Contralateral Fracture of the Penis with Concomitant Urethral Injury – Report of a Rare Case

Penile refracture is a rare urological emergency, more so on the side contralateral to the previous fracture. A 55-year-old male was referred 70 hours after sudden detumescence during sexual intercourse, with a history of blood at the urethral meatus. The patient had had a fracture of the penis four years previously. Examination revealed ecchymosis and swelling of the proximal shaft and purulent discharge from a laceration in the penile skin over the proximal corpora. Ultrasonography revealed laceration of the right tunica albuginea and corpus cavernosum. Exploration revealed scar tissue at the site of the previous operation on the left side and a fresh laceration, 1cm in size, in the right corpus cavernosum in the mid shaft, and a urethral defect of 0.5 cm. The patient had normal erections post-operatively and no complications at 6 months followup. On literature review, anecdotal cases of contralateral refracture of the penis were found. High suspicion, prompt diagnosis and expedient surgical management are essential for a good outcome with minimal complication

MR texture analysis in differentiating renal cell carcinoma from Lipid-poor angiomyolipoma and oncocytoma

OBJECTIVES: To assess the utility of Magnetic resonance texture analysis (MRTA) in differentiating renal cell carcinoma (RCC) from lipid-poor angiomyolipoma (lpAML) and oncocytoma. METHODS: After ethical approval, 42 patients with 54 masses (34 RCC, 14 lpAML and six oncocytomas) who underwent MRI on a 1.5 T scanner (Avanto, Siemens, Erlangen, Germany) between January 2011 and December 2012 were retrospectively included in the study. MRTA was performed on the TexRAD research software (Feedback Plc., Cambridge, UK) using free-hand polygonal region of interest (ROI) drawn on the maximum cross-sectional area of the tumor to generate six first-order statistical parameters. The Mann-Whitney U test was used to look for any statically significant difference. The receiver operating characteristic (ROC) curve analysis was done to select the parameter with the highest class separation capacity [area under the curve (AUC)] for each MRI sequence. RESULTS: Several texture parameters on MRI showed high class separation capacity (AUC > 0.8) in differentiating RCC from lpAML and oncocytoma. The best performing parameter in differentiating RCC from lpAML was mean of positive pixels (MPP) at SSF 2 (AUC: 0.891) on DWI b500. In differentiating RCC from oncocytoma, the best parameter was mean at SSF 0 (AUC: 0.935) on DWI b1000. CONCLUSIONS: MRTA could potentially serve as a useful non-invasive tool for differentiating RCC from lpAML and oncocytoma. ADVANCES IN KNOWLEDGE: There is limited literature addressing the role of MRTA in differentiating RCC from lpAML and oncocytoma. Our study demonstrated several texture parameters which were useful in this regard

AN OVERVIEW OF INDUSTRIAL PROCESS VALIDATION OF TABLETS

Product quality is the mainstay of pharmaceutical industries and is derived from careful attention to a number of factors including selection of quality parts and materials, adequate product and manufacturing process design, control of the process variables, in-process and end-product testing. Process validation is an integral part of quality assurance program in industries. By validating each step of production process we can assure that the final product is of best quality. This review provides information on objectives and benefits of process validation, types of process validation, major phases in validation and regulatory aspects. Guidelines and strategy for process validation of solid dosage form are also discussed. Keywords: Quality, process variables, process validation, guidelines

Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence?

PURPOSE: To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. METHODS: We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. RESULTS: Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). CONCLUSION: Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings

Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for study of the liver

Hepatic encephalopathy (HE) is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Overt HE occurs in approximately 30-45% of cirrhotic patients. Minimal HE (MHE), the mildest form of HE, is characterized by subtle motor and cognitive deficits and impairs health-related quality of life. The Indian National Association for Study of the Liver (INASL) set up a Working Party on MHE in 2008 with a mandate to develop consensus guidelines on various aspects of MHE relevant to clinical practice. Questions related to the definition of MHE, its prevalence, diagnosis, clinical characteristics, pathogenesis, natural history and treatment were addressed by the members of the Working Party

Activating Fc γ receptors contribute to the antitumor activities of immunoregulatory receptor-targeting antibodies

Fc γ receptor (FcγR) coengagement can facilitate antibody-mediated receptor activation in target cells. In particular, agonistic antibodies that target tumor necrosis factor receptor (TNFR) family members have shown dependence on expression of the inhibitory FcγR, FcγRIIB. It remains unclear if engagement of FcγRIIB also extends to the activities of antibodies targeting immunoregulatory TNFRs expressed by T cells. We have explored the requirement for activating and inhibitory FcγRs for the antitumor effects of antibodies targeting the TNFR glucocorticoid-induced TNFR-related protein (GITR; TNFRSF18; CD357) expressed on activated and regulatory T cells (T reg cells). We found that although FcγRIIB was dispensable for the in vivo efficacy of anti-GITR antibodies, in contrast, activating FcγRs were essential. Surprisingly, the dependence on activating FcγRs extended to an antibody targeting the non-TNFR receptor CTLA-4 (CD152) that acts as a negative regulator of T cell immunity. We define a common mechanism that correlated with tumor efficacy, whereby antibodies that coengaged activating FcγRs expressed by tumor-associated leukocytes facilitated the selective elimination of intratumoral T cell populations, particularly T reg cells. These findings may have broad implications for antibody engineering efforts aimed at enhancing the therapeutic activity of immunomodulatory antibodies

Regulatory T Cells Suppress T Cell Activation at the Pathologic Site of Human Visceral Leishmaniasis

Suppression of T cell response is thought to be involved in the pathogenesis of visceral leishmaniasis (VL). Regulatory T cell (Treg) mediated immune-suppression is reported in animal models of Leishmania infection. However, their precise role among human patients still requires pathologic validation. The present study is aimed at understanding the frequency dynamics and function of Treg cells in the blood and bone marrow (BM) of VL patients. The study included 42 parasitologically confirmed patients, 17 healthy contact and 9 normal bone marrow specimens (NBM). We show i) the selective accumulation of Treg cells at one of the disease inflicted site(s), the BM, ii) their in vitro expansion in response to LD antigen and iii) persistence after successful chemotherapy. Results indicate that the Treg cells isolated from BM produces IL-10 and may inhibit T cell activation in IL-10 dependent manner. Moreover, we observed significantly higher levels of IL-10 among drug unresponsive patients, suggesting their critical role in suppression of immunity among VL patients. Our results suggest that IL-10 plays an important role in suppression of host immunity in human VL and possibly determines the efficacy of chemotherapy

Stochastic Expression of the Interferon-β Gene

The analysis of stochastic interferon-beta gene expression in virus-infected mammalian cells reveals that the levels of components required for virtually every step in the virus induction pathway are limiting