Introduction:Upper Urinary Tract Small Cell Neuroendocrine Ca are extremely rare carcinomas with less than 40 reported cases in literature. Case:92 years old male with left flank pain and diagnosed to have an enhancing renal pelvic mass, which on histopathological examination was noted to have a predominant small cell carcinoma component. Conclusion:This case report attempts to shed a light on the patients with small cell neuroendocrine carcinoma of the upper tract with its silent and aggressive nature.

Pseudosarcomatous osteoblastoma is a rare benign tumor that may mimicosteosarcoma, creating a diagnostic challenge in the maxillofacial region. We report a14-year-old boy presenting with a two-week history of pain, swelling, and tooth mobilityin the right mandible, unresponsive to NSAIDS. CBCT demonstrated an expansileosteolytic lesion with a Codman triangle type periosteal reaction, raising suspicion ofmalignancy. Incisional biopsy revealed pleomorphic osteoblastic proliferation withmultinucleated giant cells. Immunohistochemistry (SATB2 positive; H3G34W andTRPS1 negative) confirmed osteoblastic differentiation and excluded other entities.CECT further defined lesion extent and regional lymph nodes. The patient underwentsegmental mandibulectomy with level Ib lymphadenectomy and microvascularreconstruction. Final histopathology confirmed pseudosarcomatous osteoblastoma withclear margins. At six months, the patient remained disease-free with satisfactoryfunctional outcomes. This case underscores the importance of clinicopathologiccorrelation and multimodal imaging in managing aggressive jaw lesions.

Aim: To explore the association between urinary stone cultures and infectious complications following PCNL. Materials and Methods: An observational case-control study was conducted in patients undergoing PCNL. The assessment included demographic parameters, medical history, urinalysis, and urine culture and blood testing. Pre-operatively, urinary stone samples were collected for cultures. Post-operatively, patients were observed for infectious complications such as fever and/or SIRS. Patients were divided into two groups based on the presence or absence of infected renal calculi. Patient characteristics, stone factors, and intra-operative and post-operative findings were studied in relation to stone culture. Descriptive statistics was used to present the data and the SPSS software was used for analysis. Results: From December 2023 to March 2025, a total of 126 patients were included in the study. A total of 16 patients (12.6%) had a positive stone culture. Statistical significance was found upon the comparison of stone culture with gender (p = 0.046), chronic kidney disease (p = 0.002), pre-operative urine culture (p = 0.001), pre-operative haemoglobin (g/dL) (<0.001), pre-operative S. creatinine (mg/dL) (p = 0.038), stone volume (mm3) (p = 0.012), CROES score (p = 0.023), SIRS (p = 0.001), and AKI (p = 0.021). Conclusions: Infected renal calculi identified by positive stone cultures were strongly associated with infective complications such as fever and SIRS following PCNL. E. Coli was the dominant bacteria present in both bladder urine and renal stone culture. The occurrence of infectious complications despite the administration of pre-operative antibiotics highlights the antibiotic resistance patterns noted among the cultured bacteria. The pre-operative factors identified to be associated with a positive stone culture could potentially be used for predicting infected stones, thereby improving outcomes.

Background: Emphysematous pyelonephritis (EPN) is a well-known clinical condition characterized by an aggressive, gas-forming infection of the kidney caused by uropathogenic bacteria. There is growing interest in identifying the effects of EPN on long-term renal function and the factors that can help predict its impact. Objectives: This study evaluated risk factors for the development of poorly functioning kidneys (PFK) in patients diagnosed with EPN. Design: A retrospective study was conducted at a university teaching hospital on patients with EPN from January 2019 to December 2024. Methods: Data were collected from the prospectively maintained patient records, and patient demographics, comorbidities, clinical presentation, laboratory investigations, imaging characteristics, and interventions were analyzed. PFKs were defined as those with less than 15% differential function on radionuclide renography performed at follow-up. Data were analyzed using SPSS version 23 (IBM Corp.). A p -value <0.05 was considered statistically significant. Results: A total of 151 patients met the eligibility criteria. PFK was present in 23 patients (15.2%) on follow-up. Univariate analysis revealed random blood sugar (RBS) at presentation >200 mg/dL ( p < 0.0001), >50% parenchymal involvement on imaging ( p < 0.00001), Huang-Tseng Class 3b ( p < 0.00001), and persistence of gas in the renal parenchyma on follow-up imaging ( p < 0.0001) to be significantly associated with the development of PFK. Multivariate Analysis revealed that >50% parenchymal involvement on initial imaging was an independent and significant predictor of PFK. Conclusion: EPN is a fulminant renal infection with a high risk of renal functional deterioration. Renal parenchymal involvement of >50% on initial imaging emerged as the most significant and independent predictor of poor renal function. Additional contributory factors included RBS >200 mg/dL, Huang-Tseng Class 3b, and persistence of gas in the renal parenchyma on follow-up. Recognizing these clinical and radiological predictors can support early risk stratification, guide patient counseling, and inform individualized management strategies aimed at preserving renal function.

Introduction:Odontogenic orofacial infections involve a broad microbial spectrum, with the rise of multidrug-resistant organisms complicating management. ESKAPE pathogens, known for their ability to evade standard antimicrobial therapies, are increasingly implicated in severe infections. However, their prevalence and resistance patterns in odontogenic orofacial space infections remain insufficiently reported. This study aimed to identify the occurrence of ESKAPE pathogens in such infections and assess their antimicrobial susceptibility to guide effective treatment. Methodology:Between August 2019 and June 2022, 132 patients with oral and maxillofacial infections were prospectively enrolled. Pus samples collected using sterile swabs were cultured following standard protocols. Bacterial identification and susceptibility testing were performed using the VITEK 2-Compact system. Results:Twenty-nine samples (21.97%) yielded at least one ESKAPE pathogen, with Enterobacter species being the most common isolate (34.48%). High resistance rates were seen to amoxicillin-clavulanic acid (62.07%), cefuroxime (62.5%) and trimethoprim-sulfamethoxazole (68.42%). Linezolid, ertapenem, and clindamycin demonstrated the highest susceptibility (100%), followed by imipenem (86.96%, p ≤ 0.05). Acinetobacter baumannii demonstrated complete resistance to all tested antibiotics. Conclusion:ESKAPE pathogens represent a significant proportion of odontogenic orofacial infections and exhibit considerable resistance to commonly used antibiotics. These findings reinforce the necessity of culture-based therapy and highlight imipenem as a potential option for resistant cases. Strengthened antibiotic stewardship and continued surveillance are essential to manage the growing threat of multidrug-resistant organisms in maxillofacial infections.

This study investigated the effects of anatomical constrictions on ureteral flow dynamics using computational fluid dynamics (CFD). Constrictions such as those at the ureteropelvic junction (UPJ), vesicoureteral junction (VUJ), and external compression by the iliac artery are common clinical issues associated with significant morbidity. However, their impact on ureteral fluid flow remains insufficiently understood. Using patient-specific computed tomography (CT) data, a constant-diameter ureter model was reconstructed. Three constriction scenarios—UPJ, VUJ, and iliac artery compression—were developed and incorporated into this baseline model. CFD simulations were conducted in ANSYS CFX to evaluate flow patterns, pressure distribution, velocity profiles, and wall shear stress in both normal and constricted geometries. Results showed clear deviations in constricted models compared to the constant-diameter ureter, including localized upstream pressure increases and elevated flow velocities within narrowed regions. These findings provide quantitative insight into altered ureteral fluid dynamics and their role in conditions such as hydronephrosis and ureteral calculi. Overall, this study demonstrates the value of CFD in analyzing ureteral flow physiology and supports its potential for improving clinical diagnosis, prediction, and development of targeted therapeutic interventions for ureteral obstructions.

CaseA 67-year-old male with hematuria and diagnosed to have a left iliac fossa malrotated ectopic kidney with enhancing renal pelvic mass; which on histopathological examination was noted to be high grade UTUC- pT3N1.ConclusionThis is the first documented high grade UTUC case of an ectopic kidney in literature. The treatment of this disease can be challenging due in part to its aberrant vascular morphology and due to its location.

Introduction:Postoperative pain following third molar extractions is a significant concern, often managed using opioids and NSAIDs, associated with considerable side effects. Lignocaine patches, known for their localized action and minimal systemic effects, have shown promise in managing various pain conditions. This study aimed to evaluate the efficacy of 5 % lignocaine patches in reducing postoperative pain following third molar extractions. Methodology:A prospective, split-mouth study was conducted on 30 patients aged 18-40 years requiring bilateral extraction of impacted mandibular third molars. Post extraction on one side (test lignocaine patches were applied postoperatively, while post extraction of contralateral side, standard oral analgesics were given. Pain levels were assessed using the Visual Analog Scale (VAS) on the day of extraction, postoperative day (POD) 1 and POD 2. Additional patches or analgesics were provided if pain exceeded VAS thresholds. Results:The test group reported significantly lower mean VAS scores (1.96 ± 0.72) compared to the control group (2.55 ± 0.35, p = 0.004). Significant reduction in pain was observed in both groups over time, but the test group showed greater pain relief by POD 2 (p = 0.000) and no major adverse effects were reported, only 13.3 % experienced inadequate analgesia, requiring the need of a second patch. Conclusion:These findings suggest that 5 % lignocaine patches offer an effective alternative to oral analgesics for managing postoperative pain after third molar extractions. Further research, however, is recommended to explore their potential in reducing opioid use and their effectiveness in other minor oral surgical procedures.

Background:Hypertension secondary to giant hydronephrosis(GH)is a rare but treatable renal condition mediated by the renin-angiotensin-aldosterone system and tubuloglomerular feedback.In adults,GH is often diagnosed late due to nonspecific abdominal symptoms that may not manifest until advanced stages.Early identification is crucial,as failure to diagnose can lead to significant complications. Case Presentation:A 60-year-old hypertensive female presented with vague right-sided abdominal pain for two weeks.Contrast enhanced computed tomography of abdomen and pelvis revealed a grossly hydronephrotic right kidney with severe pelvicaliectasis crossing the midline with thinned out parenchyma,due to ureteropelvic junction obstruction(UPJO).A renogram confirmed a non-functioning right kidney.She underwent right nephrectomy,during which 2.5 L of hemorrhagic fluid were drained.Histopathology con-firmed hydronephrosis with chronic pyelonephritis.Postoperatively,her hypertension resolved,and antihypertensive medication was discontinued.At 1-and 3-month follow-ups,her blood pressure remained stable,under-scoring the connection between GH and secondary hypertension. Conclusion:GH in adults is a rare but treatable cause of secondary hyper-tension.Clinicians should consider renal imaging for patients presenting with unexplained hypertension to rule out hydronephrosis,ensuring timely diagnosis and management.

INTRODUCTION:Various nephrolithometry scoring systems have been introduced to assess the outcomes of percutaneous nephrolithotomy (PCNL) and postoperative complications. Previous studies have incorporated various variables to determine factors influencing postoperative acute kidney injury (AKI). Using separate scoring systems or nomograms to predict postoperative outcomes and AKI is cumbersome. Our study aims to find if stone scoring systems can be used to predict AKI following a PCNL procedure. MATERIALS AND METHODS:A prospective observational study was conducted at Kasturba Hospital and Medical College from December 2023 to June 2024. All patients undergoing PCNL were included in the study. Scores were calculated for all patients pre-operatively using various nephrolithometry scoring systems. Patients were divided into two groups based on the presence or absence of AKI following PCNL. The various stone scoring systems were assessed for their ability to predict AKI following PCNL. RESULTS:Out of the 90 patients in the study, 15 (16.66%) developed AKI, and 75 (83.33%) had no AKI following PCNL. Statistical significance was found in stone size (p < 0.001), stone location (p = 0.011), Staghorn (p < 0.001), Guy's Score (p = 0.001), STONE score (0.002), CROES Score (p = 0.001), Amplatz size (p = 0.012) and energy source (p = 0.01). No statistical significance was found when comparing sex, comorbidities, number of stones, the severity of HN, puncture location and number, intraoperative hypotension, operative time, and duration of hospital stay. CONCLUSION:Nephrolithometry scoring systems, in addition to assessing postoperative outcomes such as stone-free rate and complications, can also be used to predict the occurrence of AKI. The use of a limited number of scoring systems to assess all the postoperative outcomes will help simplify and facilitate their use in routine clinical practice.

Patients with skeletal malocclusions undergo orthognathic surgery to achieve a superior facial esthetic profile. However, stable occlusion following orthognathic surgery is also paramount. This study was thus designed to conduct a functional analysis of occlusion, in terms of relative distribution of bite force in patients who underwent bi-jaw orthognathic surgeries using a T-Scan device. A prospective study was carried out on 40 patients between the age group of 18–32 years having skeletal malocclusions requiring bi-jaw orthognathic surgeries. The relative difference in bite force between the right and left side was measured using a T-Scan pre-operatively and at third month post-operatively. The data were analyzed statistically. The study included 40 patients (14 males and 26 females) with a mean age of 22.7 years. The mean difference in bite force pre-operatively was 27.95

Over the past four decades, reports have emphasized the spatial and temporal trends in human semen quality and other markers of male reproductive health, which have sparked significant debate among fertility professionals. This trend appears limited to specific geographical regions rather than being global. The study aimed to retrospectively review the comprehensive distribution of semen characteristics and analyze their temporal changes over a period of 17 years at a single center in the southern parts of India. Ejaculates of 12,151 sub-fertile men undergoing infertility workup at the University Andrology Laboratory from 2006 to 2022 were included. Semen analysis was performed as per the World Health Organization (WHO, 1999, 2010) recommendations. The primary outcome of interest was temporal changes in semen parameters, whereas data regarding the distribution of semen characteristics were also measured. Sperm concentration, total sperm number, motility, vitality, and morphology showed no significant variations over time. The fifth percentile of semen volume, sperm concentration, total motility, vitality, and normal morphology were 0.5 mL, 1.5 million/mL, 21.0%, 28.0%, and 7.0%, respectively. This study revealed no temporal decline in sperm concentration, motility, and morphology in 17 years, and found fifth percentile sperm characteristics were lower than WHO reference values, marking the extensive long-term semen quality analysis from a single Indian laboratory. The findings reported here do not support an alarming temporal decline in semen quality.

Background:Priapism is a prolonged penile erection for more than 4 hours unrelated to sexual stimulation. Rarely, it is the first clinical sign of an underlying haematological malignancy. A similar presentation is noted in childhood leukaemias. Although rare, it is known to occur and, if not managed early, can have poor long-term outcomes in terms of erectile function and psychosexual growth. We present a scoping review of leukaemia-associated priapism in children (LAPC). Methodology:We researched literature using PubMed, Google Scholar, Embase, Scopus and Cochrane databases from January 1990 to 2024. Applicable search limiters were applied, and grey literature was excluded. Results:A total of 31 articles were finally included in the review, from which 51 cases of LAPC were isolated and studied. The average age was 11.5 years, with chronic myeloid leukaemia (CML) being the most common malignancy (68.9%), and more than 71% of cases of CML with priapism were detected in the chronic phase. Twenty cases (39.2%) were managed with corporal lavage and sympathomimetic injections at the initial onset, with the rest managed with cytoreductive measures initially. Follow-up data revealed the death of three children, whereas, of those that survived, fourteen had preserved erectile functions after a variable period of time. Conclusion:Priapism in children warrants a thorough physical examination focusing on organomegaly and a complete hemogram. Initial management should be two-pronged with a priapism-directed corporal-lavage approach and cytoreductive measures for better long-term outcomes.

Background and objective:Our aim was to assess the feasibility of percutaneous nephrolithotomy (PCNL) as a day-care procedure and define the patient, stone, and perioperative characteristics of cases most suitable for this option. Methods:In this prospective observational study, patients with renal stones undergoing PCNL were enrolled on the basis of predefined inclusion and exclusion criteria. Day-care PCNL was defined as discharge within 24 h after surgery. A day-care PCNL checklist with preoperative, intraoperative, and postoperative factors was formulated on the basis of the study outcomes. Key findings and limitations:A total of 347 consecutive patients underwent PCNL, of whom 300 underwent day-care PCNL. The mean age of the study population was 47 yr (standard deviation [SD] 13). Mean body mass index was 27 kg/m2 (SD 13.52) and the mean Charlson Comorbidity Index (CCI) was 0.32 (SD 0.50). The mean stone volume was 1625 mm (SD 1376.24) and mean STONE score was 6.06 (SD 0.75). The tract size for 169 mini-PCNL procedures was ≤20 Fr and for 131 standard PCNL procedures was >20 Fr. The unplanned revisit rate was 6% and the readmission rate was 4.3%. The mean time from surgery to an unplanned revisit was 9 d (SD 5.34, range 3-20 d). Five patients had Clavien-Dindo grade 1, 12 had grade 2, and one had grade 3b complications. CCI score of 2 (p = 0.024) and stone volume >5000 mm3 (p = 0.021) were significantly associated with readmission. Diabetes (p = 0.039) was significantly associated with Clavien-Dindo grade ≥2 complications. The stone-free rate was 93%. Conclusions:PCNL is safe and feasible as a day-care procedure when applied to a carefully selected patient cohort, and can reduce hospital length of stay while maintaining acceptable rates of readmission and Clavien-Dindo grade ≤2 complications. Our proposed day-care PCNL checklist can help in identifying the most suitable patients for this strategy and ensuring optimal outcomes. Patient summary:We looked at outcomes for minimally invasive surgery to remove kidney stones performed as a day-care procedure in selected patients. We formulated a checklist that can help in selecting the patients most suitable for day-care surgery. This procedure is safe and feasible on a day-care basis for suitable patients.

Objectives To evaluate the occurrence, risk factors, and outcomes of post PCNL (Percutaneous Nephrolithotomy) Acute Kidney Injury (AKI), with a secondary goal of developing a nomogram for post-PCNL AKI prediction. Methods A prospective observational study was conducted enrolling 333 patients who underwent PCNL between February 2022 and February 2023. Patient demographics, comorbidities, perioperative lab parameters, stone characteristics, intraoperative details, and postoperative AKI were assessed. Logistic regression analyses were employed to construct a nomogram for predicting post-PCNL AKI. Results 40 patients (12.4%) experienced postoperative AKI, with recovery observed in all cases during the 3-month follow-up. Female gender ( p = 0.002), hypertension( p = 0.022), higher serum uric acid levels( p = 0.003), staghorn calculi( p = 0.001), higher Hounsfield Units( p = 0.013), bilateral PCNL( p < 0.001), larger tract size( p = 0.017), longer operative time( p < 0.001), greater stone volume( p = 0.025), higher baseline serum creatinine levels( p < 0.001), higher postoperative total leukocyte count( p = 0.005), and postoperative fever( p < 0.001) were significantly associated with the AKI group. Regression analysis identified female gender (OR = 0.26, p = 0.035), higher serum uric acid levels(OR = 1.62, p = 0.013), bilateral PCNL(OR = 12.55, p < 0.001), longer operation time(OR = 1.02, p = 0.047), and larger stone volume(OR = 1.12, p = 0.015) as independent risk factors for postoperative AKI. The internally validated nomogram( n = 70) for predicting AKI demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.984(95% CI, p < 0.001). Conclusion AKI occurs in approximately 12% of patients undergoing PCNL. We identified several significant predictors of post-PCNL AKI, including female gender, hypertension, hyperuricemia, higher Hounsfield units, larger stone volume, bilateral PCNL, larger access tract size, and longer operative time. Awareness of these factors is crucial for optimizing management and improving patient outcomes.

Introduction: Staghorn calculi are branching stones that usually fill the renal pelvis and branch into a few or all the calices. However, complex caliceal and staghorn stones are difficult to remove with a single-tract PCNL approach. A trend toward the use of percutaneous monotherapy using multiple tracts as the preferred treatment option for most staghorn or complex calculi has emerged. Methods: The single center observational study was carried out on 51 adult patients having staghorn stone from January 2020 to June 2022 at KMC Manipal. Imaging was done to assess the size of the stones, the anatomical features of the kidney and its function, and to accurately plan the operative approach. PCNL was performed in the prone-position; Postoperatively, patients were monitored determining the efficacy of PCNL, perioperative blood loss, the duration of the operative procedure and hospital stay, and the resulting complications. Results: 42 Single tracts (82.35%), 09 Multiple tracts (17.64%) PCNL was performed. Stone burden=complete staghorn, 33 (64.70%), Partial staghorn 18 (35.30%). Mean age was 48.65 years. Mean length of stones, 25.28 mm. Number of stone, Single-31 (60.78%), Multiple-20 (39.22%). Mean procedure time 117.28±9.12. 9 patients had bleeding requiring blood transfusion and one patient requiring angioembolization. Conclusion: PCNL is effective and safe in management of staghorn renal stones.

To assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24–30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm. From February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups. Mean stone volume (2.41 cm2 vs 2.61 cm2) and stone-free rates (98

Background: The overall survival rates are below 10% in patients with metastatic renal cell carcinoma (RCC) posing a significant health challenge. There is a pressing need for novel and simple predictors of metastasis in patients with RCC to aid in early detection, thereby having prognostic and therapeutic implications. Objectives: To assess the efficacy of various inflammatory markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Systemic Inflammatory Response Index (SIRI), and Systemic Immune-Inflammatory Index (SII), in predicting metastasis amongst individuals diagnosed with RCC. Methods: A retrospective study was undertaken at a tertiary hospital, focusing on individuals diagnosed with RCC. Patients were divided into two groups: Those with and without metastases. Patient demographics and clinical, pathological, and laboratory data were collected. The researchers evaluated the predictive capabilities of NLR, PLR, SIRI, and SII using ROC curves, with cut-off points determined via the Youden Index. Results: Of the 91 patients, 25 (27.5%) had metastatic RCC. Significant differences in NLR (P = 0.047), PLR (P = 0.004), SIRI (P = 0.006), and SII (P = 0.005) were noted between metastatic and non-metastatic groups. The ROC analysis showed that SIRI and SII had the highest predictive capacity with areas under the curve (AUCs) of 0.687 and 0.693, respectively. Logistic regression demonstrated NLR, PLR, SII, and SIRI as independent predictors of metastasis in RCC, with a combined predictive accuracy of 83.5%. Conclusions: Neutrophil-lymphocyte ratio, PLR, SIRI, and SII are reliable predictors of metastasis in RCC, with their combined use enhancing predictive accuracy. These hematological parameters can be easily derived from routine blood tests, could help in the early diagnosis of metastases, and tailor the management of RCC, improving patient outcomes. Further multicentric studies are recommended to validate these findings and help integrate them into clinical practice.