Massive perinephric hematoma - A rare complication of extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy is commonly used to fragment renal calculi. This treatment modality is considered safe with minimal complications. We report a case of massive retroperitoneal hematoma following extracorporeal shock wave lithotripsy in a patient with no comorbidity and normal coagulation parameters. Patient was managed conservatively and had excellent recovery with normal renal function.

Comparative study of tamsulosin versus tadalafil in benign prostatic hyperplasia patients with lower urinary tract symptoms. A prospective randomized study.

Introduction: Benign prostatic hyperplasia (BPH) is one of the common causes of lower urinary tract symptoms (LUTS) in aging men. Men with LUTS have a higher incidence of erectile dysfunction (ED), and LUTS themselves represent an independent risk factor for ED, triggering a significant negative impact on quality of life. Materials and Methods: A total of 92 patients were randomly assigned to two groups. Groups I and II had 45 and 47 patients, two patients from Group I and three patients from Group II did not follow and were excluded from the study. Patients in Group I received 0.4 mg of tamsulosin and Group II patients received 5 mg tadalafil. Patients were assessed at baseline, 3 months, and at 6 months after receiving treatment. Treatment efficacy was measured by a change in Qmax, post void residual urine (PVR), International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM) score at 3 months and 6 months. Results: Baseline parameters between the two groups were similar. Mean Qmax improved by 7 ml/s at 3 months to 9.44 ml/s at 6 months in Group I versus 4.73 ml/s at 3 months to 6.46 ml/s at 6 months in Group II (P = 0.739). Mean PVRU decreased by 35.53 ml at 3 months to 47.23 ml at 6 months in Group I versus 44.98 at 3 months to 58.28 ml at 6 months in Group II (P = 0.102). IPSS score improved by 4.24 points at 3 months to 7.22 points at 6 months in Group I versus 4 points at 3 months to 5.02 points at 6 months in Group II (P = 0.336). SHIM score improved by 0.7 points 16.2 at 3 months to 0.8 points at 6 months in Group I versus 6.12 points at 3 months to 6.3 points at 6 months (P < 0.001). Conclusion: When both groups were compared, tadalafil showed statistically similar improvements in Qmax, PVRU, and IPSS score, but statistically significant improvement was observed with tadalafil in SHIM score compared with tamsulosin in treating LUTS secondary to BPH. Our study provides evidence that once daily tadalafil 5 mg is well tolerated and can be considered for the treatment of LUTS secondary to BPH especially in patient with ED.

Massive renal infarction due to spontaneous renal artery thrombosis-a rare case report.

Spontaneous renal artery thrombosis is a rare medical emergency. The signs and symptoms of the disease are variable and non specific making it difficult to diagnose on time and easily missed for other more common pathologies. Proper evaluation and timely intervention can prevent the loss of renal function. We present a case of 45 year old male with no comorbidity who presented with complaints of right flank pain, fever and vomiting for one day. With physical examination within normal limits, evaluation revealed right renal artery thrombosis.

A childhood blast victim presenting with bladder stone in adulthood-A rare case report of retained blast fragment with secondary stone.

Secondary bladder stones in young adults are usually a result of bladder outlet obstruction secondary to urethral stricture disease or neurogenic bladder. Foreign body inside bladder is a perfect nidus for the development of secondary bladder stone. We report a rare case of bladder stone in a young adult developing on the retained blast fragment inside bladder.

Glomerular Filtration Rate Estimation With Commonly Used Methods Among Healthy Live Kidney Donors of South Punjab, Pakistan.

Background Accurate estimation of the donor's glomerular filtration rate (GFR) is crucial for not only ensuring the medical appropriateness of the donor but also for the prediction of future allograft performance. The aim of this study was to compare the GFR estimation formulas and 24-hour urine creatinine clearance with diethylene triamine pentaacetic acid (DTPA) renal scan GFR. Methods This cross-sectional study was done at the Department of Nephro Urology Dialysis & Renal Transplantation, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur, Pakistan from September 2018 to September 2021. A total of 92 potential healthy live-related kidney donors of both genders, aged 18 to 60 years having body mass index below 35 kg/m2 were included. GFR was calculated with modification of diet in renal disease (MDRD), Cockcroft-Gault (CG), chronic kidney disease epidemiology (CKD-EPI) equations as well as by 24-hour urine creatinine clearance. DTPA renal scan was done to record GFR findings. GFR was compared using analysis of variance (ANOVA) among different methods. Results Out of a total of 92 individuals, 49 (53.3%) were male and 43 (46.7%) female. Mean age and BMI were noted to be 34.62±10.57 years and 24.40±2.71 kg/m2, respectively. Statistically significant differences existed between various methods of GFR estimation (p<0.001). Mean GFR as per DTPA renal scan findings was noted to be 97.32±9.39 ml/min/1.73 m2. Difference of 31.48±20.81, 27.37±21.1, 23.38±6.38, 15.52±37.52 was noted in estimated GFR (ml/min/1.73 m2) with CG formula, MDRD formula, EPI-CKD formula and 24-hour urine creatinine clearance respectively when compared with DTPA renal scan findings. The highest proportion of patients was seen with normal GFR with DTPA renal scan findings as 83 (90.2%) individuals while 24-hour urine creatinine clearance observed these to be 59 (64.1%), CG EPI-CKD formula 44 (47.8%), MDRD formula 39 (42.4%) and 40 (43.5%) with CG formula. Conclusion None of the GFR estimation methods resulted in similar findings. With reference to the DTPA renal scan, 24-hour urine creatinine clearance was the closest GFR estimation followed by CKD-EPI and MDRD equations.

Epidemiological and Molecular Characterization of Echinococcus granulosus Isolated from Small Ruminants in Kashmir Valley, India.

BACKGROUND: Cystic Echinococcosis (CE) is an emergent or re-emergent zoonosis and remains a public health and economic problem all over the world. METHODS: The present study was carried on the prevalence and genotypes of Echinococcus present in small ruminants in Kashmir valley. A total of 2100, sheep (2052) and goats (48), slaughtered or spontaneously dead, from various areas of Kashmir valley were screened for the presence of hydatidosis. In case of goat none of the cases were found positive for hydatidosis, whereas, all the positive cases (85) were recorded in sheep only. The overall prevalence of hydatidosis was 4.04%. The prevalence was higher in female sheep (5.46%) compared to males (2.83%). Season-wise highest prevalence was in summer (4.55%), followed by autumn (4.1%), spring (3.89%) and winter (2.5%).The liver was observed to be the most frequently infected organ with relative prevalence of 61.17% followed by lungs (38.82%).The rDNA-ITS1 fragment of positive samples was amplified with BD1 / 4S primers. RESULTS: The length of amplified fragment for all isolated samples was 1000bps. The products obtained on PCR were digested with four restriction enzymes (Rsa 1, Alu 1, Msp 1 and Taq1). Rsa 1, Alu 1, Msp 1 yielded identical fragments, 300 and 700 bp in sheep. TaqI restriction enzyme had no effect on PCR product and after digestion; intact 1000bps fragment was seen. CONCLUSION: Phylogenetic analysis of ITS1 gene revealed that the common sheep strain (G1) is the predominant genotype in sheep in Kashmir valley.

Dead bone in bladder- sequestrum perforating into urinary bladder leading to hydroureteronephrosis masquerading as bladder calculus.

Sequestrum formation is a known complication of osteomyelitis. This is usually a source of chronic non resolving infection and inflammation. We present a rare case of pelvic sequestrum following septic arthritis of hip joint invading into the urinary bladder mimicking a bladder calculus and leading to hydroureteronephrosis.

Management of accidental penile incarceration due to unusual masturbation practices.

OBJECTIVE: We aimed to discuss the unusual masturbation practices performed by methods such as penile devices causing incarceration and its emergency management. MATERIAL AND METHODS: It is a retrospective study of cases who presented to the emergency department with penile incarceration by metallic and nonmetallic encircling objects from September 2015 to October 2020. The cases were analyzed for age, marital status, motive, type of object used, duration of incarceration, associated urinary retention, type of anesthesia used, methods of removal, complications of incarceration, and secondary procedures required to treat complications. RESULTS: A total of nine cases had paid emergency visit to our hospital for the past 4 years. The average age of the patients was 36.78 years. Unusual masturbation practices that underwent wrong were the common cause in most cases (77.7%). Most of cases presented after 24 hours of incident. All foreign bodies were removed under spinal anesthesia except one that was removed under penile block. Two cases (22.9%) required skin grafting and one (11.1%) underwent partial penectomy following the removal of encircling objects. CONCLUSION: This study emphasizes that the penile incarceration because of unusual masturbation practices is rare as it is sparsely reported as only a few case reports in the literature. Most of the patients presented late because of the embarrassment associated with it. This emergency requires urgent intervention, and the method used to remove the foreign body depends on the resources available, duration of incarceration, grade of injury, and the type of foreign body.

Pattern of biopsy-proven kidney diseases: experience of a teaching hospital in Bahawalpur, Pakistan.

This descriptive observational study was conducted at the Department of Nephrology, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from January 2012 to April 2018, to study the pattern of biopsy-proven kidney diseases in that region as a part to establish a national renal biopsy registry. All adult patients who underwent renal biopsy at the Bahawal Victoria Hospital, Bahawalpur, Pakistan, from January 2012 to April 2018, were included in the study. All the biopsies were evaluated by light microscopy and immunofluorescence. All the patients underwent urine dipstick, microscopic examination, and quantification of proteinuria. Hepatitis B surface antigen, anti-hepatitis C virus, human immunodeficiency virus, and serology (antinuclear antibody, anti-ds DNA, and C3 and C4) were checked in all the patients. There were a total of 195 patients, with a mean age of 30.5 ± 12.8 years. Females were comparatively younger than males (P = 0.0154). Primary glomerulonephritis (GN) accounted for 77% (155) of all the patients, whereas secondary GN contributed 15.8%. Focal and segmental glomerulosclerosis (FSGS) was the most common diagnosis (28.2%) followed by membranous nephropathy (MN) (18.9%). Lupus nephritis was the third-most common pathology, and it predominated among females (P= 0.0026). Out of the eight diabetic patients, one each had FSGS and crescentic GN. In conclusion, primary glomerular diseases were the predominant biopsy-proven kidney diseases, and FSGS and MN were the most common glomerular diseases. This pattern in South Punjab closely resembles that in southern and northern parts of the country.

Laser Myringotomy Versus Ventilation Tubes In Otitis Media With Effusion.

BACKGROUND: Otitis media with effusion (OME) is a leading cause of difficulty in hearing in paediatric population. Otitis media with effusion must be detected and managed early to prevent conductive hearing loss in children. It was aimed to compare results of laser myringotomy and ventilation tube insertion, in terms of hearing improvement and recurrence of Middle ear effusion (MEE). METHODS: This randomized controlled trial was conducted from February 2012 to January 2015. Children of 4- 12 years of age with decreased hearing due to OME were included in the study. These children were investigated with pure tone audiometry (PTA) and tympanometry to confirm conductive hearing loss. Patients were put in 2 groups, group one comprised of patients treated with laser myringotomy and group 2, treated with ventilation tube insertion. The objective was to evaluate and compare results of the two procedures in terms of resolution of middle ear effusion (MEE) and improvement of hearing. The two procedures were also compared in terms of complications like otorrhea, persistence of perforation, hypertrophic scar and thinning of tympanic membrane (TM). RESULTS: Middle ear effusion cleared in 35 out of 68 ears with laser myringotomy (LM) as compared to 52 out of 62 ears with ventilation tubes (VT). The myringotomy was still patent in 21 ears treated with LM while tube was in site in 50 years with VT after 3 months. The hearing level improved with LM by 10-15 dB after first 3 months. CONCLUSIONS: The aim in Otitis media with effusion is ventilation of tympanic cavity. Laser myringotomy can be substitute to ventilation tube insertion (VT). But it remains patent for shorter time and less effective than VT. The ears with refractory or recurrent MEE should have VT insertion.

Squamous cell carcinoma of lung with osteo-cartilaginous metaplasia - a case report and review of the literature.

Calcification and ossification are very rare in primary squamous cell carcinoma of the lung. We report a 55-year-old male with primary squamous cell carcinoma of the lung who on histopathological examination was seen to have extensive calcification and ossification. Squamous carcinoma of the lung rarely presents with osteocartilaginous metaplasia. The case is presented here for its unique presentation.

Bilateral breast metastasis from mucinous adenocarcinoma of the rectum: a case report and review of the literature.

Metastatic breast carcinoma is rarely seen in clinical practice. It has been reported that lymphoma-leukemia, melanoma and sarcomas can metastasize to the breast. Bilateral metastases to the breast are rare and commonly have been seen to originate from ovarian carcinoma. Adenocarcinoma of rectum metastasizing to breast is an extremely rare clinico-pathological situation. We report a 28-year-old female who presented with bilateral breast metastasis 9 months after abdomino-perineal resection and total meso-rectal excision for a locally advanced mucinous adenocarcinoma of the rectum. A few case reports of a mucinous adenocarcinoma of rectum presenting with bilateral breast metastasis have been seen in the world literature and we hereby report this case who till now is the youngest patient reported.

Prevalence and risk factors of renal tubular acidosis after kidney transplantation.

OBJECTIVE: To asses the prevalence of post-transplant renal tubular acidosis (RTA) and its associated risk factors. METHODS: A cross-sectional study was conducted on 100 live related renal transplant recipients, with a transplant duration of more than one year and an estimated GFR > 40 ml/min/1.73m2. Patients with acute graft rejection within last 6 months, unstable graft function, acute urinary tract infection and diarrhoea were excluded. Renal Tubular Acidosis (RTA) was diagnosed on the basis of plasma bicarbonate, venous pH, urine and serum anion gap measurements. RESULTS: Out of 100 patients (74 male, 26 female) RTA was observed in 40 (29 male, 11 female). Patients with RTA had a lower GFR (65.87 +/- 12.35 versus 74.23 +/- 14.8 ml/min/1.73m2, P = 0.004) and higher number of previous acute rejections. Lower bicarbonate was associated with higher serum chloride (108.2 +/- 3.19 versus 105.72 +/- 3.9 mEq/L, P = 0.001) and higher potassium concentration (3.95 +/- 0.53 vs 3.61 +/- 0.46 mg/dl, P = 0.001). Higher phosphorous level (3.46 +/- 0.71 in RTA vs 3.19 +/- 0.59 mg/dl in non-RTA, P = 0.045) but lower total serum calcium concentrations were found in patients with RTA. Intake of angiotensin converting enzyme inhibitors (ACE 1) was associated with the development of RTA. Calcineurin inhibitor (CNI) therapy was not associated with an increased likelihood of RTA. While no difference was noted in sex, age, pre-transplant dialysis duration, post transplant period, body mass index and serum albumin levels. CONCLUSION: There is a high prevalence of RTA in renal transplant recipients. In most of the patients, this is subclinical and does not require treatment.