A Retrospective and Comparative Analysis of Clinical Outcomes of Kidney Transplant Recipients During First and Second COVID-19 Waves in North-West India.

Introduction Kidney transplant recipients (KTRs) are prone to coronavirus disease 2019 (COVID-19) disease secondary to chronic immunosuppressive therapy. There have been differences in mortality and morbidity amongst the general population with different COVID-19 waves. This study is done to understand the effects of different COVID-19 waves amongst KTRs. Methods This was a retrospective single-centre trial from a high-volume transplant centre in North India. The immunosuppression protocol was changed according to national guidelines, and predictors of survival were evaluated. Results A total of 62 patients got infected during the first COVID-19 wave (March 2020 to February 2021) and 50 patients during the second COVID-19 wave (March 2021 to December 2021). Analysis showed a higher incidence of severe COVID-19 disease (79% vs. 50%) in the first wave, while the rest of the baseline parameters were similar in both waves. Mortality was similar in both groups. In both groups, severe COVID-19 disease, the requirement of hospitalisation, invasive oxygen therapy, and CT score findings were significant predictors of survival. There was no change in survival with respect to immunosuppression modification. Allograft dysfunction was more common in the second wave (7 vs. 1). Baseline creatinine was significantly associated with allograft dysfunction in follow-up. Conclusion Patients had severe COVID-19 disease during the first wave; however, poor availability of healthcare services during the second wave led to more patients with allograft dysfunction. Though immunosuppression change is necessary to prevent flare-ups of COVID-19 infection, it is not associated with survival benefits.

Unilateral Versus Bilateral Vasoepididymal Anastomosis for Idiopathic Obstructive Azoospermia: A Randomised Controlled Trial.

Background: Men with idiopathic obstructive azoospermia (OA) are candidates for surgical reconstruction with a vasoepididymal anastomosis (VEA) performed on one or both testis. There are no randomised trials comparing the success of unilateral versus bilateral VEA. Objective: We conducted a randomised trial to compare the two surgical options. Design setting and participants: Between April 2017 and March 2022, men with infertility due to idiopathic OA were randomised to a unilateral (group 1) or bilateral (group 2) VEA in an ethics committee-approved clinical trial, registered with the Clinical Trials Registry. Outcome measurements and statistical analysis: The primary outcome was successful surgery, defined as appearance of sperm in the ejaculate, evaluated at 3 mo intervals after surgery. Additional outcomes were pregnancy rates and complications between the two groups. Men with successful surgery were compared with those without patency to identify the predictors of success. Results and limitations: Fifty-four men fulfilled the criteria and 52 who completed follow-up were included in the analysis. The overall patency rate was 36.5% (19/52 individuals). This was higher in men with bilateral surgery (12/26 patients, 46%) than in those with unilateral surgery (7/26 patients, 27%) but was not statistically significant (p = 0.1). The overall pregnancy rate with ejaculated sperm was significantly higher in the bilateral surgery group (4 vs 0, p = 0.037), while the spontaneous conception rate was higher but not statistically significant (3 vs 0, p = 0.074). The complication rates in the two groups were similar (p = 0.7), and all complications were Clavien-Dindo grade 1. Although bilateral surgery and presence of sperm in epididymal fluid were higher in men with patency, these were not statistically significant. Conclusions: A bilateral VEA was associated with higher patency and spontaneous pregnancy rates than unilateral surgery, but the results were not statistically significant. However, the overall pregnancy rate with ejaculated sperm, spontaneous and assisted, was significantly higher in the bilateral surgery group. Patient summary: In this study, we compared between unilateral and bilateral reconstructive surgery in azoospermic men and found better overall success with bilateral surgery. However, these results were not statistically significant.

Upper Tract Urothelial Carcinoma with Intra-renal Haemorrhage.

A 60-year-old man with right upper tract urothelial carcinoma (UTUC) developed sudden onset right upper abdominal pain. He had no haematuria, nausea or vomiting and examination revealed right upper abdominal tenderness. Laboratory investigations showed drop-in haemoglobin. Computerised tomography revealed hyperdense contents within the renal pelvis extending into the renal parenchyma. After anaemia correction, radical nephroureterectomy confirmed the intra-renal haemorrhage. At 12 months follow-up, the patient is asymptomatic and recurrence-free. Only a few reported cases of perirenal haemorrhage are available in the literature. However, there is no report on intra-renal haemorrhage in UTUC. We present the first case of intra-renal haemorrhage (IRH) in UTUC managed with radical nephroureterectomy.

Male infertility in India: Demographics, aetiology and outcomes of standard clinical practice.

Background: . Although the outcomes of assisted reproductive technologies (ART) and corrective surgery for male infertility are reported in the literature, these are based on studies specifically designed to assess the outcomes of individual interventions and do not reflect the real-life (intent-to-treat) outcomes of managing infertility. There are sparse data on the actual utilization of treatment and pregnancy outcomes in these patients. We aimed to evaluate the demographics, aetiology, treatment utilization and outcomes of treatment of male infertility in a tertiary care centre. Methods: . We prospectively enrolled 447 infertile males for evaluation over 30 months beginning October 2015. All patients were evaluated and investigated as per the study protocol to identify the cause of infertility. The patients were advised interventions based on the diagnosis and were followed up to assess delivery of treatment and outcomes of interventions in terms of pregnancy rates. Results: . Of the 447 enrolled patients, 426 (mean age 31 years) completed the initial diagnostic evaluation. About 83% had primary infertility, 40% had oligo/astheno/ teratozoospermia, 40% had azoospermia, and 21.1% had obstructive azoospermia. Genetic abnormalities were detected in 9.3% of the 162 patients screened. ART was advised for 71.8% of patients, but only 18% of patients actually received the treatment though they had a high success rate (38%). In contrast, surgery was recommended to only 35 (8.2%) patients, but only 18 (58%) received the recommended treatment with a pregnancy rate of 33.3%. Overall, only 24.4% of patients received the advised treatment with a pregnancy rate of 36.8%. Conclusions: . ART was the most common intervention recommended, but less than one-fourth of couples received the recommended treatment. Surgery is indicated in a small number of patients, but is delivered to a larger proportion than those advised ART with both modalities having similar pregnancy outcomes.

High Level of Awareness but Poor Practices Regarding Dengue Fever Control: A Cross-sectional Study from North India.

BACKGROUND: Delhi, the capital of India, has suffered many outbreaks of dengue in recent past and despite the obvious magnitude of problem, very scarce evidence exists that documents the knowledge, awareness and practices of the people regarding dengue. AIM: To assess the knowledge and practices related to control of dengue fever and to assess the differences in knowledge and practices based on sex and literacy. MATERIALS AND METHODS: A cross-sectional study was conducted among persons visiting a tertiary care hospital in New Delhi. A systematic sampling procedure was adopted and a pretested questionnaire was used. RESULTS: A total of 215 individuals were interviewed. Majority of the respondents (96.3%) had heard about dengue. The important sources of information were television (54.9%) and newspaper/magazines (51.7%). Around 89% of the study participants considered dengue as "serious problem". Nearly 86% participants were aware of the spread of dengue by mosquitoes while 73% were aware of one of the correct breeding sites of Aedes mosquito. Mosquito mats/liquidators were used by 61% of respondents, coils by 56% and repellant creams by 22%. CONCLUSION: The awareness regarding dengue and mosquito control measures was satisfactory to an extent. Programs should focus that this knowledge gets translated into practice.

Most breast cancer screening trials have a flawed design.

In the present article, we discuss that why most breast cancer screening trials have a flawed origin. We suggest some solutions to correct these flaws so that more valid and reliable screening trials can be conducted in the future.