BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

Introduction: We compared the diagnostic accuracy of percentage free prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and gallium-68 prostate-specific membrane antigen positron emission tomography (Ga-PSMA PET) to detect cancer prostate in men with PSA between 4 and 20 ng/ml in prebiopsy settings. Materials and Methods: This prospective study evaluated men with PSA values between 4 and 20 ng/ml, and all patients underwent percentage free PSA estimation, mpMRI, and Ga-PSMA PET scan, followed by cognitive fusion/registration biopsy along with systematic 12-core biopsy to detect cancer prostate. The diagnostic accuracy of percentage free PSA, mpMRI, and Ga-PSMA PET scan was compared with results of cognitive fusion/registration biopsy. Results: A total of 15 patients were included, of which 11 had an identifiable lesion on imaging and 9 had malignancy on the final histopathology report. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy of mpMRI were 62.5%, 71.4%, 71.4%, 62.5%, and 66.6%, respectively, and that of Ga-PSMA PET scan were 88.8%, 66.6%, 80%, 80%, and 80%, respectively. The sensitivity of detection of clinically significant cancers for Ga-PSMA was higher (100%) compared to MRI (33.3%). However, Ga-PSMA also detected a greater number of insignificant lesions as compared to MRI. Conclusion: Ga-PSMA PET scan has high NPV and accuracy in predicting presence of cancer and can also be used to direct specific biopsy cores during systematic biopsy.

Metal-on-metal resurfacing of the hip (MoMHR) has enjoyed a resurgence in the last decade, but is now again in question as a routine option for osteoarthritis of the hip. Proponents of hip resurfacing suggest that its survival is superior to that of conventional hip replacement (THR), and that hip resurfacing is less invasive, is easier to revise than THR, and provides superior functional outcomes. Our argument serves to illustrate that none of these proposed advantages have been realised and new and unanticipated serious complications, such as pseudotumors, have been associated with the procedure. As such, we feel that the routine use of MoMHR is not justified.

Introduction:We aimed to assess the feasibility of a novel method of recording frequency volume chart (FVC) in adult patients who are either illiterate or are unable to make the required written record.Materials and Methods:This prospective study included adult patients, in whom FVC was required as part of their urological evaluation, who were either illiterate or were not sufficiently literate to make the required written record. Three groups of people were involved in the study: (i) patient, (ii) nursing staff, and (iii) the investigator/coinvestigator. The investigator/coinvestigator briefed the patient and the nursing staff, separately, regarding their roles in detail. The patient-reported (investigator/coinvestigator interpreted) data were compared with the data recorded by the nursing staff to assess the feasibility of this novel method.Results:A total of 30 patients were included in the study, with a mean age of 45.1 years and male: female ratio of 2:1. The patient-reported (investigator/coinvestigator interpreted) data including 24-h urine production, daytime urine volume, nocturnal urine volume, daytime urinary frequency, nocturia, average voided volume, and maximum voided volume were similar to the data reported by the nursing staff, with no significant differences. All patients completed the FVC satisfactorily, except one patient who failed to report the night time voids.Conclusions:Our novel method of recording FVC is feasible, reliable, and clinically as informative/applicable as the written FVC in patients who are illiterate/insufficiently literate to make a written record of FVC.

Objective: To assess the clinical, urodynamic efficacy, and safety of mirabegron in patients with neurogenic detrusor overactivity (NDO) consequent to traumatic spinal cord injury (SCI). Methods: This prospective cohort study was performed between January 2018 and July 2019 and included adult patients with stable traumatic suprasacral SCI, performing clean intermittent catheterization (CIC), and demonstrating NDO on urodynamic study (UDS). A 3-day bladder diary was made at the baseline after which all patients were started on Mirabegron 50 mg. They were followed up at 6 weeks with a repeat bladder diary and UDS which were compared with those at the baseline. Results: A total of 30 patients (4 females, 26 males, mean age: 30.07 years) were included. After 6 weeks of treatment, 5 out of the 29 incontinent patients became completely dry. The mean frequency of CIC decreased from 6.63 at the baseline to 5.37 at 6 weeks (p = .002), the mean CIC volume increased from 275 ml to 341 ml (p = .0002), the mean number of incontinence episodes in between CIC reduced from 3.97 to 2.27 (p < .0001) and time from CIC to leakage increased from 1.73 h to 2.75 h (p < .0001). The mean cystometric capacity increased from 348 ml to 406 ml (p = .008) and the maximum amplitude of NDO decreased from 54 cm H 2 O to 41 cm H 2 O (p = .005) at 6 weeks. Only two patients reported new onset dry mouth. No major adverse events were noted and none discontinued treatment. Conclusion: Mirabegron is efficacious and safe in patients with NDO consequent to traumatic SCI.

Objectives: To evaluate the neurological safety and clinical efficacy of darifenacin and mirabegron in patients with a history of cerebrovascular accident (CVA) who had overactive bladder (OAB) symptoms.Methods: This prospective randomized study, approved by the institute's ethics committee, was carried out at a tertiary care center from December 2018 to June 2020. Treatment naïve adult patients with a past history of CVA with stable neurological status for atleast past 3 months with symptoms of OAB for 3 or more months were included. Eligible patients received either darifenacin or mirabegron for a period of 3 months and various parameters on the 3-day International Consultation on Incontinence Questionnaire (ICIQ) bladder diary, the Montreal Cognitive Assessment-Basic score (MoCA-B), and the adverse events at 3 months posttreatment were compared to that at the baseline.Results: A total of 60 patients were included, 30 in each arm. After 3 months of treatment with darifenacin or mirabegron, the majority of the ICIQ bladder diary parameters improved and there was no deterioration in the cognitive function as noted on the MoCA-B score in either of the arms. On intergroup comparison, the mean change in bladder diary parameters and the MoCA-B scores was similar between the two groups. Conclusion: Darifenacin and mirabegron, in the short term, do not adversely affect the cognitive function in patients with a history of CVA with OAB symptoms. Both are safe and effective treatment options in patients with OAB post-CVA.

Two bullocks and a bull of different ages were presented to clinic with chronic orchitis, pyocele and hydrocele respectively. As the medical treatment failed, scrotal ablation was carried out under sedation with xylaxine along with local analgesia by lignocaine. Maintaining good postoperative measures rewarded proper recovery.Page68 due to trauma, ascites or strongyle larvae in spermatic artery. Depending on the extent of scrotal involvement, either unilateral orchiectomy (Maxwell, 2005) or scrotal ablation (Gupta and Khar, 2010, Sagar et al., 2010) were adopted. Case History and Clinical ObservationsCase 1: An Ongole bullock aged 10 years with severe scrotal swelling was presented to the clinic. It was reported to have resulted from an improper technique of closed method of castration conducted 5 months earlier. It was treated locally by a Veterinarian with enrofloxacin, meloxicam and chlorpheneramine maleate but in vain. Clinical examination revealed abduction of hind limbs, enlarged and painful scrotum that extended up to the hock was detected. Only left side testicle was affected but not the spermatic cord and was diagnosed as orchitis.Case 2: An Ongole cross bullock of 8 years age was presented to the clinic with a hard swelling of right side of scrotum with an open wound at its tip for the past one month. It was also as a result of faulty castration conducted three months earlier and was also treated locally by a quack without any success.Clinical examination revealed severe hard swelling of right side of scrotum including spermatic cord and abduction of hind limbs. An open septic wound was observed at its ventral most aspect which was filled with pus and on probing it extended up to the neck of scrotum. The case was diagnosed as scirrhous cord and pyocele (Fig 1). Fig 1: Photograph showing open wound (arrow) leading to unilateral scirrous cord and pyocele Case 3: A young Ongole bull of 5 yrs age was presented with intermittent accumulation of fluid in scrotal sac at weekly intervals. When swollen severely, it reaches the level of hocks affecting the normal gait and function of animal. On observation, the swelling was in left side of scrotum (Fig. 2) and on palpation it

An outbreak of immature paramphistomosis in Nellore Jodipi sheep was recorded in Nellore district of Andhra Pradesh in 158 sheep during the months of April-June-2012. The condition is diagnosed as immature paramphistomosis on the basis of symptoms, dung sample examination and necropsy findings. The infected sheep exhibited symptoms like persistent foetid, blackish diarrhoea, sub maxillary edema, dehydration and death. Necropsy findings include hemorrhagic thickening and necrosis of proximal duodenal mucosa, ascites, gelatinization of subcutaneous and renal fat. Duodenal scrapings revealed large number of immature paramphistomes under low power microscopy. Recovery of ailing sheep was observed after oral treatment of niclosamide @ of 100 mg/kg bwt along with supportive therapy.