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Introduction: Praziquantel is used to treat diseases caused by infection with numerous types of internal/gastrointestinal and external parasites. Aim: The aim of this study was to design, formulate and evaluation of Praziquantel loaded nanosponges (PZQ-NSGs) by using factorial design. Methodology: The Determination of Calibration curve by UV visible spectrophotometer and Analytical method validation by UV visible spectrophotometer. The Analytical Techniques Used to Detect Drug-Excipient Compatibility of drug. Results and Discussion: The developed nanosponge drug delivery system were subjected to stability testing at higher temperature and humidity condition i.e. at 40⁰C ± 2⁰C and RH 75% ± 5 % after 6 months as per ICH guidelines. Solid state characterization of freeze dried PZQ-NSGs have been done with FTIR, PXRD, particle size analysis. From above characterization it was observed that, the sample was remained stable at 40⁰C ± 2⁰C and RH 75% ± 5 % even after 6 months. Conclusion: Formulated nanosponges formulation was found to be stable at accelerated stability conditions as per ICH guidelines up to 6 months. Nanosized distribution, amorphous nature, better encapsulation and inclusion complexation with EC were found to be the major drivers for significant improvement in solubility, nanosized particles, dissolution efficiency and stability.

The main focus of this research study was to develop a effective face serum using salicylic acid and ascorbic acid. Four formulations where each contains 2% w/w salicylic acid and 2% w/w ascorbic acid with varying concentration of another excipients. The prepared face serum were examined visually, pH, viscosity, globule size determination, spreadability, homogeneity and after feel. Upon evaluation, the Formulation F4 showed ideal suitable pH to the skin and globule size. Through this research work we intend to show safe and effective face serum and proven to be effective as anti pigmentation and anti acne. Salicylic acid is well-known for its effectiveness in treating acne. It works by exfoliating the skin, unclogging pores, and reducing the formation of acne-causing bacteria. Ascorbic acid acts as antioxidant protection helps in collagen production, anti pigmentation (brightening and even skin tone), sun damage protection and anti-inflammatory effects. Our prepared face serum is suitable for skin care purposes. Key words: salicylic acid, ascorbic acid, Anti-pigmentation, Anti-acne.

A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach.To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH.We performed a comprehensive search using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020.We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) as measured by the IPSS quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively. While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.71, 95% CI 0.16 to 3.10; 250 participants; 4 RCTs; I² = 26%; very low-certainty evidence), PAE may increase re-treatments (RR 3.64, 95% CI 1.02 to 12.98; 204 participants; 3 RCTs; I² = 0%; low-certainty evidence). Based on 18 re-treatments per 1000 men in the TURP group, this corresponds to 47 more (0 more to 214 more) per 1000 men undergoing PAE. We are very uncertain about the effects on erectile function (MD -0.03, 95% CI -6.35 to 6.29; 129 participants; 2 RCTs; I² = 78%; very low-certainty evidence) measured by the International Index of Erectile Function at 5 on a scale from 1 to 25, with higher scores indicating better function. NRS evidence when available yielded similar results. Based on evidence from NRS, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 260 participants; 1 NRS; low-certainty evidence). Longer-term follow-up: based on RCT evidence, we are very uncertain about the effects of PAE on urologic symptom scores (MD 0.30, 95% CI -3.17 to 3.77; 95 participants; very low-certainty evidence) compared to TURP. Quality of life may be similar (MD 0.20, 95% CI -0.49 to 0.89; 95 participants; low-certainty evidence). We are also very uncertain about major adverse events (RR 1.96, 95% CI 0.63 to 6.13; 107 participants; very low-certainty evidence). We did not find evidence on erectile function and ejaculatory disorders. Based on evidence from NRS, PAE may increase re-treatment rates (RR 1.51, 95% CI 0.43 to 5.29; 305 participants; low-certainty evidence); based on 56 re-treatments per 1000 men in the TURP group. this corresponds to 143 more (25 more to 430 more) per 1000 men in the PAE group. AUTHORS' CONCLUSIONS: Compared to TURP up to 12 months (short-term follow-up), PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE may increase re-treatment rates. We are uncertain about erectile function, but PAE may reduce ejaculatory disorders. Longer term (follow-up of 13 to 24 months), we are very uncertain as to how both procedures compare with regard to urologic symptom scores, but quality of life appears to be similar. We are very uncertain about major adverse events but PAE may increase re-treatments. We did not find longer term evidence on erectile function and ejaculatory disorders. Certainty of evidence for the main outcomes of this review was low or very low, signalling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.پیشینه: طیفی از رویکردهای جراحی کم‌تهاجمی‌تر به‌عنوان گزینه‌های درمانی جایگزین رزکسیون پروستات از طریق مجاری ادراری (transurethral resection of the prostate; TURP) در مدیریت نشانه‌های دستگاه ادراری تحتانی (lower urinary tract symptoms; LUTS) در مردان مبتلا به هیپرپلازی خوش‌خیم پروستات (benign prostatic hyperplasia; BPH) پیشنهاد شده‌اند. آمبولیزاسیون شریانی پروستات (prostatic arterial embolization; PAE) یک روش درمانی نسبتا جدید و کم تهاجمی است. اهداف: ارزیابی اثرات PAE در مقایسه با سایر روش‌های درمان LUTS در مردان مبتلا به BPH. روش‌های جست‌وجو: ما جست‌وجوی جامعی را در بانک‌های اطلاعاتی مختلف (کتابخانه کاکرین، MEDLINE؛ Embase؛ LILACS؛ Scopus؛ Web of Science؛ و Google Scholar)، پایگاه‌های ثبت کارآزمایی‌ها، سایر منابع علمی منتشر نشده، و مجموعه مقالات کنفرانس منتشر شده تا 25 سپتامبر 2020، بدون اعمال محدودیت در زبان یا وضعیت انتشار، انجام دادیم. معیارهای انتخاب: ما کارآزمایی‌های تصادفی‌سازی و کنترل شده (randomised controlled trials; RCTs)، همچنین مطالعات غیر‐تصادفی‌سازی شده (NRS، محدود به مطالعات کوهورت آینده‌نگر با گروه‌های مقایسه همزمان) را با حضور مردان بالای 40 سال مبتلا به LUTS وارد کردیم که نشانه‌هایشان به BPH نسبت داده ‌شد و تحت PAE در مقابل TURP یا سایر مداخلات جراحی قرار گفتند. گردآوری و تجزیه‌وتحلیل داده‌ها: دو نویسنده مرور به‌طور مستقل از هم مطالعات را برای ورود و خروج طبقه‌بندی کرده و داده‌ها را از مطالعات وارد شده خلاصه کردند. ما تجزیه‌وتحلیل آماری را با استفاده از یک مدل اثرات تصادفی انجام دادیم و آنها را مطابق با کتابچه راهنمای کاکرین برای مرورهای سیستماتیک مداخلات تفسیر کردیم. برای ارزیابی قطعیت شواهد RCTها و NRSها از راهنمایی GRADE استفاده شد. نتایج اصلی: ما داده‌هایی را برای آگاهی از دو مقایسه یافتیم: PAE در مقابل TURP (شش RCT و دو NRS)، و PAE در مقابل روش ساختگی (یک RCT). میانگین سنی، IPSS، و حجم پروستات شرکت‌کنندگان، به ترتیب 66 سال، 22.8 و 72.8 میلی‌لیتر بود. این چکیده متمرکز است بر مقایسه PAE در مقابل TURP به عنوان موضوع اصلی مورد نظر. PAE در مقابل TURP ما شش RCT و دو NRS را با پیگیری کوتاه‌مدت (تا 12 ماه) و یک RCT را با پیگیری طولانی‌مدت (13 تا 24 ماه) وارد کردیم. پیگیری کوتاه‌مدت: بر اساس شواهد به دست آمده از RCT، ممکن است تفاوتی اندک یا عدم تفاوت در بهبود نمره نشانه‌های اورولوژیک وجود داشته باشد (تفاوت میانگین [MD]: 1.55؛ 95% فاصله اطمینان [CI]: 0.40‐ تا 3.50؛ 369 شرکت‌کننده؛ 6 RCT؛ I² = 75%؛ شواهد با قطعیت پائین) که با نمره بین‌المللی نشانه‌های پروستات (International Prostatic Symptom Score; IPSS) در مقیاس 0 تا 35 اندازه‌گیری شد، و نمرات بالاتر نشانه‌های بدتر را نشان می‌دهد. در کیفیت زندگی نیز ممکن است تفاوتی اندک یا عدم تفاوت وجود داشته باشد (MD: 0.16؛ 95% CI؛ 0.37‐ تا 0.68؛ 309 شرکت‌کننده؛ 5 RCT؛ I² = 56%؛ شواهد با قطعیت پائین) که توسط سوال کیفیت زندگی IPSS در یک مقیاس 0 تا 6 اندازه‌گیری شد، و نمرات بالاتر نشانگر کیفیت زندگی بدتر به ترتیب بین PAE و TURP است. در حالی که ما در مورد تأثیر PAE بر عوارض جانبی عمده بسیار نامطمئن هستیم (خطر نسبی [RR]: 0.71؛ 95% CI؛ 0.16 تا 3.10؛ 250 شرکت‌کننده؛ 4 RCT؛ I² = 26%؛ شواهد با قطعیت بسیار پائین)، PAE ممکن است نیاز را به درمان مجدد افزایش دهد (RR: 3.64؛ 95% CI؛ 1.02 تا 12.98؛ 204 شرکت‌کننده؛ 3 RCT؛ I² = 0%؛ شواهد با قطعیت بسیار پائین). بر اساس 18 مورد درمان مجدد در هر 1000 مرد در گروه TURP، این عدد متناظر است با 47 مورد دیگر (0 مورد بیشتر تا 214 مورد بیشتر) در هر 1000 مرد تحت درمان با PAE. ما در مورد اثرات درمان بر عملکرد نعوظ بسیار نامطمئن هستیم (MD: ‐0.03؛ 95% CI؛ 6.35‐ تا 6.29؛ 129 شرکت‌کننده؛ 2 RCT؛ I² = 78%؛ شواهد با قطعیت بسیار پائین) که توسط شاخص بین‌المللی عملکرد نعوظ در 5 روی مقیاس 1 تا 25 اندازه‌گیری شد، که نمرات بالاتر نشان دهنده عملکرد بهتر است. شواهد NRS در صورت وجود، نتایج مشابهی را به همراه داشت. براساس شواهد به دست آمده از NRS، روش PAE ممکن است بروز اختلالات انزال را کاهش دهد (RR: 0.51؛ 95% CI؛ 0.35 تا 0.73؛ 260 شرکت‌کننده؛ 1 NRS؛ شواهد با قطعیت پائین). پیگیری طولانی‌مدت‌تر: براساس شواهد RCT، ما در مورد تأثیر PAE بر نمرات نشانه‌های اورولوژیک، در مقایسه با TURP، بسیار نامطمئن هستیم (MD: 0.30؛ 95% CI؛ 3.17‐ تا 3.77؛ 95 شرکت‌کننده؛ شواهد با قطعیت بسیار پائین). کیفیت زندگی ممکن است مشابه باشد (MD: 0.20؛ 95% CI؛ 0.49‐ تا 0.89؛ 95 شرکت‌کننده؛ شواهد با قطعیت پائین). ما همچنین در مورد حوادث عمده جانبی بسیار نامطمئن هستیم (RR: 1.96؛ 95% CI؛ 0.63 تا 6.13؛ 107 شرکت‌کننده؛ شواهد با قطعیت بسیار پائین). ما شواهدی را در مورد عملکرد نعوظ و اختلالات انزال پیدا نکردیم. بر اساس شواهد به دست آمده از NRS، روش PAE ممکن است نرخ درمان مجدد را افزایش دهد (RR: 1.51؛ 95% CI؛ 0.43 تا 5.29؛ 305 شرکت‌کننده؛ شواهد با قطعیت پائین)؛ بر اساس 56 مورد نیاز به درمان مجدد در هر 1000 مرد در گروه TURP. این متناظر است با 143 نفر بیشتر (25 نفر بیشتر تا 430 نفر بیشتر) در هر 1000 مرد در گروه PAE. نتیجه‌گیری‌های نویسندگان: در مقایسه با TURP تا 12 ماه (پیگیری کوتاه‌مدت)، PAE ممکن است میزان بهبودی مشابهی را در نمرات نشانه‌های اورولوژیک و کیفیت زندگی ایجاد کند. در حالی که در مورد عوارض جانبی عمده بسیار نامطمئن هستیم، PAE ممکن است نرخ درمان مجدد را افزایش دهد. ما در مورد عملکرد نعوظ اطمینان نداریم، اما PAE ممکن است اختلالات انزال را کاهش دهد. با پیگیری طولانی‌مدت‌تر (13 تا 24 ماه)، در مورد اینکه هر دو روش با توجه به نمرات نشانه‌های اورولوژیک چگونه مقایسه می‌شوند، بسیار نامطمئن هستیم، اما به نظر می‌رسد کیفیت زندگی مشابه باشد. در مورد عوارض جانبی عمده بسیار نامطمئن هستیم، اما PAE ممکن است نرخ درمان مجدد را افزایش دهد. شواهد طولانی‌مدت‌تری را در مورد عملکرد نعوظ و اختلالات انزال پیدا نکردیم. قطعیت شواهد برای پیامدهای اصلی این مرور، پائین یا بسیار پائین بود، این نشان دهنده آن است که اعتماد ما به اندازه تاثیرگذاری گزارش شده، محدود یا بسیار محدود است، و این موضوع باید در تحقیقات آینده بهتر بررسی شود.

Background. Splenic artery aneurysm (SAA) is a rare but potentially fatal complication associated with high maternal and fetal mortality when occurring during pregnancy. Case. A 29-year-old G4P3003 at 34 4/7 weeks of gestation was admitted with left upper quadrant pain and newly diagnosed SAA in the hilum. She was scheduled for embolization of the SAA but the night before went into labor. A multidisciplinary team discussion was held, and the patient underwent successful primary low transverse c-section via Pfannenstiel skin incision followed by laparoscopic splenectomy under general anesthesia. She delivered a male newborn with birth weight of 2855 and Apgar score of 8/5. Summary and Conclusion. Early diagnosis and management of SAA are key for improved maternal and fetal outcomes. Our case demonstrates that through a multidisciplinary approach and anticipation of the possible clinical scenarios, good outcomes can be achieved.

The attempt of this work is to overcome the challenging tasks due to the inherent drawbacks of electrolytic tough pitch (ETP) copper while performing welding on it. It was a comparative investigation between gas tungsten arc welding (GTAW) as well as friction stir welding (FSW) on ETP copper. The specimen is an alloy of copper (degree C11000), which consists of pure copper and silver about 99.9%. ETP copper has vast applications in the industry because of good properties such as corrosion resistance, electrical, and thermal conductivity. The GTAW process is done after cold rolling of copper, and FSW has performed after nitriding the specimen. The micro and macrostructure hardness is calculated for parent material, weldment of GTAW and FSW process to compare the variation in mechanical properties of ETP Copper with the parent material. This experimental study observed that the GTAW process is feasible to achieve defect-free weldment but FSW process can be done by investing less energy, time, and resource.

BackgroundA variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of prostate (TURP) for the management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). A recent addition to these is prostatic urethral lift (PUL).ObjectivesTo assess the effects of PUL for the treatment of LUTS in men with BPH.Search methodsWe performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up until 31 January 2019.Selection criteriaWe included parallel group randomized controlled trials (RCTs). While we planned to include non‐RCTs if RCTs had provided low‐certainty evidence for a given outcome and comparison, we could not find any non‐RCTs.Data collection and analysisTwo review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random‐effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used the GRADE approach to rate the certainty of the evidence.Main resultsWe included two RCTs with 297 participants comparing PUL to sham surgery or TURP. The mean age was 65.6 years and mean International Prostate Symptom Score was 22.7. Mean prostate volume was 42.2 mL. We considered review outcomes measured up to and including 12 months after randomization as short‐term and later than 12 months as long‐term. For patient‐reported outcomes, lower scores indicate more urological symptom improvement and higher quality of life. In contrast, higher scores refers to better erectile and ejaculatory function.PUL versus sham: based on one study of 206 randomized participants with short follow‐up (up to three months), PUL may lead to a clinically important improvement in urological symptom scores (mean difference (MD) –5.20, 95% confidence interval (CI) –7.44 to –2.96; low‐certainty evidence) and likely improves quality of life (MD –1.20, 95% CI –1.67 to –0.73; moderate‐certainty evidence). We are uncertain whether PUL increases major adverse events (very low‐certainty evidence). There were no retreatments reported in either study group by three months. PUL likely results in little to no difference in erectile function (MD –1.40, 95% CI –3.24 to 0.44; moderate‐certainty evidence) and ejaculatory function (MD 0.50, 95% CI –0.38 to 1.38; moderate‐certainty evidence).PUL versus TURP: based on one study of 91 randomized participants with a short follow‐up (up to 12 months), PUL may result in a substantially lesser improvement in urological symptom scores than TURP (MD 4.50, 95% CI 1.10 to 7.90; low‐certainty evidence). PUL may result in a slightly reduced or similar quality of life (MD 0.30, 95% CI –0.49 to 1.09; low‐certainty evidence). We are very uncertain whether PUL may cause fewer major adverse events but increased retreatments (both very low‐certainty evidence). PUL probably results in little to no difference in erectile function (MD 0.80, 95% CI –1.50 to 3.10; moderate‐certainty evidence), but probably results in substantially better ejaculatory function (MD 5.00, 95% CI 3.08 to 6.92; moderate‐certainty evidence).With regards to longer term follow‐up (up to 24 months) based on one study of 91 randomized participants, PUL may result in a substantially lesser improvement in urological symptom score (MD 6.10, 95% CI 2.16 to 10.04; low‐certainty evidence) and result in little worse to no difference in quality of life (MD 0.80, 95% CI 0.00 to 1.60; low‐certainty evidence). The study did not report on major adverse events. We are very uncertain whether PUL increases retreatment (very low‐certainty evidence). PUL likely results in little to no difference in erectile function (MD 1.60, 95% CI –0.80 to 4.00; moderate‐certainty evidence), but may result in substantially better ejaculatory function (MD 4.30, 95% CI 2.17 to 6.43; low‐certainty evidence).We were unable to perform any of the predefined secondary analyses for either comparison.We found no evidence for other comparisons such as PUL versus laser ablation or enucleation.Authors' conclusionsPUL appears less effective than TURP in improving urological symptoms both short‐term and long term, while quality of life outcomes may be similar. The effect on erectile function appears similar but ejaculatory function may be better. We are uncertain about major adverse events short‐term and found no long‐term information. We are very uncertain about retreatment rates both short‐term and long‐term. We were unable to assess the effects of PUL in subgroups based on age, prostate size, or symptom severity and also could not assess how PUL compared to other surgical management approaches. Given the large numbers of alternative treatment modalities to treat men with LUTS secondary to BPH, this represents important information that should be shared with men considering surgical treatment.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of extracorporeal shockwave therapy (ESWT) as a treatment option for men with erectile dysfunction (ED).

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of testosterone compared to placebo or other medical treatments in men with sexual dysfunction.

Prostate cancer is a common cancer in elderly men and in some will prove fatal. Standard treatments for localised disease include surgery ( radical prostatectomy), radiotherapy and active monitoring. New emerging therapies are being evaluated with the aim of reducing the complication rate associated with standard therapies, as well as developing an effective treatment. One such modality is cryotherapy, a procedure that introduces probes directly into the prostate tumour and kills the malignant cells by a freezing process.This review aims to evaluate the relative clinical and economic benefits of cryotherapy compared to standard therapies for the primary treatment of localised prostate cancer.Our search strategy included an electronic search of MEDLINE from 1996 to December 2006, plus EMBASE (Excerpta Medica Database), the Cochrane library, ISI Science Citation Index, Database of Abstracts and Reviews of Effectiveness (DARE), and LILACS to identify all relevant published randomised trials of cryotherapy for localised prostate cancer. Cancerlit and HealthSTAR databases were searched to their final date. Handsearching of relevant journals was undertaken.Only published randomised trials comparing the effectiveness of cryotherapy with radical prostatectomy, radiotherapy or active monitoring for the primary treatment of men with localised prostate cancer were eligible for inclusion in this review.Data were extracted from eligible studies, and included study design, participants, interventions and outcomes. Primary outcome measures were biochemical disease-free survival, disease-free survival and treatment-induced complications. Secondary outcomes included disease-specific survival, overall survival, quality-of-life outcome measures and economic impact measures.There were no randomised trials found comparing cryotherapy with other therapies for the primary treatment of localised prostate cancer. All studies identified were case series. To indicate the level of the available evidence, studies that evaluated cryotherapy as a primary therapy, using transrectal ultrasound guidance and urethral warming in at least 50 patients with localised prostate cancer, and a minimum of one year follow up, were reviewed. Eight case series were identified that complied with these criteria; two were retrospective. The patients recruited (n = 1483) had an age range from 41 to 84 years, stages T1 = 0 to 43%, T2 = 24 to 88%, T3 = 1 to 41%, and T4 = 0 to 14%. The mean preoperative PSA level ranged from 9.7 to 39 ng/mL, with Gleason scores7 and ranging from 6 to 37%. One additional study that compared cryotherapy (total cryotherapy and standard cryotherapy with urethral preservation) with radical prostatectomy was also identified and reviewed. In this study the success rates, defined as a post-treatment PSA of 0.2 ng/mL or less, were reported as 96% for total cryotherapy, 49% for standard cryotherapy and 73% for radical prostatectomy. Four studies did not monitor the temperature of the cyro-procedure and reported 17 to 28% of patients had a positive biopsy following cryotherapy with a mean PSA nadir of 0.55 to 1.75 ng/mL (median 0.4 to 1.85 ng/mL). The other four studies used thermocouples to monitor the temperature of the cryo-procedure and reported progression-free survival rates of 71 to 89% with 1.4 to 13% of patients having a positive biopsy post-cryotherapy. At 5 years, overall survival was reported as 89 to 92% in two studies, and disease-specific survival as 94% in one study. The major complications observed in all studies included impotence (47 to 100%), incontinence (1.3 to 19%), and urethral sloughing (3.9 to 85%), with less common complications of fistula (0 to 2%), bladder-neck obstruction (2 to 55%), stricture (2.2 to 17%) and pain (0.4 to 3.1%). Most patients were sent home the following day (range 1 to 4 days).Cryotherapy offers a potential alternative to standard therapies for the primary treatment of localised prostate cancer. However, the poor quality of the available studies makes it difficult to determine the relative benefits of this modality. Randomised trials are needed to fully evaluate the full potential of cryotherapy in men with this disease. Patients selecting cryotherapy as their therapeutic option should be made fully aware of the reported efficacy, complications and the low-grade evidence from which these data are derived.

Background A variety of alpha-blockers are used for treating lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Silodosin is a novel, more selective alpha-blocker, which is specific to the lower urinary tract and may have fewer side effects than other alpha-blockers. Objectives To assess the effects of silodosin for the treatment of LUTS in men with BPH. Search methods We performed a comprehensive search using multiple databases (Cochrane Library, MEDLINE, EMBASE, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up until 13 June 2017. Selection criteria We included all parallel, randomized controlled trials. We also included cross-over designs. Data collection and analysis Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of evidence according to the GRADE approach. Main results We included 19 unique studies with 4295 randomized participants across four comparisons for short-term follow-up. The mean age, prostate volume, and International Prostate Symptom Score were 66.5 years, 38.2 mL, and 19.1, respectively. Silodosin versus placebo Based on four studies with a total of 1968 randomized participants, silodosin may reduce urologic symptom scores in an appreciable number of men (mean difference (MD) -2.65, 95% confidence interval (CI) -3.23 to -2.08; low-quality evidence). Silodosin likely does not result in a clinically important reduction in quality of life (MD -0.42, 95% CI -0.71 to -0.13; moderate-quality evidence). It may not increase rates of treatment withdrawal for any reason (relative risk (RR) 1.08, 95% CI 0.70 to 1.66; low-quality evidence). We are uncertain about the effect of silodosin on cardiovascular adverse events (RR 1.28, 95% CI 0.67 to 2.45; very low-quality evidence). Silodosin likely increases sexual adverse events (RR 26.07, 95% CI 12.36 to 54.97; moderate-quality evidence); this would result in 180 more sexual adverse events per 1000 men (95% CI 82 more to 388 more). Silodosin versus tamsulosin Based on 13 studies with a total of 2129 randomized participants, silodosin may result in little to no difference in urologic symptom scores (MD -0.04, 95% CI -1.31 to 1.24; low-quality evidence) and quality of life (MD -0.15, 95% CI -0.53 to 0.22; low-quality evidence). We are uncertain about treatment withdrawals for any reason (RR 1.02, 95% CI 0.62 to 1.69; very low-quality evidence). Silodosin may result in little to no difference in cardiovascular adverse events (RR 0.77, 95% CI 0.53 to 1.12; low-quality evidence). Silodosin likely increases sexual adverse events (RR 6.05, 95% CI 3.55 to 10.31; moderate-quality evidence); this would result in 141 more sexual adverse events per 1000 men (95% CI 71 more to 261 more). Silodosin versus naftopidil Based on five studies with a total of 763 randomized participants, silodosin may result in little to no differences in urologic symptom scores (MD -0.85, 95% CI -2.57 to 0.87; low-quality evidence), quality of life (MD -0.17, 95% CI -0.60 to 0.27; low-quality evidence), treatment withdrawal for any reason (RR 1.25, 95% CI 0.81 to 1.93; low-quality evidence), and cardiovascular adverse events (RR 1.02, 95% CI 0.41 to 2.56; low-quality evidence). Silodosin likely increases sexual adverse events (RR 5.93, 95% CI 2.16 to 16.29; moderate-quality evidence); this would result in 74 more sexual adverse events per 1000 men (95% CI 17 more to 231 more). Silodosin versus alfuzosin Based on two studies with a total of 155 randomized participants, silodosin may or may not result in a clinically important increase in urologic symptom scores (MD 3.83, 95% CI 0.12 to 7.54; low-quality evidence). Silodosin likely results in little to no difference in quality of life (MD 0.14, 95% CI -0.46 to 0.74; moderate-quality evidence). We found no event of treatment withdrawal for any reason. Silodosin may not reduce cardiovascular adverse events (RR 0.67, 95% CI 0.36 to 1.24; low-quality evidence) but likely increases sexual adverse events (RR 37.21, 95% CI 5.32 to 260.07; moderate-quality evidence); this would result in 217 more sexual adverse events per 1000 men (95% CI 26 more to 1000 more). Authors' conclusions Silodosin may reduce urologic symptom scores in an appreciable number of men compared to placebo. Quality of life and treatment withdrawals for any reason appears similar. Its efficacy appears similar to that of other alpha blockers (tamsulosin, naftopidil and alfuzosin) but the rate of sexual side effects is likely higher. Our certainty in the estimates of effect was lowered due to study limitations, inconsistency and imprecision.

Background A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach. Objectives To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH. Search methods We performed a comprehensive search using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020. Selection criteria We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) as measured by the IPSS quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively. While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.71, 95% CI 0.16 to 3.10; 250 participants; 4 RCTs; I² = 26%; very low-certainty evidence), PAE may increase re-treatments (RR 3.64, 95% CI 1.02 to 12.98; 204 participants; 3 RCTs; I² = 0%; low-certainty evidence). Based on 18 re-treatments per 1000 men in the TURP group, this corresponds to 47 more (0 more to 214 more) per 1000 men undergoing PAE. We are very uncertain about the effects on erectile function (MD -0.03, 95% CI -6.35 to 6.29; 129 participants; 2 RCTs; I² = 78%; very low-certainty evidence) measured by the International Index of Erectile Function at 5 on a scale from 1 to 25, with higher scores indicating better function. NRS evidence when available yielded similar results. Based on evidence from NRS, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 260 participants; 1 NRS; low-certainty evidence). Longer-term follow-up: based on RCT evidence, we are very uncertain about the effects of PAE on urologic symptom scores (MD 0.30, 95% CI -3.17 to 3.77; 95 participants; very low-certainty evidence) compared to TURP. Quality of life may be similar (MD 0.20, 95% CI -0.49 to 0.89; 95 participants; low-certainty evidence). We are also very uncertain about major adverse events (RR 1.96, 95% CI 0.63 to 6.13; 107 participants; very low-certainty evidence). We did not find evidence on erectile function and ejaculatory disorders. Based on evidence from NRS, PAE may increase re-treatment rates (RR 1.51, 95% CI 0.43 to 5.29; 305 participants; low-certainty evidence); based on 56 re-treatments per 1000 men in the TURP group. this corresponds to 143 more (25 more to 430 more) per 1000 men in the PAE group. AUTHORS' CONCLUSIONS: Compared to TURP up to 12 months (short-term follow-up), PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE may increase re-treatment rates. We are uncertain about erectile function, but PAE may reduce ejaculatory disorders. Longer term (follow-up of 13 to 24 months), we are very uncertain as to how both procedures compare with regard to urologic symptom scores, but quality of life appears to be similar. We are very uncertain about major adverse events but PAE may increase re-treatments. We did not find longer term evidence on erectile function and ejaculatory disorders. Certainty of evidence for the main outcomes of this review was low or very low, signalling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.

Effective communication skills are extremely important for the successful career of present engineering students. Candidly speaking, effective communications skills are equally essential for everyone in today’s ultra competitive business world. In the existing globalization scenario, most of the MNC’s are searching for a right and suitable candidate with sound knowledge in communication skills in addition to the hard skills. Unfortunately most of the present day so-called engineering students are not up to the mark in communication skills and as a result they are disqualified. This present paper of us tries to focus on why effective communication skills are incredibly important and also a few suggestions that are highly beneficial in overcoming the most common communicative problems of engineering students.

INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is offered to patients with small renal masses to preserve renal function and does not compromise cancer specific outcomes. Hypertension (HTN) and diabetes (DM) are the leading medical causes of chronic kidney disease (CKD) and many patients undergoing PN have these conditions. The present study therefore sought to assess the influence of DM or HTN on renal function outcomes following robotassisted PN (RPN). METHODS: Using an IRB approved multi-institution kidney cancer database, subjects who underwent RPN for a clinical stage T1 renal mass with normal baseline kidney function (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73m) and follow-up of > 2 weeks were included in the analysis. Patients were categorized based on the presence of either HTN or DM (Group 1) or neither (Group 2). Postoperative eGFR was categorized into 3-month intervals with maximum follow-up limited to 18 months. Renal function outcomes were compared using a mixed effects ANOVA model adjusting for age, body mass index (BMI) and RENAL nephrometry score. A Wilcoxon rank sum test was used to compare distribution of continuous variables and Chi-square test to compare the CKD upstaging between groups. RESULTS: We identified 324 patients with a baseline eGFR>60 mL/min/1.73m (198 with either DM or HTN, 126 with neither). There was no difference in baseline eGFR and median follow up between groups. Following RPN, there was no difference in eGFR, CKD upstaging or renal function recovery over time (figure 1). The rate of progression to CKD stage 3 did not differ between groups 1 and 2 (19% vs. 18%, p1⁄40.84). In a similar analysis of 159 patients with an eGFR >90 mL/min/ 1.73m (92 with either DM or HTN, 67 with neither) no difference in baseline eGFR, length of follow up, eGFR following RPN, CKD upstaging or renal function recovery was found (figure 1). The rate of progression to CKD stage 2 or higher did not differ between groups (48% vs. 55%, p1⁄40.34). CONCLUSIONS: In patients with a normal baseline renal function (eGFR > 60 mL/min/1.73m), the presence of DM or HTN are not independent predictors of worse renal function outcomes following RPN.

Computed tomography (CT) enteroclysis is being performed routinely for evaluation of suspected small bowel diseases. The availability of multidetector CT scanners has further increased the diagnostic yield of enteroclysis. There is excellent depiction of small bowel wall pathology on CT enteroclysis especially with use of negative enteric contrast. We discuss the CT enteroclysis technique and procedure along with the imaging spectrum of some common small bowel pathologies.

To evaluate the correlation between anterior cruciate ligament (ACL) tear and straightened, vertically oriented lateral collateral ligament (LCL).This study included 556 patients who underwent MRI of the knee and were divided into three subsets based on ACL morphology. Subset 1 included patients with unequivocal normal ACL. Subset 2 included patients with unequivocal ACL tears. Subset 3 included patients with doubtful ACL who underwent arthroscopy. MR images were reviewed and sensitivity and specificity of vertically oriented LCL as an indirect sign of ACL tear were calculated.The MRI results were as follows: subset 1, out of 282 patients, 270 had oblique LCL and 12 demonstrated vertical LCL; subset 2, out of 212 patients, 189 demonstrated vertical LCL and 23 revealed oblique LCL; subset 3, out of 62 patients, 28 patients with vertical orientation of LCL had a possible ACL tear. Patients with oblique LCL orientation (34) were reported as probably having normal ACL. On comparison with arthroscopy, in 28 patients who we reported as having possible ACL tears, there were 17 patients with torn ACL. The rest of the 11 patients revealed no ACL tears. In the group of 34 patients in whom we reported possible normal, arthroscopy-confirmed tear in 5 patients. Sensitivity and specificity of vertical LCL as an indirect sign of ACL tear was found to be 88% and the specificity 92.85%.Vertically oriented LCL is a useful indirect MRI sign of ACL tear and aids in making a diagnosis, when ACL appearance is equivocal.

Aim: To define a range of apparent diffusion coefficient values in spinal tuberculosis and to evaluate the sensitivity of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient values in patients of spinal tuberculosis. Materials and Methods: This study was conducted over a period of 20 months and included 110 patients with a total of 230 vertebral bodies. The study was performed in two parts. The first part included all patients of known tuberculosis and patients with classical features of tuberculosis. The second part included patients with spinal pathology of indeterminate etiology. All the patients underwent a routine MRI examination along with diffusion sequences. The apparent diffusion coefficient (ADC) values were calculated from all the involved vertebral bodies. Results: The mean ADC value of affected vertebrae in first part of the study was found to be 1.4 ± 0.20 ×10 -3 mm 2 /s. This ADC value was then applied to patients in the second part of study in order to determine its ability in predicting tuberculosis. This range of ADC values was significantly different from the mean ADC values of normal vertebrae and those with metastatic involvement. However, there was an overlap of ADC values in a few tuberculous vertebrae with the ADC values in metastatic vertebrae. Conclusion: We found that DW-MRI and ADC values may help in the differentiation of spinal tuberculosis from other lesions of similar appearance. However, an overlap of ADC values was noted with those of metastatic vertebrae. Therefore diffusion imaging and ADC values must always be interpreted in association with clinical history and routine MRI findings and not in isolation.

We describe the pathophysiology, differential diagnosis and urodynamic findings in patients with a large capacity bladder.This was a retrospective, observational study of 100 consecutive patients with voiding dysfunction and a cystometric bladder capacity of greater than 700 ml. Clinical data, cystometric bladder capacity and other urodynamic findings were evaluated. Bladder outlet obstruction and impaired detrusor contractility were defined by the Schaefer nomogram in men and the Blaivas-Groutz nomogram in women.A total of 56 men and 44 women 36 to 97 years old (median age 75, mean 71.2) with a bladder capacity of 700 to 5,013 ml (median 931, mean 1,091) were studied. The primary pathophysiological diagnoses were bladder outlet obstruction in 48% of cases, impaired detrusor contractility in 11%, absent detrusor contractility in 24% and normal detrusor pressure/uroflow study in 17%. Bladder outlet obstruction was attributable to anatomical obstruction in 34% of patients, acquired voiding dysfunction in 11% and detrusor-external sphincter dyssynergia in 3%. In patients with detrusor contractions the initial contraction occurred at a median of 1,000 ml (mean 1,154, range 86 to 5,000). Associated diagnoses in men included benign prostatic enlargement in 52% and neurological disease in 14%, and in women they were pelvic organ prolapse in 27%, stress incontinence in 18% and neurological disorders in 9%.The etiology of large capacity bladder is multifactorial and often a potentially remediable underlying condition exists. A large capacity bladder may be accompanied by bladder outlet obstruction, impaired or absent detrusor contractions, or normal detrusor pressure/uroflow studies. When detrusor contractions are present, they usually occur only at large bladder volumes. Therefore, it is important during cystometry to fill the bladder until capacity is achieved.

INTRODUCTION AND OBJECTIVES: Ureteral colic due to an obstructing stone is a common presentation to the emergency department. We sought to evaluate how often serum and urine studies were unremarkable in patienst with this presentation. METHODS: Two hundred thirty-two consecutive patients evaluated in an urban tertiary care emergency department and who were diagnosed with an obstructing ureteral stone on computerized tomography (CT) were evaluated. Inclusion criteria were as follows: ureteral stone diagnosed on CT, urine dipstick and serum WBC checked. Studies were considered “normal” if urine dipstick showed 0 RBC, 0 WBC, and was nitrite negative AND if serum WBC was < 12.0. RESULTS: Mean patient age was 46.9 years (SD 15.4), gender prevalence was 35.8% female:64.2% male, mean axial stone diameter was 4.0 mm (SD 2.0), and mean serum WBC was 10.1 (SD 3.7). Stone position was proximal ureter e 24.6%, distal ureter e 27.1%, and ureterovesical junction e 48.3%. Completely normal urine dipstick and serum WBC was seen in 47 patients (20.2%), whereas 185 patients (79.7%) demonstrated at least a single abnormality of urine dipstick or WBC. On mulvariate logistic regression, neither age, gender, stone location, or stone size were significant predictors of the presence or absence of laboratory abnormalities. CONCLUSIONS: Up to 20% of patients presenting with ureteral colic and ureteral stones will not demonstrate abnormalities of urine dipstick or serum WBC. These data may be helpful in selecting which patients may benefit from additional imaging or workup in cases when the diagnosis is not obvious.

Objectives To determine whether preoperative urodynamic parameters can predict the outcome in men in urinary retention and aid in counseling these men. Methods Forty men in urinary retention due to benign prostatic hyperplasia underwent photoselective laser vaporization prostatectomy (PVP). Preoperative urodynamic studies were used to identify the men with detrusor overactivity (DO) and impaired detrusor contractility (IDC). The International Prostate Symptom Score (IPSS), maximal flow rate, and postvoid residual urine volume were collected at 1, 3, 6, and 12 months after PVP. Results Of the 40 men, 8 (20%) had IDC and 30 had DO (75%) preoperatively. The men without preoperative DO had a significantly lower IPSS than those with preoperative DO at 1 month of follow-up. Men without preoperative IDC had a significantly lower IPSS and postvoid residual urine volume at the same point compared with men with preoperative IDC. The flow rate in men with preoperative IDC 1 and 6 months postoperatively was significantly lower than in men without preoperative IDC. Conclusions Preoperative urodynamic parameters predict for outcome in men in urinary retention undergoing PVP. Men in urinary retention benefit from PVP with an improvement in both subjective and objective voiding function, regardless of the presence of DO or IDC. Postoperatively, patients with DO have more voiding symptoms than those without DO, and are almost twice as likely to require anticholinergics. Men without IDC have better IPSS, flow rates, and postvoid residual urine volumes compared with men with IDC. Of the 8 men with IDC, 3 required reoperation within the first year.

Background: Every country faces an ongoing challenge to collect blood from safe donors. Chronic blood shortages are common in developing countries. According to WHO Voluntary blood donation practices are encouraged to collect safe blood units. In India for donating the blood often they say prosocial reasons. The objectives of the present study was quantitative assessment of prosocial behaviour as well as trends of transfusion transmitted infections among (voluntary blood donors) VBD . Methods: Cross-sectional study carried out between 1 st January 2016 to 31 st august 2016, at the field practice area of Institute of preventive medicine (IPM), Narayanaguda, Telangana state, India. The total sample size estimated was 41,356 (by Census survey method). Among which 25,641(62%) were current donors and 15,715 (38%) lapsed donors likewise 35,980 males and 5,376 females were enrolled . Results: Among the participants majority (87%) were males compare to females (13%). out of 41,352 donors majority were current donors (62%) compare to lapsed donors (38%). Among current donors all the mean scores of prosocial behaviour components were high and The trends of All TTIs infection prevalence rates were declined progressively . Conclusions: Sustainable motivational levels may increase the frequency of blood donation and by encouraging VBDs one can reduce the TTIs .

Sonoelastography (SE) is a new USG-based technique that is being used to assess the elasticity and pliability of various tissues and lesions. We evaluated normal and abnormal Achilles tendons and correlated SE findings with those of high-resolution USG. This article briefly discusses the principle and technique of sonoelastography and the variations in elasticity and pliability between normal and abnormal Achilles tendons.

Congenital short bowel syndrome (SBS) is a relatively rare condition as compared to acquired SBS. It is associated with significant mortality and morbidity. Infants usually present with failure to thrive, recurrent vomiting, and diarrhea. It is important to suspect and diagnose this condition promptly, as early initiation of parenteral nutrition or surgery, if necessary, may result in a favorable outcome. We discuss a case of an infant aged 26 days, who presented with failure to thrive, recurrent vomiting, and weight loss. A contrast study of the gastrointestinal tract revealed a short small bowel, with malrotation. The infant was started on parenteral nutrition, but succumbed shortly thereafter to severe disseminated sepsis.

Pelviureteric junction obstruction of the kidneys secondary to crossing renal vessels is a known entity. We report a 26-year-old woman with obstruction secondary to portosystemic collaterals; she was incidentally detected to have extrahepatic portal vein obstruction.

In the present globalized world it is incumbent upon everyone to have effective communication skills in order to compete with others. Effective communication skills constitute both the verbal and non-verbal signals. Verbal Communication refers to the communication which occurs with the help of words whereas Non-verbal communication refers to the type of communication that does not use words. As a matter of fact, non-verbal communication plays a significant role in our daily life. Surprisingly, more than 90% of all the communication we use every day while sharing information is supported by body language. According to experts, a substantial portion of our communication is nonverbal. Every day, we respond to thousands on nonverbal cues and behaviors. Hence to become better communicator one should pay attention not only to the verbal communication but also to the body language and non-verbal cues of others. The present article discusses different forms of non-verbal communication in addition to its importance.