bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebral Venous Sinus Thrombosis
Authors: Sajan Cyril , Saggu Varunsingh , Mahant Maitri , Gohel Dilsar , Bhatt Foram , Jacob Elizabeth
Published: May 2024

Cerebral venous sinus thrombosis (CVST) is a relatively uncommon but important cause of stroke-like disease, accounting for fewer than 1% of all strokes. CVST is more common in females and infants. CVST patients are most common in the third decade, with a female-to-male ratio of 5:1.5. The incidence of CVST has been found to be high in developing countries, particularly in South-East Asia. Headache is the most prevalent clinical sign of CVST, occurring in 88% to 93% of patients, followed by a seizure in 37% to 71%, focal neurological deficit in 20% to 54%, and isolated increased intracranial pressure in 23%.[1] A 34-year-old male came to the tertiary care hospital with complaints of headache, vomiting, and vertigo for 1 day. Headache is insidious, progressive, nonradiating, holocephalic, severe in intensity and associated with vertigo and dizziness, and giddiness, he also complained about nausea and vomiting (10–12 episodes/day) containing food and water. The patient had no family history but has been chronic tobacco chewer for 10 years. Past medical history revealed that he was admitted to the hospital before for the same complaints and he also had right lower vein deep-vein thrombosis 6 months back. His magnetic imaging resonance reports and protein S and C deficiency reports revealed that he was suffering from CVST. He was prescribed with anticoagulants and other supportive treatments that include antiemetic, analgesics, and multivitamins, which cause faster and better recovery of patients.
A Short Review on Black Fungal Mucormycosis Accompanied by Post-SARS-CoV-2
Authors: Lachyan Abhishek , Singh Vijay Kumar , Verma Swati , Paramanick Debashish
Published: May 2024

Many people who have recovered from coronavirus disease 2019 (COVID-19) have recently been diagnosed with black fungus – or mucormycosis – disease. Rhino-orbital mucormycosis is becoming more common in people with COVID-19, particularly in India. On its own, diabetes mellitus is a risk factor for severe COVID-19 and mucormycosis. The goal of this study is to conduct a review of the literature to determine the features of patients with mucormycosis and COVID-19. Increased mucormycosis in India appears to be the result of an unholy trifecta of diabetes (high hereditary incidence), corticosteroid overuse (increased blood glucose and opportunistic fungal infection), and COVID-19 (cytokine storm, lymphopenia, and endothelial damage). To limit the incidence of deadly mucormycosis, all efforts should be made to maintain optimum hyperglycemia, and only prudent evidence-based use of corticosteroids in patients with COVID-19 is advocated. In this review, we emphasize knowledge on diagnosis and therapy regarding black fungal mucormycosis, which is accompanied by post-SARS-CoV-2.
Identification and Management of Snake Bite in Asia: A Narrative Review
Authors: Rathinasamy M. , Mithuna M. , Ramasamy Sunitha , Antony J. , Jaishree V. , Alexander M.
Published: May 2024

Snake bites are an important cause of illness and deaths in the rural population in tropical, subtropical and southeast Asian countries. There are more than 3000 species of snakes found all over the world of which around 300 species are found in India. In India, most of snake bite deaths occur due to delayed arrival to treatment centers. The purpose of the present review article is to explore the various species of snakes, their toxicology, clinical manifestations, and management. In addition, various ways to avoid snake bites and early approaches to government centers rather than private centers for the availability of Anti-snake venom have been discussed in this article. Rapid diagnostic test for the identification of species is available in selective centers only and treatment mainly depends on the administration of anti-snake venom. In addition, proper community education and strong health-care policy will reduce the morbidity and mortality due to snake bites.
An Overview Evaluation of Bacterial Infection and Bacterial Contamination at the Hospital Environment and Antibiogram for the Isolated Pathogens at Al Kufra Teaching Hospital, Libya
Authors: Bozakouk Ismaeel H. , Hussein Alabirsh N. , Kean Iain R. L. , Bumadian Mohammed M. , Toboli Abubaker S.
Published: May 2024

Background/Aims:

Infectious diseases are the major public health problem worldwide. The medical services into the Southern Libyan sub-Saharan hospitals do not receive much attention in knowing the infection rates of pathogenic bacteria coming to the hospital, as well as there is not much information available about the hospital infection control application system. This study was performed to evaluate the infectious disease received to Al Kufra teaching hospital and determination the hospital risk factors involved in hospital-acquired infection.

Materials and Methods:

The screening was performed to investigate the distribution of potential pathogens among 157 samples collected from the four hospital wards including intensive care unit, the pediatric ward, male and female surgical ward from the hospitalizes patients, medical staff and hospital workers, and across different hospital facilities.

Results:

The bedsores swabs and urine samples showed 100% of infection, followed by sputum, stool, surgical wounds, and cerebrospinal fluid (85.8%, 67%, 62.5%, and 42.9%), respectively. Most of the hospital facilities showed 100% of contamination. The results showed Staphylococcus aureus colonized 40 (77%) of the total nasal swabs, other samples detected Bacillus cereus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Escherichia coli 0157. The sensitivity of Gram-positive organisms to the antibiotics showed resistance to Penicillin G (90.1%) and Amoxicillin + Clavulanic acid (82.7%), Methicillin (65.5%) and Vancomycin (65.5%). For Gram-negative organisms, the isolates showed resistance to tetracycline and colistin (62.5%) for each.

Conclusion:

The bacterial outbreak in the clinical and environmental samples of Al Kufra Teaching Hospital was relatively high. To control bacterial infection and hospital contamination, several instructions need to be carried out to protect the hospital staff and patients from being infected.
Primary Non-Hodgkin Lymphoma Lung
Authors: Mohamed Badri Rabab Nasir , Fatima Sohaila
Published: May 2024

Lymphomas are a heterogeneous group of malignancies that originate from the neoplastic transformation of lymphocytes. Primary pulmonary non-Hodgkin lymphoma is a rare entity with marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) which is the most common subtype is a low-grade lymphoma accounting for <0.5% of all primary lung neoplasms. The most common presentation is a mass discovered on a chest radiograph in an asymptomatic patient, with symptomatic patients presenting with cough, dyspnea, chest pain, and hemoptysis. On computerized tomography, multiple bilateral lesions are commonly seen in pulmonary MALT lymphoma with consolidation, nodule, and mass being the main morphological patterns. We present two cases diagnosed with marginal zone lymphoma of the lung which is an indolent lymphoma and the most common subtype in the lung.
Scleral Buckle versus Pars Plana Vitrectomy in the Management of Primary Chronic Rhegmatogenous Retinal Detachment
Authors: Bunajem Maryam , Ahmad Khabir , Al Zaidi Nazih , Al Bloushi Bedoor , Al Zahrani Yahya
Published: May 2024

PURPOSE:

The purpose of this study is to compare the anatomical and visual outcomes of scleral buckle (SB) surgery with the pars plana vitrectomy (PPV) in the management of chronic rhegmatogenous retinal detachment.

METHODS:

This cohort study included patients who underwent surgical repair SB group and PPV group for chronic retinal detachment during 2014–2018 at the King Khalid Eye Specialist Hospital, Riyadh. The anatomical and functional success rate at 12 months after surgery was compared in two groups. Cox regression and linear regression analysis were performed to identify the predictor of anatomical and functional outcomes, respectively. Need for second surgery was also evaluated.

RESULTS:

Our cohort had 68 eyes in SB and 64 eyes in PPV group. Eyes that underwent PPV were more likely to develop retinal detachment over 12 months than those that underwent SB surgery (adjusted heart rates 2.11, 95% confidence interval [CI], 0.95–4.64 P = 0.065). A multivariable linear regression analysis did not reveal a significant association between the surgery type and change in visual acuity (beta coefficient, 0.002; 95% CI,−0.184, 0.189 for specific bread volume; P = 0.979). A higher percentage of eyes in the PPV group compared with those in the SB surgery group required secondary surgery (39.1% vs. 22.1%; P = 0.034).

CONCLUSION:

Scleral buckling surgery showed a better single surgery anatomic success rate as compared to PPV in the management of chronic primary rhegmatogenous retinal detachment. The functional outcome of the two procedures was comparable.
Madelung’s Disease in a Middle-Aged Nigerian Man: A Case Report
Authors: Ibrahim Halima Garba , Maiyegun Afisulahi Abiodun , Oloko Nasirudeen Lanre , Shirama Yakubu Bababa
Published: May 2024

Madelung’s disease is a rare metabolic disease of surgical importance seldom reported among Africans. This case reports the condition in a middle-aged Nigerian man with Type 1 variety of the condition. In addition, he was overweight and had diastolic hypertension (90 mmHg) with a 30-year history of local alcohol consumption of 30-60 units/day. Diagnosis of Madelung’s disease was made by fine-needle aspiration cytology, ultrasound scan, and x-ray of the fatty deposits on the body. The patient also had an aspartate transaminase-to-alanine transaminase (AST/ALT) ratio of 2.0, indicative of alcoholic fatty liver disease. Management was through counseling to stop alcohol and excision of the neck mass. The case introduces this rare condition, demonstrates the need for evaluation of patients with Madelung’s disease for metabolic complications, and highlights the role of interdisciplinary collaboration in the management of this disease.
Knowledge, Perception, and Risk Awareness about Breast Cancer among Nursing Staff in a General Hospital in Riyadh, Saudi Arabia
Authors: Bhutta Muna , Almanan Sara Mohammed Atta , Marie Amal , Elmubarak Hind Elhindy Elamin , Andarawi Abeer Othman Hassan , Kashif Seemin
Published: May 2024

Context:

Early diagnosis of cancer improves chances of survival, and primary care nurses are more likely to encounter cancer signs and refer them to specialists.

Aim:

To assess knowledge of breast cancer (BC), its risk factors, and symptoms among female nurses in a Saudi hospital.

Settings and Design:

A cross-sectional study of female nurses of a general hospital in Saudi Arabia.

Methods and Material:

Female nurses with permanent jobs were included in the study. Under-training nurses were excluded from the study. Data was collected through a questionnaire containing 18 questions.

Statistical Analysis Used:

Frequencies and percentages of all the variables and regression analysis were done on IBM SPSS software.

Results:

A total of 80 female nurses participated in the study. The mean age of the study population was 28.1 ± 1.6. Their work experience was 4.8 ± 2 years. Those participants who could answer only <6 of the total 18 questions were graded to have “Poor” knowledge, those correctly answering 6–12 questions were graded to have “Moderate” knowledge, those answering 12–16 questions were graded to have “Good,” and those answering >16 questions correctly were graded to have “Very good” knowledge. About 19% of the participants had “Poor” knowledge, about 39% of participants had “Moderate” knowledge, 26% had “Good” knowledge, and 16% had “Very good” knowledge. Regression analysis could not show the effects of age or experience on knowledge.

Conclusions:

One-fifth of nurses had poor BC knowledge, highlighting the need for awareness interventions.
Galactorrhea and Galactocele Formation after Augmentation Mammoplasty and Augmentation Mastopexy
Authors: Ors Safvet
Published: May 2024

Purpose:

Some of the most common complications associated with augmentation mammoplasty (AUM) and augmentation mastopexy (AUMX) include infections, seroma, hematoma, capsular contracture, asymmetry, hypertrophic scars, implant rupture, and deformities. Galactocele and galactorrhea can rarely be observed after AUM and in reduction mammoplasties other than the AUMX, while galactorrhea is often observed after chest wall deformity correction surgery and thoracic surgery.

Patients and Methods:

In our clinic, galactorrhea was developed in five out of 540 patients who underwent AUM or AUMX, and one of these patients also had galactorrhea and galactocele in the accessory breast tissue. No patients were postmenopausal, and none of them had a history of pituitary, adrenal, thyroid, or ovarian surgery. Lactation started in average 10–15 days after surgery and lasted about 4–5 weeks. The patients were followed up for 1–10 years. In one patient who was found to be pregnant, galactorrhea ceased spontaneously 2 weeks after the termination of the pregnancy by curettage.

Results:

This clinical study presents the cases of five patients with galactorrhea and galactocele in the accessory breast tissue, with particular focus on treatment and possible risks, and discusses whether large nipples may cause a risk for galactorrhea. This study presents the second largest series of cases with galactorrhea in literature after the study reported by Caputy and Flowers.

Level of evidence:

Level V.
Assessment of Incision Types, Risk Factors, and Complication Rates in Nipple and Skin-Sparing Mastectomy
Authors: Vayvada Haluk , Demirdover Cenk , Geyik Alper , Menderes Adnan
Published: May 2024

Introduction:

The incidence of breast cancer in the female population of reproductive age is rising. Surgery is the primary approach, and other treatment options can be adopted in certain circumstances. In the surgical field, lately, there has been a growing interest for nipple–skin-sparing mastectomy (NSSM). This study aims to emphasize the effect of incision types and patient characteristics (demographics, concomitant disease, smoking, history of radiotherapy, and chemotherapy) on complication rates.

Patients and Methods:

The subjects included 184 breasts in 92 female patients who underwent the NSSM procedure at our clinic from January 2010 to May 2019. Patients who underwent bilateral NSSM and immediate reconstruction with prosthesis were included in the study.

Results:

The most commonly used incision pattern was the inverted T-scar. Seven patients who had a contralateral prophylactic mastectomy (7.6%) were found to have atypical proliferative lesions or occult breast carcinoma in the clinically healthy contralateral breast on pathological examination. Complications were seen in 36 patients (39.1%). Skin–nipple–areolar complex necrosis was the most frequent complication. A previous history of radiation therapy was associated with higher rates of complications.

Conclusion:

NSSM and immediate single-stage implant reconstruction is a procedure with high morbidity and complication rates. The incision type and smoking have the main effect on complication rates. Although most complications are manageable, the surgical approach and patient-related risk factors should be taken into consideration for avoiding them.
Use of the Superior Breast Border Landmark for Planning Reduction Mammoplasty
Authors: Demir Can Ilker , Yaşar Emrah Kagan , Asadov Mehdi , Alagöz Murat Sahin
Published: May 2024

Aims:

The aim of this study was to evaluate the reliability of the upper breast border (UBB) in determining the new location of the nipple and to objectively analyze long-term nipple position compared to pre-operative markings.

Patients and Methods:

Thirty-eight patients (76 breasts) patients who underwent superomedial pedicle, reverse-T scar breast reductions and who had long-term (>12 months) follow-up data were included. The sternal notch to the nipple, nipple to inframammarian fold (N-IMF), nipple to chest midline, and areola diameter were measured and recorded at the time of preoperative, markings, and long-term follow-up visit.

Statistical Analysis Used:

The differences in measurements were compared using a paired, two-tailed T-test, and a P < 0.05 was considered statistically significant.

Results:

The average follow-up time was 17.9 months (range 12–41 months). The nipple was located, on average, 0.95 cm lower on postoperative assessment compared to preoperative marking (P = 0.060). The nipple was located, on average, 0.75 cm lateral on postoperative assessment compared to preoperative marking (P < 0.001). The average postoperative increase in the N-IMF distance between marking and the long-term follow-up visit was 1.75 cm (P < 0.001). The areola diameter was increased 0.21 cm on postoperative assessment compared to preoperative marking (P < 0.001).

Conclusions:

The nipple position moved down and the N-IMF distance was greater than planned. However, the nipple was usually located at the area of the greatest projection of the breast due to almost equal elongation of the superior and inferior poles. The outcome of breast reduction procedures in which the postoperative nipple position is planned using the UBB was good.
Tongue Schwannoma, an Uncommon Oral Cavity Mass
Authors: Viana-Tapia Einstein Alfredo , Coronado-Sarmiento Juan Felipe , Barraza-Leones Osvaldo Camilo
Published: May 2024

Schwannomas are benign tumors arising from the Schwann cells, located in the peripheral nerve sheath. The incidence of tumor in the oral cavity is <1%, and the tongue is the most prevalent place in that area. A 32-year-old Hispanic female was sent from the otolaryngology department with a diagnosis of an oral mucocele in the oral cavity floor, after 8 months complaining of dysphonia and dysphagia. Physical examination reveals a submucosal mass in the anterior and ventral portion of the tongue. After characterization with magnetic resonance and biopsy guided by tomography, she underwent surgical management, with no complications. Tongue schwannomas are often misdiagnosed based on their very low incidence. A proper approach including a good physical examination, imaging and histological characterization of the lesion, and proper surgical management of this entity, will lead to cure this condition, with a low relapse rate.
Fournier's Gangrene as a Possible Surgical Complication of COVID-19
Authors: Zuhour Moath , Dadacı Mehmet , Baycar Zikrullah , İnce Bilsev , Soylu Arda
Published: May 2024

Fournier's gangrene (FG) is a rare form of necrotizing fasciitis affecting the perineal, perianal, or genital areas. The infection is usually seen in diabetic, alcoholic, or immunosuppressed patients. Urgent debridement and broad-spectrum antibiotics are the first-line therapy, where in some cases soft tissue reconstruction is required. We report two patients who developed FG during COVID-19 infection. None of the patients had a history of diabetes mellitus, alcoholism, or immune deficiency. The only reported health condition was COVID-19 infection. Emergent debridement and elective reconstruction were performed for both of the patients. High index of suspicion is required during the examination of the perineum and the genitalia of suspected patients with COVID-19 infection for early diagnosis and prevention of further complications. Larger studies are required to indicate the exact incidence of FG in patients with COVID 19 infection.
Forehead Reduction and Hairline Lowering Surgery
Authors: Oreroglu Ali Riza
Published: May 2024

Background:

Forehead reduction and hairline lowering is an underestimated yet important procedure in facial beautification. Proportions of the forehead to the midface and lower face can be corrected with this surgery as well as addressing changes in hairline positioning.

Objectives:

The aim of this paper was to describe in detail the author's approach to hairline lowering and forehead reduction procedures with emphasis on implications to increase the aesthetic outcome.

Methods:

The procedure was performed under general anesthesia in a single-stage approach with the following algorithm: pretrichial incision, subgaleal dissection and preparation of a parieto-occipital scalp flap, multiple horizontal galeotomies, scalp advancement and fixation, and finally forehead skin excision and closure.

Results:

Forehead reduction and hairline lowering surgery was performed on 17 female patients aged between 19 and 42. Forehead length reduction was measured between 1.7 and 4.2 cm. The patients were followed up for 6 months to 3 years.

Conclusions:

Forehead reduction hairline lowering is an underestimated yet aesthetically important procedure for correcting facial harmony, beautification, and rejuvenative purposes. Following certain planning and technical details can help the surgeon apply the procedure properly, minimizing the risks for major and minor complication and achieving aesthetically successful results.
Evaluation of intermittent tamsulosin in treating symptomatic patients with benign prostatic hyperplasia
Authors: Soliman Mohamed G. , Al-Ghadeer Mohammed R. , Al-Shabaan Hasan R. , Al-Hamrani Amer H. , AlGhadeer Hussain Adil
Published: May 2024

Purpose:

The purpose of this study is to evaluate and assess the effect of intermittent tamsulosin treatment as a trial to increase the drug safety (in terms of reducing the drug side effects, particularly retrograde ejaculation) while maintaining the effect in reducing the symptoms and assess its impact on the patients’ quality of life.

Materials and Methods:

Patients who enrolled in this study were suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and were using 0.4 mg tamsulosin daily to relieve their symptoms but complained of ejaculatory problems. A baseline assessment involves medical history and evaluation of ejaculatory function abdominopelvic ultrasound, postvoid residual volume (PVR) estimation, the International Prostate Symptom Score (IPSS), quality of life assessed using global satisfaction, vital signs, physical examination including digital rectal examination, and renal function. During the study, patients consented to take 0.4 mg tamsulosin intermittently every other day and to proceed with their sexual activities on the days they did not take the drug in. Baseline assessment was repeated and recorded after 3 months from starting the treatment. The adverse effects and compliance were analyzed in all patients.

Results:

Twenty-five patients had a mean baseline IPSS of 6.6 ± 1 and baseline PVR of 87.6 ± 15.1 ml. At the 3rd month, the mean PVR was 100.4 ± 15.1 ml and the mean IPSS was 7.3 ± 1.1. Moreover, 20 out of the total number of 25 patients (80%) reported improvement in their ejaculation. All our 20 patients who showed improvement in their ejaculatory function are either satisfied or very satisfied (4 or 5), in regard to the global satisfaction rate.

Conclusion:

Intermittent tamsulosin therapy (0.4 mg/every other day) is well-tolerated and shows a potential advantage in recovery in patients who suffer from LUTS/BPH and complaining from abnormal ejaculation, especially absent ejaculate. Although there was a significant change in PVR and IPSS after using intermittent tamsulosin therapy. Most patients show a higher overall satisfaction with the treatment compared to the standard dose (0.4 mg/daily). A study on a larger scale is still needed to confirm our results.
Management of metastatic castration-resistant prostate cancer in Middle East African countries: Challenges and strategic recommendations
Authors: Bazarbashi Shouki , Alsharm Abdullah , Meshref Alaa , Mrabti Hind , Ansari Jawaher , Ghosn Marwan , Abdulla Mohamed , Urun Yuksel
Published: May 2024

Despite the reliance on Western guidelines for managing prostate cancer (PC), there are wide variations and gaps in treatment among developing countries such as the Middle East African (MEA) region. A multidisciplinary team of experts from the MEA region engaged in a comprehensive discussion to identify the real-world challenges in diagnostics and treatment of Metastatic Castration-Resistant Prostate Cancer (mCRPC) and provided insights on the urgent unmet needs. We present a consensus document on the region-specific barriers, key priority areas and strategic recommendations by experts for optimizing management of mCRPC in the MEA. Limited access to genetic testing and economic constraints were highlighted as major concerns in the MEA. As the therapeutic landscape continues to expand, treatment selection for mCRPC needs to be increasingly personalized. Enhanced genetic testing and judicious utilization of newer therapies like olaparib, articulated by reimbursement support, should be made accessible for the underserved populations in the MEA. Increasing awareness on testing through educational activities catalyzed by digital technologies can play a central role in overcoming barriers to patient care in the MEA region. The involvement of multidisciplinary teams can bridge the treatment gaps, facilitating holistic and optimal management of mCRPC. Region-specific guidelines can help health-care workers navigate challenges and deliver personalized management through collaborative efforts – thus curb health-care variations and drive consistency. Development of region-specific scalable guidelines for genetic testing and treatment of mCRPC, factoring in the trade-off for access, availability, and affordability, is crucial.
Malignant transformation of testicular teratoma to primitive neuroectodermal tumor
Authors: Elagi Daniyah , Young Rodney , Dayili Abdulmajeed
Published: May 2024

Teratoma is a common germ cell tumor that affects young adult males. A small number of testicular teratomas have the potential for malignant transformation along endodermal, ectodermal, or mesodermal lines. The metastatic mixed germ cell tumor we reported consists of the primitive neuroectodermal tumor (PNET) with mature teratoma. PNET is a highly aggressive tumor with a poor prognosis given its poor response to standard platinum-based chemotherapy. The primary treatment for PNET is surgical resection. Malignant transformation of teratoma to PNET is a rare phenomenon. Only a few cases of malignant transformation of teratomas to PNET are reported in the literature. Here, we present a rare case of PNET arising in a malignant mixed germ cell tumor in a 23-year-old male who underwent adjuvant adriamycin, cyclophosphamide (VAC) alternating with ifosfamide and etoposide (IE) chemotherapy and retroperitoneal lymph node dissection.
Bowel obstruction incidence in urinary diversion patients: A meta-analysis study
Authors: Situmorang Gerhard Reinaldi , Irdam Gampo Alam , Abdullah Aaron
Published: May 2024

Background:

Bowel obstruction is a common complication that occurs in patient who underwent urinary diversion with an incidence of 0.7%–11%. Although previous studies have published risk factors, prevention and management of postoperative paralytic ileus, and data on urinary postdiversion bowel obstruction in the literature are still scarce and thus require further investigation of the diversion technique which allegedly has differences in pathogenesis, management, and results. To that end, this study conducted a systematic review study to compare two different diversion techniques, namely ileal conduit and continent diversion, especially orthotopic neobladder.

Methods:

This study is a systematic review by searching study in online databases such as PubMed, EBSCOhost, and ProQuest. Inclusion criteria included are full-text articles, English language, and articles of the past 10 years. After searching, we analyzed quantitatively using the RevMan application for meta-analysis.

Results:

From 3403 studies, we got 12 studies that were included in the analysis. In a study conducted from the study of van Hemelrijck et al. stated that intestinal obstruction has an incidence of 50.73–1000, the third-highest when compared with advanced complications such as death (145.07/1000 population) and urinary tract infections (127.03/1000 population). It was found that odds ratio was 0.64 (0.45–0.91).

Conclusion:

The ileal conduit and orthotopic neobladder methods have no significant difference in the incidence of intestinal obstruction.
Successful endoscopic management for early manifested postcesarean section uretero-uterine fistula
Authors: Elatreisy Adel , Al-Ayafi Mahdi , Al-Ghamdi Muhammad Ahmad , Bosily Mohanad Jebril , Al-Aown Abdulrahman
Published: May 2024

We report a rare case of post-cesarian section uretero-uterine fistula (UUF) in a 36 years old female who presented on a postoperative day 5 with paradoxical urine incontinence and occasional normal urethral voiding. After a complete evaluation, Cystoscopy and right internal JJ ureteric stent insertion was done; the patient had a dramatic response; she was completely dry until the stent was removed three months later with complete healing of UUF. To our knowledge, the present case is the 4th reported with successful endoscopic management for post-obstetrics and gynecological procedures Uretero-Uterine fistula.
Evaluation of the accessibility and content of urology residency websites
Authors: Nocera Alexander P , Boudreau Hunter S. , Boyd Carter J , Martin Kimberly D. , Rais-Bahrami Soroush
Published: May 2024

Introduction:

Students applying for urology residency often have limited resources for obtaining information on prospective programs. Applicants commonly rely on institutional websites to compare program elements. The information on these websites can attract or deter applicants and can have a major impact on application costs, rank lists, and career goals. The objective of this study was to determine the accessibility and content of urology residency program websites.

Materials and Methods:

A list of accredited urology residency programs was obtained from the American Urological Association residency directory in 2020. A total of 141 program websites were evaluated for the presence of 53 criteria, which were categorized into five groups: Personnel information, applicant information, program information, training/research, and resident benefits. Residencies lacking an available website or functional links were excluded from the study.

Results:

Of the 53 criteria analyzed, only 24 were featured on more than 50% of the websites. Less than 10% of the programs had available information regarding resident contact information (5.67%), alumni contact information (2.84%), frequently asked questions (9.22%), electives (9.93%), night float (5.67%), and board pass rates (5.67%). The three factors most commonly available included program description (100%), coordinator contact information (88.65%), and clinical sites (87.94%). None of the 141 programs had all 53 criteria available on their website.

Conclusions:

The majority of current urology residency websites may lack the accessibility and content necessary for candidates to make application decisions for desired programs. Residency programs should consider revising their websites to enhance resident recruitment and facilitate applicants’ decision-making process.
Thulium laser en bloc resection versus conventional transurethral resection of urinary bladder tumor: A comparative prospective study
Authors: Badawy Atef , Sultan Sultan Mohamed , Marzouk Asem , El-Sherif Eid
Published: May 2024

Background:

Transurethral resection of bladder tumors (TURBT) is the standard management for urinary bladder tumors; however, new techniques as Thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as a substitute to TURBT.

Objectives:

In this study safety, efficacy, and tumor recurrence after TmLRBT and TURBT were prospectively compared in patients with primary (<4 cm) bladder tumors.

Patients and Methods:

Between August 2019 and May 2021, patients with primary (<4 cm) bladder tumors were enrolled. Patients were randomized between the two procedures. All perioperative data were collected prospectively. Pathological specimen findings and recurrence rates were reported during follow-up visits.

Results:

Sixty patients underwent TURBT, and another 60 had TmLRBT. No significant differences were detected in patient demographics or preoperative tumor characteristics between the two groups. Operation time was less (28.2 vs. 38.9 min, P < 0.001), and rate of bladder perforation was lower with TmLRBT compared to TURBT (3.3% vs. 15.0%, P = 0.027). In the TmLRBT group, higher rate of muscle detection (95.0% vs. 78.3%, P < 0.001) in the pathological specimen, and lower rate of tissue destruction (0.0% vs. 21.6%, P < 0.001) were obtained compared to TURBT. Recurrence rate in cases of nonmuscle invasive bladder cancer was lower with TmLRBT (6.7% vs. 33.0%, P < 0.001).

Conclusion:

In this study, TmLRBT showed reduced operative time with lower perforation rates. Higher detection of detrusor muscle and less tissue destruction in the pathological specimen were obtained with TmLRBT, as well as lower rates of tumor recurrence. These findings suggest that TmLRBT is a safe and efficacious substitute to TURBT in tumors <4 cm.
The study of miRNA-200c expression and epithelial-to-mesenchymal transition-related transcription factors in the primary bladder urothelial carcinoma
Authors: Narwal Anubhav , Kumari Kalpana , Kaushal Seema , Seth Amlesh , Nayak Brusabhanu , Rustagi Yashika , Dinda Amit Kumar
Published: May 2024

Background:

Epithelial-mesenchymal transition (EMT) plays an important role in bladder carcinoma (BC) invasiveness and metastasis. Studies have shown that muscle-invasive BC (MIBC) and non-MIBC (NMIBC) are different at the molecular level owing to different EMT-related programming. Recent studies suggest that dysregulation of specific miRNAs is linked to EMT in BC. With this background, we aimed to study the immunoexpression of EMT-markers and its correlation with miRNA-200c expression in a series of MIBCs and NMIBCs.

Materials and Methods:

Quantitative real-time-polymerase chain reaction for the quantification of miR-200c expression was performed on 50 cases of urinary BC obtained from transurethral resection of bladder tumor (TURBT), cystectomy specimens, and ten peritumoral bladder tissue. Immunohistochemistry for ZEB1, ZEB2, TWIST, E-cadherin, and β-catenin was performed on tumor and peritumoral bladder tissue.

Results:

Thirty-five TURBT and 15 cystectomy specimens were assessed. Among MIBC, loss of expression of E-cadherin (72.3%), β-catenin (66.7%), and ZEB1, ZEB2, and TWIST2 immunoreactivity was noted in 53.3%, 86.7%, and 73.3% of cases, respectively. Among NMIBC, loss of expression of E-cadherin (22.5%), β-catenin (17.1%) and ZEB1, ZEB2, and TWIST immunoreactivity was noted in 11.5%, 51.4%, and 91.4% of cases, respectively. Upregulation of miRNA-200c was noted in cases with retained E-cadherin and negative TWIST expression. Downregulation of miRNA-200c expression was noted in all the cases showing loss of E-cadherin, β-catenin, and in cases immunoreactive for ZEB1, ZEB2, and TWIST in MIBC. Downregulation of miRNA-200c expression was also noted in cases of MIBC with retained β-catenin and those immunonegative for ZEB1 and ZEB2. A similar trend was noted in NMIBC. Median miRNA-200c expression was low in both high-grade and low-grade NMIBC compared to peritumoral bladder tissue and was not statistically significant.

Conclusion:

This study for the first time explores the relation of miR200C with E-cadherin, b-catenin, and its direct transcriptional regulators, namely Zeb1, Zeb2, and Twist in the same cohort of BC. We observed that miRNA-200c is downregulated in both MIBC and NMIBC. We identified novel expression of TWIST in cases of BC showing downregulation of miR200Cs suggesting that it is one of the protein targets of altered miRNA-200c expression contributing to EMT and can serve as a promising diagnostic marker and therapeutic target. Loss of E-cadherin and ZEB1 immunoexpression in high-grade NMIBC suggests an aggressive clinical behavior. However, ZEB2 heterogeneous expression in BC limits its diagnostic and prognostic utility.
Prostatic adenocarcinoma in a patient with persistent Müllerian duct syndrome
Authors: Umair Muhammad , Khan Ahsan U. , Arruda John B. , Lakhani Dhairya A. , Adelanwa Ayodele , Hadi Yousaf B. , Markovich Brian , Salkini Mohamad Waseem
Published: May 2024

The embryonal male sexual differentiation is driven by testosterone, and Anti-Müllerian hormone (AMH). AMH is responsible for regression of Müllerian ducts in a genetically male fetus. Mutations inactivating AMH or its receptors are responsible for persistent Müllerian duct syndrome (PMDS) in virilized 46, XY males. PMDS is a rare genetic disorder affecting males, with less than 300 cases described in literature. The syndrome is usually recognized early in life with patients present with bilateral undescended testicles, and often decreased testosterone production by Leydig cells later in life. The role of testosterone in the development and progression of prostate cancer is well established, and men with low circulating free testosterone are expected to have a lower risk of developing prostate cancer. Indeed, 2 cases of prostate cancer in patients with PMDS have previously been described. Herein, we are reporting the third of prostate cancer in patient with PMDS.
Role of videourodynamics in the identification of causes of lower urinary tract symptoms and low uroflow in young men
Authors: Gupta Naveen Kumar , Gaur Shantanu , Pal Dilip Kumar
Published: May 2024

Introduction:

The etiology of lower urinary tract symptoms (LUTS) is multifactorial with causes attributed either to the dysfunction of the bladder or its outlet. Although the etiologies are well studied in aged men, very limited research trials are available in young men with LUTS. Most of the time young men presenting with chronic irritative or obstructive symptoms are labeled with chronic prostatitis or prostatodynia and are treated empirically. In this study using videourodynamics, we prospectively investigated the etiologies of LUTS and low uroflow in young men.

Materials and Methods:

Fifty male patients, 18–50 years of age attending the urology outpatient department at a tertiary care center from January 2021 to December 2021 with symptoms suggestive of chronic LUTS and low uroflow (maximum urinary flow rate [Qmax] <15 ml/s at a voided volume >150 ml) were included in the study and underwent multichannel videourodynamic study (VUDS). Clinical characteristics and urodynamic results in different diagnostic groups were tabulated and analyzed. The P ≤ 0.05 was considered statistically significant.

Results:

Out of 50 enrolled patients, primary bladder neck obstruction was seen in 21 patients (42%), dysfunctional voiding in 14 (28%), impaired detrusor contractility (IDC) in 9 (18%), and benign prostatic obstruction (BPO) was noted in 6 patients (12%). The mean age and size of the prostate of patients with BPO were greater than those in the remaining groups and patients with IDC had lower Qmax and Pdet at Qmax than those in the remaining patients.

Conclusion:

Chronic LUTS in young men has a variety of underlying etiologies and VUDS in this population is helpful in attaining an accurate diagnosis and thus may guide toward efficient management.
Evaluation of a nitinol stone retrieval basket as an alternative to biopsy forceps for biopsy of suspected upper tract genitourinary malignancies
Authors: McClelland Daniel J. , Spencer Raven D. , McArdle Ian W. , Luchey Adam M. , Barnard John T. , Hajiran Ali J. , Crigger Chad B. , Agarwal Gautum , Morley Chad E.
Published: May 2024

Background:

The anatomical nature of the ureteroscopic approach for biopsy of upper urothelial tract tumors requires the utilization of small instruments, often limiting biopsy specimen quality. This leads to lower-than-desired tumor grading accuracy and malignancy detection capabilities on the initial evaluation of upper tract tumor specimens. This is problematic because optimal treatment of upper tract urothelial carcinoma (UTUC) depends on early disease detection and subsequent accurate diagnosis.

Objective:

The objective of our study was to compare the biopsy capabilities of two ureteroscopic biopsy instruments – biopsy forceps and the nitinol stone retrieval basket.

Methods:

We performed a retrospective analysis of ten patients who underwent biopsy of an upper tract mass with either instrument. Average specimen size, muscularis propria presence, and malignancy detection sensitivity were the variables of interest.

Results:

The nitinol stone retrieval basket obtained larger biopsy samples than the biopsy forceps, with average biopsy volumes being 0.0674 cm3 and 0.0075 cm3, respectively (P = 0.00017); this was the only statistically significant result of our study. Muscularis propria was present in 31% (4/13) of the biopsies with the nitinol stone retrieval basket, whereas 0% (0/5) of the biopsy forceps biopsies contained muscularis propria (P = 0.2778). Regarding malignancy detection sensitivity, the nitinol stone retrieval basket biopsies identified malignancy in 100% of the specimens that had confirmed malignancy; the biopsy forceps only detected malignancy 40% of the time (P = 0.4134).

Conclusion:

These findings suggest that the nitinol stone retrieval basket is a useful diagnostic tool for UTUC, although further investigation is warranted to determine its superiority compared to biopsy forceps.
Incidence, predictors, and 30-day outcomes of Clostridioides difficile infection in patients undergoing cystectomy: A national database analysis
Authors: Mansoor Armaghan-e-Rehman , Hadi Yousaf Bashir , Sarwari Arif R. , Salkini Mohamad Waseem
Published: May 2024

Clostridioides difficile infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all P < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.
Synergistic Effects of Cinnamomum verum and Stingless Bee Honey on Isoproterenol-induced Cardiac Hypertrophic Murine Model
Authors: Padmanabhan Arul Mozhi , Doss Victor Arokia
Published: May 2024

Objective:

This study aimed to validate the synergistic effects of Cinnamomum verum (C. verum) barks and stingless bee honey (SBH) against cardiac hypertrophy (CH).

Materials and Methods:

Isoproterenol (ISO-group II-30 mg/kg)-induced cardiac hypertrophic Wistar rats were used in this study. Hypertrophic rats were treated using the reference drug losartan (LOS Group III: 50 mg/kg) and aqueous extracts of C. verum barks and SBH (ACH Group IV: 250 mg/kg and 250 mg/kg). CH was characterized by electrocardiography, hypertrophic indices, and biochemical estimations such as total glucose, protein, albumin, lipid profiles, cardiac marker enzymes, and histopathological studies.

Results:

Rats received ISO had increased levels of glucose, protein, cholesterol, triglycerides, very low-density lipoprotein, and low-density lipoprotein, coupled with decreased levels of albumin and high-density lipoprotein. These levels were restored to near normal when treated with ACH extracts of the standard drugs. Contrary to the ISO-induced myocardial damaged hearts, ACH extracts had a profound effect compared to LOS, which was also reflected in histopathological studies.

Conclusion:

These data explicitly reveal that the ACH have a synergistic cardioprotective (antihypertrophic) effect.
Protective Effect of Shenfu Injection against Sepsis-induced Acute Lung Injury by Suppressing Inflammation and Apoptosis Through the Regulation of the Janus Kinase 2/Signal Transducer and Activator of Transcription 3 Pathway
Authors: Cao Li-Juan , Xie Hai-Tang , Chu Zhong-Xia , Ma Yue , Wang Ming-Ming , Zhuang Shi
Published: May 2024

Objective:

Sepsis-induced acute lung injury (ALI) is a clinically critical condition with a high mortality rate. Shenfu injection (SFI) is a Chinese herbal medicine extracted from red ginseng and Aconite, Radix Aconiti, with various pharmacological activities. This study aimed to investigate the potential mechanism of action of SFI in preventing sepsis-induced ALI.

Materials and Methods:

We established a mouse model of sepsis-induced ALI by cecal ligation and puncture (CLP). The mice were randomly divided into three groups (n = 8): Sham, CLP, and SFI (10 mL/kg). Bronchoalveolar lavage fluid (BALF) and lung tissue were collected for pathological analysis, enzyme-linked immunosorbent assay, immunohistochemistry (IHC), and protein detection.

Results:

Our results showed that SFI significantly ameliorated pathological damage caused by CLP-induced ALI. SFI treatment significantly decreased the lung wet-to-dry weight ratio. In addition, SFI treatment significantly reduced the protein levels and cell numbers in the BALF. SFI could significantly reduce the levels of tumor necrosis factor-α, interleukin-6 (IL-6), and IL-1β in plasma and BALF. SFI significantly reduced the protein expression of Bax and cleaved caspase-3 and increased the protein levels of Bcl-2. Western blotting and IHC results showed that SFI reduced the phosphorylation of Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3).

Conclusions:

In a septic ALI mouse model, SFI inhibited apoptosis and inflammation through the JAK2/STAT3 pathway, providing a candidate drug for the treatment of septic ALI.