ABSTRACT
Urethral duplication is a very rarely observed congenital anomaly, mostly affecting the males. This case report highlights the management of two patients diagnosed with Type II A, Y-type urethral duplication. An 11-year-old boy was diagnosed with Type II A of Y-type urethral duplication, where the dorsal urethra was completely hypoplastic, and the ventral urethra was communicating with rectum. After the failure of a single-stage inner preputial pedicled tube urethroplasty, a perineoscrotal flap urethroplasty was done, and at present, the patient is waiting for the 2nd stage of surgery. Case 2 is a 14-year-old boy diagnosed with Type II A2, Y-type urethral duplication, where the dorsal urethra at proximal part was hypoplastic with normal caliber of penile urethra, and the ventral urethra was communicating with rectum. The boy was treated with end-to-end urethroplasty, and good surgical outcome was observed. The purpose of this case report is to discuss the management of unusual form of Y-type urethral duplication by staging the surgical procedure.
ABSTRACT
BACKGROUND: The Human Immunodeficiency Virus (HIV) has long been known to alter the clinical presentation of tuberculosis (TB), which varies according to the time of occurrence of TB infection and the level of immunodeficiency. Identifying variations in clinical features in HIV-TB coinfection might be helpful in settings with limited diagnostic facilities. The aim of this study was to assess the clinical presentation of TB in HIV coinfection and associate clinical findings with level of immune suppression (CD4 count). MATERIALS AND METHODS: In this prospective, cross-sectional observational study 110 patients having TB-HIV co-infection were assessed for clinical presentation and correlation with CD4 count. The study setting was a tertiary care teaching hospital. Patients were categorized in three group based on CD4 counts as group I: ≤ 100 cells/cmm, group II: 101-200 cells/cmm and group III: > 200 cells/cmm. RESULTS: 110 patients were enrolled, 70% had CD4 cell count < 200 cells/mm3. Mean age and CD4 cell were 33.82±8.79 years and 181.7cells/cmm, respectively. Most common form of tubercular involvement was pulmonary (56.4%) followed by combined pulmonary and extra-pulmonary involvement (28.2%) and exclusively extra-pulmonary (15.5%). No significant intergroup difference was observed in site of involvement among three groups (p=0.700). Cough (91.8%) followed by low grade fever (85.5%), anorexia (82.7%) and weight loss (66.4%) were the commonest presenting symptom without any significant inter group difference. 70.9% patients were in undernourished category and 53.6% were febrile on examination. Sputum negative TB was noted 53.8%. 72.0% of patients with CD4 counts ≤100 had sputum negative TB as compared to sputum positive TB (28%). CONCLUSION: Due to varied clinical presentation of TB in HIV patients, ample knowledge of the clinical spectrum at different levels of immunosuppression is absolutely necessary to identify such patients early.
