Burning Micturition Research Articles

YAVAKSARA WITH MADHU ANUPANA IN LOWER URINARY TRACT INFECTION: A CASE REPORT

Urinary tract infection is the commonest of all infections and are leading causes of morbidity and health care expenditure in persons of all ages. The prevalence of UTI was estimated to be around 150 million per year. E coli is the most common organism causing UTI. The Common clinical manifestations are dysuria, burning micturition, increased frequency and urgency to micturate, nocturia, suprapubic pain and low-grade fever. In Ayurveda it can be correlated with mutrakrichra. Paneeya kṣāra is one among the important formulation that is mentioned in the management of mutrakrichra. As per textual reference Yavakṣāra have action in relieving symptoms of mutrakrichra. A 34-year-old female with OP No. 20220000308 consulted Shalyatantra OPD of hospital with symptoms of dysuria, suprapubic pain, burning sensation, urgency and frequency of urination. After urinalysis, the condition was diagnosed as lower UTI. The patient was administered 500 mg of yavaksara with madhu anupana twice daily for a period of 15 days and analyzed the condition. Along with reduction in pus cells and bacteria, great symptomatic relief was obtained. Utilizing the inherent properties of ksara, it can be employed with efficacy in the treatment of urinary tract infections.

Efficacy of Shilodbhidadi taila uttarabasti in the management of Pittaja mutrakricchra (cystitis) in female – An experience

Abstract: Urinary Tract Infections (UTIs) are a common cause of morbidity and have the potential to cause kidney damage. Mutrakricchra (~cystitis) is a disease of Mutravaha srotas (~urinary tract) and its symptomatology resembles more closely to cystitis which is the basic form of UTI. The injudicious use of prescribed antibiotics causes toxicity, drug resistance, and health hazards which make it difficult to manage the recurrent UTI. There is a need to search for an ideal therapy for UTI that causes least adversities. This case report provides an effective Ayurveda protocol to the existing modalities of UTI management. A 58-year-old female visited the Ayurveda outpatient department with the complaints of Adho udarashoola (~pain in the lower abdomen), Sashoola, Sadaha mutra pravritti (~painful, difficult, and burning micturition), and Atimutra pravritti (~increased frequency of micturition) with the frequency of 10–15 times/24 h for two months. After analysis, based on Ayurvedic and modern parameters, the condition was diagnosed as Pittaja mutrakricchra (~dysuria caused due to vitiation of Pitta dosha). After 60 days of management, the patient got complete relief after taking consecutive two sittings of Uttarabasti (~intraurethral douching) for eight days with an interval of one month along with Shamana chikitsa (~palliative therapy), suggesting in effective management of Pittaja mutrakricchra (~cystitis) in female through Ayurveda treatment protocols.

Ethno-Botanical and Phytopharmacological Study of Limnophila rugosa Roth. Merr. (Scrophulariaceae): Mini Review

Background: Limnophila rugosa (Scrophulariaceae) is an aquatic and perennial herb finds its natural habitats in ponds, rivers, lakes as well as marshy lands of India. The traditional practitioners of Bolangir and Bargarh District of Odisha use this plant as a source of Bhringaraj. Therapeutically, it is used as diuretic, stomachic, digestive tonic and as a hair perfume, treatment of elephantiasis, diarrhoea, dysentery, dyspepsia and urinary burning. Objective: The present study was focused to provide the information regarding its traditional uses, compounds identified from different parts and essential oil; and the pharmacological activities of the reported compounds, which will bring the scope for future research. Methods: Extensive literature survey was carried out up to 2021 in Google scholar, Web of science, scopus, pub med, science direct, springer, Taylor and Francis using key words pharmacognostical, phytochemical and pharmacological aspect of L. rugosa. Result: The study revealed diverse chemical compounds; flavonoids, terpenoids, amino acids, alcohol, phenol, aldehyde, ketone, carboxylic acid and ether. 5,7-Dihydroxy-6,8,4'-trimethoxyflavone (Nevadensin), 5-Hydroxy-6,7,4'-trimethoxyflavone (Salvigenin), Betulin, betulinic acid, caryophyllene, cis-anethole, methylchavicol were found as major compounds. Pharmacological activities such as antimicrobial, anti-inflammatory, diuretic and hypotensive was reported. The identified compounds exhibited several pharmacological activities including antibacterial, antimicrobial, antifungal, anxiolytic, anti-inflammatory, analgesic, antioxidant, anti-tubercular, anti-tumour, anti-cancer, immunomodulatory, hepatoprotective, antiulcer, antidiabetic, antinociceptive, antimalarial, antiviral, anti-hyperlipidaemic, anti HIV, insecticidal, herbicidal, antifeedant, anti-coagulant, gastro-protective, antihelmintic. Conclusion: As, most of the compounds exhibited significant antimicrobial, antibacterial and antifungal activity so; a novel dosage form can be prepared from the essential oil of L. rugosa for antimicrobial activity.

Chemical characterization of Callingcard Vine (Entada polystachya (L.) DC. var. polystachya) aqueous seed extract and evaluation of its cytotoxic, genotoxic and mutagenic properties.

Callingcard Vine (Entada polystachya (L.) DC. var. polystachya - Fabaceae) is a common plant in coastal thickets from western Mexico through Central America to Colombia and Brazil, especially in Amazon biome. It has been popularly used as a urinary burning reliever and diuretic. However, the plant chemical constituents are poorly understood and Entada spp. genotoxic potential have not been previously investigated. In the present study we determined the chemical composition of the aqueous E. polystachya crude seed extract (EPCSE) and evaluated the cytotoxic, genotoxic and mutagenic properties of EPCSE in Salmonella typhimurium and Chinese hamster fibroblast (V79) cells. Cytotoxic activity was also evaluated in tumor cell lines (HT29, MCF7 and U87) and non-malignant cells (MRC5). The chemical analysis by High Resolution Mass Spectrometry (HRMS) of EPCSE indicated the presence of saponin and chalcone. The results of the MTT and clonal survival assays suggest that EPCSE is cytotoxic to V79 cells. Survival analysis showed higher IC50 in non-tumor compared with tumor cell lines. EPCSE showed induction of DNA strand breaks as revealed by the alkaline comet assay and micronucleus test. Using the modified comet assay, it was possible to detect the induction of oxidative DNA base damage by EPCSE in V79 cells. Consistently, the extract induced increase lipid peroxidation (TBARS), superoxide dismutase (SOD) and catalase (CAT) activities in V79 cells. In addition, EPCSE induced mutations in S. typhimurium TA98 and TA100 strains, confirming a mutagenic potential. Taken together, our results suggest that EPCSE is cytotoxic and genotoxic to V79 cells and mutagenic to S. typhimurium. These properties can be related to the pro-oxidant ability of the extract and induction of DNA lesions. Additionally, EPCSE could inhibit the growth of tumor cells, especially human colorectal adenocarcinoma (HT29) cell line, and can constitute a possible source of antitumor natural agents.

ANTI-MICROBIAL SPECTRUM FOR BACTERIAL UROPATHOGENS IN ADULT PATIENTS ASSOCIATED WITH URINARY TRACT INFECTIONS AT GOVERNMENT TEACHING HOSPITAL

Objective: Urinary tract infection (UTI) is one of the most common bacterial infections, affecting 150 million people each year worldwide. UTI’s are a significant cause of morbidity in females, infant boys and older men of all age groups. The most common causative agent for UTI is uropathogenic Escherichia coli. Patients suffering from symptomatic UTI are commonly treated with antibiotics. The present study was undertaken to find the etiology, risk factors, clinical pattern, isolated uropathogens and therapeutic profile of UTI.
 Methods: It was a prospective, observational, descriptive, cross-sectional study conducted for a period of 6 mo from April 2022 to September 2022 at RIMS, Kadapa. A total of 35 UTI patients were recruited based on study criteria. The data was collected, analysed, summarised as averages. Graph pad prism software was applied for statistics by using Microsoft excel. Fig. represented through bar graphs, pie charts.
 Results: In a total of 35 patients suffering from UTI, we found that 7 were males and 28 were females, based on age groups; 2 patients belong to 21-30 y and 18 patients belong to 31-40 y, 10 patients belong to 41-50 age group, 3 patients belong to 51-60 y. In a total of 82 risk factors 40% were diabetes mellitus, 20% were hypertension, 17% were renal calculi, 5% were cyanosis, 11% were BPH, 6% were ESRD. In a total of 95 clinical symptoms, we observed fever (32.5%) as a major symptom, followed by burning micturition (16.5%). Other signs like abdominal pain, urine urgency, hematuria were also reported. On assessing urine culture, uropathogens Escherichia coli (35%) was isolated in majority UTI cases followed by Staphylococcus aureus (17%), Pseudomonas aeruginosa (14%), Candida species (14%), Enterococcus faecium (11%), Proteus species (8%). Total drugs prescribed were 150. Fluoroquinolones (48 in number, 32%) were the most common prescribed antibiotic drug category, followed by Anti-mycobacterial (32 in number, 21%), Cephalosporins (25 in number, 17%), Penicillins (20 in number, 13%), Macrolides (14 in number, 10%), Combinational therapy (11 in number, 7%).
 Conclusion: The UTI prevalence was more in females at GGH–RIMS, Kadapa. E. coli was the most common species isolated in UTI patients. At research site, physicians frequently prescribed medications were Ciprofloxacin (fluoroquinolones) and Nitrofurantoin (anti-mycobacterial) for UTI patients.

PREVALENCE OF URINARY TRACT INFECTIONS AMONG FEMALES OF REPRODUCTIVE AGE GROUP IN TERTIARY CARE TEACHING HOSPITAL

Objective: The purpose of the current study is to isolate, characterize, and evaluate the antibiotic susceptibility profile of the pathogenic bacteria causing urinary tract infections (UTIs) in females of reproductive age. Methods: This is a cross-sectional descriptive study carried out in a Tertiary care teaching hospital for 1 year. A total of 100 urine samples from female patients in the reproductive age range of 15–44 years constitute the study’s sample size. Clean catch midstream urine samples were taken in sterile containers and inoculated on a different culture medium, such as cysteine, lactose, and electrolyte-deficient agar, to isolate the UTI pathogen. MacConkey agar was inoculated in parallel to target the growth of Gram-negative bacilli. Thereafter, using the common microbiological procedures, all positive cultures with significant bacteriuria were identified at the species level based on the colony features, Gram-staining reaction, and pattern of biochemical profiles. To investigate the pattern of antibiotic susceptibility, the disc diffusion method was used. Results: Among the 100 study cases, the prevalence of UTI was seen in 38% of individuals and UTI was absent in 62% of individuals. Among the females (38% cases) who had UTI, 81% had symptomatic UTI and 19% had asymptomatic UTI. Among the 81% symptomatic individuals of UTI, all they showed burning micturition followed by 74% of individuals showed dysuria Among the uropathogens isolated, majority were Escherichia coli (40.7%) followed by CONS (22.3%) Majority of the E. coli isolates showed sensitivity to piperacillin/tazobactam and nitrofurantoin. Conclusion: If left untreated, UTI is a significant public health issue. Early detection and timely treatment will lower the risk of developing further UTI complications, as well as the patient’s pain, length of stay in the hospital, and economic loss.

Hypereosinophilia Syndrome: Myriad Presentation—A Case Report

AbstractHypereosinophilic syndrome is a myeloproliferative disorder that is distinguished with the presence of eosinophilia, which is an absolute eosinophil level of more than 1500/µL for no less than 6 months, no recognized cause for eosinophilia, and clear organ involvement characteristics. But, in some cases where patients require therapy to decrease eosinophil counts due to severe symptoms, a lower time period of hypereosinophilic is also admissible. In this case series, we have included three cases in which first case presented with the features of diarrhea, nausea, and decreased appetite who underwent colonoscopy and was diagnosed as a case of eosinophilic colitis. The second patient was a female came with abdominal pain and burning micturition, who was having eosinophilia on blood count examination and was diagnosed as a case of eosinophilic cystitis. Third case was young female who was diagnosed as eosinophilic endocarditis on two-dimensional echocardiography having dyspnea and rash and high eosinophil count on blood smear. All the three patients were started on steroids, who recovered well with medication and were discharged for follow-up after 7 days with complete blood count.

EXPERIMENTAL STUDY OF HARITAKYADI KWATH IN PITTAJA MUTRAKRICHHA (UTI IN PREGNANCY)

Ayurveda is referred to as a holistic system of medicine and has been integrated in general wellness applications in several countries. It deals with managing health by maintaining equilibrium of physiological constituents. Pittaj Mutrakrichha is one of the diseases caused due to Mutravaha Srotodushti i.e equivalent to UTI. Symptoms like dysuria, burning micturition and increased frequency of micturition are seen. Cases of UTI in pregnancy are generally asymptomatic. E. coli is the offending organism in over 90% cases. The incidence during pregnancy ranges from 2-10%, other pathogens include Enterococcus, Proteus mirabilis, Klebsiella pneumoniae and also fungi, yeasts and viruses. Bacteriuria is typically present at the time of the first prenatal visit, and if an initial positive urine culture is treated, less than 1% of women develop urinary infection. The topic i.e., antimicrobial effect of Haritakyadi Kwath was assessed in- vitro against most common microbial agents associated with UTI. I attempted the experimental study on Pittaja Mutrakrichha with herbal preparation named “Haritakyadi Kwath”. Experimental study was carried on 2 different characterised strain of bacteria (E. coli, Enterococcus faecalis) and characterised strain of yeast (Candida albicans). Haritakyadi Kwath has been chosen to see the effect on the patients of Pittaja Mutrakrichha (UTI in pregnancy). Haritakyadi Kwath consists of 5 constituents namely Haritaki, gokshur, amaltash, pashanbhed and yavasa. On the basis of experimental study, it can be concluded that Haritakyadi kwath is efficient in producing significant improvement in Pittaja Mutrakrichha.

Clinical Spectrum of Major Infection in Hospitalized Children with Nephrotic Syndrome at a Tertiary Care Hospital

Background : Children with Nephrotic Syndrome (NS) are exposed to multiple infections resulting in significant morbidity and mortality. Besides being a common cause of mortality, infections may also be responsible for a poor response to steroid therapy or induce relapse in a child with Nephrotic Syndrome.
 Aims: To assess the clinical spectrum of major infection in hospitalized children with Nephrotic Syndrome.
 Materials and Methods: This hospital based cross-sectional study was done in the Department of Paediatrics, Sylhet M A G Osmani Medical College Hospital, Sylhet, Bangladesh. In this study, sample size was 44 diagnosed cases of Nephrotic Syndrome with infection. After taking consent, detailed history and thorough physical examination were done in each patient. All data were collected in a preformed questioner and finally collected data were expressed in tabulated form.
 Results: In our study total 44 children with Nephrotic Syndrome were enrolled with the mean age of 5.98 ± 2.93 years and most of the childhood Nephrotic Syndrome was aged between 2 to 8 years (75.0%); 23 (52.3%) patients were male, and 21 (47.7%) patients were female with a ratio of male to female of 1.1:1. The common clinical symptoms of major infection were fever (79.5%) and cough (70.5%). Other clinical presentations were throat pain (18.2%), abdominal pain (15.9%), runny nose (11.4%), burning micturition (9.1%), respiratory distress (6.8%), vomiting (4.5%) and leg pain (4.5%). Relapse of Nephrotic Syndrome was found in 33 (75.0%) cases. The most common major infection was pneumonia (50.0%), followed by urinary tract infection (20.5%), Upper respiratory tract infection (15.9%), pneumonia with UTI (6.8%), cellulitis (4.5%) and pneumonia with UTI with spontaneous bacterial peritonitis (2.3%). The most common isolated organisms in urine were Escherichia coli (27.3%), followed by Klebsiella pneumoniae (2.3%).
 Conclusion: The common symptoms of major infection in Nephrotic Syndrome are fever and cough. The most common major infection was pneumonia and urinary tract infection.
 Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 544-547

A CASE REPORT OF AYURVEDA MANAGEMENT OF CERVICAL CELL DYSPLASIA (CIN 1)

Cervical dysplasia, also called as cervical intraepithelial neoplasia (CIN), is a precancerous condition strongly associated with human papillomavirus (HPV) infection in which healthy cells on the cervix undergo some abnormal changes. In cervical dysplasia, the abnormal cells are not cancerous, but have the potential to develop further and progress into cancer, if not diagnosed and treated early. Screening through the Pap smear test (Papanikolau test) has reduced the deaths related to cervical cancer by three-quarters. A 50-year-old female with complain of profuse vaginal discharge and burning urination since 3 months approached to outpatient department of Prasutitantra and Streeroga, JS Ayurveda Mahavidhyalaya, nadiad. She had history of irregular foul smelling menses with inter menstrual and post coital bleeding. On per speculum examination vaginitis and cervical erosion around the external os with profuse white discharge were found. Her Pap smear test reveled Low grade Squamous Intraepithelial Lesion (LSIL/CIN 1). She was successfully treated with oral medicaments of kanchanara guggulu, combination of rasayana churna and haridra churna along with local application of jatyadi taila yonipichu for 3 months. She had got significant relief in white discharge per vaginal, post coital bleeding, burning urination and cervical erosion. After completion of treatment, Pap test was done which turned negative and remained negative till 1 year follow up with no recurrence of symptoms. This case report demonstrates that cervical cell dysplasia (CIN1 /LSIL) can be effectively managed with Ayurveda Management.

Association of intermediate Nugent Score and bacterial vaginosis with sexually transmitted infections and vulvovaginal candidiasis.

Background Bacterial vaginosis is a common vaginal syndrome among females, which leads to significant morbidity and complications, if left untreated. The association of bacterial vaginosis with various sexually transmitted infections has been mentioned in previous literature. However, studies on the intermediate Nugent Score are lacking. This study was planned to examine the association of sexually transmitted infections with the intermediate Nugent Score. Materials and Methods The study included was conducted to include females presenting with vaginal discharge, burning micturition, itching, lower abdominal pain and infertility. The Nugent scoring was used to categorize patients into those having normal flora, intermediate or bacterial vaginosis. Conventional and molecular techniques targeting Trichomonas vaginalis, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Syphilis, Neisseria gonorrhoeae and vulvovaginal candidiasis were performed. Results A total of 3,531 clinical samples were collected from females with a median age of 28.0 years. The number of patients with bacterial vaginosis and intermediate Nugent Score and positive cases were significantly higher in the 21-35 years age group (P < 0.0001). We observed that the likelihood of test results being positive for Trichomonas vaginalis was higher (P < 0.05), as the abnormality of the vaginal flora increased. Mycoplasma hominis was observed to be significantly higher in the intermediate Nugent Score group than the BV-positive patients (0.6 vs 0.2, P = 0.002). The number of vulvovaginal candidiasis cases in both the bacterial vaginosis-negative and bacterial vaginosis-positive groups were nearly the same (9.3 vs 9.8%). Limitation Individual follow-up couldn't be performed on the patients. Conclusion We observed that the dysbiosis in vaginal microbiota, with an increase in Nugent scoring, was significantly associated with an increased risk for the acquisition of sexually transmitted infections and vulvovaginal candidiasis.

(032) A Large Retroperitoneal Schwannoma Masquerading as Genito-Urinary Syndrome of Menopause

Abstract Introduction Retroperitoneal schwannomas are extremely rare, slow growing, benign, neurogenic tumors. Their diagnosis is challenging and often incidentally found upon evaluation of vague symptoms. Extrinsic compression to nearby organs or nerves may cause pain and paresthesia. Vulvar pain as a presenting symptom of a retroperitoneal schwannoma is reported in the literature in a case with pudendal nerve involvement. Here we present a case report of a patient who presented with vulvar burning and lower urinary tract irritative symptoms which was found to have a large infra-hepatic retroperitoneal schwannoma. Objectives In this report we show case how performing a detailed neurological evaluation and having a good understanding of the vulvar, perineal, and lower extremity dermatomal innervation have assisted in early diagnosis and treatment of a large retroperitoneal schwannoma. Methods A 65-year-old menopausal woman presented to her primary provider for a 3-month-history of worsening vulvar burning sensation associated with urinary burning, frequency, and nocturia. The pain is worse at night and when sitting for more than an hour. The patient endorsed low back pain that radiated like pins down her anterior thighs. The patient underwent evaluation by her referring provider to rule out a urinary tract infections and vaginitis. She was treated with vaginal estrogen tablets with partial relief for a working diagnosis of Urogenital Syndrome of Menopause. Patient was then referred to Gynecology due to inadequate relief. A detailed pelvic examination revealed normal labia majora and minora with no erythema or swelling. The Vestibule, Bartholin and Skene glands were non tender. Q-tip testing provoked burning sensation in the left and right labia minora on the medial and lateral aspect as well as the labia majora. Pelvic Floor evaluation elicited left pelvic floor tenderness and bilateral ischial spine pain concerning for Pudendal neuralgia. Also, noted paresthesia overlying the left lower extremity at the L3 and L4 distribution at the medial thigh (Figure-1) The patient underwent a bilateral pudendal block with total resolution of her vulvar pain for 24 hours and hence, lumbar and pelvic nerve entrapment was suspected. Magnetic Resonance Imaging was requested. Evaluation revealed a 3.3x4.4cm left ovarian mass and uterine fibroids that could potentially explain L2-L5 radiculopathy. The Lumbar MRI noted a cystic mass in the right mid abdomen for which further evaluation with CT scan was recommended. (Image-1). Referral to Surgical Oncology and Gyn oncology was sought. Epithelial ovarian cancer tumor markers were normal. Catecholamine studies were nonrevealing except for unexplained increase in dopamine levels. Results Surgical excision of the retroperitoneal and ovarian tumor revealed a left ovarian Fibroma and Schwannoma with Cystic Degeneration, confirmed with Immuno-peroxidase studies for S100 and SOX10. The patient had an uncomplicated post-operative course and remains asymptomatic with total resolution of her urinary and vulvar burning symptoms. Conclusions This a case report of vulvar and urethral paresthesia caused by an exceedingly rare tumor located high in the retroperitoneum. Diagnosis was aided by detailed history, comprehensive gynecological, and neurodermatomal evaluation. Appropriate imaging and timely referral led to early diagnosis and treatment, resulting in symptom resolution. Disclosure No.

A Pharmaco-Therapeutic Study of Gokshur in Mutrakriccha Vyadhi w.s.r. to U.T.I.

Mutrakriccha is a big health concern these days as a result of infection, an irregular lifestyle, and poor eating habits. Mutra marga gat Strotas defined Ayurveda as being related to urinary tract infections. Mutrakriccha is a sickness documented in nearly all Ayurvedic classics in which a patient has severe and uncomfortable burning micturition. Mutrakriccha is classified into eight types, each with its own set of signs and symptoms, and may be linked to dysuria. Antibiotics are now widely used to treat the condition. However, many side effects and antibiotic resistance developed. As a result, treating the condition becomes more complicated. In Mutrakriccha Vyadhi, Gokshur is a more effective medicine. The medications used in the treatment of Mutrakriccha have been documented in numerous Ayurvedic texts. I conducted a 90-day Mutrakriccha clinical study on 20 participants. The outcomes are as follows: For B.D., these 20 patients were treated with Gokshur Mool Churna. One patient dropped out of the experiment. Out of the 19 patients who completed treatment, 12 (63.16%) were cured, 5 (26.32%) were moderately improved, and 2 (10.53%) were mildly improved.

Association of metabolic syndrome and lifestyle factors with lower urinary tract symptoms and benign prostatic hyperplasia

Objective: The study aimed to find out how often people with urinary problems also have metabolic syndrome and benign prostatic hyperplasia. It also looked at how lifestyle choices might be linked to these urinary issues. Methods: This was a cross-sectional study carried out at the Shaikha Fatima Institute of Nursing and Health Sciences in Lahore from May to December 2022. It involved 150 participants, and data analysis was done using Statistical Package for Social Sciences version 22.0. Results: The result of study revealed that mean± SD of age and BMI was 43±14.23 and23±5.2 respectively. Most common symptom was UTI which was present in 93(62.0%) of cases followed by urinary urgency 58(38.7%), and BPH 57(38.0%). About 43(28.7%) patients with LUTS had metabolic syndrome. Significant association of metabolic syndrome was found with urinary incontinence, burning micturition, urinary urgency, UTI and BPH. The life style factors were also associated with metabolic syndrome. Significant association was found between metabolic syndrome and stressful life, alcohol consumption, consumption of vegetables and fat content in diet &gt;2tbsp/ day, and sedentary working environment. Conclusion: The study concluded that metabolic syndrome was linked to lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH).

SQUAMOUS CELL CARCINOMA OF RENAL PELVIS: A CASE REPORT

Primary squamous cell carcinoma of the renal parenchyma is a rare entity. The diagnosis of squamous cell carcinoma of the renal pelvis is usually unsuspected due to the rarity and inconclusive clinical and radiological features, hence patients present at advanced stages resulting in poor prognosis. It can be associated with long standing obstructive uropathy eg. renal calculi and chronic renal infection. Radical nephrectomy is the mainstay of the treatment. We presented a case of Squamous Cell Carcinoma of right kidney with Chronic Pyelonephritis in a patient of a 60 years old male who presented with complains of burning micturition and decreased urine output. The radiological examination showed gross hydronephrosis with staghorn calculi of right kidney. The patient was treated with radical nephrectomy. The significance of this case is highlighted by the unusual location of such a tumour, and while rare, it is an important consideration in the differential diagnosis of renal tumours

Association of Urinary Tract Infection with Preterm Labor in Gravid Females in a Tertiary Care Hospital

Objective: To compare the frequency of preterm labour in pregnant patients with and without urinary tract infection in a tertiary care hospital in Punjab.&#x0D; Study Design: Cross-sectional comparative study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jul 2019 to Jan 2020.&#x0D; Methodology: Three hundred and eighty-five pregnant women were inducted into the study. The midstream urine sample was collected from patients between 24-28 weeks of gestation with complaints of burning micturition and was sent for microscopic examination. Urinary tract infection was diagnosed on the urinalysis report. Patients were followed till delivery.Patients were labelled as preterm who delivered neonates &lt;37 weeks of gestation.&#x0D; Results: In this study, the mean age of the patients was 25.2±3.0. The majority of the patients were para 1-2. The mean body mass index was 25.3±1.9 kg/m2. Urinary tract infection was found in 12 patients (3.2%), and preterm labour occurred in 52 patients (13.5%). The mean birth weight of neonates was 3.0±0.5kg. A comparison of preterm labour in patients with and without urinary tract infections revealed that patients with urinary tract infections were associated with preterm labour (p&lt;0.001).&#x0D; Conclusion: Urinary tract infection during pregnancy significantly impacts pregnancy outcomes, mainly preterm labour and low birth weight.

Lower Urinary Tract Symptoms and Urodynamic Findings in Hemodyalisis Patients

Urodynamics is the more accurate diagnostic tool to assess functional alterations of lower urinary tract. International guidelines provide specific indications to adopt this test for the evaluation algorithm of patients with lower urinary tract symptoms. Although recent innovations in diagnostic methodologies, especially regarding ultrasounds, have reduced the use of urodynamics compared to the past, this procedure retains its importance in specific conditions, such as in patients with neurogenic lower urinary tract dysfunction, when symptoms do not improve after first line therapeutic approaches, especially in cases of complicated urinary incontinence and bladder outlet obstruction. Among patients’ cathegories who are often requested to provide urodynamic data are those undergoing hemodialysis. In these subjects urinary symptoms often develop reducing quality of life and increasing the risk of severe sistemic complications. Furthermore, bladder outlet obstruction and other alterations that increase the risk of vesico-ureteral refluxes and chronic urinary retention have to be excluded before a kidney transplant. Urodynamics can properly assess lower urinary tract dysfunction of patients undergoing hemodialysis, who are often oliguric and anuric, and therefore suffering for bladder atrophy with impaired function. This alteration is frequently responsible for recurrent inflammatory disorders of the lower urinary tract. Considering these aspects and lack of data provided by Literature on this topic, aim of this study was to assess the prevalence of lower urinary tract symptoms in a cohort of patients undergoing hemodialysis and to investigate their urodynamic findings. The results show that lower urinary tract symptoms are prevalent in patients attending our hemodialysis center, being inflammatory disorders the most represented as a consequence of bacterial urinary tract infections. Lower urinary tract symptoms, especially urinary burning, frequency, urgency and nocturia, resulted to be the third reason for seeking medical assistance by patients, following cardiovascular and respiratory symptoms. Urodynamics showed in all patients a reduced cystometric capacity, often associated with reduced compliance and detrusor overactivity; pressure / flow studies provided evidence either of bladder outlet obstruction and underactive detrusor.

Efficacy and safety evaluation of Shatavari Gudam and Triphala Kashaya in leucorrhoea (Shwetapradara) – A study protocol of an open-label, multicenter, interventional, single-arm trial

BACKGROUND: In the classical text of Ayurveda, formulations Shatavari Gudam (SG) and Triphala Kashaya (TK) are indicated to treat Shwetapradara. The disease Shwetapradara can be correlated to leucorrhoea based on the similar symptom, painless, white-colored discharge from the vagina. SG is a formulation containing Shatavari (Asparagus racemosus) as a main ingredient. Several studies indicate Shatavari as a tonic for reproductive tract-related diseases. The external use of Triphala has anti-inflammatory, antiseptic, and anti-bacterial actions. The present article is a clinical study protocol on the efficacy and safety evaluation of SG and TK in leucorrhoea (Shwetapradara). MATERIALS AND METHODS: It will be a multicenter, prospective single-arm study planned to be conducted at Regional Ayurveda Research Institute, Thiruvananthapuram, Regional Ayurveda Research Institute Nagpur, National Ayurveda Research Institute for Panchakarma, Cheruturthy and Regional Ayurveda Research Institute Vijayawada. One hundred sixty participants will be recruited for the trial (40 from each center). In the dose of 6gm, SG will be administered twice daily with lukewarm water after food. Vaginal douche will be done with TK for seven days in two consecutive cycles. The primary outcome will be change in the quantity of white discharge using visual analog scale. The secondary outcome will be change in other associated symptoms like pruritis vulva, lower abdominal pain, low back ache, burning micturition, and dyspareunia using the Visual Analogue Scale; change in the Quality of life and well-being by PGWBI score; change in Score of Investigator’s Global Satisfaction Scale, and changes in Patient’s Global Satisfaction Scale from baseline to final visit. Clinical/biochemical assessments will determine the safety and tolerability of the formulation during the follow-ups. Compared with the baseline, the efficacy of interventions on the 84th and 98th day, will be assessed with Paired t-test. Data will be analyzed using SPSS 15.0 software. ETHICS AND DISSEMINATION: The IEC clearance has been obtained from each participating institute. After completion of the trial, the outcome will be disseminated through peer-reviewed journals for publication.

Urachal Adenocarcinoma: a Case Report and Review of the Literature.

Urachal adenocarcinoma is one of the rare and aggressive neoplasms that often presents at an advanced stage and has a poor prognosis. Urachal adenocarcinoma makes up 0.17 to 0.34% of all bladder carcinomas. Patients commonly present with hematuria. Wide local excision of urachal mass with umbilicus and surrounding soft tissue en bloc combined with partial or radical cystectomy and bilateral pelvic lymphadenectomy is considered to be the primary surgical management. However, many publications in literature report that en bloc removal of tumor with umbilicus, entire urachal ligament, and bladder dome alone has long-term survival and disease-free period. Here, we present a case of a 50-year-old post-menopausal female patient with a fungating mass in the umbilical region of size approximately 10 cm in maximum diameter with mucopurulent discharge from the mass. The patient had no history of any hematuria, mucinuria, burning micturition, or any particles in urine. A laparotomy was performed, and tumor mass along with the cuff of the bladder dome was removed as en bloc along with umbilectomy. This case report highlights a rare case of urachal adenocarcinoma with a fungating mass of large size in a female patient which is otherwise more commonly seen in males. A review of published literature is also presented.

Parasites observed in urine sediments: A learning from incidental rare species

Parasitic infection becomes an unsolved problem in using of automated instruments for urinalysis. Most common parasitic infections described in literature are Trichomonas vaginalis, Schistosoma hematobium and Microfilaria. Other rare organisms are Balantidium coli and Paramecium. The main purpose of this article is to raise the awareness in pathologists and clinicians on the importance of cytological evaluation of urine. This study was done to find the associations between the age and point prevalence of organisms in our zone in the last 6 years. Identification of parasites in centrifuged deposits of urine sediment is a relatively rare occurrence in clinical practice. A fairly wide morphological spectrum of parasites may be diagnosed through microscopic examination of centrifuged urine sediment. They may present with symptoms like pyuria, hematuria, diarrhoea, burning micturition, itching and morphological awareness helps in prompt and effective management in most cases.