Purple urinary bag syndrome: Our experience.

Background: Purple urinary bag syndrome (PUBS) is a visually striking and rare manifestation of urinary tract infection characterised by purple discolouration of the catheter and the urobag, which are seen primarily in patients who are on long-term indwelling catheter. This rare syndrome results due to the breakdown of indole, a by-product of dietary tryptophan metabolism, to coloured pigments indigo and indirubin by urinary bacteria, which reacts with the catheter and the bag to impart a purple colour. Methods: This was a prospective observational study, wherein all cases of PUBS diagnosed between March 2012 and February 2020 were analysed and followed up. Results: A total of five patients were presented with PUBS. Among them, four were women, and four were chronically constipated. All of them were elderly and debilitated with either being bed bound or having restricted mobility. Three of them had associated chronic kidney disease. All of them were treated successfully with change of catheters and antibiotics. Conclusion: This rare but alarming condition occurs in elderly patients who are on long-term indwelling catheters. The diagnosis is visually apparent, and the treatment may be just a simple change of catheter with oral antibiotics. The awareness may help in correct diagnosis and treatment.

Penile Chill Blains: a Case Report.

Chill blains or perniosis occurs in exposed body parts in extreme cold climate. It usually affects the tip of the upper limb, lower limb, tip of the nose or the ear lobules. It rarely occurs in the covered body parts. Chill blain usually affects the females. There are reports of occurrence of chill blains in unusual area which are covered. This case report is of a young male presenting as chill blain over the penile region. A 27-year-old male patient reported of pain and swelling of penile shaft following exposure to extreme cold climate in the month of September at high altitude. There was no history of trauma, ulcer over the penis, no blister, no discharge, or fever, with no history of cold related injuries in past. The examination revealed erythematous penile shaft with subcutaneous edema. There was no inguinal lymphadenopathy and the scrotal skin was normal. The patient responded to the conservative management for chill blains. Idiopathic penile chill blain is an extremely rare condition. People living in cold mountainous region should frequently change the clothes to keep the local area dry to avoid being victim of such cold related injuries.

Seasonal variation of acute appendicitis: An Armed Forces experience of high altitude.

BACKGROUND: Lifetime prevalence of Acute Appendicitis is about 6-7%.The seasonal variation is nearly an established fact with most of the studies suggesting that cases are more in summer and during the rainy season. There are few studies globally for evaluating the impact of altitude and temperature on the incidence of acute appendicitis. In India no such study has been reported. With this in view, a study was conducted on the incidence of acute appendicitis to evaluate the effect of absolute temperature in high altitudes >10000 ft. METHODS: Retrospective data collected for a period of five years from 2015 to 2019 for the three centres of Armed Forces, located at high altitude 10,500, 11,500 and 12,000 ft respectively and the three temperature categories viz.< 0 °C, 0-20 °C and >20 °C were made to infer if there is any correlation between these parameters. RESULTS: A total of 317 cases were operated in a period of 05 yrs at the three centres. In the three categories of temperature viz < 0 °C, 0-20 °C and >20 °C the total number of cases were 84,124 and 109 respectively over period of 5 yrs. The proportion of cases were maximum at altitude of 12000 ft. On evaluation of the effect of altitude and absolute temperature positive correlation is found. CONCLUSION: The analysis of the maiden study that was conducted for high altitude and extreme cold climate in India indicated a positive correlation of the altitude and the effect of absolute temperature on the occurrence of cases of Acute Appendicitis.

Influence of Interstitial Cells of Cajal in Congenital Ureteropelvic Junction Obstruction.

BACKGROUND: The etiopathogenesis of congenital ureteropelvic junction obstruction (UPJO) has been inconclusive in spite of the numerous studies carried out to find the possible causative factor. The results of different studies have been conflicting and contradictory. It has been postulated that the interstitial cells of Cajal (ICC) are the pacemaker cells located in the ureteropelvic junction (UPJ) and regulate the peristalsis in this region. Paucity of these cells may be one of the causative factors for congenital UPJO although there is no clear consensus on this issue. Therefore, the present study has been carried out to ascertain the role of ICC as one of the possible etiological factors for congenital UPJO. The aim of this study is to first identify the presence of ICC at UPJ, second to compare the average number of ICC in congenital UPJO with a control population without UPJO, and third to ascertain whether any correlation exists between the number of ICC and postoperative improvement in function of the affected kidney. MATERIALS AND METHODS: A total number of 30 patients who underwent dismembered Anderson-Hynes pyeloplasty for congenital UPJO between June 2016 and November 2017, were compared with seven controls who underwent nephroureterectomy for various other reasons. The specimen was subjected to immunohistochemistry (IHC), and a quantitative comparison was made for the ICC between cases and controls. The preoperative and postoperative function was evaluated by renal diuretic scintigraphy. RESULTS: The disease was more common among males in the ratio of 6.5:1, and there was a predominance of the left-sided involvement. In the studied cases, the average number of ICC seen for every high-power field (hpf) was 4.86 ± 0.76/hpf, whereas in control it was 11.74 ± 0.86/hpf (P = 0.04). The postoperative outcome, as measured by the improvement in split renal function, did not have any correlation with the number of ICC. CONCLUSION: The ICC are present at the UPJ and can be detected by immunohistochemistry due to their CD117 positivity. These cells are significantly low at this site in cases of congenital UPJO when compared to controls without any obstruction. The number of ICC bears no correlation to the postoperative improvement in function.