Foreign Body in the Male Urinary Bladder: A Case Report.

A foreign body in the urinary bladder is an uncommon finding in urology emergencies. There are several ways in which intravesical foreign bodies can occur, including iatrogenic injuries, self-insertion for pleasure, sexual abuse, assault, and migration from adjacent sites. This case report is about an interesting presentation of a 36-year-old male who presented to the urology outpatient department with a burning sensation and dribbling while urinating for 1 month. An X-ray of the pelvis revealed multiple radiodensities (morphology was suggested as magnetic balls) in the pelvic soft tissues. Cystoscopy was performed and three-pronged forceps were utilized to remove the magnetic foreign bodies. The patient had an insignificant hospital course and was discharged with analgesics and antibiotics.

Transurethral Resection of Prostate (TURP) and Vesicolithotomy for Large Bladder Stone in Single Session: The Third World Perspective.

OBJECTIVE: To study the effectiveness and safety of combined transurethral resection of prostate (TURP) and open vesicolithotomy in patients with benign prostatic hyperplasia and massive vesical calculi in a single session. METHODS: A descriptive study conducted at the Institute of Kidney and Diseases, Peshawar Pakistan from March 2013 till December 2019. In total, 43 patients were selected by nonprobability conventional sampling. We included patients with occluding enlarged prostate size of 30-60g and bladder stones of more than 35 mm which was not amenable to cystolitholapaxy or cystolithotripsy. Conventional TURP followed by formal vesicolithotomy was performed in all patients in a single session. All the preoperative, perioperative and postoperative data were documented on structured Proforma. The data analysis was done on SPSS. RESULTS: The average age of the patients included was 65 ±7.5 years. Mean size of prostate was 45.5±6.8 g and mean stone size was 38.4±4.2 mm. The majority of patients [60.4% (n=26)] presented with refractory urinary retention. On average the operation time was 66.3±5.5 minutes. The mean resected volume of prostate was 23.5±6.8g and the average hospital stay was 5.5±1.2 days. Mean trial of removal of catheter was 5±0.6 days. The trial of removal of catheter was successful in all patients. Significant improvement in maximum flow and average flow was recorded in all patients (p = 0.001). On average, the complication rate noted was 6.9% (n = 3). There was no need for blood transfusion. No mortality was recorded in the study. CONCLUSION: The combined TURP and open vesicolithotomy in a single session is an efficacious, safe and viable treatment modality for large bladder calculi secondary to moderately enlarged prostate.

Thymic Stromal Lymphopoietin (TSLP) gene variant rs1837253 is significantly associated with Asthma prevalence in Pakistani Pashtun women.

Asthma is a chronic inflammatory disease of the airways characterized by airway hyperresponsiveness and remodeling. Thymic stromal lymphopoietin (TSLP), a member of the interleukin-2 family of cytokines, is produced by activated lung and intestinal epithelial cells, mast, and other immune cells. Population-based studies identified associations between SNPs in the TSLP promoter region and asthma pathogenesis. In this study, we analyzed the genotypic association of TSLP rs1837253 with asthma predisposition in the Pashtun population of Khyber Pakhtunkhwa, Pakistan. Target DNA sequence of 250 asthmatics and an equal number of healthy individuals was PCR amplified, and allelic determination was performed by Sanger sequencing. Statistical analysis was conducted using chi-square tests and logistic regression analysis. Homozygous T/T genotype was frequent in the asthmatic subjects with a statistically significant level (P<0.05). Genetic models, including recessive, dominant, co-dominant, over-dominant, and additive were tested while adjusting allele frequencies with covariates (gender and age). Combined C/T and T/T individuals had higher odds ratios of 3.00, 1.91, and 1.73 in co-dominant, dominant, and additive models with statistically significant P-values of 0.029*, 0.022*, and 0.02*, respectively. T allele of rs1837253 was associated with increased susceptibility to asthma among Pashtuns, particularly in females, and we corroborate rs1837253 as a SNP of interest with a potential functional role.

Association of arg16gly and gln27glu, b2-adrenergic receptor gene polymorphism with asthma. A systematic review and meta-analysis of case control studies.

The study was planned to assimilate quantitatively the available evidences on association of Arg16Gly and Glu27Gln with asthma and to produce more precise results. All case-control studies conducted on adults were searched on Medline, Embase, PubMed, Wiley online library according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The strength of association was measured by odds ratios with 95% confidence interval. A total of 17 case-control studies were included in the meta-analysis and there was no significant association of asthma with Arg16Gly (odds ratio = 1.19; 95% confidence interval = 0.75-1.50, p=0.459) and Glu27Gln of ADRb2 polymorphism (odds ratio=0.87, 95% confidence interval =0.44-1.71, p=0.683). Moreover, neither Gly16 allele (odds ratio = 0.98; 95% confidence interval = 0.70-1.38, p=0.867) nor Glu27 allele (odds ratio = 0.67, 95% confidence interval = 0.38-1.19, p=0.169) contributed to asthma susceptibility. There was also no significant association between haplotypes of both single nucleotide polymorphisms and asthma (p>0.05). Data indicated that adrenergic receptor b2 did not contribute markedly to susceptibility to asthma (p>0.05).

Adipokine Serum visfatin level in pregnancy induced hypertension and uncomplicated pregnancy.

BACKGROUND AND OBJECTIVES: Hypertensive disorder in pregnancy is the significant disease that badly affects the maternal and fetal prognosis and lead to higher mortality and morbidity in the prenatal period. Visfatin, potentially a new adipokine has emerged having high contribution in pathogenesis of pre-eclampsia. The objective of the study was to find the level of Visfatin in pregnancy induced hypertension and normal pregnant women. METHODS: This study was carried out in tertiary care hospitals, Peshawar from March-October 2014. A total of 234 pregnant women (gestational age >20 weeks) were included in the study with distribution as Preeclampsia (PE=86), Eclampsia (E=74) and control (N=74). Blood was taken for measuring Visfatin level by Enzyme Linked Immunosorbent Assay (ELISA) technique. SPSS version 19 was used for statistical analysis. Student's t test was performed to evaluate the mean differences in patients and control. RESULTS: Serum level of visfatin was significantly higher in pregnancy induced hypertension when compared with control (P value<0.001).: Comparisons of mean value of visfatin with age group of 21-40 years, body mass index (BMI), primary parous and parity 2-4, gestational age of >36 weeks and both systolic and diastolic blood pressure were highly significant in pregnancy induced hypertension when compared with control (p value<0.001). CONCLUSION: Pregnancy induced hypertensive women showed increased level of serum Visfatin than normal pregnant women.

Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy.

PURPOSE: To determine the efficacy of mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy (IOU). MATERIALS AND METHODS: This was a randomized controlled trial conducted in the Department of Urology at the Institute of Kidney Diseases Peshawar from March 2011 to December 2013. A total of 151 patients who completed the study were divided into two groups by the lottery method. Group A (cases) comprised 78 patients in whom mitomycin C 0.1% was injected submucosally in the stricture after conventional IOU. Group B (controls) comprised 73 patients in whom IOU only was performed. Self-clean intermittent catheterization was not offered in either group. All patients were regularly followed up for 18 months. Recurrence was diagnosed by use of retrograde urethrogram in all patients and flexible urethroscopy in selected cases. Data were collected on a structured pro forma sheet and were analyzed by SPSS. RESULTS: The mean age of the patients in group A was 37.31±10.1 years and that in group B was 40.1±11.4 years. Recurrence of urethral stricture was recorded in 11 patients (14.1%) in group A and in 27 patients (36.9%) in group B (p=0.002). The mitomycin group also showed a delay in recurrence compared with the control group (p=0.002). CONCLUSIONS: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C was found to be highly effective in preventing the recurrence of urethral stricture after IOU.

New cholinesterase inhibitory constituents from Lonicera quinquelocularis.

A phytochemical investigation on the ethyl acetate soluble fraction of Lonicera quinquelocularis (whole plant) led to the first time isolation of one new phthalate; bis(7-acetoxy-2-ethyl-5-methylheptyl) phthalate (3) and two new benzoates; neopentyl-4-ethoxy-3, 5-bis (3-methyl-2-butenyl benzoate (4) and neopentyl-4-hydroxy-3, 5-bis (3-methyl-2-butenyl benzoate (5) along with two known compounds bis (2-ethylhexyl phthalate (1) and dioctyl phthalate (2). Their structures were established on the basis of spectroscopic analysis and by comparison with available data in the literature. All the compounds (1-5) were tested for their acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activities in dose dependent manner. The IC50 (50% inhibitory effect) values of compounds 3 and 5 against AChE were 1.65 and 3.43 µM while the values obtained against BChE were 5.98 and 9.84 µM respectively. Compounds 2 and 4 showed weak inhibition profile.

Risk factors for diabetic foot ulcer.

BACKGROUND: Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. METHODS: A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. RESULTS: Out of 196 patients 80.1% were male. One hundred and forty-six (74.48%) patients were in the range of 40-70) years. Right foot was more commonly involved (65.3%). 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients: staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease. grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. CONCLUSION: Neuropathy, peripheral arterial disease, duration of diseases and undlerlying osteomylitis are the major risk factors and need to addressed while educating patients.

Evaluation of patients with coronary artery disease for major modifiable risk factors for ischemic heart disease.

BACKGROUND: Incidence of cardiovascular diseases is on the rise in developing countries. Deaths due to ischemic heart disease can be reduced by modifying the risk factors. The present study was conducted to evaluate the patients scheduled for Coronary Artery Bypass Surgery for the presence of major modifiable risk factors for ischemic heart disease (IHD). METHODS: It was a descriptive study. All patients who underwent elective Coronary Artery Bypass cardiac surgery between November 1, 2008 and February 28, 2009 at Rehman Medical Institute, Peshawar, were included in the study. Presence of Diabetes, Hypertension, Smoking, Dyslipidemia, Sedentary life style, and Obesity was looked for in these patients. RESULTS: A total of 104 patients were studied during this period. Majority (97.11%) of patients had at least one major modifiable risk factor for IHD. Sedentary life style (53.84%) was the most common risk factor present in these patients followed by hypertension and dyslipidemia (47.11% each), smoking (43.27%), diabetes (35.57%), and obesity (9.61%). Multiple risk factors (two or more) were found in 78 (75.0%) of patients. CONCLUSION: Most of the patients with coronary artery disease, severe enough to warrant coronary artery bypass grafting, have at least one of the major modifiable risk factors for IHD. Modification of these factors may well reduce the disease burden of CAD and reduce the cardiovascular mortality.

Development of controlled-release matrix tablet of risperidone: influence of Methocel®- and Ethocel®-based novel polymeric blend on in vitro drug release and bioavailability.

Controlled-release (CR) matrix tablet of 4 mg risperidone was developed using flow bound dry granulation-slugging method to improve its safety profile and compliance. Model formulations F1, F2, and F3, consisting of distinct blends of Methocel® K100 LV-CR and Ethocel® standard 7FP premium, were slugged. Each batch of granules (250-1,000 µm), obtained by crushing the slugs, was divided into three portions after lubrication and then compressed to 9-, 12-, and 15-kg hard tablets. In vitro drug release studies were carried out in 0.1 N HCl (pH 1.2) and phosphate buffer (pH 6.8) using a paddle dissolution apparatus run at 50 rpm. The CR test tablet, containing 30% Methocel® and 60% Ethocel® (F3) with 12-kg hardness, exhibited pH-independent zero-order release kinetics for 24 h. The drug release rate was inversely proportional to the content of Ethocel®, while the gel layer formed of Methocel® helped in maintaining the integrity of the matrix. Changes in the hardness of tablet did not affect the release kinetics. The tablets were reproducible and stable for 6 months at 40 ± 2°C/75 ± 5% relative humidity. Risperidone and its active metabolite, 9-hydroxyrisperidone, present in the pooled rabbit's serum, were analyzed with HPLC-UV at λ(max) 280 nm. The CR test tablet exhibited bioequivalence to reference conventional tablet in addition to the significantly (p < 0.05) optimized peak concentration, C(max), and extended peak time, T (max), of the active moiety. There was a good association between drug absorption in vivo and drug release in vitro (R(2) = 0.7293). The successfully developed CR test tablet may be used for better therapeutic outcomes of risperidone.