Journal of Acute Disease

Aim of the present study is evaluated various medicinal plants used for antidiabetic activity. Diabetes mellitus is one of the most common non-communicable diseases globally. It is the fourth leading causes of death in the most developed countries and there in substantial evendiced that it in epidemic in many developing and newly industrialized nations. This posing a serious threat to be met within 21st century. Since ancient time plants have been exemplary source of medicine. Ayurveda and other Indian literature mentioned the used of plants in treatment of various ailments. Out of an estimated 250 000 higher plants, less than 1% have been screened pharmacologically and very few in regard to diabetes mellitus. Systematic studies on the folklore medicinal plants that combat diabetes mellitus are scanty.

Objective: To assess knowledge, attitude, and practice of medical students towards coronavirus disease 2019 (COVID-19).Methods: A self-designed questionnaire was developed and given to the students of a government medical college in Uttarakhand. The demographics, mean knowledge, attitude, and practice of the participants were investigated, and the scores were calculated. t-test and ANOVA were used for statistical analysis.Results: Out of the total participants (n=354), 50.3% were male and 54.5% were 21-23 years. Almost all the participants (96.6%) increase the frequency of washing hands under the influence of COVID-19. Although no significant relationship was found between different religions, age-categories in terms of knowledge, the participants who were aged 21-23 years had higher knowledge. In addition, gender had a significant impact on practice scores (P<0.05) while no demographic variable was found to have a significant relation with attitude score (P>0.05).Conclusions: The majority of the participants had good knowledge, positive attitude, and sufficient practice. Females and males have significantly different practices. Although the results are very positive, it is suggested that people should continue to strengthen knowledge, attitude, and practice towards COVID-19, so that India can win the battle against the disease.

Objective To evaluate the safety dose range of ethanolic extract from the leaves of Pericampylus glaucus (Lam.) Merr. by acute and sub-acute oral toxicity study on animal model. Methods The acute and sub-acute toxicity study was carried out as per Organization for Economic Co-operation and Development guidelines 423 and 407. In acute toxicity study, the oral dose (300, 2000 and 4 000 mg/kg) of tested plant extract was administered to three groups in single dose and general behavior, adverse effects and mortality were determined up to 72 h and compared to normal group. In sub-acute study, the tested crude plant extract was administered orally at doses of 600 and 1 000 mg/kg for 28 days to the two animals groups and their body weight, hematological, serum hepatic biochemical parameters were evaluated and compared to normal group by sacrificing all group animals. Results In acute toxicity, all treated groups’ revealed neither mortality nor any significant alteration in behavior only drowsiness, sedation and lethargy were observed in two group, i.e. 2 000 and 4 000 mg/kg of the tested plant extract. In sub-acute toxicity study no change in hematological, biochemical parameter and organ body weight were observed during study compared to the normal group. The kidney function parameters [serum glutamic-oxaloacetic transaminase (aspartate transaminase), serum glutamic pyruvic transaminase (alanine transaminase)] were significantly increased following administration of tested crude plant extract (600, 1 000 mg/kg). Conclusions The result indicates that the oral administration of Pericampylus glaucus (Lam.) Merr. extract did not produce any significant toxic effect in BALB/c mice. Hence, the extract can be utilized safely for therapeutic use in pharmaceutical formulations.

To evaluate the antidiabetic effect of syringic acid, a natural phenolic compound on the levels of glycoprotein components in plasma and tissues of alloxan induced diabetic rats. Diabetes was induced in male Wistar rats by a single intraperitoneal injection of alloxan (150 mg/kg b.w). Syringic acid (50 mg/kg b.w) was administered orally for 30 d. The effects of syringic acid on plasma glucose, insulin, C-peptide, plasma and tissue glycoproteins were studied. Oral administration of syringic acid (50 mg/kg b.w) for 30 d positively modulates the glycemic status in alloxan induced diabetic rats. The levels of plasma glucose were decreased with significant increase of plasma insulin and C-peptide level. The altered levels of plasma and tissue glycoprotein components were restored to near normal. No significant changes were noticed in normal rats treated with syringic acid. The present findings suggest that syringic acid can potentially ameliorate glycoprotein components abnormalities in addition to its antidiabetic effect in experimental diabetes, further clinical studies are required to evaluate the use of syringic acid as an effective therapeutic agent for the treatment of diabetes mellitus.

To evaluate the antimicrobial and toxicological effects of aqueous garlic (Allium sativum) bulbs extract in wister rat using biochemical and hematological parameters. A total of 20 wister rats were assigned into four (A–D) groups of five animals each. Group A served as the control and was administered 1 mL of distilled water. Groups B–C were given 300, 600 and 1 200 mg/kg body weight of garlic (Allium sativum) bulbs extract for 5 weeks. Garlic bulbs extract produced significant inhibitory activities against all bacteria tested at concentrations of 120 and 160 mg/mL. However, at concentration of 80 mg/mL, the extract had no inhibitory activities against Klebsiella pneumoniae and Salmonella typhi. The minimal inhibitory concentration and minimal bactericidal concentration ranged between 80–120 mg/mL and 120–160 mg/mL respectively. Toxicological study revealed that the extract did not cause any significant (P > 0.05) alteration to serum aspartate transaminase, alkaline phosphatase activities, total bilirubins, Na, K, creatinine, red blood cell, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration, granulocyte and organs-body weight ratio. However, serum alanine transaminase activities, total proteins, direct bilirubins, Cl− concentrations and body weight gain were significantly (P < 0.05) lowered while the concentrations of urea, albumin, white blood cell, mean corpuscular hemoglobin and mean corpuscular volume count were raised significantly (P < 0.05) in rats dosed with 600 and 1 200 mg/kg of the extract. However, at a dose of 300 mg/kg only, the concentrations of Cl−, urea and albumin were mildly altered. The extract caused selective changes in some biochemical parameters of organ function; however, since only mild alteration was observed at a dose of 300 mg/kg, the garlic bulb may be considered to be relatively safe and could be explored as an oral remedy at this dose.

Objective To study the antioxidative and protective properties of aqueous extract of Hammada scoparia ( H. scoparia ) against the effects of sub-chronic aluminium (Al) intoxication on mnemonic process and some neurochemical markers. Methods Al was administered intraperitoneally (50 mg/kg body weight, three times a week), and H. scoparia and malic acid were given orally by gavage at a daily dose (100 mg/kg body weight) to rats for 90 days. Results Al caused significant short-term and long-term memory disturbances, a decrease in locomotor activity, a significant inhibition of acetylcholinesterase activity in brain and a significant depletion of antioxidant enzymes (catalase, glutathione reductase and glutathione peroxidase) and glutathione. It significantly increased lipid peroxidation levels in cerebrum and cerebellum. However, treatment with H. scoparia extract protected efficiently the neurological functions of intoxicated rats by considerably increasing antioxidants levels and decreasing production of thiobarbituric acid reactive substances by 4.26% compared to untreated group. We noted some controversial results with malic acid. It showed some positive results but it was not as efficient as H. scoparia extract. Current results were consistent with histopathological observations including neurodegeneration and vacuolated cytoplasm (spongiosis) in Al treated sections when H. scoparia and malic acid treated sections showed marked neuroprotection signs. Conclusions This study strongly suggested that H. scoparia extract could possibly restore the altered neurological capacities and antioxidant power in rats, and it could even be a good alternative to chelating agents or other chemical medicines against Al-induced neurotoxicity.

Objective To evaluate the antibacterial activity of methanol extract of Hibiscus sabdariffa ( H. sabdariffa ) calyces employed in Sudanese folk medicine against five hospital isolates of multidrug resistant Acinetobacter baumannii (MDR A. baumannii ). Methods The antibacterial activity of 80% methanol extract (v/v) of H. sabdariffa calyces was evaluated by agar disc diffusion, minimum inhibitory concentration and minimum bactericidal concentration methods. Antibiotic susceptibility of selected A. baumannii strains was tested. Results In the present investigation, the methanol extract from the calyces of H. sabdariffa exhibited significant antibacterial properties against the non-MDR A. baumannii as well as the MDR A. baumannii strains with a zone of inhibition ranging from (11.3 ± 0.3) to (13.6 ± 0.3) mm. The relative percentage inhibition of H. sabdariffa extract (10 mg/disc) with respect to gentamicin (10 μg/disc) had potent antibacterial properties and was much more effective than gentamicin. Values of minimum inhibitory concentration and minimum bactericidal concentration ranged from 25 to 50 and 50 to 100 mg/mL, respectively, revealing the potential bactericidal properties of the extract. Conclusions According to the present study, the calyces of H. sabdariffa can be used as a substitute source of the current ineffective synthetic antibiotics used against MDR A. baumannii .

To survey the frequency of blaTEM, blaSHV and blaCTX-M genotypes in extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) isolated from hospitalized patients with urinary tract infection and the determination of their antibiotic resistance patterns. During 11-month study, 100 ESBL-producing E. coli were collected from 330 patients who met the definition of urinary tract infection. The phenotypic identification of ESBL was confirmed by double disk synergy test and combined disk diffusion test. In vitro, susceptibility to ESBL isolates than 14 antimicrobial agents was performed by Kirby-Bauer disk diffusion method. The frequency of blaTEM, blaSHV and blaCTX-M ESBL-producing E. coli was assessed by PCR method. The frequency of ESBL-producing E. coli was 40.8%. In vitro, susceptibility to ESBL-producing E. coli showed that the majority of isolates were highly susceptible to amikacin (74%) and imipenem (91%). The rates of resistance to other antibiotics varied from 33% to 96%. Through 100 tested isolates, the prevalence of blaTEM, blaSHV and blaCTX-M genes was determined to be 67%, 45% and 74% respectively. In comparison with other bla genes, the frequency of blaCTX-M was strikingly high. Due to the increase of E. coli with multiple ESBL genes, continuous surveillance in order to use appropriate antibiotics and the control of infections is necessary.

Alkaloids are well known phytoconstituents for their diverse pharmacological properties. Alkaloids are found in all plant parts like roots, stems, leaves, flowers, fruits and seeds. Solasodine occurs as an aglycone part of glycoalkloids, which is a nitrogen analogue to sapogenins. Solanaceae family comprises of a number of plants with variety of natural products of medicinal significance mainly steroidal lactones, glycosides, alkaloids and flavanoids. It is a steroidal alkaloid based on a C27 cholestane skeleton. Literature survey reveals that solasodine has diuretic, anticancer, antifungal, cardiotonic, antispermatogenetic, antiandrogenic, immunomodulatory, antipyretic and various effects on central nervous system. Isolation and quantitative determination was achieved by several analytical techniques. Present review highlights the pharmacological activity of solasodine, with its analytical and tissue culture techniques, which may be helpful to the researchers to develop new molecules for the treatment of various disorders in the future.

To investigate the treatment of acne and pimples as well as improves skin elasticity by solid lipid nanoparticles (SLNs) loaded Neem oil. Neem oil as a natural agent was incorporated into SLNs prepared by double emulsification method using different concentration of lecithin and Tween 80. The characteristics of SLNs with different concentration of lipid were investigated. The average particle size of Neem oil loaded SLNs decreased with increasing concentration of surfactant. SLNs of (221.6 ± 2.0) nm with a Polydispersity index of (0.948 ± 0.040) were obtained at higher concentration of lipid and surfactant. High entrapment efficiency of 82.10% revealed the ability of solid lipid nanoparticles to incorporate a high quantity of Neem oil. Furthermore the stability of SLNs indicated with negligible drug leakage after 3 weeks. The result concluded that Neem oil loaded solid lipid nanoparticles with more lecithin content in their colloid exhibit sustained effect which satisfactorily produced the antibacterial action on Acne microbes. Therefore Neem oil loaded SLN was used successfully for prolonged treatment of Acne.

Objective: To evaluate the diagnostic performance of dual-energy computed tomography (DECT) in acute appendicitis by comparing attenuation characteristics across different virtual monoenergetic energy levels, virtual non-contrast, overlay, and mixed image reconstructions. Methods: All participants underwent DECT using a dual-source scanner. Appendiceal diameter, periappendiceal findings, and attenuation values obtained from iodine maps, virtual non-contrast, overlay, mixed images, and 40, 80, and 190 keV virtual monoenergetic images were recorded. Diagnostic performance was evaluated using receiver operating characteristic analysis, and interobserver agreement was assessed using a two-way random intraclass correlation coefficient. Results: In this prospective observational case-control study, 20 patients with surgically or clinically confirmed acute appendicitis and 20 control subjects without appendicitis were included. Appendiceal diameter and all DECT-derived attenuation parameters were significantly higher in patients with acute appendicitis compared with controls ( P < .001). The highest diagnostic accuracy was achieved with 40 keV virtual monoenergetic images (AUC = 0.998), followed by appendiceal diameter (AUC = 0.994) and mixed images (AUC = 0.973). Low-keV reconstructions provided markedly improved lesion conspicuity. Periappendiceal fat stranding demonstrated high diagnostic performance (sensitivity 0.95, specificity 1.0). Interobserver agreement for attenuation measurements was excellent (intraclass correlation coefficient = 0.887). Conclusions: Low-keV (40 keV) virtual monoenergetic DECT imaging provides very high diagnostic accuracy for the detection of acute appendicitis and outperforms higher-keV reconstructions and other DECT image types. When combined with conventional CT findings such as appendiceal diameter and periappendiceal inflammatory changes, DECT-derived attenuation analysis represents a reliable and reproducible tool that may enhance diagnostic confidence in emergency imaging.

Objective: To assess the appropriateness of surgical antibiotic prophylaxis (SAP) use and its adherence to institutional guidelines, and to identify factors associated with surgical site infection (SSI) occurrence in lower segment caesarean section (LSCS) patients. Methods: A prospective observational study was conducted among women undergoing LSCS in Jubilee Mission Medical College and Research Institute, Thrissur, India. SAP appropriateness (antibiotic selection, timing, and duration) was evaluated, and participants were followed for six weeks postoperatively. Associations with SSI were analysed using chi -square and Fisher’s exact tests. Results: The overall SSI rate among the 80 women was 15.0%, all superficial. SAP adherence was 60.0% for antibiotic choice, 55.0% for timing, and 53.8% for duration. Younger women (⩽30 years) had significantly higher SSI rates compared with older women (21.6% vs 3.4%; P =.04). No significant association was observed between SSI and gestational diabetes, timing category, or antibiotic regimen group. Emergency LSCS had a higher SSI incidence than elective procedures (22.7% vs 5.6%; P =.03). The predominant organisms isolated were Escherichia coli , Klebsiella spp., and Staphylococcus aureus . Conclusions: Gaps in SAP adherence particularly in antibiotic selection and timing were identified, with younger age and emergency surgery associated with higher SSI occurrence. Ensuring the availability of recommended first-generation cephalosporins, standardising SAP protocols, and strengthening antimicrobial stewardship are essential to improve surgical outcomes following LSCS and reduce antimicrobial resistance.

Spontaneous breathing during assisted mechanical ventilation may preserve diaphragm activity, improve ventilation–perfusion matching, reduce sedation requirements, and facilitate weaning, but excessive inspiratory effort can also increase transpulmonary pressure swings, promote pendelluft, worsen patient–ventilator asynchrony, and amplify injurious mechanical energy transfer. This narrative review summarizes current evidence on how spontaneous breathing can be integrated safely into assisted ventilation by balancing its physiological benefits against the risks of patient self-inflicted lung injury and ventilator-induced lung injury. Evidence from clinical, physiological, computational, and guideline-based studies was synthesized across domains related to respiratory effort, mechanical power, monitoring, and ventilatory strategy. Mechanical power provides a useful framework for understanding ventilatory energy delivery, but in assisted ventilation it should be interpreted together with patient-generated effort, transpulmonary pressure, and regional lung mechanics. Monitoring approaches such as oesophageal manometry, electrical impedance tomography, waveform analysis, and automated algorithms may help identify excessive effort and dyssynchrony. Proportional, adaptive, and flow-controlled ventilation strategies may better match assistance to patient demand and reduce unnecessary energy delivery. Overall, spontaneous breathing during assisted ventilation should not be regarded as uniformly beneficial or harmful; instead, integrating effort monitoring with mechanical-power-aware ventilation may support more individualized, energy-efficient, and safer assisted ventilation.

Objective: To investigate the association between derangement of the serum iron profile and in-hospital mortality of adult patients diagnosed with sepsis using Sepsis-3 criteria, and to assess its potential role in improving diagnostic and prognostic accuracy. Methods: This prospective observational study (May 2023-October 2024) was conducted in the emergency and medical ward. Serum iron profile and Sequential Organ Failure Assessment (SOFA) scores were assessed on admission. Clinical outcomes were tracked; associations with serum iron profile were determined using Student's t-test and chi-square test. Results: One hundred fifty adult Sepsis-3 patients were recruited. 58 Patients (38.7%) died during hospitalization. Mean ferritin for deceased patients was 929.0±310.0 μ g/L, and was significantly higher than 417.0±311.0 μ g/L for survivors ( P <.001). A serum ferritin value of 700 μ g/L strongly predicted in-hospital mortality (69.9% mortality above this threshold). The odds ratio was 23.2 (95% CI : 9.2-58.3) for ferritin above 700 μ g/L, indicating likelihood of death 23.2 times higher in patients with serum ferritin above 700 μ g/L. With SOFA, the odds ratio was 3.7, highlighting ferritin as a stronger individual predictor. Conclusions: Serum ferritin level is an independent predictor of inhospital mortality in sepsis. Monitoring ferritin levels can enhance early risk stratification, facilitate timely intervention, and improve outcomes.

Objective: To address the critical impact of smoke inhalation lung injury on burn patient prognosis and the lack of animal models simulating varying injury severity, we established a graded rat model to facilitate research into its pathological mechanisms and treatments. Methods: Eighteen male Wistar rats were divided into a control group and groups exposed to smoke for 5, 10, 15, 30 minutes ( n =3 per group). A custom smoke chamber and specific materials (50 g pine wood chips + 10 mL kerosene) were used. Post-exposure assessments included lung function, lung coefficient (wet weight), histopathology (H&E staining), and leukocyte count and IL-6 levels in alveolar lavage fluid. Results: Lung function declined significantly in all exposure groups versus controls, with progressive worsening over time. The lung coefficient increased significantly in the 15- and 30-minute groups. Histology revealed intact structure at 5 and 10 minutes, alveolar rupture and neutrophil infiltration at 15 minutes, and hyaline membranes at 30 minutes. Leukocyte count and IL-6 levels rose markedly after 15 and 30 minutes of exposure. Statistical comparisons confirmed progressive injury severity with longer exposure. Conclusions: Graded rat models of mild, moderate, and severe inhalation lung injury were successfully established following 5, 15, and 30 minutes of smoke exposure, respectively. Injury and inflammation intensified significantly with exposure duration, providing a valuable foundation for further research.

Rationale: Atrial fibrillation is a common perioperative arrhythmia, especially in elderly patients. Although a good amount of literature exists on the perioperative management of patients with pre-existing atrial fibrillation, information on managing a case with first-detected atrial fibrillation on the day of scheduled elective surgery is scarce. Although non-cardiac surgery guidelines in patients with cardiac diseases are well-established, this dilemma is not entirely answered. Patient’s concern: A 75-year-old male patient, anemic with suspected carcinoma and planned for diagnostic cystoscopy and biopsy, presented with irregularly irregular heart rate and palpitation on the morning of scheduled surgery. Diagnosis: First-detected atrial fibrillation with first ventricular rate. Interventions: Intravenous diltiazem 10 mg was given to control ventricular rate, followed by balanced general anesthesia for the intervention. Outcomes: Patient responded to diltiazem; heart rate was controlled. General anesthesia was uneventful except for two brief episodes of hypotension. Atrial fibrillation reverted to sinus rhythm spontaneously the next day. Lessons: The case highlights the dilemma faced in the decision- making based on existing guidelines and successful management of such a rare incident.

Rationale: Nitrite, a common meat preservative, can cause life-threatening methemoglobinemia. Patient’s concern: Two men (52 and 60 years) developed sudden cyanosis, dizziness, and nausea 10-20 minutes after consuming pork skin jelly from a local deli. Diagnosis: Acquired methemoglobinemia (methemoglobin 50.7% and 37.2%); jelly contained 420 mg/kg nitrite (GB 2760-2014 limit: 30 mg/kg). Interventions: High-flow oxygen and intravenous 1% methylene blue 1-2 mg/kg in 20 mL 5% glucose over 15 minutes. Outcomes: Cyanosis was relieved within 30 minutes; methemoglobin became normalized within 2 hours. Both recovered fully and were discharged on June 24, 2024. Lessons: Sudden cyanosis after meat consumption requires immediate hospitalization, methemoglobin testing, and methylene blue treatment; food residue analysis confirms diagnosis, while supplier monitoring and record-keeping prevent recurrence.

Objective: To evaluate the association between the Geriatric Nutritional Risk Index (GNRI) at ICU admission and mortality in patients with heart failure complicated by sepsis, a high-risk population in which the prognostic value of this validated malnutrition risk assessment tool remains underexplored. Methods: Patients with heart failure and sepsis were identified from the Medical Information Mart for Intensive Care (MIMIC-IV) database and stratified into four GNRI groups. The primary endpoints were 28-day and 365-day all-cause mortality. Survival analysis used Kaplan-Meier curves and Cox proportional hazards models. Linearity was assessed using restricted cubic splines (RCS), while GNRI’s predictive performance was evaluated using receiver operating characteristic (ROC) curves. Results: Altogether, 1713 patients with heart failure complicated by sepsis were identified in the present study. Kaplan-Meier analysis revealed 28-day mortality rates of 40.44% (high-risk) vs . 25.27% (no-risk) ( P <.001), with a similar trend for 365-day mortality (63.75 % vs. 43.96%, P <.001). RCS confirmed a linear inverse relationship between GNRI and mortality. Cox regression demonstrated that each unit GNRI increase reduced 28-day (hazard ratio [HR], 0.99; 95% confidence interval [ CI ] 0.98-1.00) and 365-day mortality risk (HR, 0.98; 95% CI 0.98-0.99). ROC analysis indicated a moderate predictive value of GNRI for 28-day all-cause mortality (AUC=0.58, sensitivity=66.61%, specificity=45.62%, P <.001) and 365-day all-cause mortality (AUC=0.60, sensitivity=66.52%, specificity=51.28%, P <.001). Furthermore, the addition of GNRI significantly enhanced the predictive performance of the SAPSII (AUC increased from 0.69 to 0.70, P =.02), SOFA (AUC increased from 0.73 to 0.74, P =.02), and LODS (AUC increased from 0.67 to 0.68, P =.03) scores, with these improvements achieving statistical significance. Conclusions: Admission GNRI is an independent risk factor for in-hospital mortality in ICU patients with heart failure complicated by sepsis. GNRI scores serve as a valuable prognostic indicator for assessing mortality risk in this patient population.

Objective: To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department. Methods: In this triple-blind randomized clinical trial, eligible patients presenting with epigastric pain were randomly assigned to receive intravenous pantoprazole or famotidine. Block randomization was used, and patients, treating physicians, and outcome assessors were blinded to treatment allocation. Pain intensity was assessed at baseline and at 30 and 60 minutes after drug administration. Results: Eighty patients were enrolled, with a mean age of 36.6 years (SD, 15.0), and 42.5% were male. Mean pain scores decreased significantly over time in both treatment groups. In the pantoprazole group, pain scores declined from 8.02±1.28 at baseline to 4.75±1.31 at 30 minutes and 1.62±1.29 at 60 minutes, whereas in the famotidine group scores decreased from 8.12±1.48 to 5.37±1.23 and 2.35±1.54, respectively. There was no significant difference in baseline pain scores between groups ( P =.92). Pantoprazole resulted in greater pain reduction compared with famotidine at both 30 minutes ( P =.04) and 60 minutes ( P =.05). Conclusions: Both medications were effective in relieving epigastric pain; however, pantoprazole provided greater and more sustained pain reduction, supporting its preferential use in emergency settings.

Rationale: Infected urinomas are rare complications of urinary tract obstruction and may mimic renal abscess or pyonephrosis. Presentation as a palpable flank mass is highly unusual. Patient’s concern: An 84-year-old man with fever, flank pain, and a firm right flank mass. Imaging revealed an acute multiloculated infected urinoma communicating with the proximal ureter, associated with a ureteric calculus. Diagnosis: Infected urinoma. Interventions: He was treated with antibiotics, percutaneous drainage, and nephrostomy. Outcomes: Recurrence occurred three months later due to unresolved obstruction, requiring repeat drainage. Definitive surgical management was deferred due to advanced age and comorbidities, highlighting challenges in high-risk patients. Lessons: This case highlights the importance of considering urinoma in the differential diagnosis of flank masses, the complementary roles of multimodal imaging for accurate diagnosis, and the importance of definitive management of urinary obstruction to prevent recurrence.