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The objective of this study was to assess the knowledge and views of faculty members on criteria for authorship by International Committee of Medical Journal Editors (ICMJE), their current practice of choosing the authors, views on gift authorship and problems they had faced concerning authorship.It was a cross sectional survey from January 2011 to July 2011 among faculty members of various private and public sector medical institutions of Pakistan through a self-administered questionnaire. Main outcome measures included awareness and use of ICMJE criteria, which contribution to research merit authorship and their perceptions about gift authorship.Two hundred eighteen faculty members (180 males, 38 females) participated in the study. One hundred twenty eight (58.7%) were from surgery and allied disciplines. Ninety six percent had published between one to five papers while 60(27.5%) had six to ten papers to their credit. One hundred eleven (50.9%) claimed they were aware about the authorship criteria, only twenty two (19.8%) could name this document. Only four (1.8%) could correctly state this. Only one hundred twenty (55.0%) said that all three criteria's must be met to be eligible for authorship. Ninety three (42.7%) said that they were not included as authors though they deserved it while sixty three said they did not merit but were still included. Forty two (19.3%) said that they were not aware when they were listed as authors.A vast majority of young faculty members are not aware of the existence of authorship criteria and gift authorship is quite common.

Abstract Introduction We report the case of a true hermaphrodite with testicular seminoma with resulting metastases to the inguinal lymph nodes eight months after radical orchidectomy. This is an unusual presentation of testicular cancer and, to the best of our knowledge, the first report of this kind in the literature. Case presentation A 45-year-old Caucasian true hermaphrodite, raised as a male, developed a testicular seminoma. He had undergone a left orchidopexy at the age of 10 for undescended testes. Metastases from testicular tumors to inguinal lymph nodes are a rare occurrence. It has been suggested that previous inguinal or scrotal surgery may alter the pattern of nodal metastasis of testicular cancer. We review the literature to evaluate the incidence of inguinal lymph node involvement in early stage testicular cancer and discuss possible routes of metastases to this unusual site. We also discuss the management of the inguinal lymph nodes in patients with testicular tumors and a previous history of inguinal or scrotal surgery, as this remains controversial. Conclusion Inguinal lymph node metastases from testicular cancer are rare. A history of inguinal or scrotal surgery may predispose involvement of the inguinal nodes. During radical inguinal orchidectomy, the surgeon should be careful to minimize the handling of the testis and ensure high ligation of the spermatic cord up to the internal inguinal ring to reduce the risk of inguinal lymph node metastasis.

Abstract Introduction Intrarenal pseudoaneurysm is a rare, yet clinically significant, complication of percutaneous nephrolithotomy. A high index of clinical suspicion is necessary in order to recognize pseudoaneurysm as the cause of delayed bleeding after percutaneous nephrolithotomy and angiography confirms the diagnosis which allows endovascular management. Case presentation We present a case of a 65-year old Caucasian woman who underwent percutaneous nephrolithotomy in the supine position for a two centimetre renal calculus. The postoperative course was complicated by persistent bleeding due to a renal pseudoaneurysm. The vascular lesion was successfully managed by endovascular exclusion through the use of a covered stent graft. We report the first successful use of this method for the management of iatrogenic pseudoaneurysm in a branch of the left renal artery and we focus on the imaging findings, technical details, advantages and limitations of this technique. Conclusion As a result of its high efficacy, interventional radiology has largely replaced open surgery for the management of renal pseudoaneurysm related to percutaneous nephrolithotomy. Recent technical advancements have allowed the use of covered stent grafts as an alternative to embolisation for the angiographic management of visceral artery pseudoaneurysm located in other organs. This novel technique allows the endovascular exclusion of the pseudoaneurysm, without compromising arterial supply to the end-structures - an advantage of critical importance in organs supplied by segmental arteries - in the absence of collateral vasculature, such as the kidney.

In aerobic life forms, reactive oxygen species (ROS) are produced by the partial reduction of oxygen during energy-generating metabolic processes. In plants, ROS production increases during periods of both abiotic and biotic stress, severely overloading the antioxidant systems. Hydrogen peroxide (H2O2) plays a central role in cellular redox homeostasis and signaling by oxidising crucial cysteines to sulfenic acid, which is considered a biologically relevant post-translational modification (PTM). Until now, the impact of the nucleus on cellular redox homeostasis has been relatively unexplored. The regulation of histone-modifying enzymes by oxidative PTMs at redox-sensitive cysteine or tyrosine residues is particularly intriguing because it allows the integration of redox signaling mechanisms with chromatin control of transcriptional activity. One of the most extensively studied histone acetyltransferases is the conserved GENERAL CONTROL NONDEPRESSIBLE 5 (GCN5) complex. This study investigated the nuclear sulfenome in Arabidopsis thaliana by expressing a nuclear variant of the Yeast Activation Protein-1 (YAP1) probe and identified 225 potential redox-active proteins undergoing S-sulfenylation. Mass spectrometry analysis further confirmed the S-sulfenylation of GCN5 at cysteines 293, 368, and 400, and their functional significance and impact on the GCN5 protein-protein interaction network were assessed using cysteine-to-serine mutagenesis., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Trauma-informed care (TIC) is growing in medical education as health care systems recognize trauma's impact on health outcomes. TIC acknowledges and responds to the effects of trauma on physical, psychological, and emotional health. As TIC trainings are developed and delivered to health care professionals across the learner continuum, curricula need evaluation beyond learner satisfaction and knowledge to better assess changes in skills. We developed the Gap Kalamazoo Communication Skills Assessment Form for Trauma-Informed Care (GKCSAF-TIC) to evaluate pediatric trainees' communication skills in TIC. We describe the development and validity evidence of the GKCSAF-TIC in assessing pediatric residents' TIC skills during standardized patient encounters., Methods: We developed and implemented the TIC communication skills assessment tool in a one-year prospective cohort study involving pediatric residents. We conducted simulated patient encounters conducted before and after TIC training, with two pediatric faculty attendings assessing each encounter. We gathered validity evidence using Messick's framework, focusing on content, response process, internal structure, and relationship with other variables., Results: We analyzed 57 standardized patient encounters with 33 pediatric interns, including 23 pre-post matched pairs. The development process and rater training supported content and response process validity. Internal consistency, measured by Cronbach's alpha, ranged from 0.93 to 0.96, while inter-rater reliability, measured by intraclass correlations, ranged from 0.80 to 0.83. There was a significant improvement in scores from pre-training to post-training (3.7/5 to 4.05/5; P < 0.05)., Conclusion: The GKCSAF-TIC demonstrated strong preliminary validity and offers educators a valuable means to assess and provide formative feedback to pediatric trainees about TIC., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Plants have adopted versatile scaffold proteins to facilitate the crosstalk between multiple signaling pathways. Leaf senescence is a well-programmed developmental stage that is coordinated by various external and internal signals. However, the functions of plant scaffold proteins in response to senescence signals are not well understood. Here, we report that the scaffold protein RACK1A (RECEPTOR FOR ACTIVATED C KINASE 1A) participates in leaf senescence mediated by ethylene signaling via the coordination of the EIN3-miR164-ORE1 transcriptional regulatory cascade. RACK1A is a novel positive regulator of ethylene-mediated leaf senescence. The rack1a mutant exhibits delayed leaf senescence, while transgenic lines overexpressing RACK1A display early leaf senescence. Moreover, RACK1A promotes EIN3 (ETHYLENE INSENSITIVE 3) protein accumulation, and directly interacts with EIN3 to enhance its DNA-binding activity. Together, they then associate with the miR164 promoter to inhibit its transcription, leading to the release of the inhibition on downstream ORE1 (ORESARA 1) transcription and the promotion of leaf senescence. This study reveals a mechanistic framework by which RACK1A promotes leaf senescence via the EIN3-miR164-ORE1 transcriptional cascade, and provides a paradigm for how scaffold proteins finely tune phytohormone signaling to control plant development., (© 2023 Institute of Botany, Chinese Academy of Sciences.)

The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs' effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs., Competing Interests: S.C. and N.V. have interests in IUVO S.r.l., a spin-off company of Scuola Superiore Sant’Anna, which develops wearable robots. The remaining authors declare no competing interests exist., (© The Author(s) 2021.)

Objective: To demonstrate an outpatient vaginoscopic technique for treating multiple vaginal polyps., Design: Demonstration of surgical technique using slides, pictures, and video., Setting: Private hospital., Patient(s): Thirty-two-year-old nulligravid woman presenting to the gynecology clinic with one episode of intermenstrual bleeding, regular menstrual cycles with normal flow, and no history of dysmenorrhoea or dyspareunia. The genital local examination was normal, and speculum examination showed multiple vaginal lesions like polyps in the proximal posterior two-thirds and right lateral vaginal walls. Her transvaginal ultrasound read a normal uterus with a right ovarian simple cyst., Intervention(s): The surgeon performed an outpatient operative vaginoscopy using a 5-mm continuous flow office hysteroscope with a 2.9-mm rod lens optical system and a 5F working channel. Distension of the vagina was achieved with a normal saline solution, and an intrauterine pressure of 50 to 60 mm Hg was maintained by an irrigation and aspiration electronic pump. An inspection of the vaginal walls, fornices, and the external cervical os (Fig. 1) revealed 10 vaginal lesions like polyps in the proximal two-thirds of the posterior and right lateral vaginal wall. The vaginal lesions (Fig. 2) varied in size from 0.5 cm to 4 cm. An excisional biopsy was performed and the sample sent for histopathologic evaluation. The vaginal lesions <2 cm in length were excised by cutting the base with scissors or using a bipolar vaporization electrode, which was connected to an electrocautery unit by a bipolar high-frequency cord. Vaginal lesions >2 cm were excised with the TruClear 5C Hysteroscopic Tissue Removal System (HTRS) with a zero-degree scope using the 2.9-mm incisor with a 5-mm cutting window at one end attached to a reusable handpiece with two connectors-one to the motor unit and second to the suction bottle with a collection bag. The overall diameter of TruClear 5C is 5.7 mm, and the optic size is 0.8 mm. The same irrigation pump is compatible with HTRS, and the pressure was increased to 150 mm Hg to maintain vaginal distension. Three factors influenced our decision to use the HTRS intraoperatively: the number and size of the vaginal lesions and the surgical time in the outpatient setting. A mechanical system that works on the principle of excising and aspirating tissue, the HTRS incisor has a rotatory action with the excising window placed against the most distal part of the vaginal lesions. The cutting action is controlled via a foot pedal attached to a motor control with 800 rotations per minute. The handpiece remains stationary while the polyp is excised and aspirated through the window into the collection bag. Minimal bleeding occurred and stopped spontaneously. The institutional ethics committee exempted this case report from review, and we obtained informed written consent from the patient., Main Outcome Measure(s): All vaginal lesions excised in an outpatient setting via vaginoscopy technique without anesthesia., Result(s): The operative time with the Bettocchi hysteroscope was 14 minutes, and HTRS was 6 minutes. The patient did not complain of pain but did describe minimal discomfort, rated on the visual analog scale as 2 (where ≥5 is severe pain). She was discharged 1 hour later. The histopathology was reported as vaginal endometriosis (ectopic presentation of endometriosis is rare, accounting for 0.02% of cases). After surgery, she was started on cyclical oral contraceptive pills (OCP) in the combination of 30 mg of ethinyl estradiol + 2 mg of dienogest because she desired to delay pregnancy by 1 year. She remained asymptomatic for 6 months. These contraceptive hormones are available in the form of oral pills, vaginal rings, and transdermal patches, and a physician can provide OCP continuously or cyclically. Continuous OCP is more efficacious for control of dysmenorrhoea, but cyclical OCP is preferred because it is affordable, tolerable, effective, produces no unpredictable bleeding, and slows the progression of the disease. (A cohort study found the contraceptive vaginal ring to be more effective for symptom-control in rectovaginal endometriosis with higher patient satisfaction than the transdermal patch; vaginal rings or transdermal patches are not available in some countries.) CONCLUSION(S): Vaginoscopy allows a more in-depth visualization of the vagina with complete inspection and removal of all polyps. Vaginoscopy is feasible in the outpatient setting and allows a comfortable, ergonomic position for the surgeon. Vaginoscopy or no-touch technique avoids the use of a speculum or tenaculum and results in minimal pain during the outpatient procedure., (Copyright © 2020 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The intention to conduct this study was to evaluate the hepatoprotective effects of Fenugreek seeds' extract supplementation in thioacetamide induced liver damage in male Sprague Dawley rats. For this study, 24 male Sprague Dawley rats (200-264gm) were distributed randomly into four groups. Group I remained untreated as control rats, group II received thioacetamide (200mg/Kg b.w i.p, administered on alternative days for 8 weeks), group III received thioacetamide (200mg/Kg b.w i.p administered on alternative days for 8 weeks) as well as 2ml of 2% extract of fenugreek seeds (orally administered daily from 4th week till 8th week of the experiment. Group IV only received 2ml of 2% extract of Fenugreek seeds daily for 4 weeks respectively. At the end of the experiment, blood was sampled to obtain plasma that was used for the analysis of liver markers and liver was used for analysis of antioxidant enzymes (catalase and SOD). Increase in total bilirubin, direct bilirubin, ALT and ALP levels, catalase activity and decrease in SOD activity was found in TAA-treated groups which assured liver damage. Whereas, treatment with Fenugreek seeds extract restored the altered levels of total bilirubin, direct bilirubin, ALT, ALP, catalase and SOD activities in the Test + Supp group. The results of this study confirmed the hepatoprotective role of Fenugreek seeds extract in thioacetamide induced liver damage.

Context: Cardiovascular diseases (CVDs) are the number one cause of death globally, with low- and middle-income countries being affected disproportionately. By 2020, it is projected that there will be 25 million deaths from CVD worldwide, 19 million of which would be from middle- and low-income countries., Aims: The aim of this study was to estimate the 10-year risk of cardiovascular events among adults aged ≥40 years in a rural population of Lucknow district using the World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts for SEAR-D region., Settings and Design: This was a community based cross-sectional study, conducted from September 2017 to August 2018, in the rural areas of Lucknow district., Methods and Material: This study was conducted on 397 subjects aged ≥40 years. The two sets of the WHO/ISH risk prediction charts, with and without cholesterol, for WHO SEAR-D region were used in the study., Statistical Analysis Used: SPSS, version 23 was used for data analysis., Results: Using the risk assessment tools, with and without cholesterol, 78.5 and 76.8%, respectively, of the study population were in the 10-year cardiovascular risk category of <10% risk, while 11.2 and 10.4%, respectively, were in the category of ≥20% risk. Risk categories were found to be concordant in 86.3% of the population., Conclusions: The WHO/ISH risk prediction charts can be used at low-cost resource setting as a tool to predict CVD risk among asymptomatic individuals, thus, helping in early detection and prevention of CVDs in resource-scarce settings., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

This study was conducted to understand the dynamics of microbial communities of soil microorganisms, and their distribution and abundance in the indigenous microorganisms (IMOs) manipulated from humus collected from the forest near the crop field. The soil microorganisms originated from humus and artificially cultured microbial-based soil amendments were characterized by molecular and biochemical analyses. The bacterial population (2 × 10 6 ∼13 × 10 6 CFU/g sample) was approximately 100-fold abundant than the fungal population (2 × 10 4 ∼8 × 10 4 CFU/g sample). The 16S rDNA and ITS sequence analyses showed that the bacterial and fungal communities in humus and IMOs were mainly composed of Bacillus and Pseudomonas , and Trichoderma and Aspergillus species, respectively. Some of the bacterial isolates from the humus and IMOs showed strong inhibitory activity against soil-borne pathogenic fungi Fusarium oxysporum and Sclerotinia sclerotiorum . These bacteria also showed the siderophore production activity as well as phosphate solubilizing activity, which are requisite traits for biological control of plant pathogenic fungi. These results suggest that humus and IMOs could be a useful resource for sustainable agriculture., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of the Korean Society of Mycology.)

The present study was designed to determine the hepatoprotective effects of fenugreek seeds extract supplementation on thioacetamide induced liver damage in rats. For this purpose 24 male Sprague Dawley rats were distributed into 4 groups (n=60. Group I remained untreated throughout the study. Group II and Group III received thioacetamide intraperitoneally 200mg/kg body weight on alternative days for 8 weeks. Group III and Group IV received 2ml of 2% Fenugreek seeds extract orally daily from 4th week till 8th week of the study. Next day after completion of study, the rats were weighted and decapitated; blood was collected for plasma for glucose and lipid profile analysis. Marked reduced plasma glucose level and HDL level and increased triglyceride, cholesterol, LDL, VLDL and total lipid level were observed in test group. The Fenugreek seeds extract supplementation significantly increased plasma glucose and HDL level and remarkably decreased triglyceride, cholesterol, LDL, VLDL and total lipid level in Test+Supplement group whereas glucose and lipid profile were reduced in supplement group showing supplement is hypoglycemic and hypolipidemic. The results of this study confirmed that treatment with Fenugreek seeds extract successively ameliorates the altered glucose and lipid profile in liver damage induced by thioacetamide in male rats.

Background: Initial formative years in every children's life are critical for their optimal development, as these frame the foundation of future well-being. With a varied prevalence of developmental delays (DDs) in the world and most of the studies representing the hospital-based data. The present study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged 2 months to 6 years in the rural area of North India., Methods: This was a cross-sectional study in which a multistage random sampling technique was used. From 30 Anganwadi centers, 450 children aged 2 months-6 years were taken in the study. Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family Welfare, India, was used for developmental screening. Binary logistic regression analysis was done to identify the predictors for DDs (domain wise)., Results: Seventy-three (16.2%) children were found to have DDs and 60 (13.3%) children had the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%) children who had delay in speech and language area. About 17/190 (8.9%) children had social delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational age (adjusted odds ratio [AOR] - 13.30), complications during delivery (AOR - 25.79), meconium aspiration (AOR - 12.81), and child never breastfed (AOR - 8.34) were strong predictors for the delay in different domains of developmental milestones., Conclusion: Socio-economic, ante-natal, natal and post-natal factors should be considered for prompt identification and initiation of intervention for DDs., Recommendation: There is a need for increasing awareness and knowledge of parents regarding the achievement of developmental milestones according to the age. A multipronged approach to the holistic treatment of developmentally delayed children for early intervention is required., Competing Interests: There are no conflicts of interest.

The oxygen surface exchange kinetics of mixed ionic and electronic conducting oxides (MIECs) play a critical role in the efficiency of intermediate-to-high-temperature electrochemical devices. Although there is increasing interest in low-temperature preparation of MIEC thin films, the impact of the resultant varied degrees of crystallinity on the surface exchange kinetics has not been widely investigated. Here, we probe the effect of crystallization on oxygen surface exchange kinetics in situ, by applying an optical transmission relaxation (OTR) approach during annealing of amorphous films. OTR enables contact-free, in situ, and continuous quantification of the oxygen surface exchange coefficient ( k chem ); we previously applied it to Pr x Ce 1- x O 2-δ and SrTi 1- x Fe x O 3-δ thin films. In this work, the OTR approach was successfully extended to other mixed conducting thin film compositions for the first time (i.e., perovskite SrTi 0.65 Co 0.35 O 3-δ and Ruddlesden-Popper Sr 2 Ti 0.65 Fe 0.35 O 4±δ ), as well as to Pr 0.1 Ce 0.9 O 2-δ , enabling quantification of the k chem of their native surfaces and comparison of the behavior of films with different final crystal structures. All thin films were prepared by pulsed laser deposition at 25 or 700-800 °C and subject to subsequent thermal treatments with simultaneous OTR monitoring of k chem . The surface roughness, grain size, and crystallinity were evaluated by scanning probe microscopy, X-ray diffraction, scanning electron microscopy, and transmission electron microscopy. Fluorite Pr 0.1 Ce 0.9 O 2-δ films grown at 25 °C did not exhibit an increase in k chem after annealing, as they were already crystalline as grown at 25 °C. For all other compositions, OTR enabled in situ observation of both the crystallization process and the emergence of rapid surface exchange kinetics immediately upon crystallization. Perovskite SrTi 0.65 Co 0.35 O 3-δ and Ruddlesden-Popper Sr 2 Ti 0.65 Fe 0.35 O 4±δ thin films grown at 25 °C exhibited at least 1-2 orders of magnitude enhanced k chem after annealing compared with highly crystalline thin films grown at 800 °C, indicating the benefits of in situ crystallization.

Objective: The objective of this study is to evaluate the awareness and attitudes of medical and dental students regarding interprofessional learning (IPL)., Methods: A cross-sectional study was conducted with 278 female undergraduate Medical and Dental students from Princess Nourah bint Abdulrahman University, Riyadh. These students undertook IPL in the Foundation block, in basic science teaching, clinical skills' laboratories and in professionalism and learning skills' modules. A modified, validated RIPLS questionnaire with four subscales and 29 items was used to collect data regarding their perception and attitudes towards shared learning. A five-point Likert scale was used with a value ranging from 1 (strongly disagree) to 5 (strongly agree) for each item. Factor analysis was done using Varimox rotation. Student's t test was applied to detect difference between mean scores of medical and dental student's responses Results: The mean age of respondents was 19.8 ± 1.7 years with the majority in the second year of each program. There was no difference in mean responses of the medical and dental students. The respondents favored shared learning in the areas of professional skills and patient care. They agreed that IPL helps to develop respect, trust and appreciation for other professions; however, both groups preferred to learn uni-professionally with regard to developing discrete professional identities and roles., Conclusions: There is an overall positive response towards IPL and the value of team work; however, more attention needs to be paid to enabling students to learn about the specific roles of each profession in the healthcare team.

Context: Amidst the uncertainty in childhood blood pressure (BP) thresholds, besides the ambiguity in levels and duration of BP elevation causing organ damage, hypertension is present in substantial number of asymptomatic children and adolescents with only a few studies disclosing the setup. With projection of deaths due to noncommunicable diseases in 2030 rising to 52 million, it is necessary to know about the knowledge of present adolescents about BP and its modifiable risk factors., Aims: (1) To assess the prevalence of elevated BP among adolescents and to ascertain the associated risk factors. (2) To assess adolescent's knowledge about BP and its modifiable factors., Settings and Design: A community-based cross-sectional study was conducted on school going adolescents of Lucknow, from September 2014 to August 2015., Subjects and Methods: BP, height, and weight were measured following standard protocols, Centers for Disease Control and Prevention charts for finding respective cut-off values and oral questionnaire for assessing lifestyle risk factors were used., Statistical Analysis: Chi-square, unpaired t -test, and logistic regression were used., Results: Of the 1041 participants, elevated BP (BP percentile ≥90) was prevalent in 24.2%. On regression, factors such as obesity (adjusted odds ratio [aOR] = 5.8, 95% confidence interval [CI] = 3.6-9.4), low fruit diet (aOR = 3.3, 95% CI = 2.1-5.4), and frequent junk food consumption (aOR = 1.9, 95% CI = 1.3-2.8) raised the odds of elevated BP while it was lowered by being physically active (aOR = 0.67, 95% CI = 0.46-0.97). Of 86.3% of children ( n = 898) who were fathomed of BP, only less than third (33% and 21.9%) acquainted of BP raising and lowering practices, respectively., Conclusions: Prevalence of high BP is colossal with only a few children knowing its amendable nature. Strenuous efforts targeting detrimental behaviors and imparting the sense of healthy lifestyle enhancing practices are vital to control this epidemic., Competing Interests: There are no conflicts of interest.

Aim: To scrutinize the rapid development of robotic versus traditional laparoscopic technique in pelvic urologic surgery., Introduction: In the last few decades, advances in research and development have led to tremendous progress in medical diagnostics and treatment of disease. Minimally invasive surgery has moved from experimental to becoming the dominant form of surgical management across the surgical specialties. Laparoscopy is nowadays used widely in abdominal surgery, from simple diagnostic laparoscopy to complex colorectal and gynecologic cancer procedures., Methods: A literature search of electronic databases (PubMed, Medscape, Embase) using the key words: "pelvic laparoscopy, urologic oncology, robotic surgery, minimally invasive access" was performed for all relevant articles in the English language. Data were extrapolated from the abstracts alone to avoid subjective bias in drawing conclusions., Results: Telemedicine and telesurgery, the diagnostic and operative process is conducted from a distance. The surgeon uses computer-assisted surgery away from the bedside via a robotic system and performs the surgical task at hand. In pelvic urological cancer surgery the use of robotic technique expands to female and reconstructive procedures as well. The leap forward is so massive, that traditional laparoscopic surgery is starting to be considered less, with a growing number of organizations being now more interested in developing a robotic service. Minimally invasive surgical techniques aim to improve surgical outcome in conjunction with delivery of high-quality patient care. Quality studies demonstrating superiority and cost effectiveness are lacking, however., Conclusions: Although tremendous accomplishments took place over a few years, there is still a lot of ground to be covered in standardizing the learning process and evaluating the outcome from the application of new technologies in the field of robotic pelvic surgery.

Background/aim: Quality of life is an important health-related factor that has an impact on all health interventions. The aim of the study was to assess psychosocial outcomes in people with diabetes., Materials and Methods: A total of 142 people with type 2 diabetes were recruited from a specialist diabetes center. The validated Urdu version of the WHO-5 Well-Being Index was administered for easy understanding of the quality of life of the regional population., Results: The 142 adult participants with diabetes were recruited from a specialist diabetes clinic. The rate of likely depression (WHO-5 score of <28) was 16.9%. Neuropathy was found to have a negative impact on the quality of life in people with diabetes (P < 0.001)., Conclusion: People with complications of diabetes like neuropathy may experience worsening quality of life. It is advised to incorporate the WHO-5 into annual patient reviews as a measure of emotional well-being to drive changes that improve outcomes for people with diabetes.

Objectives: To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options., Materials and Methods: A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions., Results: Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management., Conclusions: Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular., (Copyright® by the International Brazilian Journal of Urology.)

Intra-abdominal drains have been used since long to prevent intra-abdominal collection, and detect any anastomotic leaks. We report a case of left sided fallopian tube herniation from a left lower abdominal drain site in a 27-year female who underwent caesarian section for breach presentation. Several complications related to drain usage has been described but left sided fallopian tube prolapse through drain site has not been reported in literature.

Objective: Physical activity is essential in maintaining a healthy lifestyle. Physical activity can improve general health, quality of life and diabetes management. The aim and objective of the study was to assess the physical activity trends in daily routine of people with type 2 diabetes., Methods: Two hundred persons with diabetes from four different clinical settings were included to access the trends of physical activity using a customized questionnaire EPIC-2. Pattern of physical activity was assessed across a set of domains including sleep time, hours of TV watch, preferred mode of transport for specific distance and household activities. Data was analyzed using SPSS 21., Results: Out of 200 persons with diabetes, 104(52%) were male and 96 (48%) were female. Out of the total sample of patients, 85 (81.7%) Male and 80 (83.3%) female patients preferred walk to cover a distance of less than one mile. There was a significant difference in selection of mode of transport for all other specified distance, esp. in female patients with both age groups. There was insignificant difference for physical activity pattern related to household activities in young and elderly male subjects. The mean sleeping time for younger male subjects on weekend was 464.31± 88.88 minutes/day and for elder it was 418.65± 102.66 minutes/day while for young female subjects was 476.25± 113.74 minutes/day and in female elderly subjects it was 420.62± 120.62 minutes/day respectively., Conclusion: In type 2 diabetics we observed a low level of physical activity which may be detrimental for the control of diabetes mellitus.

Rectovaginal fistula following sexual intercourse is rarely reported. It is a social stigma; and without adequate treatment and social support, the patient may end-up in isolation. A thorough knowledge of the problem and management is essential for successful outcome. We report a case of low rectovaginal fistula in a newly married female managed trans-vaginally with prior defunctioning colostomy.

Sub-costal port site abscess and sinus formation secondary to spilled gallstones during laparoscopic cholecystectomy is extremely rare, however such complications at umbilical port site has been described in literature. We present one such case in an elderly diabetic female. Spilled stones migrating to the port site should be kept in mind in a patient presenting with chronic discharging sinus at any of the laparoscopic port sites after laparoscopic cholecystectomy.

The prevention, control, and management of sexually transmitted infections/reproductive tract infection (STI/RTI) are well-recognized cost-effective strategies for controlling the spread of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). A cross-sectional descriptive study was done over a period of 1 year to assess the prevalence of STI, knowledge level about STI, and the STI-HIV link among the female sex workers (FSWs) of Lucknow city, Uttar Pradesh, India along with their biosocial characteristics. Most of the FSWs were illiterate, married, Hindus, and belonged to general category. The prevalence rates of STI among street-based and home-based FSWs were 50.6% and 29.8%, respectively. Knowledge about the role of condom in prevention of STI and the STI-HIV link was significantly less among home-based FSWs than those who are street-based. There is a great lack in the awareness among FSWs regarding STI and their prevention. Behavior change communication (BCC) and advocacy strategy were developed, especially for the home-based group, to strengthen their knowledge regarding the STI-HIV link.

Primary Segmental Infarction (PSI) of the greater omentum is rare. It usually presents as acute appendicitis and the diagnosis is made per operatively. We report a case of 22 years male who presented with history and clinical features suggestive of acute appendicitis. Laparoscopic appendicectomy was planned but during diagnostic laparoscopic phase, omentum was found infarcted in the right lower abdomen and the appendix was normal. Laparoscopic omentectomy of the infarcted segment was done and the patient had smooth recovery.

Objective: To evaluate patient safety, educational value, and ethical issues surrounding "Live surgical broadcast" (LSB) and "As-live surgical broadcast" (ALB) using data obtained from urologic delegates attending two recent endourology meetings in the United Kingdom., Subjects and Methods: Two hundred twelve delegates at the UK section meeting of the Société Internationale d'Urologie (SIU) were invited to complete an online survey using SurveyMonkey(®) to compare their previous perceptions of LSB and ALB, and to compare their current experience of ALB to previous experience of LSB. One hundred three delegates at the British Association of Urological Surgeons (BAUS) Endourology meeting used live voting keypads to compare their experience of LSB and ALB simultaneously, as well as comparing their current experience of ALB to previous experience of LSB. Responses were recorded using a Likert scale., Results: One hundred sixty-five responses were analyzed from the meetings. Most delegates were in specialist practice as a consultant or trainee (89.1%). LSB had been witnessed more than ALB (87.1% vs 66.6%, p=0.049). Based on previous experiences, the educational value of both formats was felt similar, but delegates felt there were significant patient safety benefits with ALB over LSB. Delegates were significantly less likely to recommend a friend or family, or volunteer themselves to be a patient in an LSB setting. On-the-day comparison of LSB and ALB shows a similar educational value to both formats, but with significantly less concern for the surgeon and patient's outcome with ALB., Conclusion: ALB offers similar educational opportunities to delegates when compared with LSB, while appearing to offer significant welfare benefits to both surgeon and patient. Further studies are required to objectively quantify these subjective observations.

Acute hepatitis C (HCV) infection has been identified as an important cause of fulminant hepatic failure (FHF), characterized by rapid deterioration of liver function from massive hepatic necrosis leading to encephalopathy and multi-organ failure. We admitted a female patient at Shalamar Hospital with jaundice, fever, encephalopathy and coagulopathy of short duration with no history of any comorbidity. Her hepatitis viral screen revealed positive anti HCV. Her viral loads were also high. A diagnosis of FHF due to acute HCV infection was made. Patient was treated conservatively and improved gradually. In summary, acute HCV can cause FHF and should be ruled out in patients with FHF of unknown cause in an endemic country for HCV like Pakistan.

Background: Charcot osteoarthropathy or charcot foot is a rare, chronic, non-communicable condition of bones and joints which may results into severe deformity and more prone to develop ulcers possibly leading to amputation. The purpose of this study was to determine the prevalence of Charcot osteoarthropathy and its association with age, BMI, gender, duration of diabetes, HBA1c and peripheral neuropathy., Methods: A total of 1931 subjects with type 2 diabetes having mean age 50.72 ± 10.66 years presenting in a specialist diabetes clinic at shalamar hospital, Lahore, Pakistan were enrolled. The diagnosis of Charcot osteoarthropathy was made by examination of both dorsal and plantar surfaces of foot for swelling, erythema, increase in temperature and any musculoskeletal deformity which was later confirmed by radiographs. Assessment of neuropathy was carried out by checking the sense of pressure, joint position and vibration. BMI (Body Mass Index), fasting blood glucose (FBG) and HbA1C were determined., Results: In all subjects including male 704 (36.45 %) and female 1227 (63.55 %), 0.4 % subjects had charcot deformity, while 0.2 %, 0.15 % and 0.05 % subjects having right, left and bilateral deformity respectively. Bilaterally symmetrical neuropathy was diagnosed in 25.4 % in subjects. There was a significant association (p < 0.05) of deformity with duration of diabetes, HbA1C and neuropathy, however no significant association (p > 0.05) was found with age, BMI, weight, height and gender., Conclusion: There is a need to have a special care of persons with diabetes regarding blood glucose control and development of peripheral neuropathy. Early identification and management of risk factors may prevent the occurrence of charcot deformity. Patients must be educated about the foot care.

Introduction: Sexually transmitted infections (STIs) and Reproductive tract infections RTIs are important public health problems in India. The prevalence of these infections is considerably higher among high risk groups (HRGs) ranging from 20-30%. It is high time that a study should be conducted to explore different factors and conditions responsible for the practice of unsafe sex among female sex workers (FSWs) in Uttar Pradesh (UP) and the impact of this on social life and health of FSWs. As Lucknow provides a comprehensive opportunity in terms of tourism, occupation, and economy, it becomes a potential hub for sex work. Studying FSW in Lucknow can thus be considered as a yardstick for the entire FSW population of UP population. The present study was thus planned with the objective of knowing the STI prevalence and its determinants among FSWs., Materials and Methods: A cross-sectional descriptive study was conducted on FSWs registered with Targeted Intervention-Non-government Organization (TI-NGO), registered with Uttar Pradesh State Acquired Immuno Deficiency Syndrome (AIDS) Control Society (UPSACS) of Lucknow city. Total 288 subjects were studied., Results: The average age of FSWs was 31 years. FSWs were mostly Hindus and illiterate. The overall prevalence of STI as per Syndromic diagnosis was found to be 35.8%. However, the percentage of FSWs with STI was higher in street-based (50.6%) than home-based (29.8%). Majority (42.7%) of sex workers with STI had non-regular partners only while majority (52.4%) of sex workers without any STI had only regular partners. Condom usage with regular partners was poor. However, with the non-regular partners the condom usage was better. On multivariate analysis being single, having sex work as a sole means of earning, duration of sex work > 2 years, having pallor, and giving in to client's demand for unsafe sex were found to be significant in causing STI., Conclusions: Prevalence of STI among the female sex workers as per Syndromic diagnosis was found to be 35.8%. Unemployment, anemia, and having sex without condom for extra money, failure to persuade the client and not doing anything were found to be important predictors for presence of STI.

Introduction: Calcification of the vas deferens and seminal vesicles is a rare condition of unknown incidence. It has been described in association with diabetes, hyperparathyroidism and genitourinary tuberculosis, amongst other conditions. Little is known about the clinical significance and management of this condition. We review the literature in an effort to find answers about an entity that is frequently appreciated as an incidental finding., Materials and Methods: An electronic database search was performed (Medline) using the key words: vas deferens; seminal vesicles; calcification, alone or in combination. Articles were selected according to relevance and quality of evidence., Results: The search included published manuscripts between 1960 and 2012. A total of 17 relevant publications were identified. The majority were written in the English language and mostly consisted of case presentations and reports of radiologic findings., Conclusion: Calcification of the vas deferens and seminal vesicles is a rare condition. However, it may be implicated in male factor infertility and symptoms from the urogenital tract. Treatment should be directed towards the underlying cause on an individual basis. It is unknown whether control of the primary process has any effects on the histopathological appearance of the ducts and/or their improvement of function.

Background and Objectives: To evaluate the usefulness of laparoscopic varicocelectomy in the management of chronic scrotal pain., Methods: Between 2009 and 2011, 48 patients in total were treated with laparoscopic varicocelectomy for dull scrotal pain that worsened with physical activity and was attributed to varicoceles. All patients were followed up at 3 and 6 months and biannually thereafter with a physical examination, visual analog scale score, and ultrasonographic scan in selected cases., Results: The mean age was 38.2 years (range, 23-54 years). The mean follow-up period was 19.6 months (range, 6-26 months). Bilateral varicoceles were present in 7 patients (14.6%), and a unilateral varicocele was present in 41 (85.4%). The varicocele was grade 3 in 27 patients (56.3%), grade 2 in 20 (41.6%), and grade 1 in 1 (2.1%). The mean preoperative visual analog scale score was 4.8 on a scale from 0 to 10. The mean postoperative visual analog scale score at 3 months was 0.8. After the procedure, 42 patients (87.5%) had a significant improvement in the visual analog scale score (P<.001); 5 (10.4%) had symptom improvement, although it was not statistically significant; and 1 (2.1%) remained unchanged. During follow-up, we observed 5 recurrences (10.4%) whereas de novo hydrocele formation was identified in 4 individuals (8.3%)., Conclusion: Laparoscopic varicocelectomy is efficient in the treatment of symptomatic varicoceles with a low complication rate. However, careful patient selection is necessary because it appears that individuals presenting with sharp, radiating testicular pain and/or a low-grade varicocele are less likely to benefit from this procedure.

Objectives: To define the success of a medical workshop from the trainees' perspective, where a medical workshop is a scientific event with the aim of presenting updated knowledge and to teach medical skills to the participants. In surgical specialties, it contributes to the development and maintenance of surgical skills., Methods: Medline was searched for the previous 4 months to identify articles with combinations of the keywords 'workshops', 'training', 'simulators', and 'virtual reality'. Further articles were obtained by manually searching the reference lists of identified papers. We also obtained information and critical aspects of view from other trainees., Results: Based on 30 articles from the Medline search, and mostly from the trainees' perspective, we present the basic characteristics of a successful workshop. The objective of the workshop, appropriate faculty members and presenters, highly motivated participants, the use of simulators and evaluation sheets, the venue and the registration fees all have a major role in the success of a workshop., Conclusions: A successful workshop is that from which trainees have grasped most of the knowledge and skills imparted to them, with a positive progression reflected on their learning curve. Workshops are a current necessity and all efforts should be made to achieve the desired result from the trainees' perspective.

With populations ageing and active treatment of urinary stones increasingly in demand, more patients with stones are presenting with an underlying bleeding disorder or need for regular thromboprophylaxis, by means of antiplatelet and other medication. A practical guide to thromboprophylaxis in the treatment of urinary tract lithiasis has not yet been established. Patients can be stratified according to levels of risk of arterial and venous thromboembolism, which influence the requirements for antiplatelet and anticoagulant medications, respectively. Patients should also be stratified according to their risk of bleeding. Consideration of the combined risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. The choice of shockwave lithotripsy, percutaneous nephrolithotomy or ureteroscopy with laser lithotripsy for treatment of lithiasis should be determined with regard to these risks. Although ureteroscopy is the preferred method in high-risk patients, shockwave lithotripsy and percutaneous nephrolithotomy can be chosen when indicated, if appropriate guidelines are strictly followed.

The finding of an appendix in the hernial sac is a rare entity known as Amyand's hernia. It is even more rare when it occurs on the left side. We report a rare presentation of Amyand's hernia, where the appendix was found inflamed during surgery for a left sided obstructed inguinal hernia in a 40 years old male. The patient underwent appendicectomy and repair of the hernial sac and had an uneventful recovery. The possibility of the presence of a situs inversus or malrotation, as an underlying cause for the observed pathology, was excluded by X-ray examination.

Objective: To investigate the evidence for the use of hyoscine N-butylbromide (HBB) in the treatment of acute renal colic., Methods: A literature search was performed using the keywords 'hyoscine N-butylbromide', 'ureteral colic', 'spasmolytic', 'anticholinergic' and 'analgesia'. The articles were given the appropriate level of evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence guidelines., Results: The analgesic effect of HBB as monotherapy is inferior to that of opioids and/or non-steroidal anti-inflammatory drugs (NSAIDs). It does provide an analgesic and antispasmodic effect, but not as long-lasting as NSAIDs. HBB does not serve as an adjunct to opioids. Furthermore, it does not facilitate passage of ureteral stones and has no effect on expulsion rate., Conclusions: HBB is often used where urinary tract smooth muscle spasm is thought to be part of the pathophysiological process. According to the evidence, administration of HBB follows non-peer-reviewed protocols which are based on empiric recommendations. Its role is still unclear, as it appears to have no advantage when used as monotherapy over established forms of analgesia. There appears to be a time-dependent relation to pain reduction following parenteral administration, but this needs to be confirmed by more prospective randomized cohorts., (2014 S. Karger AG, Basel.)

Purpose: To review our experience with and the effectiveness of the ureteral Memokath 051 metallic stent for the minimally invasive management of retroperitoneal fibrosis (RPF)., Patients and Methods: We retrospectively reviewed the records of patients with RPF who were treated between April 2008 and February 2013. Success was defined as improvement of renal function and lack of complications after stent placement. Follow-up was at 6 weeks, 3 months, 6 months, and annually thereafter., Results: A total of 14 patients were identified. The study included eight female and six male patients. Mean age was 60.2 years±8.4 standard deviation (SD). The majority of patients had idiopathic RPF (n=12, 85.7%). Stent placement was performed in 23 renal units in 14 patients, 9 (64.3%) of whom had bilateral disease. Ten (71.4%) patients had previously received medical treatment, while three (21.4%) presented with recurrent disease postureterolysis. The mean length of follow-up was 22.5 months (range 3-56 mos). Mean stricture length was 7.6 cm±6.2 SD on the right and 7.7 cm±5.1 SD (P=0.925) on the left. Patients tolerated the stents well with minimal discomfort. Ureteral obstruction was managed successfully in 78.6% of patients (n=11/14). All patients had improvement of renal function., Conclusions: To our knowledge, this is the first study using metal stents in patients with RPF. Retrograde placement of the ureteral Memokath 051 metal stent can be considered as a promising alternative for initial or salvage postureterolysis minimally invasive management of ureteral obstruction in RPF.

Endourological techniques are used more often nowadays in the treatment of ureteric strictures of various etiologies. Advances in technology have provided new tools to the armamentarium of the endoscopic urological surgeon. Numerous studies exist that investigate the efficiency and safety of each of the therapeutic modalities available. In this review, we attempt to demonstrate the available and contemporary evidence supporting each minimally invasive modality in the management of ureteric strictures.

Background and Purpose: Ureteral obstruction in renal transplant allografts secondary to strictures can pose a challenging problem. Its incidence is reported between 0.5% and 4.7%. Usually, open surgical repair is performed. We present a series of patients in whom a metal Memokath™ 051 stent has been used as a minimally invasive treatment alternative., Methods: We analyzed our data on the use of thermo-expandable metallic Memokath 051 stents for ureteral strictures in renal transplant patients., Results: Between 2003 and 2010, eight male kidney recipients with a mean age of 49 years and obstructed ureters after kidney transplantation were treated with ureteral Memokath insertion. In six patients, the obstruction was at the level of the anastomosis, and in two, at the pelviureteral junction. After a mean follow-up of 4 years, half of the stents are in situ providing a good graft function. The average indwelling time is 4 years. Spontaneous resolution of the stricture without the need for further stent insertion was seen in three patients after a mean indwelling time of 7.3 months. There was one treatment failure in a patient with an obstructed, dilated, and convoluted ureter that was unable to withhold the stent in situ. No perioperative complications were recorded in this series. The overall success rate was 87%., Conclusion: Ureteral stent placement with the Memokath 051 is a safe minimally invasive treatment alternative for ureteral strictures in renal transplant recipients.

Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

The treatment of urolithiasis has changed dramatically over the past several decades. Novel technologies have led to new management protocols. Percutaneous chemolysis as a primary or adjuvant treatment for urinary tract stones has widely been neglected. We present our own experience with it and discuss it in the light of an extensive literature review. From a MEDLINE search on percutaneous chemolysis we evaluated the most important studies, a total of 58 articles, 43 case series and 15 review articles. In our unit between 2001 and 2011, 29 patients (mean age 62 years) with infectious staghorn calculi were treated with adjuvant percutaneous chemolysis post-percutaneous nephrolithotripsy. There were 17 women, with 10 complete and 14 partial staghorn stones (mean size 32 mm). Patients were generally deemed at high risk to undergo another procedure in the future. Suby G solution was used following an established protocol. Sixteen patients (55.1 %) were stone free after chemolysis, eight stones showed partial dissolution, half of them with so-called "insignificant" residual fragments <4 mm. Patients with residual stones underwent SWL. Mean follow-up was 5.25 years (1-11). One stone-free patient (6 %) and three of eight patients (37.5 %) with residual fragments post local chemolysis, developed new stones during follow-up. The often neglected percutaneous chemolysis represents a significant and effective.