Comparative Study Between Silodosin Alone And Silodosin With Tadalafil For The Medical Management Of Lower Ureteric Stone In Western Part Of Rajasthan

Background:To compare the treatment outcome of Silodosin alone and Silodosin with Tadalafil as a medical expulsive therapy (MET) of lower ureteric stone in western part of Rajasthan. Material And Methods:The study was conducted in a tertiary hospital of Dr. S.N. Medical College, Jodhpur over a period of 12 months (1st January, 2020 to 31st December, 2020). Out of 108 patients, 100 meet the inclusion criteria who were purposively assigned into 2 groups. 48 patients included in Silodosin alone group and 52 in Silodosin with Tadalafil group. Result:There was a significant higher stone expulsionrate in Silodosin with Tadalafil than Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The mean stone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafil was 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were 0.7(±0.06) and 0.6(±0.2) in Silodosin with Tadalafil group that was statistically significant. Conclusion:The present study suggested that Silodosin with tadalafil combination therapy significantly increases ureteric stone expulsion rate and decreases the expulsion time and pain episodes than treatment with silodosin alone.

Safety and efficacy of percutaneous nephrolithotomy in paediatric age group: our 3 year experience in Western Rajasthan

Background: Percutaneous nephrolithotomy (PCNL) has become a well-established procedure for the management of pediatric renal calculi. Paediatric PCNL has been performed using both adult and paediatric instruments. Objectives: To evaluate the safety, efficacy and complications using the Modified Clavien scoring system (MCSS) in children undergoing PCNL using adult sized instruments.Methods: All patients less than 16 years old were analyzed retrospectively in Western Rajasthan undergoing PCNL procedure at Dr. SN Medical College and Hospital from April 2016 to March 2019. All PCNL procedures were performed in prone position under general anaesthesia with fluoroscopic guidance and using adult size instruments. All the demographics, surgical data and perioperative information were collected.Results: Total 112 patients with 120 renal units (8 patients with bilateral stones), (66 boys and 46 girls), with a mean (range) age was 10.01±4.02 (2-16) years. The mean (range) stone size in our study was 28.94±1.10 (20-50 mm). Overall, stone-free rate after PCNL was 95%. Twenty five (25) children (20.8%) had operative complications; 23/25 (92%) had, Clavien grade I in 15 (60%), grade II in 8(32%) and all managed conservatively. 2 patients had hydropneumothorax, managed with ICD tube. Stone size, operative duration and haemoglobin drop were significantly associated with complications on Univariate analysis (p<0.05).Conclusions: In paedriatric age group PCNL is considered safe with MCSS showing grade I and grade II complications in majority (92%) of patients.

Antepartum Bleeding of Unknown Origin and Sequlae.

Antepartum bleeding of unknown origin (ABUO) seems to be one of the most common causes of bleeding in third trimester of pregnancy, but has not been studied well. Objective : The present study was aimed to study the incidence, management strategies and the perinatal outcome in cases of ABUO. Methods : Cases diagnosed as ABUO and managed at the rural referral hospital over last 5 years were analyzed. The diagnosis of ABUO was by exclusion of placental abruption, placenta previa and possible causes of bleeding in the lower genital tract by clinical and ultrasonographic examination. Results : The incidence of ABUO was 0.60 % of births. Of all cases of antepartum haemorrage 18.1% were of teenage and of ABUO10.3% cases were of teenage cases compared to overall 5% cases teenage. Perinatal Mortality Rate (PMR) in cases of ABUO was 237, significantly higher than overall PMR of 66 (p value <0.001) during the study period. Preterm births were the most common cause of perinatal mortality in ABUO. Conclusion : Women with ABUO may not need special interventions, but when ABUO occurs preterm births and perinatal loss increase ,so deaths due to prematurity need to be prevented.

Chikungunya fever: a re-emerging viral infection.

Chikungunya (CHIK) fever is a re-emerging viral disease characterized by abrupt onset of fever with severe arthralgia followed by constitutional symptoms and rash lasting for 1-7 days. The disease is almost self-limiting and rarely fatal. Chikungunya virus (CHIKV) is a RNA virus belonging to family Togaviridae, genus Alphavirus. Molecular characterization has demonstrated two distinct lineages of strains which cause epidemics in Africa and Asia. These geographical genotypes exhibit differences in the transmission cycles. In contrast to Africa where sylvatic cycle is maintained between monkeys and wild mosquitoes, in Asia the cycle continues between humans and the Aedes aegypti mosquito. CHIKV is known to cause epidemics after a period of quiescence. The first recorded epidemic occurred in Tanzania in 1952-1953. In Asia, CHIK activity was documented since its isolation in Bangkok, Thailand in 1958. Virus transmission continued till 1964. After hiatus, the virus activity re-appeared in the mid-1970s and declined by 1976. In India, well-documented outbreaks occurred in 1963 and 1964 in Kolkata and southern India, respectively. Thereafter, a small outbreak of CHIK was reported from Sholapur district, Maharashtra in 1973. CHIKV emerged in the islands of South West Indian Ocean viz. French island of La Reunion, Mayotee, Mauritius and Seychelles which are reporting the outbreak since February, 2005. After quiescence of about three decades, CHIKV re-emerged in India in the states of Andhra Pradesh, Karnataka, Maharashtra, Madhya Pradesh and Tamil Nadu since December, 2005. Cases have also been reported from Rajasthan, Gujarat and Kerala. The outbreak is still continuing. National Institute of Communicable Diseases has conducted epidemiological, entomological and laboratory investigations for confirmation of the outbreak. These have been discussed in detail along with the major challenges that the country faced during the current outbreak.

Development and evaluation of an in vitro isolation of street rabies virus in mouse neuroblastoma cells as compared to conventional tests used for diagnosis of rabies.

In vitro isolation of rabies virus using mouse neuroblastoma cells (MNA) was evaluated. The sensitivity and reliability of in vitro procedure was performed in comparison with mouse inoculation test (MIT), the in vivo method of virus isolation, direct fluorescent antibody test (FAT) and Sellers staining. Of the 33 animal brain samples tested, 24 (72.72%) were positive by MIT. Sensitivity of Sellers stain, FAT and rapid tissue culture infection test (RTCIT) was found to be 54.16, 100 and 91.6% respectively. Concordance of Sellers stain, FAT, RTCIT with MIT was found to be 66.6, 100 and 93.93% respectively. Two samples which were positive by FAT and MIT showed gross contamination in cell lines, which is one of the drawbacks of RTCIT. However, rabies virus could be isolated in MNA cells from two of the eight human cerebrospinal fluid (CSF) samples from clinico-epidemiologically suspected cases of rabies. Both MIT and FAT showed negative results in the two CSF samples. RTCIT appears to be a fast and reliable alternative to MIT and holds promise in antemortem diagnosis of rabies, which is otherwise, a challenging task for a reference laboratory.

Status of lifestyle modifications in hypertension.

Hypertension is essentially the elevation of arterial blood pressure beyond an arbitrary cut off point, though the dividing line between normal and elevated BP is lacking. Hypertension can be classified into primary, essential or idiopathic hypertension on one hand, and secondary one due to some disease itself. In treating hypertension, antihypertensives have their role, but attention may be directed towards some lifestyle modifications. As regarding dietary interventions, calorie restriction may influence the minimisation of BP. Body weight reduction, less alcohol consumption, salt restriction, potassium and calcium supplementation can enhance the process of lowering BP. The role of magnesium in hypertension is debatable. Serum cholesterol level is commonly elevated in hypertensive patients and its reduction reduces the risk of non-fatal coronary events. Diet rich in plant fibres either alone or with a low fat, low sodium could lower the BP by about 5 mm Hg in hypertensives. The omega-3-polyunsaturated fatty acids found in highest concentrations in cold water fishes have a modest antihypertensive effect. Caffeine contained in two cups of coffee may raise the BP by 5 mm Hg in infrequent users but in habitual users, caffeine has no role. Deficiency of vitamin C might lead to hypertension. As regarding behavioural changes, stopping smoking, regular physical exercise, relaxation therapies like yoga, etc, have definite beneficial effect on hypertensives. The antihypertensive effect of lifestyle modifications may obviate drug therapy. For this one or more of the lifestyle modifications should be tried initially in all hypertensive patients.

Choledochal cysts in infants and children.

OBJECTIVE: To study the clinical spectrum and management of choledochal cyst in children below 12 years of age. DESIGN: Descriptive study. SETTING: Tertiary care hospital. METHODS: Twenty three children with choledochal cysts were managed between January 1991 to September 1997 and their clinical details, investigations and management were recorded. Choledochal cyst was diagnosed by ultrasonography and confirmed by ERCP or peroperative cholangioram (POC) Children were treated with antibiotics and/or percutaneous transhepatic biliary drainage if there was cholangitis and subsequently subjected to surgery (excision of the cyst and jejunal loop interposition hepaticoduodenostomy). RESULTS: The median age of these children was 3 years with an almost equal sex ratio. Predominant presentation was jaundice in 18, pain abdomen in 15, fever in 12, and lump abdomen in 9 cases. The classical triad of jaundice, pain and lump was present in only 4 cases. ERCP conducted in 7 and POC in 14 cases yielded positive findings in all. Clinically there were two distinct forms of presentation: (i) infantile form (< or = 1 year) comprised 9 infants which presented with jaundice in all, acholic stool in 6, lump abdomen in 4 but only one had classical triad; and (ii) childhood form (> 1 year) presented with pain abdomen in 12 and jaundice and cholangitis in 9 subjects each. Type I cyst was seen in 20 and type IVa in 3. Two children refused surgery, and the rest underwent surgery. Three infants died after surgery, the remaining 18 were alive and well on follow-up (median 25 months). Secondary biliary cirrhosis was seen in 6, extra hepatic biliary artresia in 2 and congenital hepatic fibrosis in 1 on histology. CONCLUSIONS: Choledochal cysts present in two clinically distinct forms. Infantile form is an important cause of cholestasis of infancy. Early diagnosis and referral is essential to prevent complications and death, and prognosis after surgery is good.

Nephrolithiasis in children.

A study of 100 cases of nephrolithiasis between 3 to 15 years of age is reported. Seventy four cases were more than 10 years old. The common presenting symptoms included abdominal pain (69%), burning micturition (23%), gross hematuria (4%) and unexplained pyrexia (6%). Associated urinary tract malformations were found in 16 cases. Twenty four had struvite calculi. Urinary infection with Proteus mirabilis was found in 23 children and idiopathic hypercalciuria in 31 cases. Following surgical removal, either percutaneously or by open surgery, 8 patients had residual calculi and in 6 cases recurrence occurred.