Complete Stone Clearance after Retrograde Intrarenal Surgery among Patients with Urolithiasis in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Retrograde intra-renal surgery using flexible scopes and laser energy is a newer alternative in stone disease treatment armamentarium. It is claimed to be superior to other modalities for stone clearance, complications and hospital stay. The aim of this study was to find out the prevalence of complete stone clearance after retrograde intra-renal surgery among patients with urolithiasis in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted in the Department of Urology in a tertiary care centre from 15 June 2021 to 14 May 2022 including adult patients with stone size up to 15 mm. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC-PA-143/2077-78). Convenience sampling was done. The prevalence of complete stone clearance (no residual fragment >4 mm) was calculated. Point estimation and 95% confidence interval were calculated. Results: Among 42 patients, 36 (85.71%) patients (75.1-96.3, 95% Confidence Interval) achieved complete stone clearance. The mean age was 40.26±14.05 (16-74) years and the stone size was 1.27±0.19 (0.9 -1.5) cm. Similarly, the mean operating time was 51.55±9.34 (40-85) minutes and the hospital stay was 1.33±0.52 (1-3) days. Grade 3 ureteric injury occurred in one case. Residual fragments were seen in 6 cases (14.29%). Sepsis occurred in 4 cases (11.11%). Conclusions: The prevalence of complete stone clearance was similar among patients undergoing retrograde intra-renal surgery in our study when compared to other studies conducted in similar settings. Keywords: laser; miniaturization; postoperative complications.

Association of SUMOylation Pathway Genes With Stroke in a Genome-Wide Association Study in India.

OBJECTIVE: To undertake a genome-wide association study (GWAS) to identify genetic variants for stroke in an Indian population. METHODS: In a hospital-based case-control study, 8 teaching hospitals in India recruited 4,088 participants, including 1,609 stroke cases. Imputed genetic variants were tested for association with stroke subtypes using both single-marker and gene-based tests. Association with vascular risk factors was performed with logistic regression. Various databases were searched for replication, functional annotation, and association with related traits. Status of candidate genes previously reported in the Indian population was also checked. RESULTS: Associations of vascular risk factors with stroke were similar to previous reports and show modifiable risk factors such as hypertension, smoking, and alcohol consumption as having the highest effect. Single-marker-based association revealed 2 loci for cardioembolic stroke (1p21 and 16q24), 2 for small vessel disease stroke (3p26 and 16p13), and 4 for hemorrhagic stroke (3q24, 5q33, 6q13, and 19q13) at p < 5 × 10-8. The index single nucleotide polymorphism of 1p21 is an expression quantitative trait locus (p lowest = 1.74 × 10-58) for RWDD3 involved in SUMOylation and is associated with platelet distribution width (1.15 × 10-9) and 18-carbon fatty acid metabolism (p = 7.36 × 10-12). In gene-based analysis, we identified 3 genes (SLC17A2, FAM73A, and OR52L1) at p < 2.7 × 10-6. Eleven of 32 candidate gene loci studied in an Indian population replicated (p < 0.05), and 21 of 32 loci identified through previous GWAS replicated according to directionality of effect. CONCLUSIONS: This GWAS of stroke in an Indian population identified novel loci and replicated previously known loci. Genetic variants in the SUMOylation pathway, which has been implicated in brain ischemia, were identified for association with stroke.

Comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials.

OBJECTIVE: There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted technique of laparotomy wound closure as compared to the continuous technique. METHODS: All randomized, controlled trials comparing continuous and interrupted methods of laparotomy wound closure, with burst abdomen and/or incisional hernia as the outcomes, were included in the meta-analysis. MEDLINE, Clinical Evidence and the Cochrane Library were searched. Burst abdomen and incisional hernia were the two primary outcomes. RESULTS: Twenty-three studies were identified, with a total of 10,900 patients. The interrupted method of closure was associated with significantly less dehiscence as compared with the continuous method (OR, 0.576; p = 0.014; relative risk reduction, 39.8%; number needed to treat, 143). The interrupted technique was also found to be better in the nonabsorbable suture, vertical incision and mass closure subgroups. However, no difference in the hernia risk was found between the two methods. CONCLUSION: Interrupted laparotomy wound closure reduces the odds of dehiscence by half compared with continuous wound closure.