Occurrence Of Stones Research Articles

Urinary Tract Stones Risk Factors in Patients with Benign Prostatic Hyperplasia in West Java, Indonesia

Background: Urinary tract stones are common in patients with benign prostatic hyperplasia (BPH); therefore, an imaging test is needed for patients who have risk factors for the formation of urinary tract stones. The purpose of this study was to explore the factors associated with the presence of urinary tract stones in patients with BPH as information to conduct imaging tests.Methods: A cross-sectional quantitative analytic study was conducted on medical records of patients with BPH, both with and without urinary tract stones, or patients with urinary tract stones registered at the Department of Urology, Dr. Hasan Sadikin General Hospital, Indonesia, from 2015 to 2018. Data on age, body mass index, hypertension, use of antihypertensive drugs, diabetes mellitus, and hyperuricemia were collected and analyzed using the Mann-Whitney, Chi-square, Fisher exact test, and multivariate logistic regression statistical test to compare variables between BPH with and without urinary tract stones.Results: In total, 235 BPH patients were registered, of whom 74 (31.5%) had urinary tract stones. The median age was 64 years old. There was a relationship between age (p=0.030), diabetes mellitus (p=0.043), and the occurrence of urinary tract stones in patients with BPH. The most dominant risk factor was diabetes mellitus (OR=3.000, 95%CI 1.03-8.69).Conclusions: Age and diabetes mellitus are the risk factors for urinary tract stones in patients with BPH. BPH patients with diabetes mellitus are at a 3-fold risk for urinary tract stones. Diabetes mellitus in BPH patients is an indication to conduct imaging tests.

Genetic polymorphisms as prognostic factors for recurrent kidney stones: A systematic review and meta-analysis.

Genetic polymorphisms have been suggested as risk factors affecting the occurrence and recurrence of kidney stones, although findings regarding the latter remain inconclusive. We performed this systematic review and meta-analysis to clarify the associations between genetic polymorphisms and recurrent kidney stones. PubMed, SCOPUS, EMBASE, and Cochrane Library databases were searched through May 28th, 2020 to identify eligible studies. The Quality in prognostic studies (QUIPS) tool was used to evaluate bias risk. Allelic frequencies and different inheritance models were assessed. All analyses were performed using Review manager 5.4. A total of 14 studies were included for meta-analysis, assessing urokinase (ApaL1) and vitamin D receptor (VDR) (ApaI, BsmI, FokI, and TaqI) gene polymorphisms. The ApaLI polymorphism demonstrated protective association in the recessive model [odds ratio (OR) 0.45, P < 0.01] albeit higher risk among Caucasians in the heterozygous model (OR 16.03, P < 0.01). The VDR-ApaI polymorphism showed protective association in the dominant model (OR 0.60, P < 0.01). Among Asians, the VDR-FokI polymorphism recessive model showed significant positive association (OR 1.70, P < 0.01) and the VDR-TaqI polymorphism heterozygous model exhibited protective association (OR 0.72, P < 0.01). The VDR-BsmI polymorphism was not significantly associated with recurrent kidney stones in any model. Urokinase-ApaLI (recessive model), VDR-ApaI (dominant model), and VDR-TaqI (heterozygous model) polymorphisms were associated with decreased recurrent kidney stone risk whereas urokinase-ApaLI (heterozygous model) and VDR-FokI polymorphisms were associated with increased risk among Caucasians and Asians, respectively. These findings will assist in identifying individuals at risk of kidney stone recurrence.

Biliary tract exploration via left hepatic duct stump versus the common bile duct incision in left-sided hepatolithiasis: a meta-analysis.

Left lateral hepatic resection is the preferred surgical approach for treating left hepatolithiasis. However, it is not clear whether cholangioscopy via left hepatic duct (LHD) orifice can replace conventional common bile duct (CBD) approach during laparoscopic procedures. We performed a comprehensive literature search by screening medical databases, then compared perioperative outcomes and occurrence of recurrent stones between LHD and CBD approaches. A total of five studies, comprising 345 patients, were included in this meta-analysis. The reported operative times, intra-operative blood loss and incidence of post-operative complications were comparable between the approaches. Pooled results revealed a positive correlation between LHD approach with shorter length of hospital stay (standard mean difference=-1.36; 95% confidence interval: -2.10, -0.61; P < 0.001). Additionally, bile duct exploration via LHD orifice was associated with similar rate of recurrent stones and cholangitis across both groups. Our results demonstrated that biliary tract exploration via LHD stump can be safely performed in left-sided hepatolithiasis. Additionally, the LHD approach was associated with comparable intra-operative outcomes and shorter post-operative hospitalization relative to CBD approach, and does not increase incidence of stone recurrence.

A 13 year hospital based study on the Trend of Urinary Stone Disease in Uttarakhand, India.

BackgroundThe present retrospective study on urinary stone disease in the Uttarakhand state was necessitated as no study has been done yet.MethodsA 13 year retrospective study (from 2005 to 2018) was conducted on the urinary stones removed from the patients, admitted at Himalayan Institute of Medical Sciences, Dehradun. The incidence of the disease, site of stones in urinary tract upon diagnosis, composition of removed stones and occurrence of a possible co-relationship between the incidence of the urinary stone disease at different times, age, sex, religion of the patients was investigated.ResultsThe frequency of occurrence of urinary stones in males was found to be almost three times more as compared to their female counterparts. The above trend was consistent over the entire period of the study. Interestingly, in the Muslim and Sikh population of the area, females were found to be less prone to the problem as compared to their Hindu counterparts. However, in all religious groups, 21-40 years old subjects were found to be most susceptible to the problem and approximately 90% of the urinary stones were recovered from the kidneys and primarily composed of calcium oxalate.ConclusionThe co-relationship between the occurrence of urinary stones with age, sex of the patients, their religion & site of stones on diagnosis was found to be statistically significant.

Polycystic Renal Disease Presented by Anuria and Nephrolithiasis Associated Progressive Kidney Damage: A Case Report

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease. Kidney stones develop in 20-30% of patients with ADPKD.Hydronephrosis, which is the most valuable radiological finding in the diagnosis of stone-related postrenal insufficiency, may be difficult to differentiate from common cysts in ADPKD patients. When kidney dysfunction develops in ADPKD patients, Glomerular Filtration Rate (GFR) loss reaches an average of 4.4 to 5.9 mL / min per year. Faster deterioration in these patients requires investigation for prerenal factors such as dehydration that triggers acute kidney damage or stone-related postrenal factors. In ADPKD, stone-related postrenal obstruction should be considered in rapid GFR losses despite negative ultrasound report for hydronephrosis as there is frequent occurrence of kidney stones and the difficulty in detecting hydronephrosis with ultrasonography (US) in these patients. Here, we present a case with ADPKD whose renal functions rapidly deteriorated while under chronic follow-up and renal function markers returned to the basal levels with the treatment of the underlying cause.

Influence of periampullary diverticula on endoscopic retrograde cholangiopancreatography.

The present study aimed to explore the influence of the presence of periampullary diverticula (PAD) on the implementation of endoscopic retrograde cholangiopancreatography (ERCP). A total of 388 patients with pancreaticobiliary disease who underwent ERCP for the first time between January 2017 and December 2018 were included and they were divided into a PAD group (n=179) and non-PAD (N-PAD) group (n=209) according to the presence or absence of PAD. A logistic regression model was used to analyze the risk factors for PAD. The prevalence of PAD in males was higher than that in females [odds ratio (OR)=2.250, 95% CI: 1.670-3.801]. The prevalence of PAD in patients with bile duct stone was 57.92% and higher than that in patients without stone (OR=4.475, 95% CI: 2.932-7.679). The morbidity of PAD in elderly patients with bile duct stone was higher than in those without stone (OR=6.728, 95% CI: 3.790-11.943). Among the elderly patients, the constituent ratio of males in the PAD group was higher than that in the N-PAD group (χ2=13.543, P<0.001). The constituent ratio of patients who underwent endoscopic sphincterotomy (EST) was lower than that in the N-PAD group (χ2=10.800, P<0.001). In conclusion, the occurrence of PAD was high in elderly males and closely related to the occurrence of bile duct stones.

Beyond Prevalence: Annual Cumulative Incidence of Kidney Stones in the United States.

It is well documented that the prevalence of nephrolithiasis is increasing in adults in the United States over time. Approximately 11% of men and 7% of women have reported a lifetime history of nephrolithiasis in cross-sectional studies. However, the burden of acute management may be better assessed from annual cumulative incidence. This accounting of new stone occurrences, however, is not well described on a national scale. The Medical Expenditure Panel Survey is a set of large-scale health care utilization surveys of families, individuals, their health care providers and employers, with surveys administered every 6 months for the duration of each individual's 2-year panel. We queried the survey data of adult participants between 2005 and 2015, with analysis conducted with provided weights and strata to allow our findings to be representative of the civilian noninstitutionalized U.S. adult population. Those with diagnosed renal or ureteral calculi as noted by ICD-9 codes were included as our incident stone formers. In 2005, the mean age of stone formers was 45 years. Of stone formers 52.2% were male, 91% were White and 47.6% were in the Southern U.S. The incidence of stone occurrences was 0.6% (177/33,961 individuals, weighted to represent population of 1,923,322/296,185,002 individuals). By 2015, the mean age was 51.7 years, with 52% male, 83% White and 38.2% residing in the Southern U.S. Between 2005 and 2015, the overall incidence increased from 0.6% to 0.9% (p <0.001). Based on this large-scale, nationally representative analysis of adults in the United States, the estimated annual cumulative incidence of stone occurrence is approaching 1%. Moreover, this incidence appears to be increasing over time, rising from 0.6% in 2005 to 0.9% in 2015. These data may help to better anticipate the need for urological care for stone disease and direct resource distribution.

Neutrophil-lymphocyte ratio acts as a novel diagnostic biomarker for kidney stone prevalence and number of stones passed.

BackgroundThis study evaluated the relationship between inflammatory biomarkers and the prevalence of kidney stones and number of stones passed.MethodsWe conducted a cross-sectional study of adult participants (≥20 years) in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014. We calculated key inflammatory biomarkers, such as the systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR). Multivariate logistic regression analysis was used to determine the effect of inflammatory biomarkers on the prevalence of kidney stones and number of stones passed.ResultsA total of 21,106 participants were included in the final study, and 1,864 patients reported a history of kidney stones (including 292 who had passed no stones, 1,462 who had passed stones 1–5 times, and 110 who had passed stones >5 times). The chi-square test showed that the NLR, MLR and SII were closely related to the occurrence of kidney stones and the number of stones passed. Multivariate logistic regression analysis showed that a high NLR (>1.72) was associated with an increased prevalence of kidney stones and number of stones passed (OR =1.18, 95% CI: 1.03–1.36, P=0.019).ConclusionsA convenient biomarker, the NLR can be used as a good predictor for the diagnosis of kidney stones and number of stones passed; these findings are worthy of further research and application in clinical practice.

Outcomes of kidney donors with pre- and post-donation kidney stones.

Roughly 25% of US transplant centers exclude donor candidates with kidney stones fearing future obstructive consequences and the possible association between stones and CKD. We compared the development of hypertension, proteinuria, and reduced eGFR in 227 kidney donors with kidney stones to 908 propensity score-matched donor controls without kidney stones using data from The Renal and Lung Donor Evaluation (RELIVE) Study which studied intermediate and long-term outcomes of 8922 donors who donated between 1963 and 2007. 200 donors had kidney stones prior to donation, 21 had post-donation stones, and 6 had pre- and post-donation stones. Donors with stones were older, more likely to be Caucasian, less likely to be related to the recipient and had a higher fasting glucose. After 16.5±10.9years (range 0-44years) from donation to study close, no ESKD occurred in donors with stones. The multivariable risks of hypertension, proteinuria, and reduced GFR were similar in donors with and without kidney stones. We could not demonstrate an association between stones and adverse renal outcomes in kidney donors, and the occurrence of post-donation stones was distinctly rare. These data may provide a rationale for possibly a wider acceptance of donor candidates with low kidney stones burden.

Гендерні та вікові особливості мінерального складу сечових каменів у пацієнтів з сечокам’яною хворобою

The paper presents the results of studying the features of the mineral composition of urinary stones obtained after spontaneous passage, as well as the use of minimally invasive surgical techniques. Material and methods. The study involved 61 patient with urolithiasis, depending who were examined depending on the sex and age of the patients. Infrared spectroscopy in the spectral range of 4000-400 cm-1 was used as a method for assessing the mineral composition of the stone. The next stage of the study consisted of analyzing the occurrence of stones of various mineral types in groups of patients with different gender and age characteristics. Results and discussion. Infrared spectroscopy identified a wide range of chemical compounds in urinary stones, in which calcium oxalate in the form of monohydrate (vevelite) or dihydrate (vedelite), calcium phosphate in the form of hydroxylapatite and uric acid were most often identified. Calcium carbonate, aragonite, struvite, ammonium urate, and cystine were detected in single samples. 45 patients (73.77%) had a mixed composition of the stone, consisting of two or more mineral components. Depending on the prevailing component, which is more than 50% vol. the sample, urinary stones were classified into 3 mineral types: type 1 – calcium oxalate calculi, the prevailing component of which is calcium oxalate in the form of monohydrate (vevellite) or dihydrate (veddelite); Type 2 – calcium phosphate, in which more than 50% vol. represented by apatite, hydroxylapatite or fluorapatite; Type 3 – stones, the dominant substance of which is uric acid or uric acid dihydrate. Most of the urinary stone samples were represented by type 1 stones, which were significantly more often detected in males. The study of gender dependence in the prevalence of stones of types 2 and 3, corresponding to these minerals, was not identified. Type 1 urinary stones were observed in all age categories, with a predominance in patients aged 30-39 years (41.38%). The age distribution of stones of type 2 had similar characteristics, while the maximum number of patients with this type of stone was noted in the age range of 40-49 years (40%), followed by a decrease in this indicator in older age groups. The minimum number of cases of type 3 stone formation was registered among patients aged 30-39 years (8.33%). In the following age periods, the quantitative presence of this type of stones increased with a maximum value in the age range of 50-59 years (41.67%). Conclusion. The mineral composition of urinary stones has features, depending on the sex and age of patients. The formation of oxalate-calcium urinary stones is most characteristic of men, the peak incidence occurs at the age of 40-49 years. Gender features of the distribution of stones, the dominant components of which are calcium phosphate and uric acid were not detected. The frequency of detection of uric acid stones increases with age, the inverse relationship is characteristic of the age distribution of phosphate-calcium stones

The Efficacy and Safety of Medical and Surgical Therapy in Patients With Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Both medical and surgical therapy represent potential management options for patients with asymptomatic primary hyperparathyroidism (PHPT). Because uncertainty remains regarding both medical and surgical therapy, this systematic review addresses the efficacy and safety of medical therapy in asymptomatic patients or symptomatic patients who decline surgery and surgery in asymptomatic patients. We searched Medline, Embase, Cochrane Central Register of Controlled Trials, and PubMed from inception to December 2020, and included randomized controlled trials in patients with PHPT that compared nonsurgical management with medical therapy versus without medical therapy and surgery versus no surgery in patients with asymptomatic PHPT. For surgical complications we included observational studies. Paired reviewers addressed eligibility, assessed risk of bias, and abstracted data for patient-important outcomes. We conducted random-effects meta-analyses to pool relative risks and mean differences with 95% confidence intervals and used Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) to assess quality of evidence for each outcome. For medical therapy, 11 trials reported in 12 publications including 438 patients proved eligible: three addressed alendronate, one denosumab, three cinacalcet, two vitamin D, and two estrogen therapy. Alendronate, denosumab, vitamin D, and estrogen therapy all increased bone density. Cinacalcet probably reduced serum calcium and parathyroid hormone (PTH) levels. Cinacalcet and vitamin D may have a small or no increase in overall adverse events. Very-low-quality evidence raised the possibility of an increase in serious adverse events with alendronate and denosumab. The trials also provided low-quality evidence for increased bleeding and mastalgia with estrogen therapy. For surgery, six trials presented in 12 reports including 441 patients proved eligible. Surgery achieved biochemical cure in 96.1% (high quality). We found no convincing evidence supporting an impact of surgery on fracture, quality of life, occurrence of kidney stones, and renal function, but the evidence proved low or very low quality. Surgery was associated with an increase in bone mineral density. For patients with symptomatic and asymptomatic PHPT, who are not candidates for parathyroid surgery, cinacalcet probably reduced serum calcium and PTH levels; anti-resorptives increased bone density. For patients with asymptomatic PHPT, surgery usually achieves biochemical cure. These results can help to inform patients and clinicians regarding use of medical therapy and surgery in PHPT. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study.

ObjectivesTo compare the efficacy and safety of citrate mixture and sodium bicarbonate on urine alkalization in gout patients under benzbromarone treatment.MethodsA prospective, randomized, parallel controlled trial was conducted among 200 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University. The participants were randomly divided into two groups (1:1), sodium bicarbonate group (3 g/day) and citrate mixture group (7 g/day). All patients were prescribed with 25 mg/day benzbromarone at initiation and maintained at a dose of 50 mg/day. Clinical and biochemical data were collected at each follow-up time point (baseline, weeks 2, 4, 8 and 12).ResultsA total of 182 patients completed the 12-week urine alkalization study. The urine pH value of both groups increased significantly from the baseline to the final follow-up time point (sodium bicarbonate group, 5.50–6.00, P < 0.05; citrate mixture group, 5.53–5.93, P < 0.05). While the comparisons regarding urine pH between treatment groups showed no significant differences for each time point. The estimated glomerular filtration rate (eGFR) dropped significantly after 12 weeks’ trial in the sodium bicarbonate group (P < 0.01), while it was comparable between baseline and the last follow-up (P > 0.05) in the citrate mixture group. Results of urine analysis showed that the incident rate of occult blood in the sodium bicarbonate group was higher than that in the citrate mixture group (38 vs 24%, P < 0.05), accompanied by a similar occurrence of kidney stones. After 12-week follow-up, the frequency of twice gout flare in the citrate mixture group was significantly lower than that in sodium bicarbonate group (4 vs 12%, P = 0.037). No treatment-emergent adverse events occurred.ConclusionThe efficacy of citrate mixture on urine alkalization is comparable to sodium bicarbonate under benzbromarone treatment without significant adverse events. Citrate mixture is superior to sodium bicarbonate in lowering the incidence of urine occult blood and the frequency of gout attacks.Trial registrationRegistered with ChiCTR (http://www.chictr.org.cn), No. ChiCTR1800018518.

The pelvis urinary microbiome in patients with kidney stones and clinical associations

BackgroundThe long-held notion that, without urinary tract or circulatory infection, bladder urine and blood are sterile biofluids has been disproven. There have been no previous reports on the kidney pelvis urinary microbiome after bladder disinfection in kidney stone patients. This study aimed to determine whether a kidney pelvis urinary microbiome is present after eliminating the influence of the bladder urinary microbiome, whether the microbiome composition is different in patients with stone kidney pelvis (SKP) and non-stone kidney pelvis (NSKP), and the correlation between SKP and patient clinical characteristics.ResultsComparisons of bacterial diversity and community structure exhibited that urine in bladder was similar to SKP and NSKP. However, the comparisons showed that urine samples were different from blood. The most common operational taxonomic units were shared by all three types of urine samples. Corynebacterium was significantly higher in SKP compared to NSKP. Several bacteria were associated with patient characteristics, including Lactobacillus, which was positively correlated with fasting blood glucose, and Prevotella was negatively correlated with BMI. Lactobacillus was significantly higher in SKP compared to blood but not in NSKP compared to blood.ConclusionsThe composition of the kidney pelvis urinary microbiome after disinfection of the bladder and its similarity to the bladder microbiome indicate that bladder urine can be used to replace kidney pelvis urine in microbiome research. Additionally, the comparison of SKP and NSKP and clinical associations suggest that the occurrence of kidney stones is responsible for the SKP urinary microbiome.

Correlation of Dietary Factors and Physical Activities With the Formation of Renal Stones

Objective: This study was undertaken to find out the roles of dietary factors and physical activities in the formation of renal stones in our socio-demographic conditions. Methods: This cross-sectional analytical study was conducted among 70 patients from October 2011 to November 2012 in the department of SSMCMH and a few other private hospitals in Dhaka city. The study included all patients of either gender and all ages attending our out-patient department who were diagnosed to have renal stones. The dietary habits of the patients were explored by face to face interview using food frequency questionnaire (FFQ). The physical activities were evaluated by structured questionnaire, and the metabolic work-ups were done by urinalysis and blood analysis. The results were reviewed and analyzed with the help of SPSS 17. Result: Out of 70 patients about one-third were female (31.4%) and two-third were male (68.6%). Most of the study people belonged to age group 40-50 years. Mean was 43.7 years with standard deviation of 10.28 years. One-fifth of the respondents did minimal activities (0-5 hrs/day), One –third moderate activities (5-10 hrs/day) and about half severe activities (10-15hrs/day). One-fifth did not take any table salt but about one-fourth indulged much (&gt;half tsf/day) and more than half took excessive (&gt; 1tsf/day) salt. About 57.1% stone patients of the present study habitually have taken excessive salt, 24.3% patients took much salt and 18.6% used no added table salt. About one-third (37.71%) of the patients took calcium, one-fourth (25.71%) vitamin-D, one-fifth ascorbic acid and the rest had no supplementations. The patients having supplementations found to have more urinary levels of the corresponding supplements. More ingestion of green leafy vegetables and fruits and juices are associated with increased level of urinary oxalate. 24-hrs urinary oxalate level found to be associated with increased occurrence of renal stones. Most of the patients (64.3%) ingested habitually inadequate amount of fluid. Conclusion: The study showed some important observational facts in regard to the respondent’s diet and physical activities. The dietary and lifestyle modifications can reduce urinary stone disease. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.23-27

Laparoscopic removal of giant gallstones

Abstract The gold standard treatment of gall stones is laparoscopic cholecystectomy, but in case of giant gall stone (when size is more than 5 cm), its removal by laparoscope is slightly difficult. The occurrence of giant gall stones in young patient is extremely rare. The common reason for this giant gall stone is usually because of its asymptomatic nature. We are presenting three cases of giant gall stones of size 55 × 50 × 45 mm, 58 × 56 × 45 mm and 50 × 56 × 40 mm in 12 years old male, 18 years old female and 14 years old female respectively. To the best of our knowledge only few cases of such giant gall stones are reported. Open cholecystectomy may be required sometimes to remove such giant gallstone. The slight increase in skin incision at epigastric port at the time of specimen removal is a wise decision to remove the giant gall stone laparoscopically.

Urine stones of different chemical composition occurrence depending on the level of uricuria

Introduction. According to modern concepts one of the key links in the pathogenesis of urolithiasis is metabolic lithogenic disturbances. The study of the complex effect of many factors on the metabolism of urolithiasis patient is the basis of modern scientific research. We studied the frequency of various chemical urinary stones occurrence depending on various levels of uricuria.&#x0D; Materials and methods. Data from of 708 urolithiasis patients (303 men and 405 women) were analized. The results of blood and urine biochemical analysis and chemical composition of urinary stone were studied. The degree of uricuria was ranked by 10 intervals: from 0.4 to 14.8 mmol/day to assess the occurrence of different stones at various levels of uricuria.&#x0D; Results. The incidence of calculi consisting of uric acid also increases with increasing levels of uric acid in the urine. An increase in the level of uricuria above 3.11 mmol/day is observed to increase calcium-oxalate stones occurrence. Decrease in the prevalence of carbonatapatite and struvite stones observed at an increase of urine uric acid excretion. At high levels of uric acid excretion, we found uric acid and calcium oxalate stones most often.&#x0D; Conclusion. Control over the level of urinary acid excretion in urine is important in case of calcium-oxalate and uric acid urolithiasis.

Right posteroinferior bile duct angulation correlates with bile duct stone occurrence in patients with hepatolithiasis.

This study aimed to examine the correlation between right posteroinferior bile duct (RPBD) angulation and the occurrence of bile duct stones in patients with hepatolithiasis. Patients presenting with hepatolithiasis in our hospital from January 2011 to July 2016 were divided into two groups according to whether their RPBD was affected by stones. A statistical analysis for the relevant factors associated with bile duct stone formation in the RPBD was performed. The binary logistic regression results showed that stenosis of the right hepatic duct [odds ratio (OR): 7.313; 95% confidence interval (CI) 4.131-12.945)] and the angle of the RPBD (OR 0.896; 95%CI 0.877-0.916) were risk factors associated with the formation of RPBD stones. Further, the receiver operating characteristic curve indicated that, when the angle of the RPBD was less than 44.58°, stones were able to form more easily in the RPBD. The occurrence of bile duct stones is well correlated with sharp bile duct angulation.

Aesthetic Value of Colluvial Blocks in Geosite-Based Tourist Destinations: Evidence from SW Russia

Nature-based tourism is stimulated by the aesthetic properties of landscapes, and particular elements of the latter determine the overall scenic beauty. Big stones on forested mountain slopes are among such elements. The Partisan Glade geosite-based tourist destination ofthe Western Caucasus in southwestern Russia is distinguished by the occurrence of such stones. Their field investigation (measurements of physical parameters and interpretation of the common criteria of tourist-meaningful beauty) shows that these are essentially blocks (clasts with the size of 1–10 m) of all grades (fine, medium, and coarse blocks) and colluvial origin. The blocks influence on such parameters of scenic beauty as scale, condition, balance, diversity, shape, and uniqueness, and, therefore, these blocks are of aesthetic value. The most important is color and size. Apparently, the presence of these big stones stimulates tourists’ positive emotions. It is recommended to avoid block removal or breaking in the course of road maintenance.

Occurence of gallbladder stones and its association with HbA1C among participants with type 2 diabetes mellitus: One-year cross-sectional study

Aims: The aim was to study the occurrence of gallbladder stones and its association with HbA1c among participants with Type 2 diabetes mellitus. Settings and Design: This was a 1-year cross-sectional study. Subjects and Methods: The study was done on 200 participants of Type 2 diabetes mellitus admitted in the Department of General Medicine over a period of 1 year from January 2018 to December 2018. A thorough medical history was obtained, and clinical examination and investigations were performed on the study participants. Ultrasonography of the abdomen was done with special reference to gallbladder and gallstones. Statistical Analysis: The data were entered into Excel 2010 and analyzed by SPSS version 20.0 software. The data were analyzed by descriptive statistics including frequency, percentage, mean, and standard deviation. The Chi-square test was used to assess the association between the two attributes. Results: The occurrence of gallbladder stones was 33.50%, with 67 Type 2 diabetes mellitus participants having asymptomatic gallstones out of the total 200 study participants. The association of higher occurrence of gallstones was found to be statistically significant with higher HbA1c values. In the participants with gallstones, the mean HbA1c was 9.67 ± 2.16%. The maximum number of participants belonged to the group of study participants having HbA1c range of 08%–9.9%, which consists of 44.5% of the total study participants. Conclusions: The occurrence of gallbladder stones was 33.50% among Type 2 diabetes participants. A higher HbA1c level was found to be significantly associated with gallstone formation. This knowledge may provide an early interventional opportunity to implement adequate measures for a strict glycemic control and prevent further morbidity and mortality.

Renal Calculi as Initial Presenting Symptom of Glycogen Storage Disease (Type 1 A) in Early Infancy

AbstractGlycogen storage diseases are a group of heterogeneous metabolic disorders that result from a defect in enzymatic pathway of either glycogen synthesis or glycogen degradation. Here we are reporting a case of glycogen storage diseases type 1 with renal stone as initial manifestation of disease at 2 months of age. There were case reports of recurrent renal calculi in older age group with this disease and considered to be arisen due to metabolic derangements. Although the exact mechanism of renal stones in glycogen storage disease is not clear, in this unique case occurrence of renal stones at 2 months of age suggests that the pathogenesis of renal calculi is probably multifactorial or a part of disease.