Search

Byline: Ankush. Modi, Prabhjot. Singh, Amlesh. Seth, Rajeev. Kumar Introduction: Elevated serum prostate-specific antigen (PSA) is the most common trigger for a prostate biopsy. However, the range of normal PSA [...]

Objectives: To evaluate the role of combined intravoxel incoherent motion and diffusion kurtosis imaging (IVIM–DKI) and their machine‐learning‐based texture analysis for the detection and assessment of severity in prostate cancer (PCa). Materials and methods: Eighty‐eight patients underwent MRI on a 3 T scanner after giving informed consent. IVIM–DKI data were acquired using 13 b values (0–2000 s/mm2) and analyzed using the IVIM–DKI model with the total variation (TV) method. PCa patients were categorized into two groups: clinically insignificant prostate cancer (CISPCa) (Gleason grade ≤ 6) and clinically significant prostate cancer (CSPCa) (Gleason grade ≥ 7). One‐way analysis‐of‐variance, t test, and receiver operating characteristic analysis was performed to measure the discriminative ability to detect PCa using IVIM–DKI parameters. A chi‐square test was used to select important texture features of apparent diffusion coefficient (ADC) and IVIM–DKI parameters. These selected texture features were used in an artificial neural network for PCa detection. Results: ADC and diffusion coefficient (D) were significantly lower (p < 0.001), and kurtosis (k) was significantly higher (p < 0.001), in PCa as compared with benign prostatic hyperplasia (BPH) and normal peripheral zone (PZ). ADC, D, and k showed high areas under the curves (AUCs) of 0.92, 0.89, and 0.88, respectively, in PCa detection. ADC and D were significantly lower (p < 0.05) as compared with CISPCa versus CSPCa. D for detecting CSPCa was high, with an AUC of 0.63. A negative correlation of ADC and D with GS (ADC, ρ = −0.33; D, ρ = −0.35, p < 0.05) and a positive correlation of k with GS (ρ = 0.22, p < 0.05) were observed. Combined IVIM–DKI texture showed high AUC of 0.83 for classification of PCa, BPH, and normal PZ. Conclusion: D, f, and k computed using the IVIM–DKI model with the TV method were able to differentiate PCa from BPH and normal PZ. Texture features of combined IVIM–DKI parameters showed high accuracy and AUC in PCa detection. [ABSTRACT FROM AUTHOR]

Introduction: The blood-based inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), is a reliable prognostic biomarker for several cancers. Although the literature supports the correlation between preoperative NLR, clinicopathological characteristics, and oncological outcomes in upper tract urothelial carcinoma (UTUC), the cutoff of NLR is still debated. This study aimed to determine the prognostic value of NLR in patients with UTUC. Methods: This was a retrospective analysis of prospectively collected data from July 2012 to December 2022 evaluating patients with UTUC who underwent radical nephroureterectomy (RNU). NLR was calculated using the neutrophil and lymphocyte counts obtained a day before the surgery and the cutoff value was set as 2.5. Kaplan-Meier and Cox's proportional hazards regression were used to analyze the association between NLR and the oncological outcomes. Results: The study included 91 patients (78 males, 13 females) in the final analysis with a median follow-up of 49 months (8-130). The mean age of the patients with NLR <2.5 and NLR >2.5 was 56.88 years and 56.35 years, respectively, and the pathological stage was pT1 in 48%, pT2 in 20.88%, pT3 in 27.47%, and pT4 in 3.30% of the patients. Multivariable Cox regression analysis showed that the preoperative NLR >2.5 was significantly associated (Hz = 7.17) with higher T stage, lymphovascular invasion, necrosis, nodal involvement, adjuvant chemotherapy, and worse overall survival (OS) (Hz = 9.87). The Kaplan-Meier analysis revealed an improved OS in patients with NLR <2.5, but a statistically significant difference in the recurrence-free survival was not found. Conclusions: Preoperative NLR is an easily available, inexpensive, and important prognostic biomarker of survival in patients with UTUC and has a potential role in risk stratification by predicting adverse clinicopathological characteristics. [ABSTRACT FROM AUTHOR]

Byline: Harshit. Garg, Brusabhanu. Nayak, Ashish. Kumar, Prabhjot. Singh, Rishi. Nayyar, Aashir. Kaul, Amlesh. Seth Background: Renal cell carcinoma (RCC) presents with inferior vena cava (IVC) thrombus in 10%-30% cases [...]

Byline: Biswamohan. Mishra, Ankit. Sachan, Chandrasekhar. Bal, Achal. Srivastava, Amlesh. Seth, Anubhav. Narwal, Mehar. Sharma, Seema. Kaushal, Anoop. Saraya, Awadh. Pandit Sir, A 43-year-old male without any co-morbidity presented with [...]

Byline: Prashant. Sharma, Sridhar. Panaiyadiyan, Santosh. Kurra, Raman. Kumar, Brusabhanu. Nayak, Seema. Kaushal, Alpana. Sharma, Rajeev. Kumar, Amlesh. Seth, Prabhjot. Singh We appreciate the author's interest in our recently published [...]

Byline: Harshit. Garg, Amlesh. Seth, Rajeev. Kumar Introduction: Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as 'high-risk' prostate cancer (PCa). However, among Indian men, PSA [...]

Byline: Sumit. Saini, Brusabhanu. Nayak, Prashant. Singh, Amlesh. Seth Renal lymphangiectasia characterised by either unilocular or multilocular cystic lesion in and around the kidney is an uncommon condition. Presentation of [...]

Objectives: Contrast‐enhanced ultrasound (CEUS) allows excellent delineation of perfusion in septa and nodules without exposure to ionizing radiation or nephrotoxic contrast media. The aim of our study was to evaluate the role of CEUS for the assessment of cystic renal masses and compare its diagnostic performance with that of CECT. Methods: Exactly 40 patients diagnosed to have cystic renal masses on CECT scan were prospectively evaluated with CEUS and were assigned a Bosniak class. Based on results of final histopathology and clinical follow‐up, internal validity of both CEUS and CECT was evaluated, including agreement between these two modalities. Results: Out of the 40 patients (mean size 3.1 ± 2.5 cm), 23 patients had benign lesions and 17 patients had malignant lesions. For CEUS, the sensitivity and negative predictive value was 100%, the specificity and positive predictive value was 73.9%. For CECT, the sensitivity and negative predictive value were 88.2 and 83.3%, respectively, whereas the specificity and positive predictive value was 87 and 90.9%, respectively. Both imaging modalities had similar accuracy with fair to good agreement with the final diagnosis (Κ = 0.71 and 0.75 for CEUS and CECT, respectively). Concordance between CEUS and CECT was seen in 29 patients (72.5%) with fair agreement between the two modalities (K = 0.66). Conclusion: CEUS has comparable accuracy with CECT and could be used as screening modality to rule out the presence of complex cystic renal masses without exposure of nephrotoxic contrast media and ionizing radiation. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: To study the presentation and natural course of cystitis cystica et glandularis. Methods: A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years' follow-up was performed. Perioperative details along with the last available follow-up were included in the analysis. Results: A total of 10 patients were included. The mean age (± standard deviation) was 33.4 (±14.0) years and nine (90%) were men. The most common presentation was storage and voiding lower urinary tract symptoms (80%) along with haematuria (40%) and dysuria (20%). Four patients had the presence of hydronephrosis in preoperative imaging, of which three patients had bilateral mild hydroureteronephrosis. All the patients underwent transurethral resection of the bladder tumour as all were diagnosed with urinary bladder mass on preoperative imaging. All the patients had a trigonal lesion with a bullous appearance partially obstructing the bladder neck. Six patients underwent double J stenting in the perioperative period. The mean (± standard deviation) follow-up duration was 32.8 (±7.5) months. Patients were kept on regular surveillance with imaging and cystoscopy as indicated. Eight patients (80%) developed recurrence in the follow-up period. The mean number of recurrences was 1.5 (±1.1). One of the patients had to undergo augmentation ileocystoplasty with bilateral ureteric reimplantation because of the recurrent lesion with small contracted bladder, while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. Besides, there was no evidence of malignancy after this entity in any of the patients. Conclusion: Cystitis cystica et glandularis is a rare clinic pathological entity which often mimics bladder tumour. Cystitis cystica et glandularis is common in men and often presents with lower urinary tract symptoms. Transurethral resection forms the mainstay of treatment. However, it is often associated with upper tract hydronephrosis. Its controversial premalignant nature compounded with recurrence and risk of upper tract deterioration warrants close surveillance. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Introduction: Abnormal levels of heavy metals (HM) and trace elements (TE) affect body metabolism and can induce carcinogenesis. This study aims to evaluate the role of HM and TE in carcinoma urinary bladder (CAUB). Methods: Patients with biopsy-proven CAUB (n = 100) were taken as the study group, while age-and sex-matched healthy volunteers were taken as control (n = 100). Blood and urine samples were compared for Arsenic (As), Copper (Cu), Manganese (Mn), Selenium (Se), Cadmium (Cd), Lead (Pb), and Mercury (Hg) levels. Serum glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and lipid peroxidation (LPO) levels were assessed to know the redox status between the two groups. Results: A significantly higher blood level of As, Mn, and Pb was observed in CAUB cases as compared to controls. Blood Se level was significantly lower in CAUB patients. On comparing urinary levels, CAUB patients had a higher As, Mn, and Pb levels compared to controls. Further, 68% and 59% of patients had their blood and urinary HM and TE levels above the permitted level, respectively. CAUB cases also had a lower GSH-Px (113.5 ± 44.7 vs. 163.9 ± 120.5, P = 0.0002), lower SOD levels (11.35 ± 5.6 vs. 13.75 ± 3.9, P = 0.008), and a higher LPO levels (15.5 ± 14.7 vs. 11.18 ± 11.2, P = 0.02) in the serum. Conclusions: A significantly higher concentration of As, Mn, and Pb was noted in the blood and urine of CAUB patients compared to controls. CAUB cases also had lower serum GSH-Px and SOD levels with a concomitant increased serum LPO assay suggesting underlying oxidative stress. [ABSTRACT FROM AUTHOR]

Byline: Devanshu. Bansal, Brusabhanu. Nayak, Prabhjot. Singh, Rishi. Nayyar, Rashmi. Ramachandran, Rajeev. Kumar, Amlesh. Seth We thank the authors for their kind appreciation and keen observations. We performed a randomized [...]

Byline: Harshit. Garg, Deviprasad. Tiwari, Brusabhanu. Nayak, Prabhjot. Singh, Siddharth. Yadav, Rajeev. Kumar, Amlesh. Seth, Rishi. Nayyar, Premnath. Dogra Background: Nephron-sparing surgery (NSS) is the standard of care for small [...]

Byline: Tushar. Narain, Gagan. Gautam, Amlesh. Seth, Vikas. Panwar, Sudhir. Rawal, Puneet. Dhar, Harkirat. Talwar, Amitabh. Singh, Jiten. Jaipuria, Ankur. Mittal The Corona Virus Disease-2019 (COVID-19), one of the most [...]