Injury pattern of road traffic accident cases attending trauma centre of tertiary care hospital of North India.

Introduction: Injury is a significant global health burden and can result in mortality if not attended to on time. Trauma system refers to a collection of services provided by various super-specialties. According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. Materials and Methods: The study was done at Advanced Trauma Centre (ATC) at PGIMER, a teaching hospital of north India. Study included area from most of the patient come for treatment (rural/urban) and injury patterns seen in these patients, which included mode of injury, type of injury, type of road accidents and location of injury. Results and Observations: In maximum cases, 60.2% (245) of the mode of injury was RTA. It was seen that the maximum number of patients, 44.4%, (115) had motorbike/scooter collisions with vehicles. In most patients, the type of injury seen was 35.9% (147) head, neck and back injuries, and in maximum cases, the location of the accident site was road/street 63.2%. Discussion: In our country, where the trauma delivery system is poorly developed, teaching hospitals have to bear the burden of treating many patients. No concept of emergency medicine or trauma care is in use, even in urban areas. As a result, teaching hospitals' emergency departments receive many referrals for emergency conditions.

Metal-Coordination-Induced Fusion Creates Hollow Crystalline Molecular Superstructures.

In this work, we report the formation of superstructures assembled from organic tubular crystals mediated by metal-coordination chemistry. This template-free process involves the crystallization of molecules into crystals having a rectangular and uniform morphology, which then go on to fuse together into multibranched superstructures. The initially hollow and organic crystals are obtained under solvothermal conditions in the presence of a copper salt, whereas the superstructures are subsequently formed by aging the reaction mixture at room temperature. The mild thermodynamic conditions and the favorable kinetics of this unique self-assembly process allowed us to ex-situ monitor the superstructure formation by electron microscopy, highlighting a pivotal and unusual role for copper ions in their formation and stabilization.

Tubular Hybrids: A Nanoparticle-Molecular Network.

We report here a new methodology for the formation of freestanding nanotubes composed of individual gold nanoparticles (NPs) cross-linked by coordination complexes or porphyrin molecules using WS2 nanotubes (INT-WS2) as a template. Our method consists of three steps: (i) coverage of these robust inorganic materials with monodispersed and dense monolayers of gold NPs, (ii) formation of a molecular AuNP network by exposing these decorated tubes to solutions containing a ruthenium polypyridyl complex or meso-tetra(4-pyridyl)porphyrin, and (iii) removal of the INT-WS2 template with a hydrogen peroxide solution. Nanoindentation of the template-free AuNP tubes with atomic force microscopy indicates a radial elastic modulus of 4 GPa. The template-free molecular AuNP tubes are characterized using scanning and transmission electron microscopy, energy-dispersive X-ray spectroscopy, and micro-Raman spectroscopy. The methodology provides a convenient and scalable strategy for the realization of molecular AuNP tubes with a defined length and diameter, depending on the dimensions of the template.

Metallic Nanocrystal Ripening on Inorganic Surfaces.

In this paper, we demonstrate the formation of hybrid nanostructures consisting of two distinctive components mainly in a one-to-one ratio. Thermolysis of inorganic nanotubes (INT) and closed-cage, inorganic fullerene-like (IF) nanoparticles decorated with a dense coating of metallic nanoparticles (M = Au, Ag, Pd) results in migration of relatively small NPs or surface-enhanced diffusion of atoms or clusters, generating larger particles (ripening). AuNP growth on the surface of INTs has been captured in real time using in situ electron microscopy measurements. Reaction of the AuNP-decorated INTs with an alkylthiol results in a chemically induced NP fusion process at room temperature. The NPs do not dissociate from the surfaces of the INTs and IFs, but for proximate IFs we observed fusion between AuNPs originating from different IFs.

Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature.

INTRODUCTION: Gastrointestinal complications are common after renal transplantation, including oral lesions, esophagitis, gastritis, diarrhea, and colon carcinoma. The differential diagnosis is difficult in this scenario because multiple factors such as drugs, infections, and preexisting gastrointestinal disease come into play. CASE PRESENTATION: We report a case of varicella zoster virus-induced pancreatitis and hepatitis in a renal transplant recipient. The patient underwent renal transplantation 3 years earlier and now presented with severe pain in the epigastrium radiating to his back and had raised serum lipase levels and skin lesions characteristic of varicella. Liver enzyme levels were also elevated. He was started on a regimen of acyclovir. His pain improved in 24 hours, and liver enzyme levels returned to normal in 48 hours. DISCUSSION: There is a paucity of literature on the simultaneous occurrence of varicella zoster virus-induced hepatitis and pancreatitis in both immunocompetent and immunocompromised patients. Our case highlights the gastrointestinal complications of varicella infection in immunocompromised patients that may precede the characteristic dermatologic manifestations, and the fact that rarely both hepatitis and pancreatitis may be seen.

Reno-invasive fungal infection presenting as acute renal failure: importance of renal biopsy for early diagnosis.

Renal zygomycosis, caused by invasive fungi, is a rare and potentially fatal infection. The patient usually presents with non-specific symptoms and renal failure. A 34-year-old male non-diabetic and without any predisposing factors for systemic fungal infection presented to the emergency department with diffuse abdominal pain, high-grade fever and acute renal failure with a serum creatinine of 6.5. A computed tomography showed bilateral diffuse globular nephromegaly. A urine smear for fungal examination showed right angle branching hyphae and kidney biopsy showed fungal hyphae within the glomeruli, tubules and interstitium. Although radiological investigations can give us a clue, the definitive diagnosis can only be made by kidney biopsy. A high index of suspicion and timely diagnosis is important for a proper management.

Urethral stricture and stone: their coexistence and management.

PURPOSE: The aim of the study was to determine whether the coexistence of urethral stricture and stone influence the treatment modality of each other and to ascertain the best treatment modality for these group of patients. We also tried to speculate whether the stone is an effect or a cause of the stricture. MATERIALS AND METHODS: Retrospective analysis of prospectively collected data of 35 male patients with coexistent urethral stricture and stone were done between January 1998 and December 2011. Patients were divided in two groups (1 and 2) - limited stone bulk (group 1, n =30) and extensive stone bulk (group 2, n = 5). The former group was treated with endourologic procedures and the latter group managed with open staged procedures. We used ureter scope for endourological management which we think eases the management. RESULTS: Endoscopic management of both stone and stricture were successful in all patients of group 1. Patients of group 2 have been managed by open surgery in two stages. All of them are urologically asymptomatic after a mean of 28 months of follow up. The principle of treatment modality were the bulk of stone, its location and characteristics of stricture. determinants. CONCLUSION: Both stone and stricture can be managed successfully by endoscopic method in most of the patients. Bulk, location of the urethral stone and length of stricture is the main limiting factor for the endoscopic management. A stone can be an "effect" as well as the "cause" of strictured urethra.

Inflammatory myofibroblastic tumor of the urinary bladder managed by laparoscopic partial cystectomy.

Inflammatory myofibroblastic tumor of the urinary bladder is a rare mesenchymal tumor with uncertain malignant potential. It often mimics soft tissue sarcomas both clinically and radiologically. Surgical resection in the form of partial cystectomy or transurethral resection remains the mainstay of treatment. Herein we report the case of an inflammatory myofibroblastic tumor in a young girl, which was managed by laparoscopic partial cystectomy. To the best of our knowledge, this is the first reported case of laparoscopic management of an inflammatory myofibroblastic tumor of the urinary bladder.

Endoscopic management of emphysematous periurethral and corporal abscess.

We came across an interesting case which was presented with fever, dysuria and perineal pain, not responding to antibiotics. The computed tomography scan showed periurethral abscess containing multiple air specs with involvement of bilateral corpora cavernosa. We successfully treated this patient with endoscopic drainage. Spontaneous periurethral and corporal abscess in male is a rare entity and emphysematous form in corpora has not been described before.

Impaired flow-mediated vasodilatation in Asian Indians with erectile dysfunction.

Endothelial dysfunction is the postulated link between coronary artery disease (CAD) and erectile dysfunction (ED). Brachial artery flow-mediated vasodilatation (FMD) is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED (assessed using the International Index of Erectile Function (IIEF-5) questionnaire); ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD (6.40%±4.60% vs. 9.10%±4.87%, P<0.001) compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD (≤5.5%) was twice as common in ED patients (52% vs. 24% without ED). Patients with impaired FMD had higher ED prevalence (85% vs. 62%) and lower mean IIEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors (odds ratio, 2.33; 95% confidence interval: 0.59-9.23; P=0.03). An inverse correlation between FMD and ED severity was observed (r=-0.22; P=0.004). ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.

A rare case of obstructive azoospermia due to compression of the seminal vesicle and ejaculatory duct by a large lower ureteric stone.

Male infertility due to obstructive azoospermia is a well-known entity. It is characterised by obstruction to the outflow of sperms either in the epididymis, vas, seminal vesicles or the ejaculatory ducts. We describe a rare case of obstructive azoospermia due to compression of the ejaculatory duct and seminal vesicle by a large lower ureteric stone in a 30-year-old man who had infertility for the past ten years. The patient's azoospermia resolved after removal of the stone.

Erectile dysfunction precedes and is associated with severity of coronary artery disease among Asian Indians.

INTRODUCTION: Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. AIM: To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. METHODS: In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. MAIN OUTCOME MEASURES AND RESULTS: Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41-141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11-111.09, P = 0.001). CONCLUSION: Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.

Gabapentin: a novel drug as add-on therapy in cases of refractory overactive bladder in children.

OBJECTIVE: To determine the effectiveness of gabapentin as an add-on therapy in children presenting with overactive bladder (OAB) not responding to conventional anticholinergics. MATERIALS AND METHODS: Children with refractory OAB were included prospectively from March 2009 to February 2010. The inclusion criterion was persistence of symptoms while on conventional anticholinergics for 6 months. Gabapentin was prescribed as an add-on therapy. The patients were followed 4 weekly with bladder diary and urodynamic study was repeated at 3 months. RESULTS: There were 31 children, 26 of neurogenic OAB and 5 of non-neurogenic origin. Mean ± SD age was 8.5 ± 5.3 years. Data were analyzed in 30 patients as treatment was terminated in 1 due to adverse effects. Continence improved in 16 (53.3%) patients. Voiding volume improved from 175 ± 90 to 320 ± 110 ml (p<0.03). Objective assessment of OAB symptom relief showed marked improvement (p<0.05). Mean maximum cystometric bladder capacity improved from 210 ± 94 to 360 ± 110 ml (p<0.02). The maximal detrusor contraction decreased from 75 ± 35 to 25 ± 15 cmH(2)O (p<0.02). Fourteen patients (46.7%) failed to respond to gabapentin therapy. These patients had baseline maximum cystometric bladder capacity <60% for age and maximum detrusor contractions >50 cm of water (p<0.03). CONCLUSIONS: Gabapentin gives moderate results in children with OAB refractory to conventional anticholinergics. In general, the drug is well tolerated with fewer adverse effects.

Dual-responsive nanoparticles and their self-assembly.

Dual-responsive nanoparticles are designed by functionalizing magnetic cores with light-responsive ligands. These materials respond to both light and magnetic fields and can be assembled into various higher-order structures, depending on the relative contributions of these two stimuli.

Total laparoscopic management of a large renal hydatid cyst by using hydatid trocar cannula system.

Renal hydatidosis usually requires surgical treatment such as pericystectomy, marsupialization, or nephrectomy. In the era of minimally invasive surgery, laparoscopic treatment is preferred. Two main challenges in laparoscopy are to avoid the spillage of contents and to minimize incision for delivering the specimen. We herein discuss the use of a hydatid trocar cannula system (HTCS) to overcome these problems. A 46-year-old male patient having a large renal hydatid cyst (18×15 cm) was operated using HTCS. Three standard laparoscopic ports were placed and the HTCS was placed from the fourth port (18 mm). After aspiration of contents, the cyst was inspected using laparoscope and all contents were sucked. The operation time was 120 min and the total blood loss was around 100 ml. No intraoperative spillage was noted. The patient was orally allowed on Day 2 and discharged on Day 3. Oral albendazole therapy was continued 3 months after the operation. He remained symptom free and abdominal computed tomography did not reveal any recurrences during a follow-up of 2 years. Use of HTCS in renal hydatidosis not only prevents the spillage of hydatid fluid, but also assists in the complete evacuation of contents and allows intracystic visualization to check complete removal of scolices.

Female urethral diverticulum presenting with acute urinary retention: Reporting the largest diverticulum with review of literature.

Female urethral diverticulum is a rare entity with diverse spectrum of clinical manifestations. It is a very rare cause of bladder outlet obstruction and should be considered as a differential diagnosis in females presenting with acute urinary retention associated with a vaginal mass. Strong clinical suspicion combined with thorough physical examination and focused radiological investigations are vital for its diagnosis. Herein we report a case of giant urethral diverticulum presenting with acute urinary retention in a young female. It was managed by excision and urethral closure, and is the largest urethral diverticulum reported till date in the literature.

Trans-vaginal total pelvic floor repair using customized prolene mesh: A safe and cost-effective approach for high-grade pelvic organ prolapse.

AIMS: To assess safety, efficacy, and cost-effectiveness of trans-vaginal total pelvic floor repair with customized prolene mesh in patients with high-grade pelvic organ prolapse. MATERIALS AND METHODS: A total of 32 patients, who underwent trans-vaginal total pelvic floor repair using a customized prolene mesh from January 2007 to June 2010 for grade III and IV pelvic organ prolapse, were analyzed retrospectively. Prolapse was graded using Pelvic Organ Prolapse Quantification system of International Continence Society. Patients were evaluated for symptoms associated with prolapse pre- and postoperatively. RESULTS: Of the 32 patients, 18 were grade IV uterine prolapse, 10 were grade III uterine prolapse, and 4 were grade IV vault prolapse. Twenty-eight patients underwent vaginal hysterectomy at the time of repair. All the patients had associated anterior and posterior prolapse of varying degree. Follow-up ranged from 6 to 42 months. All patients had symptomatic relief after surgery. There were no intraoperative rectal or bladder injuries. Early complications were perineal pain (30), de novo urgency (4), vaginal discharge (3), vaginal wall hematoma (2), and failure to void (2). Two patients had vaginal erosion of mesh. CONCLUSIONS: Trans-vaginal total pelvic floor repair using a customized prolene mesh is safe and effective treatment for comprehensive repair of high-grade pelvic organ prolapse. The use of this custom-made prolene mesh makes the procedure very cost-effective and affordable. The reduction in cost is about 25-30 times with the use of this mesh when compared with commercially available variety.

Isolated renal zygomycosis: novel diagnostic and prognostic criteria with experience of a tertiary care center.

BACKGROUND: Isolated renal zygomycosis is a life-threatening infection and difficult to diagnose ante mortem due to varied presentations. Most reports in the literature are case reports. We are presenting our experience of 10 patients. MATERIALS AND METHODS: Retrospective data of 10 consecutive patients with primary renal zygomycosis, including 2 post-transplant patients, in our tertiary care center was analyzed. Epidemiological characteristics, predisposing conditions, clinical presentation, diagnostic findings and treatment outcomes were recorded. Characteristic radiological findings were recorded. Localized disease was managed by supportive treatment or percutaneous drainage and extensive disease with unilateral or bilateral nephrectomy. Renal involvement was confirmed in all patients by histopathology. RESULTS: The mean age of presentation was 35 years. Five patients who had bilateral renal involvement presented with oliguric acute renal failure, hematuria and abdominal pain. Three had unilateral renal disease and presented with flank pain and fever. The two post-transplant patients presented with fever and graft dysfunction. Even after aggressive treatment 5 patients died, accounting for a mortality rate of 50%. CONCLUSION: Isolated renal zygomycosis can be diagnosed with typical radiological findings, combined with clinical, laboratory and histopathological features. This study describes the newer ante mortem radiological diagnostic criteria and prognostic predictors of the disease.