bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-Life Disability-Adjusted Life Years (DALY) Capture the Disability of Epilepsy Better from an Individual's Perspective
Authors: Sumedha Maturu Mohan V. , Thomas Sanjeev V. , Sarma P Sankara , Arjun S
Published: August 2023

Background and Objective:

For 1.3 billion population in India, there are only scarce reports on disability of epilepsy using disability-adjusted life year (DALY) as a measure. Our objective was to estimate DALY using real-life data over a period of time for a cohort of people with epilepsy (PWE) admitted to an Epilepsy Monitoring Unit (EMU) of a tertiary care epilepsy center.

Materials and Methods:

We ascertained survival status as on December 31, 2016 of all eligible admissions to the EMU between 01/01/2005 and 12/31/2015. We examined the medical records of randomly selected 200 of the 1970 survivors and all the expired PWE (n = 40) for clinical characteristics. The cumulative real-life DALY (cr-DALY) for individual was calculated as the sum of the years lost to disability (YLD) and the years of life lost (YLL). Annual population-based DALY (p-DALY) was estimated from the cr-DALY, total patient-years of follow-up, and regional population prevalence.

Results:

The cr-DALY per PWE was 17.63 (generalized seizures only). The cr-DALY increased by 23.7% when all seizure types were considered (23.12). PWE with epilepsy onset <10 years of age, focal epilepsy (particularly, extratemporal lobe epilepsy), and premature death had significantly higher cr-DALY. Those who underwent surgery for epilepsy or achieved remission had significantly lower cr-DALY. The computed p-DALY was 583/1,00,000 population (generalized epilepsy contributed 165/1,00,000 population; focal epilepsy contributed 418/1,00,000 population).

Conclusion:

Our study had identified, for the first time, several determinants that reduced DALY significantly. Real-life DALY, rather than prevalence-based DALY, captures the cumulative disability of affected individuals. Epilepsy leads to loss of 23 years of disability-adjusted life span for the affected person. This can be extrapolated to substantial economic benefits.
Brain Tumor Detection using Deep Learning Approach
Authors: Sahoo Debendra Kumar , Mishra Satyasish , Mohanty Mihir Narayan , Behera Rajesh Kumar , Dhar Srikant Kumar
Published: August 2023

Early detection of brain tumor has an important role in further developing therapeutic outcomes, and hence functioning in endurance tolerance. Physically evaluating the various reversion imaging (magnetic resonance imaging [MRI]) images that are regularly distributed at the center is a problematic cycle. Along these lines, there is a significant need for PC-assisted strategies with improved accuracy for early detection of cancer. PC-backed brain cancer detection from MR images including growth location, division, and order processes. In recent years, many inquiries have turned to zero in traditional or outdated AI procedures for brain development findings. Presently, there has been an interest in using in-depth learning strategies to detect cerebral growths with an excellent accuracy and heart rate. This review presents a far-reaching audit of traditional AI strategies and in-depth study methods for diagnosing brain cancer. This research paper distinguishes three main benefits i.e. exhibition, estimation and measurements of brain tumour detection.
Effects of Vitamin D on Migraine
Authors: Das Saibal , Roy Ayan , Behera Sapan Kumar , Selvarajan Sandhiya , Kamalanathan Sadishkumar , Sahoo Jaya Prakash , Nair N Sreekumaran
Published: August 2023

Objective:

The aim of this study was to evaluate the difference in mean serum 25-hydroxy vitamin D level between migraineurs and nonmigraineurs, the association between hypovitaminosis D and migraine, and the effects of oral vitamin D supplementation on migraine-related symptoms as compared to placebo.

Methods:

Relevant databases were searched for observational studies and randomized-controlled trials (RCTs) which evaluated the difference in mean serum 25-hydroxy vitamin D level between migraineurs and nonmigraineurs; the association between hypovitaminosis D and migraine; and the effects of vitamin D supplementation on migraine-frequency, duration, and severity. Pooled mean difference and odds ratio were calculated (random-effects model, RevMan version 5.3).

Results:

Ten observational studies and two RCTs were included. The serum 25-hydroxy vitamin D level in the migraineurs was significantly lower than that in the nonmigraineurs [mean difference − 4.44 ng/mL (95% CI: −6.11, −2.77)] (low-GRADE evidence). Hypovitaminosis D was found to be significantly associated with migraine [OR: 1.95 (95% CI: 1.07, 3.58)] (low-GRADE evidence). As compared to placebo, oral vitamin D supplementation significantly reduced the monthly migraine-frequency [mean difference: −2.20 (95% CI: −3.04, −1.36)]

,

although it did not reduce the migraine-duration [mean difference: −16.00 hours per month (95% CI: −42.77, 10.76)] and migraine-severity score [standardized mean difference: −0.23 (95% CI: −0.79, 0.32)] (moderate-GRADE evidence).

Conclusion:

Serum 25-hydroxy vitamin D level was significantly lower in the migraineurs than that in the nonmigraineurs, and hypovitaminosis D was significantly associated with migraine. Oral vitamin D supplementation significantly reduced migraine-frequency, but not its duration and severity.
Long-Segment Intradural Extramedullary Teratoma of Dorsolumbar Spinal Cord in an Adolescent
Authors: Senapati Debadutta , Mishra Sanjib , Shukla Nishant K , Behera Tapaprakash
Published: August 2023

Spinal intradural extramedullary teratomas are rare tumors arising from more than one germ cell layers and are more common in children than in older age groups. Teratomas are more commonly seen in intracranial compartment and are extremely rare in the spine. They are difficult to diagnose pre-operatively and the definitive diagnosis is usually done by histopathologic evaluation. Intraspinal teratomas should be considered in the differential diagnosis of any intradural extramedullary tumor of the spine. We reviewed the literature and reported a rare case of intradural extramedullary teratoma in an adolescent located in dorsolumbar spine without any history of prior spinal procedure.
Comparison of the Degree of Expanded Spinal Canal Area between the Hinge-Side Area and the Open-Side Area in Cervical Open-Door Laminoplasty
Authors: Doi Kazuma , Mizuno Junichi , Ohara Yukoh , Tani Satoshi
Published: August 2023

Background:

There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion between the hinge-side area (Area H) and the open-side area (Area O) has been reported. This study aimed to measure the spinal CSA expansion between Area H and Area O retrospectively after open-door laminoplasty using new titanium spacers and evaluated this common decompression procedure's effectiveness.

Materials and Methods:

This study included 27 patients diagnosed with cervical spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and developmental canal stenosis from February 2021 to October 2022. The CSA difference between pre- and post-cervical laminoplasty (C4–C6 levels) was measured with cervical transverse computed tomography scan images. The CSA difference in Area H and Area O between pre- and post-laminoplasty was similarly calculated.

Results:

The spinal canal areas of each segment after open-door laminoplasty were significantly enlarged (P < 0.05). Area O was also significantly enlarged compared to that of Area H (P < 0.05).

Conclusion:

Area O was more enlarged than Area H, and both sides were statistically enlarged after open-door laminoplasty.
Diffusion Restriction in Bilateral Thalami
Authors: Shaik Reshma S , Manorenj Sandhya , Marupaka Sravan K. , Ara Tasneem
Published: August 2023

Background:

Bilateral thalamic infarction, especially the medial thalamus, has been characteristically described in the artery of Percheron (AOP) affection. However, bilateral thalamic restriction has been described in many entities beyond the AOP infarction.

Objective:

Here we describe a case series (three cases) with infection as an etiology for bilateral thalamic lesions in the topographic distribution of the AOP from a tertiary care center in tropical India.

Materials and Methods:

Case series during a 1-year period collecting cases with bilateral thalamic diffusion restriction on MRI who did not have thalamic infarcts and their outcomes.

Results:

Bilateral thalamic lesion can occur in both bacterial and viral infections such as tuberculosis, dengue, and SARS-COV-2. Thus, we intend to add infections as one of the etiologies in the ever-expanding list of conditions that produce bilateral thalamic restriction.

Conclusions:

All the acute symmetric thalamic lesions are not always secondary to vascular insult. Accurate assessment and prompt diagnosis can prevent unnecessary delays in treatment. To our knowledge, this is the first case series in the literature that throws light on the bilateral thalamic lesions in the topographic distribution of the AOP secondary to infections in a tropical country like India.
Could the Cerebral Involvement of COVID-19 Disease be Related to Microstructural Changes that are not Reflected in Conventional MRI Images?
Authors: Celiker Fatma B , Kanat Ayhan , Turan Arzu , Beyazal Mehmet , Burakgazi Gulen , Hursoy Nur , Gundogdu Hasan , Polat Hatice B
Published: August 2023

In patients with COVID-19, neurodegeneration may develop before clinical symptoms appear. Diffusion-weighted (DW) MRI is an important technique for analyzing microstructural changes such as gliosis. In this study, a quantitative evaluation of microstructural changes in the brain with apparent diffusion coefficient (ADC) values in patients presenting with a headache after the COVID-19 disease was analyzed and compared. DW MR images of patients of 20 COVID-19 patients (13 females, 7 males) who required imaging due to headache; 20 controls (16 females, 4 males) were retrospectively reevaluated. ADC measurements were taken from 16 regions of the brain, including right and left symmetrical in patients with COVID-19 infections and control groups. All regions of interest (ROIs) were taken from the hypothalamus, parahippocampus, thalamus, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, and medulla oblongata posterior. ADC values in the dentate nucleus right (784.6 ± 75.7 vs. 717.25 ± 50.75), dentate nucleus left (768.05 ± 69.76 vs. 711.40 ± 52.99), right thalamus (731.15 ± 38.14 vs. 701.60 ± 43.65), left thalamus (744.05 ± 39.00 vs. 702.85 ± 28.88), right parahippocampus (789.10 ± 56.35 vs. 754.75 ± 33.78), right corpus striatum (710.00 ± 39.81 vs. 681.55 ± 39.84) were significantly higher than those in the control group. No significant changes were observed in other areas. A significant increase in ADC values at many levels in the brain in patients with COVID-19 disease and headache was observed. Thus, this study indicates that cerebral involvement in COVID-19 disease may be related to microstructural changes that are not reflected in conventional MRI images.
Evaluation of Invasive Tumour Front in Primary and Secondary Oral Squamous Cell Carcinoma – A Reliable Prognostic Parameter
Authors: Joshi Hemal , Parikh Neelampari , Nandini C , Bhatt Garima , Jain Sandeep , Parmar Ashwini
Published: August 2023

Introduction:

Oral squamous cell carcinoma (OSCC) is the most common malignant epithelial neoplasm affecting the oral cavity. Recent work indicates that morphological and molecular characteristics of tumour cells at invasive tumor fronts (ITF) underlie the biological aggressiveness of OSCC. The aim of the study was to compare the pattern of invasion (POI) (Type I to V) at tumour–host interface in 150 primary and 50 secondary OSCC cases.

Materials and Methods:

Both pre-dominant POI and worst POI was evaluated in all cases. Pre-dominant pattern of invasion and worst pattern of invasion (WPOI) were compared with Broder's grading system. Statistical analysis was done using a statistical software package (SPSS) and Fisher's exact test.

Results:

Results showed that the WPOI pattern also moves towards higher scores as the grade increases.

Conclusion:

We thus conclude that POI could serve as an individual prognostic marker irrespective of the histologic differentiation of the tumour.
Disability assessment in the persons with schizophrenia: Inter-rater agreement and correlation between self-, proxy-, and interviewer-rated versions of the World Health Organization Disability Assessment Schedule 2.0
Authors: Paul Fayaz Ahmad , Ali Arif
Published: August 2023

Background:

Schizophrenia has been described as the most disabling mental disorder, and patients with schizophrenia have been said to be disabled mostly in occupation, sexual relation, self-care, and social relationship domains.

Aim:

The present study aimed at assessing disability through self-, proxy-, and interviewer-rated versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 among persons with schizophrenia.

Materials and Methods:

The study was cross-sectional. Thirty samples of patients with schizophrenia as per the International Classification of Diseases-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included in the study. The study was conducted at the Outpatient Department of Mental Health Institute and Department of Psychiatry, Government Medical College and Hospital Sector 32, Chandigarh, India.

Results:

The overall inter-rater reliability in schizophrenia was 0.599 (0.395–0.767), indicative of moderate reliability. Domains, namely, getting along with people (0.803) and life activities of household (0.854) had a good reliability, whereas domains such as cognition (0.681), mobility (0.616), self-care (0.636), life activities at school/work (0.664), and participation in the society (0.753) indicated a moderate reliability.

Conclusion:

There was no significant difference among the self, proxy, and interviewer assessments for most items. This study highlighted the fact that service users can also carry out an objective self-assessment of disability, thus upholding the principles of advanced directives as envisaged under the Mental Health Care Act, 2017.
Assessment of mental health among hospital-discharged patients of COVID-19 in North India: A cross-sectional study
Authors: Kour Preeti , Singh Manmeet , Sahni Bhavna
Published: August 2023

Background:

Psychological impact of COVID-19 is an emerging area of interest among researchers worldwide. We aimed to study the prevalence of anxiety and depression among COVID-19 survivors and its association with individual characteristics including demographic variables.

Methods:

One hundred and fifty COVID-19 survivors from a tertiary care hospital were contacted to collect information regarding anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) scale and Patient Health Questionnaire-9 (PHQ-9). The Pearson’s Chi-square was used for univariate analysis of categorical variables. The Mann–Whitney test was used to check the significance between group medians.

Results:

21.3% of the survivors (n = 32) reported postdischarge COVID-19 anxiety. Mild, moderate, and moderately severe anxiety was reported by 17.3%, 3.3%, and 0.7% of the patients, respectively, on using the GAD-7 questionnaire. PHQ-9 revealed that 29.3% (n = 44) had depression. Minimal, mild, moderate, and moderately severe depression was reported by 19.3%, 24.0%, 2.0%, and 3.3% of the respondents, respectively. None of the survivors had severe anxiety or depression. In both the questionnaires, variation in median scores was statistically significant with age, whereas for GAD-7 scores, the difference in median scores was statistically significant only for gender. On analysis, age above 40 years was a statistically significant determinant for both anxiety (P = 0.041) and depression (P = 0.018) while male gender showed a statistically significant association in case of anxiety (P = 0.028). The correlation between age and respective scores and GAD-7 scores and PHQ-9 scores was also found to be significant (P < 0.001).

Conclusion:

These preliminary screening results provide convincing evidence of anxiety and depression among COVID-19 survivors, thus reiterating the need of timely detection and management of mental health issues through formulation of strategies to tackle the concurrent psychological comorbidities amid the ongoing pandemic.
Nicolau syndrome: A dreaded complication of vitamin-12 injection
Authors: Harode Shantanu , Jain Sonia P. , Ambulkar Aditya
Published: August 2023

Nicolau syndrome, often referred to as embolia cutis medicamentosa or livedoid dermatitis, is an uncommon cutaneous adverse drug reaction that develops at the site of injection of some specific pharmaceuticals. Commonly seen with NSAIDS given intra-muscularly, it can be observed with a variety of drugs given subcutaneously, intra-articularly and sometimes intravenously. Here, we present a rare case of Nicolau syndrome following an intramuscular injection of Vitamin B-12 over gluteal region that turned out to be fatal.
Clinical patterns of cutaneous adverse drug reactions in tertiary care centre of central India: A cross-sectional study
Authors: Roge Rakesh P. , Mukhi Jayesh Ishwardas , Mamidwar Sudhir M. , Rokade Pallavi Rupkumar , Supekar Bhagyashree Babanrao
Published: August 2023

Introduction:

Cutaneous adverse drug reactions (CADRs) are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated.

Aim and Objectives:

To study the morphological patterns of various types of CADRs.

Materials and Methods:

It was a descriptive cross-sectional study carried out from November 2017 to September 2019, where medical records of diagnosed cases of CADRs were analyzed in a predesigned proforma with respect to demographic data, clinical features, treatment history (topical and oral), offending drug, temporal association with a skin eruption, investigations, and treatment outcome. Statistical analysis was done using mean, median, and proportion.

Results:

A total of 180 patients with CADRs were enrolled. There was a male preponderance with the mean age being 32.9 ± 2.9 years. The most common CADR reported was fixed drug eruption (n = 77). Steven Johnson syndrome was the most common (n = 7) severe cutaneous adverse reaction. The mean duration of latency was 6.2 (±8.61 days). Antimicrobial drugs accounted for most of the benign as well as severe CADRs (41.4%). Among all cases, 43.9% of patients had mild CADR and 16.7% had severe CADR. Causality assessment using the Naranjo adverse drug reaction probability scale, 70% had a possible association, 18.3% probable and 11.7% had a doubtful association.

Conclusion:

Early identification of CADR is important to reduce morbidity and mortality. Patient education is required to avoid self-administration of drugs and re-administration of the same offending drugs to prevent further morbidity. Immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving.
Evaluating the efficacy of apremilast combined with low-dose steroids versus combination of apremilast with low-dose steroids and low-dose aspirin for selected cases in the management of erythema nodusum leprosum: A pilot study
Authors: Patil Nitin Krishna , Bubna Aditya Kumar
Published: August 2023

Background:

Erythema nodosum leprosum (ENL) is a reactional state observed in the lepromatous spectrum of leprosy. Currently, systemic steroids and thalidomide constitute the backbone of ENL therapy.

Aim:

The aim of this study was to evaluate the efficacy of apremilast as a standalone steroid-sparing drug for ENL and its combination with aspirin for selected cases.

Materials and Methods:

This was a pilot study on 10 patients having recrudescence of ENL following reduction of prednisolone dose to 20mg. Apremilast (30 mg twice daily) was administered to these patients as prednisolone was gradually tapered. The severity of ENL was evaluated based on the 16-item ENLIST ENL Severity Scale (EESS). If the EESS score reduced to zero with 20 mg of prednisolone following apremilast addition, patients were considered apremilast responsive. In case the EESS score reduced by> 50% then low-dose aspirin was added to the therapeutic regimen with gradual taper of steroids, and patients were accordingly evaluated. Those patients not responding to apremilast were labeled non-responders and were switched to thalidomide after appropriate investigations.

Results:

Out of 10 patients, 1 demonstrated complete clinical response with apremilast. In 5 patients the EESS score with apremilast had reduced by 50% or more; and following the addition of low-dose aspirin complete clinical cure was obtained. The remaining 4 patients were apremilast unresponsive.

Conclusion:

Apremilast may not be an effective standalone steroid-sparing drug for ENL in all patients. EESS scoring is a valuable tool in assessing treatment responses in all patients with ENL. Low-dose aspirin shows efficacy in those ENL patients demonstrating partial response to apremilast.
Silodosin as a medical expulsive therapy for distal ureteral stones
Authors: Ramadhani Muhammad Zaniar , Kloping Yudhistira Pradnyan , Rahman Ilham Akbar , Yogiswara Niwanda , Soebadi Mohammad Ayodhia , Renaldo Johan
Published: August 2023

Introduction:

Tamsulosin is the most commonly used medical expulsive therapy (MET). However, it does not alleviate ureteral colic. It is important to develop MET that can reduce ureteral colic while maintaining a high stone clearance rate. Silodosin is an α1A adrenoceptor with high affinity and selectivity for the distal ureter, which may reduce ureteral colic and enable stone expulsion for distal ureteral stones. Therefore, we performed this systematic review and meta-analysis to evaluate the efficacy of silodosin as MET and its role in reducing ureteral colic among patients with distal ureteral stones.

Materials and Methods:

This research was conducted in accordance with the Cochrane Handbook for Systematic Review and Intervention, in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021249003). A comprehensive literature search was performed in several databases including Medline, EMBASE, and Scopus up to July 2021 for randomized trials comparing silodosin with placebo for MET. RevMan 5.4 was used for data analysis.

Results:

A total of six randomized controlled trials were included in this analysis with a total of 907 patients. Our analysis revealed that the patients who received silodosin had significantly higher stone expulsion rate (SER) (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.34, 4.76, P < 0.01), significantly shorter stone expulsion time (SET) (mean difference −3.79, 95% CI −4.51, −3.06, P < 0.01), and lower analgesic use (OR 0.4, 95% CI 0.23, 0.69, P < 0.01) compared to the group receiving placebo.

Conclusion:

Silodosin showed significantly higher SER, lower SET and lower analgesic use in patients with distal ureteral stones as compared to a placebo.
Continuous ambulatory peritoneal dialysis catheter insertion by open technique
Authors: Pahwa Mrinal , Singh Mahendra , Tyagi Vipin , Gupta Manu , Jain Saurabh , Chaddha Sudhir , Jauhari Harsha
Published: August 2023

Introduction:

Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is a part of renal replacement therapy. We describe our 20-year experience in using the open technique and assess its safety, efficacy, and outcome in the treatment of end-stage renal disease patients.

Methods:

In a retrospective study, we analyzed data of all patients who had a CAPD catheter placed using our open dissection technique using local anesthesia over the previous 20 years, with minimum 1 year of follow-up. Intraoperative data, postoperative data, and complications were noted.

Results:

A total of 1410 cases were included in the study. The mean duration of follow-up was 72 ± 18 months (range 12–120 months). The mean operative time was 19 ± 7.5 min and mean hospital stay was 3 ± 1 days. No major intraoperative complications were noted. We observed a peritonitis rate of 0.49 episodes/patient/year. The most common reason for permanent catheter removal was refractory peritonitis in 21%, followed by flow failure in 7%, and ultrafiltration failure in 6.5%. The death-censored technical survival rate was 94.3%, 83.2%, 75.9%, 69.2%, and 60.6% patients at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively.

Conclusions:

The open dissection method of peritoneal dialysis catheter insertion using local anesthesia at well-experienced center is a simple, painless, and uncomplicated procedure with excellent outcomes. Optimal exposure, judicious use of energy source, and using appropriate technique provide good technical success rate with lesser complications.
Urodynamics in the evaluation of lower urinary tract symptoms in young adult men: A systematic review
Authors: Singh Gurpremjit , Mittal Ankur , Sinha Sanjay , Panwar Vikas Kumar , Bhadoria Ajeet Singh , Mandal Arup Kumar
Published: August 2023

Introduction:

This review aims to systematically evaluate the available evidence on the different urodynamic diagnoses of lower urinary tract symptoms (LUTS) in young adult men aged 18–50 years and to summarize the various urodynamic parameters based on these diagnoses.

Methods:

This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement and the search was performed in PubMed, Embase, and Cochrane library from inception till September 2021. A total of 295 records were identified using a combination of keywords such as LUTS, urodynamics (UDS), and young males. The review was registered in PROSPERO (CRD42021214045).

Results:

All the ten studies, which were included in this analysis, categorised the patients into either of the four primary diagnoses after the UDS – primary bladder neck obstruction (PBNO), dysfunctional voiding, detrusor underactivity (DU), or detrusor overactivity. Five of these studies used the conventional UDS, and in the other five a video UDS was performed. The most common abnormality on the conventional UDS was DU with a pooled estimate of 0.24 (95% confidence interval [CI] - 0.104–0.463, I2-95.35, (τ2-1.07). The most common abnormality on the video UDS was PBNO with a pooled estimate of 0.49 (95% CI - 0.413–0.580, I2-66.59, 2-0.09). The point estimates of various UDS parameters were also recorded.

Conclusion:

A urodynamic diagnosis was possible in 79% and 98% of the young men who underwent a conventional UDS or a video UDS, respectively. However, the men subjected to the conventional UDS and the video UDS had significant differences in their primary urodynamic diagnostic label. These results will help to plan future trials for the evaluation and management of LUTS in young men.
Perioperative, oncological, and survival outcomes of robotic radical cystectomy with urinary diversion in females
Authors: Agarwal Varun V. , Thyavihally B. Yuvaraja , Waigankar Santosh Subhash , Dev Preetham , Pednekar Abhinav P. , Roy Diptiman , Athikari Nevitha , Hastak Meenal , Badlani Naresh , Pokharkar D. Harshwardhan , Ayyalasomayajula Nagaraja Sekhar , Khandekar Archan , Asari Ashish
Published: August 2023

Introduction:

Robot-assisted radical cystectomy (RARC) is a standrad approach for surgical management of bladder cancer. Currently, most literature on RARC is in men, possibly due to the higher incidence of bladder cancer in males. We reviewed the perioperative, oncological and survival outcomes in 41 women who underwent RARC by a single surgeon at a tertiary health-care center.

Methods:

Out of 225 RARC and urinary diversion procedures performed from 2012 to 2020, a retrospective analysis of 41 women was performed. Baseline demographic and perioperative details, oncological data, and survival were recorded and analyzed. Kaplan–Meir analysis was done for survival outcomes and prognostic factors were assessed by log rank test.

Results:

Thirty-eight patients underwent intracorporeal urinary diversion, while three underwent extracorporeal diversion. One patient underwent organ preserving cystectomy. Clavien–Dindo 30-day postoperative complications were Grade I in 8 (19.5%), Grade II in 4 (9.8%), and Grade IIIa in 3 (7.3%) patients with no mortality. During the median follow-up of 34 months (range: 6–87 months), 7 patients died of disease recurrence. Five-year survival was 74% (95% confidence interval [CI]: 59–82) and 35% (95% CI: 10–91) in transitional cell carcinoma (TCC) and non-TCC group, respectively, with P = 0.04. There was no mortality in Stages 0 and 1 disease. Five-year survival was 78% in Stage 2 and 41% in Stage 3 and 4.

Conclusion:

Our study demonstrates acceptable clinical, perioperative, and oncological outcomes of robotic radical cystectomy in females, thus highlighting its safety and feasibility.
Role of color Doppler assessment in predicting outcomes of wrist Brescia-Cimino arteriovenous fistula creation
Authors: Patel Priyeshkumar , Prabha Vikram , Verneker Ritesh R. , Nerli Rajendra B. , Patel Taral , Ghagane Shridhar C.
Published: August 2023

Introduction:

The most common reason for constructing an arteriovenous fistula (AVF) is chronic kidney disease. Various factors are associated with nonmaturation or failure of AVF, which can be evaluated using color Doppler/duplex ultrasound (DUS). We carried out this study to evaluate the role of pre- and postoperative DUS for the prediction of outcomes of wrist radiocephalic (RC) AVF.

Methods:

In our prospective observational study, dialysis-dependent patients between 20 and 70 years of age undergoing primary RC-AVF from May 2019 to July 2020 were included. All patients underwent pre- and postoperative DUS examination after obtaining consent.

Results:

Among 104 participants, 87 (83.7%) were male and 17 (16.3%) were female. Successful maturation was seen in 68 (65.4%) participants, whereas 90 (86.53%) had functional maturation. Radial artery diameter (RAD) ≥1.6 mm, cephalic vein diameter (CVD) ≥2.0 mm, vein distensibility (VD) ≥0.5 mm, and peak systolic velocity (PSV) RAD ≥30 cm/s were associated with higher successful maturation of AVF with statistically significant results (P < 0.05). RAD ≥1.6 mm, CVD ≥2.0 mm, VD ≥0.5 mm, and PSV RAD ≥30 cm/s were related to a greater probability of RC-AVF maturation. Among them, VD and PSV-RA were the most influencing factors predicting RC-AVF successful maturation.

Conclusions:

If we consider the rule of six for AVF maturation, then the results will be much less than the actual fistulas which are dialyzable with adequate blood flow as per functional maturation criteria. Thus, more randomized studies are needed to define maturation criteria for the Indian population and to identify the effect of papaverine on successful AVF maturation.
Xanthogranulomatous epididymo-orchitis
Authors: Vijayvergiya Garima , Gulwani Hanni Vasudev , Ul Hasan Shariq
Published: August 2023

Introduction:

Xanthogranulomatous inflammation is a rare nonneoplastic and chronic inflammatory process, characterized by proliferation of foamy macrophages resulting in damage and necrosis of the affected tissue. Involvement of the testis/epididymis by the disease is a rare event.

Methods:

A case series of four male patients diagnosed with xanthogranulomatous epididymitis/orchitis (XGEO) at our institute was reviewed. In addition, a systematic review of XGEO was carried out using PRISMA Guidelines 2020. Twenty-nine articles describing 38 patients of XGEO were included in the study.

Results:

XGEO usually has a subacute or chronic presentation and affects male individuals in the 5th or 6th decades of life. The disease is also known to occur in the pediatric age group. The patients present with swelling, tenderness, or pain in the scrotal region. Bilateral involvement has also been documented. Thirty patients were known to have one or more causal risk factors including diabetes mellitus (23.7%), spinal cord injury/neuropathic bladder (7.9%), prostatectomy (7.9%), trauma (4.1%), and transurethral resection of prostate procedure (4.1%). Complications observed were scrotal fistula, adhesions, and abscess formation. Radiological features reported are nonspecific and include heterogeneous echotexture, hypoechoic areas, and/or scrotal wall collections. Bacterial microorganisms isolated from the affected tissue demonstrated the presence of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Histological subtypes of XGEO are diffuse and focal. In the diffuse subtype, which is more common, there is extensive parenchymal destruction by inflammatory process accompanied by widespread ischemic necrosis.

Conclusion:

The mainstay of treatment in XGEO cases is surgical excision preferably orchidectomy. Conservative management has been attempted in young individuals and in patients with focal XGEO, but there is limited supporting evidence. We present data of four cases along with detailed systematic review of the disease examining its clinicopathological behavior and associated risk factors followed by operative approach.
Peri-operative antibiotic usage during endourological surgery: A multi-institutional, national-level, cross-sectional audit of prevalent practice pattern in India
Authors: Nayyar Rishi , Kumar Shritosh ,   Collaborative Working Group on Use of Antibiotics in Endourology
Published: August 2023

Introduction:

Antibiotic use during endourological procedures is often discordant from the reported guidelines, despite the potential risks of antibiotic resistance, adverse effects, and health-care costs. A nationwide audit was conducted, with the support of the Urological Society of India, to ascertain the current antibiotic prescription practices for the endourological procedures and the reasons associated with them.

Methods:

A multi-institutional, national-level, cross-sectional audit analyzing elective endourological procedures was performed. The data regarding the disease profile; risk factors for infectious complications; urine culture; pre-, per-, and post-operative antibiotic use; additional antibiotic use; and patient demographics were collected in a standardized pro forma. Reasons for prescribing antibiotics divergent from the guideline recommendations were also noted. Any infectious complication that necessitated the antibiotic use was also noted prospectively up to 1 month. All the data were entered into a single centralized and customized online portal on a real-time basis.

Results:

One thousand five hundred and thirty-eight cases were recruited from 20 hospitals. A single-dose prophylaxis was prescribed in only 319 (20.7%) of the cases, and the majority received a multi-day prophylaxis. A combination of two or more antibiotics was prescribed as the prophylaxis in 51% of the cases. One thousand three hundred and fifty-six (88.2%) cases were continued on a long-duration prophylaxis after the discharge, with 1191 (77.4%) receiving it for > 3 days. One thousand one hundred and sixty (75.4%) cases received a guideline-discordant prophylaxis solely on the basis of the surgeon’s or institution’s protocol, rather than any specific case based need. Ninety eight (6.4%) cases developed postoperative urinary tract infection.

Conclusions:

Multi-dose, combination and post-discharge antibiotic prophylaxis for endourological surgeries is highly prevalent in India. This audit highlights the huge potential to reduce such guideline-discordant overuse of antibiotics during the endourological procedures.
Overall survival of prostate cancer from Sangrur and Mansa cancer registries of Punjab state, India
Authors: Budukh Atul Madhukar , Thakur Jarnail S. , Dora Tapas Kumar , Kadam Prithviraj R. , Bagal Sonali S. , Patel Kamalesh Kumar , Goel Alok K. , Sancheti Sankalp M. , Gulia Ashish R. , Chaturvedi Pankaj P. , Dikshit Rajesh P. , Badwe Rajendra A.
Published: August 2023

Introduction:

There is a scarcity of population-based prostate cancer survival data in India. We assessed the population-based, overall survival of patients with prostate cancer from the Sangrur and Mansa cancer registries of the Punjab state, India.

Methods:

In the year 2013–2016, a total of 171 prostate cancer cases were registered in these two registries. Based on these registries, survival analysis was performed using the date of diagnosis as the starting date and the last follow-up date being December 31, 2021 or the date of death. Survival was calculated using STATA software. Relative survival was calculated using the Pohar Perme method.

Results:

Follow up was available for all the registered cases. Of the 171 cases, 41 (24%) were alive and 130 (76.0%) were dead. Of the prescribed treatments, 106 (62.7%) cases completed the treatment and 63 (37.3%) cases did not complete the treatment. Overall, 5-year age-standardized prostate cancer relative survival was 30.3%. Patients who completed the treatment had a 7.8 times higher 5-year relative survival (45.5%) compared to those who did not (5.8%). The difference between the two groups is statistically significant (hazard ratio 0.16, 95% confidence interval [0.10–0.27]).

Conclusion:

To improve survival, we need to raise awareness in the community and among primary physicians so that prostate cancer cases can reach the hospital early and should be treated effectively. The cancer center should develop the systems in their hospital so that there will be no hurdles to the patients in treatment completion. We found a low overall relative survival among patients of prostate cancer in these two registries. Patients who received treatment had a significantly higher survival.
An unusual, delayed, solitary manifestation of a penile lesion in chronic lymphocytic leukemia
Authors: Hamid Tariq Abdul , Elmekresh Amr , Bagheri Fariborz
Published: August 2023

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the adult western population. It is characterized by the proliferation of mature but dysfunctional lymphocytes, primarily CD5+ B cells. It primarily affects the reticuloendothelial system in the majority of the cases, but can rarely manifest as extranodal and extramedullary lesions. One of the rare presentations is genitourinary cutaneous infiltration, and only a handful of cases of secondary metastases to the genitourinary skin, have been reported in the literature. The current report describes a patient with solitary lesion of CLL in the penis, manifesting almost two decades after the complete treatment of CLL.
Impact of diabetes and chronic kidney disease on active surveillance outcomes for small renal masses: A cohort study
Authors: Alcalá Nicolas E. , Futral Cameron D. , Miller Caroline A. , Sinks Alexander L. , Clark Peter E. , Roy Ornob P.
Published: August 2023

Introduction:

The American Cancer Society estimates 79,000 individuals will be diagnosed with kidney cancer in 2022, most of which are initially found as small renal masses (SRMs). Proper management of SRM patients includes careful evaluation of risk factors such as medical comorbidities and renal function. To investigate the importance of these risk factors, we examined their effect on crossover to delayed intervention (DI) and overall survival (OS) in patients undergoing active surveillance (AS) for SRMs.

Methods:

This is an Institutional Review Board-approved retrospective analysis of AS patients presented at kidney tumor conferences with SRMs between 2007 and 2017. Univariable and multivariable logistic regression analyses were performed to determine how factors including estimated glomerular filtration rate (eGFR), diabetes, and chronic kidney disease are associated with DI and OS.

Results:

A total of 111 cases were reviewed. In general, AS patients were elderly and had significant comorbidities. On univariate analysis, intervention was more likely to occur in patients with a younger age (P = 0.01), better kidney function (P = 0.01), and higher tumor growth rates (GRs) (P = 0.02). Higher eGFR was associated with better survival (P = 0.03), while higher tumor GRs (P = 0.014), greater Charlson Comorbidity Index (P = 0.01), and larger tumors (P = 0.01) were associated with worse OS. Of the comorbidities, diabetes was found to be an independent predictor of worse OS (P = 0.01).

Conclusions:

Patient-level factors – such as diabetes and eGFR – are associated with the rate of DI and OS among SRM patients. Consideration of these factors may facilitate better AS protocols and improve patient outcomes for those with SRMs.
Prosthetics in urology
Authors: Cheriyan Abhilash
Published: August 2023

The field of genitourinary prosthetics has evolved rapidly to become the standard of care for conditions such as incontinence and refractory erectile dysfunction. Its scope has expanded to encompass newer indications such as Peyronie's disease and gender-affirming surgeries. This review, based on the Urological Society of India's Best Essay Award 2022, aims to elaborate on the advances in the field of urological prosthetics in the past 20 years as well as to provide an insight into ongoing research and what one can expect to see in the next decade, particularly in the area of penile and testicular prosthetics as well as treatment of incontinence. A PubMed and patent search was performed to achieve these objectives. Future considerations include improving acceptance, reliability, making them more accessible for developing countries and improving training and education to improve outcomes.
YKL-40 tissue expression in lichen planus
Authors: Doss Reham W. , Rashed Laila A. , Abdellatif Mona E.A.
Published: August 2023

Background

Lichen planus (LP) is an idiopathic chronic inflammatory disease of the skin, mucous membranes, and nails. The exact pathogenesis of LP is still unclear. Chitinase-3-like protein 1 (YKL-40) is one of the 18 glycosyl hydrolases, but lacks enzymatic activity. Recent studies have shown that YKL-40 is present at sites of inflammation and tissue remodeling, triggers immune responses, and attracts eosinophils and T cells.

Objective

To clarify a suggested role of YKL-40 in LP inflammation.

Patients and methods

This case–control study included 30 cutaneous LP patients and 30 healthy volunteers serving as controls. About 4-mm punch-skin biopsies were taken from skin lesions in LP patients and healthy skin from controls. Skin biopsies were examined for YKL-40 using PCR technique.

Results

The expression of YKL-40 in LP lesions (5.12±1.02 pg/ml) was significantly higher than their expression in control-tissue biopsies (1.02±0.05 pg/ml) (P<0.001). No significant relation was detected between the expression of YKL-40, type of LP, and the disease duration.

Conclusion

We can conclude that upregulation of YKL-40 could point to a possible role in the pathogenesis of LP.
Carcinoma en cuirasse as a first sign of underlying breast carcinoma
Authors: Bains Pooja , Monga Gagandeep S.
Published: August 2023

We report a case of a 65-year-old female who presented to the Dermatology Outpatient Clinic with large crusted indurated plaques and nodules on bilateral breast, which were sudden in onset, nonpruritic, slightly painful, and increasing in size over a period of 2 months. There was no history of any internal malignancy at the time of admission. A wedge biopsy was sent and the patient was admitted under surgery ICU with a provisional diagnosis of carcinoma en cuirasse. On the second day of admission, the patient died of respiratory failure and cardiac arrest. Hematoxylin and eosin-stained sections of biopsy were consistent with invasive ductal carcinoma breast. Carcinoma en cuirasse occurrence is normally seen during treatment of the primary breast tumor or after mastectomy. It may rarely precede the diagnosis of carcinoma of the breast. This is a rare and important case where carcinoma en cuirasse is the first manifestation of primary breast tumor.
Follicular-unit extraction hair transplantation for lymphocytic cicatricial alopecia
Authors: Soliman Mohamed M. , El-Komy Mohamed H.M. , Hassan Akmal S. , Elhady Mohamed Abd
Published: August 2023

Treatment of cicatricial alopecia resulting from lymphocytic inflammatory diseases, namely lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia is challenging. Here, follicular-unit extraction hair transplantation was successfully performed for four cases of chronic lymphocytic inflammatory diseases after quiescence of the diseases.
Assessment of serum total antioxidant status and interleukin-6 in vitiligo patients
Authors: Habib Mohammed A. , Mahdi Mohammed S. , Ibrahim Mona A.
Published: August 2023

Background

Vitiligo is an acquired pigmentary disease resulting from the loss of melanocytes. Multiple theories are suggested in the etiopathogenesis of vitiligo. Of these, autoimmune cytokine aberrations and oxidant–antioxidant imbalance are highly incriminated.

Objective

To study the serum level of total antioxidant status (TAS) and interleukin-6 (IL-6) in both active and stable vitiligo patients, and to correlate between these serum markers and between different disease characteristics.

Patients and methods

This case–control study was carried out on 25 vitiligo patients (15 with active and 10 stable vitiligo), and 25 age-matched and sex-matched healthy controls. Full history taking, general, and dermatological examination were done for all patients. Five milliliters of whole blood from all participants were collected, and TAS and IL-6 were measured by enzyme-linked immunosorbent assay.

Results

There was a highly significant difference between patients and controls regarding the TAS and IL-6 levels, with lower TAS levels and higher IL-6 levels among patients as compared with controls. Higher TAS levels were found among stable than active patients. A highly significant positive correlation was found between the duration of the last activity and TAS level, while a highly significant negative correlation was present between vitiligo disease activity score and TAS level among patients. No significant difference was found in IL-6 between active and stable patients. There was a highly significant negative correlation between TAS level and IL-6 level among all participants, while no significant correlation was found between TAS and IL-6 levels among patients.

Conclusion

Depressed TAS and elevated IL-6 levels may play a role in vitiligo pathogenesis. TAS levels are related to the disease activity and can be used as an activity marker to distinguish active from stable vitiligo patients.
Efficacy of combined use of mycophenolate mofetil and granulocyte-colony-stimulating factor in the treatment of patients with dystrophic epidermolysis bullosa
Authors: Eldarouti Mohammad , Nada Hanan R. , El-Komy Mohamed , Abdelhady Mohamed , Saadi Dina G. , Doss Sally S. , El Sayed Hagar , Mostafa Pakinam I.N.
Published: August 2023

Back

ground Patients with dystrophic epidermolysis bullosa (DEB) experience various degrees of widespread recurrent skin blistering and erosions that characteristically heal with exuberant scarring and milia formation. DEB may lead to the development of skin cancers. Advances in understanding the pathogenesis of EB in the last decade have led to the development of several therapeutic strategies.

Objective

To investigate the effectiveness of the combined use of granulocyte-colony-stimulating factor (GCSF) and mycophenolate mofetil (MMF) in the treatment of DEB and to compare our results with those of the previous studies that used either GCSF alone or MMF alone.

Patients and methods

Fifty-one patients with DEB were enrolled into this study. They were clinically assessed for total body blisters and erosions (both count and size) and scored using the Birmingham scoring system.

Results

There were significant improvements (P<0.001) with the use of combined treatment which was superior to each treatment alone.

Conclusion

Subcutaneous GCSF combined with MMF was shown to be superior to the use of either MMF or GCSF alone, in decreasing the rate of blister formation and in wound healing in patients with DEB.