Nonlinear optical phase shift in blood plasmas for neoplasia diagnosis.

Detecting cancer at an early stage is crucial for timely treatment and better chances of survival. This research focuses on a scanning method for detecting cancer by examining the nonlinear optical characteristics of blood plasma samples. The study used both cancerous and noncancerous plasma samples and presented the results statistically by utilizing an incident laser power-dependent nonlinear optical phase shift variable called ζ in the Z-scan technique. The results showed a clear difference between the cancerous and non-cancerous samples with an accuracy of 92%. Furthermore, the study suggests the potential for measuring the cancer staging from the cancerous plasma. The study also confirmed a significant difference in ζ for plasma samples undergoing chemotherapy. A red laser with high power (above 18mW) was used to avoid the involvement of fluorophores or other chemical reagents in the plasma samples during the measurement.

A comparative study between the outcomes of visual internal urethrotomy for short segment anterior urethral strictures done under spinal anesthesia and local anesthesia.

OBJECTIVE: This study is a randomized controlled study comparing the effectiveness and outcomes of direct visual inter urethrotomy (DVIU) for short segment anterior urethral strictures performed under local anesthesia versus spinal anesthesia. MATERIAL AND METHODS: Patients presenting with an anterior urethral stricture up to 2 cm were randomized into two interventional groups: Group I-DVIU done under spinal anesthesia and Group II-DVIU performed under local anesthesia. Procedural discomfort was analyzed with a visual analog scale (VAS) immediately postoperatively and after one hour of the procedure. The changes in the vital parameters (systolic blood pressure and pulse rate) were recorded. The success of the procedure was defined as the absence of symptoms of recurrent stricture along with the ability of self-urethral calibration with an 18Fr catheter on follow-up. RESULTS: One hundred and twenty patients, between December 2015 and February 2017, were randomized into the two above-mentioned groups with 60 patients each. The demographic profile, the stricture characteristics (etiology, length, and duration of symptoms), and the preoperative parameters (Qmax, preoperative pulse rate, and systolic blood pressures) were comparable in both the groups. The mean (±SD) intraoperative and one-hour postoperative VAS scores were 1.96 (±1.04) and 1.20 (±0.73), respectively, for Group I, which were significantly less (p<0.05) than the VAS scores 4.26 (± 1.98) and 2.13 (±1.71), respectively, for Group II. The intraoperative mean increases in pulse rate and systolic blood pressure were also significantly lower in Group I (p<0.05). The change in postoperative Qmax (mL/sec) was comparable in both the groups (mean of 20.75±4.31 vs. 19.041 4.88) and so is the stricture free rate at a one-year follow-up. No significant differences in complication rates were observed in both the groups. CONCLUSION: Although perioperative procedural parameters seem to be in favor of spinal anesthesia, the outcome of DVIU is independent of the type of anesthesia used.

Superwavelength, wavelength, and subwavelength laser-induced periodic surface structures on zinc and their energy-dispersive x-ray analysis.

In this work, we demonstrated simultaneous generation of three types of laser-induced periodic surface structures (LIPSSs) on a metal surface by processing Zn with a linearly polarized femtosecond laser pulse of 100 fs duration at a wavelength of 800 nm. In the center of the laser-processed region (a line), the period was found to be as high as 1470 nm (superwavelength LIPSS), whereas at the outer region, the LIPSS period was found to be as small as 200 nm (subwavelength LIPSS). In between these two regions, the LIPSSs were found to have period of 800 nm (wavelength LIPSS). In the energy-dispersive x-ray (EDX) study, the Zn:O atomic ratio was found to be 70%∶30% in the LIPSS-containing region. In contrast to this, in the region containing no LIPSS, the Zn:O atomic ratio was found to be 90%:10%. Discussion is given on the significance of the observed LIPSS, in terms of their possible growth mechanism and comparison with previously published results.

Distraction during cystoscopy to reduce pain and increase satisfaction: Randomized control study between real-time visualization versus listening to music versus combined music and real-time visualization.

PURPOSE: This study aims to compare the various distraction methods used during office cystoscopy to decrease pain and dissatisfaction among patients. MATERIALS AND METHODS: Two hundred patients undergoing rigid cystoscopy between January 2017 and July 2017 were randomized into four groups of 50 patients: (1) Group I: Patients who listened to music during the cystoscopy, (2) Group II: Patients allowed real-time visualization of the cystoscopy, (3) Group III: Patients who listened to music and had real-time visualization of the procedure, (4) Group IV: Control group undergoing cystoscopy without any distraction used. A visual analog scale (VAS) (1-10) was used for a self-assessment of pain, satisfaction, and willingness for repeat cystoscopy. RESULTS: Demographic characteristics, mean age, procedure duration, and procedure indications were statistically similar between the four groups. The mean VAS pain score were significantly lower in the three study Groups (I, II, and III) where distraction methods were used during cystoscopies as compared to the control Group IV (P < 0.001) and the satisfaction VAS scores and VAS scores for willingness to undergo a repeat procedure were significantly higher in the study groups (P < 0.001). Statistically significant decreased postprocedural pulse rate and blood pressure in comparison with to their preprocedural values were observed when distraction methods were used (P < 0.01). Patients undergoing cystoscopies listening to music and real-time visualization (Group III) had better VAS scores than the others (P < 0.01). CONCLUSIONS: Distraction methods reduce pain and increase satisfaction among patients. Best results are with combined listening to music and direct real-time visualization.

Total tubeless ultra-mini supine percutaneous nephrolithotomy: A feasibility study.

OBJECTIVE: The ultra-mini percutaneous nephrolithotomy (PCNL) for treating low-volume renal nephrolithiasis is being used as an alternative modality to the conventional PCNL. However its use in the supine position has been scarcely reported. MATERIAL AND METHODS: Patients who underwent ultra-mini PCNL in the supine position within the time frame of January 2017 to July 2017 were studied. All these patients had this as their first-line treatment. The patients had calculus limited to either a single calyx or just extending to the pelvis and the stone size was less than 2 cm in its maximal dimension. An 8.5 Fr operating nephroscope was used. The patients were positioned in the Galdakao modified Valdivia supine position. The stones were fragmented using Holmium-YAG laser. Various surgical outcomes including duration of the surgery, stone-free rate and any subsequent complications-if any-were analyzed. RESULTS: The study includes a series of 14 patients with 15 renal units (one patient treated with bilateral renal stone disease). The mean age of the patients was 39.07 years and body mass index was 25.5 kg/m2. Intrarenal stone location was as follows: lower calyx, n=8; middle calyx, n=3, upper calyx, n=1, and pelvis, n=3. Median operative time was 52.66 min (range: 40-70) and the stone-free rate was 93.3%. Only one patient had residual fragments and needed subsequent extracorporeal shock wave lithotripsy. CONCLUSION: Ultra-mini PCNL in supine position with a complete tubeless approach for renal stone disease is a safe method for treating low-volume disease. Studies with a larger cohort may be required to finally validate this technique.

Is urodynamic study is a necessity for evaluation of lower urinary tract symptoms in postmenopausal female patients? Result of a prospective observational study.

AIM: The aim of this study is to evaluate the causes of lower urinary tract symptoms (LUTS) in postmenopausal female patients (PMFP) and correlate their symptoms with their urodynamic study (UDS) findings. MATERIALS AND METHODS: A prospective observational study analyzing the clinical and UDS findings of PMFP presenting with LUTS. A detailed history including history of diabetes, neurological disease, drug history, and pelvic surgeries was taken, followed by physical examination and urodynamic assessment. RESULTS: A total of 100 patients were classified according to their predominant symptoms into three categories: (1) voiding dysfunction (45 patients), (2) storage symptoms (30 patients), and (3) urinary incontinence (25 patients). The patients with voiding LUTS could be categorized urodynamically into three grades of bladder outlet obstruction (BOO): (a) early (37.8%) (maximal flow [Qmax] >15 mL/s and detrusor pressure at maximal flow [PdetQmax] >30 cm of water), (b) compensated (31.1%) (Qmax <15 mL/s and PdetQmax >30 cm of water), and (c) late (31.1%) (Qmax <15 mL/s and PdetQmax <30 cm of water). The patients with storage symptoms could be categorized into two with either the presence of demonstrable idiopathic detrusor contractions (53.3%) or not (46.7%). The patients with incontinence were of three types: (a) stress incontinence (44%), (b) urge incontinence (28%), and (c) mixed incontinence (28%). UDS showed no demonstrable leak in nine patients (36%) and the rest had UDS findings corroborative to their symptoms. CONCLUSIONS: Thus, the major LUTS in PMFP were BOO, storage symptoms, and incontinence. Proper evaluation of LUTS necessitates UDS and along with good physical examination can help us in reaching a correct diagnosis and plan respective treatment.

Acute leukemia masquerading as xanthogranulomatous pyelonephritis.

An 82-year-old man presented with high-grade fever, left flank pain with dysuria. Urine culture revealed the growth of Escherichia coli. Contrast-enhanced computed tomography features were suggestive of xanthogranulomatous pyelonephritis (XPN) of the left kidney. Serial hemogram studies revealed markedly raised white cell count with the presence of blast cells. On further evaluation by peripheral blood smears and bone marrow biopsy studies, a background disease setting of acute prolymphocytic leukemia was diagnosed. This is a very rare case report of acute leukemia masquerading as a case of XPN, and the optimum treatment protocol is yet to be established in such a scenario.

Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature.

Metronidazole is an antimicrobial agent mainly used in the treatment of several protozoal and anaerobic infections, additionally, is often used in hepatic encephalopathy and Crohn disease. Apart from peripheral neuropathy, metronidazole can also cause symptoms of central nervous system dysfunction like ataxic gait, dysarthria, seizures, and encephalopathy which may result from both short term and chronic use of this drug and is collectively termed as "metronidazole induced encephalopathy"(MIE). Neuroimaging forms the backbone in clinching the diagnosis of this uncommon entity, especially in cases where there is high index of suspicion of intoxication. Although typical sites of involvement include cerebellum, brain stem and corpus callosum, however, lesions of other sites have also been reported. Once diagnosed, resolution of findings on Magnetic Resonance Imaging (MRI) of the Brain along with clinical improvement remains the mainstay of monitoring. Here we review the key clinical features and MRI findings of MIE as reported in medical literature. We also analyze implication of use of this drug in special situations like hepatic encephalopathy and brain abscess and discuss our experience regarding this entity.

Angiolymphoid hyperplasia with eosinophilia presenting with peri-ocular swelling.

Angiolymphoid hyperplasia with eosinophilia and Kimura's disease share many clinical and histological features. Although they were once considered different stages of the same disease, they are now known to represent separate entities. Here a case is reported in a 14-year-old girl who presented with bilaterally symmetrical gradually progressive peri-ocular swelling involving both upper and lower eyelids of two months' duration. Peripheral blood showed eosinophilia, MRI scan of orbit revealed soft tissue mass in both lids encroaching into the globe, histopathology of biopsy specimen revealed angiolymphoid hyperplasia with eosinophilia. The case is reported for the peculiarity of presentation and rare location of the disease.

Pulsatile scalp swelling.

Metastasis from follicular carcinoma is usually blood-borne. Here, we present a case of skull metastasis with intracranial extension presenting as a pulsatile scalp swelling from the follicular thyroid carcinoma.

Gitelman's syndrome presenting with hypocalcaemia, basal ganglia calcification and periodic paralysis.

Gitelman's syndrome (GS), also referred to as familial hypokalaemia-hypomagnesaemia syndrome, is an autosomal recessive renal tubular disorder characterised by hypokalaemic metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is caused by a defect of the thiazide-sensitive sodium chloride co-transporter at the distal tubule. This condition was previously confused with Bartter syndrome. Documentation of hypocalciuria helps to differentiate GS from Bartter syndrome. We report a 44-year-old woman who presented with a history of seizure disorder and periodic paralysis. On investigation, she was found to have hypokalaemic metabolic alkalosis, hypomagnesaemia, hypocalciuria, hypoparathyroidism, hypocalcaemia and basal ganglia calcification, consistent with GS. The atypical features in our case, namely basal ganglia calcification and hypocalcaemia, prompted the writing of this case report.

Reconfigurable wavefront sensor for ultrashort pulses.

A highly flexible Shack-Hartmann wavefront sensor for ultrashort pulse diagnostics is presented. The temporal system performance is studied in detail. Reflective operation is enabled by programming tilt-tolerant microaxicons into a liquid-crystal-on-silicon spatial light modulator. Nearly undistorted pulse transfer is obtained by generating nondiffracting needle beams as subbeams. Reproducible wavefront analysis and spatially resolved second-order autocorrelation are demonstrated at incident angles up to 50° and pulse durations down to 6 fs.

Primary cold agglutinin disease: a case report.

Chronic cold agglutinin disease is a subgroup of auto-immune haemolytic anaemia. Primary cold agglutinin disease has traditionally been defined by the absence of any underlying or associated disease. It usually affects elderly. The term cold refers to the fact that the auto-antibody involved reacts with red cells poorly or not at all at 37 degrees C, whereas it reacts strongly at lower temperature. Here a case of severe pallor, jaundice and red colour urine in winter season for last 10 years diagnosed as a case of primary cold agglutinin disease is reported.The patient was managed conservatively.

A patient with recurrent attacks of drowsiness and lethargy--a diagnosis not to be missed.

Polyglandular auto-immune syndromes are uncommon constellation of organ specific auto-immune diseases, characterised by the existence of two or more endocrinopathies. Polyglandular autoimmune type II syndrome also known as Schmidt's syndrome is more common, comprising Addison's disease, auto-immune thyroid disease, type 1 diabetes mellitus and/or hypogonadism, pernicious anaemia, coeliac disease, vitiligo, hypophysitis, etc. Here a case of a 56-year-old man is reported with a prior history of hypothyroidism who presented with adrenal crisis. Further laboratory investigations revealed primary auto-immune hypothyroidism, primary adrenal insufficiency, hypogonadism and he was diagnosed as a case of polyglandular auto-immune type II syndrome or Schmidt's syndrome. Early recognition of the syndrome and replacement therapy can be life saving, particularly when there is adrenal or thyroid insufficiency.

A patient with bilateral midbrain syndrome due to Plasmodium falciparum infection - a rare presentation

Cerebral malaria is a serious complication of Plasmodium falciparum infection with a high mortality rate, usually present with diffuse cerebral involvement and rarely with focal neurologic defi cit. Here we report a case of a young adult without any risk factors for stroke who presented with quadriparesis and was diagnosed to have bilateral midbrain stroke-like syndrome due to Plasmodium falciparum malaria. This is an unusual presentation of Plasmodium falciparum malaria. In tropical countries like India, all patients who present with fever and neurologic defi cit should be tested for malaria.

Highly efficient THG in TiO2 nanolayers for third-order pulse characterization.

Third harmonic generation (THG) of femtosecond laser pulses in sputtered nanocrystalline TiO2 thin films is investigated. Using layers of graded thickness, the dependence of THG on the film parameters is studied. The maximum THG signal is observed at a thickness of 180 nm. The corresponding conversion efficiency is 26 times larger compared to THG at the air-glass interface. For a demonstration of the capabilities of such a highly nonlinear material for pulse characterization, third-order autocorrelation and interferometric frequency-resolved optical gating (IFROG) traces are recorded with unamplified nanojoule pulses directly from a broadband femtosecond laser oscillator.

Chronic portal vein thrombosis due to combined deficiency of protein C and protein S.

Portal vein thrombosis (PVT) is a rare disorder that is associated with a variety of underlying condition of which liver cirrhosis, malignancy and myeloproliferative disorders are the most common. It is of two types, acute and chronic portal vein thrombosis. Anticoagulation therapy is recommended for all patients with acute portal vein thrombosis. Chronic portal vein thrombosis is characterised by the development o f portal hypertension. Bleeding from ruptured varices is the main complication. In the absence of bleeding, continuous anticoagulation therapy should be considered for chronic portal vein thrombosis in whom an underlying prothrombotic factor is to be identified. Here in this report a 13-year-old girl presented with haematemesis. The spleen was hugely enlarged. Her Hb was 8.38 g/dl. Grade III oesophageal varices were found in oesophagogastroduodenostomy. CT abdomen showed portal cavernoma formation with increased splenic collateral. Protein C activity was 45% and protein S activity was 40%. She was treated with beta-blocker, endoscopic variceal ligation followed by low molecular weight heparin and warfarin.

Extended-area nanostructuring of TiO2 with femtosecond laser pulses at 400 nm using a line focus.

An efficient way to generate nanoscale laser-induced periodic surface structures (LIPSS) in rutile-type TiO(2) with frequency-converted femtosecond laser pulses at wavelengths around 400 nm is reported. Extended-area structuring on fixed and moving substrates was obtained by exploiting the line focus of a cylindrical lens. Under defined conditions with respect to pulse number, pulse energy and scanning velocity, two types of ripple-like LIPSS with high and low spatial frequencies (HSFL, LSFL) with periods in the range of 90 nm and 340 nm, respectively, were formed. In particular, lower numbers of high energetic pulses favour the generation of LSFL whereas higher numbers of lower energetic pulses enable the preferential creation of HSFL. Theoretical calculations on the basis of the Drude model support the assumption that refractive index changes by photo-excited carriers are a major mechanism responsible for LSFL. Furthermore, the appearance of random substructures as small as 30 nm superimposing low spatial frequency ripples is demonstrated and their possible origin is discussed.

Clinicopathological profile of renal changes in systemic lupus erythematosus.

A study was done on 30 patients admitted in the department of medicine, RG Kar MCH to know the incidence and prevalence of systemic lupus erythematosus (SLE) patients and among them whether there were any cases of renal involvement, time of onset of clinicopathological features of renal involvement and renal changes if already been started in them who had no renal problem clinically. The cases were selected on the basic of revised ARA criteria. Total clinical examination and biochemical tests were done followed by renal biopsy in 28 cases. In rest 2 case, renal biopsy could not be performed because one case presented with severe azotaemia and another case presented with end stage renal disease with severe pallor. There were 28 females and 2 males in the present study presenting chiefly with joint pain and fever. Although renal symptoms were not very common in their presentation, in the present study, some form of renal abnormality (either on urine analysis or histology) was found in 26 patient. Among renal involvement, type IV diffuse proliferative lupus nephritis was more common. Incidence and prevalence of SLE was more common in this part of the world. When worldwise incidence of SLE is considered, renal involvement was quite high (96%) in the present study, type IV diffuse proliferative lupus nephritis was commonest type and in severe form.