Unusual complications of hypospadias repair: diagnosis and management

Background: Epidermal inclusion cyst, smegma stones and urethral calculi of the penis are rare and may result as a late complication of hypospadias repair. This study reported the presentation and management of these late complications.Methods: A prospective observational study included male patients aged more than 6 years of age, who had undergone hypospadias repair 3-15 years back and presented with slow growing, non-tender, mobile, firm to hard swelling. Histopathological and radiographic examination were done and surgery was used for management of epidermal inclusion cyst, urethral calculi and smegma stone. Patients were followed up for one year, postoperatively.Results: Out of 15 patients, two (13.3%), four (26.7%) and nine (60%) patients were diagnosed with smegma stones, epidermal inclusion cyst and urethral calculi, respectively. The median (range) age of patients was 17 (8-30) years. Patients were presented with slow growing, non-tender, mobile swelling measuring from 1 cm x 3 cm to 2 cm x 1.5 cm. The average size of epidermal inclusion cyst, and urethral calculi was 2 cm x 2.5 cm x 1.5 cm, and 2 cm x 3 cm, respectively. Treatment were complete excision of cyst and removal of smegma stones by surgery and urethral calculi by dorsal urethrotomy. All patients had an uneventful postoperative period and were asymptomatic up to one year of follow-up.Conclusion: Results suggest that these complications can be managed with complete excision and surgical removal and care must be taken while performing the hypospadias repair to avoid these unusual late complications in patients

Spectrum of pediatric urinary stone composition in North Western India: analysis at tertiary care center

Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied

Lavage through malpositioned nasogastric tube: a cause of concern

Nasogastric tube (NGT) placement is a frequently used procedure in intensive care units either for enteral feeding or in cases of poisoning, where it is an important and emergent tool for gastric irrigation. Although, insertion of NGT has been pronounced as being easy and without risks, the increasing prevalence of the use of enteral feeding tubes during critical illness leads to the increased potential for malpositioning of a nasogastric tube. It is more hazardous if any therapeutic procedure has been performed through these malpositioned nasogastric tubes. Here, we are describing a unique case of malpositioning of nasogastric tube into left main bronchus in a case of unknown drug poisoning. The consequences of malposition of NGT, lavage through this NGT leading to grave respiratory complications and significance of a check x-ray chest following tube placement are discussed here

Radiographic manifestations of tuberculosis in HIV-co-infected patients and correlation of the findings with CD4 counts

Background: Chest X-ray plays a vital role in diagnosis of tuberculosis (TB) in HIV infection. These patients present with variable chest radiographic presentation, making diagnosis and treatment of TB notoriously challenging and increasing the risk of treatment failure, relapse, and even death. Aims: The objective of this study was to identify various radiological patterns of TB in HIV-TB-co-infected patients and to correlate with CD4 count. Setting and Design: This was an analytical cross-sectional study conducted in a tertiary care center in the southern part of Rajasthan, India. Materials and Methods: In our study, 110 consecutive patients with pulmonary TB-HIV co-infection were subjected to chest radiographs and evaluated for the types of lesion/TB; anatomical distribution, and type of radiological shadows. The findings were correlated with CD4 counts and sputum acid-fast bacilli (AFB) status. The main outcome measures were radiological shadows and their correlation with level of immune suppression. The sample size was 110 patients. Results: Patients of Group I (CD4 200). Nodular shadow (54.1% vs. 46.9%), consolidation (28.4% vs. 25.0%), hilar lymphadenopathy (23.0% vs. 9.4%), and miliary shadow (9.5% vs. 3.1%) in Group I, while cavitation (25.0% vs. 20.3%) and pleural effusion (18.8% vs. 16.2%) were more frequent in Group II. In Group I, consolidation (44.8% vs. 17.8%, P = 0.012) while in Group II, both consolidation (46.2% vs. 10.5%, P = 0.038) and cavitation (46.2% vs. 10.5%, P = 0.038) were present in significantly higher proportion in AFB-positive cases. Conclusion: A wide spectrum of radiographic shadows in consonance with varying CD4 counts was observed in the study. Along with well-known atypical radiological findings, some features were present throughout spectrum of CD4 counts, indicating that TB should be considered in this group of patients with these radiographic presentations, regardless of CD4 count. The small study population, majority of the patients' already hospitalized indicating serious nature of illness. In addition, no prospective follow-up of the study population to identify over the time changes in radiological pattern