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Introduction: There is an ongoing need to identify various pathological factors that can predict various survival parameters in patients with upper tract urothelial carcinoma (UTUC). With this review, we aim to scrutinize the impact of several pathological factors on recurrence free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) in patients with UTUC. Materials and Methods: Systematic electronic literature search of various databases was conducted for this review. Studies providing multivariate hazard ratios (HR) for various pathological factors such as tumor margin, necrosis, stage, grade, location, architecture, lymph node status, lymphovascular invasion (LVI), carcinoma in situ (CIS), multifocality and variant histology as predictor of survival parameters were included and pooled analysis of HR was performed. Results: In this review, 63 studies with 35.714 patients were included. For RFS, all except tumor location (HR 0.94, p=0.60) and necrosis (HR 1.00, p=0.98) were associated with worst survival. All the pathological variables except tumor location (HR 0.95, p=0.66) were associated with worst CSS. For OS, only presence of CIS (HR 1.03, p=0.73) and tumor location (HR 1.05, p=0.74) were not predictor of survival. Conclusions: We noted tumor grade, stage, presence of LVI, lymph node metastasis, hydronephrosis, variant histology, sessile architecture, margin positivity and multifocality were associated with poor RFS, CSS and OS. Presence of CIS was associated with poor RFS and CSS but not OS. Tumor necrosis was associated with worst CSS and OS but not RFS. Tumor location was not a predictor of any of the survival parameters.

Detailed chemical kinetic models involving hundreds of species and thousands of reactions have recently been developed for biomass thermochemical conversion. The high computational cost of these kinetic models makes them impractical even for simple reactor geometries. In this work, we develop a recurrent neural network (RNN) model for the secondary gas-phase reactions of biomass gasification in an inert environment in the temperature range of 800-1000 $\degree$C. A gated recurrent unit (GRU) based RNN architecture is used to ensure accurate predictions over the entire range of time in the reactor. A compact kinetic model reduced from a detailed kinetic scheme using an automated reduction algorithm is employed as the reference kinetic scheme for the gas-phase reactions. A comprehensive range of biomass composition and reactor conditions are used to generate the training data ensuring a wide range of the model applicability. The developed GRU-based RNN model can predict the temporal evolution of important reactants and products during biomass gasification in the freeboard region of a fluidized bed reactor. The model reduces the computational cost associated with the reference kinetic scheme by four orders of magnitude.

Purpose To assess the surgical outcomes of augmentation urethroplasty (AU) using penile skin graft (PSG) compared to buccal mucosa graft (BMG) in anterior urethral stricture disease. Method Between January 2018 and January 2019, 100 patients with anterior urethral stricture planned for AU were randomized into PSG or BMG arms (CTRI/2018/07/015028). Anatomic and functional variables were compared pre-operatively and post-operatively. Primary outcome was success rate at 18 months and it was defined if any of the three criteria were met, i.e. either maximum urinary flow (Qmax) > 15 ml/s or urethral calibration of 16 French or ability to traverse the repair with 17 French cystoscope. Secondary outcomes were functional parameters such as International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) Score, Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), and Urethral Stricture Surgery-Patient Related Outcome Measure (USS-PROM). Results Pre-operative variables were comparable between both the arms. Median duration of follow-up was 22 months (18-24 months). At 18 months, the success rates of AU with PSG and BMG were comparable (89% v/s 91%; p = 0.70, 95% CI-0.33 to 5.21). The improvements in Qmax (p = 0.06), IPSS (p = 0.43) and USS-PROM (p = 0.49) were comparable between the two arms. There was no statistically significant difference in the IIEF-Erectile domain (p = 0.07), IIEF-Orgasmic domain (p = 0.11) and MSHQ-EJD (p = 0.20) following AU at 18 months. Clavien-Dindo grade I complications were 12.7% in PSG and 16.7% in BMG. Conclusion This study provides level 1 evidence of no statistical significant difference in outcomes of AU using BMG or PSG.

Introduction: Pain is important morbidity following percutaneous nephrolithotomy (PNL). Various adjunctive procedures such as intercostals nerve block (ICNB) have been described to reduce post-operative pain. The aim of this review was to determine the analgesic efficacy of ICNB in PNL patients. Materials and Methods: Systematic literature search was conducted to identify relevant publications. We followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines while conducting this review. Results: In this review, five randomized studies with 319 patients were included. The analgesic requirement was statistically similar in ICNB and control group (Standard mean difference (SMD) -0.48 confidence interval (CI)[-1.4, 0.44] p=0.31) whereas analgesic requirement was lower for peritubal infiltration group (PTI) as compared to ICNB (SMD 0.85 CI[0.25,1.44] p=0.005). Also, time to first analgesic requirement was similar between ICNB and PTI (SMD 0.86 CI[-9.3,11.0]), p=0.87). Pain according to VAS (visual analog scale) and Dynamic VAS (DVAS) at 24 hours was lower in ICNB group as compared to the control group; however, only DVAS at 24 hours was statistically significant. DVAS and VAS at 24 hours were similar for both ICNB and PTI. Conclusions: Intercostal nerve block in terms of analgesic requirement appears to be inferior to peritubal block and no better than control group. Also, mean pain scores for ICNB were similar to control group and peritubal block. Keywords: Percutaneous nephrolithotomy, Intercostal nerve block, Peritubal block, PNL, PCNL.

Introduction: Hilar tumors are a unique subset of complex renal masses posing a potential surgical challenge during partial nephrectomy. The outcomes of hilar masses have not been compared to non-hilar renal masses of similar RENAL nephrometry score (RNS). In this study, we analyzed the outcomes of hilar versus nonhilar masses after a propensity score matching. Methods: Prospectively maintained database of patients who underwent robot assisted PN between November 2014 and December 2018 was abstracted for hilar and nonhilar tumors. We performed propensity matching for baseline variables such as age, sex, body mass index, comorbidities, preoperative glomerular filtration rate, and RNS for each patient on the basis of propensity scores. Results: We included 48 patients with hilar tumors and 153 with nonhilar tumors. On propensity matching, 41 patients were included in each group. The mean operative time (162.4 ± 48.9 min vs. 144.1 ± 38.8 min, P = 0.48), warm ischemia time (29.0 ± 8.8 min vs. 24.4 ± 8.2 min, P = 0.12), and the estimated blood loss (201.8 ± 184.7 ml vs. 150.6 ± 160.5 ml, P = 0.37) were not significantly different between the hilar and the nonhilar groups. Trifecta was achieved in only 14/41 (34.1%) of the patients in the hilar group as compared to 24/41 (58.5%) in the nonhilar group (P = 0.027). Logistic regression analysis identified that hilar location of the tumors was not an independent predictor of overall complications (OR 6.37, confidence interval [CI] 0.5–69.4, P = 0.4), trifecta (OR 0.38, CI 0.14–1.0, P = 0.051), and pentafecta outcomes (OR 0.4, CI 0.1–1.51, P = 0.17). Conclusions: Hilar location was associated with poorer trifecta outcomes compared to the nonhilar tumors. However, hilar location per se was not an independent predictor of overall complications and trifecta and pentafecta outcomes.

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). 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

COVID-19 pandemic has created a prolonged impact globally and destructed the life all over the world. The necessary use of personal protective equipments, masks, gloves and other plastic products has to some extent reduced transmission of virus. However, the impact of plastic waste generated worldwide due to the pandemic has affected the environment globally. The coronavirus disease (COVID-19) has destructed and altered every part of life and environment globally. Potential impacts on environment are seen due to the transmission of virus as well as a slowdown in economic activities as lockdown prevails. Increased biomedical waste, improper usage and disposal of surgical masks, disinfectants, gloves, and increasing plastics wastes from domestic households continuously endangers environment. Not only it has an impact on the environment, but also deteriorates human health in the future. Global environmental sustainability is necessitated to overcome the plastic pollution problem and facilitate strategies to recycle and reuse plastics products. This review highlights the influence of COVID-19 on wastes generated by plastic products along with environmental challenges and repercussions. Also, measures to combat the plastic pollution problem have to be implemented for future protection and safety of the environment. [ABSTRACT FROM AUTHOR] Copyright of Journal of Pure & Applied Microbiology is the property of Dr. M. N. Khan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Libraries have always been the integral components of the academic institutions world over. Earlier known for housing the spectrum of books permitting their ready access to knowledge seekers, libraries of current age are no more confined spaces with limited functions. With the advancing information technology, the conventional definition of a library is changing to accommodate newer roles and challenges. Twenty-first century academic libraries are extending beyond the walls of their individual institutions and are evolving as open access information spaces, dealing with intelligent sharing through social communication and networking technologies. Despite such massive changes in the information storage and retrieval patterns across the globe, libraries at Ayurveda institutions in India seem by and large unbothered and unaffected. Poor educational and research standards in Ayurveda seem to have direct links with libraries contributing minimally to academic exchange and progress. An SCONUL survey conducted for the first time in any ayurvedic library setting in the country came as an eye opener stating clearly that Ayurveda institutional libraries require a major reform first to bring them at par with other academic libraries and subsequently to evolve them as the nucleus of knowledge fostering. These setups direly need a hand of help to become eligible for contributing what they are really meant to.

The abnormalities in the ionosphere Total Electron Content (TEC) is linked to the deformation, stress accumulation and earthquake preparation processes in the earth’s crust and show anomaly prior to the occurrence of earthquakes. Detail analysis on TEC variation prior to 2016 Mw = 6.7 Imphal (India) earthquake is carried out using three Global Positioning System (GPS) Continuously Operating Reference Stations (CORS) installed each at Cherrapunjee (Meghalaya), Khanapara (Assam) and Madankamdev (Assam). TEC time series prior to earthquake indicates strong consistent anomalies at regular intervals on 5th, 9th, 25th, and 27th of December 2015. The time at which the TEC deviation is maximum and minimum as anomaly time is studied in detail to understanding TEC-earthquake epicenter distance relationship. It is observed that for positive anomaly, i.e., when TEC crosses upper limit defined by statistical method, at detected anomaly time, TEC concentration increases towards the epicenter. For negative anomaly when TEC crosses lower limit, TEC concentration decreases towards the epicenter. It is also observed that with distance the magnitude of TEC anomaly decreases and the maximum anomalous values are observed near to the earthquake epicenter. The study indicates need of a real time TEC monitoring system for effective precursor detection.

Introduction: Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and efficacy in this population. Materials ande methods: Systematic literature search of various electronic databases was conducted to include all the randomized studies and quasi-randomized studies. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019123381). Results: Out of 9 studies included in this review, 5 were randomized controlled trials, and rests of the 4 studies were quasi-randomized studies. Tramadol resulted in significantly higher improvement of IELT with the mean difference (MD) of 139.6 seconds and confidence interval (CI) 106.5-172.6 seconds with a p-value of p

Fault analysis study is the important parameter of economic, reliable and secure power system planning and operation. Power system studies are important during the planning and conceptual design stages of the project. This paper presents the fault analysis on IEEE-9 bus system. The line to ground fault is created on bus 5th and analyzed the variation in Voltage, Real power, Reactive power on different buses. The fault at 5th bus of IEEE-9 bus system is analyzed on PSCAD software.

Uterine fibroid is the common type of benign tumor of uterus which affects the health of women. These are mostly asymptomatic but still cause major morbidity in women. Along with menorrhagia, dysmenorrhoea fibroid also shows symptoms such as infertility, pain in lower abdomen, anemia due to blood loss. Hormonal therapy and symptomatic treatment are carried out to treat this disease. . In some advance cases, surgery is carried out. But there is no absolute treatment for cure of uterine fibroid till today. There is a description of various Ayurvedic diseases affecting the health of women. There is somewhat resemblance between Vyadhis in Ayurveda and uterine fibroid such as RaktajaGulma, Granthi and Arbuda. But there is an evidence gap regarding correlation of uterine fibroid with disease mentioned in Ayurveda. So we have made sincere effects to correlate Ayurvedic disease with uterine fibroid with the help of an observational study. Our study will aid to treat uterine fibroid using Ayurvedic principles. For this observational , study 30 womenof the age group 30-60 having uterine fibroid after takingtheir prior consent were taken by considering inclusion and exclusion criteria. Their USG reports of abdomen and pelvis were collected. Detailed clinical examination was carried out and case report formsfilled. After hysterectomy, gross examination of fibroid was carried out and their histopathology reports were collected for further study. We found mean age of occurrence of fibroid was40.4 years.Mean of symptoms to be visible was 22.44. Avednam, Snigdha, Na-Anyavearnam, Ashmopam, Apakam,AprachalyamaLakshana was found in 80%, 90%, 100%, 66.66%, 93%, 63.33% respectively From all the observation and results, at the end of this study, we concluded that uterine fibroid can be correlated with Arbuda and its subtype Mansarbuda.

Robot-assisted pelvic surgeries in steep Trendelenburg position present unique challenges to the anaesthesia team. Pneumoperitoneum, also, puts additional strain on the cardiovascular and respiratory requirements of the patient. In-depth knowledge of the effect of this position on patient’s physiology is essential for intraoperative safety and better management. Robotic arms can also cause steric hindrance and limited access to the patient thus better intraoperative communication may help in averting any untoward event. With this review, we discuss the effect of steep Trendelenburg position and pneumoperitoneum on the intraoperative physiology of the patient. Keywords: Robotic, Trenedeleburg, Pelvic surgery.

Past earthquakes in the Himalayas are mainly due to tectonic activities along the thrust faults parallel to the Himalayan belt. In order to study the ongoing tectonic process, crustal deformation at a selected transect in a part of western Himalayas as well as of the Indian plate, then: are studied by the analyses of GPS data processed in a GAMIT/GLOBK platform. The data were collected from four local continuous operating reference stations (CORS), six International Global Navigation Satellite System Service (IGS) stations and five surveyed based GPS campaign stations transverse to major faults system. Results show an annual crustal motion of 19.18 mm Near Southern Tibetan Detachment (STD), 18.72 mm near Main Central Thrust (MCT), 11.93 mm near Main Boundary Thrust (MBT) and 11.53 mm near Himalayan Frontal Thrust (HFT) in India fixed reference. The present day Indian plate motion was estimated to be 55.33 mm/yr. In the study region at western Himalaya, crustal convergence of 13.83 mm/yr was observed in Dehradun-Badrinath sector in Uttarkhand. GPS sites near to north of HFT shows a westward movements and sites at peninsular India shows eastward movements suggesting possible counter clockwise rotation of the Indian plate. The annual motion across HFT varies between 0.1 and 2.0 mm, suggesting that HFT is locked in Garhwal region of western Himalaya. Insignificant movement across HFT indicates greater strain accumulation and the possibility of earthquakes in near future. The study suggests requirement of continuous monitoring of deformation across major thrusts in the Himalaya with dense network of GPS stations.

A total of 160 earthquakes in North East Indian region and surroundings were analysed for earthquake precursor detection using GPS based Total Electron Content (TEC) estimation in the Ionosphere. TEC is very sensitive to short-term disturbances of a geomagnetic storm, solar flares and seismic activities. In the present study, TEC in the ionosphere was measured using dual-frequency signals from five GPS-based continuously operating reference stations/system (CORS) installed in North Eastern states of India. The abnormality in TEC variations was observed by constructing boundary limits using statistical method, the values crossing the limits being the anomaly. The results for Mw > 5 earthquakes such as Mw 5.5 Kohima Earthquake (July 14, 2012), Mw 6.8 Myanmar earthquake (November 11, 2012) and Mw 5.6 Kokrajhar Earthquake (June 28, 2015) covering North East India suggest TEC anomaly 10 days, 12 days and 13 days prior to the events. Analysis of 160 earthquakes suggests that the rate of success in TEC based anomaly detection for earthquake precursor increases with increase in Magnitude of the earthquakes. In average Mw 6 earthquakes could be fully detectable. Rate of success with reference to CORS were also computed and was found in the order of Cherrapunjee, Meghalaya > Madankamdev, Assam > Mohanpur, Agartala > Mawtawar, Meghalaya > Khanapara, Assam. Therefore present investigations confirmed TEC anomalies prior to earthquakes and present the expected rate of success, making it imperative to set up an automated system for real-time monitoring of TEC for Earthquake precursor detection and appropriate forewarning in near future.

From the past decades, researchers are looking for advanced materials that will cut down the overuse of fossil fuels to decrease the negative impact on the environment. This paper aims to investigate the methods of harnessing energy from the advanced materials and their properties, types, and application in detail. Phase change materials having the potential to absorb or release the energy as latent heat and posses own phase temperature. PCM's are classified generally into three types organic, inorganic, and eutectics. We also review the applications of phase change materials in different sectors and recent advances from the material aspects are studied.

Objectives: Post-operative complete wound dehiscence, being an unfortunate and also a very serious complication, is associated with a high morbidity and mortality rate despite the most sophisticated intensive care these patients receive today. The quest for the best closure technique for abdominal incisions continues. To achieve this goal, several modifications in opening the abdomen and closing the wound have been tried. There are many studies in the literature comparing various methods of wound closure, with conflicting results. The aim of the present study was to assess the proportion of wound infection and wound dehiscence in the post-midline laparotomy patients, using interrupted X suture versus continuous suture technique in sheath closure. Material and Methods: A total of 80 patients undergoing vertical midline emergency laparotomy at one of the gynecology units were recruited randomly after taking written informed consent and were equally divided into 40 cases each group (interrupted X suture) and (continuous suture) they were randomized into two groups depending on whether the patient registration number was odd or even. Results: The age of the patients varied from 16 years to 82 years. In Group A, the mean age was 36.75 ± 13.78 years, and in Group B, the mean age of the patients was 38.37 ± 12.56 years. In Group A, 8 (20%) patients had comorbidity, whereas, in Group B, 10 (25%) patients had comorbidity. In Group A, 12 patients had wound infection, while in Group B, ten patients had wound infection (P = 0.001 [statistically significant]). In Group A, two patients had wound dehiscence, while none of the patients in Group B had wound dehiscence (P = 0.001 [statistically significant]). There was no incisional hernia in both the groups. Conclusion: Emergency laparotomy is associated with a higher rate of burst abdomen as compared to elective laparotomy, but using interrupted X suture technique in sheath closure, wound dehiscence can be prevented up to some extent.

Transurethral resection of bladder tumor is the standard of care for the management of patients with bladder mass. Primary objective of this study was to compare safety and efficacy of the two energy modalities used for TURBT (monopolar and bipolar). Systematic literature search of various electronic databases was conducted to include all the randomized studies comparing two groups. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019139987). In the present review, eight RCTs including 1147 patients were included. Resection time, hospital stay and catheter duration were significantly shorter with bipolar group. There was no significant difference in incidence of obturator reflex (OR 0.65, CI [0.35, 1.2], p = 0.17), whereas incidence of bladder perforation was significantly higher in the monopolar group (6.4% versus 3.3%, p = 0.01. However, sensitivity analysis including 3 high quality studies revealed equal incidence of bladder perforations. Need for blood transfusion was similar in the two groups but fall in hemoglobin was significantly lower in bipolar group (MD − 0.45 CI [− 0.72, − 0.18], p = 0.0009). Bipolar group was found to have significantly lower incidence of tissue artifacts due to thermal energy on pathological examination (OR 0.27 CI [0.15, 0.47], p

Penile skin (PSG) and the buccal mucosa (BMGs) are the most commonly used grafts for substitution urethroplasty. The aim of this study was to compare the success rates of substitution urethroplasty using either of these grafts. We systematically searched PubMed/Medline, EMBASE, Scopus and Web of science to identify studies comparing the two types of graft urethroplasties. Search strategy was based on Patient, Intervention, Control and Outcome guidelines. Studies reporting data on success of PSG versus BMG within the same manuscript were included. Standard Preferred reporting Items for Systematic reviews and Metaanalysis guidelines were followed while conducting this review and study protocol was registered with PROSPERO in priori (CRD42018114258). Sixteen studies, including 5 prospective and 11 retrospective studies, with a total of 1406 (896 BMG and 510 PSG) patients were included in the final analysis. In the overall analysis, BMG had significantly higher success rate (83.7% vs. 76.1%, P ≤ 0.0001). Duration of followup was heterogeneous across the studies, ranging from 15.9 to 201 months. Comparing the five studies where the data on duration of follow up was available, BMG showed a significantly higher success rate compared to PSG (90% vs. 80.4%; P = 0.02). In the subgroup of patients with bulbar urethral strictures, BMG urethroplasty had significantly higher success rate (87.4% vs. 78.0%; P = 0.0001). From the results of this study, buccal mucosa may appear to be a better choice, however, the data is still immature and a properly conducted randomized controlled trial with an adequate duration of followup is required.

OBJECTIVE To develop and validate a novel prediction model predicting renal function recovery following diversion in patients with obstructive uropathy (OU) to the emergency department (ED). METHODS After a systematic literature search, a novel prediction model called PGIMER Obstructive Uropathy Score (POUS) was constructed including five variables: age ( 60 years), duration of symptoms ( 4 weeks), presence of solitary functioning kidney, baseline hemoglobin levels and venous blood pH. This model was then validated in a prospective, observational single-center study of patients presenting with OU caused by various etiologies. Patients with OU and raised serum creatinine (>2 mg/dL) presenting to our ED were included. Renal function recovery was defined as creatinine value

Introduction Primitive neuroectodermal tumor (PNET) of the kidney is unusual in adults. These tumors are diagnosed mainly on histopathology and that too sometimes has limitations. With this study we aimed to review our clinical and histopathological data of patients with renal PNET and reviewing the world literature. Methods In this retrospective study, we reviewed our database from January 2006 to July 2018 to include all the cases of primary PNET of the kidney. We also performed systematic literature search to identify all the relevant series on renal PNET. Results A total of 12 cases including 5 males and 7 females were managed during the above mentioned period. Out of these 7 patients, 2 patients had metastasis at diagnosis, one had locally advanced disease, 6 underwent radical nephrectomy, 5 patients received adjuvant chemotherapy (two currently receiving) and only 1 patient received adjuvant radiotherapy. On Immunohistochemistry (IHC), CD99 and FLI1 were positive in all the cases. Median survival was 10 months. In our review 10 studies were included, 38.6% of the patients had metastatic disease and 10.7% had locally advanced disease at diagnosis. Overall mean survival was 33.75 months. CD99 and FLI1 were positive in 94.3% and 78.5% respectively. Conclusion PNET remains a pathological diagnosis and IHC has important place in diagnosis of PNET. Locally advanced and metastatic disease is common at diagnosis leading to overall poor survival.

Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory infection caused by severe acute respiratory syndrome virus (SARS-CoV-2), a novel human coronavirus. COVID-19 was declared a pandemic by World Health Organization in March 2020 for its continuous and rapid spread worldwide. Rapidly emerging COVID-19 epicenters and mutants of concerns have created mammoth chaos in healthcare sectors across the globe. With over 185 million infections and approximately 4 million deaths globally, COVID-19 continues its unchecked spread despite all mitigation measures. Until effective and affordable antiretroviral drugs are made available and the population at large is vaccinated, timely diagnosis of the infection and adoption of COVID-appropriate behavior remains major tool available to curtail the still escalating COVID-19 pandemic. This review provides an updated overview of various techniques of COVID-19 testing in human samples and also discusses, in brief, the biochemical composition and mode of transmission of the SARS-CoV-2. Technological advancement in various molecular, serological and immunological techniques including mainly the reverse-transcription polymerase chain reaction (RT-PCR), CRISPR, lateral flow assays (LFAs), and immunosensors are reviewed.

The year 2019 was ending and the New Year was also bringing a novel coronovirus to the world. COVID-19, the novel Coronavirus, was notified as a PHEIC and later a Pandemic on the 11th of March, 2020. The Disease has symptoms which are similar to the flu (influenza) or the common cold, which are a lot more common than COVID-19. In more severe cases, an infection can present as pneumonia or acute onset breathlessness with a mode of transmission as direct Contact with respiratory droplets. The Indian government was instrumental in taking action swiftly right from the time when this disease was just an epidemic and yet to be declared as a pandemic. GOI started the measures like screening of interbnational travelers, surveillance through IDSP network, Quarantine for 14 days on entry, suspension of entry of any foreign nationals from PRC, establishment of control room and many more to delay the inevitable outcome and buy time for health department to do the mitigation.GOI had responded to the ‘Test, Track and Treat’ strategy proactively. It included augmentation of lab facilities, involvement of private sector, declaring mask & sanitizers as essential commodity, constitution of RRT’s in states, testing at maximum number of sites followed by contact tracing of positives and furthermore active surveillance in a few parts of country. India learned a lesson from other countries and adopted social vaccine as a definite measure until the vaccine was there. Benefits of non- pharmacological interventions was acknowledged and percolated to the masses through various IEC measures. These all measures were taken before the ‘LOCKDOWN’ was being imposed on 24th of March, 2020. Although lockdown had many anticipated negative consequences but it was the only preventive measure viewed by GOI to curb the surge. The lockdown had no impact on the delivery of essential health services. All Health Facilities, Govt & Private, were instructed to remain functional. All the above-mentioned measures had contributed to serving the prime purpose of early, emphatic containment of SARS-CoV-2 in a country like India, inhabited by 1.3 billion people. Although later there was a surge of cases, but when we infer the same result in comparison to the no of cases would have been there without the lockdown, no action at policymakers would have overwhelmed the health services severely. Hence, the lockdown in India had served the purpose for which it was imposed, thereby had prevented major humanitarian losses on account of COVID-19.

Defect reporting customarily exists in most applications and web sites to support issue reporting by end users and for developers to receive actionable feedback. However, the impact of "human-centric" issues - such as age, gender, language, culture, physical and mental challenges, and socio-economic status - is often overlooked in the development process and during product inception and defect reporting. Most defect reporting tools lack necessary human-centric features to enable a challenged user to adequately navigate and report defects i.e. do not take into account the human differences between end users that cause defects for them in their software and make reporting of such defects difficult for them. Most defect reporting tools also lack sufficient defect report structuring, reporting guidance, and do not emphasize the possible perceived severity of the defect to developers from end users who are very different to them. If users are unable to report defects due to usability issues, this makes those same defect reports difficult to understand by the developer. In this paper, we aim to improve human-centric defect reporting by employing cognitive walkthrough with diverse end user personas, develop a prototype of an improved defect reporting tool, and evaluate the prototype’s defect reporting process from end user and developer perspectives. Our findings offer a foundation for improved human-centric defect evaluation, reporting and fixing.

To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.

Background: Stoma is often constructed in emergency surgical conditions like enteric or tubercular perforations when patients present late in the course of illness to preclude primary closure. The early closure of stoma can minimize the associated morbidity and help the patient to enjoy better quality of life. The aim of our study was to compare the outcome of early stoma closure with delayed closure. Methods: The present study was conducted in the Postgraduate Department of Surgery, Government Medical College, Jammu with effect from 1st july 2016 to 30st june2017. The study was conducted on 32 patients on whom temporary stoma was performed. Patients were divided into two groups with 16 patients in each group after matching the parameters like age, sex, co morbid conditions, using simple random sampling technique. Parameters analyzed were Duration of surgery, stoma related complications, intra and post operative complications and hospital stay. Results: The mean age of patients in group A (early stoma closure) was 30.20±10.08 years while in group B (delayed stoma closure) was 38.03±12.60. The number males patients in group A was 10 while no females was 6 whereas in Group B number of males was 12 and females were 4. Cause of stoma formation was enteric perforation 18(56.25%), tubercular abdomen 6(37.5%), caecal perforation 1(6.25%), trauma 2(12.5%), defunctioning stoma 3(12.56%). The duration of surgery in group A was 52±0.50min and in group B was 70±0.80min. The difference was statistically significant between group A and B (p

Stent-related symptoms are frequent following stent placement for various indications. Use of PDE inhibitors has expanded beyond their classical indication and has been tried in patients with stent-related symptoms. The systematic review was conducted to ascertain the efficacy of PDE inhibitors in ameliorating stent-related symptoms.We performed systematic review and metanalysis on the use of PDE inhibitors for stent-related symptoms in patients who underwent stent placement for various reasons (postpercutaneous nephrolithotomy or ureterorenoscopy). We followed PRISMA guidelines while conducting this review and study protocol was registered with PROSPERO (CRD42019121781) RESULTS: Three studies with 280 participants were included in this review. There was considerable heterogeneity across all the outcome parameters assessed; thus, random-effect model was used for analysis. Comparison of PDE inhibitors with control arm revealed that PDE inhibitors were significantly more effective than placebo in all but one domain (Work performance) of the USSQ. On comparison with alfa blockers, PDE inhibitors were found to be equally effective for urinary symptoms, general health, and body pain parameters, but sexual health parameters improved significantly with PDE inhibitors.PDE inhibitors can be considered an option for patients with stent-related symptoms especially in patients with sexual dysfunction. Due to various limitations of the studies included in this review, we recommend conducting further high-quality studies.

Introduction: Primary salivary gland-type tumors of the lung (PSGTTL) are rare intrathoracic malignant neoplasms. Their description in literature is largely limited to a few case series and case reports. A systematic review and pooled analysis of the previously reported cases of PSGTTL is presented here. Methods: Electronic database of PubMed using keywords “lung neoplasm” AND “salivary gland tumors” was used to identify the papers documenting the PSGTTL. Filters (publication date from January 1, 1900–-December 31, 2015, Humans and English) were applied to refine the search. A pooled analysis of clinical, pathological, treatment, and survival data was performed. Results: The present systematic review included 5 studies and a total of 233 patients. Mean age of the patients was 41 years (range 6–80 years) and there was a male preponderance (1.3:1). Common pathological types were mucoepidermoid (MEC) (56.6%), adenoid cystic (ACC) (39.5%), and epithelial-myoepithelial cancer (3.8%). Tumors were located in the central airways (trachea and major bronchi) in 43.3% of patients. Weighted median tumor size was 4.2 cm. Surgery was the primary treatment undertaken in 82.4% of the patients, while radiotherapy and chemotherapy were also used in 15.9% and 9.4% of the patients. Lymph node involvement was seen in 15.2% of the patients. Disease recurrences were observed in 21.1% of the patients (12.9% and 37.5% in MEC and ACC, respectively). Three-, 5-, and 10-year weighted overall survival was 86.4%, 81.4%, and 73.6% (93.8%, 90.0%, and 85.0%, respectively, for MEC and 76.7%, 62.8%, and 50.5%, respectively, for ACC). Conclusion: Surgery is the primary treatment of PSGTTL to achieve long-term survival. Role of chemotherapy and radiotherapy in the management of PSGTTL warrants further studies.

Context Mini percutaneous nephrolithotomy (mPNL) involves the creation of a smaller access tract compared with standard PNL (sPNL). Smaller tract sizes could lead to decreased blood loss, pain, and need for blood transfusion. Previous studies on this topic have reported variable findings and were of poor quality. Objective To compare the safety and efficacy of mPNL with those of sPNL for the management of patients with renal stone disease by conducting a systematic review and meta-analysis. Evidence acquisition Systematic literature search was performed to identify relevant randomized controlled trials (RCTs) for the review. The primary outcomes for the study were stone-free rate (SFR) and blood transfusion rate. The secondary outcomes were complication rates, fever, fall in hemoglobin, operative time, length of stay (LOS), need for auxiliary procedure, and visual analog scale (VAS) score at 24 h. We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the study protocol was registered with PROSPERO in priori (CRD42021252444). Evidence synthesis In this review, 16 RCTs with 3961 patients were included. SFR was comparable between the two groups (risk ratio [RR] 1.01 [0.99, 1.04], p = 0.30), whereas the need for transfusion was lower with mPNL (RR 0.54 [0.37, 0.78], p = 0.001). Fall in hemoglobin (mean difference [MD] –0.67 [–0.93, –0.41], p = 0.000) and LOS (MD –0.59 [–0.81, –0.37], p = 0.000) were shorter with mPNL. Operative time was significantly shorter with sPNL (MD 8.28 [3.96, 12.59], p = 0.000). Complications were lower with mPNL (RR 0.89 [0.79, 0.97], p = 0.01). The need for auxiliary procedures (RR 0.77 [0.58, 1.03], p = 0.08) and VAS at 24 h (MD –0.79 [–1.63, 0.05], p = 0.06) were similar in the two groups. Conclusions Mini PNL has similar efficacy to sPNL in terms of SFRs. However, mPNL has a superior safety profile with fewer overall complications and a reduced need for blood transfusion. Patient summary In this study, we conducted a meta-analysis comparing mini and standard percutaneous nephrolithotomy (PNL) for the management of patients with renal stone disease. We showed that mini and standard PNL are associated with similar stone-free rates. Overall complications and the need for blood transfusion were lower with mini PNL.

OBJECTIVE The use of lubrication before performing urethral catheterization has been recommended. However, the benefit of using lidocaine gel over plain lubricant gel in reducing pain perception during female urethral catheterization is unclear. With this review, we aimed to compare the pain perception during female urethral catheterization with or without lidocaine lubricant gel. METHODS In this study, we systematically searched PubMed, Scopus, Embase, and Web of Science to identify randomized controlled trials (RCTs) comparing 2% lidocaine gel and plain lubricant gel in reducing pain perception during female catheterization. Standard Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed while conducting this review (CRD42020207312). RESULTS In this review, six RCTs with 464 participants were included. The overall risk of bias for these studies was low. Pain score was presented as standard mean difference (SMD) with a 95% confidence interval (CI). In the overall and subgroup analysis (according to types of pain scores) no significant difference was found between the use of lidocaine and plain lubricant jelly (SMD -0.24 95% CI [-0.96 0.47]). On trial sequential analysis (TSA), by setting alpha = 5% and beta = 20% for moderate evidence the information size calculated was 440 participants. The cumulative Z-score crossed the TSA line proving the reliability of the results. According to Grading of Recommendations Assessment, Development and Evaluation, the evidence is "moderately" certain. CONCLUSION The use of 2% lidocaine gel in female catheterization does not provide a significant reduction in pain perception as compared to plain lubricant gel.

OBJECTIVES Medical expulsive therapy has been found to be effective for distal ureteric stones; however, which drug is most efficacious in terms of stone expulsion rate (SER) and stone expulsion time (SET) is not known. With this review we aimed to compare the efficacy of various drug treatments for distal ureter stones used as medical expulsive therapy in terms of SER and SET. METHODS Systematic literature search was conducted to include all the randomised study comparing various drug interventions for lower ureter stones. Standard preferred reporting items for systematic review and meta-analysis for network meta-analysis (PRISMA-NMA) were pursued. RESULTS In this review, 50 randomised studies with 12,382 patients were included. For stone expulsion rate (SER), compared with placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained, naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared with placebo only tadalafil plus silodosin, nifedipine plus steroid, alfuzosin, silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. CONCLUSION For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as monotherapy is no more effective than control group.

Introduction: Trauma is a major cause of morbidity and mortality in both developed and developingcountries. Globally 10% of all trauma admissions results from chest injury and 25% of trauma related deathsare attributed to chest injuries. Chest trauma may present as isolated injury or as a part of polytrauma.Aim & Objectives: To study the clinical profile of cases with blunt trauma chest in reference to mode ofinjury, hospital stay, diagnosis, severity of injury, treatment offered morbidity and mortality.Material & Methods: A prospective, observational, clinical study was conducted at Department of Surgery,MMIMSR, Mullana, and Ambala. Consecutive type of non-probability sampling was used for the selectionof study subjects during study duration. A total of 50 consecutive cases fulfilling the eligibility criteria weretaken for study after informed consent. Data was collected from these patients admitted in surgical wardsand ICU. All the patients admitted with provisional diagnosis of blunt trauma chest were admitted in surgicalward/ ICU. Data was analyzed using statistical software SPSS vesion 21.Results: As per injury severity score, low to medium severity injury was observed in 66% and 22% casesrespectively. Severe injury was seen in 12% cases. As per injury severity score, low to medium severityinjury was observed in 66% and 22% cases respectively. Severe injury was seen in 12% cases. Conservativemanagement was sufficient in 36% cases while remaining cases required surgical intervention. Tubethoracotomy was required in 62% while mechanical ventilation was seen in 36% cases. Laparotomy wasrequired in 20% cases. Pneumonia developed in 10% cases while pyothorax and septicaemia was seen in4% and 8% cases respectively. Acute renal failure and Multi-organ dysfunction was seen in 1 case each.Increased injury severity score was associated with poly-trauma patients (p

The power sector in Rajasthan has shown substantial improvement over the past few years or in a decade due to an increase in generation capacity, renewable generation, strengthening of network infrastructure leading to an improvement in the overall power supply position of the state. But still, there is a gap to be fulfilled between demand and the supply from capacity tied up under power long-term, bilateral contracts, short-term contracts, and making the renewable generators as must-run plants. Distribution Company continues to be an insufficient supplier to serve the entire demand across various time blocks for the state of Rajasthan. The state continues to depend on peak load power plants, typically gas-based or diesel-based-close to load centers for meeting their deficit peak and uncertain seasonal demand increase. A linear optimization mathematical model has been developed to address the delinquent of power purchase and its planning encountered by the distribution utilities and large consumers. A power procurement framework is much needed for the state of Rajasthan that can provide the three major distribution utilities, and other power procurement suppliers and producers better views in respect of procuring the right quantum of power from various available markets sources under different time scenario to counter the demand.

Aim: To avoid recurrence and scarring following surgical treatment, the present study demonstrated a sutureless excision of the Bartholin’s gland cyst or abscess using hydro-dissection and bipolar coagulation hemostasis. Materials and methods: In a retrospective case series, we studied consecutive cases who had received surgical treatment of the Bartholin’s gland cyst or abscess for benign indications in our private hospital. Results: Of the total 28 cases, Seven cases received incision and drainage of the Bartholin’s abscess, 21 cases underwent excision of Bartholin’s cyst or abscess by the described procedure using hydro-dissection and bipolar coagulation haemostasis.No suture was used for layer closure of the wound. There were no major intraoperative complications. All cases experienced less postoperative pain. Spontaneous apposition of the vaginal wound margins was observed 24 hours after operation in all cases. None of the cases developed a postoperative hematoma, severe cellulitis, or abscess of the operation site requiring readmission. Postoperative-ly, five cases developed postoperative pyrexia, that sub-sided with broad-spectrum antibiotics. None of the cases developed severe postoperative scarring at the operation site following sutureless excision. None of the cases complained of difficulty in sexual function after 6 weeks. The median operation time was 17 min (13–23 min). None of the 21 cases reported recurrence of the cyst or abscess. All those seven cases who received incision and drainage of Bartholin’s abscess developed recurrence. Conclusion: Sutureless excision of Bartholin’s gland cyst using hydro-dissection with bipolar coagulation hemostasis can be performed to avoid postoperative scarring and recurrence.

There is an ongoing need and search for a simple yet accurate nephrometry scoring system for predicting the postoperative outcomes after partial nephrectomy (PN). Simplified PADUA Renal (SPARE) Nephrometry Scoring System, a simplified version of Preoperative Aspects and Dimensions Used for an Anatomical Classification (PADUA) has been proposed as a predictor of postoperative complications following PN recently. However, this score has never been externally validated and assessed as a predictor of trifecta and pentafecta outcomes of PN. In the current study, we applied the SPARE scoring system to our robot-assisted PN cohort (RAPN).Prospectively maintained data of patients, who underwent RAPN from November 2014 to December 2018, was abstracted. Imaging was analyzed to calculate SPARE and RENAL nephrometry scores (RNS) by two urologists, independently. SPARE was compared with complications, trifecta outcomes, pentafecta outcomes, and RENAL nephrometry scoring (RNS).Data of 201 RAPN patients were analyzed. The mean SPARE score was 3 (range 0-11). One hundred thirteen patients were classified as low risk, 64 as intermediate risk, and 24 as high risks. On multivariate analysis SPARE score alone predicted complications (OR=1.37, P=0.014) and trifecta outcomes (OR=0.75, P=0.000) while age (OR=0.96, P=0.042), preoperative eGFR (OR=0.97, P=0.001) and SPARE scores (OR=0.81, P=0.016) were predictors for pentafecta outcomes. Receiver operated curve (ROC) analysis between SPARE and RNS in predicting the complications; trifecta and pentafecta outcomes had a comparable area under the curve.Our study validates the SPARE nephrometry scoring system in predicting postoperative complications, trifecta, and pentafecta outcomes in a RAPN cohort. The predictive accuracy of SPARE is similar to RNS.

Introduction There is a need for sensitive and specific biomarkers for detecting recurrences in patients with non-muscle invasive bladder cancer (NMIBC) on surveillance. Xpert bladder cancer (BC) monitor is the latest rapid in vitro qualitative test that detects expression of 5 mRNAs using a GeneXpert instrument. The primary aim of this review was to systematically review and pool the data regarding the diagnostic performance of Xpert BC in patients with NMIBC. Methods Systematic literature search using 4 electronic databases (PubMed, EMbase, Scopus and Web of science) was performed. Pooled sensitivity, specificity and diagnostic odds ratio (DOR) were estimated using DerSimonian-Laird random-effects model. Standard Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed and the study protocol was registered with PROSPERO (CRD42021249762). Results In this review, 11 prospective studies with 2,896 patients were included. Pooled sensitivity and specificity for Xpert BC were 73% (95% confidence interval (CI) 65%–80%) and 77% (95% CI 69%–84%) respectively. Area under curve (AUC) for Xpert BC monitor was 0.81 (0.78–0.84) respectively. Subgroup analysis from 7 studies for patients with high-grade recurrence revealed sensitivity, specificity and AUC of 0.86 (0.77–0.92), 0.78 (0.75–0.81) and 0.87 (0.84–0.90) respectively. Similar analysis for patients with low-grade recurrence revealed sensitivity, specificity and AUC of 0.58 (0.47–0.68), 0.79 (0.75–0.82) and 0.79 (0.75–0.82) respectively. Conclusion Xpert BC monitor has overall acceptable diagnostic accuracy. Sensitivity is higher for high-grade disease for detecting recurrences in patients with NMIBC on surveillance.

Objectives To assess how UK General Practitioners (GPs) and Practice Managers (PMs) have coped with the challenges posed by the coronavirus disease-19 (COVID-19) pandemic and whether they felt adequately supported by the wider National Health Service (NHS). Methods This is a cross-sectional survey. All GPs and PMs (total 1,354) in Leicester, Leicestershire, and Rutland (LLR) were invited to participate in an online questionnaire. Results A total of 95 invitees completed the survey. Over a quarter had required time off work due to COVID symptoms or contact. All respondents described either introducing or increasing the use of remote patient consultations. Most striking was the rise in video consultations from just 3% to 95% during the pandemic. Almost half of the feedback on the usefulness of remote consultations were positive, 16% were negative and 17% were mixed. The most commonly cited benefit was time efficiency. Drawbacks of remote consultations included technical difficulties and poor patient communication. Practice premises, systems and processes also required significant modifications during the pandemic to ensure the provision of safe clinical care, including reception screens, one-way patient flow, greater infection prevention measures. However, despite their ability to introduce such widescale change virtually overnight, over 10% of respondents reported that the strain had placed their practice at risk of closure. Over half of respondents felt they were not provided with adequate personal protective equipment (PPE) for the safety of their staff. Perception of the support provided by NHS England and the Clinical Commissioning Groups (CCGs) was rather mixed, although additional guidelines were broadly welcomed. The most requested enduring changes related to remote patient consultations (59%) and remote triage (19%). However, in order to support such largescale permanent change, study respondents felt that a different funding and financial structure is required together with improved IT infrastructure, greater patient education and a more supportive regulatory environment. Conclusions COVID-19 has substantially accelerated the pace of change within NHS primary care. The long-term fear is that there may be insufficient financial and clinical backing from regulatory bodies to support such rapid and far-reaching changes.

Background- Perforation peritonitis is amongst the most common emergency condition in surgical practice and is a common cause of mortality in tropical countries like ours. Factors contributing to the high mortality rate include advanced age, late presentation, septicaemia, comorbidities and delay in the treatment. Previous literature has shown peritoneal drainage does improve morbidity and mortality. Not much literature is available on role of NS in pre-operative peritoneal lavage. Aims and Objectives - To assess and compare the morbidity, mortality and final outcomes of the patients who were given peritoneal lavage pre operatively with patients who were not given peritoneal lavage in the pre-operative period. Material and Method- 60 Patients, with generalised perforation peritonitis; reporting in MMIMSR, MMDU, Mullana, Ambala (Haryana); were included in this Randomised control study and divided into two groups. Group I (study group) underwent pre-operative peritoneal lavage under local anaesthesia and group II (control group) without pre-operative peritoneal lavage. The Mannheim’s peritonitis index (MPI) of the patients was calculated and was used to estimate the probable outcome/prognosis of the patient. The haemodynamic parameters and vitals of the patient were recorded just before surgery, before induction of anaesthesia as well as at the end of procedure. On discharge the duration of stay of each patient, complication, suture site infection, recovery period were recorded and analysed using the appropriate statistical tests. Results The ratio of male: female population in the study was found to be 5:1. 26 patients had MPI score of >25, 22 patients had scores between 15-25 and 12 patients had score of

Background After laparoscopic cholecystectomy, gallbladder can be extracted either from epigastric/subxiphoid port or umbilical port. We conducted systematic review of randomized controlled trials comparing the two. Methods PRISMA-compliant systematic review and meta-analysis was conducted with pre-specified study protocol registered on PROSPERO (CRD42019128662). Multiple databases were searched from inception till 14 September 2019 using search terms “gallbladder”, “specimen”, “extraction’, “extract”, “cholecystectomy”, “epigastric port”, “subxiphoid port” “umbilical port”. Outcomes assessed were postoperative pain (visual analog scale at 24 h postoperatively), port-site hernia, port-site infection, operative time and gallbladder retrieval time. Data were analyzed using random-effects models with risk ratios (RR) for dichotomous variables and mean difference (MD) for continuous variables. Results Of 280 articles retrieved, 9 RCT's with 1036 participants were included. Quality of included studies was judged to be “moderate” to “low”. There was no difference in postoperative pain at 24 h (p = 0.76), total operative time (p = 0.11), gallbladder retrieval time (p = 0.72) or surgical site infection (p = 0.93). Umbilical port retrieval was associated with significantly higher risk of port-site herniae (RR 2.68, 95%CI:1.06–6.80, p = 0.04). After sensitivity analysis, operative time was significantly shorter with epigastric retrieval (p = 0.0007). Trial sequential analysis showed that current studies were successful in achieving optimum information size for primary outcome. Conclusions There was no difference in postoperative pain and infections between umbilical and epigastric port retrieval. Umbilical port retrieval was associated with significantly higher risk of developing port-site hernia and could also be associated with longer operative time. Epigastric port may be favorable for gallbladder retrieval in multiport laparoscopic cholecystectomy.

Introduction: The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from “very low” to “moderate” according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.

A 26-year-old young male presented with recent onset hypertension and left-sided varicocele. On physical examination, his blood pressure was elevated and varicoceles were visible. On evaluation with computed tomography of abdomen, a large left-sided para-aortic mass was seen. His 24-hour urinary metanephrines and normetanephrines levels were within normal limits. Subsequently, the mass was excised. Tumor was excised completely after carefully dissecting it from left kidney and final histopathology revealed paraganglioma and postoperatively varicoceles disappeared.