A comparative study between one step dilatation and serial dilatation technique in percutaneous nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the first line treatment for treating kidney stones larger than 2 cm size with the advantages of lower morbidity and faster post-operative recovery. Creation of a nephrostomy access is one of the major steps of PCNL. It can be done either by single-step dilatation or by multi-step serial dilatation technique. OBJECTIVES: To compare the outcome and evaluate the efficacy of percutaneous nephrolithotomy done by single-step versus serial dilatation technique with specific reference to access time, fluoroscopy time, rate of blood transfusion, length of hospital stay (post-op) and complication rate. METHODS: It was a prospective study with a sample size of 100 where 50 patients underwent one-step dilatation and other 50 patients underwent serial-dilatation technique. These patients were analysed on the basis of their demographic profile, renal access time, total fluoroscopy time for access, post-operative haematuria, duration of post-operative hospital stay and complications after operative procedure. Data was analysed and reported using statistical tools. RESULTS: Demographic profile of the patients and stone characteristics were equivalent between two groups. Mean access tract dilatation time, mean total fluoroscopy time were significantly less in one of the groups. Requirement of blood transfusion, and post-operative complications rate were not significant between two groups. CONCLUSION: Both methods are safe and effective for tract dilatation. However, PCNL can be successfully performed by one-step dilatation with the added advantages of lesser time of renal access, lesser radiation exposure. Blood loss and hospital stay after operative procedure were not statistically significant between two groups.

Multi­objective optimization of nitrile rubber and thermosets modified bituminous mix using desirability approach.

A variety of materials, including waste and rubber products, have been used in road construction to improve the performance of bituminous pavements. The present investigation is focused on modifying bitumen using Nitrile rubber (NBR) with different thermosets namely Bakelite (B), Furan Resin (FR), and Epoxy resin (ER). The emphasis of the problem is to arrive at a mix to achieve maximum Marshall Stability (MS) and minimum flow value of Modified Bituminous Concrete. Taguchi DOE technique has been used to design the experiments using Minitab software. Analysis of Variance (ANOVA) and Multi-objective optimization has been performed using the desirability approach in Design expert software. ANOVA analysis predicts that NBR, B, ER, and FR are the major significant parameters for Marshall Stability (MS) and Flow Value (FV). It has also been analyzed from SEM and EDS images of modified bitumen that sample S1 (5% NBR, 10% Bakelite, 10% FR, 2.5% ER) has a fine surface with small pores as compared to sample S34 (10% NBR, 0% Bakelite 10% FR, 2.5% ER). Multi-optimization results suggested the optimal conditions are achieved at NBR-7.6%, Bakelite-4.8%, FR-2.5%, and ER-2.6% for MS and FV. The maximum MS is 14.84 KN and the minimum FV is 2.84 mm is obtained using optimum conditions. To validate the optimization results, the confirmation runs have been conducted, and obtained results are within 5% error with optimal conditions.

Role of videourodynamics in the identification of causes of lower urinary tract symptoms and low uroflow in young men.

Introduction: The etiology of lower urinary tract symptoms (LUTS) is multifactorial with causes attributed either to the dysfunction of the bladder or its outlet. Although the etiologies are well studied in aged men, very limited research trials are available in young men with LUTS. Most of the time young men presenting with chronic irritative or obstructive symptoms are labeled with chronic prostatitis or prostatodynia and are treated empirically. In this study using videourodynamics, we prospectively investigated the etiologies of LUTS and low uroflow in young men. Materials and Methods: Fifty male patients, 18-50 years of age attending the urology outpatient department at a tertiary care center from January 2021 to December 2021 with symptoms suggestive of chronic LUTS and low uroflow (maximum urinary flow rate [Qmax] <15 ml/s at a voided volume >150 ml) were included in the study and underwent multichannel videourodynamic study (VUDS). Clinical characteristics and urodynamic results in different diagnostic groups were tabulated and analyzed. The P ≤ 0.05 was considered statistically significant. Results: Out of 50 enrolled patients, primary bladder neck obstruction was seen in 21 patients (42%), dysfunctional voiding in 14 (28%), impaired detrusor contractility (IDC) in 9 (18%), and benign prostatic obstruction (BPO) was noted in 6 patients (12%). The mean age and size of the prostate of patients with BPO were greater than those in the remaining groups and patients with IDC had lower Qmax and Pdet at Qmax than those in the remaining patients. Conclusion: Chronic LUTS in young men has a variety of underlying etiologies and VUDS in this population is helpful in attaining an accurate diagnosis and thus may guide toward efficient management.

A Numerical Investigation on Hydrothermal Performance of Micro Channel Heat Sink with Periodic Spatial Modification on Sidewalls.

Electronic gadgets have been designed to incorporating very small components such as microcontrollers, electronic chips, transistors, microprocessors, etc. These components are exceptionally heat sensitive and can be wrecked if heat is not released. As a result, the thermal control of such components is critical to their optimum performance and extended life. The use of a microchannel heat sink (MCHS) has shown promising solutions to remove the excess heat. In this paper, we have proposed a novel design of MCHS and investigated it numerically. Four different surface modifications on the sidewall of the passage, namely, extended triangular surface (ETS), extended circular surface (ECS), triangular groove surface (TGS), and the circular groove surface (CGS) in the passage of the microchannel have been exploited in the Reynolds number of 100-900. In the presence of geometrical modification, the cooling capacities have been enhanced. The results show that the Nusselt numbers of ETS-MCHS, ECS-MCHS, TGS-MCHS, and CGS-MCHS are increased by 4.30, 3.61, 1.62, and 1.41 times in comparison to the Nusselt number of MCHS with smooth passage, while the friction factor values are increased by 7.33, 6.03, 2.74, and 1.68 times, respectively. In addition, the thermohydraulic performance parameter (THPP) has been evaluated and discussed. The fact that MCHS have THPP values greater than unity demonstrates that the passage's geometries are a practical means of achieving effective thermal management.

One-pot thiol-free synthetic approach to sulfides, and sulfoxides selectively.

A facile and efficient thiol-free one-pot method for direct synthesis of sulfides and sulfoxides under green conditions without using any metal catalyst is reported. For this purpose, we used benzyl bromides as starting materials in the presence of potassium thioacetate (PTA) and Oxone® which are low-cost, and readily accessible chemicals. This method is highly compatible with a variety of functional groups and delivered a series of sulfides, bis-sulfides, and sulfoxides in good yields. The selective formation of sulfoxides over sulfones is discussed via a mechanism.

Analysis of Microchannel Heat Sink of Silicon Material with Right Triangular Groove on Sidewall of Passage.

Microchannel heat sink (MCHS) is a promising solution for removing the excess heat from an electronic component such as a microprocessor, electronic chip, etc. In order to increase the heat removal rate, the design of MCHS plays a vital role, and can avoid damaging heat-sensitive components. Therefore, the passage of the MCHS has been designed with a periodic right triangular groove in the flow passage. The motivation for this form of groove shape is taken from heat transfer enhancement techniques used in solar air heaters. In this paper, a numerical study of this new design of microchannel passage is presented. The microchannel design has five variable groove angles, ranging from 15° to 75°. Computational fluid dynamics (CFD) is used to simulate this unique microchannel. Based on the Navier-Stokes and energy equations, a 3D model of the microchannel heat sink was built, discretized, and laminar numerical solutions for heat transfer, pressure drop, and thermohydraulic performance were derived. It was found that Nusselt number and thermo-hydraulic performance are superior in the microchannel with a 15° groove angle. In addition, thermohydraulic performance parameters (THPP) were evaluated and discussed. THPP values were found to be more than unity for a designed microchannel that had all angles except 75°, which confirm that the proposed design of the microchannel is a viable solution for thermal management.

rac-(2aS,2a1 R,3aR,3a1 S,5aS,6aR)-2a-Allyl-2,4-di-chloro-2a,2a1,3a1,5a,6,6a-hexa-hydro-3aH-3-oxadi-cyclo-penta-[cd,gh]penta-len-3a-ol.

The title racemic triquinane, C14H14Cl2O2, is composed of four five-membered rings, one of which is a tetra-hydro-furan ring to which an allyl group on one side and a hydroxyl group on the other side are attached. The core of the triquinane unit has a cis-syn-cis configuration. In the crystal, the mol-ecules are linked by pairwise O-H⋯O hydrogen bonds, generating inversion dimers featuring R 2 2(8) loops.

5-[(1,3-Dimethyl-5-oxo-2-sulfanylideneimidazolidin-4-yl-idene)amino]-2-methyl-isoindoline-1,3-dione.

The title N,N-di-methyl-thio-hydantoin containing an N-methyl-ated pthalimide group, C14H12N4O3S, arose from an unexpected reaction in a deep eutectic di-methyl-thio-urea-tartaric acid solvent system. The mean planes of the ring systems are twisted at an angle of 73.84 (17)°. In the crystal, weak C-H⋯O hydrogen bonds connect the mol-ecules.

Monthly maintenance protocol Bacillus Calmette-Guerin as a viable alternative to Southwest Oncology Group maintenance protocol in nonmuscle-invasive bladder cancer: A prospective randomized study.

INTRODUCTION: Bladder cancer is the most common malignancy of the urinary tract, and recurrence following transurethral resection poses the biggest challenge. Intravesical Bacillus Calmette-Guerin (BCG) maintenance with the Southwest Oncology Group (SWOG) protocol remains the gold standard but with poor patient compliance. MATERIALS AND METHODS: The present study aims to compare the SWOG maintenance protocol with a monthly maintenance protocol comprising 12 monthly doses of intravesical BCG. Patients are included in the study only if induction BCG is completed and cystoscopy at 3 months is negative. All patients receive 80 mg BCG in each dose with strict cystoscopic surveillance every 3 months. RESULTS: Patient demographics and tumor characteristics were similar in the two groups. There were no statistically significant differences in outcome in terms of recurrence, progression, and adverse reactions in both the groups. Although a larger number of patients in the SWOG maintenance group were lost to follow-up, the difference was not statistically significant proportions. CONCLUSION: From this study, we can conclude that monthly maintenance BCG for 1 year is comparable in terms of outcome with SWOG protocol maintenance BCG. A greater percentage of patients in the monthly maintenance protocol completed the treatment as planned.

(E)-3-Thia-1,5(1,3)-dibenzena-cyclo-undeca-phan-8-ene-6,11-dione 3,3-dioxide.

The molecular structure of the title cyclophane, C20H18O4S, has two benzyl groups, a sulfone group, and two carbonyl groups adjacent to a double bond. The phenyl rings do not show intra-molecular stacking.

Serovar diversity of Salmonella among poultry.

Background & objectives: Salmonellosis due to the consumption of contaminated poultry products is a well-known public health concern, and assessing the distribution of Salmonella serovars among poultry becomes important for better prevention and control. The objective of the present study was to assess the distribution of Salmonella serovars among poultry. Methods: The isolates received at National Salmonella and Escherichia Centre during 2011-2016 were subjected to biochemical identification, followed by serological characterization to identify the Salmonella serovars, and the data were presented to exhibit the distribution of Salmonella serovars among poultry. Results: Salmonella was found to be present in poultry in all the regions included in the study. Salmonella Typhimurium, S. Gallinarum and S. Enteritidis were the most prevalent serovars accounting for 96.2 per cent of isolates. Salmonella was identified in poultry from all major egg-producing and egg-consuming States. Other serovars which were scantly identified included S. Infantis (2.7%), S. Montevideo (0.64%), S. Newport (0.26%) and S. Pullorum (0.13%). Interpretation & conclusions: Diverse distribution of Salmonella serovars in poultry in India, with known potential to infect human population and/or other poultry flocks, requires urgent nationwide stringent control measures.

Systemic non-Hodgkin's lymphoma initially presenting as a bladder mass.

Urinary bladder lymphomas are rare lesions which may be primary bladder lymphomas or part of systemic lymphoma with bladder involvement. We report a case of non-Hodgkin's lymphoma (NHL) in a 73-year-old female who presented with bladder tumor which on evaluation revealed NHL with extensive systemic involvement. The management of such an advanced case is discussed here with literature review.

The Antioxidant Potential of Azadirachta indica Ameliorates Cardioprotection Following Diabetic Mellitus-Induced Microangiopathy.

BACKGROUND: Cardiac complications associated with diabetes mellitus have become major cause of concern. Antidiabetic drugs, with varied mode of action, are although available, apprehensions exist for their limited action or side effects upon prolonged use. Efforts are therefore inclined toward finding other alternatives. The present study was, thus, undertaken to evaluate the cardioprotective effect of Azadirachta indica (AI) on microangiopathic changes in rat model of diabetes. MATERIALS AND METHODS: Diabetes was induced in male rats by single intraperitoneal injection of streptozotocin (60 mg/kg body weight). Seven days after glucose levels are stabilized, aqueous leaf extract of AI (ALE) (600 mg/kg(1) body weight) was administered orally to diabetic animals every day for 7 days. RESULTS: High blood glucose characterizing diabetes in these animals was found to show increased lipid peroxidation (LPO), altered antioxidant biomarkers together with microangiopathic alterations. The treatment of diabetic rats with ALE reduced the levels of blood glucose, LPO, and restored the activities of antioxidant enzyme. Light and transmission electron microscopic analysis revealed reduced necrotic areas and inflammation in tissue architecture of ALE treated heart in comparison to untreated diabetic group. CONCLUSION: AI provides cardioprotection by ameliorating oxidative stress in rat model of diabetic mellitus. SUMMARY: The streptozotocin (STZ) treatment (60 mg/kg body weight) to animals induced diabetic changes such as elevated blood glucose levels, decreased body weight, altered lipid profiles together with development of proxidant state evidenced by elevated levels of lipid peroxidation (LPO), depletion in reduced glutathione (GSH) levels and altered antioxidant enzymes with consequent microangiopathic alterations in heart tissue evinced by localization of necrotic and inflamed areas in heart tissueThe treatment of animals with Azadirachta indica leaf extract (ALE) (600 mg/kg body weight) post-STZ treatment significantly reversed the adverse effects witnessed by normalized blood glucose levels, improvement in reduced body weight and stabilized lipid profilesFurther, ALE treatment also significantly reduced the LPO indices, improvement in GSH content and restoration of antioxidant enzyme activities, suggesting antioxidatant potential of ALEThe microangiopathic changes in the heart tissue consequent to induction of diabetes and oxidative stress by STZ as reiterated through light microscopy and transmission electron microscopy were found to be reversed by ALE treatment. These observations pointed toward cardiopreventive effects of ALE following microangiopathic changes as seen following induction of diabetes mellitus. Abbreviations used: AI: Azadirachta indica, ALE: Azadirachta indica Leaves Extract. STZ: Streptozotocin, LPO Lipid per oxidation, GSH: Glutathione, GSSG: Glutathione disulphide, SOD: Superoxide dismutase, GP: Glutathione peroxidase, GR: Glutathione reductase.

Laparoscopic versus open splenectomy in the treatment of idiopathic thrombocytopenic purpura: an Indian experience.

UNLABELLED: Laparoscopic splenectomy (LS) is emerging as the treatment of choice over open splenectomy (OS) in cases of idiopathic (immune) thrombocytopenic purpura (ITP) that is either steroid resistant or steroid unresponsive.The aim of the present study is to compare therapeutic response and outcome of patients with ITP undergoing LS with a similar group undergoing OS.The study was performed on 63 patients with ITP attending Medical College and Hospital, Kolkata, a tertiary level referral centre in Eastern India during 2005-2009.Twenty-seven patients with ITP underwent LS and the rest underwent OS. Twenty-eight patients were steroid resistant whereas the rest were diagnosed to be refractory to steroids. Parameters assessed were demographic characteristics of patients, peri-operative data, complications and haematological outcome.The patients were followed up for a mean period of 40 months. RESULTS: Demographic characteristics of the patients in LS and OS group were comparable. Patients undergoing LS were found to require a longer operative time but had lower intra-operative blood loss, less postoperative pain, decreased incidence of complications, reduced hospital stay and comparable haematological response as compared to that for patients undergoing OS. LS for ITP is a safe technique associated with lower morbidity and faster convalescence and similar haematological response when compared to OS.

Laparoscopic repair of late presenting congenital Bochdalek diaphragmatic hernia.

Bochdalek diaphragmatic hernia is a common congenital anomaly presenting in the neonatal period and managed by open surgical procedures. Late presentation is usually associated with better prognosis. Here a case of a 10 years old boy presenting with Bochdalek hernia, managed primarily by laparoscopic approach is reported.

Emergency management of sigmoid volvulus--institutional experience over four years.

Sigmoid volvulus is a serious surgical emergency and a common cause of large bowel obstruction in India. Patients present with abdominal pain, distension and obstipation and abdominal skiagram usually reveals the characteristic omega sign. Non-operative detorsion with early elective sigmoidectomy is the procedure of choice where gut viability is not in doubt and features of peritonitis are absent. The objective of this study was to demonstrate the most suitable procedure for management of patients with sigmoid volvulus needing emergency surgery. Results revealed a high incidence of burst abdomen and anastomotic leak as well as a high mortality rate in patients undergoing resection with primary anastomosis without proximal colostomy. Mortality was least with Hartmann's procedure although there was a higher incidence of wound infection. Thus, in the hospital setting, we consider Hartmann's procedure to be the best emergency surgical procedure for sigmoid volvulus as it limits mortality to the least.

Sensitivity pattern of Salmonella serotypes in Northern India

BACKGROUND: Enteric fever continues to be a major public health problem, especially in the developing countries of the tropics. We determined the incidence of Salmonella bloodstream infections and their antimicrobial resistance patterns from May to August in the years 1997-2001 in Haryana, a large state of India. The minimum inhibitory concentration (MIC) was also determined for 60 isolates of S. typhi to various commonly used antimicrobial agents. MATERIAL AND METHODS: Blood cultures of 6,956 patients (PUO/septicemia) were processed by standard procedures and the Salmonella spp. isolates were identified with specific antisera and with standard biochemical tests. Antimicrobial susceptibilities were determined by Stokes disc diffusion method. The MIC of 60 randomly isolated strains of S. typhi was determined by agar dilution method using Mueller Hinton Agar medium. RESULTS: Isolation rates of Salmonella spp. increased in 2000 and 2001. Multidrug resistance (MDR) in S. typhi had increased while in S. paratyphi it had decreased markedly. Ninety per cent chloramphenicol sensitivity was seen in S. typhi by MIC method. There was a decrease in the susceptibility to ciprofloxacin of S. typhi with MIC showing an upward trend. All S. typhi tested were sensitive to third generation cephalosporins and aminoglycosides with MIC well below the breakpoint. DISCUSSION: Our study indicates that MDR in S. typhi is on the rise in our area. There is also re-emergence of chloramphenicol sensitivity. Rising MIC values of ciprofloxacin may lead to prolonged treatment, delayed recovery or pose treatment failure. Thus, sensitivity pattern of causative organism must be sought before instituting appropriate therapy to prevent further emergence of drug resistance.

Sensitivity pattern of Salmonella serotypes in Northern India.

BACKGROUND: Enteric fever continues to be a major public health problem, especially in the developing countries of the tropics. We determined the incidence of Salmonella bloodstream infections and their antimicrobial resistance patterns from May to August in the years 1997-2001 in Haryana, a large state of India. The minimum inhibitory concentration (MIC) was also determined for 60 isolates of S. typhi to various commonly used antimicrobial agents. MATERIAL AND METHODS: Blood cultures of 6,956 patients (PUO/septicemia) were processed by standard procedures and the Salmonella spp. isolates were identified with specific antisera and with standard biochemical tests. Antimicrobial susceptibilities were determined by Stokes disc diffusion method. The MIC of 60 randomly isolated strains of S. typhi was determined by agar dilution method using Mueller Hinton Agar medium. RESULTS: Isolation rates of Salmonella spp. increased in 2000 and 2001. Multidrug resistance (MDR) in S. typhi had increased while in S. paratyphi it had decreased markedly. Ninety per cent chloramphenicol sensitivity was seen in S. typhi by MIC method. There was a decrease in the susceptibility to ciprofloxacin of S. typhi with MIC showing an upward trend. All S. typhi tested were sensitive to third generation cephalosporins and aminoglycosides with MIC well below the breakpoint. DISCUSSION: Our study indicates that MDR in S. typhi is on the rise in our area. There is also re-emergence of chloramphenicol sensitivity. Rising MIC values of ciprofloxacin may lead to prolonged treatment, delayed recovery or pose treatment failure. Thus, sensitivity pattern of causative organism must be sought before instituting appropriate therapy to prevent further emergence of drug resistance.