Stentless pyeloplasty for ureteropelvic junction obstruction in children

Introduction Stenting after pyeloplasty is an established practice and helps in  ensuring a patent anastomosis until healing has completed. Stents, however, may cause complications such as infection and displacement and increase the cost of management; therefore, stentless pyeloplasty is now considered as feasible  alternative.Patients and methods From August 2008 to October 2010, we retrospectively analyzed the results of stentless surgery in patients with ureteropelvic junction  (UPJ) obstruction. In all, 42 patients with UPJ obstruction were managed. Nine patients who were treated conservatively, one who underwent nephrectomy, and one pyelostomy for pyonephrosis in solitary kidney were excluded. Age range at surgery was 14 days–12 years with a mean age of 12.7 months.Results There were 23 male patients and eight female patients with a male-to-female ratio of 3 : 1. Fourteen patients had left, 12 right, and five had bilateral UPJ obstruction. A total of 34 pyeloplasties were performed in 31 patients. Of the five patients with bilateral UPJ obstruction, three underwent bilateral pyeloplasty and remaining two underwent unilateral pyeloplasty with conservative management on the opposite sides. Two patients underwent laparoscopic pyeloplasties and32 pyeloplasties by open technique. Double J stent was placed at initial surgery in three patients and 31 stentless pyeloplasties were performed. The mean operative time was 75 min. The mean perinephric drain removal time was 2 days. None of the patients had persistent urinary leak. The mean hospital stay was 3.2 days. Reduction in anteroposterior diameter was noticed in 91% cases on 12 weeks  follow-up scan. Complications included persistent or increase in hydronephrosis in three (9%) patients. In all the three patients, cystoscopic stenting was attempted. In two patients, size 4 Fr double J stent was passed easily into the renal pelvis. Onepatient improved, whereas other still has a dilated pelvis with static anteroposterior diameter after removal of stent at 6 weeks; patient is kept on close surveillance on regular ultrasonography. Re-exploration was performed in one patient, which showed kinking at the anastomosis site. Pyeloplasty was revised and patient improved. Other complications included lumbar hernia in one patient, which improved at 6-month follow-up, and stitch granuloma in one patient, which improved after removal of residual stitch.Conclusion Stentless surgery for UPJ obstruction is a safe and feasible technique; it reduces the cost of surgery and avoids multiple procedures. Keywords: management, pyeloplasty, stentless, ureteropelvic junction obstruction

Ethnomedicinal plants used against common digestive problems

Background: Ethnomedicinal knowledge is highly significant for persistence of human health care. Different studies have shown that medicinal plants are considered as curing agent for digestive disorders in Pakistan. The aim of present review is to explore this ethnomedicinal information all over the Pakistan and to investigate the ecological status of these species in the country.Methodology: Online literatures on ethnomedicinal plants used to treat digestive complaints in Pakistan were searched and gathered using online bibliographic databases including PubMed, Scopus, Google Scholar, Web of Science and Flora of Pakistan.Results: The review documented 178 medicinal plant species, belonging to 59 families, used for different digestive ailments. The majority of species were herbs (60%), used in drug preparation. The most frequent part used in preparation of these remedies is leaves (23%), followed by roots (19%).Conclusion: In conclusion, the study provides enormous ethno-medicinal knowledge and due to the unsustainable activities of the people of Pakistan, some medicinal plants need to be conserved for the future.Key words: Ethno-medicine, medicinal plants, gastrointestinal diseases, ecological status

Role of SAARC for Countering Terrorism in South Asia

Terrorism poses a serious threat to security of any region and South Asia has become one of the most dangerous regions of world due to terrorist activities. Since the inception of SAARC in 1985, concerns over terrorism have been showed and realization for collective regional mechanism is prominently highlighted in its agenda as the terrorism is threatening political stability and mutual understanding in the region. Owing to increased threats, terrorism was high on agenda during the 3rd summit of SAARC at Kathmandu in 1987. All the seven members signed ‘SAARC Regional Convention on Suppression of Terrorism and were agreed to take effective measures. The Convention warned the member countries against this menace and its dangerous effects towards regional security. In 1988, the convention came into force but did not control the terrorist activities by taking any effective measure. Several other initiatives have also been taken from this forum but the desired results are not achieved. The paper is to examine the counterterrorism initiatives taken by this forum and to explore impediments blocking the path of cooperation for an effective and joint strategy as well as suggestions for countering terrorism and securing regional peace and stability.&nbsp

ESAT6-Induced IFNγ and CXCL9 Can Differentiate Severity of Tuberculosis

BACKGROUND: Protective responses against Mycobacterium tuberculosis are dependent on appropriate T cell and macrophage activation. Mycobacterial antigen six kDa early secreted antigenic target (ESAT6) and culture filtrate protein 10 (CFP10) can detect M. tuberculosis specific IFNgamma responses. However, most studies have been performed in non-endemic regions and to study pulmonary tuberculosis (PTB). We have studied ESAT6 and CFP10 induced cytokine and chemokines responses in PTB and extrapulmonary (EPul) TB. METHODOLOGY: IFNgamma, IL10, CXCL9 and CCL2 responses were determined using an ex vivo whole blood assay system in PTB (n = 30) and EPulTB patients with limited (LNTB, n = 24) or severe (SevTB, n = 22) disease, and in healthy endemic controls (ECs). Responses to bacterial LPS were also determined. PRINCIPAL FINDINGS: ESAT6- and CFP10-induced IFNgamma was comparable between ECs and TB patients. Both ESAT6- and CFP10-induced IFNgamma secretion was greater in LNTB than PTB. ESAT6-induced CXCL9 was greater in EPulTB as compared with PTB, with an increase in SevTB as compared with LNTB. CFP10-induced CCL2 was higher in PTB than LNTB patients. LPS-stimulated CXCL9 was greatest in SevTB and LPS-induced CCL2 was increased in PTB as compared with LNTB patients. A positive correlation between ESAT6-induced IFNgamma and CXCL9 was present in all TB patients, but IFNgamma and CCL2 was only correlated in LNTB. ESAT-induced CCL2 and CXCL9 were significantly associated in LNTB while correlation in response to LPS was only present in SevTB. CONCLUSIONS: ESAT6 induced IFNgamma and CXCL9 can differentiate between limited and severe TB infections

Perinatal maternal antibiotic exposure augments lung injury in offspring in experimental bronchopulmonary dysplasia

Copyright © 2020 the American Physiological Society. During the newborn period, intestinal commensal bacteria influence pulmonary mucosal immunology via the gut-lung axis. Epidemiological studies have linked perinatal antibiotic exposure in human newborns to an increased risk for bronchopulmonary dysplasia, but whether this effect is mediated by the gut-lung axis is unknown. To explore antibiotic disruption of the newborn gut-lung axis, we studied how perinatal maternal antibiotic exposure influenced lung injury in a hyperoxia-based mouse model of bronchopulmonary dysplasia. We report that disruption of intestinal commensal colonization during the perinatal period promotes a more severe bronchopulmonary dysplasia phenotype characterized by increased mortality and pulmonary fibrosis. Mechanistically, metagenomic shifts were associated with decreased IL-22 expression in bronchoalveolar lavage and were independent of hyperoxia-induced inflammasome activation. Collectively, these results demonstrate a previously unrecognized influence of the gut-lung axis during the development of neonatal lung injury, which could be leveraged to ameliorate the most severe and persistent pulmonary complication of preterm birth

Current and Emerging Treatments for Urothelial Carcinoma: A Focus on Enfortumab Vedotin

Muhammad Ashir Shafique, Abdul Haseeb, Mohammad Arham Siddiq, Abdullah Mussarat, Hussain Sohail Rangwala, Muhammad Saqlain Mustafa Department of Medicine, Jinnah Sindh Medical University, Karachi, PakistanCorrespondence: Muhammad Ashir Shafique, Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Road, Karachi, Pakistan, Tel +92 334 326954, Email [email protected]: Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.Keywords: urothelial carcinoma, enfortumab vedotin, erdafitini

Role of oxidative stress and altered thyroid hormones in unexplained infertility

Objective: To explore the link between altered thyroid profile and oxidative stress marker in females with unexplained infertility. Methods: The cross-sectional case-control study was carried out at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2016 to August 2017, and comprised women aged 18-40 years regardless of ethnic background who were divided into two groups; those with unexplained infertility were the cases, while fertile women acted as the controls. Serum was analysed for triiodothyronine, thyroxine and thyroid stimulating hormone as well as for oxidative stress markers including manganese superoxide dismutase, glutathione reductase and adrenaline using enzymelinked immunosorbent assay. Data was analysed using SPSS 19. Results: Of the 88 subjects, there were 44(50%) in each of the two groups. There was no significant difference in terms of thyroids markers except thyroxine and thyroid stimulating hormone (p0.05). Conclusions: Increased thyroxine levels in females with unexplained infertility was associated with decrease in the serum levels of antioxidants