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Gossypiboma, a retained surgical sponge, is a rare complication following any surgical procedure and is primarily a result of human error. Such patients often have vague clinical presentations and the diagnosis often comes as a surprise and has serious medicolegal implications. We present a case of a 28-year-old female with a long-standing duration of 9 months with purulent discharge from the operated scar site of Lower segment caesarean section done 2 years back and then diagnosed to have a gossypiboma in the ureterovesical space causing structuring of the ipsilateral ureter which was successfully managed by Exploratory laparotomy with removal of the retained gossypiboma and right sided ureteric reimplantation.

Colovesical fistula is an improper connection between the urinary bladder and intestinal tract. Although there are many possible causes of colonovesical fistula, Chen et al. have classified them into five main classes: congenital, traumatic, tumor, inflammatory, and other. Intestinal diverticulitis accounts for 50-70% of cases in Western countries, and nearly all of them are related to colonic or bladder fistulas. Malignant tumors (20%) rank second in Western countries as the most common cause, which are situated largely in the large intestine. Other related tumours include bladder, cervical, ovarian and prostate cancers, and non-Hodgkin's lymphoma in the small intestine. The third most prevalent cause is Crohn's disease (10%), which occurs mainly in the ileum. "Other causes" include iatrogenic injury; trauma; foreign bodies in the intestinal tract; radiotherapy; chronic appendicitis

Urologists commonly make use of ureteral double J stents in endourology. If a DJ stent is forgotten to be removed, then complications happen in the form of encrustations, infection, migration, renal dysfunction and hydronephrosis. Ectopic pelvic Kidney is a relatively rare congenital anomaly caused by lack of ascent of the kidney. We report a very rare case of forgotten DJ stent in an ectopic kidney in a 55 years old patient with diabetes mellitus with history of left sided open pyelolithotomy done 21 months back. Redo open surgery was done to remove DJ stent along with stone removal.

Background: Prostatic abscess is uncommon in adults and is infrequently noted in the paediatric population. Surgical drainage with adequate antibiotics is the current recommended management for prostatic abscess larger than 1 cm. However, it is still a topic debate that what should be the appropriate management of a prostatic abscess. Case presentation: Herein, we present the case of a 16-year-old young adolescent patient with a large prostate abscess without any systemic disease who was successfully managed with antibiotics only and surgical drainage was not required for this patient. Conclusion: Thus, we conclude that in a young adolescent patient with acute prostatic abscess, medical management with intravenous antibiotics deferring surgical drainage can be used an effective treatment option for management of this condition.

BACKGROUND: Carcinoid tumors are rare neuroendocrine tumors that can be found in the gastrointestinal tract as well as other areas throughout the body. The neurosecretory nature of these tumors can have implications for other chronic diseases that patients may have, including diabetes and hypertension. Certain treatments that may be implemented for patients that have carcinoid tumors, such as somatostatin analogs and Everolimus, can also alter blood glucose control. This highlights the importance of diagnosing and treating carcinoid tumors as early as possible to avoid complications associated with metastasis and more intense treatment. With more advanced disease, clinicians should consider the possible effects of carcinoid tumors and their treatments on other chronic conditions as they manage the patient. For gastrointestinal carcinoid tumors, colonoscopy screening guidelines are incredibly important to counsel patients on, as resection can yield a complete cure for carcinoid tumors when they are found at an early stage. THE CASE: We describe the case of an incidentally diagnosed rectal carcinoid tumor in a 46-year-old female patient with a history of type 2 diabetes mellitus and hypertension. This tumor was discovered on colonoscopy, which had been delayed due to complications following a surgical procedure that the patient had recently undergone. CONCLUSION: Carcinoid tumors are quite rare, however, the incidence of neuroendocrine tumors, including gastrointestinal carcinoid tumors, is growing. Thus, it is important to consider the implications of such tumors on pre-existing chronic conditions, such as diabetes and hypertension. Also, more research efforts should be directed towards standardizing the treatment protocol for such tumors, specifically rectal carcinoid tumors, and counseling patients on the importance of screening guidelines. When rectal carcinoid tumors are caught early, complete surgical resection can be curative, which is ideal. However, with more advanced disease, symptoms of the tumor itself as well as necessary treatments can impact other chronic conditions, possibly requiring modifications to a patient’s prior medication regimen. Fortunately, the carcinoid tumor in the described patient was not advanced enough to cause significant alteration in her other chronic conditions, however, this case is still a great example of how carcinoid tumors can arise asymptomatically, which is why it is important for the astute clinician to counsel on screening recommendations. This emphasizes the importance of using a team-based approach to ensure that the carcinoid tumor is diagnosed and adequately treated without significantly affecting other conditions so that patients can achieve optimal outcomes for each condition being managed. It also highlights the crucial importance of screening guidelines so that conditions can be caught early to mitigate downstream consequences.

Abstract Background Little published data currently exist regarding the potential relationships between spondylolisthesis, mismatch deformity, and clinical outcomes following total knee arthroplasty (TKA). We hypothesize that preexisting spondylolisthesis will result in decreased functional outcomes after TKA. Methods This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure the degree of spondylolisthesis. Ninety-five TKAs were subsequently available for inclusion and divided into two groups: those with spondylolisthesis and those without. Within the spondylolisthesis cohort, pelvic incidence (PI) and lumbar lordosis (LL) were calculated on lateral radiographs to determine the difference (PI–LL). Radiographs with PI–LL > 10° were then categorized as having mismatch deformity (MD). The following clinical outcomes were compared between the groups: need for manipulation under anesthesia (MUA), total postoperative arc of motion (AOM) both pre-MUA or post-MUA/revision, incidence of flexion contracture, and a need for later revision. Results Forty-nine TKAs met the spondylolisthesis criteria, while 44 did not have spondylolisthesis. There were no significant differences in gender, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with spondylolisthesis and concomitant MD were more likely to have MUA (p = 0.016), ROM

Introduction: An opportunity for e-learning has been created by the ongoing pandemic and lockdown, along with the availability of efficient technology. Webinars have filled in the lacunae of the learning process. We conducted an online survey to evaluate the interest and opinion regarding webinars, which enables for standardization of future webinars and reap the maximum benefits. Methods: An online survey was conducted among practicing urologists and urology residents. The survey was formulated and edited by a group of urologists and uro-oncologists who had experience conducting several regional and international conferences and webinars. The survey comprised 39 questions divided into six parts. Results: A total of 328 urologists throughout the country participated in the survey, and 303 complete responses were obtained for the analysis. 67.3% subjects felt that live webinars are the preferred method of knowledge exchange during the coronavirus disease pandemic, and 58.1% felt that this concept of webinars had to be extended even after the pandemic was over. Few shortcomings in the webinars included lack of networking (41.3%), lack of personal connection (73.3%), and lack of practical skills (35%). About 85.5% felt that the duration should be

Excessive bronchial secretions pose a challenge in mechanically-ventilated patients and may prolong the time to extubation, increasing the risk for pneumonia. Octreotide, a somatostatin analog, has been used to decrease bronchial secretions especially for the symptomatic management of patients with lung cancer. We describe three patients in the form of a case series and discuss effect of octretotide on bronchial secretions and management of bronchorrhea in the intensive care unit. Similar to reports of its utilization in palliative care in patients with lung cancer, we observed a clinically significant decrease in the rate of bronchial secretions.

Abstract Background Recent studies have noted that patients with pre-existing lumbar spinal stenosis (LSS) have lower functional outcomes after total knee arthroplasty (TKA). Given that LSS manifests heterogeneously in location and severity, its influence on knee replacement merits a radiographically targeted analysis. We hypothesize that patients with more severe LSS will have diminished knee mobility before and after TKA. Methods This retrospective case series assessed all TKAs performed at our institution for primary osteoarthritis from 2017–2020. Preoperative lumbar magnetic resonance image (MRI) with no prior lumbar spine surgery was necessary for inclusion. Stenosis severity was demonstrated by (1) anterior–posterior (AP) diameter of the thecal sac and (2) morphological grade. TKA outcomes in 103 cases (94 patients) were assessed by measuring preoperative and postoperative arc of motion (AOM), postoperative flexion contracture, and need for manipulation under anesthesia. Results Patients with mild stenosis did significantly better in terms of postoperative knee AOM. As AP diameter decreased at levels L1–2, L2–3, L3–4, and L4–5, there was a significant reduction in preoperative-AOM (p

Background Pregnancy denial can be broken into two major types, non-psychotic and psychotic deniers, and further classified into pervasive, affective and persistent sub-types. It can lead to increased morbidity and mortality of the mother and neonate. Psychotic pregnancy denial is rare and the medical literature existing on the subject is limited to a small number of case reports and case series. No formal recommendation exists on the clinical management of psychotic pregnancy denial in the antenatal or postpartum period. The authors provide a comprehensive review of the literature regarding psychotic pregnancy denial, present an example of an unpublished case and provide suggestions for clinical management. Case A 33-year-old primigravida at 37 6/7 weeks gestation presented with new-onset psychotic pregnancy denial with no prior history of psychosis. She had a negative medical work-up for organic causes of psychosis. Using a multidisciplinary approach, the decision was made to deliver the fetus at 38 1/7 weeks via cesarean section due to concerns for patient and fetal safety. Following delivery, she was admitted to an inpatient psychiatric facility and underwent 16 bilateral electroconvulsive therapy (ECT) treatments to which she showed complete response. Conclusion Psychotic pregnancy denial is rare and potentially dangerous. Delivery prior to 39 weeks gestation is reasonable for worsening psychiatric disease but careful consideration of the risk–benefit analysis and ethical framework must be deliberated. Teaching points: In cases of worsening psychiatric disease in pregnancy, a multidisciplinary approach is necessary for comprehensive care. Psychotic denial of pregnancy leads to increased maternal and neonatal morbidity and mortality. Delivery prior to 39 weeks gestational age is reasonable to expedite psychiatric treatment. Precis Using a multidisciplinary approach, the decision to deliver before 39 weeks gestation is reasonable for worsening psychiatric disease.

Added sugars contribute to caloric intake in the diet, which may lead to conditions like obesity. Replacing added sugar with a natural sugar substitute like zero-calorie stevia may help in reducing sugar and caloric intake. Methods: An open-label, single-arm pilot study was conducted to evaluate the efficacy and safety of a stevia-based tabletop sweetener among overweight subjects with normal blood sugar levels (n = 24) and overweight prediabetic subjects (n = 21). Subjects were instructed to replace added sugar in their daily diet with the test product over a study period of 90 days. Primary outcomes included change in body weight and waist circumference, while the secondary outcomes included change in blood glucose (PPBG), body mass index (BMI), and lipid parameters evaluated at baseline, 30 days, 60 days, and 90 days. Glycated hemoglobin (HbA1c) was evaluated at baseline and 90 days. Results: When compared with the baseline, a significant reduction in weight (p < 0.001) and waist circumference (p < 0.001) was observed at Day 90 in overweight subjects. Similarly, in overweight prediabetic subjects, a significant reduction in weight (p < 0.001) and waist circumference (p < 0.05) with non-significant change in HbA1c was observed at Day 90 from baseline. In a subgroup analysis, among the subjects who lost weight, 2.12 kg (n = 35) weight loss and 4.78 cm (n = 32) reduction in waist circumference were observed at 90 days. No adverse outcomes were reported throughout the study period. The consumption of steviol glycosides was within the acceptable daily intake (ADI). Conclusions: Replacing added sugar in the daily diet with stevia-based tabletop sweetener, along with a physical activity regimen, promotes weight loss and reduction in waist circumference in overweight subjects with normal blood sugar levels and prediabetic subjects (CTRI/2019/12/022470).

Background: The use of megaprostheses in nononcologic patients has been associated with complication rates greater than 50%. In patients with prior periprosthetic joint infection (PJI) with subsequent two-stage reimplantation, this complication rate may be even higher. This study was to investigate the outcomes of megaprostheses in nononcologic patients undergoing revision hip/knee arthroplasty. Methods: We retrospectively studied patients who underwent megaprosthesis replacements from 1999 to 2017 at 5 hospitals with minimum 24 months of follow-up. Patients were stratified based on history of prior PJI (septic vs aseptic) and location of the megaprosthesis (the hip or knee). Postoperative complications were classified as soft-tissue failure, aseptic loosening, structural failure, and infection. Results: Of the 42 patients, 19 were in the septic cohort and 23 were in the aseptic cohort. The overall complication rate was 28.6%. Complication rates for the septic and aseptic cohorts were 32% and 26%, respectively (P = .74). By anatomic location, there were 2 of 13 (15%) and 10 of 29 (34%) complications in the hip and knee groups, respectively (P = .28). In the septic cohort, there were no (0%) complications in the hip group and 6 of 14 (43%) complications in the knee group (P = .13), all due to infection. In the aseptic cohort, there were 2 of 8 (25%) and 4 of 15 (27%) complications in the hip and knee groups, respectively (P = 1.0). Conclusions: There is no difference in the postoperative complication rates between the septic or aseptic cohorts undergoing revision hip or knee megaprosthesis replacements. In patients with prior PJI, proximal femoral replacements have improved short-term survivorship compared with distal femoral or proximal tibial replacements.

Background: Early imaging-based treatment response assessment of brain metastases following stereotactic radiosurgery (SRS) remains challenging. The aim of this study is to determine whether early (within 12 weeks) intratumoral changes in interstitial fluid pressure (IFP) and velocity (IFV) estimated from computational fluid modeling (CFM) using dynamic contrast-enhanced (DCE) MRI can predict long-term outcomes of lung cancer brain metastases (LCBMs) treated with SRS.Methods: Pre- and post-treatment T1-weighted DCE-MRI data were obtained in 41 patients treated with SRS for intact LCBMs. The imaging response was assessed using RANO-BM criteria. For each lesion, extravasation of contrast agent measured from Extended Tofts pharmacokinetic Model (volume transfer constant, Ktrans) was incorporated into a computational fluid model to estimate tumor IFP and IFV. Estimates of mean IFP and IFV and heterogeneity (skewness and kurtosis) were calculated for each lesion from pre- and post-SRS imaging. The Wilcoxon rank-sum test was utilized to assess for significant differences in IFP, IFV, and IFP/IFV change (Δ) between response groups.Results: Fifty-three lesions from 41 patients were included. Median follow-up time after SRS was 11 months. The objective response (OR) rate (partial or complete response) was 79%, with 21% demonstrating stable disease (SD) or progressive disease (PD). There were significant response group differences for multiple posttreatment and Δ CFM parameters: post-SRS IFP skewness (mean −0.405 vs. −0.691, p = 0.022), IFP kurtosis (mean 2.88 vs. 3.51, p = 0.024), and IFV mean (5.75e-09 vs. 4.19e-09 m/s, p = 0.027); and Δ IFP kurtosis (mean −2.26 vs. −0.0156, p = 0.017) and IFV mean (1.91e-09 vs. 2.38e-10 m/s, p = 0.013). Posttreatment and Δ thresholds predicted non-OR with high sensitivity (sens): post-SRS IFP skewness (−0.432, sens 84%), kurtosis (2.89, sens 84%), and IFV mean (4.93e-09 m/s, sens 79%); and Δ IFP kurtosis (−0.469, sens 74%) and IFV mean (9.90e-10 m/s, sens 74%).Conclusions: Objective response was associated with lower post-treatment tumor heterogeneity, as represented by reductions in IFP skewness and kurtosis. These results suggest that early post-treatment assessment of IFP and IFV can be used to predict long-term response of lung cancer brain metastases to SRS, allowing a timelier treatment modification.

Alzheimer’s disease is a type of dementia characterized by problems with short-term memory, cognition, and difficulties with activities of daily living. It is a progressive, neurodegenerative disorder. The complement system is an ancient part of the innate immune system and comprises of more than thirty serum and membrane-bound proteins. This system has three different activating pathways and culminates into the formation of a membrane attack complex that ultimately causes target cell lysis (usually pathogens) The complement system is involved in several important functions in the central nervous system (CNS) that include neurogenesis, synaptic pruning, apoptosis, and neuronal plasticity. Here, we discuss how the complement system is involved in the effective functioning of CNS, while also contributing to chronic neuroinflammation leading to neurodegenerative disorders such as Alzheimer’s disease. We also discuss potential targets in the complement system for stopping its harmful effects via neuroinflammation and provide perspective for the direction of future research in this field.

Objective: The aim of this study was to identify the publication speed (peer review time and publication time) of biomedical Indian journals and identify the journals having the facility of advance online publication (AOP). Materials and Methods: Biomedical Indian journals were identified from the Journal Citation Report of 2013. Thirty original articles published between January 2012 and June 2014 were systematically selected from each journal. Information about the date of submission, revision, and acceptance were extracted from the full text of the articles. Median peer review time (submission to acceptance) and publication time (acceptance to AOP/electronic publication) were calculated for each journal. Results: Of the 19 journals studied, 5 (26.3%), 15 (78.9%), and 6 (31.6%) journals did not mention details about date of submission, date of revision, and date of acceptance, respectively. The individual median peer review time of the journals ranged from 87 to 377.5 days and the combined median peer review time (interquartile range) was 143.5 days (105.5, 238). The individual median publication time ranged from 14 to 349 days. The publication time for journals with AOP was significantly lesser (29.5 [19.6, 50.6] vs. 146.5 [126.5, 202.5]; P = 0.02) compared to journals without AOP. Impact factor of the journal did not correlate with the publication speed. The facility of AOP was provided by 6 (31.6%) journals. Conclusions: Overall, the peer review time and publication time of biomedical Indian journals included in our study seems to be fairly long. Less than one-third of biomedical Indian journals provide the facility of AOP.

Herpes zoster maxillaries following cataract surgery is rare. We report here a case of a 70-year-old male who presented with vesiculo-papulo-macular rashes with hyperpigmented crusts over right malar prominence of cheek, side, and tip of the nose and upper lip, 3 days after undergoing uneventful cataract surgery of the right eye. He was treated with systemic acyclovir with resolution of skin lesions.