RG Stone Urology & Laparoscopy Hospital

Background: Congenital hernia and undescended testis are significant pediatric surgical conditions traditionally managed through open techniques. With advances in minimally invasive surgery, laparoscopic approaches now offer an alternative for treating these conditions. Methods: We present a retrospective study outlining our experience with laparoscopic herniotomy and, when indicated, laparoscopic orchidopexy in paediatric patients. In all cases, pneumoperitoneum pressures were adjusted appropriately to ensure procedural safety and efficacy. Results: Our findings demonstrate that laparoscopic repair of both congenital hernia and undescended testis is technically feasible and effective in children. All procedures were completed successfully, with minimal complications and satisfactory postoperative outcomes. Conclusion: Laparoscopic management of congenital hernias and undescended testes is a safe and effective alternative to open surgery in paediatric patients, given the availability of an advanced surgical setup and experienced personnel.

Abstract Background: Oral semaglutide has shown efficacy in clinical trials worldwide; however, real-world evidence in Indian settings is scarce. The current study examined the effectiveness of oral semaglutide in patients with type 2 diabetes within the context of routine clinical practice in Indian settings. Methodology: This retrospective, multicenter, observational study assessed the effectiveness of oral semaglutide in adult patients with type 2 diabetes who had inadequate glycemic control (HbA1c ≥6.5). The included patients need to have ≥1 HbA1c report within 12 weeks of the study initiation. The primary end point was change in HbA1c% from baseline to end of study (EOS; 30 weeks), with secondary end points including changes in body weight, waist circumference, and body mass index (BMI). These end points were evaluated for patients who were on oral semaglutide at EOS. Results: Of 414 screened patients, 340 were included in the study, with 176 patients on oral semaglutide at EOS. A mean reduction of 0.96 ± 1.02% (P < 0.001) in HbA1c from baseline to EOS was observed, with greater reductions in patients with 5–10 years of diabetes. At EOS, 92.6% of patients achieved a target of ≥1% HbA1c reduction from baseline. In addition, significant reductions in body weight (6.04 ± 5.40 kg, P < 0.001), waist circumference (3.47 ± 5.42 cm, P < 0.001), and BMI (1.94 ± 1.42 kg/m2, P < 0.001) were observed at EOS. Conclusion: Oral semaglutide shows promise as a therapeutic option for glycemic control and weight management in diabetic patients in Indian settings. However, further randomized clinical trials in Indian patients are warranted to validate these findings and optimize further treatment strategies.

The microfluidic-based Glomerulus-on-Chips (GoC) are mostly cell based, that is, 3D cell culture techniques are used to culture glomerular cells in order to mimic glomerular ultrafiltration. These chips require high maintenance to keep cell viability intact. There have been some approaches to build non-cell-based GoCs but many of these approaches have the drawback of membrane fouling. This article presents a structural design and simulation study of a dialysate free microfluidic channel for replicating the function of the human glomerular filtration barrier. The key advancement of the current work is addressing the fouling issue by combining a pre-filter to eliminate cellular components and performing filtration on the blood plasma. The Laminar Flow Mixture Model in COMSOL Multiphysics 5.6 has been utilized to simulate the behavior of blood flow in the microchannels. The geometrical effect of microchannels on the separation of the filtrate was investigated. The velocity at the inlet of the microchannel and pore size of the filtration membrane are varied to see the change in outflow and filtration fraction. The efficiency of the device is calculated in terms of the filtration fraction (FF%) formed. Simulation results show that the filtrate obtained is ~20% of the plasma flow rate in the channel, which resembles the glomerular filtration fraction. Given that it is not dependent on the functionality of grown cells, the proposed device is anticipated to have a longer lifespan due to its non-cell-based design. The device's cost can be reduced by avoiding cell cultivation inside of it. It can be integrated as a glomerular functional unit with other units of kidney model to build a fully developed artificial kidney.

Objectives: The objective of this consensus article was to form a list of expert recommendations and an easily adaptable algorithm for obesity management in India by primary care physicians (PCPs). Methods: A Delphi-based model was followed to form a list of the consensus recommendations. Consensus statements were created from the results of a literature review that were graded as per the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. After being evaluated by an expert panel comprising diabetologists, endocrinologists, cardiologists, bariatric surgeons, and gynecologists, the statements were revised and reevaluated by a larger group of practitioners, including PCPs and diabetologists, to arrive at a consensus. Results: The panel opined that obesity is increasing in prevalence in India and is projected to rise in the coming years. Body mass index and waist circumference were both recommended for better identification of people at risk of obesity-related comorbidities than either of them alone. The Edmonton Obesity Staging System (EOSS) was suggested as being most suitable for the assessment (staging) of obesity. A multidisciplinary team was considered invaluable for assessing and managing patients with obesity. The use of once-a-week semaglutide (2.4 mg) via the subcutaneous route was suggested as the first-choice anti-obesity treatment when pharmacotherapy is deemed necessary. An algorithm considering all these aspects was proposed. Conclusion: Obesity needs to be recognized as a significant contributor to other comorbidities. The diagnosis and management of obesity should be comprehensive and consider patient psychology, the presence or absence of comorbidities, available pharmacologic agents, and long-term outcomes. The proposed algorithm could help clinicians in this aspect and improve the overall outcomes. How to cite this article: Deshpande NR, Kapoor N, Dalal JJ, et al. Consensus on Current Landscape and Treatment Trends of Obesity in India for Primary Care Physicians. J Assoc Physicians India 2023;71(10):69-77.

Abstract The human body is a highly sophisticated machine that is not fully understood to date. The body function is highly dependent on the versatile functions performed by different organs, which have their diverse arrangement of cells. Every organ (perhaps every body part) is prone to damage and malfunction because of the topological conditions, lifestyle, habitats, and food chemicals. Helping humans to lead an easy, luxurious, and healthy life are the primary goal of any technology, especially extending human life is the ultimate target of medical instrumentation. The importance of developing innovative techniques for disease diagnosis and treatment are burning topics since the start of the medical and pharmaceutical industry. Kidney failure is one of the common health issues worldwide, which is a slow poison affecting 10% of the world population. The importance of replacing the kidney is essential to extend a patient life. This review focuses on Organ-on-Chip technology with a major focus on Kidney-on-Chip (KOC). The evolution of techniques to diagnose and treat organ failure is elaborately presented. Major emphasis solely on the development of kidney failure causes, diagnostic techniques, replacement techniques are reported with a timeline of developments. The major functions of the kidney that have been achieved artificially so far are reviewed to the deepest level. The future directions in this field are predicted and presented. MEMS and microfluidics allow the design and manufacturing of devices at microscale without compromising the actual functionalities, especially in terms of disease diagnosis and treatment. Microfluidics technology revolutionized the development of artificial organ industry, the chances of realizing an organ substantially improved.KeywordsOrgan-on-ChipKidney-on-ChipMicrofluidicsArtificial kidney

Abstract We hereby report a case of a 35-year-old male who presented to us with infected pancreatic necrosis, 4 weeks after an episode of acute alcoholic pancreatitis. Imaging investigations showed a predominantly left-sided pancreatic and peripancreatic infected collection. This case was managed successfully in a single sitting by retroperitoneoscopic intervention.

Various operative procedures have been described for urogenital tuberculosis (UGTB). These include percutaneous drainage of hydronephrosis or abscesses, double-J stenting for hydronephrosis, definitive local extirpative treatment of the affected part of a kidney (cavernotomy/partial nephrectomy) and epididymis (epididymectomy). Many forms of reconstructive surgery of the upper urinary tract (uretero-calycostomy, ureteric reimplantation, ileal ureteric replacement) and the lower urinary tract have been described. Nephrectomy is performed in 27% of UGTB patients and the frequency is similar in developing and developed countries. Radical and reconstructive procedures should be done within the first two months of intensive chemotherapy. A contracted bladder may need augmentation cystoplasty or even cystectomy if the capacity is less than 100 ml.

The importance of replacing dialysis is growing day to day because of its disadvantages. Kidney-on-Chip is the right candidate to save kidney patients in an efficient way. The major parts of KOC are ultrafilter and bio-reactor unlike dialysis possessing of only ultrafiltration. This paper deals with designing of bioreactor for regenerating the reabsorption function based on size dependent selective function of kidney. The structure is designed with a main tubule carrying lumen fluid surrounded by blood tubules on the either side. The main tubule and blood tubules are connected through tiny transporting channels, which reabsorb the required solutes based on size. The flow velocity in the channels is found to be 8.82×10-5 m/s and total flow rate is 0.6 ×10-16 m3/s. Results show that the structure is capable of reabsorbing 52% of solutes. The present work has the potential to be applied in the design of Kidney-on-Chip.