INTRODUCTION The management of subdural hematoma (SDH) in the setting of antithrombotic (AT) ther... more INTRODUCTION The management of subdural hematoma (SDH) in the setting of antithrombotic (AT) therapy, which includes antiplatelet and anticoagulant therapy, is especially challenging. While there exists consensus that AT should be discontinued during initial workup and surgical treatment of SDH, guidance regarding whether and when to restart AT is lacking. This study aims to characterize the association between the timing of AT restart and rates of thrombotic and hemorrhagic adverse events among SDH patients previously on AT in order to inform future clinical decision making. METHODS A 10-yr retrospective analysis of SDH patients treated with antiplatelet or anticoagulant therapy was performed. Patients were grouped based on time to restart of AT therapy from admission (within 14, 15–29, 30–44, 45–59 d, and not within 60 d), and multivariable regression was used to compare the rates of adverse events between these groups. Adverse events included bleeding, thromboembolism, myocardial...
Patients with abnormal body habitus because of spinal deformities and patients having undergone p... more Patients with abnormal body habitus because of spinal deformities and patients having undergone previous spinal surgeries present a challenge during surgical, anesthesiologic, and technical procedures. In these patients, management of urolithiasis may be difficult because of anatomic variations and respiratory dysfunction, stone size, spinal deformities, or risk of spinal injuries. Percutaneous nephrolithotomy (PCNL) as monotherapy has advantages in removing large stones and achieving excellent results with minimal morbidity. PCNL in supine position has several advantages attached to it, which include improvement in anesthetic management, decreased intrarenal pressures, decreased radiation exposure and improved ergonomics of fluoroscopy, improvements in patient positioning, and shorter operative time. We report a case of supine PCNL in a patient who was operated previously on the cervical and lumbar spine.
PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 check... more PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol. (PDF 145Â kb)
Additional file 1. PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Pr... more Additional file 1. PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol.
Evidence from several studies has shown that the penile length varies among different populations... more Evidence from several studies has shown that the penile length varies among different populations of different racial/ethnic groups. Size abnormalities of the newborn external genitalia may be a pointer to some endocrine and genetic disorders. In this study we have prospectively measured the stretched penile length of all newborns at our hospital in an attempt to define normative data for full term neonates of our region. All live male neonates born at our hospital were enrolled into the study. Stretched penile length was measured from the pubic ramus to the tip of the glans penis using a digital Vernier Calliper. The measurements were taken within 48 hours of birth. Two consecutive measurements were taken and the average was recorded as the final measurement. The mean stretched penile length was 2.63±0.35 mm and the mean diameter of glans was 1.04±0.09 mm respectively. The penile length significantly varied with the length (height) of the neonate as expressed in cms. The taller the...
Hypospadias is a very common congenital anomaly in which the urethra opens onto the ventral aspec... more Hypospadias is a very common congenital anomaly in which the urethra opens onto the ventral aspect of the penis rather than at the tip. It has an incidence of less than 1% of live male births. In humans, anogenital distance (AGD) is a sexually dimorphic measure of genital development. In this study, we intended to examine the association between AGD and hypospadias using a homogenous group of patients. The same investigator examined all male newborns in our hospital, and anthropometric measurements of the anogenital distance were recorded. All the measurements were made in millimeters (mm) with a sliding digital caliper (graduated in millimeters) used for measuring the distance between the base of the scrotum to the center of the anus; defined as AGD. During the period Jan 2015 to December 2019 (both inclusive), there were 28,426 (14,615 males and 13,811 females) full-term live births in our hospital. The gestational age of the newborns ranged from 37 to 42 weeks. The mean AGD was 2...
1Assistant Professor, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India 2Former Associa... more 1Assistant Professor, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India 2Former Associate Professor, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India 3U.G. Student, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India ---------------------------------------------------------------------***---------------------------------------------------------------------Abstract Climatic variability particularly rainfall and temperature has received a greater attention throughout the world. Climate change and its variability in the climatic parameters may adversely affect the agriculture sector and water resources of agrarian country like India. The research on change of rainfall, occurrence and its allocation are the most significant way for sustainable water resource management and food security. Hence an understanding of rainfall patterns in the changing environment will help in better decision making and improving the adopting of the communities to sustain the extr...
A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symp... more A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symptoms consistent with COVID-19 infection. Apart from a small left-sided ischaemic stroke 10 years prior with very minor residual deficit, he had been well and in full-time employment until development of symptoms. Within minutes of commencing non-invasive ventilation (NIV) in the ED, he developed a complete left-sided paralysis and hemineglect. This case highlights the significance of the prothrombotic complications associated with COVID-19 infection. It also raises the question whether pressure changes upon commencing NIV could lead to clot migration.
The placement of a penile prosthesis has been considered the most reliable and effective treatmen... more The placement of a penile prosthesis has been considered the most reliable and effective treatment for erectile dysfunction in men with failed medical treatment. The 2-piece system eliminates a need for separate reservoir making the surgery easy for the treating surgeon/urologist. We report the use of this two-piece prosthesis in a 50-year-old patient with erectile dysfunction and describe the surgical steps of the same.
The current coronavirus pandemic forces us to realize the significance of the careful utilization... more The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long wa...
The urachus or median umbilical ligament is a normal embryonic remnant of the primitive bladder d... more The urachus or median umbilical ligament is a normal embryonic remnant of the primitive bladder dome and extends upward from the anterior dome of the bladder toward the umbilicus. The tubular urachus is normally changed into a fibrous band after birth. If this regression is incomplete, disorders of the urachus can appear. Umbilical-urachal sinus occurs when the umbilical end of the urachus fails to obliterate and persists as a fusiform outpouching structure just below the navel. Periumbilical pain and tenderness with a periodic discharge through the navel and a wet umbilicus are usually reported in patients with an umbilical-urachal sinus. We report the case of a 40-year-old, diabetic, and hypertensive male presenting with recurrent episodes of pus discharge from the umbilicus. Further, evaluation with a computed tomography confirmed the presence of urachal sinus. We discuss the management of the same, along with a brief review of the literature.
Flecainide toxicity can result in increased cardiovascular instability which can significantly al... more Flecainide toxicity can result in increased cardiovascular instability which can significantly alter patient outcome if not recognised early. In this case report, the management of a 68-year-old woman who took an unintentional overdose of flecainide is detailed. We look at the management she received in the emergency department and her successful recovery and follow-up since the admission. In addition, the case report outlines the ECG changes that are most commonly documented in flecainide overdose and reviews the frequently used treatment methods for the overdose as summarised in current literature.
INTRODUCTION The management of subdural hematoma (SDH) in the setting of antithrombotic (AT) ther... more INTRODUCTION The management of subdural hematoma (SDH) in the setting of antithrombotic (AT) therapy, which includes antiplatelet and anticoagulant therapy, is especially challenging. While there exists consensus that AT should be discontinued during initial workup and surgical treatment of SDH, guidance regarding whether and when to restart AT is lacking. This study aims to characterize the association between the timing of AT restart and rates of thrombotic and hemorrhagic adverse events among SDH patients previously on AT in order to inform future clinical decision making. METHODS A 10-yr retrospective analysis of SDH patients treated with antiplatelet or anticoagulant therapy was performed. Patients were grouped based on time to restart of AT therapy from admission (within 14, 15–29, 30–44, 45–59 d, and not within 60 d), and multivariable regression was used to compare the rates of adverse events between these groups. Adverse events included bleeding, thromboembolism, myocardial...
Patients with abnormal body habitus because of spinal deformities and patients having undergone p... more Patients with abnormal body habitus because of spinal deformities and patients having undergone previous spinal surgeries present a challenge during surgical, anesthesiologic, and technical procedures. In these patients, management of urolithiasis may be difficult because of anatomic variations and respiratory dysfunction, stone size, spinal deformities, or risk of spinal injuries. Percutaneous nephrolithotomy (PCNL) as monotherapy has advantages in removing large stones and achieving excellent results with minimal morbidity. PCNL in supine position has several advantages attached to it, which include improvement in anesthetic management, decreased intrarenal pressures, decreased radiation exposure and improved ergonomics of fluoroscopy, improvements in patient positioning, and shorter operative time. We report a case of supine PCNL in a patient who was operated previously on the cervical and lumbar spine.
PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 check... more PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol. (PDF 145Â kb)
Additional file 1. PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Pr... more Additional file 1. PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol.
Evidence from several studies has shown that the penile length varies among different populations... more Evidence from several studies has shown that the penile length varies among different populations of different racial/ethnic groups. Size abnormalities of the newborn external genitalia may be a pointer to some endocrine and genetic disorders. In this study we have prospectively measured the stretched penile length of all newborns at our hospital in an attempt to define normative data for full term neonates of our region. All live male neonates born at our hospital were enrolled into the study. Stretched penile length was measured from the pubic ramus to the tip of the glans penis using a digital Vernier Calliper. The measurements were taken within 48 hours of birth. Two consecutive measurements were taken and the average was recorded as the final measurement. The mean stretched penile length was 2.63±0.35 mm and the mean diameter of glans was 1.04±0.09 mm respectively. The penile length significantly varied with the length (height) of the neonate as expressed in cms. The taller the...
Hypospadias is a very common congenital anomaly in which the urethra opens onto the ventral aspec... more Hypospadias is a very common congenital anomaly in which the urethra opens onto the ventral aspect of the penis rather than at the tip. It has an incidence of less than 1% of live male births. In humans, anogenital distance (AGD) is a sexually dimorphic measure of genital development. In this study, we intended to examine the association between AGD and hypospadias using a homogenous group of patients. The same investigator examined all male newborns in our hospital, and anthropometric measurements of the anogenital distance were recorded. All the measurements were made in millimeters (mm) with a sliding digital caliper (graduated in millimeters) used for measuring the distance between the base of the scrotum to the center of the anus; defined as AGD. During the period Jan 2015 to December 2019 (both inclusive), there were 28,426 (14,615 males and 13,811 females) full-term live births in our hospital. The gestational age of the newborns ranged from 37 to 42 weeks. The mean AGD was 2...
1Assistant Professor, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India 2Former Associa... more 1Assistant Professor, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India 2Former Associate Professor, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India 3U.G. Student, Dept. of Civil Engineering, PESCE, Mandya, Karnataka, India ---------------------------------------------------------------------***---------------------------------------------------------------------Abstract Climatic variability particularly rainfall and temperature has received a greater attention throughout the world. Climate change and its variability in the climatic parameters may adversely affect the agriculture sector and water resources of agrarian country like India. The research on change of rainfall, occurrence and its allocation are the most significant way for sustainable water resource management and food security. Hence an understanding of rainfall patterns in the changing environment will help in better decision making and improving the adopting of the communities to sustain the extr...
A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symp... more A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symptoms consistent with COVID-19 infection. Apart from a small left-sided ischaemic stroke 10 years prior with very minor residual deficit, he had been well and in full-time employment until development of symptoms. Within minutes of commencing non-invasive ventilation (NIV) in the ED, he developed a complete left-sided paralysis and hemineglect. This case highlights the significance of the prothrombotic complications associated with COVID-19 infection. It also raises the question whether pressure changes upon commencing NIV could lead to clot migration.
The placement of a penile prosthesis has been considered the most reliable and effective treatmen... more The placement of a penile prosthesis has been considered the most reliable and effective treatment for erectile dysfunction in men with failed medical treatment. The 2-piece system eliminates a need for separate reservoir making the surgery easy for the treating surgeon/urologist. We report the use of this two-piece prosthesis in a 50-year-old patient with erectile dysfunction and describe the surgical steps of the same.
The current coronavirus pandemic forces us to realize the significance of the careful utilization... more The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long wa...
The urachus or median umbilical ligament is a normal embryonic remnant of the primitive bladder d... more The urachus or median umbilical ligament is a normal embryonic remnant of the primitive bladder dome and extends upward from the anterior dome of the bladder toward the umbilicus. The tubular urachus is normally changed into a fibrous band after birth. If this regression is incomplete, disorders of the urachus can appear. Umbilical-urachal sinus occurs when the umbilical end of the urachus fails to obliterate and persists as a fusiform outpouching structure just below the navel. Periumbilical pain and tenderness with a periodic discharge through the navel and a wet umbilicus are usually reported in patients with an umbilical-urachal sinus. We report the case of a 40-year-old, diabetic, and hypertensive male presenting with recurrent episodes of pus discharge from the umbilicus. Further, evaluation with a computed tomography confirmed the presence of urachal sinus. We discuss the management of the same, along with a brief review of the literature.
Flecainide toxicity can result in increased cardiovascular instability which can significantly al... more Flecainide toxicity can result in increased cardiovascular instability which can significantly alter patient outcome if not recognised early. In this case report, the management of a 68-year-old woman who took an unintentional overdose of flecainide is detailed. We look at the management she received in the emergency department and her successful recovery and follow-up since the admission. In addition, the case report outlines the ECG changes that are most commonly documented in flecainide overdose and reviews the frequently used treatment methods for the overdose as summarised in current literature.
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