Comparison of STONE Score, Guy's Stone Score, CROES Nomogram, and Seoul National University Renal Stone Complexity Score in Prognosticating Outcomes of Multiple-Tract Mini-Percutaneous Nephrolithotomy: A Retrospective Study.

Objective  The objective of this study was to compare the STONE score (Size of the stone, Topography or location, degree of Obstruction of the urinary system, Number of stones, and Evaluation of Hounsfield units), Guy's stone score (GSS), Clinical Research Office of the Endourological Society (CROES) nomogram, and Seoul National University Renal Stone Complexity Score (RSCS) in prognosticating multiple tract mini-percutaneous nephrolithotomy (mPCNL) outcome. Methodology This descriptive retrospective analysis was carried out at the Urology Department, Lady Reading Hospital, Peshawar, Pakistan. Male and female patients in the age range of 18-70 years who underwent multiple tract mPCNL for renal stones from July 1, 2021, to June 30, 2023, were included in the analysis. Results  A total of 110 patients were registered. Stone-free status (SFS) was achieved in 78.2% (n=86), and complications were observed in 13.6% (n=15) patients. The odds ratio for STONE score, GSS, CROES scoring system, and RSCS for predicting the SFS was 7.093 (95%CI 2.40-20.89), 9.333 (95%CI 2.92-29.81), 11.70 (95%CI 2.56-53.38) and 3.450 (95%CI 1.25-9.53), respectively. Conclusion  Multiple tract mPCNL is a safe and effective technique for the management of renal stones, producing a high stone-free rate. This study demonstrated adequate efficacy and dependability of the four scoring systems in predicting SFS.

Therapeutic Chemoresistance in Ovarian Cancer: Emerging Hallmarks, Signaling Mechanisms and Alternative Pathways.

Ovarian cancer is the fifth leading cause of mortality and the most lethal gynecologic malignancy among females. It may arise from atypical borderline tumors (Type I) or serous tubal intraepithelial carcinoma (Type II). The diagnosis of cancer at its early stages is difficult because of non-specific symptoms, most patients are diagnosed at the advanced stage. Several drugs and therapeutic strategies are available to treat ovarian cancer such as surgery, chemotherapy, neoadjuvant therapy, and maintenance therapy. However, the cancer cells have developed resistance to a number of available therapies causing treatment failure. This emerging chemoresistance in ovarian cancer cells is becoming an obstacle due to alterations in multiple cellular processes. These processes involve altered drug target response, drug pumps, detoxification systems, lower sensitivity to apoptosis, and altered proliferation, and are responsible for developing resistance to anticancer medicines. Various research reports have evidenced that these altered processes might play a role in the emergence of resistance. This review addresses the recent advances in understanding the underlying mechanisms of ovarian cancer resistance and covers sophisticated alternative pathways to overcome these resistance mechanisms in patients.

Role of Human Papillomavirus in Various Cancers: Epidemiology, Screening and Prevention.

It is estimated that viral infections contribute 15-20% of all human cancers. Several types of human papillomaviruse (HPV) are related to the development of many cancer types and their treatment. About 200 HPV viruses have been identified, and each type of virus is integrated with a certain type of clinical lesions affecting the areas of skin and mucous membranes. Infections associated with HPV are known to cause multiple cancer types such as uterine cancer, cervical, vaginal carcinoma, and other varieties of carcinomas such as genital and oropharyngeal, penile, and short-lived carcinomas. Most of the HPV types are considered as high-risk mutants that can provoke cervical cancer in females in addition to significant contribution to other cancer types such as anogenital cancer and tumor in head and neck regions. Among them, high risk human papilloma viruses (HR-HPV) subtypes 16 and 18 play a major role in the etiology of cervical cancer worldwide. Although, cervical cancer incidence and fatality rates vary greatly depending on geographical area, it is the leading cause of mortality in women around the world. In addition, it is epidemiologically similar to a sexually transmitted disease of low infectivity. In this review article, the association of HPV with different types of cancers have been explained, but the main focus remains on cervical cancer.

Computational approaches for innovative anti-viral drug discovery using Orthosiphon aristatus blume miq against dengue virus.

Dengue virus has emerged as infectious mosquito borne disease involved in lowering platelets and white blood cells (WBC) count particularly. The genome structure is based on several structural and non-structural proteins essential for viral replication and progeny. One of the major proteins of replication is non-structural protein 3 (NS3) that transforms polyproteins into functional proteins with a cofactor non-structural protein (NS2B). Heat Shock Protein 70 (HSP70), is a human protein that assists in replication, viral entry and virion synthesis. Therefore, to inhibit the spread of dengue infection, there is a need of antivirals targeting replication proteins and other human proteins that help in dengue virus multiplication. By systemic approach based on molecular docking, ADMET (absorption, distribution, metabolism, excretion and toxicity) properties and molecular dynamic simulation (MD), potent inhibitors can be predicted. Inhibition of NS2B/NS3 dengue and HSP70 proteins involved in multiple steps in dengue virus progression can be prevented by using different phytochemicals. Molecular docking was performed using AutoDock Vina, PatchDock, and SwissDock. Interactions of obtained complex were observed in PyMOL and PLIP. Validation was checked by PROCHEK, simulation was performed using iMODS followed by preclinical testing by admetSAR. Ladanein, a flavonoid of Orthosiphon aristatus, was obtained as the lead compound to inhibit major replication protein of dengue virus with inhibitory potential against HSP70 protein. In summary, various in silico approaches were used to obtain the best phytochemical having anti-dengue potential.Communicated by Ramaswamy H. Sarma.

APPENDICEAL TIE SYNDROME: A RARE CAUSE OF SMALL BOWEL OBSTRUCTION.

Acute appendicitis and intestinal obstruction are two common surgical emergencies. Acute appendicitis as a cause of closed-loop bowel obstruction is a rare surgical entity. The first case was reported in 1901 and since then only a few cases have been reported. We report an unusual case of a 25-year-old female who presented with the clinical picture of acute small bowel obstruction and was found to have an appendicular knot intraoperatively, through which a small bowel was herniating. The patient was managed via a midline laparotomy and appendectomy.

Gall Bladder Ascariasis: A Rare Entity.

Gall bladder ascariasis is a rare entity accounting for only 2.1% of biliary ascariasis features due to anatomical features of the cystic duct. It usually presents with vague abdominal features. Ultrasonography is the most sensitive and useful investigation for its diagnosis. We present a case of gall bladder ascariasis in an antenatal young female patient showing features of cholecystitis. She was diagnosed by ultrasonography and managed by laparoscopic cholecystectomy followed by oral anti-helminthic drugs. She made an uneventful recovery and is doing great in follow-up visits.

Spontaneous perforation of Meckel's diverticulum: A rare entity.

Meckel's diverticulum is the most common gastrointestinal tract's congenital abnormality. Spontaneous perforation of Meckel's diverticulum is very rare and can mimic acute appendicitis. Here we report the case of an 11-year-old male patient, who was presented to the Surgical A unit of Ayub Teaching Hospital, Abbottabad on 21st January, 2021 with one-day history of abdominal pain, predominantly in the periumbilical area and right iliac fossa, associated with nausea. On physical examination his abdomen was tense, tender with guarding and generalized rigidity. A provisional diagnosis of perforated appendix or enteric perforation of a hollow viscus was made. The patient had an emergency laparotomy, where a perforated Meckel's diverticulum was discovered. Resection of the portion of gut containing Meckel's diverticulum was done along with primary anastomosis. Heterotopic gastric mucosa of diverticulitis, associated with perforation was confirmed on histopathology. The patient made an uneventful recovery during postoperative period. This case report is an interesting and an unusual case of Meckel's diverticulum complication. It highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen in this age group.