Association of male lower urinary tract symptoms with metabolic syndrome: a prospective study from tertiary care centre

Background: The exact nature of the association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) is still not completely understood. There appears to be support for the hypothesis that metabolic and pathological derangements characterizing MetS can promote the development and progression of Benign Prostatic Enlargement and LUTS. Methods: A total of 212 patients were included in the study, of whom 106 (50%) had LUTS and metabolic syndrome and 106 (50%) had LUTS without metabolic syndrome. The severity of the patient抯 lower urinary tract symptoms was assessed by the International Prostate Symptom Score (IPSS). Erectile function was assessed by a 5 question International Index of Erectile Function (IIEF) Questionnaire. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII). Results: The study showed a statistically significant association between prostate volume, IPSS score, and each individual component of metabolic syndrome. There is a significant association between metabolic syndrome and sexual dysfunction in men, and the severity of lower urinary tract symptoms is correlated with the severity of erectile dysfunction in the age group in the department of urology. Conclusions: Patients with MetS, characterized by increased waist circumference, BMI, triglycerides, and decreased HDL levels, exhibited more severe Lower urinary tract symptoms, along with heightened sexual dysfunction, particularly erectile and ejaculatory dysfunction.

Unusual sites of delayed metachronous metastases from renal cell carcinoma: a case series of five cases and review of literature

Renal cell carcinoma (RCC) is the most common malignant tumour of the kidney, representing 3% of all adult malignancies. Among men it is the sixth most common cancer while among women it is the ninth most common cancer. The mainstay of treatment for localized RCC is surgical resection with curative intent. The aggressive and often insidious nature of RCC is reflected by high recurrence rates of upto 20-40% after nephrectomy. Most commonly encountered sites of recurrent metastases include the lung, followed by bone, liver, brain, and local recurrence. Atypical sites of delayed metastases of RCC, although rare, have been reported in literature. We present our series of five cases where delayed metastasis has occurred at atypical sites including right sartorius muscle, right atrium and ventricle, urinary bladder, shaft of tibia and distal phalanx of hand upto six years later from the time of initial curative treatment of primary. The metastatic lesions in sartorius muscle, right atrium and ventricle, urinary bladder and distal phalanx were primarily managed by metastatectomy while that in the tibial shaft was managed by palliative targeted therapy with tyrosine kinase inhibitors. The key takeaway from this case series is that any primary neoplastic lesion in a patient with history of RCC should be evaluated with histopathology before definitive intervention is undertaken keeping in mind the notorious tendency of RCC to cause delayed metachronous metastases at unusual sites. In presence of solitary metastatic lesions at resectable locations, curative treatment can be offered by metastatectomy.

STUDY OF OVIPOSITION IN CARYEDON SERRATUS ON PHASEOLUS VULGARIS

Control of insect pest is a serious problem, as the use of different chemical pesticides to control them is injurious to human health and environment. Thorough knowledge of their biology is quite important to manage them. During present investigations oviposition in Caryedon serratus have been observed on Phaseolus vulgaris for the first time. The female C. serratus preferred to lay eggs near the depression as convex surface of the seed of P. vulgaris. Maximum number of eggs per seed was 15. Maximum egg laying occurred during the first 6-days of oviposition under all three temperatures (25C, 28C and 34C). The peak of egg laying occurred on 3-day at 25C and 34C, however, it occurred on 5-day at 28C. C. serratus prefer laying eggs in the depression, may possibly be due to two reasons, first, the seed coat may be weakest at this point, second, eggs laid in depression may be protected. Most of egg laying activity by day-6, helps the female to conserve its energy for greater longevity.

Magnetic resonance arthrography in recurrent anterior shoulder instability as compared to arthroscopy: a prospective comparative study.

AIM: To evaluate the accuracy of magnetic resonance (MR) arthrographic imaging in the diagnosis of glenoid labral and ligament tears in recurrent shoulder instability. SETTINGS AND DESIGN: Prospective, comparative study at a tertiary care centre. MATERIAL AND METHODS: Patients with three or more episodes of anterior shoulder dislocation were enrolled in the study. They were subjected to magnetic resonance arthrography (MRA) for delineation of abnormalities. The findings obtained at MRA were compared with those found at arthroscopy and surgical exploration. RESULTS: MRA detected glenoid tears in all 22 patients with 20 (90%) patients having antero-inferior tears, 3 (14%) patients had superior labral involvement and 2 (10%) patients had posterior labral abnormality. On arthroscopy, antero-inferior, superior and posterior labral tear were found in 21 (95%), 5 (22%) and 7 (32%) patients respectively. MRA showed a sensitivity of 95%, and a specificity of 100% for the detection of the antero-inferior labral tears. The sensitivity of MRA for the detection of superior, middle and inferior glenohumeral ligament tear was 83%, 80% and 86% with a specificity of 100%, 71% and 93% respectively. MRA was 100% sensitive for the detection of rotator cuff injuries and detection of bony lesions like Hill-Sach's and bony Bankart's lesion. CONCLUSIONS: MRA is a sensitive and specific modality for evaluation of anterior shoulder instability.

Thrombolysis utilisation in acute myocardial infarction in Bahrain.

We retrospectively studied 114 consecutive patients of acute myocardial infarction diagnosed in the Accident and Emergency department of our hospital, to determine the percentage of eligible patients who actually received thrombolytic therapy, the number of those excluded from receiving such therapy and the various exclusion criteria. We found that 66 patients (57.9%) received thrombolysis with either streptokinase or tissue plasminogen activator (tPA). The remaining 48 (42.1%) were excluded because of delayed presentation to hospital after the onset of symptoms (23.7%), old age or other contraindications. Although the percentage of thrombolysis utilisation in acute myocardial infarction in our centre is much higher as compared to others in the world, we find that there is a scope for improving these figures by reducing the number of patients excluded because of late presentation through health education and improved utilisation of ambulance services.

Ascitic fluid cholesterol in differential diagnosis of ascites.

Cholesterol was estimated in ascitic fluid of 89 patients (29 malignant and 60 non-malignant ascites). Mean ascitic cholesterol level was significantly higher in malignant ascites (89.52 mg/dl) as compared to non-malignant ascites (29.93 mg/dl). At a cut off value of 48 mg/dl, the sensitivity, specificity, positive and negative predictive value and overall diagnostic accuracy for diagnosing malignant ascites is 96.5%, 96.6%, 93.3%, 98.3% and 96.6% respectively. Ascitic fluid cholesterol estimation is an easy and reliable test for differentiating malignant ascites from non-malignant ascites.

Serum and hair zinc in Indian childhood cirrhosis.

Zinc levels in serum and hair were estimated in 32 cases of Indian Childhood Cirrhosis (ICC)--14 in Stage II and 18 in Stage III. Levels were compared with 20 cases of age matched healthy controls. Mean serum zinc level in ICC was 62.0 +/- 13.10 micrograms/dl as compared to 115.7 +/- 12.62 micrograms/dl in controls. The difference was statistically significant. Further, mean level of serum zinc (70.78 +/- 12.95 micrograms/dl) in Stage II was significantly higher than the level 55.88 +/- 8.16 micrograms/dl in Stage III, thereby showing an inverse relationship with the severity of the disease. Mean hair zinc level of 144.53 +/- 23.26 micrograms/g in ICC was much lower than that of 172.5 micrograms/g in controls. The study revealed an altered state of zinc nutrition in children with ICC.