In various patients conditions involved in lower urinary tract disease LUT (like overactive bladder, bladder neck sclerosis, dis –synergy (with our synenrgic contraction between bladder detrusor and bladder neck, BPH, recurrent cysytitis, interstitial cystitis, chronic prostatitis, uretral stenosys, loss of sfinteric coordination.
Prostatic cancer, anatomic abnormalities and other the receptor status play relevant role to reduce effect of vicious clycle that can be responsible in progression of the pathologic process.
In this work the complex receptorial status is analyzed to verify new therapeutic strategies.
Starting from the observation that various irritant substanties produce irritant stimulus in Prostatic Patients or in bladder neck condition is interesting to deep understand the etio-patogenesys and Functional results.
In Various prostatic, bladder neck or ureteral condition a reduced urinary fluss can produce infectious.
Conditions like acute or chronic prostatitis.
Irritants sustanties in diet (in example etilic alcohol drink, hot spices, crud meats, carbonate drinks, caffeine and other) can produce Painful stimulus in innervations of vecical trigonous, bladder neck and prostatic urethra.
The same recurrent cystitis and Bph contribute in a complex situation.
This stimulus produce ipertonus of bladder muscle involved in the expulsion of urine.
The event related inflamation and edema (bladder, prostatic uretra, trigonus) contribute to the global effect.
So conditions like bladder neck sclerosys IPB, recurrent prostatitis and cistitys in acts in a vicious circle. (Also immunomediated: Bph and cronic prostatitis with linfocite infiltration and tissue remodeling).
The ormonal status check the systems (see 5-ARI efficacy in Bph).
Simpatic, parasimpatic and other system are deeply involved.
Also behavioral habits or diet can influence in example urinary flux in a complex system like LUT. (Bladder and prostatic irritants that can produce edema and acute inflamation).
Other behavior habits are deeply involved as too much sedentary, water intake, coffee, pee modality and also psychological profile and stressing conditions.
Some disease like diabetes produce high consequences in all this systems due to
Bladder modification, oxidative stress, osmotic movens, and increase susceptibility of urinary infections.
This article are verified this kind of movens that contribute in physio -pathology of some low urinary tract conditions.
The anatomic abnormalities produces, obviously, physiological disfuntions.
Recurrent urinary tract infections, inadequate antimicrobial therapy:
Profile of resistance, duration of therapy, kind of antimicrobials, posology,
Pk. Kinetics, associations, compliance, biofilms, micro calcifications (recurrent chronic prostatitis) contribute to a progression of the condition.
Background: Patients with chronic kidney disease (CKD) are at the risk of increase hospital admission as compared to the general population, due to various reasons. They have increased vulnerability to cardiovascular diseases (CVD) as well as infections, therefore they usually got admit in health care units due to various reasons. The causes of hospitalization in CKD patients in this part of the world are not studied well.
Methods: This cross sectional study was conducted in The Kidney Centre Post Graduate Training Institute (TKC-PGTI) of Karachi. Variables included in the study were age, gender, are of residence, ethnicity, smoking status and level of education. Comorbid conditions like causes of CKD and causes of hospitalization. Data analysis performed by using software IBM SPSS 21.
Results: Total of 269 patients were enrolled in our study. The male 148(55%), mean age was 55 years. The most common cause of hospitalization in our population was infection148 (55%) and urinary tract infection (UTI) was the most common site of infection 55 (20%) followed by sepsis of unknown origin 29(10.8%). Cardiovascular events like volume overload 32 (11.4%) and acute coronary syndrome 20(7.4%) were the second most important cause of hospitalization.
Conclusion: Hospitalization of CKD patients is high, and in our population infection is found to be the leading cause of hospital admission. Infection originating from urinary tract is more common in all stages of CKD patients, while blood born infection originating from double lumen (DL) dialysis catheter or arteriovenous fistula (AVF) cannulation is more common in dialysis population. Cardiovascular events, both acute coronary syndrome and pulmonary edema due to volume overload followed the infections.
Trichosporonosis is a disease caused by Trichosporon spp. which are ubiquitous anamorphic yeast that commonly inhabit the soil. In human they are found in the skin, gastrointestinal tract and respiratory tract. Globally, Trichosporon spp. infection is rare and remains scantily reported in urinary tract infections and disseminated invasive infection amongst immunocompromised and cancer patients with neutropenia. Trichosporon asahii is the most commonly reported species. Virulence factors like proteinases, lipases, and phospholipases may be responsible for disease manifestation. We report a case of recurrent urinary tract infection due to Trichosporon spp. in a 62-year-old immunocompetent diabetic female which remained misdiagnosed for a long period of time. The patient was subsequently treated successfully by oral fluconazole drug.
Urinary tract infection (UTI) is one of the extremely popular causes of febrile illness in children, demanding antimicrobial therapy . Overall, 8% of females and 2% of males, experience at least one incident of UTI by seven years of age, and recurrence takes place in up to 30% during a year .
Background: Recent years have seen chaos in the neonatology use of antibiotics with diverse opinions and recommendations in international guidelines and societies. This has created great uncertainty in which cases to use, for how long, and which tests apply to make these decisions.
We conducted a retrospective cohort study about the use of antibiotics in the EpicLatino neonatal units and a Latin American network database, after noting these variations in the 2019 report.
Methods: For the year 2019 using the EpicLatino database, we included cases (only first admission) ≤ 32 weeks gestational age at birth, excluding one unit that did not accept to participate.
The number of cases and days receiving antibiotics were recorded as well as the progression for each unit. Inappropriate use of antibiotics was defined as greater than 3 days in patients with negative cultures (blood/CSF cultures) excluding: major malformations, urinary tract infections, necrotizing enterocolitis (NEC) and cases with suspected chorioamnionitis in the mother (the latter two only during the course of diagnosis of NEC or chorioamnionitis).
Results: A total of 6,543 days of antibiotics were observed, 49.5% of cases had at least one positive blood/CSF culture.
A total of 595 days of antibiotics without justification were found in 72 courses in 61 cases: 19.4% had no diagnosis of infection in the database, 9.7% did not document any culture throughout their stay, and 51,4% obtained only one blood/CSF culture during their entire stay. In the 58 cases with diagnosis of infection: 41% were clinical sepsis and a diagnosis of pneumonia with a poor positive culture correlation was found. Furthermore, 74% of the unit’s didn´t use pneumonia as a justification to use antibiotics.
Other diagnosis found: Conjunctivitis, NEC 1A and rotavirus NEC.
Conclusion: Although the method of reviewing the use of antibiotics in a database has a number of limitations, especially the cause that motivated the use of antibiotics and other tools used for diagnosis of infections, the notable differences between units is striking.
Although it is difficult to make recommendations to all units, it is important to control infections in some units and in others to reduce the excessive use of antibiotics, especially with diagnosis of pneumonia in neonates and negative blood/CSF cultures.
Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identified include financial problems, organization of care, human error, hospital environment and patient-related factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered.
Granulomatosis with polyangiitis (GPA), a form of ANCA-associated vasculitis (AAV), is a rare disease with an often-occult presentation. It is more common in 4th and 5th decades of life but can be seen in all ages.
This case report details a 76-year-old female presenting with abdominal pain, generalized weakness, and malaise, who was found to have pulmonary nodules on chest imaging. Biopsy of the lung nodule showed organizing pneumonia. Initially, antibiotics were used to treat the patient. However, she developed acute renal failure a few days after presentation and found to have positive serum C-ANCA as well as elevated ANCA-PR3 serologies. A subsequent kidney biopsy demonstrated pauci-immune necrotizing and crescentic glomerulonephritis that was consistent with GPA and the patient was started immediately on combination immunosuppressive therapy, plasmapheresis, and hemodialysis.
GPA’s clinical and radiological presentation can mimic other common conditions such as pneumonia, malignancy, bacterial sinusitis, pulmonary tuberculosis, sarcoidosis, and urinary tract infection. Because of this, a high level of suspicion is required for early diagnosis and treatment to alter the high mortality rate in this disease entity. All forms of ANCA-associated vasculitis (AAV) should be in the differential diagnosis for all patients presenting with multiorgan system involvement particularly in individuals with pulmonary and renal manifesations.
Urinary tract infections are common affection in the general population.
Diagnosis is often easy in the presence of evocative clinical signs.
The diagnosis of urinary tract infection is evoked in the presence of an uropathogenic germ in the urine in sufficient quantity associated with urinary signs. The presence of lower back pain, chills, fever higher than 39° is suggestive of a high urinary tract infection localized in the kidney, the absence of fever associated with dysuria is suggestive of low urinary tract infection localized in the bladder.
Background: Down syndrome (DS) is associated with various congenital diseases and malformations, including those of the kidneys and urinary tract. It has been thought that renal tubular acidosis (RTA) is more frequent in this population. The objective of this study was to assess the frequency of RTA and, secondarily, of other renal and urological disorders in persons with DS.
Method: An observational, ambispective, descriptive and cross-sectional study of patients diagnosed with RTA, or suspected kidney or urological disorders, was carried out from July 2016 to September 2017 at the Down syndrome clinic of the Mexican National Institute of Paediatrics. Urinalysis was performed, along with analyses of venous blood gas, sodium, potassium, chlorine, calcium, phosphorus, albumin and creatinine. Those with any abnormal values were referred to nephrology for diagnostic evaluation.
Results: Of a total of 700 patients seen at the clinic, 47 met the selection criteria. Of these, 32 had no RTA or other renal or urological alterations. The remaining 15 continued to the second phase of the study, where 6 were diagnosed with nephropathy or uropathy (RTA, systemic arterial hypertension, monosymptomatic familial haematuria, mild renal failure secondary to reflux nephropathy, urinary tract infection or right ureteropelvic stenosis). Four had mild metabolic acidosis without meeting the criteria for diagnosis of RTA.
Conclusion: RTA is not more common in children with Down syndrome. Nephropathies and uropathies should be investigated in the evaluation of DS patients.
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