Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareNegative Appendectomy Rate in a Tertiary Care Hospital of Quetta: A Cross-Sectional Study
English0106AllauddinEnglish Muhammad Sohaib KhanEnglish Azmat UllahEnglish Seemin KashifEnglish Gulalai RehmanEnglish Muhammad Kashif MalikEnglishIntroduction: Acute appendicitis is the most common surgical pain that requires surgical intervention in an emergency. Diagnosis of acute appendicitis is mainly a clinical judgment but many clinical scoring systems and advanced radiology is routinely used in developed countries. The aim is to reduce unnecessary removal of the normal appendix, which is still very high up to 37% in some parts of the world. Aim: The aim of this study was to assess the Negative appendectomy rate (NAR) in a tertiary care hospital of Quetta. Method: This is a prospective observational study carried out between November 2020 and June 2021.121 cases of acute appendicitis that underwent surgical management. Results: The study data revealed a negative appendectomy rate of 59.5% Tenderness rebound tenderness and total leucocyte count (TLC) showed statistical significance with histopathology findings. Females had a high negative rate of appendectomy. Conclusion: The study showed that on clinical judgment in the diagnosis of acute appendicitis will result in a high negative appendectomy rate, it is need of time to add radiology at least ultrasonography should be mandatory in every suspected case of appendicitis in our part of the world, and diagnostic laparoscopy in equivocal cases, especially in female patients.
EnglishAcute appendicitis, Advance radiology, Clinical judgment, Diagnostic laparoscopy, TLC, HistopathologyIntroduction:
Acute appendicitis is 2nd most common acute emergency, after nonspecific abdominal pain in presentation to the emergency department 1. It has a rate of 7-12% in the general population. The peak age of incidence is between 16 to 40 years in adults 2.More common in males. However, in young women of childbearing age, the diagnosis of appendicitis is difficult due to the wide range of differential diagnoses 3.Acute appendicitis is a clinical diagnosis and many surgeon resorts to a clinical judgment for the management. This clinical decision has a lot of potential for improvement as reflected by the high negative appendectomy rate (NAR) up to 37%4. A major problem is overtreatment in the form of normal appendectomy (removal of the histologically normal appendix), which may be lead to high cost and postoperative complications 5, 6 There is little consensus on optimal diagnostic pathways for right iliac fossa pain diagnosis 7. Although different scoring systems are used to reduced negative appendectomy rate (NAR)., In the USA and Europe, CT scan is routinely used for appendicitis diagnosis 6, Equivocal cases Diagnostic laparoscopy is used routinely specially in female patients,7,8. which reduced the negative rate as low as 3.5 %. But in South Asia like Pakistan lack of routine CT scans and even the non-availability of routine use of U/S, the NAR is as high as up to 20—37% 9.
The negative appendectomy rate is 11-36% 8,9 in Australia and 15-33% in the United Kingdom 10,11. But in the United States the NAR rate is less than 5% 11. The availability of advance radiology and its utilization in appendicitis reducing the negative appendectomy rate. Despite this great achievement The questions remains regarding the cost-benefit of imaging verses to other clinical indicators 9. Diagnosis of appendicitis is possible only on histological examination, regardless of the gross appearance of the appendix and the clinical picture 12.
This study was conducted at a tertiary care teaching hospital where the emergency presentation of acute abdominal pain is attended by junior residents. We evaluate and diagnose acute appendicitis on clinical judgment with histopathological findings rather than a specific scoring system. Whenever needed or was available ultrasonography was done. So the objective of this study was to find out the NAR in a tertiary care hospital of Quetta and to see the positive clinical predictors in our sitting
Material and method:
The study is a prospective observational study conducted between Nov 2020 and June 2021.The study was approved by the institutional review board, informed consent was taken from all the study participants. 121 consecutive adults patients who presented with the clinical feature of acute appendicitis and underwent appendectomy were included in the study.
Inclusion criteria:
All patients with acute pain in right lower quadrant and with clinical features suggestive of acute appendicitis
All patients who underwent open appendectomy after satisfying the above mention criteria
Adults patients aged 15 and above
Patients whose appendix was sent for Biopsy with standard protocol.
Exclusion criteria:
1. Age below 15 years
2. Female patient with known gynecological conditions
3. Patient had a recent abdominal surgery minor or major
4. Interval appendectom
All patients admitted with features suggestive of acute appendicitis like right iliac fossa pain, rebound tenderness, nausea, total leucocyte count, and-in case of u/s- a high suspicion of acute appendicitis underwent appendectomy. The appendectomy specimen was sent for histopathology as the final step for diagnosis. And the histopathology report was used as the gold standard reference for the study. All the biographic and demographic data, clinical assessment and per operative finding were recorded on a proforma prospectively then analyzed.
The statistical analysis of the study was performed by using a statistical package for social sciences (SPSS version21.IBM corporation USA). In the study p-value of less than 0.05 was considered to be statistically significant. The mathematical tools used in the analysis were the chi-square test and Binary regression analysis.
Results:
A total of 121 appendicectomies were performed. About 88.4% of the patients were 30 years old or younger. Only 11.6% of this population was older than 30 years of age (Table 1). Out of 121 patients, 43% were males, and 57% were females. Migration of pain to the right iliac fossa (RIF) was present in 55.4% of the patients. Anorexia was present in 66.9%, and nausea in 84.3% of patients. Although rebound tenderness in RIF was present in 40.5% of patients, tenderness in RIF was present in 17.4 % of the patients. Rovsing’s sign was positive in 47.1%. (Table 1). TLC was ≥12,000/mm³ in 47.9% of patients, Ultrasound abdomen showed inflamed in appendix in 41.3% of patients. Histopathology was suggestive of acute appendicitis only in 40.5% of patients (Table 1).
Crosstabs between histopathological findings (inflamed or normal appendix) and gender showed that they had a statistically significant (p=0.002), but weak and positive correlation (r=0.277) (Table 2; Fig 1a). Similarly, both tenderness in RIF and rebound tenderness in RIF had a statistically significant (p=0.007, r=0.244, and p=0.007, r=0.245, respectively), but weak, positive correlation with histopathological appearance (Table 2; Fig 1b, 1c). Histopathological findings and TLC also showed that they had a statistically significant (p=0.031), but weak and positive correlation (r=0.186) (Table 2: Fig 1a). No other significant correlations were found.
Binary logistic regression analysis was done to assess the effects of various predictors on inflammation of the appendix (through positive or negative histopathological reports) (Table 3). The model was statistically significant (p=0.000), variation in the dependent variable based on our model ranged from 22.0% to 30.0%, and the model correctly classified about 72% of patients. Results showed that only gender and rebound tenderness in RIF was the true predictors of histopathological proven inflammation of the appendix (Table 3). The odds ratio for the male gender was found to be 3.52 (95% CI [1.47, 8.38]), for rebound tenderness was found to be 3.5 (95% CI [1.02, 12.13]), and for TLC was 2.96 (95% CI [1.23, 7.13]), after adjusting for all remaining variables included, plus age, gender, and ultrasound findings. Male gender, rebound tenderness in RIF, and TLC was found to be strong predictors of inflammation of the appendix.
Discussion:
Acute appendicitis can often prove to be a diagnostic perplexity. More so in female patients. This is attributed to the myriad presentations, these patients can have the numerous other conditions that mimic acute appendicitis
In our study, more than 88.4% of the patients were ≤30 years of age (Table 2). In this younger age group, the males was less than females i.e. 43%. However, 59.2% of the histologically inflamed appendix belonged to the male group, only31.9% of female appendix was inflamed. These findings were comparable with the literature, where it was found that acute appendicitis was commoner in younger people, and in males, but it was falsely diagnosed twice as commonly in females2.
The negative appendicectomy rate (NAR) ranges from 19% to 34% in the UK 12. In our study, however, only about 40.5% of the appendicectomy specimens were found to be inflamed, and the rest of the samples either showed normal histopathology or some other pathology. It meant that about 59.5% of the patients had undergone negative appendicectomy. This finding was alarming.
In a study done in Australia, NAR for males was 9.0%, and for females was 12.7% 13 and in a Pakistani study, it was 7%-12.7% for males, and 7%-29% for females. In our sample, about 19% of males, and 40% of the females had undergone negative appendicectomy. Negative appendicectomy rate (NAR) is common in females due to certain gynecological conditions like ovarian cysts, pelvic inflammatory disease, ectopic pregnancy, etc.14 To reduce NAR among young age females, a transvaginal ultrasound would be required, in addition to abdominal ultrasound, in suspected gynecological issues15 which is not practiced routinely in our setups. Apart from gynecological causes, certain non-gynecological causes can also cause lower abdominal pain in young girls, which might mimic acute appendicitis, and lead to unnecessary surgery 16These causes might include mood disorders, depression, anxiety, eating disorders (anorexia nervosa, bulimia), or other emotional problems.
Another important reason for this sizeable NAR was a fear of appendix perforation. Perforation of appendix rate was reported to be 7% to 13% in Pakistan. Therefore, surgeons prefer to do appendicectomy as soon as possible to avoid perforation and peritonitis. But avoidable surgery is a financial burden for the patients as well as for the healthcare system.
NAR of 15 to 30% is mostly acceptable 17.However, efforts are being made to reduce it further. Different scoring systems have been developed for proper diagnosis. In a study done in India, it was suggested that this could have been prevented by using criteria of RIPASA>11 instead of 7.518. Similarly, ultrasound together with a modified Alvarado score could be a better way for better diagnosis 19. Appendicitis was histologically confirmed in more than 95% of patients with help of CT and abdominal ultrasound. About 97% of these cases were diagnosed with help of a CT scan, and 93% of the cases with ultrasonography 20 The false-positive rate for assessing appendicitis was 5.4% with ultrasound, and 2.3% with CT scan 21. Hence, the negative appendicectomy rate could be improved by preoperative imaging22. The diagnostic laparoscopy7.This could also save costs of surgery, hence avoiding wastage of resources23. However, in developing countries, like India and Pakistan, using imaging in every patient is expensive nor all time available in the hospital premises in government set up. And very expensive for patients from private systems to have u/s.24 Hence, making decisions under these circumstances can be difficult for surgeons, especially junior doctors 25According to a study in Pakistan, even imaging techniques were believed not to significantly reduce the negative appendicectomy rate26, probably due to comparatively inexperienced sonographers, because regardless of a high rate of negative appendicectomies, about 25% of the non-inflamed appendix was found to be with other pathologies which might have caused RIF painand they could not be differentiated on imaging.
Conclusion:
The Negative appendectomy rate was very high in comparison to other regional and global setups. Tenderness in right iliac fossa (RIF), rebound tenderness, total leukocyte count were found to be the positive predictor of acute appendicitis. Moreover negative appendectomy rate was found more prevalent in female population.
Recommendation:
Further studies needed to be carried out to take a deep insight and causative factors of High negative appendectomy rate in this area. Need of time to add advance radiology routinely like ultrasonography and CT Scan to avoid unnecessary removal of appendix.
Disclosure: The authors declare no conflicts of interest and no source of funding for this study.
Acknowledgement: The authors are grateful to Immaduddin Khan a 9th class student for his contribution in formatting and typing of the this article.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcarePredicted Interactions of Cyclooxygenase2 with Nasopharyngeal Cancer-linked Ribosomal Proteins, uS19 and eL27
English0713Alyaa Syafiqah Binti ShamsuriEnglish Edmund Ui-Hang SimEnglishIntroduction: The Cyclooxygenase 2 (COX-2) and ribosomal proteins (RP) of uS19 and eL27 were reported to be associated with nasopharyngeal cancer (NPC). However, there is no studies on their interactions. Objective/Aim: This study aimed to extrapolate the interactions of COX-2 with uS19 and eL27 via in silico approach. Methods: Bioinformatics analysis involving the web-based applications of SWISS-MODEL, ClusPro, FireDock/PatchDock and Protein Interaction Calculator (PIC), and the UniProtKB database were used for the purpose of our study. Results: We revealed possible interactions between uS19 and eL27 with COX-2 individually. Evaluation of the interacting inter-face amino acid residues of the uS19-COX2 and eL27-COX2 complexes show hydrophobic and ionic bonds in the former and only hydrophobic bonds in the latter. Conclusion: Our findings provide novel in silico evidence of COX-2’s interactions with two NPC-associated RPs (uS19 and eL27), and propose an interplay among these proteins during the oncogenesis of NPC.
EnglishCyclooxygenase 2, Nasopharyngeal carcinoma, Molecular docking, Protein-protein interaction, Ribosomal proteins, uS19 (S15), eL27 (L27)http://ijcrr.com/abstract.php?article_id=4451http://ijcrr.com/article_html.php?did=4451Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareThe Curious Case of Night Blindness: A Rare Case Report
English1418Mahak ThakurEnglish Shahjadi PraveenEnglish Mohd SaifEnglish Abdul WarisEnglishIntroduction: Gyrate Atrophy of the choroid and the retina is a rare autosomal recessive disorder caused by a mutation in ornithine aminotransferase. Case Report: We present an interesting case of a 55-year-old male who presented to us with complaints of night blindness, increase in the number of minus glasses, senile cataract in both eyes, constriction of peripheral visual field and chorioretinal atrophic lesions in both eyes. Blood investigation revealed raised plasma ornithine levels at 690 micromole/L (normal range 30-90 micromole/L). There is progressive night blindness and visual field constriction due to progressive chorioretinal degeneration. It has now progressed to the diminution of central visual acuity due to progressive macular and glaucomatous changes and cataract formation. Conclusion: There is a history of blindness in two out of 6 more siblings which indicates a hereditary pattern.
EnglishGyrate Atrophy, Fundus Albipunctatus, glaucoma, OAT gene, Ornithine amino transferase, Chorioretinal degenerationhttp://ijcrr.com/abstract.php?article_id=4452http://ijcrr.com/article_html.php?did=4452Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareRelationship of Work Hours and Sleep Hours with Anthropometric Measures in Pakistani Laborers in Saudi Arabia
English1925Mehreen MehtabEnglish Farooq Ahmad KhanEnglish Muhammad Atif MalikEnglish Seemin Kashif MalikEnglishIntroduction: Obesity is a known risk factor for type2 DM, hypertension, fatty liver, cardiovascular disease and cancer. Long work hours and short sleep duration might lead to obesity in migrant workers. Objective/Aim: Study was done to show the effects of work hours and sleep hours on the nutritional status of Pakistani laborers working in KSA. Method: It was a cross-sectional study. Pakistani male, 25-60 years old, unskilled and semi-skilled workers were included. Sociodemographic profile, length of work hours, and sleep hours were recorded. Anthropometric measures included BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and conicity index (CI). Results: About 80% of participants were 48 hours/week, and half of the participants slept for English Sleep, Work hours, BMI, Waist circumference, Binary regression analysis, Obesityhttp://ijcrr.com/abstract.php?article_id=4453http://ijcrr.com/article_html.php?did=4453Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareUndiagnosed Neurodegenerative Syndrome - A Case Study
English2628Ashish KakkadEnglishIntroduction: Due to advancements in medical services, life span of individuals has increased. Increased age also increases neurodegenerative problems generally in the geriatric population. Neurodegenerative disorders affect many individuals across the world by increasing their disability. Aim: Aim of the study was to evaluate undiagnosed neurodegenerative disorders in detail to understand and gain insight into the selected case. Case Report: Here reported case is affected by undiagnosed neurodegenerative syndrome at the early age of 34 years. The patient was also invited by the National Institute of Health, US under the Undiagnosed Program for further investigations. The patient was managed by a combined approach of allopathy, physiotherapy and naturotherapy. Discussion: The patient was also suspected for diagnosis of Bipyramidal syndrome, Stiff man syndrome, Motor Neuron Disease, Neimann pick disease type C, Krebbee’s disease, Chediak Higashi disease affecting the central nervous system by Neuro physician. The patient represents a rarest of rare case of an Undiagnosed Neurodegenerative Program. Conclusion: The patient can be benefited in symptoms by a combined approach of medicine and physiotherapy in case of undiagnosed neurodegenerative.
EnglishBipyramidal syndrome, Neurodegenerative Disorder, Stiff man syndrome, Undiagnosed Neurodegenerative Syndromehttp://ijcrr.com/abstract.php?article_id=4454http://ijcrr.com/article_html.php?did=4454Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareGlutathione Peroxidase and Catalase Gene Polymorphism in Pakistani Cataract Patients
English2934Atif MahmoodEnglish Qamer AzizEnglish Ruqaya NangrejoEnglish Iftikhar Ahmed SiddiquiEnglish Mohammad Saleh SoomroEnglish Iffat Ara AzizEnglishIntroduction: Cataract is the major cause of blindness and visual impairment. Although there are several reasons for the generation of cataracts, however, most of the cases are due to inter-individual genetic variations in antioxidant genes. Many studies have been conducted for the understand of the role of reactive oxygen species (ROS) in the regulation of cataracts. However, the study of single nucleotide polymorphisms (SNP) of the Glutathione peroxidase gene and Catalase gene and its association with cataracts is still lacking in the Pakistani population. Objective: To investigate the relationship between GPX and CAT gene variations and the development of Cataract in Pakistani cataract patients. Methods: This was a case-control study carried out at different centers in Karachi, Pakistan between September 2019 and 2020. A single nucleotide polymorphism (SNP) at rs1050450 for GPX and rs7943316locus for Catalase gene mutations was examined with polymerase chain reaction (PCR) using high resolution melting curve (HRM) technique in 250 cataract patients and 250 healthy control groups of similar age. Results: We detected the ratio of SNP in GPX gene in cataract patients higher than in control (OR: 1.8, 95% CI) while there is no significant difference in CAT gene between cataract and control participants. Conclusion: Our findings indicate potential genetic variations in antioxidant genes particularly GPX and CAT genes polymorphisms as risk factors for cataracts. This is study the first study to report the antioxidant SNPs associated with the development of cataracts in the Pakistani population.
EnglishCataract, Glutathione peroxidase, Catalase, Polymorphism, SNP, ROShttp://ijcrr.com/abstract.php?article_id=4455http://ijcrr.com/article_html.php?did=4455Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareComparison of Gastrocnemius-Soleus Stretching Program versus Tendoachilles Stretching Exercises for Management of Chronic Plantar Fasciitis
English3539Saifullah SoomroEnglish Zamir Ahmed SoomroEnglishIntroduction: On the sole of the foot, the plantar fascia is a thick, multi-layered fibrous connective tissue. Plantar fasciitis is a painful and incapacitating ailment that frustrates both the patient and the physician. Stretching exercises that target the plantar fascia are an excellent therapy option for plantar fasciitis. Objective: The objective of this study was to compare the outcome of the Gastrocnemius-Soleus Stretching Program versus tendon Achilles stretching exercises for the management of chronic plantar fasciitis Material and Methods: This randomized controlled trial was conducted from March 2020 to May 2021 at the department of orthopedic Chandka medical Larkana after getting approval from institutional ethical committee. Patients of age 30-70 years of either gender, undergoing chronic plantar fasciitis, were included and were randomly divided in two groups. In group A, Gastrocnemius Soleus Stretching Program was applied. In group B, tendon Achilles stretching exercises were applied. Pain score was noted at baseline and after 8 weeks, a change in pain score was calculated. All the information was noted on proforma while entered and analyzed in SPSS version 21. Independent samples t-test was applied to compare the mean change in pain score in both groups. P-valueEnglishGastrocnemius-Soleus Stretching Program, Tendoachilles stretching exercises, Chronic plantar fasciitis, Painhttp://ijcrr.com/abstract.php?article_id=4456http://ijcrr.com/article_html.php?did=4456Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareEffect of Altered Lifestyle During Lockdown on Pandemic of Obesity
English4045Shah SEnglish Shrivastava SEnglish Singh SEnglish Sarode VEnglishIntroduction: India reported the first COVID-19 case on 30 January 2020 and due to the mass and rapid spread of the disease in other countries, the Indian government took immediate steps. India observed lockdown from 22 March to 31 May 2020 with conditional relaxation after that. The schools, colleges, and workplaces continued to be closed or functioned online only. So, young age group observed a marked shift to a sedentary lifestyle. Aim: Study was aimed to assess the effect of a changed lifestyle during the lockdown on leading us to another pandemic of obesity. Methodology: An electronic questionnaire was distributed using applications like Whatsapp and Instagram to people of age group 15 to 30 years across India. The questionnaire had 3 sections -general questions, and questions related to lifestyle patterns before lockdown, and during the lockdown. Results: We received 500 responses. Study found that 60.74% of males and 64.42% of females showed an increase in BMI during the lockdown. It was observed that before lockdown 47.8% of the participants lived with family but during the lockdown, 98.6% of participants lived with their family. Sleeping hours and the number of meals taken daily increased. An unexpected increase in physical exercise was reported. Fast food, alcohol intake and smoking are reduced to a minimum. Participants also reported reductions in stress eating habits. Conclusion: The changes observed during lockdown led to an increase in BMI but participants already in the obese category reported decreased BMI. So, more participants shifted to the overweight category while the number of participants in the obese category decreased. Conclusion: We observed that more participants shifted to the overweight category while the number of participants in obese category decreased during the lockdown period.
EnglishPandemic, Corona, Obesity, Lifestyle, Participants, Diseasehttp://ijcrr.com/abstract.php?article_id=4457http://ijcrr.com/article_html.php?did=4457Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareValidity and Reliability of a Core Competencies Instrument for Nursing Students
English4655Eunhee JoEnglish Soon-Jung HwangEnglish Jeong-Lim RyuEnglish Shin-Hee KimEnglishIntroduction: One of the basic competencies to become a professional nurse is clinical performance. Therefore, many studies use tools modified and supplemented by Choi to measure the clinical performance of nursing students, but there is no tool to measure the core competencies of nursing students. Aim/Objectives: This methodological study tested the reliability and validity of a self-report instrument measuring the core competencies of nursing students. Internal consistency, reliability, and construct validity were assessed using confirmatory and exploratory factor analysis. Methods: Questionnaire data was collected from 249 nursing students at four universities in J province, South Korea, from August 20 to September 30, 2020. Results: The core competencies showed reliable internal consistency, with a Cronbach’s alpha of 0.90 for the total scale. Factor loadings of the 32 items on seven subscales ranged from 0.53 to 0.88, and three factors explained a total variance of 66.22%. The seven subscales model was validated by confirmatory factor analysis (root mean square residual 0.90). Conclusions: The results demonstrate that the instrument is useful in measuring the core competencies of nursing students.
EnglishFactor analysis, Professional competence, Validation study, Seven subscales model, Core potencies, Confirmatory and exploratory factor.http://ijcrr.com/abstract.php?article_id=4458http://ijcrr.com/article_html.php?did=4458Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareCompilation of Developmental and Neoplastic Entities in Kidney with Histomorphology and Immunohistochemistry as an Eye-Opener in Troubleshooting the Diagnostic Errors
English5660Das SaptangshuEnglish SnehaEnglish Ghosh SukanyaEnglish Das Tushar KantiEnglishIntroduction: Renal cell tumors are common neoplasms with varying incidence and mortality rates across the globe. There are many histological types forming not merely the basis of classification but being associated with unique immunological and molecular profiles governing the biological behavior. Apart from these, there are a separate spectrum of neoplasms restricted particularly to pediatric age group. The overall prognosis is conferred by an array of factors including the histological grade, stage, necrosis and lymphovascular invasion. Case Reports: This discussion aims to outline the renal mass encountered in our setting with special reference to age group and the light microscopic picture. However, we encountered diagnostic dilemmas while dealing with the cases and these were further resolved to employ relevant immunohistochemical markers. A particular mention of protocols for staging, grading and relevance of special stains has also been outlined. Conclusion: To conclude, 1 case each of chromophobic renal cell carcinoma and infiltrating urothelial carcinoma of pelvis in middle-aged adults have been discussed. 2 cases in paediatric age group have been highlighted namely triphasic nephroblastoma and multicystic dysplastic kidney (MCDK).
EnglishChromophobic, MCDK, Nephroblastoma, Renal cell carcinoma (RCC), Urothelial carcinoma, Wilms tumourhttp://ijcrr.com/abstract.php?article_id=4459http://ijcrr.com/article_html.php?did=4459Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareThe Study of Trends and Treatments of Neural Tube Defects: A Cross-Sectional Study
English6167Abdul Razaque MariEnglish Fahmida Arab MallahEnglish MuzamilEnglish Rayif Rashid KanthEnglish Asim ShahzadEnglish Syed Aamir ShahEnglishIntroduction: Neural tube defects (NTDs) are serious birth abnormalities of the central nervous system caused by a defect in the embryonic neurulation process. The most common congenital defects are congenital heart defects (CHDs) and neural tube defects (NTDs). Aim: The study’s aim was to figure out the patterns of neural tube defects (NTD) and how to treat them. Methodology: The ages of the mother, the method of delivery, the kind, and quality of neural tube defects (NTDs,) and also the treatment, were all acquired from case reports (medical and surgical). Warmth was provided to the newborn with an open NTD, and the abnormality was coated with a sterile moist saline bandage. To avoid putting strain on the deformity, the patient was placed in a supine posture. Children with breathing difficulties were given supplemental oxygen. In patients with urine dysfunction, clean intermittent catheterization (CIC) was employed. All infants with an open NTD had to have the problem checked right away. Conventional neurosurgical procedures were used to close the wound. Once the NTD was closed, a ventriculoperitoneal shunt was implanted in infants with associated hydrocephalus. Results: A total of 59 patients were involved in this study. Males made up 50.6% of the population, while females made up 49.4%, resulting in a gender ratio of 1.5 in males. The majority of the participants’ parents (57.6%) were socioeconomically poor. The most prevalent kind was myelomeningocele (62.7%), followed by 5.08 percent cases of meningocele and 11.8 percent cases of lipomeningocele. The lumbosacral area was the most frequent site of these abnormalities (55.9 percent). Lumbar (32.2 percent), sacral (6.77percent), and thoracolumbar (5.08 percent) locations were among the others. Conclusion: The most frequent kind of NTD in our area was Lumbosacral Myelomeningocele. The main concern factor was lower economic level.
EnglishNeural tube defects, Newborn, Myelomeningocele, Birth abnormalities, Congenital Disorders, Clean intermittent catheterizationhttp://ijcrr.com/abstract.php?article_id=4511http://ijcrr.com/article_html.php?did=4511Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareIdentification of the Location of Migraine Pain in an Adult Population of a Tertiary Care Hospital: A Cross-Sectional Study
English6872Muhammad Asif KhaskheliEnglish Lal ChandEnglish SaifullahEnglish Shoaib AhmedEnglish Majid Ali khandEnglishIntroduction: Headache is the most common disorder that occurs in the general population and affects half of the world’s population. Several reasons have been associated with the cause of this disorder. It is one of the most regularly seen medical symptoms in many specialties in outpatient departments of hospitals. Migraine and Tension-type headache (TTH) are prevalent disorders, and in 2013 migraine was identified as the 6th common cause of disability. Aim: To identify the location of migraine pain in an adult population of a tertiary care hospital: Methodology: This study included 870 patients with migraine for more than 6 months duration. The data were collected through a semi-structured questionnaire, and the patients that were on any medication and had 2 attacks of migraine each month were included in the study. ICHD-2 criteria were used to diagnose migraine and their subtypes. The assessment was performed at several stages: Results: In total, 870 patients, 350 (40.3%) were males, and 520 (59.7) were females. The mean age of patients was 24 years, and the mean duration of migraine was 5.6 years. In our study, 66% of patients were Sindhi, 27 % were Punjabi, and 7% belonged to other ethnic groups. A total of 49% of patients were experiencing unilateral onset in which ocular, frontal and temporal were observed as 50%, 11%, and 39%, respectively. Bilateral/central pain, typically bitemporal or at the vertex, was mentioned in 26% of the patients. In 25% of patients, the start of cervicooccipital discomfort was reported. Conclusions: This study inspects the site of pain in migraine patients during the outset and established migraines. More than half of the participants reported discomfort in the cervicooccipital area and bilaterally/centrally.
EnglishHeadache, Migraine, Discomforts, Unilateral, Pain location, Cervicooccipitalhttp://ijcrr.com/abstract.php?article_id=4512http://ijcrr.com/article_html.php?did=4512Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareTibial Fractures with Signs of Delayed Union: The Effects of Autogenous Bone Marrow Injection: A Longitudinal Study
English7377Madan LalEnglish Asfandyar KhanEnglish Zahoor Illahi SoomroEnglish Abdul Rehman KhanEnglish Sajjad Ali BughioEnglish Muhammad Tahir LakhoEnglish Niaz Hussain KeerioEnglishIntroduction: Tibial fracture union is a lengthy process that begins with the initial trauma and continues for years following clinical and radiological union until the bone regains its previous structure and function. Delayed union and non-union are two typical issues that any surgeon dealing with fracture healing may encounter. Aim/Objective: To evaluate how autogenous bone marrow injection affects clinical and radiographic evidence of union in tibial delyed union fractures. Methodology: The study involved patients admitted with tibial shaft fractures that had not healed. Bone marrow is aspirated from the anterior iliac crest under local anesthetic using a specific bone marrow aspiration needle into heparinized syringes to avoid clotting. Bone marrow is aspirated from various locations to avoid aspirating the blood. Under fluoroscopy supervision, the aspirate is injected percutaneously into and around the fracture site. Results: There were 95 patients with tibial shaft fractures that had not yet healed. There were 66 males and 29 females. The mid-shaft of the tibia was affected in 52 (54.7%) patients, followed by the distal tibia in 25 (26.3%) patients and the proximal tibia in 19 (20%) patients. A total of 36 patients were smokers, while 59 patients were nonsmokers. The right side of the limb was involved in 60 (63.2%) of patients, while the left side was involved in 35 (36.9%). The union rate for delayed tibial fractures was 96.8%. Conclusion: While the retained hardware appears robust and stable, percutaneous autogenous bone marrow injection is a somewhat invasive, safe and affordable therapeutic option for tibial delayed unions. Smoking is a major controllable risk linked to delay fracture healing. After tibia fractures or documented delayed union, smokers’ bones take longer to fuse
EnglishBone marrow, Delayed union, Fracture healing, Non-union, Tibial fractures, Union ratehttp://ijcrr.com/abstract.php?article_id=4531http://ijcrr.com/article_html.php?did=4531Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareEffect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study
English7882Muhammad ZakiEnglish Misbah MunirEnglish Muhammad Aslam ChandioEnglish Farhan SaeedEnglish Bindia KailashEnglish Shazia AliEnglishIntroduction: Iron deficiency anemia (IDA) is a significant health problem that is seen in about 40% of children worldwide. It affects a child’s physical and mental development, performance of work and maintenance of their health. Anemia increases the risk of lower respiratory tract infection in children, yet there is not enough evidence that shows the effect of iron deficiency anemia on acute bronchiolitis. Aim: To evaluate the effect of anemia on the severity of acute bronchiolitis in infants. Methodology: A total of 160 infants were included in the study, 100 of whom were having acute bronchiolitis while 60 of them were included as a control group. This contrast analysis was conducted on 3 groups of patients having mild, moderate and severe bronchiolitis. A low haemoglobin level (HB) was below 12 grams/dL. This is considered to be an SD of EnglishAnemia, Infants, Bronchiolitis, Iron deficiency, Negative correlation, Mean cell haemoglobin concentrationhttp://ijcrr.com/abstract.php?article_id=4532http://ijcrr.com/article_html.php?did=4532Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareOperative Versus Non-Operative Management of Distal Radius Fractures, in Elderly Patients: A Retrospective Study
English8387Hussain Bux PalhEnglish Syed Muhammad Khalid KarimEnglish Sajjad Hussain BhattiEnglish Muhammad Shuaib ChandioEnglish Muhammad YounisEnglish Lachman Das MaheshwariEnglishIntroduction: One of the major public health concerns across the world is the fractures occurring at the distal end of radius with an incidence rate of 25.4 per 10000 elderly people who are of about 65 years of age. These fractures are the most common fractures occurring in the upper extremities of elderly patients. More than 210 million dollars are regularly spent on the management of radial fractures of the distal ends which are expected to increase every year, however, the process of managing radial distal fractures is still controversial. Aim: To compare the outcomes of surgical and non-surgical management of distal radial fractures in elderly patients. Methodology: The current study involved 90 patients who were more than 65 years of age and were treated either surgically or non-surgically. Patients who were treated non-surgically were treated with cast immobilization whereas patients who underwent surgery had either plate or external fixation. Functional scores and baseline radiographs were recorded before treatment, and follow-up was conducted at 2, 6, 12, 24, and 52 weeks. Radiographic and clinical follow-ups were observed along functional scores were calculated and observed. Results: Patients who were treated without surgery had a mean age of 76 years, whereas 44 patients who were treated with surgery had a mean age of 73 years. No significant differences were observed between the groups in terms of other demographic factors. No differences in the functional status were observed in terms of arms, hands, and shoulders whereas pain scores also exhibited no significant differences. Conclusion: It is suggested that minor limitations exist between wrist motion range and grip strength which was diminished with the non-operative care, but functional recovery was not limited during 12 months follow-up.
EnglishDistal radial fractures, Surgical treatment, Non-surgical treatment, Cast immobilization, Functional recovery, Radiographic and clinical follow-upshttp://ijcrr.com/abstract.php?article_id=4533http://ijcrr.com/article_html.php?did=4533Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3HealthcareNeonatal Sepsis and its Bacteriological Profile in a Tertiary Care Hospital: A Cross-Sectional Study
English8893Shazia AliEnglish Bindia KailashEnglish Farhan SaeedEnglish Muhammad Aslam ChandioEnglish Misbah MunirEnglish Muhammad ZakiEnglishIntroduction: A condition in which bacteria, viruses or fungi causes hemodynamic changes in the neonates and results in morbidity and mortality is called Neonatal sepsis. The symptoms of neonatal sepsis are nonspecific but some of them are respiratory distress convulsions and temperature dysregulation. Aim: To determine the Neonatal Sepsis and its Bacteriological Profile in a tertiary care hospital: Methodology: All neonates who were suspected of having neonatal sepsis were included in the study. Sepsis was diagnosed through clinical examination. Some clinical features were observed such as fever, lethargy, respiratory distress, jaundice and umbilical infections. Under aseptic conditions, sepsis cultures and screens were sent. Analyzation of data was done using STATA version 11. Chi-square test was used to analyze clinical features. Descriptive statistics was helpful in analyzing bacteriological profile. Results: A total of 2325 neonates were admitted to the hospital. Out of these admissions, 312 were eligible for clinical sepsis. The blood culture positivity rate was 12%. Early-onset sepsis was present in 52.2% cases. Culture positive rate in late-onset sepsis was increased due to low birth weight, prematurity and parenteral nutrition. Positive screen had sensitivity of 80.1% and negative value of 85.6%. Isolation of gram-negative organisms was more common. Klebsiella pneumoniae and Acinetobacter were the commonly isolates. Conclusion: Neonatal sepsis was associated with low birth weight, low APGAR score, preterm and parenteral nutrition. Klebsiella pneumoniae, Acinetobacter and Staphylococci are the main causative organisms. Gram-negative bacteria were resistant to a wide range of medications.
EnglishNeonatal sepsis, Neonates, Prevalence, Bacterial profile, Klebsiella pneumoniae, Acinetobacterhttp://ijcrr.com/abstract.php?article_id=4534http://ijcrr.com/article_html.php?did=4534Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3Healthcare
Histopathological Evaluation of Neoplastic and Non-neoplastic Lesions of Urinary Bladder: A Five-year Experience from a Tertiary Care Center
English9397Marvi UmairEnglish Noshaba RahatEnglish Zumrud MominEnglish Farah SirajEnglish Prih BashirEnglish Humera ShezadEnglish
Introduction: Neoplastic and non-neoplastic lesionsof the urinary bladder, cause significant morbidity and mortality around the world. Non-malignant lesions are more incapacitating than lethal. There has been significant progress in understanding their origins and improving methods of diagnosis and treatment, but bladder tumors remain a serious health problem.
Objectives: To perform the histopathological evaluation of neoplastic and non-neoplastic lesions of the urinary bladder. Methodology: A retrospective study was conducted at the Basic medical sciences institute JPMC Karachi between 2016 and 2020. All urinary bladder tissue specimens received for histopathological evaluation during the study period were included in the study.
Results: A total of 160 patients were assessed between 2016 to 2020. The majority of the patients were above the age of 45 years i.e. 121 (75.6%) while 39 (24.4%) were 45 years or younger. 119 (74.4%) were male patients. A total of 51 patients (31.9%) were diagnosed with low-grade noninvasive papillary urothelial carcinoma while around 24.4 percent were diagnosed with high-grade noninvasive papillary urothelial carcinoma. Almost 20% of the patients were diagnosed with infiltrating urothelial carcinoma with detrusor muscle invasion or squamoid differentiation or both. Only one case of squamous cell carcinoma was diagnosed. One case of follicular cystitis was also diagnosed while 19 patients (11.8%) had acute and chronic cystitis. The majority of the participants underwent transurethral resection of bladder tumor (TURBT).
Conclusion: We received a high percentage of patients with low-grade noninvasive papillary urothelial carcinoma as well as infiltrating urothelial carcinoma. Thus, the current study hopes to highlight the high-risk patients and recommends that such patients should be screened so that the neoplastic lesions can be diagnosed early which in turn would improve patient outcomes.
EnglishDysplasia, Papilloma, Papillary urothelial carcinoma, Transurethral, Follicular cystitis, Squamoid
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Englishhttp://ijcrr.com/abstract.php?article_id=4586http://ijcrr.com/article_html.php?did=4586
1. Shrestha M, Gautam D, Shah P, Shrestha PK. Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Urinary Bladder. Nepalese Medical Journal. 2021 Dec 31;4(2):473-7.
2. Vaidya S, Lakhey M, KC S, Hirachand S. View of Urothelial Tumours of the Urinary Bladder: A Histopathological Study of Cystoscopic Biopsies. J Nepal Med Assoc 2013; 475– 78. URL: Website 3.
3. Baidya R, Sigdel B, Baidhya N. Histopathological study of cystoscopic bladder biopsies. J Pathol Nepal 2015; 5: 717–19.
4. Rangaswamy R. Spectrum of Lesions in Urinary Bladder Biopsies-A Histopathological Study. IJHSR. 2015;5(5):144–152.
5. Ploeg M., Aben, K.K.H. & Kiemeney, L.A. The present and future burden of urinary bladder cancer in the world. World J Urol 27, 289–293 (2009). https://doi.org/10.1007/s00345-009- 0383-3
6. Murta-Nascimento, Cristiane, et al. “Epidemiology of urinary bladder cancer: from tumor development to patient’s death.” World journal of urology 25.3 (2007): 285-295.
7. Ferlay JF. GLOBOCAN 2000. Cancer incidence, mortality, and prevalence worldwide, version 1.0. IARC cancer base. 2001. 8. Young, R. Tumor-like lesions of the urinary bladder. Mod Pathol 22, S37–S52 (2009). https://doi.org/10.1038/modpathol.2008.201
9. Yousef PG, Gabriel MY. An update on the molecular pathology of urinary bladder tumors. Pathology-Research and Practice. 2018 Jan 1;214(1):1-6. 10.1016/j.prp.2017.11.003
10. Batista da Costa, José, et al. “Molecular characterization of neuroendocrine-like bladder cancer.” Clinical cancer research 25.13 (2019): 3908-3920.
11. Cumberbatch MG, Foerster B, Catto JW, Kamat AM, Kassouf W, Jubber I, Shariat SF, Sylvester RJ, Gontero P. Repeat transurethral resection in non–muscle-invasive bladder cancer: a systematic review. Eur Urol. 2018 Jun 1;73(6):925-33.
12. Fahmy NM, Mahmud S, Aprikian AG. Delay in the surgical treatment of bladder cancer and survival: a systematic review of the literature. European urology. 2006 Dec 1;50(6):1176-82.
13. Rink M, Crivelli JJ, Shariat SF, Chun FK, Messing EM, Soloway MS. Smoking and bladder cancer: a systematic review of risk and outcomes. European urology focus. 2015 Aug 1;1(1):17-27.
14. Kim, Y. A., & Moon, K. C. (2018). Histological Classification of Bladder Tumors. Bladder Cancer, 147–180. doi:10.1016/b978- 0-12-809939-1.00011-4
15. Shah A, Srivastava M, Samdurkar A, Sigdel G. Spectrum of lesions in the urinary bladder-A histopathological study. Journal of Universal College of Medical Sciences. 2018;6(2):24-7.
16. Manjula K. Spectrum of lesions in urinary bladder biopsies: A histopathological study. International Journal of Clinical and Diagnostic Pathology 2020; 3(1): 302-304
17. Pudasaini S, Subedi N, Prasad KB, Rauniyar SK, Joshi BR, Bhoomi KK. Cystoscopic bladder biopsies: A histopathological study. Nepal Med Coll J. 2014 Sep 1;16(1):9-12.
18. Raghuveer CV, Hingle S. Profile of lesions in cystoscopic bladder biopsies: a histopathological study. Journal of Clinical and Diagnostic Research: JCDR. 2013 Aug;7(8):1609.
19. Ströck V, Holmäng S. A prospective study of the size, number, and histopathology of new and recurrent bladder tumors. Urology Practice. 2015 Sep;2(5):260-4.
20. Altaf MO, Ali T, Awais A, Siddique K, Asghar SA. Metastases in Transitional Cell Carcinoma: A Pictorial Essay from Tertiary Care Cancer Hospital. EAS J Radiol Imaging Technol. 2020:2(2):20-26.
21. Nugroho TS, Safriadi F, Noegroho BS. The role of intraoperative kidney mucosal biopsy on screening of squamous cell carcinoma of the kidney in nephrolithiasis patients with stones larger than 20 mm. Journal of Clinical Urology. 2020 Jul 3:2051415820936885.
22. Kumar M, Yelikar BR. The spectrum of Lesions in Cystoscopic Bladder Biopsies-A Histopathological Study. Al Ameen J Med Sci. 2012:5(2);132-136.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241149EnglishN2022May3Healthcare
Histopathological Evaluation of Neoplastic and Nonneoplastic Lesions of Urinary Bladder: A Five-year Experience from a Tertiary Care Center
English9397Marvi UmairEnglish Noshaba RahatEnglish Zumrud MominEnglish Farah SirajEnglish Prih BashirEnglish Humera ShezadEnglish
Introduction: Neoplastic and non-neoplastic lesionsof the urinary bladder, cause significant morbidity and mortality around the world. Non-malignant lesions are more incapacitating than lethal. There has been significant progress in understanding their origins and improving methods of diagnosis and treatment, but bladder tumors remain a serious health problem. Objectives: To perform the histopathological evaluation of neoplastic and non-neoplastic lesions of the urinary bladder. Methodology: A retrospective study was conducted at the Basic medical sciences institute JPMC Karachi between 2016 and 2020. All urinary bladder tissue specimens received for histopathological evaluation during the study period were included in the study. Results: A total of 160 patients were assessed between 2016 to 2020. The majority of the patients were above the age of 45 years i.e. 121 (75.6%) while 39 (24.4%) were 45 years or younger. 119 (74.4%) were male patients. A total of 51 patients (31.9%) were diagnosed with low-grade noninvasive papillary urothelial carcinoma while around 24.4 percent were diagnosed with high-grade noninvasive papillary urothelial carcinoma. Almost 20% of the patients were diagnosed with infiltrating urothelial carcinoma with detrusor muscle invasion or squamoid differentiation or both. Only one case of squamous cell carcinoma was diagnosed. One case of follicular cystitis was also diagnosed while 19 patients (11.8%) had acute and chronic cystitis. The majority of the participants underwent transurethral resection of bladder tumor (TURBT). Conclusion: We received a high percentage of patients with low-grade noninvasive papillary urothelial carcinoma as well as infiltrating urothelial carcinoma. Thus, the current study hopes to highlight the high-risk patients and recommends that such patients should be screened so that the neoplastic lesions can be diagnosed early which in turn would improve patient outcomes.
EnglishDysplasia, Papilloma, Papillary urothelial carcinoma, Transurethral, Follicular cystitis, Squamoidhttp://ijcrr.com/abstract.php?article_id=4590http://ijcrr.com/article_html.php?did=4590
1. Shrestha M, Gautam D, Shah P, Shrestha PK. Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Urinary Bladder. Nepalese Medical Journal. 2021 Dec 31;4(2):473-7.
2. Vaidya S, Lakhey M, KC S, Hirachand S. Urothelial Tumours of the Urinary Bladder: A Histopathological Study of Cystoscopic Biopsies. J Nepal Med Assoc 2013;52(191):475–8.
3. Baidya R, Sigdel B, Baidhya N. Histopathological study of cystoscopic bladder biopsies. J Pathol Nepal 2015; 5: 717–19.
4. Rangaswamy R. Spectrum of Lesions in Urinary Bladder Biopsies-A Histopathological Study. IJHSR. 2015;5(5):144–152.
5. Ploeg M., Aben, K.K.H. & Kiemeney, L.A. The present and future burden of urinary bladder cancer in the world. World J Urol 27, 289–293 (2009). https://doi.org/10.1007/s00345-009- 0383-3
6. Murta-Nascimento, Cristiane, et al. “Epidemiology of urinary bladder cancer: from tumor development to patient’s death.” World journal of urology 25.3 (2007): 285-295.
7. Ferlay JF. GLOBOCAN 2000. Cancer incidence, mortality, and prevalence worldwide, version 1.0. IARC cancer base. 2001. 8. Young, R. Tumor-like lesions of the urinary bladder. Mod Pathol 22, S37–S52 (2009). https://doi.org/10.1038/modpathol.2008.201
9. Yousef PG, Gabriel MY. An update on the molecular pathology of urinary bladder tumors. Pathology-Research and Practice. 2018 Jan 1;214(1):1-6. 10.1016/j.prp.2017.11.003
10. Batista da Costa, José, et al. “Molecular characterization of neuroendocrine-like bladder cancer.” Clinical cancer research 25.13 (2019): 3908-3920.
11. Cumberbatch MG, Foerster B, Catto JW, Kamat AM, Kassouf W, Jubber I, Shariat SF, Sylvester RJ, Gontero P. Repeat transurethral resection in non–muscle-invasive bladder cancer: a systematic review. Eur Urol. 2018 Jun 1;73(6):925-33.
12. Fahmy NM, Mahmud S, Aprikian AG. Delay in the surgical treatment of bladder cancer and survival: a systematic review of the literature. European urology. 2006 Dec 1;50(6):1176-82.
13. Rink M, Crivelli JJ, Shariat SF, Chun FK, Messing EM, Soloway MS. Smoking and bladder cancer: a systematic review of risk and outcomes. European urology focus. 2015 Aug 1;1(1):17-27.
14. Kim, Y. A., & Moon, K. C. (2018). Histological Classification of Bladder Tumors. Bladder Cancer, 147–180. doi:10.1016/b978- 0-12-809939-1.00011-4
15. Shah A, Srivastava M, Samdurkar A, Sigdel G. Spectrum of lesions in the urinary bladder-A histopathological study. Journal of Universal College of Medical Sciences. 2018;6(2):24-7.
16. Manjula K. Spectrum of lesions in urinary bladder biopsies: A histopathological study. International Journal of Clinical and Diagnostic Pathology 2020; 3(1): 302-304
17. Pudasaini S, Subedi N, Prasad KB, Rauniyar SK, Joshi BR, Bhoomi KK. Cystoscopic bladder biopsies: A histopathological study. Nepal Med Coll J. 2014 Sep 1;16(1):9-12.
18. Raghuveer CV, Hingle S. Profile of lesions in cystoscopic bladder biopsies: a histopathological study. Journal of Clinical and Diagnostic Research: JCDR. 2013 Aug;7(8):1609.
19. Ströck V, Holmäng S. A prospective study of the size, number, and histopathology of new and recurrent bladder tumors. Urology Practice. 2015 Sep;2(5):260-4.
20. Altaf MO, Ali T, Awais A, Siddique K, Asghar SA. Metastases in Transitional Cell Carcinoma: A Pictorial Essay from Tertiary Care Cancer Hospital. EAS J Radiol Imaging Technol. 2020:2(2):20-26.
21. Nugroho TS, Safriadi F, Noegroho BS. The role of intraoperative kidney mucosal biopsy on screening of squamous cell carcinoma of the kidney in nephrolithiasis patients with stones larger than 20 mm. Journal of Clinical Urology. 2020 Jul 3:2051415820936885.
22. Kumar M, Yelikar BR. The spectrum of Lesions in Cystoscopic Bladder Biopsies-A Histopathological Study. Al Ameen J Med Sci. 2012:5(2);132-136