Complete urethral duplication: description of surgical approach mimicking distal epispadias repair

ObjectiveTo present two cases of type IIA urethral duplication and propose a reproducible surgical approach.MethodsTwo cases are presented in this report. The first was a male child with a type IIA1 urethral duplication with two urethral channels arising from the bladder through separate bladder necks coursing to the glans penis. The second infant had a type IIA2 urethral duplication with a single bladder neck. Both children were repaired using a surgical approach that joined both urethral openings into a single orthopic meatus. This was accomplished by incising the common septum and utilizing techniques similar to that of a distal epispadias repair.ResultsAt six months of follow-up both infants are voiding from a single stream without complication. Long-term outcomes remain to be determined.ConclusionsThe technique presented in this report both functionally and cosmetically unites the two urethral meatuses while eliminating the risk of damage to the sphincter.     

Coinfection of Leptomonas seymouri and Leishmania donovani in Indian leishmaniasis

Leishmania donovani is considered the causative organism of visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL). Testing of 4/29 DNA samples from VL and PKDL patients as well as 2/7 field isolates showed an aberrant internal transcribed spacer 1 (ITS1) restriction fragment length polymorphism (RFLP) pattern, which upon sequencing strongly matched Leptomonas seymouri, thus confirming its presence in Indian leishmaniasis.     

Expanding the live kidney donor pool: ethical considerations regarding altruistic donors, paired and pooled programs

In renal transplant, there is a well-known deficiency in organ supply relative to demand. Live donation provides superior results when compared with deceased donation including a better rate of graft success and fewer immunologic complications. This deficiency in organs leads to significant morbidity and mortality rates. Alternative avenues have been extensively explored that may expand the live donor pool. They include altruistic donation as well as paired and pooled exchange programs. Altruistic donation is a truly selfless act from a donor unknown to the recipient. Kidney paired donation involves 2 incompatible donor-recipient pairs swapping donors to produce compatibility. Pooled donation involves at least 2 pairs, and can take the form of domino chains in which altruistic input sets up a chain of transplants, in which each recipient's incompatible donor makes a donation for the next recipient. Despite application of these various methods, there lie extensive ethical issues surrounding them. Misconceptions frequently occur; for instance, the perceived benefit that donating an organ to a loved one is greater for a related donor than for an altruistic one. Additionally, it is frequently believed that immunologic incompatibility offers coerced donors liberation from surgery, and that overcoming these barriers by introducing exchange programs provides vulnerable donors less protection. This article explores these and other complex ethical issues surrounding the various methods of expanding the donor pool. The authors offer opinions that challenge the ethical issues and attempt to overcome those views that hinder progress in the field.     

The Role of Religiosity and Guilt in Symptomatology and Outcome of Obsessive Compulsive Disorder

Importance:Religiosity and guilt are commonly featured in obsessive-compulsive disorders (OCD). The role of religiosity and guilt in OCD has been frequently studied in the literature and suggested that greater religiosity/spirituality, paranormal beliefs, and magical ideation have often been associated with enhanced obsessive-compulsive behavior. India being a multi-religious country, it is particularly notable that a research was required to assess the role of religiosity and guilt in symptomatology and outcome in OCD, a condition in which religious themes are often present. It has also been documented that the fear of guilt for doing something irresponsibly may lead to OCD symptoms.Objective:The study aimed to seek the role of religiosity and guilt in symptomatology and outcome of OCD. This study also aimed to assess the pattern of symptomatology of patients with OCD and the relation between religiosity and guilt.Settings and Design:This was a single-centered, prospective study for one year with six months follow-up.Methods and Material:Fifty OCD subjects of either gender, aged between 18 years and 45 years were included in this study and were assessed using Yale-Brown Obsessive Compulsive Scale, Belief into Action Scale, and The Guilt Inventory instruments for the measurement of OCD severity, religiosity, and guilt, respectively. All the recorded data were analyzed using IBM^® SPSS^® version 20.1.Results:At baseline, OCD severity was positively correlated with religiosity and guilt, while after 6-month follow-up, OCD severity was negatively correlated with religiosity and positively correlated with guilt.Conclusion:Religiosity and guilt have significant effect on the symptomatology and outcome of OCD.     

Cataract surgical reach: Falling short to catch white cataracts!

Purpose:The aim of this study was to know proportion of white cataracts from among patients coming for cataract surgery, and to find causes delaying uptake of cataract surgery.Methods:A hospital-based, prospective study enrolled patients of senile cataract between April 2018 and March 2019. The proportion of white cataract was calculated and underlying causes delaying uptake of cataract surgery studied.Results:White cataracts constituted 13.5% of total 3634 senile cataract patients, with gender disparity disfavoring women. Bilateral white cataract was presentation in 39 (8%) patients and lens-related glaucoma in 24 (5%) patients. Pseudophakia in the other eye was single most common cause of delay.Conclusion:A large proportion of white cataracts suggest that penetration of cataract surgical services in not reaching to the most eligible individual.