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Relapsed lymphoma mimicking venous ulcer: A case report

Kamal WSA, Affandi AM, Bhullar A, Kamal WSZ

Med J Malaysia, 2018 08;73(4):253-254.
PMID: 30121690 MyJurnal

Lymphoma presenting with ulceration is not typical. We report a case of relapsed DLBCL in a 73-year-old man presenting with a chronic non-healing leg ulcer. He has underlying varicose veins with recurrent venous ulcers. This patient was diagnosed to have DLBCL six years earlier when he presented with recurrent epistaxis originating from a left nasal cavity nodule. Complete resolution was achieved after eight cycles of R-CHOP and intrathecal methotrexate. For this current problem, this patient was treated with rituximab combined with chemotherapy which resulted in healing of the ulcer.
Fulltext Hypopigmented patches in an 8-year-old boy

Malek KA, Kamal WW

Malays Fam Physician, 2018;13(1):49-51.
PMID: 29796212 MyJurnal

An 8-year-old boy presents with asymptomatic hypopigmented patches on his bilateral cheeks which
have been worsening for two weeks. The patches are oval in shape and have spared other parts of the
body. There is no preceding erythematous rash. Similar lesions appeared two years ago which took
several months to resolve. There are no recent triggers, such as personal care products. He has no history
of atopy, but his mother has a recent history of atopic eczema. There is no known history of thyroid
problems in the family. He was prescribed a topical cream from a general practitioner, but the patches
persisted, and new patches appeared. He is otherwise well and actively participating in outdoor physical
activities with frequent sun exposure. (Copied from article).
Generation and characterization of monoclonal antibodies against prostate-specific antigen

Karuppaiya A, Cheah SH, Mohd S, Kamal WH, Zulkifli MH

Hybridoma (Larchmt), 2009 Apr;28(2):133-7.
PMID: 19249990 DOI: 10.1089/hyb.2008.0085

Prostate-specific antigen (PSA) is widely used as a diagnostic marker for the detection of prostate cancer in men. We have generated stable hybridomas producing specific monoclonal antibodies (MAbs) of the IgG class against PSA from fusions of splenocytes from immunized mice with myeloma cells. The hybridomas were adapted into serum-free media and cultured in CELLine CL-1000 bioreactors to produce milligram quantities of MAbs. Cross-reactivity study demonstrated that all the MAbs reacted did not cross-react with several other types of tumor antigens. Two of the MAbs were successfully radiolabeled by the iodogen method. The (125)I-labeled MAbs demonstrated strong binding to PSA on the surface of the LNCaP cells (Kd of 1.16 x 10(-9) M and 1.4 x 10(-9) M). Thus the (125)I-labeled MAbs retained their immunoreactivity and possessed high affinity and is potentially useful for binding to tumor cells. In conclusion, the MAbs can be used to develop radioimmunodiagnostic, radioimaging, and immunohistochemistry techniques for the early detection and treatment of prostate cancer.
Fulltext Elliptical metallic rings-shaped fractal metamaterial absorber in the visible regime

Bilal RMH, Saeed MA, Choudhury PK, Baqir MA, Kamal W, Ali MM, et al.

Sci Rep, 2020 Aug 20;10(1):14035.
PMID: 32820192 DOI: 10.1038/s41598-020-71032-8

Achieving the broadband response of metamaterial absorbers has been quite challenging due to the inherent bandwidth limitations. Herein, the investigation was made of a unique kind of visible light metamaterial absorber comprising elliptical rings-shaped fractal metasurface using tungsten metal. It was found that the proposed absorber exhibits average absorption of over 90% in the visible wavelength span of 400-750 nm. The features of perfect absorption could be observed because of the localized surface plasmon resonance that causes impedance matching. Moreover, in the context of optoelectronic applications, the absorber yields absorbance up to ~ 70% even with the incidence obliquity in the range of 0°-60° for transverse electric polarization. The theory of multiple reflections was employed to further verify the performance of the absorber. The obtained theoretical results were found to be in close agreement with the simulation results. In order to optimize the results, the performance was analyzed in terms of the figure of merit and operating bandwidth. Significant amount of absorption in the entire visible span, wide-angle stability, and utilization of low-cost metal make the proposed absorber suitable in varieties of photonics applications, in particular photovoltaics, thermal emitters and sensors.
Multicenter outcome analysis of different sheath sizes for Flexible and Navigable Suction ureteral access sheath (FANS) ureteroscopy: an EAU Endourology collaboration with the global FANS study group

Kwok JL, Somani B, Sarica K, Yuen SKK, Zawadzki M, Castellani D, et al.

Urolithiasis, 2024 Nov 15;52(1):162.
PMID: 39545972 DOI: 10.1007/s00240-024-01662-4

Flexible and navigable suction ureteral access sheath (FANS) is a potential game changer in flexible ureteroscopy (FURS). The influence of sheath size on outcomes needs research. The primary aim was to analyze 30-day single stage stone free status (SFS), zero fragment rate (ZFR) and complications when using 10/12Fr sheaths vis a vis other sheath sizes. The global FANS research group published the 30-day outcomes in patients who underwent FANS and reasoned this can be a potential game changer. We included 295 patients from this anonymized dataset with division into two groups: Group 1 (Smaller sheath) - 10/12Fr FANS, and Group 2 (Larger sheath) - 11/13Fr or 12/14Fr sheaths. Stone volume was similar between both groups (median 1320 mm3, p = 0.88). Ureteroscopy and total operative time was longer in the smaller sheath group (35 vs. 32 min, p = 0.02 and 50 vs. 45 min, p = 0.001, respectively). While 30-day computed tomography SFS (100% stone free or single residual fragment ≤ 2 mm) were not significantly different (96% vs. 95%, p > 0.99), ZFR (100% stone-free) was better with smaller sheaths (68% vs. 53%, p = 0.02). There was no difference in postoperative complication rates, and no sepsis in both groups. Urologists should consider individualizing appropriate sheath size in normal adult kidneys. Sheath size did not affect complication rates, risk of perioperative injury to the pelvicalyceal system or ureteric injury, but smaller FANS sheaths had similar high SFS. The ZFR with smaller sheaths was better, but this needs to be validated. These smaller sheath outcomes need to be balanced with longer ureteroscopy time, operative time, reach to the lower pole, ease of suction and visibility during lithotripsy. Large volume studies in different types of pelvicalyceal anatomy can determine if indeed smaller FANS is the best choice in FURS.
International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management

Zhong W, Osther P, Pearle M, Choong S, Mazzon G, Zhu W, et al.

World J Urol, 2024 Mar 25;42(1):189.
PMID: 38526675 DOI: 10.1007/s00345-024-04816-6

BACKGROUND: The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis.
PURPOSE: To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones.
METHODS: A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion.
RESULTS: The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document.
CONCLUSION: A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.
International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis

Zeng G, Zhu W, Somani B, Choong S, Straub M, Maroccolo MV, et al.

Urolithiasis, 2024 Sep 04;52(1):124.
PMID: 39230669 DOI: 10.1007/s00240-024-01621-z

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.
International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy

Zeng GH, Zhong W, Mazzon G, Zhu W, Lahme S, Khadgi S, et al.

Mil Med Res, 2024 Oct 28;11(1):70.
PMID: 39465407 DOI: 10.1186/s40779-024-00562-3

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts' experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.