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The coherent manipulation and control of bright and dark solitons through sodium atomic medium have been investigated in this manuscript. Dark soliton is reported for reflection and bright soliton is reported for transmission pulses with variation in position and driving field parameters through sodium atomic medium. Further the transmission pulse is periodic dark and bright solitonic behaviors and reflection pulse is periodic bright solitonic behavior with variation in the incident angle and Rabi frequency of the control field. Elliptical dark and bright solitons as well as breather types solitons are also investigated for reflection and transmission pulses. The dark soliton in reflection is due to slow light propagation and bright soliton is obtained due to fast light propagation of transmission through the medium. The modified results of the dark and bright solitons are useful for telecommunication and ultra-fast signal routing system.

This study investigates and analyzes the effect of flux intensification due to the propeller shaft and rudder on the 3D mapped induced magnetic signature of marine vessels. The study was designed to extrapolate the 3D induced magnetic signature and to analyze the difference between signature components in two different cases: a vessel without propeller shaft or rudder and a vessel with the propeller shaft and rudder attached. Numerical modeling was conducted using full-scale vessel dimensions and finite-element analysis (FEA) modeling software. Measurements on a 1:100 properly scaled and designed physical scale model (PSM)were conducted in a magnetically clean area. To enrich the analysis, both signature components from the numerical evaluation and experimental measurements were 3D mapped. Both the scaling technique and scaling effect on magnetic signature were investigated. The signature measurements of the scaled vessel model were performed to verify the numerical model. Both the numerical and experimental results are both discussed and shown to be consistent. The extrapolated signature components revealed that the studied effect became prominent as the saliency of the 3D mapped signature components increased. Consequently, this effect increases the magnetic susceptibility of the vessel to detection or destruction. Finally, this study suggests solutions to reduce this effect.

Abstract Background Despite being a priority population for HIV prevention and harm reduction programs, the sexual and reproductive health (SRH) needs of women who inject drugs are being overlooked. Furthermore, models for providing integrated SRH, HIV, and harm reduction services for women who inject drugs are rare. This article reports the development of community-based outreach services that integrated family planning and other SRH interventions with HIV and harm reduction services for this population in coastal Kenya. Methods Using mixed-methods implementation research, a qualitative baseline needs assessment was conducted with women who inject drugs and harm reduction stakeholders using a combination of in-depth interviews and focus group discussions. The qualitative data from participants was subjected to thematic analysis using Nvivo. Based on the baseline needs assessment, integration of SRH into existing HIV and harm reduction services was implemented. After two years of implementation, an evaluation of the program was conducted using a combination of qualitative interviews and review of quantitative service delivery records and other program documents. The process, impacts, and challenges of integrating SRH into a community-based HIV prevention and harm reduction program were identified. Results This article highlights: 1) low baseline utilization of family planning services among women who inject drugs, 2) improved utilization and high acceptability of outreach-based provision of SRH services including contraception among this population, 3) importance of training, capacity strengthening, technical support and financial resourcing of community-based organizations to integrate SRH into HIV prevention and harm reduction services, and 4) the value of beneficiary involvement, advocacy, and collaboration with other partners in the planning, designing and implementing of SRH interventions for women who inject drugs. Conclusions Women who inject drugs in this study had low utilization of family planning and other SRH services, which can be improved through the integration of contraceptive and other SRH interventions into existing outreach-based HIV prevention and harm reduction programs. This integration is acceptable to women who inject drugs, and is programmatically feasible. For successful integration, a rights-based beneficiary involvement, coupled with sustainable technical and financial capacity strengthening at the community level is essential.

The initial fault signal of rolling element bearing is extremely weak and could be easily masked by strong background noise. Different features of vibration signal can be different sensitivity to initial fault and performance degradation. Moreover, individual features cannot reflect bearing fault rationally and these features reveal non-monotonic behavior when the bearing condition deteriorates. A Health Indicator (HI) is proposed based on Mahalanobis Distance and Cumulative Sum (MD-CUMSUM). The time-frequency domain features extracted through Singular Value Decomposition based on Variational Mode Decomposition (VMD-SVD) and several optimal time domain features are used to calculate Mahalanobis Distances (MDs). The coarse-to-fine diagnosing strategy is proposed to determine the initial fault of rolling bearing. The obtained HI is utilized to estimate the different performance degradation stages of the bearing depending on the thresholds. This method is verified by utilizing two different experiments. The results demonstrate that the approach has the capability of estimating initial fault and determining degradation stages of bearing.

Severe acute alcoholic liver disease (SAAH) unresponsive to medical therapy shows one-year-mortality rates of up to 90%. Most transplant centers request six months of alcohol abstinence prior to transplantation, the so-called “6-month rule.” This regulation is not based on strong evidence, repeatedly making it a topic of controversial debates. The majority of patients with SAAH will die before fulfilling the 6-month rule. Therefore, liver transplantation (LT) protocols are becoming more flexible towards the rigid abstinence regulation, especially concerning SAAH patients. We conducted a literature review regarding LT in SAAH and its outcomes, including post-transplant mortality and recidivism. We studied available data on PubMed from 2011 and onwards whilst including articles dealing with genetic components, medical therapy and historic snapshots of alcoholism. Emerging studies recommend LT in SAAH not responding to medical therapies even without realizing the required abstinence period, since the majority of these patients would die within 6 months. SAAH without response to medical therapy has one-year-mortality rates of up to 90%. The 6-month rule is not based on strong evidence and is repeatedly a topic of controversial debates. There is genetic linkage to alcoholism and medical therapy is not as effective as estimated, yet. The 6-months-regulation has not shown to evidently decrease the risk of recidivism post-LT, which is a lifesaving treatment in SAAH patients. Insisting on rigid sobriety rules results in excluding patients with a low risk of recidivism from being transplanted. Moreover, the genetic linkage of alcoholism must be recognized.

Abstract Background Obesity presents one of the leading causes of many chronic liver disorders and injuries. Nowadays, non-alcoholic steatohepatitis (NASH) demonstrates a challenging issue for the global health system. NASH can progress to life-threatening conditions such as cirrhosis and hepatocellular or cholangio carcinoma. Currently, NASH cirrhosis is a major indication for liver transplant (LT). Case presentation We present the case of a 37 year-old male who has lost 74 kg after undergoing successful laparoscopic sleeve gastrectomy (SG) four years ago. Recently, he underwent right hepatectomy in the course of living-donor liver transplantation for his sick father in our clinic. Before the SG was conducted four years ago, his weight was at 157 kg and his Body Mass Index (BMI) at 49 kg/m2. At that time, Ultrasound examination showed severe fatty liver changes and intraoperative inspection of the liver was consistent with that observation. At the time of surgery, he weighed 83 kg and his BMI was at 27 kg/m2. An effective weight reduction after bariatric surgery might protect NASH patients from further deterioration of their medical condition. Conclusion To our knowledge, we report the first successful case of a right lobe living-donor hepatectomy in a patient who previously underwent successful laparoscopic sleeve gastrectomy (LSG).

The aim of this study was to investigate the feasibility of stimulating ovarian follicle development in order to improve fertility in water buffalo cows by immunization against inhibin. The experiment was carried out in early summer (May) and included 24 multi-parity crossbred Murrah-Swamp buffaloes that were divided into immunized (n=11) and control (n=13) groups. Each immunized cow was administered with a 2-mL immunogen of mineral oil adjuvant containing 2 mg of recombinant inhibin α-subunit fusion protein. The controls were treated with the adjuvant only. All animals received Ovsynch protocol treatment, starting on the day of the antigen administration, and they were artificially inseminated upon behavioral estrus. As a result, all of the immunized buffaloes generated antibodies against inhibin during the experimental period and had higher plasma concentrations of follicle-stimulating hormone (FSH), activin, and estradiol (E2) related to estrous expression. A higher proportion of immunized animals expressed estrus behavior than did the controls (72% vs. 30%, P0.05). These results demonstrate that immunization against inhibin, coupled with the treatment with the Ovsynch protocol, can constitute a new technique to increase fertility in water buffalo cows.

Abstract: Prolonged air leak (PAL) represents the most commonly encountered complication following pulmonary resection. This review aims to show the role of autologous blood pleurodesis (ABPP) in the management of PAL. A search was conducted on the Web of Science, PubMed, MEDLINE, and Google Scholar for English-language articles until September 15, 2023, with titles containing the related phrase "autologous blood patch pleurodesis (ABPP), and prolonged air leaks." Included studies comprised four randomised controlled trials, ten cohort studies, a case series, and nine case reports from various countries. Patients undergoing ABPP had a mean age of 52.7 years. Autologous blood volumes for pleurodesis varied (50 mL to 250 mL). Approximately 73.8% of cases responded to ABPP in 1 to 30 days (mean 3.75 days), and in-hospital complications were infrequent (3.9%). Follow-up durations post pleurodesis were up to 20 months. The evidence presented in this systematic review supports the role of ABPP as an effective and safe intervention for managing PAL, particularly after pulmonary resection., (Copyright © 2024 Copyright: © 2024 Indian Chest Society.)

Introduction: The third most prevalent malignant neoplasm involving the urinary tract is renal cell carcinoma (RCC), encompassing nearly 3.5% of the entire cancers afflicting the body. The aim of this research was to explore how the R.E.N.A.L. nephrometry score relates to the decisions made regarding surgery in individuals with localized RCC., Methods: This prospective study, assessed patients with localized parenchymal renal masses (stages I and II) tentatively diagnosed as RCC. Utilizing preoperative multiphasic renal CT scans and MRI, the R.E.N.A.L. score categorized masses for nephrometry values. Inclusion criteria involved collecting patient data, and data collection utilizing a structured format focusing on the nephrometry grading system., Results: The study included 64 patients aged (mean ± SD) 49.78 ± 12.35 yrs. Undergoing renal mass surgery, there were 17 (26.5%) low, 28 (43.8%) moderate and 19 (29.7%) high-complexity lesions. All patients with a low Nephrometry score (n = 17) underwent partial nephrectomy, and all cases with a high score (n = 19) underwent radical nephrectomy. For those with a moderate Nephrometry score (n = 28), 13 (46.4%) underwent partial nephrectomy, while the remaining 15 (53.6%) cases underwent radical nephrectomy. Morbidity was low, and no mortality occurred at 180 days. Patients who had lesions fully above or below polar lines were less likely to need blood transfusions. A trend towards higher Fuhrman grades in patients receiving transfusions suggests a potential link between tumor aggressiveness and bleeding risk., Conclusions: Our findings provide insight on the utilization of the R.E.N.A.L. nephrometry score in forecasting perioperative, post-surgical, and oncological results. Such data might help optimize surgical methods and pre-operative patient counseling.

Introduction: While the efficacy of flexible ureterorenoscopy (URS) in managing solitary kidney stones (KSs) is widely acknowledged, its effectiveness in treating multiple stones has scarcely been investigated. This study aims to assess the effectiveness and safety of retrograde intrarenal surgery (RIRS) utilizing flexible URS and laser lithotripsy in the management of multiple KSs.  Methods: This study was a single-group cohort study conducted on patients with multiple KSs who underwent treatment with RIRS using flexible URS and laser lithotripsy. Stone-free status was considered as the lack of residual stone fragments or any residual stone of any size. The first follow-up appointment was arranged 3-4 weeks following the procedure. If significant residual stones were present, patients underwent reintervention within 2-4 weeks., Results: A total of 110 patients with multiple KSs were included. The mean stone burden was 27.5 ± 7.9 mm, and the mean duration of the operation was 54.9 ± 19.7 minutes. Seven cases (6.3%) experienced intraoperative complications, while postoperative complications were found in eight cases (7.3%). After four weeks, a stone-free rate (SFR) was documented in 80.9% of the cases, and this rate increased to 93.6% after three months. The SFR after three months was significant with Guy's stone score (p < 0.001); however, it did not reach a significant level with any other parameters.  Conclusions: The RIRS with flexible URS may be an effective and potentially safe procedure for treating multiple KSs. It may yield a favorable SFR with an acceptable complication rate.

Giant adrenal myelolipoma (AML) may cause severe symptoms. In contrast to the previous reports, laparoscopy may play a pivotal role in the management of giant AML. This report aims to discuss a case of giant AML managed successfully by laparoscopy. A 63-year-old male was found to have a giant (12 × 10 × 8 cm) left AML during a workup for left lower chest pain on imaging. laparoscopic excision of a left adrenal gland with the lesion was performed under general anesthesia. The patient was discharged from the hospital after 3 days uneventfully. AML is a benign tumor that is characterized by the presence of adipose tissue and hematopoietic elements. Myelolipomas are typically asymptomatic. AML diagnosis is based on imaging and blood workup. Small asymptomatic AML is usually managed conservatively, while symptomatic AML is managed with surgery. Even though an open approach is the standard option, laparoscopy, as a minimally invasive technique, in some centers may replace laparotomy. Laparoscopy can be a successful method for managing AML, even when they are large in size., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Donor-derived cell-free DNA (dd-cfDNA) is an emerging noninvasive biomarker that has the potential to detect allograft injury. The capacity of dd-cfDNA to detect kidney allograft rejection and its added clinical value beyond standard of care patient monitoring is unclear. We enrolled 2,882 kidney allograft recipients from 14 transplantation centers in Europe and the United States in an observational population-based study. The primary analysis included 1,134 patients. Donor-derived cell-free DNA levels strongly correlated with allograft rejection, including antibody-mediated rejection (P < 0.0001), T cell-mediated rejection (P < 0.0001) and mixed rejection (P < 0.0001). In multivariable analysis, circulating dd-cfDNA was significantly associated with allograft rejection (odds ratio 2.275; 95% confidence interval (CI) 1.902-2.739; P < 0.0001) independently of standard of care patient monitoring parameters. The inclusion of dd-cfDNA to a standard of care prediction model showed improved discrimination (area under the curve 0.777 (95% CI 0.741-0.811) to 0.821 (95% CI 0.784-0.852); P = 0.0011) and calibration. These results were confirmed in the external validation cohorts (n = 1,748) including a cohort of African American patients (n = 439). Finally, dd-cfDNA showed high predictive value to detect subclinical rejection in stable patients. Our study provides insights on the potential value of assessing dd-cfDNA, in addition to standard of care monitoring, to improve the detection of allograft rejection. ClinicalTrials.gov registration: NCT05995379 ., (© 2024. The Author(s).)

Background: Carotid body tumors are uncommon neuroendocrine growths near the carotid bifurcation. While some advocate preoperative embolization to minimize bleeding, others avoid it due to complications. This study shares the experience of a single center in managing patients with carotid body tumors without practicing preoperative embolization., Methods: This was a cross-sectional study of patients with carotid body tumors managed between 2020 and 2024. Data were collected from the hospital's registry. When necessary, routine blood tests, neck ultrasonography, and computed tomography scans were conducted. The tumors were categorized according to Shamblin's classification. The average duration of follow-up was 20 months., Results: The study involved 25 patients, 22 (88%) females and 3 (12%) males. Their ages ranged from 27 to 85 years old. Twenty (80%) cases presented with neck swelling, and six (24%) had a positive medical history. Tumors were mainly on the right side (52%), with 20 (80%) showing ill-defined neck masses. Tumor sizes ranged from 1.5 to 7 cm, with Shamblin type II tumors being discovered in the majority of cases (72%). Types of tumors were significantly associated with the tumor size (p-value < 0.05). Blood transfusion was required in five cases (20%), three from type III and two from type II, with none from type I (p-value = 0.001). Temporary neurological deficits occurred in 3 cases (12%). No functional impairment or mortality was recorded., Conclusions: Carotid body tumors are rare tumors with an unknown etiology. Operation without practicing preoperative embolization may be feasible with an acceptable outcome., (© 2024. The Author(s).)

Background and Aims: Behçet's disease is a chronic, multisystemic, and relapsing inflammatory disorder. It lacks a permanent cure, the focus of treatment is on mitigating symptoms, decreasing the frequency and severity of relapses, and preventing life-threatening complications. This study aims to report the experience of a single center in managing patients with Behçet's disease and discuss the treatment outcomes., Methods: This study was a retrospective case series conducted over 2 years. All cases were clinically diagnosed according to the International Criteria for Behçet's Disease. The extracted data were demographics, family history, clinical findings, criteria scores, treatment, and outcomes., Results: A total of 31 patients were included, consisting of 13 males (42%) and 18 females (58%). Most cases were over the age of 30, and both genders were nearly equally distributed among age groups. The most commonly affected site was the oral cavity, observed in 96.77% of cases. Genital, cutaneous, and vascular involvements were more common in males, while females were more likely to have oral, ocular, and musculoskeletal involvements. For various treatment regimens, oral, cutaneous, vascular, and musculoskeletal involvements showed complete response in all cases. Among cases with genital involvement, complete response was achieved in seven cases (41.2%), while four cases (23.5%) showed only partial response, and six cases (35.3%) experienced recurrence. In cases with ocular involvement, only partial responses were observed., Conclusion: Oral, cutaneous, vascular, and musculoskeletal involvements may have a higher likelihood of a complete response to treatment regimens. However, genital involvement may be the most recurrent manifestation, followed by ocular involvement., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Thoracic outlet syndrome (TOS) typically considered a condition of the adult population; it is often disregarded in children and adolescents due to its limited recognition within the pediatrics. The current study aims to systematically review and provide insights into TOS among pediatric patients., Methods: PubMed, Scopus, Web of Science, and Google Scholar databases were thoroughly searched for English language studies published until March 15th, 2024. The study included those articles focusing on pediatric or adolescent individuals diagnosed with TOS. Data collected from studies encompassed date of publication, number of participants or reported cases, age (years), gender of participants, type of TOS, affected side, type of treatment, surgical approach, bony abnormality, duration of symptoms (months), outcome, and follow-up time duration (months)., Results: The current study comprised 33 articles, 21 of which were case reports, 10 of which were case series, and the remaining were cohort studies. In this study, 356 patients were included. Females constituted 234 (65.73%) of the patient population. Among TOS types, neurogenic TOS was found among 201 (56.5%) patients. Sporting-related activity or physical activity was present in 193 (54%) patients, followed by a history of trauma in 27 (7%) patients., Conclusions: Pediatric patients exhibited a higher percentage of vascular TOS than their adult counterparts, with the supraclavicular approach emerging as the preferred treatment method. Sports-related activities were identified as the primary risk factor associated with pediatric TOS., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes., Methods: We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120-129 and dBP < 80), stage 1 hypertension (sBP 130-139 or dBP 80-89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group., Results: From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes., Conclusion: The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension., (© 2024. The Author(s).)

Urolithiasis is a common disease that affects approximately one-fifth of the global population. This systematic review explores the predictive role of inflammatory markers for the spontaneous passage of ureteral stones. The literature was systematically searched via Google Scholar, PubMed/MEDLINE, the Cochrane Library, Science Direct, CINAHL, Web of Science, and EMBASE databases to identify papers published until 2023. Overall, 26 articles were identified, of which 10 were excluded. The remaining 16 papers reported 2,695 patients (1,723 males and 972 females), with 1,654 (61.37%) experiencing spontaneous stone passage (SSP) and 1,041 (38.63%) not experiencing it (non-SSP). Stones located in the upper part of the ureter were less likely to pass spontaneously (152/959, 15.94% in the SSP group vs. 180/546, 32.48% in the non-SSP group; p < 0.001). Mid-ureteral stones were present in 180/959 (18.75%) of the SSP group compared to 84/546 (14.52%) of the non-SSP group (p = 0.0974). Lower ureteral stones were more likely to pass spontaneously, with 627/959 (63.31%) in the SSP group compared to 282/546 (49.36%) in the non-SSP group (p < 0.001). No significant correlation was found between most inflammatory markers and SSP (p > 0.05). However, procalcitonin levels were lower in the SSP group compared to the non-SSP group (132.7 ± 28.1 vs. 207 ± 145.1, respectively) (p < 0.001). This systematic review has revealed that except procalcitonin, most inflammatory markers do not offer significant predictive capability for ureteral SSP., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The choice between nodulectomy and lobectomy for managing thyroid nodules is a subject of debate in the field of thyroid surgery. The present study aims to share the experience of a single center in managing solitary thyroid nodules through nodulectomy from January 2023 to October 2023. The inclusion criteria encompassed symptomatic or suspicious solitary nodules and medically necessitated cases. The extracted data included patient demographics, medical history, symptoms, diagnostic details, surgery indication, procedure outcome and histopathological findings. The follow-up included clinic visits and phone calls. The mean age of the patients was 36.64±11.63 years, with 85.0% females and 15.0% males. Predominantly, patients were housewives (58.5%). Neck swelling (62.3%) was the most common presentation. Ultrasound examination revealed mixed nodules in more than half of the cases (54.7%). Right nodulectomy was performed in 26 cases (49.1%) and left nodulectomy in 23 (43.4%), and four cases (7.5%) underwent isthmusectomy. The mean operation time was 36.04±9.37 min and no drainage tube was used in any of the cases. One case (1.9%) of seroma was the only observed complication during the observational period. Nodulectomy may be a suitable choice for managing benign, large, solitary thyroid nodules, small suspicious nodules or microcarcinomas., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Salih et al.)

Introduction: While different methods are employed for fixing narrowed nasal valves and preventing the notching of soft triangles, this study aims to demonstrate the effectiveness of a new technique called Süreyya-Dani Technique., Methods: This prospective study composed 100 patients who underwent rhinoplasty using the Süreyya-Dani technique. All patients presented with either notching of the soft triangle and/or external nasal valve dysfunction. Patients with the absence of soft triangle notching and external nasal valve dysfunction were excluded from this study. Facial analysis was conducted for all patients to identify any asymmetry in the face, and all nasal defects were identified. Descriptive statistics were calculated for different variables. Analytical statistics, namely Chi-Square test, was conducted with a significance level set at P  < 0.05., Results: In the current study, 100 patients were involved, out of which 63 (63%) were female and 37 (37%) were male. The participants' ages ranged from 18 to 46 years, with a mean age of 30 years. various chief complaints were found among patients, with the majority 37(37%) expressing cosmetic concerns. A statistically significant difference was found for the association of nasal tip defects with genders, intraoperative findings, and chef complaints, and the association between the degree of external valve insufficiency and crural weakness ( P -value < 0.05)., Conclusion: Despite many techniques that have been put forward to fix narrowed nasal valves and prevent notching of the soft triangle, the Süreyya-Dani Technique could work to prevent its occurrence successfully., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Omer, Şeneldir, Di Girolamo, Habibullah, Ahmed, Ali, Abdullah, Mustafa, Abdalla, Hassan, Mohammed and Kakamad.)

Introduction: The rising prevalence of global end-stage renal disease (ESRD) is a significant health concern, especially among children. Although renal replacement therapy is available, children with ESRD are at an increased risk of mortality. Kidney transplantation is the preferred modality of treatment and surpasses renal replacement therapy in terms of survival. However, pediatric renal transplantation could prove difficult due to factors like smaller recipients and donor-recipient mismatches leading to higher complications., Materials and Methods: A retrospective single-group case series study was conducted on children with ESRD who were planned to undergo kidney transplantation from living donors between 2015 and 2021. The data was collected from two centers in the city of Sulaymaniyah., Results: The study comprised a predominantly male patient population, with a total of 39 individuals (n = 39) and 13 female patients. The donors were mostly males between 25-40 years old. The majority of participants were 15-18 years old. In majority of the patients Thymoglobulin was the immunosuppressive agent used in induction. The most common etiology for renal failure was reflux nephropathy and artery anastomosis was performed to the external iliac artery in the majority of patients. Only 9 patients had complications following the transplantation and 3 patients had an episode of acute rejection., Conclusions: Renal transplantation is the preferred treatment of renal failure in pediatric patients in the city of Sulaymaniyah. The most common etiology for pediatric renal failure was reflux nephropathy which was different from the findings of North American Pediatric Renal Trials and Collaborative Studies.

Background: Urolithiasis is one of the most prevalent urological diseases and is associated with a substantial economic burden. Its prevalence varies according to geographical location. Qatar is a Middle Eastern country located in the Afro-Asian Stone Belt. It has a dry and hot climate, which may predispose individuals working in these environments to form kidney stones (KSs)., Methods: A population sample of 4204 patients was categorized into five occupational classes. The frequencies and correlations of these occupations with KS formation were calculated., Results: Among the total cases, 2000 presented with KSs, with the majority being of Asian descent (49%), followed by individuals of Middle Eastern descent (35.1%). Technicians accounted for 35.15% of KS cases followed by clerks (29.2%) and executives (14.6%). Among KS cases, 44% had a single stone, 30% had multiple stones, and 26% had two stones. In comparing both KS and non-KS groups, age, gender, occupation, and race were significantly associated with KS formation (p<0.05), while BMI did not show any significant correlation (p>0.05). Asian males aged 31-40, working as technicians, were significantly more prone to urolithiasis. In comparing age, BMI, and gender with stone characteristics, only age was found significantly associated with stone size (p<0.05). Occupation showed an impact on all studied stone characteristics. Clerks and technicians presented more frequently with stones within the 11-15 mm range, while executives more frequently presented with smaller stones (p<0.001). Stone density was more frequently <500 HU in workers, technicians and housewives and >500 HU in executives and clerks (p<0.001)., Conclusions: Our findings revealed an elevated risk of urolithiasis among certain occupational groups, particularly technicians, who frequently work outdoors in high-temperature environments. Alternatively, the sedentary nature of clerical and executive positions can also contribute to the risk of urolithiasis.

Introduction: The prevalence and risk factors of stunting in various geographical regions have been well investigated. However, not enough data exists regarding the communities in Iraq. This study investigated the prevalence and risk factors of stunting in preschool children in Halabja governorate., Methods: The required data for the study was collected through a structured questionnaire form from the children's parents. Then, the height and weight of the children were measured. According to the World Health Organization Child Growth Standards and using the WHO Anthro Survey Analyser software, children were classified as "stunted" when their height-for-age z-score was below two standard deviations., Results: A total of 646 children were included, of which 310 (48%) were male and 336 (52%) were female. The gestational age of 556 (86%) children was 9 months, while 84 (13%) were born between 7-9 months, and 6 (1%) were born in 7 months. Regarding feeding during the first 2 years of life, 229 children (35.4%) were exclusively breastfed, 93 (14.4%) were bottle-fed, and 324 (50.2%) had mixed feeding. The prevalence of stunting was 7.9% in the sample pool, with 4.6% of females and 3.3% of males. Among stunted children, 6.35% were term babies, and 1.55% were preterm babies. None of the studied factors had a significant association with stunting., Conclusion: The prevalence of stunting in the studied population was 7.9%. However, we could not find any significant association between the studied factors and stunting. Thus, the factors that may significantly affect stunting in our area of study, especially the historical chemical warfare side effects, need to be more extensively investigated in future studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mhamad, Najmadden, Hama Salih, Hama, Abdullah, Hasan, Kareem, Mohammed, Fattah, Abdalla, Kakamad and Mohammed.)

Thyroglossal duct cysts (TGDCs) are unusual remnants of the thyroid gland that are rarely observed in association with carcinoma. The present study aimed to showcase the clinical characteristics, diagnosis and management of patients with TGDC carcinoma. It was a single-center study conducted from February 2016 to February 2020. The study involved the retrospective analysis of a series of cases with TGDC carcinoma. A total of 10 patients were included in the study, of whom eight (80%) were females. Their age ranged from 25 to 48 years with a mean age of 39.1 years. A total of five cases (50%) underwent only Sistrunk's procedure, four patients (40%) underwent total thyroidectomy along with Sistrunk's procedure and one patient (10%) was treated by Sistrunk operation and lobectomy. In all of the cases (100%), histopathological examination confirmed papillary thyroid carcinoma in TGDCs. In addition, in the thyroid tissue, 2 cases (20%) also had papillary thyroid carcinoma and 3 cases (30%) had papillary thyroid microcarcinoma. Radioiodine was administered in one patient (10%) with suppressive thyroxine. A three-year follow-up with ultrasound revealed no suspicious lesions in any of the cases. Although rare, carcinoma may develop in the thyroglossal cysts. In this situation, both the thyroid gland and different lymph node compartments should be evaluated for malignancy. Surgical intervention is the cornerstone of management., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Salih et al.)

Brucella epididymo-orchitis (BEO) is a rare complication of brucellosis. Despite the high incidence of brucellosis in developing countries, few case series on BEO are available. This study focuses on the clinical presentations, diagnosis, and treatment of BEO with a review of the literature. This study included consecutive BEO patients diagnosed and treated at Smart Health Tower between 2021 and 2023. The required data were retrospectively collected from patients' profiles. The BEO diagnosis was established through scrotal Doppler ultrasound in cases with a positive Rose Bengal test and positive IgG and IgM results for brucellosis, in addition to scrotal pain and swelling. This study included 11 cases whose ages ranged from 22 to 55 years. Most of the cases presented with testicular pain (72.7%), followed by fever (63.6%) and arthralgia (63.6%). The right side (54.5%) was slightly more affected than the left side (45.5%). The major abnormal laboratory finding was an elevated C-reactive protein (82%). The treatment was conservative, in which a combination of gentamicin, doxycycline, and rifampicin was administered to the patients for about 6-8 weeks. One case underwent an orchiectomy due to the abscess formation. All the patients responded well to the treatment, with no recurrence. In the Middle East, brucellosis remains a concerning infectious disease. Early diagnosis, aimed at preventing abscess formation and other complications, takes first priority to avoid invasive interventions.

Background: The role of sexual intercourse as an alternative treatment approach for ureteral stones (UTSs) is a recent area of investigation with only small sample-sized studies. This study aims to evaluate the role of sexual intercourse in the spontaneous passage of distal or intramural UTSs via a larger sample size., Materials and Methods: The study population included cases that had either a distal ureteric or an intramural radiopaque stone. The patients were divided into two groups; group A was instructed to engage in sexual intercourse two to three times per week while also receiving symptomatic treatment for 4 weeks. Group B received symptomatic treatment alone and was instructed to abstain from sexual intercourse or masturbation for the same period., Results: A total of 160 male patients were enrolled in this study. The ages of the patients ranged from 21 to 58 years. The rate of stone expulsion after 2 weeks was 68.18% in group A and 53% in group B ( P =0.053). The expulsion rate after 4 weeks was 80% in group A and 68.4% in group B ( P =0.072). The mean expulsion time was 13.9±5.4 days for the experimental group and 15.2±6.7 days for the control group ( P =0.179). The experimental group required fewer analgesic injections in comparison to the control group ( P <0.05)., Conclusion: While the role of sexual intercourse in facilitating the passage of distal or intramural UTSs cannot be fully established, it may aid to some extent. However, it should not be relied upon as a standalone treatment modality., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The characteristics of the pilonidal sinus that are associated with recurrence have scarcely been investigated in the literature. This study aims to evaluate the outcomes of patients with sacrococcygeal pilonidal sinus disease who were managed by a non-operative technique using Salih's preparation. This study also tries to classify the patients according to the features that determine the outcome of the intervention. This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus. All the patients were managed using Salih's preparation. The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence. The Statistical Package for the Social Sciences (SPSS) Version 25 was used for coding and analysing the data. Test of significance and odds ratio were calculated for all of the features. The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study. The mean age of the participants was 26.95 years, ranging from 14 to 55 years. The most significant factor related to the recurrence was the presence of an abscess. After summation of all odd ratios, the percentage of each one from the total was calculated, and accordingly, the patients were divided into three classes. Non-operative methods using a preparation with antimicrobial and sclerosing properties can be an alternative for surgical intervention with a lower risk of recurrence. Classification of patients based on specific criteria can give clinicians and even patients themselves a vision of the chance of recurrence and treatment success., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Introduction and Importance: A sacrococcygeal teratoma (SCT) is a rare embryonal tumor that emerges in the sacrococcygeal area. It affects one in every 35 000-40 000 live births. Herein, we report a case of a substantial SCT in a neonate., Case Presentation: A neonate girl from consanguineous parents was delivered by cesarean section with a large mass (18×17 cm) in the sacrococcygeal area. The baby's birth weight was 5 kg, of which 2.5 belonged to the mass. The vital signs were within normal ranges and she had weak movement with bluish peripheral limbs. Oxygen saturation was around 85% for a short period after birth. According to the American Academy of Pediatric Surgical Section, the tumor was type I. After the fifth day of delivery, a complete resection was done through a chevron incision. The patient was put on 'nil by mouth' for about 24 h and given intravenous fluid., Clinical Discussion: The histopathological examination of the surgical specimen confirmed extragonadal immature teratoma. The histological classification of SCT is divided into three types: malignant teratomas (consisting of malignant germ cells); immature teratomas (incompletely differentiated structures with a high risk of malignancy or embryonal components); and mature teratomas (fully differentiated tissues)., Conclusion: SCT has rarely been reported as a giant mass. Radiologic examinations in the early stages of pregnancy may be essential to the early diagnosis of the condition., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence., Method: This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started., Results: Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BIRADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm 2 ), skin thickening, and white blood cell count enhanced the chance of recurrence., Conclusion: Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence., Competing Interests: All authors declare that they have no conflict of interest., (Copyright © 2023 by S. Karger AG, Basel.)

Introduction: It is crucial to be aware of post-COVID-19 non-pulmonary complications. Avascular necrosis (AVN) is one of these complications. It should be noted that the risk of AVN persists in individuals who have recovered from the COVID-19 infection. The current study aims to report several cases of AVN after being infected with SARS-CoV-2., Materials and Methods: This is a single-centre retrospective case series conducted over a 2-year period (January 2021-December 2022) involving individuals who developed AVN after being infected with COVID-19., Result: The study included a total of 17 patients. The mean age of patients was 38.65±6.1 years. Twelve of them were male (70.6%) and five were female (29.4%), with a ratio of 3:1. The mean BMI of the patients was 28.3±2.4 kg/m 2 . Eleven (64.7%) patients reported administering steroid injections throughout the infection course. The mean interval between COVID-19 infection and presentation to the clinic was 6.53 months. The majority of patients (82.3%) complained of bilateral hip pain. Limping was observed in 47% of the cases. MRI showed AVN in all cases. Bilateral core decompression was performed in five cases (29.4%), total hip replacement in three cases (17.6%), and conservative treatment in nine cases (53%)., Conclusion: The ongoing pandemic may have many long-term sequelae. There is a risk of developing AVN after COVID-19., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Renal cell carcinoma (RCC) is a heterogeneous and complex disease with numerous pathophysiologic variants. ~40% of patients succumb due to the progression of the disease, making RCC the most fatal of the common urologic malignancies. Prognostic factors are indicators of the progression of the disease, and the precise determination of these factors is important for evaluating and managing RCC. In the present study, it was aimed to determine and find associations among the histopathological features of RCCs and their impact on survival and metastasis. This is a cross-sectional study of RCC cases who have undergone partial or radical nephrectomy from March 2008 to October 2021 and have been pathologically reviewed at Shorsh General Teaching Hospital in Sulaimani, Iraq. The data in the pathology studies were supplemented by follow-up of the patients to obtain information about survival, recurrence and metastasis. In total, 228 cases of RCC were identified, among whom 60.5% were men and 39.5% were women, with a median age of 51 years. The main tumor types were clear cell RCC (71.1%), papillary RCC (13.6%), and chromophobe RCC (11%). Various measures of aggressiveness, including tumor necrosis, sarcomatoid change, microvascular invasion, and parameters of invasiveness (invasion of the renal sinus and other structures), were significantly correlated with each other, and they were also associated with reduced overall survival and an increased risk of metastasis on univariate analysis. However, on multivariate analysis, only tumor size and grade, and microvascular invasion retained statistical significance and were associated with a lower survival rate. In conclusion, pathological parameters have an impact on prognosis in RCC. The most consistent prognostic factors can be tumor size and grade, and microvascular invasion., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Ali et al.)

Acute pancreatitis is an inflammatory disease that can affect both the peripancreatic tissues and distant organs. There are few reports of acute pancreatitis caused by endourological procedures. However, an obstructing ureteral calculus causing acute pancreatitis is very rare., Case Presentation: A 36-year-old male patient presented with epigastric, and right loin pain with decreased urine output for 3 days. On physical examination, he had central abdominal and right flank tenderness. An abdominal ultrasound showed mild to moderate ascites, a hyperechoic pancreas, a small (26×77 mm) left kidney with increased echogenicity, right renal hypertrophy with moderate hydronephrosis, and a dilated upper ureter due to a 10 mm obstructing stone with a perirenal fluid collection. The diagnosis of acute pancreatitis with an obstructing right upper ureteric stone was established. Under spinal anesthesia, an emergency ureteroscopy with laser fragmentation of the stone was performed, and a JJ stent was inserted. He developed postobstructive diuresis and his renal function was improved with a rapid decline of pancreatic enzymes as well., Clinical Discussion: Two theories explain the presentation of acute pancreatitis by ureteral obstruction. First, the obstructed severe hydronephrotic kidney compresses the duodenum and head of the pancreas, obstructing the distal part of the common bile duct and triggering the elevation of pancreatic duct pressure, bile reflux, trypsin activation, and pancreatic autodigestion. The second theory states that acute pancreatitis develops when urine is extravasated from an obstructed kidney into the adjacent tissues, irritating the uncinate process of the pancreas., Conclusion: Although mentioning ureteral obstruction as a cause of pancreatitis is scarce, the clinician should be aware that in each case of ureteral obstruction, the emergence of acute pancreatitis is a possible complication., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Various studies on the etiology and other aspects of granulomatous mastitis (GM) have been performed; however, a lot of controversies have arisen. The present study aimed to present the clinicopathological findings and identify the sensitivity and resistance of isolated bacteria in patients with GM. In this cross-sectional study 63 female patients with a confirmed histopathological diagnosis of GM were included. A core needle biopsy was conducted for the patients to obtain a sample for histopathological examination and bacterial culture. In total, 46 types of antibiotics were used to determine the sensitivity and resistance of each isolated bacterial species. All the medical and clinical records of the patients were acquired through the completion of a questionnaire form in person or, if necessary, through the evaluation of their medical records in the database of the relevant center. The majority of the patients were in the premenopausal or perimenopausal period. GM was unilateral in 58.7% of the patients. The most common symptom was pain, followed by fever and chills. The mean ranges of the erythrocyte sedimentation rate, C-reactive protein, IL-6, IL-17, C5a, white blood count, neutrophil-to-lymphocyte ratio, and prolactin tests were significantly elevated in comparison to the normal ranges. In total, nine different bacterial species were isolated from the bacterial culture of the core biopsy samples, and 50% of the isolated bacterial species were sensitive to trimethoprim-sulfamethoxazole. Since there is no consensus on the etiology of GM, any additional studies related to this aspect expand the current understanding of this puzzling condition., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Esmaeil et al.)

Although some recent studies have found that original and generic clopidogrel brands are acceptable and have the same pharmacokinetic and pharmacodynamic properties, there is insufficient evidence to compare the clinical effectiveness and safety of brand and generic clopidogrel. The current study aims to evaluate the clinical safety of brand and generic clopidogrel by comparing clinical outcomes in patients undergoing carotid endarterectomy (CEA)., Method: This was a single centre, parallel-arm, phase III, open-label, and randomized group sequential trial. It was conducted to compare the clinical safety of a brand and three generic clopidogrel forms in patients who have undergone CEA. All enrolled subjects were treated perioperatively with dual antiplatelet (aspirin and clopidogrel). The involved participants were assigned randomly into four groups based on the type of clopidogrel. Safety parameters were measured, including haematoma, blood draining from drainage, mouth deviation, tongue deviation, and stroke. SPSS software was used to perform the data analysis., Results: The trial included 80 patients in total (20 patients per group). Thirty-one (38.8%) patients were male. The mean age of patients was 65.6 years (49-79). Eighteen (22.5%) patients had a history of previous coronary intervention, and seventeen (21.3%) had symptomatic carotid artery stenosis. Overall, Plavix or Piax combined with aspirin were linked to better clinical safety than the other two generic clopidogrel, as the amount of bleeding was nearly two times lower in patients treated with Plavix or Piax (270±92.39 and 271.5±80.60, respectively) compared to PlavigrelAwa or Plavineer (505.7±169.1 and 496.5±174.6, respectively) ( P ≤0.001)., Conclusion: The findings of the current study showed diversity in clinical safety of different clopidogrel formulations that were provided perioperatively in CEA patients., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Cardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma., Method: This study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection., Result: The mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%., Conclusion: Recurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Alhasso, Ahmed, Mohammed-Saeed, Kakamad, Almodhaffer, Zaid, Abdullah, Ali, Kakamad, Omar, Abdalla, Mohammed and Mustafa.)

De Quervain's tenosynovitis (DQT) is a painful stenosing tenosynovitis of the first dorsal compartment of the wrist, which may be refractory to conservative treatments. The present study aimed to evaluate the efficacy of ultrasound (US)-guided platelet-rich plasma (PRP) injection for the management of DQT. For this purpose, from January, 2020 to February, 2021, 12 patients with DQT who received the US-guided PRP injection were studied prospectively. All patients were evaluated clinically for pain intensity using the visual analog scale and sonographically prior to treatment. The patients were followed-up at 1 and 3 months after the procedure to evaluate the efficacy of the treatment. In total, 12 hands of 12 female patients with DQT were analyzed in the present study. The post-treatment clinical evaluation revealed complete recovery in 4 (33.3%) of the patients, and 6 (50%) of them had recovered and returned to their daily activities. The sonographic evaluation revealed a significant reduction in the mean retinaculum thickness from 1.84 to 1.069 mm, and mean tendon sheath effusion from 2.06 to 1.25 mm, with only 58% of the cases having tendon sheath effusion at 3 months post-treatment. On the whole, the findings of the present study demonstrate that US-guided PRP injection with needle tenotomy can be used as an alternative non-surgical therapy for patients who do not respond to conventional conservative treatments, particularly in cases with sub-compartmentalization. The use of US may play a crucial role in the treatment of DQT, as improved clinical outcomes can be obtained with US-guided injections, particularly in cases with sub-compartmentalization., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Asaad et al.)

Renal cell carcinoma (RCC) accounts for 1-2% of all malignancies and is the most common renal tumor in adults. Imaging studies are used for diagnosis and staging. Tumor-Node-Metastasis staging strongly affects prognosis and management, while contrast-enhanced computed tomography (CECT) is regarded as a standard imaging technique for local and distant staging. The present study aimed to evaluate the accuracy of CECT for the preoperative staging of RCC by using surgical and pathological staging as the reference methods. This single-center prospective study was conducted between October 2019 and November 2021. The preoperative abdominal CT scans of patients suspected of having RCC were reviewed. Imaging data were collected, including tumor side and size, and perinephric fat invasion. Intraoperative notes were recorded, including the operation type, perinephric fat invasion, renal vein (RV) or inferior vena cava (IVC) tumor extension, and surrounding organ invasion. pathological data were collected on tumor size, RCC type, presence of clear margins, presence of renal capsule or perinephric fat invasion, renal sinus or pelvicalyceal system (PCS) invasion, segmental or main RV extension, and the involvement of Gerota's fascia and nearby organs. Preoperative CECT revealed that 42 out of 59 tumors had a greater maximum diameter than the pathological specimen, with an overall disparity of 0.25 cm. The specificity of CT for the detection of tumor invasion of the perinephric and renal sinus fat and PCS was 95%, and the sensitivity ranged from 80 to 88%. CT had an 83% sensitivity and a 95 specificity in detecting T4 stage cancer, with a 100% specificity for adrenal invasion. The concordance between radiographic and histological results for RV and IVC involvement was high, with specificities of 94 and 98%, and sensitivities of 80 and 100%, respectively. Overall accuracy for correct T staging was 80%. In conclusion, CECT is accurate in the local T staging of RCC, with high sensitivity and specificity for estimating tumor size and detecting extension to nearby structures and venous invasion., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Fateh et al.)