Male Genital Injuries in Infants Caused by the Bite of Pet Pups: Case Series and Literature Review.

Injuries to male genitalia of infants due to bite of a pet pup are a rare occurrence. Few dog bite injuries to the genitalia of male infants have been reported, however, similar injuries have not been reported by the bite of pet puppies. Male genital injury in three male infants aged 8, 10, and 11 months, by the bite of pet puppies aged 1-2 months, ranged from avulsion of penile and part of scrotal skin with loss of both testes in case 1, a near circumferential laceration of penile skin at the base of penis with scrotal laceration in case 2, and laceration in mid penile shaft resulting in degloving and complete transaction of distal penile urethra with scrotal laceration in case 3. All these infants were appropriately managed surgically (case 1 and 3) and conservatively (case 2) and were given thorough toileting of wound, antibiotics, prophylaxis for tetanus and rabies. Some of these injuries may require complex surgical procedures to reconstruct the male genitalia. Timely management with aggressive intent and conserving the local tissue is the key to success. We describe a case series of injury to the external genitalia of three male infants by the bite of pet puppies, their possible predisposing factors, treatment, and follow-up. A case report and series like this have not been reported in literature so far to the best of our knowledge.

MN/CA9 gene expression as a potential tumor marker for renal cell carcinoma.

MN/CA9 is a cell surface glycoprotein and a tumor-associated antigen. It plays a crucial role in the regulation of cell proliferation and oncogenesis. There is no ideal tumor marker currently available for renal cell carcinoma (RCC) with sufficient sensitivity and specificity. Therefore, we studied MN/CA9 gene expression in the tumor tissue, apparently normal kidney tissue, preoperative blood, and urine samples of patients with RCC. We included thirty cases of renal tumors (26 RCC and 4 benign tumors) in the study. We applied an RT-PCR assay for MN/CA9 gene expression to 26 RCC kidney tumor samples and four benign kidney tumor tissue samples. We also evaluated MN/CA9 gene expression in preoperative blood and urine samples of 15 of these cases. Additionally, thirty-five grossly normal renal tissue samples, including 21 from kidneys with RCC, were also evaluated for gene expression. The RT-PCR analysis revealed that twenty-one out of 26 RCC tissue samples showed MN/CA9 gene expression compared to three out of 35 non-malignant renal tissue samples (p < 0.05). Two out of four benign renal tissue samples also expressed this gene. We also observed MN/CA9 gene expression in nine out of 15 blood samples and four out of 15 urine samples. All patients with urinary MN/CA9 gene expression showed expression in blood and tumor tissue samples. We found a correlation in terms of MN/CA9 expression between blood and tumor tissue samples of RCC patients as those who exhibit MN/CA9 expression in blood were also positive at the tumor tissue levels. The difference in MN/CA9 gene expression in tumor tissue, blood, and urine samples in relation to the stage of the disease, nuclear grade, and histological cell-type was not statistically significant. However, all the three patients who had metastatic RCC had MN/CA9 gene expression in their blood. The existence of a tumor-associated antigen such as MN/CA9 may present a possible target for molecular diagnosis and management of RCC.

Ignac Semmelweis-Father of Hand Hygiene.

Hungarian obstetrician Ignac Semmelweis (1818-1865) was one of the earliest clinical investigators of modern medical science. In nineteenth century Europe, puerperal fever (childbed fever) was a major clinical and public health problem with very high maternal mortality. It was thought to be caused by miasma, epidemicity, or the Will of Providence. Apart from bloodletting, there was no cure for it. Semmelweis cared for the childbed fever women during their illness, and when they died, he did autopsies on them. Astute clinical observations and logical reasoning goaded Semmelweis to suspect the role of "unholy" hands of "holy" physicians in the transmission of puerperal fever. He enforced a hand-washing policy for physicians. Those with unwashed hands were disallowed into labor room. The hand-washing practice for 1 year led to unprecedented decrease in maternal mortality. It enabled Semmelweis to establish a strong, specific, temporal causal association between unclean hands and puerperal fever. Although not accepted during his lifetime, this causal hypothesis contributed significantly to the understanding of etiopathophysiology of not only puerperal fever but also many other communicable diseases. Clinical hand washing, since then, has prevented millions of deaths of humankind. In the present times too, his idea of hand hygiene plays a central role in COVID-19 pandemic management. Authors present a brief account of life and work of this maverick genius, who was born "too early in the darkness." He is also called the "Father of infection control" and "Savior of mothers."