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Cureus Sep 2023Basal ganglia are highly metabolically active deep gray matter structures that are commonly affected by toxins, metabolic abnormalities, and systemic, degenerative, and...
Basal ganglia are highly metabolically active deep gray matter structures that are commonly affected by toxins, metabolic abnormalities, and systemic, degenerative, and vascular conditions. Basal ganglion affected by uremic encephalopathy can typically result in a "Lentiform fork sign" on T2-weighted imaging (T2WI) and a fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI). This sign represents bilateral symmetrical hyperintensities in the basal ganglia surrounded by a characteristic hyperintense rim demarcating the lentiform nucleus from surrounding structures. This finding is also reported in other conditions resulting in metabolic acidosis from any cause, e.g., diabetic ketoacidosis, organic acidemias, dialysis disequilibrium syndrome, and drugs like metformin. In an appropriate clinicopathological context, the presence of this sign helps in the accurate diagnosis of uremic encephalopathy. The peculiarity lies in the reversible nature of these lesions and their affective response to treatment. However, sometimes these lesions may not be reversible. We present the case of a 60-year-old female who presented to the ER with chief complaints of fever and altered sensorium. Laboratory workup revealed deranged renal function tests (RFTs) and leukocytosis with pyuria. MRI of the brain showed bilateral basal ganglion hyperintensities on T2WI/FLAIR images characteristic of the lentiform fork sign. Therefore, a diagnosis of uremic encephalopathy due to acute kidney injury (AKI) secondary to septic shock from urosepsis was made. The patient was managed conservatively with IV hydration and antibiotics. Remarkable clinical recovery was seen over three weeks. The patient was stable on a five-month follow-up. However, the repeat MRI did not show resolution of the lesions.
PubMed: 37809160
DOI: 10.7759/cureus.44850 -
Clinical Microbiology and Infection :... Feb 2024Urinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive...
OBJECTIVES
Urinary tract infection (UTI) is common among older women. However, diagnosis is challenging because of frequent chronic lower urinary tract symptoms, cognitive impairment, and a high prevalence of asymptomatic bacteriuria (ASB). Current urine diagnostics lack specificity, leading to unnecessary treatment and antimicrobial resistance. This study aimed to evaluate the diagnostic accuracy of 12 urine biomarkers for diagnosing UTI in older women.
METHODS
In this case-control study, cases were women ≥65 years with ≥2 new-onset lower urinary tract symptoms, pyuria, and one uropathogen ≥10 CFU/mL. Controls were asymptomatic and classified as ASB (one uropathogen ≥10 CFU/mL), negative culture, or mixed flora. Urine biomarker concentrations were measured through liquid chromatography-mass spectrometry and ELISA. Diagnostic accuracy parameters of individual biomarkers and a biomarker model were derived from receiver operating characteristic curves.
RESULTS
We included 162 community-dwelling and institutionalized older women. Five urine inflammatory biomarkers demonstrated high discriminative ability (area under the curve ≥0.80): interleukin 6, azurocidin, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinases 2, and C-X-C motif chemokine 9. Azurocidin exhibited the highest diagnostic accuracy (sensitivity 86% [95% CI 75%-93%] and specificity 89% [95% CI 82%-94%] at 16.7 ng/mmol creatinine). A combined biomarker and pyuria model showed improved diagnostic accuracy in patients with UTI and ASB, compared with pyuria alone.
DISCUSSION
We identified several urine biomarkers that accurately differentiated older women with UTI from asymptomatic women, including ASB. These findings represent a potential advancement towards improved diagnostics for UTI in older women and warrant validation in a diverse population.
Topics: Humans; Female; Aged; Male; Pyuria; Case-Control Studies; Urinary Tract Infections; Bacteriuria; Lower Urinary Tract Symptoms; Biomarkers
PubMed: 37805035
DOI: 10.1016/j.cmi.2023.09.023 -
Children (Basel, Switzerland) Sep 2023This study aimed to investigate the characteristics of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome...
This study aimed to investigate the characteristics of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome (KDSS) and to compare the similarities and differences between the two diseases. The incidence of KDSS and MIS-C was also estimated. Medical records of patients diagnosed with MIS-C or KDSS at four hospitals from January 2013 to December 2022 were retrospectively reviewed. Thirty-one patients were enrolled in the study in either an MIS-C group ( = 22) or a KDSS group ( = 9). The incidence of KDSS in KD was 0.8% (9/1095) and the incidence of MIS-C versus KD was 10.2% (22/216). Compared with the MIS-C group, the KDSS group had longer hospital stays and more severe systemic inflammation (e.g., anemia, elevated C-reactive protein, hypoalbuminemia, and pyuria) and organ dysfunction (e.g., number of involved organs, shock, vasoactive infusion, and intensive care unit admission). All patients in the MIS-C group, but none in the KDSS group, including two patients during the COVID-19 pandemic, had laboratory evidence of SARS-CoV-2 infection. MIS-C and KDSS shared demographic, clinical, and laboratory characteristics; organ dysfunction; treatment; and outcomes. Overall severity was more severe in patients with KDSS than in those with MIS-C. The most important difference between MIS-C and KDSS was whether SARS-CoV-2 was identified as an infectious trigger.
PubMed: 37761488
DOI: 10.3390/children10091527 -
Scientific Reports Sep 2023Systemic lupus erythematosus (SLE) is a chronic rheumatic disorder. Endothelin-1, a vasoconstrictor, belongs to the endothelin family and is associated with...
Systemic lupus erythematosus (SLE) is a chronic rheumatic disorder. Endothelin-1, a vasoconstrictor, belongs to the endothelin family and is associated with vascular-related damages. To date, association between ET-1 and pathogenesis of SLE remains unclear. This case-control study was carried out by 314 SLE, 252 non-SLE diseases patients and 500 healthy controls. Serum ET-1, CCN3, IL-28B levels were detected by ELISA, and ET-1 gene polymorphisms (rs5369, rs5370, rs1476046, rs2070699, rs2071942, rs2071943, rs3087459, rs4145451, rs6458155, rs9369217) were genotyped with Kompetitive Allele-Specific PCR. SLE patients had high levels of ET-1, which were correlated with some clinical, laboratory features. Serum CCN3, IL-28B levels were higher in SLE patients, and ET-1 levels were positively correlated with the two cytokines. Rs5370, rs1476046, rs2070699, rs2071942, rs2071943, rs3087459, rs6458155 and rs2070699 were associated with SLE risk. Rs2070699 (T, TT) was related to SLE patients with alopecia. Rs5370 (T, TT, TG), rs1476046 (G,GA), rs2071942 (G,GA) and rs2071943 (G,GA) were associated with SLE patients with pericarditis, pyuria and fever manifestation, respectively. Rs3087459 (CC) and rs9369217 (TC) were related to SLE patients with positive anti-SSB antibody. Rs5369 (AA) was associated with IgG and CRP levels in SLE patients. In conclusion, elevated serum ET-1 in SLE patients may be a potential disease marker, and its gene polymorphisms were related to SLE susceptibility.
Topics: Humans; Case-Control Studies; Endothelin-1; Lupus Erythematosus, Systemic; Pericarditis
PubMed: 37749230
DOI: 10.1038/s41598-023-43350-0 -
Current Urology Jun 2023This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review...
OBJECTIVES
This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.
MATERIALS AND METHODS
After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.
RESULTS
Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.
CONCLUSIONS
Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
PubMed: 37691985
DOI: 10.1097/CU9.0000000000000159 -
The Journal of Small Animal Practice Dec 2023To assess relationships between urine sediment and microbial culture findings and the presence of proteinuria in canine urine samples, and to assess the change in the...
OBJECTIVES
To assess relationships between urine sediment and microbial culture findings and the presence of proteinuria in canine urine samples, and to assess the change in the percentage of proteinuric samples and urine protein-to-creatinine ratio when urine abnormalities resolve.
MATERIALS AND METHODS
Canine urine samples collected via cystocentesis and submitted for culture and contemporaneous urinalysis (including urine protein-to-creatinine ratio) were retrospectively identified. Dogs receiving corticosteroids were excluded. Associations between haematuria (red blood cells>5/high-power field), pyuria (white blood cells>5/high-power field), presence of microorganisms on microscopy, active sediment, and positive culture and proteinuria (urine protein-to-creatinine ratio>0.5) were investigated. Patient characteristics were considered possible confounders. In dogs with repeat urinalysis, the associations between active sediment and positive culture resolution on proteinuria and urine protein-to-creatinine ratio were assessed.
RESULTS
One hundred and ninety-two of 491 samples were proteinuric (39.1%). Age was positively associated with proteinuria. In the multivariable analysis corrected for age, active sediment was the only variable significantly associated with proteinuria (adjusted odds ratio: 2.12; 95% confidence interval: 1.44 to 3.11); however, only 49.8% of samples with active sediment were proteinuric. Neither resolution of active sediment nor positive culture were associated with reduced proportions of proteinuric samples (from 57.9% to 42.1% and from 40.0% to 25.0%, respectively) or significant reductions in urine protein-to-creatinine ratio (median change: -0.16 and -0.14, respectively).
CLINICAL SIGNIFICANCE
Attributing proteinuria to urinalysis abnormalities or a positive urine culture in canine cystocentesis samples is not supported by our findings, and could result in alternative causes of proteinuria (e.g. renal proteinuria) being overlooked.
Topics: Humans; Dogs; Animals; Creatinine; Retrospective Studies; Dog Diseases; Urinalysis; Proteinuria
PubMed: 37632274
DOI: 10.1111/jsap.13669 -
Ghana Medical Journal Jan 2023This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks,...
OBJECTIVES
This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks).
DESIGN
A cross-sectional study with stratified simple random sampling.
SETTING
Urology Unit, Korle Bu Teaching Hospital.
PARTICIPANTS
One hundred and thirty-seven male patients with long-term urinary catheters.
INTERVENTIONS
Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacements.
PRIMARY OUTCOMES MEASURES
Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed.
RESULTS
Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065.
CONCLUSIONS
In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.
FUNDING
Enterprise Computing Limited.
Topics: Humans; Male; Catheters, Indwelling; Urinary Tract Infections; Silicon; Urethral Stricture; Cross-Sectional Studies; Prostatic Hyperplasia
PubMed: 37576373
DOI: 10.4314/gmj.v57i1.10 -
Antimicrobial Stewardship & Healthcare... 2023The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics...
The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics for BPCUS, we found frequent readmissions, which were mitigated by outpatient follow-up visits. Observation and follow-up for an unknown diagnosis should be emphasized over antibiotics due to high likelihood of readmissions.
PubMed: 37502236
DOI: 10.1017/ash.2023.204 -
Experimental and Clinical... Jun 2023Abū Bakr Muḥammad ibn Zakariyyã al-Rãzî is a historical physician who made theoretical and practical contributions to medicine. The aim of al-Rãzî's book, Man...
OBJECTIVES
Abū Bakr Muḥammad ibn Zakariyyã al-Rãzî is a historical physician who made theoretical and practical contributions to medicine. The aim of al-Rãzî's book, Man lã yaḥḍuruhu al-ṭabîb, is to provide a valuable benefit to the general public. The book was written for people who do not have access to physicians, critical medical manuscripts, and medications. Our study aimed to add to the literature and discuss the issues concerning urinary tract problems in al-Rãzî's Man lã yaḥḍuruhu al-ṭabîb.
MATERIALS AND METHODS
The sections of al-Rãzî's Man lã yaḥḍuruhu al-ṭabîb dealing with the urinary system were discussed and translated from Arabic to English.
RESULTS
Urinary system problems are discussed in al-Rãzî's book under the headings of "Pains in the kidneys and bladder (nephritis and cystitis) and stones in the kidneys," "Hematuria," "Pyuria and painful micturition/dysuria," "Prescription for medicine on this subject," and "Drug for the difficulty of passing urine/strangury." The relevant sections mention drugs and approach to be used, particularly in the face of problems, rather than theoretical explanations. Changes in practice and treatment have been suggested in various symptomatic situations.
CONCLUSIONS
Rather than theoretical and etiological explanations for urinary problems, al-Rãzî provides accessible and applicable practical drugs and approaches for the general public, which can be considered suitable for the purpose mentioned in al-Rãzî's introduction to the book.
Topics: Humans; Books; Hematuria; Urinary Tract
PubMed: 37496333
DOI: 10.6002/ect.IAHNCongress.01 -
Current Urology Sep 2023We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic...
OBJECTIVES
We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy.
MATERIALS AND METHODS
This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire.
RESULTS
After treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3-29) to 4 (0-18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups.
CONCLUSIONS
Our results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.
PubMed: 37448620
DOI: 10.1097/CU9.0000000000000197