Development of inclined plate honey moisture reduction system.

Honey is delicious, nutritious and has high medicinal value in comparison to other sweeteners. Honey is usually extracted from comb as immature product which results in high moisture which makes it more liable to be fermented by osmophilic yeasts. So, it needs to be processed for moisture reduction, to delay crystallization and to overcome the problem of fermentation. In the present investigation, a honey moisture reduction system was developed and tested to reduce the moisture content of honey to about 17%. The system consisted of a flat plate inclined at an angle. The plate was heated from the underside and honey for moisture reduction was re-circulated over it until desired moisture content was achieved. Experiments were conducted for honey moisture reduction at water temperature of 40-70 °C with plate inclinations of 30°-60° according to four level full factorial design of experiment. The results showed that the total reduction time required for reaching moisture content of about 17% varied with water temperature and angle of inclination. The moisture reduction time required for reaching a moisture content of 17 percent at 40 °C was about five times the time required at 70 °C. The energy cost of honey moisture content reduction from 21.5 to 17% was Rs. 4.7 to Rs. 12.5 per kg.

Efficacy and safety of tamsulosin vs its combination with mirabegron in the management of lower urinary tract non-neurogenic overactive bladder symptoms (OABS) because of Benign Prostatic Enlargement (BPE)-An open label randomised controlled clinical study.

PURPOSE: The efficacy and safety of ßeta-3 agonists (Mirabegron 50 mg) have been sparingly assessed in the published English literature. We aim to do an efficacy-safety analysis of Mirabegron-Tamsulosin combination therapy vs tamsulosin-placebo monotherapy in a select subset of medication virgin Benign Prostatic Enlargement (BPE) patients with coexisting predominant non-neurogenic overactive bladder symptoms (OABS). METHODS: After prior written informed consent and IEC, 80 patients of uncomplicated BPE with coexisting non-neurogenic OABS and IPSS of >7 without contraindications to drug therapy were computer randomised/allocated to receive either[50 mg Mirabegron plus Tamsulosin 0.4 mg (Intervention arm-I)]or [Tamsulosin 0.4 mg plus capsule lactobacillus (Comparator arm-II)] once daily for 8 weeks. Efficacy was evaluated using the OABS Score (OABSS), mean change in nocturnal frequency (NF), PVR and IPSS, while safety was assessed by recording treatment emergent adverse events (TEAE). Follow-up visits were performed at second, fourth and eighth week. RESULTS: Patient data in both groups were generally comparable with the exception of NF and IPSS storage sub score (IPSS-ss). Significant improvements were visualised in the eighth week primary endpoint total OABS sub score (OABSS-ss) in the combination group (P < .001).Similar significant improvements were seen with most secondary parameters such as the mean change in NF, IPSS, IPSS-ss, OABS-ss, voided volume, Qmax, and Quality of life index (QOL) (P < .001). No significant increase in PVR was observed in the Mirabegron arm and no patient developed urinary retention. The TEAE were minor, self-limiting and managed symptomatically without drug discontinuity. CONCLUSION: Mirabegron can be significantly efficacious and safe in ameliorating non-neurogenic OABS induced by BPE vs placebo by initiating combination therapy from the start as opposed to the usual 'add on therapy' protocol. This combination appeared to be superior in terms of overall safety, minimal side effects, better compliance and tolerability vs Tamsulosin monotherapy in select BPE patients with predominant non-neurogenic OABS.

Efficacy and safety of tadalafil vs tamsulosin in lower urinary tract symptoms (LUTS) as a result of benign prostate hyperplasia (BPH)-open label randomised controlled study.

INTRODUCTION & AIM: Several newer medications have emerged for the management of lower urinary tract symptoms secondary to benign prostate hyperplasia (BPH). The efficacy/safety of PDE-5 inhibitors (Tadalafil 5 mg) in BPH-lower urinary tract symptoms (LUTS) has been sparingly assessed in the published English literature as compared with their established role in erectile dysfunction. We aim to assess the efficacy/safety of tadalafil vs tamsulosin in symptomatic patients of BPH in a tertiary care teaching institution. METHODS: After obtaining an informed written consent and institutional ethics clearance, 100 patients of BPH with an IPSS score of more than 7, without any complications of the disease were computer randomised to receive therapy with either tamsulosin 0.4 mg or tadalafil 5 mg once daily for a period of 2 months. They were evaluated for its efficacy (IPSS, Peak flow rate, IIEF-5, quality of life index [QOL] and PVR) and safety (side effect profile) with monthly visit assessments for 2 months. Data were analysed statistically using ANOVA and unpaired t-tests.The protocol was registered with the CTRI/2018/03/012825. RESULTS: Patients in both groups were comparable on basis of their demographic data, renal function, PSA and baseline efficacy parameters. Significant improvements were visualised amongst/within both groups for IPSS, however the intergroup improvement was not significant (P = .096). Similar trends were seen with peak flow rate and PVR with intergroup improvement differences not being significant (P = .552 and P = .131, respectively).Improvements in QOL index were more significant in the tamsulosin group (mean difference -2.3 vs -3.06 P = .010).The adverse effects were minor and were managed symptomatically without any drug discontinuity. CONCLUSIONS: In summary, therefore, we may conclude that that once daily monotherapy with tadalafil 5 mg or tamsulosin 0.4 mg was equally efficacious in the management of moderate to severely bothersome LUTS in majority of patients as a result of BPH. The role of Tadalafil monotherapy in BPH patients with predominant storage LUTS merits further evaluation with larger trials.

Honey moisture reduction and its quality.

Beekeeping has been widely promoted in many countries as a major contributor to rural development. Honey is a sweet and viscous liquid which has sweetness due to the presence of monosaccharides. The major constituents of honey are sugars, water, proteins, enzymes, acids and minerals, while the major causes of quality deterioration include heating at high temperatures, high moisture content, adulteration, poor packaging and poor storage conditions. Heating not only eases the processing of bottling by reducing the viscosity of honey, but also reduces the water content in honey to prevent fermentation and delays the granulation by destroying large sugar nuclei. The paper discusses about the different honey moisture reduction systems designed by research workers as well as beekeepers at farm level and the different quality parameters affected by thermal treatment of honey.

Robotic repair of a rare case of symptomatic "Ureterosciatic Hernia".

Ureterosciatic hernia (USH) is a rarely described entity and is an extremely rare cause of refractory flank pain. We report the diagnostic dilemma, and sequential endourological and finally the successful robotic management of one such symptomatic USH in an elderly woman who had presented with ipsilateral refractory flank pain, hydroureteronephrosis, and compromised renal function. We have also reviewed the current literature regarding the etiopathogenesis, presentation, diagnosis, and management of USHs. To the best of our knowledge, this is the first such case to describe the robotic-assisted laparoscopic management of a case of USH.

Learning from the handling of the referral of Dr Manjula Arora.

The Singh and Forde review of the General Medical Council's handling of Dr Manjula Arora's referral made a number of recommendations for the General Medical Council, the wider NHS and other organisations. This article discusses how to move forward with the recommendations and deliver 21st-century regulation that is truly compassionate, fair and supportive.

System failures and learning from the case of Dr Manjula Arora: 21st century regulation needs to be compassionate, caring and supportive.

The recent judgement and suspension of Dr Manjula Arora has caused huge apprehension within the medical community and raised debate about whether the fitness to practise process is fit for purpose. This editorial focuses on the need for 21st century regulation to be proportionate, fair, supportive and compassionate.

Spectrophotometric analysis of color stability of esthetic restorative material in chlorhexidine mouthwash: An in vitro study.

Background: Commendable aesthetic properties of composites make it a pioneer filling material. However, discoloration of composite resin materials emerges as a major clinical problem in a long term. Aims and Objectives: Aim of the study is to evaluate the color stability of nano filled and micro hybrid dental composite resin in chlorhexidine mouthwash. Materials and Methods: 20 specimens of dimension 10*2mm were prepared of A2 shade. All the prepared samples were immersed in 20 ml of distilled water in separate containers according to the group. Further incubation at 37°C for 24 h was done. After 24 h, baseline color values of each sample were recorded using a spectrophotometer. After recording the baseline color measurements, 10 specimens (random selection) from each group were placed in 20 ml of 0.2% chlorhexidine mouthwash for 24 h duration. The L*a*b* system of the Commission Internationale de l'Eclairage (CIE L*a*b* Color Scale) was used for the determination of colorimetric values of the specimens. Results: The color change was displayed by both the samples after immersion in the mouthwash but the change was not statistically significant (0.763). ΔE value for nano filled composites is 3.25 while for the micro-hybrid composites the value is 3.56. Conclusion: The colorimetric values of nano filled composite resins are more stable than the micro hybrid composite due to exposure to chlorhexidine mouthwash.

Assessment of Prevalence of Dental Caries among School-going Children: A Cross-sectional Study.

BACKGROUND: The background of the study was to assess the prevalence of dental caries among school-going children. MATERIALS AND METHODS: Six thousand eight hundred and ninety school-going children was enrolled. General clinical examination was carried out. Mouth mirror, probe, and explorer were used for carrying out the clinical examination. Over a time span of 6 months, the entire study was completed. All the examiners who performed clinical examination underwent a single-day training program for detecting dental caries. All the participants were seated on straight wooden chairs and were examined clinically. The prevalence of caries was recorded. RESULTS: The prevalence was 26.02%. Among these children with dental caries, 50.25% of the children belonged to the age group of 13-15 years, while the remaining 49.75% of the children belonged to the age group of 9-12 years. Prevalence of dental caries was significantly higher in females (71.11%) in comparison to males. Furthermore, dental caries was significantly more prevalent among participants with toothbrushing frequency of less than once a day (51.20%). CONCLUSION: There is an imperative need for intimating health check-up camps among school-going children.

Assessment of Habits of Tobacco Use among Dental and Nondental Students of Indian Population: A Cross-sectional Study.

BACKGROUND: Tobacco usage can be equated to an unending progressive pandemic which continues to spread globally at an alarming unhindered pace. Dental surgeons have a key role in initiating reduction and even cessation of tobacco habits. Hence, the present study was undertaken for analyzing the habits of tobacco use among dental and nondental students of Indian population. MATERIALS AND METHODS: A total of 500 dental students and 500 nondental students were enrolled in the present study. Among dental students, only interns were enrolled across different dental colleges of India. A questionnaire was framed and was sent to all the students in the form of Google Forms. The questionnaire contained questions pertaining to the assessment of prevalence of tobacco use and type of tobacco use habit. All the results were recorded and analyzed. RESULTS: Five hundred dental students and 500 nondental students were enrolled. Among the dental group, tobacco use habits were present in 23.8% of the students, whereas in the nondental group, tobacco use habits were present in 43.6% of the students. While comparing the prevalence of tobacco use habits among the dental and nondental groups, significant results were obtained. In the dental group, smoking habit and chewing habit were present in 44.54% and 32.77% of the students, respectively. In the nondental group, smoking habit and chewing habit were present in 52.29% and 29.82% of the students, respectively. While comparing the pattern of tobacco use among students of the two study groups, nonsignificant results were obtained. CONCLUSION: There is an urgent need of tobacco cessation programs in the community to decrease the morbidity and mortality associated with it.

Strangulation of penis by a ball bearing device.

INTRODUCTION: Penile strangulation is rare and usually results following placement of constricting objects to enhance sexual stimulation. It requires urgent treatment as delay may lead to irreversible penile ischemia and gangrene. Various objects causing penile strangulation have been reported. Nonmetallic and thin metallic objects can be removed easily as compared to heavy metallic objects. Cutting is the commonest method described, although procuring special cutting tools may be difficult and the process of cutting may be tedious with the possibility of iatrogenic penile injury. AIM: To present a simple, safe, minimally invasive, effective, and feasible technique for removing heavy metallic objects constricting the penis. METHODS: The published English literature (PubMed™) was searched for cases of "penile strangulation" using the keywords penile strangulation, penile injury, penile trauma, penile constriction, penile entrapment, and penile incarceration. The described treatment modalities were carefully reviewed and studied. MAIN OUTCOME MEASURES: Reviewed published English literature on the various causes of penile incarceration and the various techniques used for their extrication. RESULTS: Search results yielded several cases of penile strangulation caused by a variety of metallic and nonmetallic objects. Various modalities have been described in the English literature for their safe removal, each with its own merits and demerits. CONCLUSIONS: Penile strangulation should be viewed and managed as an emergency in order to prevent penile necrosis and urethral injury and to preserve erectile function. The modified method described herein for managing penile strangulation due to heavy metallic rings is minimally invasive, safe, effective, does not require any special cutting instrument(s) or skill, and is free of causing iatrogenic collateral thermal or mechanical damage to the penile organ. A stepwise algorithm depicting a rational and comprehensive approach to the diagnosis and management of penile incarceration is also suggested for the clinicians.

Robot-assisted pyeloplasty: review of the current literature, technique and outcome.

AIM: To review the global select data on the current technique, perioperative outcome and literature on the robot-assisted pyeloplasty (RAP). METHODS: The published English literature (PubMed) was extensively searched using the key words; robot, robot-assisted pyeloplasty, laparoscopy, laparoscopic pyeloplasty and ureteropelvic junction obstruction. The selected studies were then reviewed, tracked and analyzed in order to determine the current role, outcome and status of robot-assisted laparoscopic pyeloplasty. RESULTS: The search yielded about 25 published series on RAP comprising about 740 cases with a mean operative time, estimated blood loss, crossing vessel prevalence, hospital stay,perioperative complication rate and follow up duration of 194 min, 50 mL, 47%, 2.3 days, 6% and 14.9 months respectively. CONCLUSION: The initial peri-operative results and intermediate follow up of cases of repair of the ureteropelvic junction obstruction with robot-assisted pyeloplasty appear to be favorable and comparable to that of open pyeloplasty, while long term outcome data is still awaited. The da Vinci surgical robotic system is a promising surgical armamentarium in the hands of the modern day urologist for the minimally invasive definitive surgical management of both primary and secondary ureteropelvic junction obstruction.

Time for a culture change: understanding and reducing risk, morbidity and mortality from COVID-19 in those of black and minority ethnicity.

Following a number of epidemics in the 21st century, including Ebola and Middle East respiratory syndrome, the SARS-COV-2 virus, causing COVID-19 disease, was declared a pandemic health emergency of international concern in January 2020.

Robotic distal ureterectomy with reimplantation in malignancy: technical nuances.

AIM: To present the point of technique of robotic distal ureterectomy under cystoscopic guidance with pelvic lymphadenectomy (PLND), ureteral reconstruction with and without a psoas hitch in patients with distal ureteral urothelial cancer (DUCC) and to review the current literature. METHODS: The various steps of operative technique of robotic PLND, distal ureterectomy under cystoscopic guidance, ureteral reconstruction with and without a psoas hitch in patients of DUCC are described. Several tricks have been highlighted to undertake such procedure. The published English literature was also searched using the key words; robot, laparoscopy, ureteral reimplantation, distal ureterectomy, psoas hitch, and ureteroneocystostomy; so as to provide an up to date review on subject. RESULTS: The technique robotic pelvic lymphadenectomy, distal ureterectomy, ureteral reimplantation with and without a psoas hitch in patients with DUCC was successful in both our patients. The mean operating room time, robotic (console) time, mean estimated blood loss and mean hospital stay were 250 min, 130 min, 150 cc and 2.2 days respectively. There were no complications. CONCLUSIONS: The technique of robotic distal ureterectomy with ureteral reimplant for malignant ureteral strictures continues to be in evolution. Surgeon should be versatile with various options and technical nuances while dealing with these cases. The short term oncologic outcomes appear to be satisfactory and encouraging, while the long term results are awaited.

Spontaneous renal forniceal rupture due to advanced cervical carcinoma with obstructive uropathy.

AIMS: To report and describe the clinical presentation and outcome of a woman presenting with gross perinephric urinary extravasation (due to spontaneous renal forniceal rupture), secondary to malignant obstructive uropathy caused by advanced cervical carcinoma. To review the etiopathogenesis, approach to diagnosis and management of 'spontaneous renal forniceal rupture. METHODS: The published English literature (PubMed) was searched for similar cases of 'spontaneous renal forniceal rupture' using the keywords: carcinoma cervix, metastatic carcinoma cervix, renal pelvis rupture, renal fornix rupture, spontaneous renal fornix rupture and urinoma. RESULTS: The diagnosis of renal forniceal rupture with gross urinoma formation secondary to advanced cervical carcinoma was suspected on ultrasound and was subsequently confirmed by a computed tomographic scan of the abdomen. Percutaneous nephrostomy with a pigtail catheter resolved the urinoma. Search results for similar cases yielded several causes of spontaneous renal forniceal rupture, however, only one such case report due to advanced cervical carcinoma was found. CONCLUSION: To the best of our knowledge, this is the second case of spontaneous renal forniceal rupture secondary to ureteral obstruction caused by advanced cervical carcinoma to be reported in the published English literature. A high clinical index of suspicion is warranted in any patient of advanced cervical carcinoma that presents with sudden uremia or oliguria with flank pain and swelling in order to arrive at an early diagnosis. A decompressive nephrostomy may provide the much needed comfort and succor towards prolonging the life of such unfortunate patients.

Role of robot-assisted pelvic surgery.

The purpose of this study was to assess the current role of robot-assisted urological surgery in the female pelvis. The recently published English literature was reviewed to evaluate this role, with special emphasis on reconstructive procedures. These included colposuspension for genuine female stress urinary incontinence, repair of female genitourinary fistulas, ureterosciatic hernias, sacrocolpopexy for vault prolapse, ureterolysis and omental wrap for retroperitoneal fibrosis, ureteric reimplantation, and bladder surgery. To date, a wide spectrum of urogynecological reconstructive procedures have been performed with the assistance of the surgical robot and have been reported worldwide. Currently, a number of female pelvic ablative and reconstructive procedures are technically feasible with the aid of the surgical robot. While the role of robot-assisted surgery for bladder cancer, ureterolysis, ureteric reimplantation, repair of genitourinary fistulas, colposuspension, and sacrocolpopexy is nearly established among urologists, other procedures, such as myomectomy, simple hysterectomy, trachelectomy, and Wertheim's hysterectomy, are still evolving with gynecologists. The advantages of robot assistance include better hand-eye coordination, three-dimensional magnified stereoscopic vision with depth perception, intuitive movements with increased precision, and filtering of hand tremors. For most of the currently performed procedures in selected patients, the robot-assisted surgical outcomes appear to be relatively superior as compared to an open and purely laparoscopic surgical procedure.

CTAB Surfactant Assisted and High pH Nano-Formulations of CuO Nanoparticles Pose Greater Cytotoxic and Genotoxic Effects.

Toxicity of synthesized nanoparticles is the area of concern to all the researchers due to their possible health implications. Here we synthesized copper oxide nanoparticles (CuO NPs) without surfactant at pH value of 2, 7, 10 and with cetyletrimethylammoniumbromide (CTAB) surfactant at pH 7. Synthesized nanoparticles were characterized for various structural parameters including crystallite size, lattice parameters, strain, phase analysis using X-ray diffraction analysis, and morphological aspects have been analyzed using FESEM and HRTEM imaging. All the four nano-formulations were analyzed for their toxic potential using Allium cepa L. at three different concentrations (0.1, 0.01 and 0.001 g/100 ml). Cytological and genetic parameters including mitotic index, mitotic inhibition, aberrant cells, binucleated cells, micronucleated cells, chromosomal bridges, fragmentation, stickiness, laggards, vagrants, c-mitosis and disturbed spindle were analyzed. Our results revealed a dose dependent increase in cytotoxic parameters including decreased total dividing cells, mitotic index, and increased mitotic inhibition. Genotoxic parameters also increased at higher treatment concentrations including chromosomal aberrations and percent aberrant cells. The pH value at the time of particle synthesis has significant influence on the crystallite size and agglomeration as assessed by XRD, FESEM and HRTEM analysis. The NPs synthesized at pH 2 and 10 were found to be of smaller size and posed more toxic effects as compared to particles synthesized at neutral pH. On the other hand, CTAB assisted CuO NPs synthesized at pH 7 revealed even smaller crystallite sizes and thus boost the toxicity in all the parameters as compared to NPs synthesized without CTAB. The present study suggested an increase in toxic parameters of synthesized CuO NPs with respect to crystallite size which is pH dependent. Addition of CTAB at pH 7 decreased the crystallite as well as particle size and enhanced the toxic potential. Further studies are recommended to analyze the effect of surfactant addition in toxicological studies on CuO NPs.

Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial.

INTRODUCTION AND AIM: Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared. MATERIALS AND METHODS: After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717. RESULTS: Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien-Dindo classification) which were not statistically significant. CONCLUSION: Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.