Papel de la resonancia magnética multiparamétrica en la selección y el seguimiento de pacientes en vigilancia activa por cáncer de próstata. Revisión del grupo de Uro-Tecnología (ESUT) de la EAU / The role of multiparametric magnetic resonance imaging in the selection and follow-up of patients undergoing active surveillance for prostate cancer. An European Section of Uro-Technology (ESUT) review

Introducción: En los últimos años, la vigilancia activa (VA) ha ganado popularidad como una opción segura y razonable para los pacientes con cáncer de próstata de bajo riesgo clínicamente localizado.ObjetivoResumir la información más reciente sobre el uso de resonancia magnética multiparamétrica (RMmp) en el contexto de la vigilancia activa (VA) para el tratamiento del cáncer de próstata (CaP).Adquisición de la evidenciaSe realizó una búsqueda en la literatura en inglés mediante PubMed hasta febrero de 2020. Se seleccionaron los artículos originales, metaanálisis, y revisiones sistemáticas más relevantes.Síntesis de la evidenciaLa gran importancia de la RMmp de la próstata en el contexto del diagnóstico del CaP es su capacidad de detectar lesiones cancerosas de alto grado que pueden haber sido omitidas en biopsias sistemáticas. Diversos estudios han demostrado que la RMmp tiene un rendimiento superior con respecto a los modelos basados en la clínica para identificar aquellos candidatos que se beneficiarán más de la VA. Aunque hay poca información sobre la RMmp de próstata durante el seguimiento de hombres en VA, existe la posibilidad de que ésta pueda mejorar significativamente los programas de VA, gracias a una selección más rigurosa de candidatos óptimos, una identificación más precisa de la progresión de la enfermedad, y una reducción en el número de biopsias. El objetivo de la reevaluación de los pacientes sometidos a VA es encontrar el momento en el que cambiar la estrategia hacia el tratamiento activo sea lo más efectivo.ConclusiónEl valor de la RMmp ha sido reconocido debido a su alto valor predictivo negativo (VPN) en la detección de lesiones de mayor grado en pacientes con CaP de bajo riesgo. Un mejor sistema de detección en las pruebas de imagen y un diagnóstico más exacto con RMmp podría reducir las clasificaciones erróneas en el diagnóstico inicial y durante el seguimiento, reduciendo así el número de biopsias. (AU)

Introduction: In recent years, active surveillance (AS) has gained popularity as a safe and reasonable option for patients with low-risk, clinically localized prostate cancer.ObjectiveTo summarize the latest information regarding the use of mpMRI in the setting of active surveillance (AS) for the management of prostate cancer (PCa).Evidence acquisitionA PubMed-based, English literature search was conducted through February 2020. We selected the most relevant original articles, meta-analyses and systematic reviews that could provide important information.Evidence synthesisThe great importance of mpMRI of the prostate in the setting of PCa diagnosis is its ability to visualize primarily high-grade cancerous lesions potentially missed on systematic biopsies. In several studies, mpMRI has shown an improved performance over clinically based models for identifying candidates which will benefit the most from AS. Although data on prostate mpMRI during follow-up of men under AS is sparse, it holds the probability to improve significantly AS programs by a more precise selection of optimal candidates, a more accurate identification of disease progression and a reduction in number of biopsies. The goal of reassessment of patients undergoing AS is to find the most effective moment to change attitude to active treatment.ConclusionThe value of mpMRI has been recognized due to its high negative predictive value (NPV) for lesion upgrading in low-risk PCa patients. The improvement in imaging detection, and precise diagnosis with mpMRI could reduce misclassifications at initial diagnosis and during follow-up, reducing the number of biopsies. (AU)

The role of multiparametric magnetic resonance imaging in the selection and follow-up of patients undergoing active surveillance for prostate cancer. An European Section of Uro-Technology (ESUT) review. / Papel de la resonancia magnética multiparamétrica en la selección y el seguimiento de pacientes en vigilancia activa por cáncer de próstata. Revisión del grupo de Uro-Tecnología (ESUT) de la EAU.

INTRODUCTION: In recent years, active surveillance (AS) has gained popularity as a safe and reasonable option for patients with low-risk, clinically localized prostate cancer. OBJECTIVE: To summarize the latest information regarding the use of mpMRI in the setting of active surveillance (AS) for the management of prostate cancer (PCa). EVIDENCE ACQUISITION: A PubMed-based, English literature search was conducted through February 2020. We selected the most relevant original articles, meta-analyses and systematic reviews that could provide important information. EVIDENCE SYNTHESIS: The great importance of mpMRI of the prostate in the setting of PCa diagnosis is its ability to visualize primarily high-grade cancerous lesions potentially missed on systematic biopsies. In several studies, mpMRI has shown an improved performance over clinically based models for identifying candidates which will benefit the most from AS. Although data on prostate mpMRI during follow-up of men under AS is sparse, it holds the probability to improve significantly AS programs by a more precise selection of optimal candidates, a more accurate identification of disease progression and a reduction in number of biopsies. The goal of reassessment of patients undergoing AS is to find the most effective moment to change attitude to active treatment. CONCLUSION: The value of mpMRI has been recognized due to its high negative predictive value (NPV) for lesion upgrading in low-risk PCa patients. The improvement in imaging detection, and precise diagnosis with mpMRI could reduce misclassifications at initial diagnosis and during follow-up, reducing the number of biopsies.

Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology.

The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.

Double-step invagination technique-A novel approach to retrieve embedded esophageal self-expanding metal stent.

Self-expanding metal stenting is an established treatment modality in the management of esophageal growth and stricture. Reactive tissue ingrowth at the uncovered portion of the self-expanding metal stent (SEMS) anchors it in position, preventing its migration. When removal of such an embedded SEMS is clinically indicated, the procedure of endoscopic retrieval is fraught with serious complications. Temporary deployment of a larger fully covered "rescue" SEMS within the embedded SEMS has been reported to be useful in the extraction of the embedded SEMS. When the regression of embedding tissue, is only partially achieved by such "rescue" fully covered SEMS, further extraction of the embedded SEMS can prove to be technically challenging. Here we report two cases where a novel technique, namely the "double-step invagination technique," was useful in retrieving such embedded esophageal SEMS.

A whole system approach to improving mortality associated with acute kidney injury.

BACKGROUND: Acute kidney injury (AKI) is in the main managed by non-nephrologists, many who feel challenged by or lack awareness of the complexity that the renal element adds to their patients' care. National reports have raised major concerns about the quality of care and have predicted that mortality reductions of 30% are achievable with good medical practice. AIM: This quality improvement project evaluated whether a whole system approach could improve outcomes for patients with AKI. DESIGN AND METHODS: Quality improvement methodology was used to understand hospital patterns, processes and professional knowledge. Change concepts were developed which included management of patients at risk, staff education and awareness program, development of a patient specific electronic alert to prompt diagnosis, easy to remember care bundle (ABCDE-IT), dedicated outreach team and patient and family empowerment leaflet. RESULTS: Statistical process control analysis was used to verify outcomes over time. A shift in the in-hospital mortality rate corresponded to a relative 23.2% reduction in mortality and was sustained over the next 33 months (P < 0.0001). The favourable shift in mortality was temporally distinct from the improved AKI detection rate. This timeframe corresponded to lying below the 99.8% lower confidence limit in comparison with all English acute trusts for comparative AKI specific SHMI/HSMR mortality rates. Length of stay also reduced shortly after onset of the project by 14.1% or 2.6 day reduction (P < 0.0001). CONCLUSION: This project demonstrated that an integrated, whole-system approach is necessary to ensure sustained improvements in AKI mortality and length of stay.

Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology.

BACKGROUND: Bleeding from small intestinal ectopic varices and persistent anemia caused by portal hypertensive enteropathy (PHE) can be very challenging. Capsule endoscopy (CE) is one of the best noninvasive modalities in identifying such lesions. AIM: The aims of this study are to study the prevalence of small-bowel changes related to portal hypertension (PHT) and to correlate them with the observations related to the effects of portal hypertension in the esophagus, stomach, and colon. METHODS: Thirty-two patients with various etiologies of PHT with either anemia or gastrointestinal bleed were included along with age- and sex-matched controls without PHT. All patients underwent blood tests, gastroscopy, colonoscopy, and CE. The small-bowel findings by CE were categorized as inflammatory-like and vascular lesions. The small-bowel changes were analyzed to find out any association with various demographic, clinical, and endoscopic variables. RESULTS: Thirty-one out of 32 patients with PHT (96.8%) had PHE identified by CE. Of them, 31 (96.8%) had inflammatory-like appearance, 11 (34.4%) had vascular lesions, and 2 (6.2%) had small-bowel varices. Inflammatory-like appearance was noted in eight (25%) and angiodysplastic lesions in two (6.2%) controls. Findings compatible with PHE were detected in 96.8% of the patients and 25% of the controls (X 2 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables. CONCLUSIONS: Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.

Relationship of prepartum udder and teat measurements with subsequent milk production traits in primiparous Nili-Ravi buffaloes.

AIM: This study was conducted to find out the relationship of prepartum udder and teat measurements with subsequent milk production traits in primiparous Nili-Ravi buffaloes. MATERIALS AND METHODS: A total of 12 Nili-Ravi buffalo heifers were selected from Buffalo Farm, Central Institute for Research on Buffaloes, Regional Station- Bir Dosanjh, Nabha, Patiala, Punjab. The udder length (UL), udder width (UW), udder depth, teat length (TL), teat diameter (TD), and teat distances were measured at fortnightly interval from 60 days prepartum until calving. After calving, 60 days total milk yield (TDMY), peak yield (PY), and days taken to attain PY (DPY) were also recorded. The correlation coefficients of various prepartum udder and teat measurements since 60 days prepartum to calving with 60 days TDMY, PY, and DPY were calculated to find out the relationship between the traits in primiparous Nili-Ravi buffaloes. RESULTS: The result envisaged that all udder and teat measurements were increased gradually toward the date of calving in primiparous buffaloes. The UL, UW, left fore (LF) and right rear (RR)TL, RRTD, and the distance between LF to left rear (LR) teat were positively correlated with 60 days TDMY. The UL and UW depicted positive but nonsignificant correlation with PY. Fore TLs showed positive correlation where as TDs and teat distances had a negative correlation with the DPY in primiparous Nili-Ravi buffaloes. CONCLUSION: It was concluded that milk production performance could be assessed on the basis of prepartum udder and teat measurements in primiparous Nili-Ravi buffaloes.

A new endoscopic method of retrieval of a migrated and transmurally embedded intrauterine contraceptive device in the rectum.

A 45-year-old lady presented with left lower quadrant abdominal pain and hematochezia of 1 month duration. She had Copper-T, an intrauterine contraceptive device (IUCD) inserted in the immediate post-partum period 25 years ago elsewhere and was lost to follow up. CT abdomen done 2 weeks earlier before reporting to us revealed a migrated and translocated IUCD embedded in the right lateral wall of the rectum. On colonoscopy, an area of friable mucosal nodule was noticed in the right lateral wall 10 cm from the anal verge but the IUCD was not visible intraluminally. Fluoroscopy showed the horizontal limb lying in close approximation with the rectal wall and the vertical limb of the IUCD embedded at the site of mucosal nodule in the rectum. After a careful endoscopic mucosotomy, the vertical limb was exposed and the Copper-T in its entirety was retrieved using a polypectomy snare. The mucosal defect was closed with hemoclips. She became asymptomatic after the procedure.

Optimization of dry period in Karan Fries cow.

AIM: The objective of this study was to optimize dry period (DP) length that can maximize the production across adjacent lactations and overall lifetime yield. MATERIALS AND METHODS: Performance records with respect to DP spread over a period of 15-year in Karan Fries (KF) cattle maintained at Livestock Research Centre (National Dairy Research Institute), were collected for the study. Data of 681 KF cows were analyzed by least square technique to examine the effect of non-genetic factors on DP. Season of calving was classified into four seasons: Winter season (December-March), summer season (April-June), rainy season (July-September), and autumn season (October-November); period of calving into five periods: 1998-2000 (1-period), 2001-2003 (II-period), 2004-2006 (III-period), 2007-2009 (IV-period), and 2010-2012 (V-period), and parity into six parities, i.e., 1(st), 2(nd), 3(rd), 4(th), 5(th), and >6(th) parities to see the effect of non-genetic factors on DP. RESULTS: Period of calving, season of calving, and parity did not affect the DP significantly (p<0.05). The overall least square mean of DP was 67.93±2.12 days. For the optimization of DP with regard to milk productivity, analysis was carried out by class interval method. DP was classified into eight classes (<22, 23-45, 46-67, 68-89, 90-111, 112-133, 134-155, and >156 days), and optimum level was obtained at 46-67 days (3(rd) class) with the following respective milk yield (MY) of 305 daily MY (4016.44±43.68 kg), total MY (4704.21±61.51 kg), MY per day of lactation length (13.03±0.13 kg), and MY per day of calving interval (11.68±0.41 kg). CONCLUSION: From the study, it was concluded that this optimal DP length (46-67 days) is suitable for maximizing the production. Hence, one should aim to dry off pregnant cows to achieve a DP of appropriate length to enhance productivity in the next lactation, as very short and very long DP reduces the economic profitability in dairy animals.

Effect of infrared lamps to ameliorate cold stress in Vrindavani calves.

AIM: This study was conducted to determine the effect of infrared lamps to ameliorate cold stress in Vrindavani (Holstein Friesian × Brown Swiss × Jersey × Hariana) calves. MATERIALS AND METHODS: For the present investigation, ten newborn Vrindavani calves were randomly divided into two groups (G1 and G2) of five each. The experiment was conducted from 2(nd) November to 8(th) February when the environmental temperature was at the lowest. The calves of G1 were provided with no additional protection while the calves of G2 were protected against the cold weather by providing heat using the infrared lamps. The body weight (kg) of the calves was recorded at weekly interval. The blood samples collected within 6 h of birth and then at fortnightly interval were analyzed for packed cell volume (PCV, %), hemoglobin (Hb, g/dl). Besides, the serum biochemical parameters, viz., Total serum protein (TSP, g/l), albumin (g/l), globulin (g/l), albumin globulin ratio (A:G) and important stress parameters, viz., triiodothyronine (T3, ng/ml), thyroxine (T4, ng/ml) and cortisol (ng/ml) were also estimated. RESULTS: The calves of G2 showed higher body weight gain as compared to G1. The differences were found to be highly significant (p<0.01). The calves in G1 showed comparatively higher values of PCV and Hb and the differences were found to be significant (p<0.05) on 45(th) day for PCV and highly significant (p<0.01) on 60(th) day for PCV and on 45(th) day for Hb. The values of TSP and albumin were comparatively higher in calves of G1 as compared to G2 and the differences were highly significant (p<0.01) on 45(th) day for both TSP and albumin and significant (p<0.05) on 60(th) day for albumin. Significantly (p<0.01) higher values of cortisol and T4 were observed on 15 and 45(th) day in calves of G1 as compared to G2. The T3 levels were also found higher in calves of G1 than G2 and the differences were significant (p<0.05) on 15 and 30(th) day and highly significant (p<0.01) on 45(th) day of the study. CONCLUSION: Based on the results, it could be concluded that the infrared lamps are efficient in providing favorable microclimate and hence can be effectively used in calf shed to protect newborn calves from adverse conditions of winter and to improve their body growth performance.

Novel predictors for immediate puncture site bleed during endoscopic glue injection for gastric varices without using lipiodol.

Endoscopic obturation of gastric varices using tissue adhesive glues like cyanoacrylate is an accepted modality for the treatment of gastric varices. This study was undertaken to determine whether it was possible to predict immediate puncture site bleed on withdrawal of needle catheter during endoscopic glue injection without lipiodol. We prospectively analyzed 100 consecutive patients with cirrhosis who underwent glue injection. Glue injection was successful in all the patients. Immediate puncture site bleed was observed in only four cases and all of them correlated with negative catheter pull sign and positive red catheter sign. Catheter pull sign and red catheter sign were excellent predictors of immediate puncture site bleed during endoscopic glue injection and should be routinely tested.

Dermatoglyphics in patients with dental caries: a study on 1250 individuals.

AIM: This study was undertaken to investigate and analyze the significance of dermatoglyphics in predicting the susceptibility of individuals to develop dental caries. MATERIALS AND METHODS: This case-control study was conducted on 1250 children in the age group of 5 to 12 years from Chennai Corporation School, Vadapalani, Chennai. Out of 1250 subjects, 625 subjects were in the study group and the remaining 625 subjects were the control group. The study group included children with dental caries in 5 or more teeth based on the DMFT index performed and control group consisted of normal, healthy children without any dental caries. The finger and palmar prints of both hands were taken using a stamp pad. The fingertip patterns were analyzed according to the classical method and configurational types were classified according to the topological method. Statistical analysis was performed using nonparametric tests and t-test to compare the dermatoglyphic pattern changes between the study group and the control group and was applied for each variable, to compare the proportions, and p-value. RESULTS: (1) Dental caries susceptibility of an individual increases with an increase in the incidence of whorl pattern (83% correlation). (2) All the variables show statistically significant value, with a degree of divergence of specific dermatoglyphic patterns among study and control group. (3) The dermatoglyphic patterns are efficient and can predict in assessing the risk of susceptibility to dental caries in study group. CONCLUSION: The dental caries susceptibility of an individual increased with incidence of whorl pattern and it decreased with incidence of loop pattern. CLINICAL SIGNIFICANCE: The dermatoglyphic patterns may be utilized effectively to study the genetic basis of dental caries. In a developing country like India, it might prove to be a noninvasive, inexpensive and effective tool for screening.

Morphometry of buccal mucosal cells in fluorosis--a new paradigm.

STUDY BACKGROUND: Fluorosis is one of the manifestations of chronic poisoning from long-term exposure to high levels of fluoride. An estimated 62 million people in 17 states in India are affected with dental and skeletal fluorosis. OBJECTIVE: To evaluate the cytological morphology of exfoliated oral mucosal cells among various stages of fluorosis patients compared with controls. DESIGN AND METHODS: Exfoliative cytology PAP-stained smears of 21 cases of fluorosis and 21 controls subjected to morphometric analysis using image Proplus software. For the assessment parameters like maximum and minimum diameter of the nucleus, cell and perimeter of the cell and nucleus were considered. RESULTS: An increase in maximum and minimum diameter of nucleus, perimeter of nucleus and cell in cases when compared to controls. CONCLUSIONS: Fluorosis induces oxidative stress, DNA damage and apoptosis which can be the reasons for the increase in the nuclear size and decrease in the cell size. Community dental and medical programmes should be stringently implemented in fluorosis-endemic areas, to create awareness regarding the toxic effects of fluoride to the body, especially within the oro-facial region.

Characterization of different tissue changes in normal, betel chewers, potentially malignant lesions, conditions and oral squamous cell carcinoma using reflectance confocal microscopy: correlation with routine histopathology.

The goal of this study was to characterize the features of normal mucosa, mucosa in betel chewers and smokers, potentially malignant lesions and squamous cell carcinoma of oral mucosa using reflectance confocal microscopy. Oral cavity biopsies were acquired from 25 patients from College of Dental Surgery, Saveetha University who underwent screening for suspected lesions of Oral precancer and Oral cancer along with normal patients who underwent impaction. Biopsies were acquired from the clinically suspicious area and immediately placed in Dulbecco modified eagles growth medium (DMEM). Reflectance confocal images were obtained at multiple image plane depths from biopsies within 6h of excision. After imaging, biopsies were fixed in 10% formalin and submitted for routine histopathological examination by an experienced oral and maxillofacial pathologist. Reflectance confocal images were compared with histological images from the same sample to determine the tissue features which contribute to early cellular changes, image contrast and early diagnosis. The confocal images were obtained to a depth of up to 150 microns on intact biopsy specimens and subsequent 3-dimensional images, keratin thickness measurements, cell measurements, cell density analysis and graphical representations were performed using Leica image analysis software. In normal mucosa keratin deposition were seen as alternating dark and bright stacks and in different cell layers the nuclei were seen as disks of varying intensities. In pre-cancerous lesions the keratin thickness and cell nuclear density were found to be increased when compared to normal controls. In OSMF cases confocal images of fibrosis show scattering from individual fibres as hyperdense areas. Oral squamous cell carcinoma cases demonstrated extensive variations in cell size, nuclear size and nuclear morphology. At cellular level, dysplastic features like increased nuclear density, increased nuclear cytoplasmic ratio, nuclear and cellular pleomorphism with loss of cohesiveness were identified in all five cases. Our results support the potential of reflectance confocal microscopy to play a significant role in clinical evaluations of oral lesions, early diagnosis of potentially malignant and malignant oral lesions and real time identification of tumour margins.

Portal biliopathy in a 13-year-old Asian girl: a case report and review of literature.

Portal biliopathy (PB) is a term used to describe biliary ductal and gallbladder wall abnormalities seen in patients with portal hypertension. The pathogenesis of PB is not well known. It has been postulated that external pressure of portal cavernoma and/ or ischemia may play a role. We report a case of a patient with PB presenting with obstructive jaundice that involved endoscopic sphincterotomy and stenting.

Unilocular cystic sebaceous lymphadenoma: a rare tumour.

A unique variant of the sebaceous lymphadenoma, so-called unilocular cystic sebaceous lymphadenoma, occurred in a 28-year-old male with a painless swelling in the left parotid region. The recognition of key histological features will readily allow differentiation of this unique neoplasm from its benign and malignant mimics. To our knowledge, out of 21 cases of sebaceous lymphadenoma reported, only 3 unilocular cystic variants have been recorded.