Articles

The terms urotherapy and urotherapist are often mentioned in the literature, but their origins and meanings are less well-known. Objective: To describe the background and development of the concept of urotherapy in pediatric care and the profession of urotherapist.Methods: Data has been searched for in Medline PubMed and selection has been limited to papers important for the purpose.Results: Understanding of urinary bladder function was developed in the 1970’s, mainly due to new urodynamic methods opened up for possible treatment options. Standard urotherapy is a concept developed in the 1980’s and aims to treat dysfunction by helping the patient to learn to understand bladder function and then practice certain techniques in order to normalize it. To succeed, guidance and support are needed from a skilled urotherapist. In Scandinavian and German-speaking countries, quality-assured training for urotherapists at the university level is available.Conclusion: Urotherapy standard therapy is a non-invasive treatment recommended as the first-choice treatment for lower urinary tract disorders. However, we must have requirements as to what knowledge a urotherapist needs to have, and training has to be certified and be at the university level.

Background: Ovarian fibroma is a very unusual epithelial tumor representing less than 1% of all ovarian tumors. It can be asymptomatic and discovered during surgery or be associated with a pleural effusion preferentially located on the right side and a more or less abundant free ascites in the framework of the so-called Meigs syndrome. The challenge of management then lies in distinguishing benign from malignant since clinically, radiologically, and biologically everything points towards malignant which requires radical surgical treatment. We report here the case of a 69-year-old postmenopausal patient with a clinical form of Meigs' syndrome that strongly suggested ovarian cancer.Case presentation: We hereby report here the case of a 69-year-old patient, menopausal, gravida 4 para 3 with 3 live children delivered vaginally and one miscarriage. She presented with ascites, hydrothorax, and a solid tumor of the ovary. Serum CA 125 and HE 4 levels were very high. ROMA score was highly suggestive of malignancy. A hysterectomy with adnexectomy was performed. It was only the histological evidence of ovarian fibroma and the rapid resolution of its effusions that confirmed Meigs syndrome.Conclusion: Meigs syndrome is an anatomical-clinical entity that associates a benign tumor of the ovary, ascites, and hydrothorax. Highly elevated CA 125 and HE-4 tumor markers often point clinicians toward a malignant tumor and compel radical surgical treatment. This case report reminds us once again that only histology confirms the diagnosis of cancer.

Background: Among the different forms of ectopic pregnancy, cesarean scar pregnancy is one of the most uncommon with an estimated incidence of 1/1800 pregnancies. A major risk of massive hemorrhage, it requires active management as soon as it is diagnosed because it can affect the functional prognosis of the patient (hysterectomy) but can also be life-threatening. Different surgical techniques are generally proposed in first intention to patients who no longer wish to have children, who are hemodynamically unstable and/or in case of failure of medical treatment.Case presentation: We hereby report the case of a young 19-year-old patient with no particular medical history, gravida 2 para 1 with a live child born after a cesarean section for fetal heart rhythm abnormalities during labor 5 months earlier and who presented to the emergency room of our structure for the management of a cesarean pregnancy scar diagnosed at 6 weeks of amenorrhea. She was successfully managed with an intramuscular injection of methotrexate. The follow-up was uneventful.Conclusion: The implantation of a pregnancy on a cesarean section scar is becoming more and more frequent. With consequences that can be dramatic, ranging from hysterectomy to life-threatening hemorrhage, clinicians must be familiar with this pathological entity and be prepared for its management. The latter must be rapid and allow, if necessary, the preservation of the patient's fertility. In this sense, conservative medical treatment with methotrexate injections should be proposed as a first-line treatment in the absence of contraindication.

Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP).Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05.Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI.Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.

Cancer is a disease that implies several different genotypic and phenotypic traits in its whole process of development: tumorigenesis.

Introduction: Percutaneous kidney biopsy is a necessary tool to diagnose many kidney diseases. However, major complications were reported in adults, including bleeding in the kidney or around it, creation of arteriovenous fistula, wound infection, damage to adjacent organs, or even loss of the kidney. Such complications can rapidly develop serious consequences. Exploring risk factors might help in preventing them.Objective: The current study aims to evaluate and explore the complications that happened after percutaneous kidney biopsy in children and associated risk factors.Methodology: A retrospective record-based study was conducted by reviewing the medical records of children with post-ultrasound-guided percutaneous kidney biopsy complications at King Saud Medical City, a tertiary hospital in Riyadh, Saudi Arabia during the period from May 2014 to June 2021. Data were extracted using pre-structured data collection sheet. Data collected included children’s age, gender, primary disease, laboratory findings, and kidney complications with needed management. Results: The study identified 76 children who had undergone 86 ultrasound-guided percutaneous kidney biopsies in the study period and fulfil the inclusion criteria. Children’s ages ranged from 1 years to 15 years with a mean age of 7.3 ± 4.0 years old. Most of the study children had nephrotic syndrome (61.6%; 53), followed by glomerulonephritis (25.6%; 22). Thirty-five (40.7%) children developed at least one of the complications. The most-reported complication was microscopic haematuria (32.6%; 28), followed by gross haematuria (3.5%; 3), Flank pain was reported among 3 (3.5%) children also and hematoma (1 child), only 2 children (3.9%) among those who had no complications recorded Haemoglobin drop > 2 g/dl compared to 3 of those who had complications with no statistical significance (p = .365). Prothrombin time was significantly higher among children who had renal complications than others who had not (11.7 ± 1.8 vs. 10.8 ± 1.2 seconds; p = .022).Conclusion: Suggestive by the low need to intervene in complications, ultrasound-guided percutaneous kidney biopsy is a relatively safe procedure in children. Even in the most commonly observed complication, i.e. hemorrhagic ones, blood transfusion is rarely needed.

Introduction: Diabetes mellitus and diabetic nephropathy are the most common causes of end-stage renal disease (ESRD) in developed countries, accounting for about 30% of these cases. Up to 40% of patients with type 2 diabetes with micro albumin uria progress to overt nephropathy and develop ESRD after one to two decades. Albumin uria is the most important indicator of diabetic nephropathy and its progression. Also, hyperuricemia has been suggested as a risk factor for kidney damage, this study was designed to determine the relationship between serum uric acid level and proteinuria in patients with type 2 diabetes.Materials and methods: In this descriptive-analytical and cross-sectional study, data collection was performed among patients with type 2 diabetes referred to the diabetic Center in Gorgan from the years 2015 to 2018. The data collection tool was a two-part questionnaire including demographic and anthropometric characteristics and information about the disease. Serum levels of Uric Acid, Blood Urea Nitrogen (BUN), Creatinine (Cr), Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1C) were measured in all patients. 24-hour urine collection was performed for proteinuria, albuminuria, urinary volume, and Cr volume. Patients’ GFR was also calculated using the CKD-EPI formula. Patients were re-evaluated 1 year after the initial evaluation in terms of measured factors and the relationship between serum uric acid and albuminuria, proteinuria, kidney function, and other serum factors were evaluated.Results: Among 823 diabetic patients that were referred to the nephrology center in this study, 90 patients were included. 34 (37.8%) of these patients were men. The age range of patients was between 32 years to 70 years with a mean of 56.31 and a standard deviation of 7.84 years. According to the Pearson correlation coefficient, a direct correlation was observed between uric acid with proteinuria and creatinine levels, and an inverse correlation was observed between uric acid and GFR. But we didn’t find any correlation between uric acid and microalbuminuria.Conclusion: According to the results of this study, the relationship between uric acid level and the severity of nephropathy (based on proteinuria) is proven. It seems that maintaining serum uric acid levels in patients with type 2 diabetes within the normal range and treatment with serum uric acid-lowering drugs may be possible to reduce the progression of diabetic nephropathy and proteinuria.

Aim: The current paper presents a subjective symptom survey regarding postpartum discomfort (Study 1) and a case study on postpartum care using the program developed based on the survey results (Study 2). Thereafter, health care during the postpartum period is discussed.Methods: Study 1 analyzed 1638 postpartum women who completed the Subjective Fatigue Symptom Scale (SFSS) over the period from June 2012 to December 2019. Study 2 detailed the case of a 33-year-old primiparous woman who answered questions regarding the rehabilitation care program.Results: The 1638 subjects included in Study 1 had a mean age of 32.4 ± 8.2 years and a mean postpartum duration of 4.3 ± 2.3 months. Subjective symptoms included lower back pain, shoulder stiffness, sleepiness, wanting to lie down, yawing, and eye strain. The case included in Study 2 showed certain psychological and physical changes following the exercise program. The results of Study 1 showed that motor system discomfort, such as stiff shoulders and lower back pain, occurred in women across all postpartum stages. Our results demonstrated that care and exercise geared toward improving motor system function are imperative after childbirth. Meanwhile, the results of Study 2 imply that our rehabilitation program based on postpartum physical conditions had positive psychological and physical effects.Conclusion: Taken together, our results suggest that continuing rehabilitative care based on the physical condition during each postpartum stage facilitates improvement in mothers’ physical and psychological discomfort.

Background: Liver Transplantation (LT) is the definitive treatment for Autoimmune Hepatitis (AIH) in patients with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Outcomes of LT in AIH among black-Africans are not well-defined. We performed a single-center retrospective-review of adult LT patients. The study period was from 1st August 2004-31st August 2019. The primary aim was to document 1- & 5- year patient and graft survival. A secondary aim was to compare the survival of black-Africans to Caucasians. Data was analyzed using survival-analysis. Results: A total of 56 LT were performed for AIH. Sixty-seven percent (n = 38/56) had confirmed AIH on explant histology. Of these, the majority i.e., 79% (30/38) were female and 21% (8/38) were male. There were equal numbers of black-African 42% (n = 16/38) and Caucasian 42% (n = 16/38) patients. Rejection was four-times higher in black-Africans as compared to Caucasians. Forty-four percent (n = 17/38) had an acute rejection episode and 13% (5/38) had chronic rejection. Recurrence was found in four black-African females. Post-LT patient survival at 1- and 5- years was 86.5% and 80.7%, and graft survival was 94% and 70.8% respectively. The 5- year patient survival was insignificantly lower for black-Africans (73.9%) as compared to Caucasians (83.7%) (p - value 0.26, CI 6.3 - 12.2). Five-year graft survival was significantly lower among black-Africans (55%) as compared to Caucasians (84.8%) (p - value 0.003 CI 3.8 - 8.1)Conclusion: Black-Africans had a four-fold higher rate of rejection compared to Caucasians. Recurrent AIH was only found in patients of black ethnicity. Similar 1- & 5- year patient survival rates were observed between the two ethnicities. The 5-year graft survival among black-Africans was significantly lower than Caucasians.

Meat species identification has become essential with the increasing events of frauds like the illegal slaughter of cows, meat adulteration, and substitution. Food scam directly influences public well-being, trade, and wildlife. In Pakistan, donkey meat is used as adulterants for cow meat and is considered Haram in Islamic concepts. In this study PCR, based detection methods are used for identification purposes. The mitochondrial gene cytochrome b has been used in this study to identify the origin of meat specie. Specie-specific primers of cyt b of cow and donkey were used for identification. DNA from different binary ratios of cow and donkey meat was extracted by the phenol-chloroform method. Ratios were made from 1-10 and extracted DNA was subjected to PCR to amplify the target fragment of the cyt b gene. Primers were sensitive to identifying species origin in all meat ratios. Multiplex PCR was designed to identify both species and the results were analyzed by gel electrophoresis. Fragment size of 309bp for cow and 475bp for donkey was observed.Results of the current study conclude that PCR assays, including multiplex PCR, is efficient and has a high sensitivity for even small amount of meat. It is concluded that multiplex PCR is useful and reliable for adulterated meat detection.