Novel thymohydroquinone gallate (THQG) derivative loaded ligand Modified quantum dots as pH-Sensitive Multi-Modal theragnostic agent for cancer treatment.

BACKGROUND: Nanomedicine, as the combination of radiopharmaceutical and nanocarrier (QDs), is developed for treating cancer. Gallic acid is antimutagenic, anti-inflammatory, and anti-carcinogenic. Typical retention time of gallic acid is approximately 4 to 8 h. To increase the retention time gallic acid is converted to prodrug by adding lipophilic moieties, encapsulating in lipophilic nanoparticles, or liposome formation. Similarly, thymoquinone is powerful antioxidant, anti-apoptotic, and anti-inflammatory effect, with reduced DNA damage. METHODS: In this study, a hydrophilic drug (gallic acid) is chemically linked to the hydrophobic drug (thymohydroquinone) to overcome the limitations of co-delivery of drugs. Thymohydroquinone (THQG) as the combination of gallic acid (GA) and thymoquinone (THQ) is loaded onto the PEI functionalized antimonene quantum dots (AM-QDs) and characterized by FTIR, UV-visible spectroscopy, X-ray powder diffraction, Zeta sizer, SEM and AFM, in-vitro and in-vivo assay, and hemolysis. RESULTS: The calculated drug loading efficiency is 90 %. Drug release study suggests the drug combination is pH sensitive and it can encounters acidic pH, releasing the drug from the nanocarrier. The drug and drug-loaded nanocarrier possesses low cytotoxicity and cell viability on MCF-7 and Cal-27 cell lines. The proposed drug delivery system is radiolabeled with Iodine-131 (131I) and Technetium (99mTc) and its deposition in various organs of rats' bodies is examined by SPECT-CT and gamma camera. Hemolytic activity of 2, 4, 6, and 8 µg/ml is 1.78, 4.16, 9.77, and 15.79 %, respectively, reflecting low levels of hemolysis. The system also sustains oxidative stress in cells and environment, decreasing ROS production to shield cells and keep them healthy. CONCLUSIONS: The results of this study suggest that the proposed drug carrier system can be used as a multi-modal theragnostic agent in cancer.

Performance of HCV core antigen and PCR testing in a predominantly genotype 3 population.

Hepatitis C core antigen (HCVcAg) is becoming increasingly recognized as an alternative to molecular testing for the confirmation of chronic hepatitis C. However, there are limited data on the performance of this assay in a genotype 3 (GT3) predominant country like Pakistan. We conducted a study to evaluate the diagnostic performance of HCVcAg against the HCV polymerase chain reaction (PCR) molecular test. HCV antibody-positive patients requiring confirmatory testing were recruited from August to October 2018 at the Pakistan Kidney and Liver Institute and Research Center (PKLI&RC), Lahore, Pakistan. Patients with previously known diagnoses or treatment histories were excluded. The Abbott HCV Ag assay was used for HCVcAg testing. Results ≥3.00 fmol/L were considered positive for HCVcAg. The Abbott RealTime HCV assay was used for PCR testing with a lower detection limit of ≥12 IU/mL. We computed the sensitivity, specificity and correlation of HCVcAg against HCV PCR. A total of 394 patients were recruited. The median age of the patients was 42 years. Most participants were females (51.5%, n = 203), 30.7% (n = 121) had HTN, 10.4% DM (n = 41) and 5% had APRI ≥2. The overall sensitivity was 98.0% and the specificity was 98.6%. The lowest detection limit of cAg was an HCV RNA value of 4657 IU/mL. The levels of cAg were highly correlated with those of HCV RNA by Spearman's rank correlation test (r = 0.935, p < .001). HCVcAg represents a suitable alternative with high sensitivity and specificity compared with HCV PCR in the GT3-predominant population and can be incorporated into algorithms to improve linkage to care.

Intrarater Reliability Of Cervical Range Of Motion Device Among Adults With And Without Chronic Non-Specific Neck Pain.

Objective: To evaluate the intrarater reliability of the cervical range of motion device among adults with and without chronic non-specific neck pain. METHODS: The analytical, cross-sectional study was conducted from January to March 2019 at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, and comprised healthy adults with no neck pain in the preceding 6 months in Group A, and adults of either gender with chronic non-specific neck pain for >3 months in Group B. The two groups were further divided into age groups 21-30 years, 31-40 years and 41-50 years. A cervical range of motion device was used to measure the range of flexion, extension, right and left lateral flexion and right and left rotation of all the subjects. The measurements were taken by a single tester on day-1 and day-3 to assess the intrarater reliability. Data was analysed using SPSS 26. RESULTS: Of the 60 subjects, there were 30(50%) in each of the two groups. Within the groups, there were 10(33.3%) subjects in each of the 3 age subgroups. Overall, there were 27(45%) males and 33(55%) females. In Group A, the intraclass correlation coefficient values for all cervical ranges were between 0.81 and 0.99, whereas in Group B, the values ranged from 0.64 to 0.88. The intraclass correlation coefficient values yielded good to excellent agreement in both groups (>0.75) except for left lateral flexion in Group B (p=0.64), and all the values were statistically significant (p<0.05). Conclusion: There was good to excellent intrarater reliability of cervical range of motion device in adults with and without chronic non-specific neck pain.

Effects of autogenic and reciprocal inhibition techniques with conventional therapy in mechanical neck pain - a randomized control trial.

BACKGROUND: Neck pain is a common musculoskeletal issue that has been seen as high in terms of disability. Muscle Energy Techniques (MET) are advanced soft tissue techniques to treat Mechanical Neck Pain (MNP). This study compares the Autogenic inhibition (AI) technique with the Reciprocal Inhibition (RI) technique providing conventional treatment to improve functional outcomes. METHODS: A randomized control trial was conducted at Sindh Institute of Physical Medicine & Rehabilitation, Karachi, Pakistan from August 28, 2021, to December 31, 2021 among 20-50 years old patients with Moderate intensity MNP for more than 4 weeks and with limited Neck ROMs. The sample were divided randomly and allocated into two groups (groups 1 and 2). Group 1 and 2 received 12 sessions of AI and RI with Conventional therapy respectively. The randomization sheet was generated online from randomization.com for a sample size of 80 and two groups of study 'AI' and 'RI' with a ratio of 1:1 by an independent statistician. Pain (primary outcome), range of motion, and functional disability (secondary outcomes) were assessed through visual analog scale (VAS), Goniometer, and Neck disability index (NDI) at baseline, 1st, and last session respectively. Mean and standard deviation, frequency, and percentages were calculated. Chi-square test and independent t-test compare baseline characteristics. The Repeated Measure Two-Way ANOVA compared mean VAS, NDI, and ROM. The significant P-value was less than 0.05. RESULTS: The mean duration of neck pain was 8 weeks. There was a more significant (p < 0.001) improvement in pain (ES = 0.975), disability (ES = 0.887), neck ROMs; flexion (ES = 0.975), extension (ES = 0.965), right and left lateral flexion (ES = 0.949 and 0.951), and right and left rotation (ES = 0.966 and 0.975) in the AI group than the RI group at 12th session. CONCLUSION: The Autogenic Inhibition-MET is more beneficial than Reciprocal Inhibition-MET in improving Pain, Range of Motion, and Functional Disability in patients with Sub-Acute and Chronic Mechanical Neck Pain. Therefore, it is a beneficial technique to add with conventional neck pain therapy to get better treatment outcomes in MNP patients. TRIAL REGISTRATION: Prospectively registered on ClincalTrials.Gov with ID: NCT05044078 .

Outcome of tubeless percutaneous nephrolithotomy in elder patients: A single-center experience from a developing country.

Background: Percutaneous nephrolithotomy (PCNL) has evolved as a standard procedure to treat large-sized renal stones. A nephrostomy tube is used frequently in this procedure; however, data regarding tubeless PCNL procedures in elder patients is scarce. Aim: The aim of this study was to review the results and outcomes associated with tubeless PCNL procedures in the elderly population. Materials and Methods: A retrospective review of patients aged ≥60 years at our hospital that was treated for renal stones by PCNL procedure. The patients were separated into two groups: Group 1 underwent tubed PCNL procedures and Group 2 received tubeless PCNL procedures. Information regarding variables were recorded in specified pro forma and then processed in Statistical Package for the Social Sciences statistics analyses. Statistical tests were utilized for continuous and categorical variables and a P<0.05 was considered statistically significant. Results: 121 patients with a mean age of 65±5 years were included in the analysis. Mean stone size and body mass index were 3.4±1.5 cm and 26.2±4.3 kg/m2, respectively. Mean operative time was longer in tubed PCNL as compared to the tubeless group. Mean hospital stay was similar among the tubed and tubeless PCNL treated groups. Mean analgesic doses were significantly lower in the tubeless group. The overall stone-free rate was 89/121 patients (74%). Conclusion: Tubeless PCNL can be safely undertaken in geriatric patients and has potential advantages associated with shorter operative times and reduced necessity for analgesia. Relevance for Patients: Tubeless PCNL is considered advantageous as it can reduce post-operative pain and analgesia necessity; shorten hospitalization and lower cost in young patients. However, there is no clear evidence with reference to virtue of tubeless PCNL in the elderly age groups. This study will analyze and review results and outcomes associated with tubeless PCNL in a cohort of elderly patients.

Use Of Computed Tomography-Based Nomogram In Adult Age Patients To Predict Success Rates After Shock Wave Lithotripsy For Renal Stones: A Single Center Experience.

BACKGROUND: The Triple D score is a novel and easy to use nomogram to predict shock-wave lithotripsy (SWL) outcomes. It is based on Computed Tomography (CT scan) parameters including stone density, skin-to-stone distance, and stone volume. However, its use has not been validated much as studies are sparse regarding its use. Our aim was to validate and evaluate accuracy of the Triple D scoring system in predicting SWL success rates. METHODS: It was a prospective study of 277 patients who had undergone SWL procedure for renal stones. They were evaluated by using non-contrast tomography, before undergoing SWL. CT scan-based parameters including distance of stone to skin (SSD), stone volume (SV), stone density was assessed. Computation of Cut off values was done with receiver operating characteristics analysis. Score was assigned on the basis of these cut-off values and success rate of SWL was determined. This score ranged from 0 (least favourable score) to 3 (most favourable score). RESULTS: Stone-free status was attained in 160 patients (57.7%), and 117 (42.3%) patients were labelled to have failed the procedure. Differences between these two groups in terms of Stone volume, stone density and skin to stone distance were significant. Triple D scores of zero,1, 2, and 3 had stone-free rates of 3.6%, 52.56%, 53.3%, and 93.1% respectively (p-vaue<0.001). CONCLUSIONS: Shock-wave lithotripsy outcomes can be predicted with use of Triple D score and hence, it's externally corroborated. It may help urologist in appropriate patient selection and hence decision making and patient counselling.

Outcomes Of Percutaneous Nephrolithotomy In Elder Age Patients-Single Center Experience.

BACKGROUND: Urolithiasis is a prevailing ailment affecting all age groups across global population. In modern innovative industry endoscopic instruments alterations and miniaturization has simplified the interventional strategy for undertaking these procedures for renal stones. However, there has been paucity of studies regarding outcomes of Percutaneous Nephrolithotomy (PCNL) in elder age group. We aimed to report success rates and complications in elder age group. METHODS: This was a retrospective review of the charts for subjects that underwent unilateral PCNL from 2012 till 2018 November at a tertiary care hospital at capital of Pakistan. Patients of age ≥60 years were chosen for this study. PCNL procedures were done in prone position. We implemented the Guy stone scoring (stone complexity) to forecast the net results of PCNL. Information regarding variables were recorded in specified proforma and then processed in SPSS version 16 for the statistical computations. RESULTS: On the whole 79 patients were incorporated for this study. Most common presenting complaint in clinic was flank pain followed by haematuria and fever respectively. Mean age in this analysis was calculated as 63.36±5.19 years. Mean size for calculi was 449±163mm2. One patient underwent transfusion after surgery while only 2.5% of these patients had sepsis (post PCNL procedure). Stone free rate was significantly affected by Guys stone score (GSS). CONCLUSIONS: PCNL can be undertaken safely and effectually for achieving treatment goals even in elder subjects. Stone free rates are higher in lower Guys stone score as compared to the higher scores.

Role of Stone Heterogeneity Index in Determining Success of Shock Wave Lithotripsy in Urinary Calculi.

INTRODUCTION: Various stone factors can affect the outcome of shock wave lithotripsy (SWL). A novel factor called the stone heterogeneity index (SHI) may have an impact on stone free rates. The objective of this study was to assess the role of SHI in SWL outcomes. METHODS: Patients' medical records were reviewed for the collection of data variables. They were subjected to SWL, using an electromagnetic lithotripter machine (Storz Modulith SLX-MX). Computation of mean stone density (mean value of the Hounsfield units) and SHI was accomplished by generating elliptical regions of interest on the computed tomography (CT) scan images. Grouping was performed on the basis of stone free and failure outcomes. Relevant statistical tests were applied for continuous and categorical variables. P ≤ 0.05 was considered statistically significant. RESULTS: Overall, 385 subjects were included having a mean age of 38.4 ± 14.7 years. The cohort comprised 276 (71.7%) males and 109 (28.3%) female patients. A total of 234 (60.8%) patients were rendered successful (stone free after one session) while 151 (39.2%) of the patients were declared to have failed the SWL procedure. Stone length, stone density, and SHI values were 13.7 ± 7.6 mm, 935 ± 404, and 201 ± 107, respectively. The stone density, SHI, and stone length were significantly different between the two groups (p-values of 0.001, 0.02, and 0.04, respectively). CONCLUSIONS: SHI can be a helpful CT scan-based parameter to assess stone fragility. It can help clinicians in the judicious selection of patients before implementing SWL procedure. RELEVANCE FOR PATIENTS: Non-contrast CT-based stone parameters have been found to be effective for predictions of outcomes. SHI can be a helping tool to better predict SWL success rates when treating the renal stones.

Managing Patient With Coexisting Emphysematous Pyelonephritis And Cystitis.

Emphysematous pyelonephritis (EPN) is a type of critical renal infection having dire consequences at times. It is said to be result of gases produced inside renal parenchymal tissue or pelvicalyceal system. Rarely coexistence of emphysematous pyelonephritis and emphysematous cystitis (EC) may lead to an intimidating condition in case it is not dealt with swiftly. The resent case report narrates the management of a 45-year-old female patient who suffered from EPN with concomitant EC. Right-sided emergency percutaneous nephrostomy was passed. Afterwards, Double J stent was passed under general anaesthesia. Although she had an initial improvement clinically but later on due to recurrent urinary tract infections and non-resolving right kidney abscess and fever right sided nephrectomy was done. This is a very rare presentation and has not previously reported much in literature.

Laparoscopic Orchiopexy For Management Of Bilateral Non-Palpable Testes

BACKGROUND: Despite numerous clinical studies regarding the management of unilateral impalpable testes by laparoscopy, there is a paucity of such studies regarding the management of bilateral 'non-palpable' testes. We shared the outcome of the laparoscopic management of bilateral 'non-palpable' testes in terms of successful orchiopexy and complications in children. METHODS: A total of 22 children underwent bilateral diagnostic laparoscopy for undescended testes who presented to our department from January 2010 till March 2018. We did chart review for variables such as the age of children, operative time, hospital stay, single-stage or 2 stage procedure, and operative complications. Preoperatively history and physical examination were done along with baseline investigations and Ultrasound abdomen and scrotum before surgery for general anaesthesia fitness. They were managed by single or two steps laparoscopic orchiopexy according to suitability for each case. RESULTS: We performed bilateral laparoscopic orchidopexies in 22 children having a mean age of 4.1±1.98 years (49.2 months) Mean operative time for single setting bilateral single-stage orchiopexy was 136±32 minutes. Out of twenty-two children with bilateral impalpable testes, 12 boys (54.5%) were managed with a single-stage Bilateral Laparoscopic technique while the other 10 (45.45%) were managed in 2 staged laparoscopic intervention using Fowler-Stephens technique. Testicular atrophy was seen in 2/44 testes (4.54%). While 1 /44 (2.27%) testis had ascended to the inguinal region requiring redo surgery. CONCLUSIONS: Laparoscopic management of bilateral 'non-palpable' testes in a single or double setting is a safe and effective method of bringing testes down to the scrotum. It has no major morbidities.

Outcome Of Percutaneous Nephrolithotomy In Preschool And School-Age Children-Single Center Experience.

BACKGROUND: Efficacy of percutaneous nephrolithotomy in adults has been studied well in past. However, such studies are sparse within paediatric age group. As this procedure is being adopted in smaller and older children alike, we wanted to determine its safety and efficacy in two different age groups of children (preschool age and school age). METHODS: The records of 59 children undergoing PCNL at our department from December 2009 to May 2017 were reviewed retrospectively. Patients were placed into 2 age groups including children ≤7 years old (group 1) and those ≥7 years (group 2). Twenty-seven patients were put in preschool group with mean age of 4.8±2.1 years while 32 patients in school age group having mean age of 11.8±4.6 years. RESULTS: Stone size was calculated showing mean 309±55 mm2 in preschool and 324±63 mm2 in school age group respectively (p=0.1). The mean operative time was 150.1±38.7 minutes and 166.3±39.6 minutes in the preschool and school age children respectively (p=0.1). The mean length of hospital stay was 3.1±1.4 days and 2.9±1.3 days in preschool and school going children (p=0.5). The stone clearance with PCNL was seen in 96.3% (pre-school group) and 93.75% (school age group) as monotherapy (p=0.1), which increased to 100% after combining it with extracorporeal shock wave lithotripsy. CONCLUSIONS: PCNL is equally effective in both pre-school and school age groups in terms of stone free rates. Complication rates were not different between the two groups.

Overcoming the Immunological Barrier in Highly HLA Sensitized Renal Transplant Recipients - A Desensitization Experience from a Transplant Center in Pakistan.

Highly Human Leukocyte antigen sensitized patients have relatively fewer chances of being transplanted successfully and may remain dialysis dependent for a long time. In the last few years with the development of immunomodulatory therapies and advancements in immunological investigations, the chance s of transplantation in these sensitized patients have improved. Desensitization therapies in these patients include plasma exchange, intravenous immune globulins and immunomodulatory agents such as rituximab and bortezomib. These agents used together in desensitization protocols across the world have shown encouraging results in highly Human Leukocyte Antigen sensitized recipients awaiting renal transplant. We used a desensitization protocol using rituximab followed by bortezomib with concurrent plasma exchange sessions and Intravenous Immune Globulins. Our aim was to assess improvement in renal function and quality of life in these patients after desensitization and renal transplantation. To the best of our knowledge, this is the first account of desensitization prior to renal transplantation from Pakistan.

Utility of Mitrofanoff as bladder draining tool: A single center experience in pediatric patients.

OBJECTIVE: Mitrofanoff procedure has been employed commonly as bladder draining tool in patients unable to do clean intermittent self catheterization through native urethera. Single centre experience of pediatric age group patients undergoing Mitrofanoff procedure has been presented here. MATERIAL AND METHODS: It was a retrospective study of 29 children who underwent continent catheterizable conduit (CCC), from January 2009 till March 2017. Charts were reviewed for age, gender, presenting complaints, need for augmentation cystoplasty, Mitrofanoff channel source such as appendix or ileal patch, duration of surgery in minutes, hospital stay in days, per operative and postoperative complications. Preoperative evaluation of the children was done by doing complete blood picture, serum electrolytes, and renal function tests. Radiological evaluation included ultrasound kidney,ureter and bladder, voiding cystourethrography, urodynamic analysis and a nuclear renal scan with 99m Technetium dimercapto-succinic acid or MAG-3 scan. The abdominal end of the conduit was brought through the abdominal wall, and a stoma was fashioned by the V-quadrilateral-Z technique. RESULTS: Twenty nine children having mean age of 9.54±4.88 years underwent CCC. There were 19 males (65.51%) and 10 females (34.48%). Children who underwent CCC included 18 children having neurogenic bladder, 2 cases of urethral trauma/stricture 3 patients with history of posterior uretheral valve and 6 patients with exstrophy bladder. Augmentation cystoplasty plus mitrofanoff was done in 18 children while only mitrofanoff in 11 children. Stuck catheter was seen in one patient which was removed successfully via normal urethral route under general anesthesia. Stomal stenosis in first year was noted in 4 patients (13.79%). CONCLUSION: Continent catheterizable conduit based on Mitrofanoff principle have durable outcome over long term follow up in terms of urinary continence and complications.

Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience.

OBJECTIVE: To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. MATERIAL AND METHODS: We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. RESULTS: The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). CONCLUSION: The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.

Clinicopathological Characteristics of Prostate Cancer in Patients Presenting to a Tertiary Care Private Sector Hospital.

Prostate cancer (PCa) is one of the leading cancers in older males. The aim of this study was to evaluate the clinico-pathological characteristics of prostate cancer and rate of detection of prostate cancer by DRE (digital rectal exam) in patients presenting to a tertiary care private sector hospital in Islamabad, and determine the awareness about PCa in these patients. There were 226 patients who presented from December 2009 to December 2015 having mean age of 68.63 ±8.76 years and median Prostate Specific Antigen (PSA) value of 19.12 ng/mL (IQR=35.8). Median prostatic volume was 49 (IQR=22) gram/cc in the subjects. DRE was abnormal in 164 (72.56%) patients and normal in 62 (27.43%) patients only. Majority of patients presented relatively late, which may be due to lack of screening programme or public awareness.

Partial Nephrectomy in Adults - A Single-Centre Experience.

Partial nephrectomy is the preferred procedure in benign renal lesions requiring surgical removal. It has also been accepted procedure for malignant renal conditions of smaller size. The aim of this observational study was to determine the outcome of partial nephrectomy in terms of complications and recurrence rates. Twenty patients with renal mass underwent this procedure from January 2010 till June 2014 at our Department, with mean age of 46.51 ±1.53 years. There were 14 males and 6 females. Renal mass on CT scan had the mean size of 3.80 ±1.15cm. The mean hospital stay in this series was 5.11 ±1.42 days, while mean operative time was 247 ±79.71 minutes. Twelve patients had malignant histology. They were followed using CT scan abdomen and pelvis with contrast at six and 12 months. Out of these, 10 (83.3%) patients were found to have no recurrence after six months.

Outcome Of Trans Rectal Ultrasound Guided Twelve Core Biopsy Of Prostate For The Detection Of Prostate Cancer- A Single Centre Experience.

BACKGROUND: This study was conducted to determine the outcome of trans-rectal ultrasound (TRUS) guided biopsy of prostate for the detection of prostatic carcinoma in a single tertiary care hospital in Pakistan. METHODS: This is a retrospective study including three hundred and eightythree patients who underwent trans rectal ultrasound guided biopsy of prostate in a single tertiary care hospital. Indications for biopsy were raised prostate specific antigen (PSA), abnormal digital rectal examination (DRE) and/or both. Twelve core biopsy of prostate was done.. RESULTS: The overall detection rate of prostate cancer was 59%. Prostate cancer detection in various PSA ranges of 0-3.99, 4-9.99, 10-19.99 and >20 ng/ml are 22.22%, 37.88%, 50.0% and 89.9%. PSA density >0.15ng/ml2 can diagnose 74.5% of patients with cancer. Prostate cancer detection rate based on abnormal DRE is 64.6% compared to 60.8% detected by PSA>4 ng/ml. CONCLUSIONS: In conclusion raised PSA, smaller prostate volume, abnormal DRE and raised PSA density are associated with greater chances of detection of prostate carcinoma.

Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study.

OBJECTIVE: To evaluate and compare the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) and tubed PCNL by using small bore nephrostomy tube (12Fr) in children for the management of nephrolithiasis. MATERIAL AND METHODS: This study was a retrospective analysis of 35 children where tubed PCNL (Group 1) was done in 18, and tubeless PCNL (group 2) in 17 patients from January 2010 to December 2016. Charts were reviewed for age, mass, stone size, operative time, hospital stay and stone-free rates. These variables were compared between the two groups. SPSS version 21 was used for data analysis. The data were shown as mean±standard deviation for continuous variables. Categorical variables were presented in percentages. RESULTS: There is no difference in terms of age, stone sizes, operative times, hospital stays, stone-free rates and post-PCNL complications between the two groups (p>0.05). The mean drop in hemoglobin level was 0.7±0.1 g/dL and 1.3±0.2 g/dL in Groups 1 and 2, respectively (p=0.01). CONCLUSION: Tubeless PCNL in children is a safe option in well selected cases.

Evaluating the importance of different computed tomography scan-based factors in predicting the outcome of extracorporeal shock wave lithotripsy for renal stones.

PURPOSE: To evaluate the impact of various computed tomography scan-based parameters of renal stones on the outcome of extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: We conducted a retrospective study of patients who underwent ESWL for renal stones (sized 5-20 mm) from January 2013 to December 2016. We evaluated body mass index, location of the stone, skin-to-stone distance (SSD), stone attenuation value (SAV), stone diameter, Hounsfield density, stone area, and stone volume. Statistical analysis was done and significance was confirmed by multivariate logistic regression analysis. RESULTS: Of the 203 patients 122 (60.1%) had successful clearance of the stone. The presence of a double J stenting, a lower pole location, a higher SAV, higher Hounsfield density, larger stone area, larger stone diameter, and higher stone volume were negative predictors of ESWL outcome. When these parameters were analyzed with multivariate logistic regression analysis, stone location, SSD, and SAV were the only significant independent predictors of the outcome of ESWL. CONCLUSIONS: Stone location, SSD, and SAV are reliable and strong predictors of ESWL outcome for the treatment of renal stones.

A 3' untranslated region polymorphism rs2304277 in the DNA repair pathway gene OGG1 is a novel risk modulator for urothelial bladder carcinoma.

Altered DNA repair capacity may affect an individual's susceptibility to cancers due to compromised genomic integrity. This study was designed to elucidate the association of selected polymorphisms in DNA repair genes with urothelial bladder carcinoma (UBC). OGG1 rs1052133 and rs2304277, XRCC1 rs1799782 and rs25487, XRCC3 rs861539, XPC rs2228001, and XPD rs13181 were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 200 UBC cases and 200 controls. We found association of OGG1 rs2304277 [odds ratio (OR)GG = 3.55, 95% confidence interval (CI) = 1.79-7.06] and XPC rs2228001 (ORAC = 2.38, 95% CI = 1.43-3.94) with UBC. In stratified analysis with respect to smoking status, OGG1 rs2304277 and XPC rs2228001 exhibited increased risk in smokers [(rs2304277 ORGG = 4.96, 95% CI = 1.51-16.30) (rs2228001 ORAC = 2.19, 95% CI = 1.02-4.72)] as well as nonsmokers [(rs2304277 ORGG = 2.95, 95% CI = 1.26-6.90) (rs2228001 ORAC = 2.57, 95% CI = 1.31-5.04)]. These polymorphisms were also associated with both low-grade [(rs2304277 ORGG = 3.73, 95% CI = 1.72-8.09) (rs2228001 ORAC = 2.18, 95% CI = 1.21-3.92)] and high-grade tumors [(rs2304277 ORGG = 3.45, 95% CI = 1.52-7.80) (rs2228001 ORAC = 2.81, 95% CI = 1.48-5.33)] as well as with non-muscle-invasive bladder cancer [(rs2304277 ORGG = 4.03, 95% CI = 1.87-8.67) (rs2228001 ORAC = 2.14, 95% CI = 1.20-3.81)] and muscle-invasive bladder cancer [(rs2304277 ORGG = 3.06, 95%CI = 1.31-7.13) (rs2228001 ORAC = 2.95, 95%CI = 1.51-5.75)]. This is the first study on DNA repair gene polymorphisms and UBC in the Pakistani population. It identifies OGG1 rs2304277 and replicates XPC rs2228001 as significant modulators of UBC susceptibility.