A patient safety culture is critical to providing high-quality healthcare. The purpose of this study was to assess nurses’ perceptions of patient safety culture at Ibri Hospital in Oman, as well as to identify key factors influencing their perceptions. The study also evaluated the efficacy of patient safety management practices, with an emphasis on improving safety outcomes and cultivating a culture of non-punitive error reporting. A cross-sectional, quantitative study was carried out using the Hospital Survey on Patient Safety Culture (HSOPSC), a validated tool for assessing PSC in healthcare settings. A stratified random sample of 100 registered nurses across various departments at Ibri Hospital participated in the study. The findings revealed a generally positive perception of patient safety culture, with high scores for teamwork within units (M = 4.10) and communication practices (M = 4.22). However, areas for improvement were identified, particularly in terms of workload management (M = 3.03) and the promotion of a non-punitive reporting culture (M = 3.61). The questionnaire’s overall reliability was high (Cronbach’s alpha = 0.975), indicating that the tool was internally consistent.
Background: The optimal timing of urethral catheter removal following percutaneous nephrolithotomy (PCNL) remains undefined, with practices varying widely. Early removal may reduce catheter-associated complications and accelerate recovery, but concerns about urinary retention, clot obstruction, and nephrostomy site leakage persist. Objective: To systematically evaluate the evidence on early urethral catheter removal (within 24 hours) versus delayed removal (beyond 24 hours) after PCNL, examining safety outcomes, patient comfort, and enhanced recovery endpoints. Methods: A systematic search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science were conducted up to May 2026. Studies comparing early catheter removal (postoperative day 0–1) with delayed removal (postoperative day ≥2) in adult PCNL patients were included. Outcomes assessed were urinary retention, recatheterization rates, hematuria, nephrostomy site leakage, pain scores, catheter-associated urinary tract infection (CAUTI), and length of stay. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Meta-analysis was performed where feasible using a random-effects model. The protocol was submitted to PROSPERO prior to data extraction and has now been registered (CRD4202461XXXX). Results: Twelve studies (4 randomized controlled trials, 8 observational studies) involving 1,847 patients met inclusion criteria. Early catheter removal did not increase the risk of urinary retention (RR 0.89, 95% CI 0.52–1.52, p=0.67) or recatheterization (RR 1.12, 95% CI 0.65–1.93, p=0.68). A sensitivity analysis restricted to the four RCTs confirmed these findings for both urinary retention (RR 0.94, 95% CI 0.38–2.31, p=0.89) and recatheterization (RR 1.05, 95% CI 0.42–2.62, p=0.92). CAUTI rates were significantly lower in the early removal group (RR 0.31, 95% CI 0.16–0.59, p<0.001). Pain scores were consistently and significantly lower after early removal (standardized mean difference -1.25, 95% CI -1.78 to -0.72, p<0.001). Nephrostomy site leakage did not differ between groups (RR 1.05, 95% CI 0.68–1.62, p=0.83). Early removal was associated with earlier ambulation; length of stay showed a non-significant trend toward reduction (MD −0.4 days, 95% CI −0.9 to 0.1, p=0.13; I² = 62%) and a confirmed benefit cannot be claimed. Conclusions: Early urethral catheter removal within 24 hours after uncomplicated PCNL is safe and does not increase the risk of urinary retention, clot retention, or nephrostomy leakage. It significantly reduces catheter-related pain and CAUTI rates while promoting earlier mobilization. Early removal should be incorporated into enhanced recovery protocols for PCNL.
Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. In Nepal, prevalence is rising, yet determinants of blood pressure (BP) control remain insufficiently understood. This study examined socio-demographic, lifestyle, and clinical factors associated with BP control among hypertensive patients attending a tertiary hospital. Methods: A descriptive cross-sectional study was conducted at the cardiology outpatient department of Bir Hospital, Kathmandu, between July and August 2018. A total of 360 hypertensive patients, aged ≥18 years with at least one year since diagnosis, were recruited using convenience sampling. Data on socio-demographics, hypertension knowledge, and lifestyle practices were collected using a validated bilingual questionnaire. BP was measured twice, and control was defined as <140/90 mmHg. Logistic regression was applied to identify independent predictors of BP control. Results: The mean age of participants was 50.8 ± 15.3 years; 59.4% were female, 52.5% resided in rural areas, and 48.9% lived in joint families. Overall, 21.9% (79/360) of participants achieved BP control, while 78.1% (281/360) were uncontrolled. Logistic regression showed that rural residence (OR 0.47, 95% CI 0.27–0.84, p = 0.012), alcohol use (OR 0.28, 95% CI 0.13–0.58, p = 0.001), and family history of hypertension (OR 0.50, 95% CI 0.28–0.89, p = 0.021) were associated with poorer control. Conversely, joint family structure (OR 1.51, 95% CI 1.10–2.08, p = 0.011) and reported normal salt intake (~5 g/day) (OR 7.69, 95% CI 2.68–22.0, p < 0.001) were positively associated with BP control. Conclusion: Socio-demographic and lifestyle factors strongly influence BP control in Nepal. Strengthening rural outreach, promoting family-based interventions, and delivering culturally appropriate counseling on alcohol reduction and dietary salt are essential. Future community-based longitudinal studies are recommended to validate these findings and inform national strategies.
A 13 year old post pubertal nomadic girl came to us with a history of recurrent lower abdominal pain and urinary incontinence of 3 years duration. She also had intermittent hematuria. She also stated that her late (mentally deranged) mother had inserted multiple needles into her (patient’s) vagina when she was 5 years of age. She underwent a successful 2 stage surgical procedure for removal of the needles, calculus and repair of the fistula.
Purpose: To explore the association between marital status and testosterone, and cortisol serum levels in 119 healthy men aged 45 to 60 years representing the general population. Material and Methods: Data on men’s age, waist circumference, body mass index, smoking, alcohol consumption, and marital status were collected. Serum levels of LH, testosterone, and cortisol were also measured. Two groups were identified according to marital status: paired (married, living together, and living apart) and unpaired men (divorced or separated). Results: The participants had a mean age of 55 (± 4.0 years). Testosterone level was significantly lower in paired as compared to unpaired men (14 nmol/L vs. 19 nmol/L, p = 0.01). The opposite trend was found regarding cortisol levels (350 nmol/L vs. 293 nmol/L, p = 0.01). No significant differences between the two groups were found regarding men’s age, body mass index, waist circumference, and LH level (p > 0.05). Using a multivariate regression analysis test adjusted for men’s age, body mass index, waist circumference, smoking, and alcohol consumption; a significant negative association between marital status and testosterone level (β = -04.00; 95% CI = -7.00, -1.00; p = 0.01), and a significant positive association between marital status and cortisol level (β = 47.00; 95% CI = 6.00, 89.00; p = 0.03) were found. Conclusions: Paired men were associated with lower testosterone levels. These findings might be partially explained by the concomitant higher cortisol level found in this group of men.
With trauma representing the leading cause of death in children, and renal injuries representing a large proportion of that trauma, understanding the appropriate management of renal injuries is vital to preventing pediatric morbidity and mortality. Cases involving aberrant anatomy are even more crucial to understand as there is less data on appropriate management. Here, a case is presented of a 7-year-old male presenting after a horse kick to the abdomen resulting in traumatic disruption of a previously unknown horseshoe kidney and the subsequent conservative management. The patient presented with abdominal pain, leukocytosis, and elevated liver function enzymes. An abdominal and pelvic Computed Tomography (CT) demonstrated a horseshoe kidney with a grade IV laceration to the isthmus and left lower pole of the kidney resulting in fracture/disruption of previously fused horseshoe kidneys. Additionally, there was a large retroperitoneal hematoma and hemoperitoneum. The patient was successfully managed with observation, and hemodynamic monitoring and has had resolution of hematoma and preserved kidney function through 8 months of follow-up. In conclusion, this is an example of how a patient with complicated renal anatomy can be managed conservatively to model for potential future cases.
Mullerianosis is a rare benign lesion consisting of an admixture of two or more of the following tissues: endometriosis, endocervicosis, and endosalpingiosis. It most commonly affects the urinary bladder and females of reproductive age group. Müllerianosis of the bladder is an extremely rare entity with fewer than 30 cases reported. Herein we report one such rare case of mullerianosis of the urinary bladder in a 33-year-old female who had undergone cesarian section 2 years back, presented with painless hematuria associated with menstruation. USG revealed a soft tissue lesion measuring 23×11 mm abutting the wall of the urinary bladder and extending into it. These findings were suspicious for endometriosis. The patient was admitted to the hospital for transurethral resection of a bladder lesion (TURBT). Operative findings revealed a solid 2x2 cm mass in the posterior wall of the urinary bladder. Superficial and deep TURBT chips were sent for histopathological examination. On microscopic examination, there were variable-sized glands lined by endometrial, endocervical, or tubal epithelium embedded in the bladder wall. The case was diagnosed as mullerianosis of the urinary bladder. As this rare entity, since it mimics benign and malignant neoplasms clinically and radiologically, pathologists should be aware of this rare entity to avoid misdiagnosis, which has great therapeutic implications for the patient.
A 33-year-old female patient who presented with urinary retention was found to have a large pelvic mass that was initially diagnosed as a pedunculated posterior wall uterine mass. Further evaluation revealed the mass to be a dumbbell-shaped neural tumor that extended into the sacral canal, corresponding to sacral segments 2, 3, and 4. The patient experienced no neurological deficits. The pelvic part of the tumor was eventually excised and the tumor portion in the sacral canal remained in place. The patient was followed up for 2 years and remained free of urological and neurological symptoms. Histological evaluation of the excised mass demonstrated that it was a neurofibroma.
Amyloidosis is a group of diseases in which insoluble proteins called amyloids deposit in tissues and cause problems with body functions. It is not a form of cancer but is a serious condition. It may be symptomatic or localized. The latter is a rare condition and the affection of the ureter has been reported in fewer than 50 cases so far. This case is unique because of its presentation with features of a urothelial tumor of the upper tract and bilateral involvement of the ureter. The affection of the ureters was separated by more than a decade. Given the knowledge gained after treating the first lesion, it was possible to anticipate and suspect a similar lesion affecting the other ureter. A conservative and reconstructive surgery was performed with gratifying results.
Background: For the majority of renal injuries, non-operative management is the standard of care with nephrectomy reserved for those with severe trauma. The aim of our study is to assess the characteristics of perinephric hematoma and other prognostic factors of surgical intervention for high-grade renal trauma independent of AAST OIS. Materials and methods: A total of 119 patients with high-grade renal trauma from January 2005 to September 2021 were identified for analysis. Hospital records and diagnostic imaging were reviewed to identify the need for surgical intervention, including total and partial nephrectomy. Factors examined include patient age, gender, ISS (Injury severity score), AAST-OIS, laceration location, length and number, perinephric hematoma characteristics, intravascular contrast extravasation, and devitalized segment status. Descriptive statistics and binary logistic regression were performed as appropriate. Results: The mean patient age was 31,39 and the mean ISS was 22,80. A total of 24 surgical interventions were required (20%) including partial and total nephrectomy. On univariate analysis, hypotension on admission, hematoma diameter, degree of devitalized fragment superior of 25%, and AAST OIS grade was associated with the need for surgical intervention. On multivariate analysis, only hypotension on admission (p: 0,029), hematoma diameter greater than 3,5 cm (p: 0,021), and AAST-OIS grade (p: 0,010 ) remained independently associated with surgical intervention. Conclusion: Perinephric hematoma size remains among prognostic factors for surgical intervention that allow better stratification of renal lesions and its study allows a better management of high-grade renal trauma.
Introduction: A varicocele is a vascular lesion characterised by dilatation and tortuosity of the veins of the pampiniform plexus and is found in approximately one-fifth of the adult male population. It is the most common cause of treatable infertility. Physical examination may or may not show a varicocele which is mostly diagnosed only when patients present with infertility or adolescents during a physical examination, like testicular hypotrophy, impairment in spermatogenesis mainly in the form of low or absent count, decreased sperm motility, and abnormal sperm morphology. Treatment for varicocele includes medical therapies, radiological embolization, and surgical techniques. Medical therapy, including antioxidants and anti-inflammatory agents, has been utilized with variable success. Radiological embolization of varicocele is a new technique in the treatment of varicocele, but it is associated with high recurrences and high cost. Varicoceles are surgically treated either by open or laparoscopic approaches the principal aim being occlusion of the dilated veins of the pampiniform plexus. A definitive conclusion of indication of medical treatment cannot be drawn at present because most published studies have inadequate design and lack controls. Various studies in the past have concluded significant changes in sperm parameters (total count, motility, morphology) post-varicocele repair. However, few other studies suggest no improvement in sperm parameters following surgical varicocele repair and studies that conclude recommendations against repair of varicocele. Thus, conflicting opinions have opened the scope to establish this fact by this study. Aim: To evaluate changes in sperm morphology, sperm count, and sperm motility in a patient with varicocele after varicocele surgery. Materials and methods: The study was conducted in the Department of Surgery, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi, India from August 2019 to February 2021. The sample size was calculated to be 50 using Slovin’s formula with a confidence level of 95% with a margin error taken as 5% (p - value 0.05). Sperm morphology, sperm count, and sperm motility were the parameters studied before and after 3 months of surgery. Results: The majority of patients belonged to the age group of 18 to 25 years (42%) followed by 26 to 35 years (40%) (27.78 ± 6.547 years). Left-sided varicocele was more common (54%), followed by bilateral varicocele (42%). Varicocele grade II was most common (58%) followed by grade I (30%) and lastly grade III (12%). Total sperm count improved by 8.88 million per ml after varicocelectomy. Total sperm motility improved by 6.08% after the surgery. Total normal sperm forms improved by 6.44% after varicocele repair. Conclusion: Based on the findings it was concluded that Varicocelectomy results in significant improvement in total sperm count, total sperm motility, and total normal sperm morphology. The best improvement was seen in sperm count followed by total normal sperm forms and lastly total sperm motility.
Robotic-Assisted Laparoscopic Radical Prostatectomy (RARP) is the gold standard surgical treatment for localized clinically significant prostate cancer. In patients undergone previous abdominal or pelvic surgery, it can be difficult to perform and it is also contraindicated execution of radiotherapy. We have described step-by-step the first case of RARP performed with the robotic system HugoTM RAS in a patient previously subjected to proctocolectomy and ileal pouch-anal anastomosis packaging for ulcerative colitis. The procedure was found to be safe and feasible, with intra- and post-operative data overlapping those of the same procedure in the general population. Execution by an experienced surgeon is in any case recommended.
Folk medicine has been considered one of the novel remedies for treating cancers. Women's cancers are increasing worldwide, and disease recurrence has been a major threat all over the world. Our current study focused on the formation of silver nanoparticles (AgNPs) by organic methods and their chemo-preventive capacity against the breast (MCF-7) and ovarian cancer (PA-1) cell lines from humans by employing MTT, Flow cytometry, and migration assays. Plant extracts in organic nanoparticle production have become more common in recent years due to their benefits, including affordability, effectiveness, simplicity and briefness. Melia azedarach leaf and fruit methanolic extracts were used to successfully create silver nanoparticles simultaneously to evaluate the potency and efficacy of the extracts. Characterization studies were performed using synthesized M. azedarach silver nanoparticles (MA-AgNPs). A typical SPR peak was discovered ranging from 400 nm (leaf) and 427 nm (fruit) using absorption spectroscopy, with an average particle size of 92.5 nm (leaf) and 124.1 (fruit) nm. The zeta potential for Melia leaves and fruits was found to be -20.9 and -31.2 mV for the extracts. The relevant functional groups for the capping agent found in the extracts and silver nanoparticles formed as a result of the reduction of silver nitrate were identified using Fourier transform infrared spectroscopy (FTIR). Antimicrobial activity against Escherichia coli, Bacillus aureus, Staphylococcus aureus, and Klebsiella pneumonia would be useful in new antimicrobial medications being developed. MCF-7 and PA-1 cell lines were found to be more susceptible to the cytotoxic action of the biosynthesized nanoparticles. The silver nanoparticles that were synthesized exhibited extremely positive anti-cancer activity.
Escherichia coli-induced urinary tract infections (E.coli-UTIs) are considered one of the most prevalent infections in Iran. One of the important factors of pathogenicity, particularly in its binding to epithelial cells, is the presence of iutA and papG virulence genes in Escherichia coli (E.coli). Lactobacilli, as a group of probiotics, play a vital role in the body and are useful in some cases due to their therapeutic effects. The aim of this study was to evaluate how the molecular activity of Lactobacillus casei PTCC1608 influences different strains of pathogenic E.coli isolated from urinary infections through PCR. In this study, the pathogenic strain of E.coli was isolated from the patients with Urinary Tract Infections (UTIs) and analyzed by the use of the PCR method. Then, the strains with positive genotypes were isolated and the antimicrobial effect of Lactobacillus casei was evaluated through the disc diffusion and dilution methods in liquid medium. The antimicrobial effect of Lactobacillus casei on E.coli bacteria isolated from urine samples from 40 patients with UTI was studied. In addition, the results of the antibiotic sensitivity test at 1:10 dilution showed a growth inhibition zone of 9 mm. The results indicated that the isolated bacterium was not resistant to the ampicillin and the antibiotic treatment was effective for this strain. Moreover, the probiotic also plays a therapeutic role and can improve urinary infections.
Several lesions of the bladder are incidental findings and a few of them are seen against a background of bladder outlet obstruction. Tuberculosis of the bladder is associated with characteristic lesions and changes. Presented here is a never-seen-before bladder lesion in a patient presenting with symptoms of Bladder Outlet Obstruction due to an enlarged tuberculous prostate, and no evidence of tuberculous cystitis.
Renal duplexing (also known as a duplicate collection system) occurs in about 1% of children and does not usually require medical attention. The condition results in two tubes rather than the normal single ureter tube for each kidney. Medical problems that warrant attention are obstruction of urine flow or the backflow of urine into the kidney (reflux). These double ureter tubes can join in a "y" shape before reaching the bladder (partial duplex) and combining their urine delivery. In other cases, each duplicate ureter empties into the bladder on its own (complete duplex). There is cause for concern when a duplex kidney is associated with urological conditions requiring treatment. Renal duplexing can cause urine to reflux into the kidney (vesicoureteral reflux) rather than going into the bladder and can cause subsequent Urinary Tract Infection (UTI). This can result in serious consequences like the loss of renal parenchyma (reflux nephropathy) and sometimes death in acute infections if not attended to in a timely manner. Weigert-Meyer postulated that rule i-e in a complete duplex system is mostly associated with reflux in lower moiety and obstruction in upper moiety with ectopic insertion and ureterocele. Ureteroceles may require simple management of symptoms or surgery, depending on the size of the ballooning, the functioning of the kidney and bladder and the degree of urine obstruction. An ectopic ureter is when the ureter opens and drains urine outside the bladder rather than inside.
Background: A prostatic biopsy is a diagnostic test used in cases of suspected prostate cancer. The patient expresses significant levels of anxiety from the very first outpatient visits; anxiety and pain management is essential for a successful outcome of the procedure. Lavender oil is one of the essential oils that is commonly used in aromatherapy to reduce anxiety and pain, its low toxicity and side effects have made it the preferred treatment in complementary medicine. Aim: To assess the 'effectiveness of lavender scent in decreasing the levels of anxiety and pain in patients undergoing a prostatic biopsy. Methods: An interventional non-pharmacological, randomized, two-arm, multi-center, nonprofit study. The SS Antonio e Biagio e Cesare Arrigo Hospital and the City of Alessandria Clinic, Monza Polyclinic of Alessandria, will enroll consecutively all adult patients undergoing outpatient prostatic biopsy from April 1, 2022, to October 1, 2022. The Numerical Rating Scale and Hamilton Anxiety Rating Scale will be used for assessments. Conclusion: Lavender oil aromatherapy could have a clinically significant effect on reducing pain and anxiety during prostatic biopsy procedures; its simple use, safety, and low cost provide a therapeutic option to be considered, complementary to other medical interventions in certain clinical settings.
Purpose: To compare accuracy in predicting final Gleason Grade Group (GGG) of Prostate Cancer (PCa) of US/MRI fusion guided target (fBx) vs. systematic Transrectal Ultrasound-Guided (TRUS) biopsy, using histopathologic analysis at prostatectomy as the gold standard. Materials and methods: After obtaining IRB approval, we retrospectively reviewed records of patients who underwent Radical Prostatectomy (RP) from January 2014 through May 2019 with prior US/MRI fusion guided target or TRUS biopsy. The rates of upgrading (RP GGG > BX GGG), downgrading (RP GGG < BX GGG), and concordance (RP GGG = BX GGG) were compared between the fBx and TRUS groups. Age, PSA, PSA density, and prostate volume were also noted for all patients. Statistical analysis was utilized to assess the data. Results: A total of 348 men with complete clinical data were included in this study. The rate of downgrading and upgrading in the fBx group was less than in the TRUS biopsy group (14% vs. 19.6%, and 13.2% vs. 19.6%, respectively). The concordance rate was higher in the US-MR fBx group (72.9% vs. 60.7%, p < 0.05)) across all GGG. Notably, lower rates of concordance were found for GGG 1 (24.1%) and GGG 4 (3.6%) in the TRUS Bx group. Patients who underwent US-MR fBx had higher average PSA (9.4 vs. 6.5 ng/ml), higher PSA density (0.3 vs. 0.2 ng/ml2), and lower prostate volume (31 vs. 42 cc). Additionally, biopsy results showed a lower rate of GGG 1 (3.1% vs. 13.2%) and a higher rate of GGG 5 (14.7% vs. 5.5%) in the US-MR fBx group. Conclusions: Target biopsy has a higher GGG concordance compared to TRUS biopsy (72.9% vs. 60.7%, p < 0.05). In addition, there was less downgrading or upgrading of final PCa GGG in the fBx groups compared to TRUS Bx (14% vs. 19.6%, 13.2% vs. 19.6%, respectively). This finding may have important implications for treatment decisions.
Objectives: Complication of obstetric fistula is the formation of bladder stones which rarely occur in Vagina-Vesico Fistula (VVF) patients. In this study, the metal and organic characterization of bladder stones removed between 2010-2019 from vesicovaginal fistula patients managed at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Ebonyi State, Nigeria were carried out. Methods: The solubility of the bladder stones in different solvents were investigated and metal compositions were determined using Inductively Coupled Plasma- Optical Emission Spectrometry (ICP-OESS). The qualitative chemical composition was determined following standard procedures while the structural chemical characterization and functional groups were determined using the Gas Chromatography-Mass Spectrometry (GC-MS) and Fourier-Transform Infrared spectroscopy (FTIR). Results: Distilled water and aqueous solvent chloroform extract of W. lateritia demonstrated significant capacity to dissolve bladder stones in-vitro. Chemical compounds identified include uric acid, oxalate, cysteine, and phosphate from the bladder stones. The metals found in the bladder stones were: Ca, Na, Cu, Zn, Mg, B, Pb, and Al. Trace elements can influence the external morphology of growing crystals and may increase or decrease the speed of the crystallization process. The GC-MS revealed the presence of the following compounds: methyl 2-Hydroxyethyl sulfoxide; methylene chloride; mercaptamine;1,1diethoxy, dichloroactealdehyde; Cyclopentasiloxane; monoammonium salt; di-Allo-Cystathionine; dichloroacetaldehyde; 2-(2Furyl)-2,5-dimethyltetrahydrofuran; Methenamine; 1,1-Difluoro-1-sila-5-thiacyclooctane; Triacetonetriperoxde; 4-Aminosalicylic acid, 3-Trimethylsilyl (3TMS) derivative;Pentanethiol; and 2,5-Bis-(5-hexyl-[1,3,2]dioxaborinan-2-yloxy)-benzene. FTIR revealed the following: hydroxyl, carboxylic, ester, aromatic, and aliphatic groups, confirming the compounds identified. Conclusion: Metals (Mg, Ca, Pb, etc), organic metabolites (oxalate, cystine, uric acid, phosphate, methenamine, methylene chloride, 4-Aminosalicylic acid, 3-Trimethylsilyl, etc) were found in the bladder stones.
The main target in the treatment of proximal ureteral stones (PUS) is to provide a high stone-free rate (SFR) with low morbidity. In this study, we aimed to evaluate the need for flexible ureteroscopy (URS) by retrospectively examining one surgeon’s two-year experience of URS for PUS in a center where the flexible ureteroscope and holmium laser lithotriptor are available.
