Urinary adenosine triphosphate and nitric oxide levels in patients with underactive bladder: a preliminary study.

INTRODUCTION: Various in vitro and in vivo animal studies have shown that adenosine triphosphate (ATP) has a stimulatory role and nitric oxide (NO) has an inhibitory role in modulating bladder contractility. However, it is not known what happens to the urinary levels of ATP and NO in humans with underactive bladder (UAB). METHODS: In this prospective case-control study, we compared ATP and NO levels in twenty six male patients of UAB with a bladder contractility index (BCI) of < 100 and 18 healthy male volunteers without any lower urinary tract symptoms (LUTS). RESULTS: The mean urinary ATP levels were significantly lower in cases compared to controls (546.1 ± 37.3 pg/µl vs. 610.7 ± 24.9 pg/µl, p value < 0.001) and the mean NO levels were significantly higher in cases compared to controls (1233.4 ± 91.2 pg/µl vs. 1126.3 ± 91.3.4 pg/µl, p value < 0.001). The mean NO/ATP ratio in cases was significantly higher than that of controls (2.26 ± 0.2 vs. 1.84 ± 0.18, p value < 0.000). Using receiver operating curve (ROC) analysis, we noted the area under the curve (AUC) for NO/ATP ratio to be 0.91 in the diagnosis of cases. A cut-off value of 2.06 for NO/ATP ratio had sensitivity, specificity and diagnostic accuracy of 88.5%, 88.9% and 88.6%, respectively, in diagnosing patients with UAB. CONCLUSION: Patients with UAB have significantly higher levels of urinary NO and decreased levels of urinary ATP. Urinary NO/ATP levels can be considered as a noninvasive alternate test for diagnosing bladder underactivity.

Fluidized bed combustion bottom ash: A better and alternative geo-material resource for construction.

Though the majority of research on fly ash has proved its worth as a construction material, the utility of bottom ash is yet questionable due to its generation during the pulverized combustion process. The bottom ash produced during the fluidized bed combustion (FBC) process is attracting more attention due to the novelty of coal combustion technology. But, to establish its suitability as construction material, it is necessary to characterize it thoroughly with respect to the geotechnical as well as mineralogical points of view. For fulfilling these objectives, the present study mainly aims at characterizing the FBC bottom ash and its comparison with pulverized coal combustion (PCC) bottom ash, collected from the same origin of coal. Suitability of FBC bottom ash as a dike filter material in contrast to PCC bottom ash in replacing traditional filter material such as sand was also studied. The suitability criteria for utilization of both bottom ash and river sand as filter material on pond ash as a base material were evaluated, and both river sand and FBC bottom ash were found to be satisfactory. The study shows that FBC bottom ash is a better geo-material than PCC bottom ash, and it could be highly recommended as an alternative suitable filter material for constructing ash dikes in place of conventional sand.

SINE polymorphism reveals distinct strains of Entamoeba histolytica from North India.

Entamoeba histolytica is an intestinal parasite causing significant morbidity and mortality in the developing world. More tools are needed to understand the epidemiology and molecular pathogenesis of amebiasis. Virulence pattern of E. histolytica could be linked with the genotype of a strain. Several loci showing insertion polymorphism of retrotransposable short interspersed nuclear elements EhSINE1 and EhSINE2 have been reported among laboratory strains of E. histolytica. The present study was undertaken to validate this observation in clinical isolates from north India. Our results indicate that the Indian samples show a different propensity of SINE retention or loss at two of the polymorphic loci compared with non-Indian samples. Statistical analysis of different loci revealed Locus 17 of EhSINE1as a potential geographical marker for distinguishing Indian isolates from non Indian isolates.

Postradiotherapy small cell neuroendocrine carcinoma of base of tongue: An unusual clinical and site presentation.

Small cell neuroendocrine carcinoma (NEC) of the tongue is an extremely rare entity with only seven cases reported in literature till date. These are high-grade tumors with a dismal prognosis. There is much ambiguity regarding the classification, treatment protocols and prognostic factors of these tumors due to the paucity of studies. We describe an exceptionally rare and unusual case of small cell NEC of the base of tongue arising in an elderly man 6 years after receiving radiotherapy for the treatment of squamous cell carcinoma at the same site. The diagnosis was confirmed on histopathological examination and supported by immunohistochemical positivity for neuron-specific enolase, synaptophysin, chromogranin, pan-cytokeratin, and cytokeratin 7. To the best of our knowledge, this is the first case of intraoral NEC arising many years later within the irradiated field of the initial tumor.

Effect of age and sex in determining cognitive ability in Vanaraja chickens.

(1) To evaluate the cognitive ability of male and female Vanaraja birds, three hundred and sixty 1-d-old sexed chickens were reared under similar conditions in three treatment groups with 4 replicates in each group: 120 females in Treatment 1, 120 males in Treatment 2 and both males and females (60 + 60) as a mixed group in Treatment 3. (2) To assess learning ability, the birds were trained in T- and Y-mazes and tested at 3-week intervals in 4 test schedules (21, 42, 63 and 84 d). The birds were put into tonic immobility (TI) in each test schedule. (3) In each maze test, the latency to find the feed was regarded as a successful completion of the task. In the TI-test, the time taken to stabilise on a plane surface after swinging in the hanging cradle for 20-25 s was recorded. (4) The results indicated that male birds appeared to be cognitively superior to females in terms of learning and cognitive evolution in all the mazes, but by d 84, the females performed as well as the males. With increasing age, spatial memory gathering and processing improved. In the TI-test, the effect of sex or grouping system had no significant effect on the performance of birds at the various ages.

Production of thermal insulation blocks from bottom ash of fluidized bed combustion system.

The issues of disposal and environmental problems are increased by the generation of bottom ash from the thermal power plants day by day; hence, its recycling is required. The present study aimed to make thermal insulation blocks using as raw material bottom ash and iron ore slime as a binder and to characterize their engineering properties. Two different fineness values of bottom ash were considered with varying amounts of iron ore slime (0-10%) to make the blocks. Blocks were dried followed by firing at 1000, 1100 and 1200°C, respectively. Cold crushing strength, density and thermal conductivity of these fired blocks showed increasing behaviour with firing temperature, fineness of bottom ash and iron ore slime content. In contrast, a reverse trend was observed in the case of porosity. With increasing firing temperature, the formation of lower melting phases like iron silicate followed by iron aluminium silicate was observed, which imparts the strength inside the blocks. The coarser particles of bottom ash increase the interparticle spaces, which enhances the apparent porosity, resulting in higher thermal insulation property in the blocks. Blocks having better thermal insulation property could be possible to make effectively from coarse bottom ash by adding iron ore slime as a binder.

Distinct subclonal tumour responses to therapy revealed by circulating cell-free DNA.

BACKGROUND: The application of precision medicine in oncology requires in-depth characterisation of a patient's tumours and the dynamics of their responses to treatment. PATIENTS AND METHODS: We used next-generation sequencing of circulating cell-free DNA (cfDNA) to monitor the response of a KIT p.L576P-mutant metastatic vaginal mucosal melanoma to sequential targeted, immuno- and chemotherapy. RESULTS: Despite a KIT mutation, the response to imatinib was mixed. Unfortunately, tumours were not accessible for molecular analysis. To study the mechanism underlying the mixed clinical response, we carried out whole-exome sequencing and targeted longitudinal analysis of cfDNA. This revealed two tumour subclones; one with a KIT mutation that responded to imatinib and a second KIT-wild-type subclone that did not respond to imatinib. Notably, the subclones also responded differently to immunotherapy. However, both subclones responded to carboplatin/paclitaxel, and although the KIT-wild-type subclone progressed after chemotherapy, it responded to subsequent re-administration of paclitaxel. CONCLUSION: We show that cfDNA can reveal tumour evolution and subclonal responses to therapy even when biopsies are not available.

Chylocolporrhea or chylous vaginal discharge: diagnostic conundrum with therapeutic challenge.

BACKGROUND: Chylocolporrhea or chylous vaginal discharge is an extremely rare manifestation of chylous reflux syndrome. Continuous loss of chyle adversely affects quality of life and results in increased morbidity due to the chronic loss of nutrients. Diagnosis and management of this condition is very challenging. CASE HISTORY: A 35-year-old multiparous lady presented with the chief complaints of excessive milky vaginal discharge for 10 years. Microscopic and biochemical analysis of vaginal discharge along with hysteroscopy confirmed diagnosis of chylocolporrhea. Lymphoscintigraphy along with magnetic resonance imaging revealed site of leakage from the right external iliac lymphatics. She was started on medium-chain triglycerides-rich diet and meticulous ligation of all visible megalymphatics with tension-free lymphovenous anastomosis was done to right external iliac vein. CONCLUSION: Chylocolporrhea can be managed successfully using operative and nonoperative modalities.

Extrarenal calyces: a rare renal congenital anomaly.

The congenital anomalies of urogenital system are not uncommon. The anomalies of renal collecting system form a complex subset of urogenital anomalies. Among these, extrarenal calyces are one of the infrequently found anomalies of the renal collecting system. Extrarenal calyces may be detected incidentally or when thoroughly investigated for its associated complications. We report two cases of extrarenal calyces characterized by the presence of major calyces and renal pelvis outside the renal parenchyma. The awareness of this anomaly can help in making the definitive preoperative diagnosis and prevent injury to pelvicalyceal system during surgery.

Impact of hepatitis B immunization among the Nicobarese tribe--antibody titres & seroprotection five years after vaccination.

BACKGROUND & OBJECTIVES: A total of 237 Nicobarese subjects who had received hepatitis B vaccination as part of mass vaccination project during 2000-2001 were screened for anti-HBsAg titres by quantitative ELISA five years after vaccination. METHODS: Anti-HBsAg antibody was estimated using quantitative ELISA. Proportion of the subjects with protective levels of antibody and geometric mean antibody titres were calculated. RESULTS: Among the 237 study subjects, 213 had received three doses of vaccine, 17 had received two doses and seven had received one dose. The geometric mean titres of anti-HBs antibodies were 201.7, 31.9 and 23.1 mIU/ml among those who received three, two and one dose of vaccine, respectively. Among those who received three doses of vaccination, 85.9 per cent had anti-HBs antibody levels of 10 mIU/ml or more, indicating seroprotection. The difference in the seroprotection rates among those who received three doses of vaccination (85.9%) and those who received less than three doses (58.3%) was significant. Seroprotection rates one month after the first, second and third dose of vaccination were 49.1, 86.9 and 96.7 per cent, respectively. It then declined to 89 per cent by the end of the second year and to 85.5 per cent by the end of the third year, but there was no decline thereafter. INTERPRETATION & CONCLUSIONS: Seroprotection rate reached at the maximum one month after the third dose of HBV vaccine. Although about 15 per cent of the vaccinated persons lost seroprotection by the end of the third year, no further loss in seroprotection was observed between the third year and the fifth year.

Penile metastasis secondary to bladder cancer: a report of two cases.

Penile metastasis secondary to primary bladder cancer is a rare entity and represents a challenging problem. The common mode of spread to the penis is by retrograde venous route. The overall outcome is dismal and most patients will die within 1 year even after optimum treatment. Here, we report two such cases.

Robot-assisted and conventional urology surgical procedures: comparison of average length of stay, economic status, operative time and patient's expenditure in a tertiary care hospital of North India.

Robot-assisted surgeries allows the surgeons to operate using remote-controlled robotic arms that are more effective in comparison to conventional (open/laparoscopic) surgeries. However, there is substantial lack of evidence on the effectiveness of robot-assisted surgeries in low to middle income countries (LMICs) like India. A study was conducted with an aim to evaluate the average length of stay (ALOS), Operative time, economic status (patient's) and cost borne by the patient (patient's expenditure) for undergoing robot-assisted surgeries and conventional surgeries. Grouping of the surgical procedures was done wherein patients who were treated with robot-assisted surgical procedures were placed in Group-01 whereas those treated with conventional surgical procedures were placed under Group-02. Comparative evaluation of the two surgical groups revealed that in robot-assisted surgical procedure, the ALOS was less (18.43 vs. 23.14 days, p = 0.06) whereas operative time (316.7 vs. 252.63 min, p = 0.05) and patient's expenditure were more (INR 70,654.29 vs. INR 41,314.73, p = 0.00). However, there was no significant difference between the economic statuses of patients in both groups. The study concluded that in this era of rapidly expanding health care scenario; targeted, regular, rigorous and repeated training programmes in future may shorten the learning curve thereby paving a way to reduce the cost as well as the operative time of robot-assisted surgeries in LMICs.

HPV typing and its relation with apoptosis in cervical carcinoma from Indian population.

Definite progress in understanding the etiology of cervical cancer has been achieved, and some types of human papillomavirus have been established as the central cause of cervical cancer worldwide. This study investigates the human papillomavirus infection and its correlation with apoptosis and clinicopathologic characteristics in squamous cell carcinoma of uterine cervix. Human papillomavirus typing was done by type-specific primers for high-risk human papillomavirus using standard polymerase chain reaction method. Programmed cell death (apoptosis) was determined by terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling assay. Human papillomavirus infection in tissue biopsy of cervical carcinoma was detected in 131 of 135 (97%) cases. Among the positive cases of human papillomavirus, 123 (94%) cases were human papillomavirus type 16, and five (4%) cases were human papillomavirus type 18. Out of 135 cervical carcinoma cases, 81 (60%) cases showed presence of apoptosis. The phenomenon of apoptosis was seen slightly higher in squamous cell carcinoma than in adenocarcinoma (40% in squamous cell carcinoma and 33% in adenocarcinoma). The human papillomavirus infection in cervical cancer might not play any role in the occurrence of apoptosis.

Glutathionyl hemoglobin is elevated in iron deficiency anemia.

There are few good biomarkers of iron deficiency anemia (IDA). Since IDA patients have evidence for increased oxidative stress, we used mass spectrometry (MS) [i.e. matrix-assisted laser desorption/ionization (MALDI) and electrospray ionization] to identify novel biomarkers. Using MALDI-MS, the following oxidative modifications of hemoglobin with the following mass-to-charge ratios were identified: 1,087.5 (α32-40), 1,545.7 (α17-31), 1,290.0 (ß31-40) and 2,076.1 (ß41-59). On electrospray ionization MS, the IDA patients had significantly elevated glutathionyl hemoglobin (GSHb) compared with the controls (16.9 ± 9.6 vs. 7.7 ± 3.7%; p = 0.002). GSHb levels correlated inversely with serum ferritin (Spearman rho -0.485; p = 0.003) and positively with serum transferrin receptor (0.460; p = 0.002). GSHb also demonstrated inverse correlations with hemoglobin (-0.512; p = 0.001), mean cell volume (-0.419; p = 0.026), serum iron (-0.446; p = 0.008) and transferrin saturation (-0.460; p = 0.008). For the first time, we show that GSHb is elevated in patients with IDA and has potential as a biomarker of this form of anemia.

Genetic diversity analysis of Sclerotinia sclerotiorum causing stem rot in chickpea using RAPD, ITS-RFLP, ITS sequencing and mycelial compatibility grouping.

Sclerotinia sclerotiorum is one of the most devastating soil-inhabiting fungal plant pathogens infecting various crop plants including chickpea. Genetic diversity of 24 isolates of S. sclerotiorum representing 10 different states of India was determined by different molecular markers and mycelial compatibility grouping (MCG). The majority of the isolates showed more than 90% genetic similarity. Unweighted paired group method with arithmetic average cluster analysis of DNA profiles generated by 21 RAPD primers grouped the isolates into seven categories showing high magnitude of genetic homogeneity and showed partial correlation with geographical origin of the isolates. Identical ITS-RFLP profiles were generated in all the isolates. Limited variability was observed among the nucleotide sequences of ITS region of the isolates. The phylogenetic tree generated from bootstrap neighbor-joining analysis indicated that 50% of Indian populations were distinct and grouped separately. The isolates were variable in mycelial compatibility and they were grouped into seven MCGs, namely, MCG A, MCG B, MCG C, MCG D, MCG E, MCG F and MCG G.

Efficacy and outcome of percutaneous nephrolithotomy in patients with calculus nephropathy.

The aim of this study was to prospectively evaluate the efficacy and outcome of percutaneous nephrolithotomy in patients with nephrolithiasis and chronic renal insufficiency. Between January 2006 and June 2009, 30 patients (20 males and 10 females; mean age 45 years, range 18-65; mean serum creatinine 6.3 ± 1.57 mg%) with calculus nephropathy were treated in our department. In 25 patients with obstructed and infected systems preliminary percutaneous nephrostomy or double J stenting was done. After stabilization and treatment of sepsis, percutaneous nephrolithotomy was done. Eight patients underwent bilateral procedure and 22 underwent unilateral procedure. Twenty-two patients needed a single sitting while eight patients needed two sittings for stone clearance. The renal function was monitored by serial creatinine estimations. Of the 30 patients, 27 patients achieved complete clearance. Renal function was improved in 27 patients. Six patients developed postoperative sepsis. Two patients required angioembolization for uncontrollable bleeding. There was no mortality. Patients with calculus nephropathy can be salvaged using PNL with good improvement in renal function and acceptable morbidity when appropriate preoperative preparation and perioperative care are given.

A study on sexual function of men with anterior urethral stricture before and after treatment.

INTRODUCTION: Male urethral reconstruction for anterior urethral stricture has become increasingly popular and effective. Little is known about its potential impact on subsequent sexual performance. PATIENTS AND METHODS: Thirty-four patients of anterior urethral stricture disease were studied from January 2008 to November 2009. The data were collected before surgery and at a follow-up of 3 months after completing the treatment. Evaluation of sexual function was done using O'Leary's Brief Male Sexual Function Inventory. RESULTS: Patients were divided into two categories: <40 and >40 years of age. Younger patients had more improvement in ejaculatory function and overall satisfaction after surgery than elderly. Elderly males had lower sexual drive scores. Patients with traumatic stricture had significant improvement in ejaculation and overall satisfaction. Patients without history of prior optical internal urethrotomy or dilatations reported a significant improvement in their ejaculatory function and overall satisfaction. CONCLUSION: Erectile dysfunction is not significant after anterior urethral reconstruction. The improvement is most pronounced in ejaculation and overall satisfaction, which was mostly appreciated by younger men. A successful urethral reconstructive procedure leads to rehabilitation of the patient back into a healthy sexual life. Dorsomedial dissection of bulbar urethra should be limited and cautery use should be minimized in that area.

Corrosion performance of various deformed surfaces of implant steel for coronary stent applications: Effect of protein concentration.

This work was done to systematically elucidate the corrosion behavior of austenitic stainless steel subjected to various degree of cold deformation (10 %, 20 % & 30 %). The experiments were performed in phosphate buffer saline (PBS) solution having different concentrations of bovine serum albumin (0.2, 0.5, 1.0, 2.0, 4.0 g L-1). Potentiodynamic polarization tests and electrochemical impedance spectroscopy (EIS) analysis were performed to obtain the corrosion parameters. Scanning electron microscopy with energy dispersive X-ray (SEM-EDX), atomic force microscopy (AFM) and X-ray photoelectron spectroscopy (XPS) were used to determine the surface morphologies and chemical compositions of the surface films. Contact angle analysis was also used to detect the hydrophilic character of sample surfaces. The BSA had a considerable effect of inhibition on the corrosion of SSs in annealed as well as in deformed state due to its adsorption on surface of steel. For annealed samples, at 4.0 g L-1BSA concentration, the corrosion resistance was drastically decreased but interestingly not for sample with more than 10 % deformation and the concentration effect of BSA is also not very significant after 0.5 g L-1 for deformed surfaces. The breakdown potential for 30 % deformed sample is quite higher in presence of BSA even at 4.0 g L-1 while it is lowest for annealed samples in the same condition. The variation in contact angle with deformation is very less after adsorption of BSA. On the basis of the obtained results, mechanism aspect for corrosion of steel in presence of protein is also deliberated.

Development, evaluation and validation of machine learning algorithms to detect atypical and asymptomatic presentations of Covid-19 in hospital practice.

BACKGROUND: Diagnostic methods for Covid-19 have improved, both in speed and availability. Because of atypical and asymptomatic carriage of the virus and nosocomial spread within institutions, timely diagnosis remains a challenge. Machine learning models trained on blood test results have shown promise in identifying cases of Covid-19. AIMS: To train and validate a machine learning model capable of differentiating Covid-19 positive from negative patients using routine blood tests and assess the model's accuracy against atypical and asymptomatic presentations. DESIGN AND METHODS: We conducted a retrospective analysis of medical admissions to our institution during March and April 2020. Participants were categorized into Covid-19 positive or negative groups based on clinical, radiological features or nasopharyngeal swab. A machine learning model was trained on laboratory parameters and validated for accuracy, sensitivity and specificity and externally validated at an unconnected establishment. RESULTS: An Ensemble Bagged Tree model was trained on data collected from 405 patients (212 Covid-19 positive) producing an accuracy of 81.79% (95% confidence interval (CI) 77.53-85.55%), the sensitivity of 85.85% (CI 80.42-90.24%) and specificity of 76.65% (CI 69.49-82.84%). Accuracy was preserved for atypical and asymptomatic subgroups. Using an external data set for 226 patients (141 Covid-19 positive) accuracy of 76.82% (CI 70.87-82.08%), sensitivity of 78.38% (CI 70.87-84.72%) and specificity of 74.12% (CI 63.48-83.01%) was achieved. CONCLUSION: A machine learning model using routine laboratory parameters can detect atypical and asymptomatic presentations of Covid-19 and might be an adjunct to existing screening measures.