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Objective: Placenta accreta spectrum (PAS), which occurs in ~1/500 deliveries, represents the disorders that arise due to adherent placenta, which may infiltrate adjacent organs, including the urinary tract. Recently, its incidence rate has increased because of increasing rate of cesarean deliveries worldwide. Materials and Methods: Case records of all institutional deliveries that took place at a single, tertiary care hospital within two years were reviewed to identify all patients with PAS. The case records of patients who required urological referral were studied. Results: In total, 80 patients were diagnosed with PAS. Ten patients (12.5%) required urological referral for urinary tract involvement. All (100%) patients showed bladder involvement. Two patients (2.5%) required ureteric reimplantation. One patient (1.2%) required bilateral ureterostomies as an urgent temporizing measure because the bladder was extensively infiltrated. All patients were discharged in a stable condition. There were no long-term urological complications observed in patients who followed up (90%). Conclusion: PAS is a condition with high mortality and morbidity rates and increasing incidence. The findings of this study correlate well with international series on PAS. A multidisciplinary management team is necessary to manage the myriad complications that may arise from PAS. Keywords: Placenta accreta, placenta percreta, bladder injury

Objective: To compare fissure healing and complications in chronic anal fissure with use of lateral anal sphicterotomy and 0.2% GTN.Study Design: Randomized controlled trial.Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Kohat over a period of 15 months.Material and Methods: Chronic anal fissure was treated with use of lateral anal sphicterotomy after admission to surgical ward and by application of 0.2% glyceryltrinatrate as an outdoor case on 202 patients over a period of 15 months. Sample size was calculated by sample size calculator. Pain was measured using visual analog scale and incontinence to flatus and faeces was inquired from the patients. All cases were called for regular follow up visits but 10 patients failed to report back. Informed written consent was taken from each patient. Inclusion and exclusion criteria were followed. Analysis was done by SPSS version 13 and Chi Square test was applied.Results: Total 202 patients were included in the study and randomly divided into two groups of 101 patients each using random numbers table. Both GTN and sphincterotomy groups revealed significant, but comparable results. Pain relief, fissure healing and incontinence were significantly higher in group B (Lateral anal sphincterotomy) as compared to group A (0.2% GTN). At the end of 8th week pain relief and incontinence became comparable between both the groups but fissure healing remain significantly higher in group B as compared to group A.Conclusion: GTN when applied to patients produces comparable results if used in long term i.e. eight weeks. It produces adequate symptomatic control and healing of the anal fissures and can be considered equivalent to and one of the recommended treatment options along with lateral anal sphincterotomy in treatment of chronic anal fissure if use for more than 8 weeks. Lateral anal sphincterotomy gives early resolution of symptoms and healing.

The Proterozoic Chotanagpur Granite Gneiss Complex (CGGC) at the northern boundary of the Central Indian Tectonic Zone (CITZ) of the eastern Indian shield preserves relics of fossilized oceanic back-arc crust. We describe the field, petrographical and geochemical characteristics of the mafic rocks comprising pillow basalts and dolerites from the Bathani area of the northern fringe of the CGGC, eastern India. The basalts consist of plagioclase feldspar, hornblende, opaque minerals (Fe–Ti oxide) and chlorite, and the dolerite consists of plagioclase, hornblende and opaque minerals. Our data indicate that the Bathani mafic rocks have tholeiitic to transitional composition and are overprinted by greenschist facies metamorphic conditions; however, REE and fluid immobile elements preserve their primary geochemical signatures. The (La/Sm)N ratios (1.38–2.15) and chondrite-normalized REE patterns point to an enriched mid-ocean ridge basalt (E-MORB) mantle source. Geochemical characteristics indicate a mixed signature of MORB and arc tholeiite with enrichment of Ba, Th, Eu and Sr, similar to that of back-arc supra-subduction zone ophiolites. These mafic rocks are the product of MORB-like magma derived from a depleted mantle corresponding to < 2% partial melting of spinel lherzolite, enriched by subduction-induced slab metasomatism and melting. The Bathani mafic rocks are representative of the upper part of a supra-subduction zone columnar ophiolite section, which was emplaced onto the present-day northern margin of the CGGC during suturing of the northern and southern Indian block at c. 1.9 Ga during the Nuna amalgamation.

Extra-medullary leukemic infiltration of the breast by acute lymphoblastic leukemia (ALL) is very rare. We report two cases of ALL presenting as breast masses and diagnosed on fine-needle aspiration (FNA). Our first patient, a post-partum 30-year-old female, developed bilateral breast lumps in her last trimester of pregnancy and complained of easy fatigability. Our second patient, a 14-year-old girl, presented with a right-breast lump of 1-week duration. She had received treatment for ALL 1 year back and had been in complete remission for the last 1 year. FNA of the breast nodules done in both the cases revealed diffuse infiltration by lymphoblasts. Subsequent hematological investigations confirmed bone marrow involvement by ALL in the first case and extra-medullary relapse in the second case. Fine-needle aspiration cytology (FNAC) is an easy and cost effective method for the early diagnosis of metastatic leukemic infiltration, avoiding unnecessary excisional biopsies in such cases.

If James Taylor had been an options trader, he might well have not written that second line. Options \"smile\" at traders, but that smile is not a source of happiness. It is in fact a source of considerable confusion and misunderstanding. In this paper, we explore how this confusion manifests in the pattern of different implied volatilities for different options on the same stock, a pattern commonly known as the volatility smile.

Data regarding racial disparities in the incidence, treatment, and outcomes of diffuse large B-cell lymphoma (DLBCL) is limited in the adolescent and young adult (AYA) population. We utilized the surveillance, epidemiology, and end-result (SEER) registry research plus database to evaluate racial/ethnic disparities in 8605 AYA patients with DLBCL. Race/ethnicity was categorized into three main subsets: non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and ‘other races’ that included Hispanics (H), American Indian/Alaskan Native (AI/AN), Asian or Pacific Islander (A/PI). NHB were more likely to present with advanced stage disease (p < 0.001) and B symptoms (p < 0.001) and were less likely to receive chemotherapy (p < 0.001) compared to non-Hispanic white (NHW) patients and other races respectively. NHB patients had inferior 5-year disease specific survival (DSS) (70% vs 85% vs 80%, p < 0.001) and 5-year overall survival (OS) (66% vs 82% vs 77%, p < 0.001) compared to NHW and other races respectively. Black race was independently associated with both inferior DSS (HR 1.55, 95% CI 1.17–2.05, p = 0.002) and OS (HR 1.41, 95% CI 1.10–1.83, p = 0.007) after adjusting for age, gender, stage, presence of B symptoms, receipt of chemotherapy and radiation. NHB-DLBCL patients also had a lower 1-year relative survival rate (RSR) compared to NHW and other races. The low RSR in NHB patients persisted up to 5 years from diagnosis unlike NHW and other races. Our study shows that despite significant therapeutic advances in DLBCL over the last two decades, NHB AYA patients with DLBCL continue to have inferior survival outcomes compared to other ethnic and racial groups with disparities arising as early as the first year of diagnosis.

Reinforced concrete walls are being widely adopted as lateral load resisting systems for high rise structures. The current practice among design engineers for modelling of such walls is by idealizing the same as ‘wide’ columns, which is uncertain from safety as well as economy point of view. The most efficient modelling strategy of RC walls involves use of shell elements. Such an approach can be computationally much intensive, especially from a seismic analysis perspective. The present study utilizes an equivalent strut approach for modelling RC walls. The modelling strategy is demonstrated on a G + 15 storey residential apartment located in Calicut city. The proposed methodology will be compared with the traditional ‘wide’ column method as well as the one with shell element discretization. Comparison of modal properties such as frequencies and vibration modes from the various models are initially made to assess the model accuracy. Various seismic analyses viz. Equivalent static approach, Response spectrum approach and the assessment the storey shear, inter storey drifts as well as computation times using various models were performed using time history analysis. From preliminary results, it is understood that the modelling strategy could serve as an efficient alternative to more robust and computationally demanding scheme involving use of shell elements.

Introduction: Benign prostatic hyperplasia (BPH) is a disease of the prostate commonly seen in elderly males known to cause lower urinary tract symptoms (LUTS) that may require surgery as a part of treatment. Transurethral resection of the prostate (TURP) is considered the gold standard of surgical treatment, but it is not without complications. Laser photoselective vaporisation of the prostate (PVP), introduced in 1998 as an 80 W Nd:YAG laser which passed through a KTP (potassium-titanylphosphate) crystal, emerged as a safe alternative to TURP in selected cases. A recent upgrade to the Greenlight XPS 180 W powered with an LBO (lithium triborate) crystal has been available for use since 2012. Data on the use of this new upgrade is still being collected and analysed, especially in patients with large prostates or high risk cases. We analysed cases done at Jaslok Hospital over a 2-year period. Methods: A total of 34 patients who underwent Laser PVP using XPS 180W for LUTS due to BPH at Jaslok Hospital were part of this study. We analysed the pre- and postoperative variables and the intraoperative parameters of all patients. Results: The XPS 180W was found to be safe and efficacious. Eighteen patients were high-risk cases, classified as ASA (American Society of Anesthesiologists) Classes 3 and 4. Average postoperative catheter duration was 40.18 hours. In prostates of size <80 mL, an average of 229 kJ of energy was used. In large prostates (>80 mL), an average of 390 kJ of energy was used. No major complications were seen in any of the high-risk patients, classified as Clavien Dindo Class 3 and 4. The postoperative drop in IPSS (International Prostate Symptom Score) was 8.7. Conclusion: We found that Green Light Laser XPS 180W may be used for large (>80 g) prostates, hitherto an indication for open surgery, and that it may be used in high-risk patients, who were otherwise unfit for TURP. It is safe and efficacious. Further, multicenter trials are required to confirm the findings.

Castleman's disease is a morphologically distinct form of lymph node hyperplasia. The disease is rare and the etiology remains poorly understood. Three morphological variants of the disease are described- hyaline vascular, plasmacytic and a mixed variant. Clinically, the presentation of the disease is heterogeneous. Most often, the disease presents as a localized lymph node enlargement, referred to as the unicentric type and the multicentric form is rare. In unicentric disease, surgical resection is usually curative, however in the multicentric form the management is poorly defined and the disease has a more fatal outcome. We present a case of 48 year old female presenting with peripancreatic unicentric Castleman's disease involving peripoartal lymph nodes.