0.001) between the cases and controls. MPV 3.5 and LDH >452 U/L showed a high likelihood ratio in predicting bone marrow metastases. Conclusion: Parameters such as MPV, NLR and LDH can be used as efficient and easily available methods to predict bone marrow metastasis for a rapid diagnosis.

ObjectiveTo evaluate the efficacy of corneal neurotisation using sural nerve graft coaptation of the contralateral supratrochlear nerve in unilateral neurotrophic keratopathy and corneal anesthesia. Corneal neuralization has emerged as a potential option in the treatment of neurotropic keratopathy, however not free from the predicament. We evaluated the long-term outcome of corneal neurotisation in the treatment of unresponsive unilateral neurotropic keratopathy using surgical variations to mimic and expedient the surgical procedure.MethodsA Prospective interventional study involving patients with unilateral neurotrophic keratopathy (NK) who did not respond to medical measures was conducted. The study parameters evaluated were best-corrected visual acuity improvement, ocular surface evaluation parameters [tear break-up time (TBUT), Schirmer's 1, and ocular surface staining scores (corneal and conjunctival staining)], central corneal sensation (Cochet Bonnet esthesiometer), sub-basal nerve fiber length (SBNFL), and sub-basal nerve fiber density (SBNFD) determined by central confocal microscopy at recruitment and during follow-up at 1-month, 3-month, 6-month, 9-month and 12-month respectively, following corneal neurotization.ResultsEleven eyes of 11 patients with unilateral neurotrophic keratopathy (NK) who underwent corneal neurotisation were studied. The mean follow-up was 10.09±2.31months (range, 6-12). Mean best corrected visual acuity in log MAR at baseline, 1.35±0.52 improved significantly to 1.06±0.76 (P = 0.012) at 3 months and continued to 0.55±0.60 (P = 0.027) at 12 months. There was a significant reduction in NK grade severity and improvement in the ocular surface as early as 1 month, and central corneal sensations (P = 0.024) as soon as 3 months. Mean corneal SBNF improved from 3.12±1.84 mm/mm2 to 4.49±1.88 at 1 month (P = 0.008), 13.31±3.61 mm/mm2 (P = 0.028) at 12 months. Mean central corneal SBNFD evident at 6 months was 1.83±2.54no/mm2 (P = 0.018) and 4.90±3.12no/mm2 (P = 0.028) at 12 months.ConclusionThis study substantiates the routine practice of corneal neurotisation by simplifying the intricacies observed during the procedure.

Introduction: Gender-affirming peritoneal vaginoplasty has been described, and previous descriptions are modifications of the Davydov technique. Aim: To describe our alternative technique for gender-affirming peritoneal vaginoplasty (PV) using a single-pedicled, urachus-peritoneal hinge flap, discussing proposed advantages. Methods: Retrospective review of all consecutive transfeminine patients with neovaginal shortening after prior penile inversion vaginoplasty (PIV) who underwent our PV technique from May 2019 to July 2022. PV was performed via combined transperineal and laparoscopic (robot-assisted) approaches. After spatulation of the neovaginal remnant, a midline, inferiorly based urachus-peritoneal hinge flap was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The free end of the flap was flipped posteriorly and sutured to posterior edge of the open canal remnant, forming a peritoneal pouch. The lateral edges of the pouch were sutured together for water-tight closure. Patients resumed dilation on POD 6 and douching on POD 10. Main Outcome Measures: Ten transfeminine patients underwent PV, with good outcomes. We measured: Pre-op penile and scrotal skin lengths, intra-op tubularized scrotal skin length, pre and post-op vaginal depth and width (immediate and at last follow-up). Results: Pre-op: mean neovaginal depth was 9.2cm (SD 1.5); width was 12cm. Immediate post-op: mean depth was 15.1 cm (SD 2.2 cm, mean net increase: 5.9 cm). At mean follow-up of 18.3 months, mean depth was 12.5 cm (SD 2.1 cm, mean net increase: 3.3 cm) and width was 12 cm. There were no immediate post-op complications. Eight (80%) of the 10 patients report satisfactory vaginal receptive intercourse. The other 2 have not yet attempted vaginal receptive intercourse. Clinical Implications: Advantages of the proposed technique over existing techniques include no tension on peritoneal suture lines and total exclusion of the rectum. Strengths and Limitations: Strengths include a short learning curve for urologic surgeons with robotic experience. The study is limited by small sample size. Conclusions: Our PV technique is a safe and effective option for salvage peritoneal vaginoplasty after primary PIV.Smith SM, Yuan N, Stelmar J, et al. An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap. Sex Med 2022;10:100572.

Abstract Background Due to insufficient accuracy, urine-based assays currently have a limited role in the management of patients with bladder cancer. The identification of multiplex molecular signatures associated with disease has the potential to address this deficiency and to assist with accurate, non-invasive diagnosis and monitoring. Methods To evaluate the performance of Oncuria™, a multiplex immunoassay for bladder detection in voided urine samples. The test was evaluated in a multi-institutional cohort of 362 prospectively collected subjects presenting for bladder cancer evaluation. The parallel measurement of 10 biomarkers (A1AT, APOE, ANG, CA9, IL8, MMP9, MMP10, PAI1, SDC1 and VEGFA) was performed in an independent clinical laboratory. The ability of the test to identify patients harboring bladder cancer was assessed. Bladder cancer status was confirmed by cystoscopy and tissue biopsy. The association of biomarkers and demographic factors was evaluated using linear discriminant analysis (LDA) and predictive models were derived using supervised learning and cross-validation analyses. Diagnostic performance was assessed using ROC curves. Results The combination of the 10 biomarkers provided an AUROC 0.93 [95% CI 0.87–0.98], outperforming any single biomarker. The addition of demographic data (age, sex, and race) into a hybrid signature improved the diagnostic performance AUROC 0.95 [95% CI 0.90–1.00]. The hybrid signature achieved an overall sensitivity of 0.93, specificity of 0.93, PPV of 0.65 and NPV of 0.99 for bladder cancer classification. Sensitivity values of the diagnostic panel for high-grade bladder cancer, low-grade bladder cancer, MIBC and NMIBC were 0.94, 0.89, 0.97 and 0.93, respectively. Conclusions Urinary levels of a biomarker panel enabled the accurate discrimination of bladder cancer patients and controls. The multiplex Oncuria™ test can achieve the efficient and accurate detection and monitoring of bladder cancer in a non-invasive patient setting.

Esophageal lung is a type of Group-II communicating bronchopulmonary foregut malformations (CBPFM) usually diagnosed beyond neonatal period during investigation for recurrent respiratory symptoms and persistent radiographic features suggesting pneumonia or bronchiectasis. In our case, we noticed bronchiectasis and disproportionately severe volume loss in an infant with associated multisystem anomalies in the absence of “significant” lower respiratory tract symptoms. A detailed evaluation with repeat imaging confirmed a Group-II CBPFM, a congenital pathology instead of an infective cause. Pneumonectomy is a more prudent option instead of undertaking major airway reconstruction for the dysplastic “dysfunctional” tissue. Amongst the various associated anomalies reported till now, the associated rib and renal anomalies noted by us have not been described earlier to the best of our knowledge.

Aims: Cost-utility studies are crucial tools that help policy-makers promote appropriate resource allocation. The objective of this study was to evaluate the extent and quality of cost-utility analysis (CUA) in India through a systematic literature review. Methods: Comprehensive database search was conducted to identify the relevant literature published from November 2009 to November 2019. Gray literature and hand searches were also performed. Two researchers independently reviewed and assessed study quality using Consolidated Health Economic Evaluation Reporting Standards checklist. Results: Thirty-five studies were included in the final review. Thirteen studies used Markov model, five used decision tree model, four used a combination of decision tree and Markov model and one each used microsimulation and dynamic compartmental model. The primary therapeutic areas targeted in CUA were infectious diseases (n = 12), ophthalmology (n = 5), and endocrine disorders (n = 4). Five studies were carried out in Tamil Nadu, four in Goa, three in Punjab, two each in Delhi, Maharashtra, and Uttar Pradesh, and one each in West Bengal and Karnataka. Twenty-three, eight, and four studies were found to be of excellent, very good, and good quality, respectively. The average quality score of the studies was 19.21 out of 24. Conclusions: This systematic literature review identified the published CUA studies in India. The overall quality of the included studies was good; however, features such as subgroup analyses and explicit study perspective were missing in several evaluations.

Proteinuria can range from subnephrotic to nephrotic amounts during pregnancy, though nephrotic syndrome (NS) is rare (0.012%–0.025%). Without a renal biopsy, this distinction may be difficult at times. The objective of our study was assessing about renal and feto-maternal outcomes of these patients. This study was done in a tertiary-care hospital in north India from 2010 to 2019. We included all pregnant women with nephrotic-range proteinuria, with no signs or symptoms suggestive of pre-eclampsia. We studied their treatment modalities, renal, maternal, and fetal outcomes. Eighteen eligible pregnant women diagnosed with NS with no features suggestive of pre-eclampsia or associated comorbidities were included. The gestational age of presentation was 23.2 ± 1.36 weeks. The average proteinuria was 4.38 ± 0.76 g/day. The patients were managed conservatively without kidney biopsy. About 16.7% of pregnancies had worsening of hypertension and acute kidney injury which recovered after delivery. Anasarca was troublesome for four patients requiring fresh-frozen plasma infusion. All were managed conservatively; however, five patients were started on empirical immunosuppression, all five with steroids, while two required the addition of calcineurin inhibitors as well. All had live births, but 25.7% each had preterm and intrauterine growth restriction while one required neonatal intensive care unit admission. The degree of proteinuria had an impact on maternal and fetal outcomes, especially on risk to pre-eclampsia. NS during pregnancy needs evaluation and counseling. Majority of them can be managed conservatively yet specific therapies can safely be tried among symptomatic ones. Despite good outcomes, a sizeable risk to maternal and fetal complications can occur.

The Coronavirus Disease 2019 (COVID-19) pandemic wreaked havoc on almost all aspects of life and has undeniably altered the landscape of the world forever. In the medical profession, everything from education to scheduling operations was affected. Educational events such as conferences, Continuing Medical Education (CME) and other events had to be converted into virtual conferences and meetings. However, now that the pandemic is slowly coming to an end and countries and borders have started to reopen, the question now remains- should we go back to our old ways or has this become the new normal? This review discusses the advantages and limitations of conducting virtual events and discusses future trends of holding such events in these uncertain times.

BackgroundHealthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs.Methods and findingsWe conducted a cross-sectional analysis using data from the baseline questionnaire of the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH) cohort study, administered between December 2020 and March 2021. We used logistic regression to examine associations of demographic, household, and occupational risk factors with SARS-CoV-2 infection (defined by polymerase chain reaction (PCR), serology, or suspected COVID-19) in a diverse group of HCWs. The primary exposure of interest was self-reported ethnicity. Among 10,772 HCWs who worked during the first UK national lockdown in March 2020, the median age was 45 (interquartile range [IQR] 35 to 54), 75.1% were female and 29.6% were from ethnic minority groups. A total of 2,496 (23.2%) reported previous SARS-CoV-2 infection. The fully adjusted model contained the following dependent variables: demographic factors (age, sex, ethnicity, migration status, deprivation, religiosity), household factors (living with key workers, shared spaces in accommodation, number of people in household), health factors (presence/absence of diabetes or immunosuppression, smoking history, shielding status, SARS-CoV-2 vaccination status), the extent of social mixing outside of the household, and occupational factors (job role, the area in which a participant worked, use of public transport to work, exposure to confirmed suspected COVID-19 patients, personal protective equipment [PPE] access, aerosol generating procedure exposure, night shift pattern, and the UK region of workplace). After adjustment, demographic and household factors associated with increased odds of infection included younger age, living with other key workers, and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.59, 95% CI 2.11 to 3.18 for ≥21 patients per week versus none), working in a nursing or midwifery role (1.30, 1.11 to 1.53, compared to doctors), reporting a lack of access to PPE (1.29, 1.17 to 1.43), and working in an ambulance (2.00, 1.56 to 2.58) or hospital inpatient setting (1.55, 1.38 to 1.75). Those who worked in intensive care units were less likely to have been infected (0.76, 0.64 to 0.92) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known risk factors. This study is limited by self-selection bias and the cross sectional nature of the study means we cannot infer the direction of causality.ConclusionsWe identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection among UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic.Trial registrationThe study was prospectively registered at ISRCTN (reference number: ISRCTN11811602).

Follicular thyroid carcinoma (FTC) presenting as an isolated spinal metastasis with features of compression myelopathy is extremely rare with

Crossmatching of prospective renal transplant donors against recipients is a mandatory component of the transplant workup, being performed for over 40 years now. Allografting patients with human leukocyte antigens which are recognized by preformed antibodies constitutes the main cause of hyperacute or acute rejections. The existence of these donor-specific anti-human leukocyte antigen antibodies (DSAs) is regarded as a contraindication for graft trans-plantation, both cadaveric and live kidney. We present two unusual cases in which both complement-dependent cytotoxicity crossmatch and DSA by Luminex were falsely positive due to autoimmune and infectious causes, but single-antigen bead assay showed these antibodies to be against nondonor antigens. After treating their basic disease, thought to be responsible for false-positive DSA, these patients became DSA negative and underwent transplantation with an uneventful posttransplant period. Our aim through these examples is to highlight the problem of false-positive crossmatch in potential renal allograft transplant recipients. Further, we propose antigenic determination of donor-specific antibodies in such patients where we suspect the immune system to be chronically activated to pick up false-positive cases and therefore increase the donor pool without compromising the transplant outcome.

Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the study was to identify the hotspot regions and relationship of gallstones to GBC in two northern states of India. Materials and Methods: It was a retrospective, observational, hospital-based cohort study. The data of patients with locally advanced (LA) or metastatic GBC from January 2019 to December 2019 were evaluated for geographical distribution of cases, and their clinical spectrum was compared with the presence or absence of associated cholelithiasis. Statistical analysis was performed using R Statistical software version 3.6.2. Results: Forty-two patients were enrolled in our study. A high burden of GBC was observed from Western Uttar Pradesh (District Bijnor 12(29%) and Muzaffarnagar 7(17%)) and Uttarakhand (District Haridwar 7(17%), whereas the remaining 16(38%) patients were residents of other districts of Uttarakhand (UK) and Western Uttar Pradesh (UP). In our study, only 17(40.5%) patients had associated cholelithiasis. Metastatic disease at presentation was seen in nearly 59% of patients with cholelithiasis and 52% of patients without cholelithiasis. Jaundice was the most common presentation in 12(70.6%) patients, followed by pain in 9(nearly 53%) patients with GBC associated with gallstones. Whereas in patients with GBC without gallstones, loss of appetite and loss of weight was the most common presentation in 16(64%) followed by jaundice in 13(52%). Conclusion: Most cases with LA or metastatic GBC in the present study were not associated with cholelithiasis. Clinical spectrum of either LA or metastatic GBC is similar, irrespective of presence or absence of gallstones.

Abstract Background The utilization of monoclonal antibodies has become more widespread over the past decade. However, the development of non-caseating granulomas with the use of monoclonal antibodies, such as ustekinumab, is not widely reported in the literature. Case presentation We report a case of a 50-year-old Caucasian male who presented complaining of weight loss and shortness of breath. He was receiving ustekinumab for refractory psoriasis but had no other significant medical comorbidities. On physical examination, reduced breath sounds on the right side were noted. Blood cultures were drawn on presentation and came back negative in 48 hours. A chest computed tomography scan revealed a large right lung mass in addition to right-sided pleural effusion. Therapeutic thoracocentesis was done; fluid cytology and analysis were negative for malignancy, acid-fast bacilli, or fungal infections. A positron emission tomography scan showed multifocal radiotracer uptake including within right lung mass, multiple bones, lymph nodes, liver and spleen. Biopsies showed hyalinized non-necrotizing granulomas. Immunohistochemical stains for AE1/AE3, cytokeratin 7 and 20, and thyroid transcription factor 1, were all negative. He was started on steroid therapy, and ustekinumab was discontinued and the follow-up computed tomography after a few months showed substantial improvement. However, over the course of next 4 months patient developed hepatic dysfunction and recurrent ascites and ultimately underwent transjugular intrahepatic portosystemic shunt placement. Furthermore, he was started on azathioprine and steroids were tapered. He improved clinically and was discharged from our hospital within a week. Conclusions This case highlights the need for careful consideration of patient medication history while evaluating the possible differential diagnoses that may contribute to a patient’s presentation.

Abstract Background Rectal perforation by foreign bodies is known; however, high-pressure injury leading to rectal blowout has been confined to battlefields and is less often encountered in general medical practice. Apart from iatrogenic injuries during colonoscopy, barotrauma from compressed air is encountered very less frequently. Owing to the infrequent nature of these injuries, the mechanism is still not well understood. We present our experience with treating high-pressure transanal barotrauma to the rectum and colon in three similar cases. Case presentation The mode of injury was accidental or a cruel, perverted joke played by acquaintances. The high-pressure air jet column overcomes the anal sphincter barrier, pushing enormous amounts of air through the anus into the bowel, which ruptures when the burst pressure is reached. A huge amount of free gas was noted in the peritoneal cavity on x-rays, and a big gush was noted during surgery. All these cases had rectosigmoid junction blowout with multiple colonic injuries. The patients underwent exploratory laparotomy with resection of severely injured segments and proximal ileostomy. They underwent restoration of bowel continuity after 2–3 months and were doing well in follow-up. Conclusions Colorectal injuries by pneumatic insufflation through the anus depends on the air pressure, air flow velocity, anal resting pressure, and the distance between the source and anus. The relative fixity of the rectum and the bends of the sigmoid make the rectosigmoid junction more prone to rupture by high-pressure air jet. Education regarding such machines and their safe use must be encouraged because most of these cases are accidental and due to ignorance.

Background: Acanthamoeba are amphizoic amoeba majorly responsible for causing Acanthamoeba keratitis (AK) and Granulomatous amoebic encephalitis (GAE). Despite its ubiquitous nature, the frequency of infections is not high, probably due to the existence of non-pathogenic isolates. The whole-genome sequencing and an annotated genome assembly can unravel the biological functions and help in identifying probable genes related to pathogenicity. Methods: Illumina and Nanopore sequencing were performed for keratitis, encephalitis, and non-pathogenic environmental isolates. Hybrid assembly was prepared for the AK and GAE isolates, while only the Illumina reads were utilized for a non-pathogenic environmental isolate. Protein coding genes were identified using the GeneMark-ES program and BLASTx module of Diamond used for gene prediction. Additionally, the Kyoto Encyclopedia of Genes and Genomes annotation and cluster of orthologous group’s annotation using RPS-blast against the CDD database was performed. The subsequent data analysis and validation will help identify probable pathogenic genes. Results: The genome assemblies of 9.67, 8.34, and 8.89 GBs were reported for GAE, AK, and non-pathogenic isolate, respectively. KEGG reported 22,946 in GAE, 24,231 in keratitis, and 9367 genes in the environmental isolate. The COG annotation revealed 3232 in GAE, 3403 in keratitis, and 1314 genes in the non-pathogenic isolate. Conclusion: The present study has attempted to generate de novo hybrid genome assemblies of Acanthamoeba that would help decode the genome of free-living amoeba and will provide genomic data for a better understanding of virulence-related factors.

Introduction The COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).Methods and analysis A baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.Ethics and dissemination The study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals.Trial registration number ISRCTN11811602; Pre-results.

Introduction As the world continues to grapple with the COVID-19 pandemic, emerging evidence suggests that individuals from ethnic minority backgrounds may be disproportionately affected. The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) project has been initiated to generate rapid evidence on whether and why ethnicity affects COVID-19 diagnosis and clinical outcomes in healthcare workers (HCWs) in the UK, through five interlinked work packages/work streams, three of which form the basis of this protocol. The ethico-legal work (Work Package 3) aims to understand and address legal, ethical and acceptability issues around big data research; the HCWs experiences study (Work Package 4) explores their work and personal experiences, perceptions of risk, support and coping mechanisms; the stakeholder engagement work (Work Package 5) aims to provide feedback and support with the formulation and dissemination of the project recommendations.Methods and analysis Work Package 3 has two different research strands: (A) desk-based doctrinal research; and (B) empirical qualitative research with key opinion leaders. For the empirical research, in-depth interviews will be conducted digitally and recorded with participants permission. Recordings will be transcribed, coded and analysed using thematic analysis. In Work Package 4, online in-depth interviews and focus groups will be conducted with approximately 150 HCWs, from across the UK, and these will be recorded with participants consent. The recordings will be transcribed and coded and data will be analysed using thematic analysis. Work Package 5 will achieve its objectives through regular group meetings and in-group discussions.Ethics and dissemination Ethical approval has been received from the London-Brighton & Sussex Research Ethics Committee of the Health Research Authority (Ref No 20/HRA/4718). Results of the study will be published in open-access journals, and disseminated through conference presentations, project website, stakeholder organisations, media and scientific advisory groups.Trial registration number ISRCTN11811602.

Introduction COVID-19 has spread rapidly worldwide, causing significant morbidity and mortality. People from ethnic minorities, particularly those working in healthcare settings, have been disproportionately affected. Current evidence of the association between ethnicity and COVID-19 outcomes in people working in healthcare settings is insufficient to inform plans to address health inequalities.Methods and analysis This study combines anonymised human resource databases with professional registration and National Health Service data sets to assess associations between ethnicity and COVID-19 diagnosis, hospitalisation and death in healthcare workers in the UK. Adverse COVID-19 outcomes will be assessed between 1 February 2020 (date following first confirmed COVID-19 case in UK) and study end date (31 January 2021), allowing 1-year of follow-up. Planned analyses include multivariable Poisson, logistic and flexible parametric time-to-event regression within each country, adjusting for core predictors, followed by meta-analysis of country-specific results to produce combined effect estimates for the UK. Mediation analysis methods will be explored to examine the direct, indirect and mediated interactive effects between ethnicity, occupational group and COVID-19 outcomes.Ethics and dissemination Ethical approval for the UK-REACH programme has been obtained via the expedited HRA COVID-19 processes (REC ref: 20/HRA/4718, IRAS ID: 288316). Research information will be anonymised via the Secure Anonymised Information Linkage Databank before release to researchers. Study results will be submitted for publication in an open access peer-reviewed journal and made available on our dedicated website (https://uk-reach.org/).Trial registration number ISRCTN11811602.

Objectives To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes.Design Longitudinal prospective cohort study with preintervention and postintervention cohorts.Setting Major trauma centre in India.Participants Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories.Intervention A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care.Main outcome measures The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality.Results Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p

With growing knowledge and advances in surgery and critical care, we are witnessing new concepts and understanding in spectrum of disease pathology. Abdominal compartment syndrome (ACS) or intraabdominal hypertension (IAH) is one such intriguing entity that has rapidly caught attention of all surgeons and intensivists. Lately, lot of researches are showing the correlation of ACS-IAH with worse outcomes and even mortality in sick patients. IAH has been found to be an important contributor to early organ dysfunction among patients with trauma and sepsis that can cause significant impairment of renal, gastrointestinal, hepatic, cardiac, pulmonary, and central nervous system function. The pathology is even more significant in cases of abdominal surgery or trauma. ACS-IAH is commonly seen in severely sick patients, with prevalence reaching to as high as 50%. There is an increasing awareness of IAH as evidenced by increasing number of studies in the literature. Although there is lot of documented evidence around the topic of ACS-IAH, measuring and managing it still does not figure in most of protocols and practice guidelines in India. The authors believe that a thorough understanding about IAH will enable medical professional in reducing surgical mortality and morbidity. Hence, there was a need to review literature for the latest concept and evidence especially in the area of ACS-IAH, in context of our country India, where there is dearth of knowledge in this subject and its implications. The present review is set to present the current understanding of IAH from pathophysiological and clinical point of view with future insights.

Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries. This is a retrospective analysis among all pregnant females presenting with AKI from January 1999 to December 2014 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 15 years and to evaluate precipitating factors responsible for RCN. RCN constituted 8.3% of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 1999 to 2008 to 7.8% from 2009 to 2014. The patient’s median age was 29.3 ± 5.2 years. The average time to presentation from the day of delivery was 8.7 ±2.1 days. The mortality was observed in 11.7% of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 15.3% each. Postpartum hemorrhage was a cause in 9.09% of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 48.7% of patients. Kidney biopsy was helpful in diagnosis in 31 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 35.4% of patients and morbidity in terms of prolonged hospitalization was seen in 22.7% while dialysis dependency in 61.5% of the study population. In conclusion, strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.

Gallbladder duplication is a rare congenital anomaly. Knowledge of its various types is important since it can complicate cholecystectomy. Many varieties of gall bladder duplication and its classification are reported in the literature. Pre-operative diagnosis plays a crucial role in the planning of surgery and preventing possible injuries or re-operation if the accessory gallbladder has been overlooked during the initial surgery. Gallbladder duplication though rare requires special attention to pre-operative anatomy and its variation. The operative challenge is more than the usual laparoscopic cholecystectomy and should be done by fundus first approach by an experienced laparoscopic surgeon. We report a case of a 44-year-old -male who presented with biliary colic. His pre-operative imaging confirmed the diagnosis of the duplicated gall bladder, and he underwent successful laparoscopic cholecystectomy.

Introduction: Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine. While the liver is a common site of metastases. Case Presentation: We describe a 73-year-old female who reported to our center with complains of swelling and pain in the right upper quadrant of stomach. CECT revealed large well-localized multicystic mass in the right lobe of the liver. A suspicion of hydatid cyst was given. However, immunogenic tests results were negative for hydatid cyst. The AFP level was also unremarkable. Conclusion: Histopathological examination with immunohistochemical panel along with other serological and radiological investigations made the diagnosis possible due to its vague clinical presentation.

Reactivation of cytomegalovirus (CMV) and BK polyomavirus (BKV) can result in virus-associated tubulointerstitial nephritis in renal allografts. All those renal biopsies reported as viral cytopathic were isolated and examined by two independent renal histopathologists from our institute and classified as CMV, BKV, and CMV-BKV coinfection-associated viral cytopathic changes with confirmation through polymerase chain reaction technology in either serum or urine or both. All twenty patients were categorized as 10 in CMV, four in BKV, and six were in CMV-BKV coinfection. One patient each had received antithymocyte globulin and basiliximab as induction all patients received triple-drug immunosuppression. The mean graft survival was 69, 61, and 59 months in CMV, BKV, and CMV-BKV coinfection group, respectively. At the end of the study period, 10 (50%) patients died. 1-, 3-and 5-year patient survival was 94%, 88% and 76% among CMV group, 75%, 75% and 50% in BKV group, and 96%, 83% and 62%, in CMV-BKV coinfection group (P = 0.157). CMV and BK virus are not so common infections in postrenal transplant patients yet an important cause of graft dysfunction. Coinfection did not pose an increased risk for acute rejection or patients and death-censored and uncensored graft survival among compared groups

Background and aims: Medicinal plant products are considered to be an effective candidate against the number of viral diseases as generally observed or reported in developing countries. As per the literature, secondary metabolites (i.e. Alkaloids, flavonoids, saponins etc.) are reported in medicinal plant products and showed its antiviral properties. In this study, our group focused on those medicinal plants especially roots of Ficus benghalensis and Ficus racemosa related to New castle Disease Virus (NDV) and Infectious Bursal Disease (IBD) having in vitro antiviral activity. These studies were conducted on the human peripheral blood mononuclear cells (PBMC). Methods: For antimicrobial studies, different medicinal plant products especially roots of Ficus benghalensis and Ficus racemosa were collected from Vidya Pratishthan’s garden, School of Biotechnology, Baramati. These medicinal plant leaves are used in the form of aqueous extract and determined its anti-microbial activity against poultry viruses (i.e. NDV and IBD) in PBMC and determined proliferation assay, Th1 (TNF alpha) cytokine production and CD14 monocyte surface marker. Results: Three medicinal plant aqueous extracts showed noteworthy antimicrobial activity with respect to decline in proliferation assay, TNF alpha production and CD14 monocyte surface marker in human PBMC as compared to control. Conclusion: Some of the medicinal plant products have shown antimicrobial activity. Further immunobiological research is mandatory to elucidate the most active constituents that are present in these aqueous extracts which may be useful or target molecule in the development of new effective and safe antiviral agents.

Abstract Background Studies to identify an ideal trauma score tool representing prediction of outcomes of the pediatric fall patient remains elusive. Our study was undertaken to identify better predictor of mortality in the pediatric fall patients. Methods Data was retrieved from prospectively maintained trauma registry project at level 1 trauma center developed as part of Multicentric Project—Towards Improving Trauma Care Outcomes (TITCO) in India. Single center data retrieved from a prospectively maintained trauma registry at a level 1 trauma center, New Delhi, for a period ranging from 1 October 2013 to 17 February 2015 was evaluated. Standard anatomic scores Injury Severity Score (ISS) and New Injury Severity Score (NISS) were compared with physiologic score Revised Trauma Score (RTS) using receiver operating curve (ROC). Results Heart rate and RTS had a statistical difference among the survivors to nonsurvivors. ISS, NISS, and RTS were having 50, 50, and 86% of area under the curve on ROCs, and RTS was statistically significant among them. Conclusions Physiologically based trauma score systems (RTS) are much better predictors of inhospital mortality in comparison to anatomical based scoring systems (ISS and NISS) for unintentional pediatric falls.

Background: Tuberculous mastitis (TM) is a rare extra pulmonary presentation of tuberculosis. It may be problematic to distinguish from carcinoma breast, a condition with which it may coexist. Fine needle aspiration cytology (FNAC) / biopsy are indispensable for diagnosis and tuberculosis culture when positive may be very valuable to guide antimicrobial therapy. Aims and Objectives: To disseminate the message to the concerned expertise that it can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Materials and Methods: 19 cases of tubercular mastitis between January 2012 to March 2014 were identified and included in the present study. Cytology and biopsy alongwith AFB stain was done for confirmation. Results: Age ranged between 23- 55 years (median 33 years). Axillary nodes were palpable in 9 (47.3%) patients. Acid Fast Bacilli stain which was positive in only 3 patients. All the 19 patients were started on antitubercular treatment. Conclusion: This study highlights the importance of early diagnosis and aggressive medical and if required surgical management to cure this disease.

Background and aims: Terpenoids are one of the largest groups of natural compounds and is generally used for the treatment of human diseases e.g. taxol (anticancer drug) and artimesinin (antimalarial drug). Thus, these agents (terpenoids) derived from medicinal plant products that are effective against intracellular or extracellular infections and these are urgently required. Therefore, this research was directed to assess its immunosuppressive activity of crude terpenoids on hepatitis B vaccine containing surface antigen (HBsAg) on human whole blood.Methods: In this study, crude terpenoids (6.25-25 mg/ml; 50 µl) extricate from the leaves of these medicinal plants and evaluated its immunosuppressive activity on HBsAg (20 µg/ml) using human whole blood in order to determine the analysis of blood counts (flow cytometry), cytotoxicity assay (MTT (3-[4,5-dimethylthiazol–2-yl]-2, 5-diphenyltetrazolium bromide) and nitric oxide (NO) production from cell culture supernatant.Results: The results showed that these terpenoids showed drastic decrease in monocytes and granulocytes count but increased in lymphocytes count and inhibited NO production at higher doses (25 mg/ml; 50 µl).Conclusion: These terpenoids exhibited immunosuppressive activity and could be a promising source of medicinally important natural compound.

Abstract Garcinol (GAR) is a naturally occurring polyisoprenylated phenolic compound. It has been recently investigated for its biological activities such as antioxidant, anti-inflammatory, anti ulcer, and antiproliferative effect on a wide range of human cancer cell lines. Though the outcomes are very promising, its extreme insolubility in water remains the main obstacle for its clinical application. Herein we report the formulation of GAR entrapped PLGA nanoparticles by nanoprecipitation method using vitamin E TPGS as an emulsifier. The nanoparticles were characterized for size, surface morphology, surface charge, encapsulation efficiency and in vitro drug release kinetics. The MTT assay depicted a high amount of cytotoxicity of GAR-NPs in B16F10, HepG2 and KB cells. A considerable amount of cell apoptosis was observed in B16f10 and KB cell lines. In vivo cellular uptake of fluorescent NPs on B16F10 cells was also investigated. Finally the GAR loaded NPs were radiolabeled with technetium-99m with >95% labeling efficiency and administered to B16F10 melanoma tumor bearing mice to investigate the in vivo deposition at the tumor site by biodistribution and scintigraphic imaging study. In vitro cellular uptake studies and biological evaluation confirm the efficacy of the formulation for cancer treatment.

More than 50% of patients with systemic lupus erythematosus (SLE) have renal involvement at presentation or during their illness. Lupus nephritis (LN) encompasses several patterns of renal disease, including glomerular, tubulointerstitial, and vascular pathologies. The presence and significance of renal vascular lesions (VLs) are often overlooked. VLs in LN are not rare with an incidence of 10%–40% on renal biopsies from various studies and their presence is often labeled as poor prognostic markers. The current treatment protocol for LN is mainly based on the glomerular pathology, and no guidelines/consensus exists for treatment of LN with VLs. We describe the clinical presentation, course, response to therapy, and outcomes in five patients with SLE with histological evidence of renal VLs.

We studied the impact of residual renal function (RRF) on clinical outcome and quality of life in 61 patients on peritoneal dialysis (PD). They were assigned to two groups, at the time of initiation of PD, based on their estimated glomerular filtration rate (eGFR). The high RRF group had eGFR ≥5 mL/min/1.73 m[2] and the low RRF group hade GFR

We aim to evaluate the disturbances in mineral metabolism, abnormalities in bone mineral density (BMD), and extraskeletal calcification in newly detected, untreated predialysis stage 4 and 5 chronic kidney disease (CKD) patients at a tertiary care hospital in North India. This is cross-sectional observational study. A total of 95 (68 males, 27 females) newly detected patients underwent clinical evaluation, biochemical assessment [serum calcium, phosphorus, alkaline phosphatase (ALP), albumin, creatinine, intact parathyroid hormone (iPTH), 25- hydroxyvitamin D (25(OH)D)], BMD measurement (at spine, hip, and forearm) by dual-energy X-ray absorptiometry (DXA), lateral abdominal radiograph [for abdominal aortic calcification (AAC)], skeletal survey (to look for any abnormality including fractures), and echocardiography [for any cardiac valvular calcification (CVC)]. Symptoms related to CKD-mineral bone disorder were seen in 33.6% of the study patients. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism, and hypovitaminosis D was 64.2%, 81.1%, 49.5%, and 89.5%, respectively. CVC was seen in 22.1% of patients on echocardiography, mostly involving the mitral valve. Patients with CVC were more likely to be males and smokers. There was no significant difference in iPTH levels between patients with or without CVC. AAC was seen in 10.5% of patients on lateral abdominal X-ray. Patients with AAC had higher levels of iPTH, phosphorus, and ALP and lower levels of calcium compared to patients without AAC. BMD by DXA showed a low bone mass in 41.05% of our patients and was more prevalent in CKD stage 5. Most of the study patients had hyperparathyroidism and low 25(OH)D levels. Our study shows that newly detected, naïve Indian CKD patients have a high prevalence of disturbances of mineral metabolism including hyperparathyroidism, Vitamin D deficiency, abnormal BMD, and valvular and vascular calcification, even before initiating dialysis.

Background: There is a worldwide interest in searching for potential and effective medicinal plant candidates against various diseases or disorders. Till now, there are number of anti-inflammatory drugs like NSAIDs are available which showed various adverse effects in our body. To reduce these adverse effects, some of medicinal plants have been experimentally validated. Aim: The aim of our immunopharmacological study is to investigate the immunosuppressive and anti-inflammatory activity of aqueous leaves extract of Mangifera indica in human peripheral blood mononuclear cells (PBMC) extracellular against hepatitis B vaccine antigen (HBsAg) Methods: In this study, aqueous leaves extract were collected from Mangifera indica and determined its effect on total blood counts (using forward and side scatter) and monocyte CD14 FITC surface markers using flow cytometry. In addition, the effect of aqueous leaves extract on nitric oxide (NO) production from PBMC cell culture supernatant and also estimate its proliferation assay using Concanavalin A (Con A, 0.5 mg/ml, 50 µl). Data analysis was performed using BD cell Quest Pro software for flow cytometric analysis and one way ANOVA test (Boniferroni multiple comparison test). Results: The results displayed that aqueous leaves extract of Mangifera indica showed dose dependent decline in blood counts (increased in side scatter and slightly decreased in forward scatter), monocyte CD14 FITC surface marker; Con A proliferation and nitric oxide production from cell culture supernatant in human PBMC. Conclusion: Overall, the results claimed that aqueous leaves extract of Mangifera indica at higher doses showed immunosuppressive and anti-inflammatory activity.

Introduction: Acne vulgaris is a chronic inflammatory disease of pilosebaceous unit characterised by areas of seborrhoea, comedones, papules, nodules, pimples, and possibly scarring that may remain for rest of the life. Acne is a treatable disease but needs prolonged treatment with patience and its onset in adolescence has been found to influence the patient physically, socially, economically as well as psychologically. This can seriously affect their quality of life. Aim: To determine patients’ knowledge and perception about acne vulgaris and analyse the association of patient characteristics with the impact of acne on their psychosocial life. Materials and Methods: A total of 183 subjects of acne vulgaris of either gender, visiting Dermatology OPD and willing to participate in the study were asked to fill in a pre-tested, prevalidated questionnaire consisting 20 items- 6 based on general information about their condition, 5 based on knowledge about acne and 9 questions on perception about their condition and its treatment. A total of >4 questions about knowledge correctly answered was considered as good knowledge and

Introduction: Fungal keratitis has been reported to cause up to 50% of all corneal ulcers in the Indian subcontinent. Fungal keratitis is also associated with a very poor outcome with conventional treatment modalities. A few limited case reports/ series have demonstrated the usefulness of Intracameral injection of liposomal Amphotericin B in severe fungal keratitis. However, several questions regarding intracameral therapy using antifungal agents are, as yet, unanswered, including when to intervene with this treatment modality. Aim: To evaluate whether an ‘early’ versus ‘delayed’ intervention using Intracameral Injection of Liposomal Amphotericin B (ICAMB) influences the efficacy, outcomes and complications in severe recalcitrant Keratomycosis. Materials and Methods: This prospective interventional study enrolled 50 eyes of proven fungal keratitis, not responding to conventional antifungal therapy administered over two weeks. They were randomly allocated to Group A (25 eyes) and Group B (25 eyes). Intervention with Intracameral injection of liposomal Amphotericin B, 10 micrograms/0.1 mL was done at either two weeks (Group A) or at four weeks (Group B). The clinical profile, visual acuity, time to epithelial defect closure, time to heal, final anatomical outcome, surgical interventions and complications were compared between the groups. Spearman correlation between healing time and other clinical characteristics was also done. The primary outcome measures were healing time, functional (final visual acuity) and anatomical outcomes (type of corneal opacity). Results: The mean healing time in Group A was 17.5±3.64 days and 32.2±8.89 days in Group B (p

Introduction: Condylar fracture accounts for 25-35% of all mandibular fracture. When it comes to open reduction and internal fixation, the design of the plate plays a crucial role to withstand the amount of masticatory force in the condylar region. Aim: To evaluate the biomechanical stability of osteosynthesis using the Trapezoidal plate, Delta plate and Miniplate in subcondylar fracture. Materials and Methods: The condyle of 36 porcine hemimandible was osteotomized at a defined location with the help of a jig. Three groups A, B, C were created and each group had 12 hemimandibles. Group A was fixed with trapezoidal plate, group B was fixed with delta plate and group C was fixed with 2 four-hole miniplates. Each group was subjected to a linear loading using a Universal Testing Machine (UTM) in four different directions. The direction of the force used was from lateral to medial, medial to lateral, anterior to posterior and posterior to anterior was indicated using (1,2,3,4) respectively. Yield load and yield displacement were measured for the trapezoidal plate, delta plate and miniplate. Means were derived and compared for statistical analysis using the Kruskal-Wallis test and Mannwhitney U test with a confidence level of 95%. Results: None of the plates fractured. Screw loosening was seen in one delta plate and in two miniplate. In posterior to anterior and from medial to lateral the trapezoidal plate tolerated the highest load. From anterior to posterior and lateral to medial the miniplate tolerated the maximum load. Statistically significant difference was seen for yield load and no difference was seen for yield displacement in three groups. Conclusion: This biomechanical study indicates that like miniplate, trapezoidal and delta plates exhibit stable osteosynthesis for subcondylar fractures. The trapezoidal and delta plate has the advantages of providing three dimensional stability using single plates.

Bioelectrical impedance analysis (BIA) is a method for the assessment of nutritional status. We studied the effect of graft function on nutritional status in postrenal 45 transplant patients with borderline to good allograft function using BIA. The patients had a mean serum creatinine of 1.42 ± 0.42 mg% and mean glomerular filtration rate (GFR) of 45.1 ± 14.1 mL/min. Based on BIA-derived GFR, the patients were divided into two groups; group 1: borderline graft function GFR 4.0) in extracellular water (P

Renal dysfunction is common in Takayasu arteritis. Uncommonly, renal failure in a case of Takayasu arteritis can be due to an unrelated disease, and if the disease is a rare complication, it is even more difficult to diagnose. We report a 21-year-old male with type IV Takayasu arteritis presenting with fever and renal failure, who was diagnosed to have enteric fever- related glomerulonephritis which was successfully treated.