Dengue hemorrhagic fever as a rare cause of bleeding following percutaneous nephrolithotomy

Post percutaneous nephrolithotomy (PNL) bleeding is an uncommon yet serious complication and is almost always related to a surgical cause. Nevertheless, medical cause of bleeding is rarely encountered as a cause of this dangerous complication. Dengue has been rarely reported as a cause of post operative bleeding. Bleeding diathesis in dengue occurs not only due to thrombocytopenia but also due to dysfunctional surviving platelets and increased fibrinolysis. We report a patient who developed bleeding after an uneventful PNL due to dengue hemorrhagic fever. Medical causes of bleeding such as locally endemic viral hemorrhagic fevers should also be kept in mind and evaluated especially when a surgical cause of the bleed is not found or suspected in bleeding after any surgery.     

Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1?week of nitrofurantoin in reducing the risk of urosepsis

The purpose of this study was to analyze the various risk factors for urosepsis following percutaneous nephrolithotomy (PNL) and to study the role of 1-week nitrofurantoin before PNL in reducing the risk of urosepsis. All patients undergoing PNL from April 2007 to November 2008 were prospectively included and grouped into four cohorts according to the following inclusion criteria: group A: stones ≤ 2.5 cm, no hydronephrosis, sterile urine; group B: diabetes mellitus, serum creatinine > 2 mg/dl, positive urine culture, stag horn stones, presence of nephrostomy or simultaneous bilateral PNL; group C: stones ≥ 2.5 cm and/or hydronephrosis, sterile urine; group D: similar to group C, but received nitrofurantoin 100 mg bid for 7 days before operation. Preoperative urine culture, intraoperative renal pelvic urine culture and stone cultures were obtained. Fever > 380°C and leukocyte counts > 12,000 were considered as systemic inflammatory response syndrome (SIRS). Endotoxemia was assessed in serum samples. A total of 205 patients were included in the study and grouped into four cohorts as group A (n = 50), group B (n = 54), group C (n = 53) and group D (n = 48). Overall 23% patients had positive renal pelvic urine and/or stone culture, 25% had endotoxemia and 34% developed SIRS. Female gender, chronic renal failure, anemia, hydronephrosis, stones larger than 2.5 cm and prolonged surgery were found to be risk factors associated with urosepsis. Nitrofurantoin prophylaxis resulted in decreased culture positivity (30.2 vs. 8.3%, odds ratio 0.36, p = 0.087), endotoxemia (41.9 vs. 17.5%, odds ratio 0.22, p = 0.001) and SIRS (49 vs. 19%, odds ratio 0.31, p = 0.01). In conclusion, female gender, chronic renal failure, anemia, hydronephrosis, stones larger than 2.5 cm and prolonged surgery were risk factors for urosepsis. Nitrofurantoin is beneficial in the prevention of endotoxemia and urosepsis especially in patients with larger stones and hydronephrosis.     

Measurement of intelligence and its usefulness

Intelligence tests are essentially a 20th century phenomena. The construction of these tests, is a long drawn out technical procedure. Currently there are not many standardised intelligence tests available for use in India. There is a dire need to construct many such tests especially for use with children in the Indian sociocultural set up. Standardised tests currently available for use in India have been reviewed. The uses of these tests—both in clinical practice and research—in the field of pediatrics has been pointed out along with some of the major problems that can crop up if the tests are not used scientifically in a judicious manner.     

Dimethyl sulfoxide with lignocaine versus eutectic mixture of local anesthetics: prospective randomized study to compare the efficacy of cutaneous anesthesia in shock wave lithotripsy

The objective of the study was to compare the efficacy of dimethyl sulfoxide (DMSO) mixed with lignocaine and eutectic mixture of local anesthetics (EMLA) cream as topically applied surface anesthetics in relieving pain during shock wave lithotripsy (SWL) in a prospective randomized study. Of the 160 patients, 80 patients received DMSO with lignocaine and 80 patients received EMLA cream, applied to the skin of the flank at the area of entry of shock waves. SWL was done with Seimens lithostar multiline lithotripter. The pain during the procedure was assessed using visual analog and verbal rating scores. The mean visual analog scale scores for the two groups were 3.03 for DMSO group and 4.43 for EMLA group. The difference of pain score on visual analog scale was statistically significant (p < 0.05). Similarly, the pain scores as rated on the verbal rating scale were also evaluated; the mean score on verbal rating scale were 2.34 for DMSO group and 3.00 for the EMLA group. The difference between the pain score on verbal rating scale was also found to be statistically significant (p < 0.05). Our study showed that DMSO with lignocaine is a better local anesthetic agent for SWL than EMLA cream. The stone fragmentation and clearance rates are also better in the DMSO group.     

Sexual dysfunction in single males: a perspective from India

Various personal, familial, and socio-cultural factors play a crucial role in the development of sexuality and sexual practices. They often influence the occurrence and maintenance of sexual dysfunctions. Therapies with individuals with sexual dysfunctions often emphasize the involvement of both the partners. Issues related to single males, especially in the Indian context, have not been explored. The present study is a retrospective analysis of clinical case records of single males who reported sexual dysfunctions between the years 1990 to 2000. Thirty-eight clinical case records were analyzed for the demographic details, nature of the problems, and interventions provided with the aim of exploring the reported symptomatology, precipitating and maintaining factors, prevalent beliefs about the causation of sexual dysfunction, and the outcome of interventions. The role of cultural and psychosocial issues is discussed and the need for research in this area is emphasized.     

Schizophrenia and the cultural epidemiology of stigma in Bangalore, India

Illness-related stigma is a complex and important issue, and its social impact contributes to a hidden burden of many health problems. Mitigating effects of stigma are a priority for mental health policy, especially for schizophrenia. Although numerous studies document its impact on patients and their families, health studies of stigma typically regard it in global terms without adequate attention to the conceptual and practical importance of sociocultural contexts and the particular features of illness that evoke stigma. Research at a psychiatric referral center in Bangalore, India, studied the cultural epidemiology of schizophrenia and stigma in interviews with family caretakers of 60 patients, using a locally adapted EMIC interview and the Positive and Negative Symptom Scale. An index of 13 stigma queries based on Goffman's formulation covered relevant aspects and proved to be internally consistent (Cronbach alpha = 0.81). Multivariate statistical regression and qualitative analysis of narratives were used to analyze this stigma index and identify explanatory variables based on cultural patterns of distress (PD), perceived causes (PC), and previous help seeking (HS). Significant variables included suspiciousness and inappropriate sexual behavior (PD), heredity and bad deeds (PC), and informal help seeking (HS). Previous allopathic help seeking was negatively associated with stigma. Analysis of coded text segments from respondent narratives showed how these variables were related to family-perceived stigma, with reference to marriage practices, moral meanings of schizophrenia, and ways in which effective allopathic care minimized stigma. Findings identify features of schizophrenia-related stigma in India, contribute to comparative culture studies, and inform practical approaches to mitigate stigma through community awareness and improved mental health services.     

Learning in the crucible of supervision: Experiences of trainee psychotherapists in India

Trainee perspectives about supervision were examined in the relatively unexplored landscape of psychotherapy training and development in India. Ninety-four trainee therapists drawn from eight centers completed a questionnaire, Development of Psychotherapists–Trainee Background and Process Forms, at the end of training. Results indicated significant relationships between supervision satisfaction and indices of stressful work involvement, experiences in therapy sessions with clients, and perceived professional development and growth among trainees. Qualitative analysis of narratives captured both the perceived benefits and inadequacies in their experience of supervision. The findings are discussed in the context of clinical and cultural realities in training frameworks in India.     

Role of active mentoring during flexible ureteroscopy training

Abstract Purpose: To evaluate the outcome of flexible ureteroscopy training with or without an active mentor. Materials and Methods: Thirty-six flexible ureteroscopy naive practicing urologists and urology residents, after an initial introductory refreshment course, underwent training under a mentor for 15 minutes each in a high-fidelity nonvirtual reality Endo-Urologie-Modell (Karl Storz). The trainees were then randomized into two equal groups for training: One under a mentor and the other without. These two groups completed the training for 2 hours. Global rating scale (GRS) for the performance of flexible ureteroscopy was measured by a blinded expert at the beginning and end of the training. A specific task completion time (TCT) was noted at the end of the training. The trainees noted their own global rating scale at the end of the training. Results: The GRS by the expert at the end of the training was significantly higher in the mentor group. TCT was significantly lower in the mentor group. TCT correlated well with the GRS as measured by the expert rather than the trainee. Conclusion: Mentorship during flexible ureteroscopy training results in higher GRS and lower TCT at the end of the training. Self-assessment GRS by trainee does not correlate well with the skills acquired.