Cause Of Urinary Tract Infections Research Articles

Effects of pH on the Pathogenicity of Escherichia coli and Klebsiella pneumoniae on the Kidney: In Vitro and In Vivo Studies.

Urine pH reflects the functional integrity of the body and may influence the virulence of uropathogenic Escherichia coli and Klebsiella pneumoniae, the main causes of urinary tract infections (UTIs). This study evaluated the effects of acidic pH on the pathogenicity of uropathogenic E. coli and K. pneumoniae strains, in vitro and in vivo. Four uropathogenic E. coli and four K. pneumoniae strains were used. Biofilm formation, growth competition indices, motility, and adhesion and invasion of human renal cells were analyzed in media with acidic, neutral, and alkaline pH. A murine lower UTI model was used, with urine adjusted to acidic, neutral, or alkaline pH. At acidic pH, E. coli and K. pneumoniae exhibited higher bacterial concentrations in the kidneys and systemic symptoms, including bacteremia. Alkaline urine pH did not affect bacterial concentrations of any strain. In mice with UTIs caused by E. coli Nu14 and K. pneumoniae HUVR42 and acidic urine pH, histopathological studies of the kidneys showed acute inflammation affecting the urothelium and renal parenchyma, which are traits of acute pyelonephritis. These results indicate that acidic pH could increase the pathogenicity of E. coli and K. pneumoniae in murine models of lower UTI, promoting renal infection and acute inflammation.

Exploring bacterial profiles and antibiotic susceptibility patterns in urinary tract infection cases at Idlib university hospital, Syria

The main objective of this study was to identify, analyze, and evaluate the bacteriological profile and antimicrobial susceptibility patterns of symptomatic urinary tract infections (UTIs) among patients at Idlib University Hospital in Northwest Syria. By isolating and characterizing the uropathogens, the study aimed to gain insights into their current antimicrobial susceptibilities. This information is crucial in order to combat the increasing antibiotic resistance and provide effective treatment options for UTIs, which are prevalent both in the community and hospital settings.This observational research took place at Idlib University Hospital in Northwest Syria spanning from June 2022 to December 2023. Our study involved 320 patients exhibiting symptoms of UTI (68.4% females and 31.6% males). Urine samples were cultured to identify the microorganisms responsible for UTI. Biochemical tests were employed to identify the isolated bacteria, while the antimicrobial susceptibility was determined through disk diffusion susceptibility testing. Our study found to be the leading cause of UTIs, accounting for 58.4% of cases, followed by spp. Gram-negative bacteria comprised 85% of isolated strains. The 13–65 age group showed the highest UTI susceptibility (41.3%). High resistance was observed to ampicillin/sulbactam, cefotaxime, ceftriaxone, and co-trimoxazole. Conversely, minimal resistance was noted against Meropenem, Imipenem, Gentamicin, and Levofloxacin.This research highlights the prevalence of antibiotic-resistant infections within the hospital under study. Hence, there is an imperative to enhance the efficiency of comprehensive infection control initiatives to effectively handle and regulate hospital-acquired infections caused by highly resistant microorganisms.

A Concise Overview on Urinary Tract Infection (UTI) includes Microbial agents, Predisposing factors, Antibiotic Resistance and Antibiotic Stewardship.

Introduction: Urinary tract infections (UTI) are the second most common infectious disease affecting more than 150 million people globally annually.Most predominant cause of UTI is UropathogenicE. coli (UPEC) associated with antimicrobial resistance.

Impact of the COVID-19 pandemic on extended-spectrum β-lactamase producing Escherichia coli in urinary tract and blood stream infections: results from a nationwide surveillance network, Finland, 2018 to 2022

BackgroundBefore the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum β-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen.MethodsSusceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018–2019), during (2020–2021), and after (2022) the pandemic and stratified these by age groups and sex.ResultsThe annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018–2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018–2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years.ConclusionsThe reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.

Pangenome Analysis Reveals Novel Contact-Dependent Growth Inhibition System and Phenazine Biosynthesis Operons in Proteus mirabilis BL95 That Are Located in An Integrative and Conjugative Element.

Proteus mirabilis is a leading cause of urinary tract infections and a common commensal of the gastrointestinal tract. Our recent study (JB) showed that P. mirabilis strain BL95 employs a novel contact-dependent killing system against enteric bacteria in the mouse gut and in vitro. To uncover the genetic determinants of this system, we performed whole-genome sequencing of BL95 and compared it with 98 complete genomes of P. mirabilis. BL95 carries 56 coding sequences (CDSs) not found in other P. mirabilis. Over half of these unique genes are located on a novel integrative conjugative element (ICE) named ICEPm2, inserted in tRNA-Phe and exclusive to BL95. ICEPm2 has integration, conjugation, and DNA replication modules nearly identical to ICEPm1 (common in P. mirabilis), but ICEPm2 of BL95 carries two unique operons for P. mirabilis-a phenazine biosynthesis and a contact-dependent growth inhibition (CDI) system. ICEPm2 is absent in the P. mirabilis (AR_0156) closest to BL95 and it is present in the genomes of several Escherichia coli from mouse intestines, indicating its recent horizontal mobilization. BL95 shares over 100 genes of five different secretion systems with other P. mirabilis, mostly poorly studied, making a large pool of candidate genes for the contact-dependent growth inhibition.

Metabolic flux regulates growth transitions and antibiotic tolerance in uropathogenic Escherichia coli.

Uropathogenic Escherichia coli (UPEC) are the leading cause of urinary tract infections (UTIs). Upon invasion into bladder epithelial cells, UPEC establish quiescent intracellular reservoirs that may lead to antibiotic tolerance and recurrent UTIs. Here, we demonstrate using an in vitro system that quiescent UPEC cells are tolerant to ampicillin and have decreased metabolism characterized by succinyl-CoA limitation. We identify the global regulator integration host factor complex and the cell division protein ZapE as critical modifiers of quiescence and antibiotic tolerance. Finally, we show that ZapE interacts with components of both the cell division machinery and the tricarboxylic acid cycle, and this interaction is conserved in non-pathogenic E. coli, establishing a novel link between cell division and metabolism.

Prevalence and Antimicrobial Resistance Pattern of Uropathogenic Escherichia coli at a Tertiary Care Hospital: A Retrospective Study

Background: Uropathogenic Escherichia coli (UPEC) is the most common cause of urinary tract infection in humans including cystitis and pyelonephritis. Antimicrobial resistance (AMR) in UPEC is one of the global public challenges that is due to prevalent use of antibiotics in healthcare setting. Therefore, the purpose of this study is to investigate the frequency and antibiotic resistance pattern of UPEC isolated from patients admitted to Modares Hospital in Saveh, Iran. Methods: In this study, in total 633 isolates were evaluated. UPEC isolates were obtained from patients with urinary tract infection and identified using conventional microbiological protocols. Antibiotic resistance pattern of UPEC against different antibiotic were determined using disk diffusion method. SPSSTM software was used for statistical analysis Results: In this study, the most sample was related to outpatients and the lowest sample was related to the CCU wards. The highest antibiotic resistance showed against cephalothin (63.8%) and nalidixic acid (62.2%) antibiotics. The highest effective antibiotics for the tested UPEC was nitrofurantoin (90.7%) and gentamicin (77.3%). Cephalothin and nalidixic acid in hospitalized patients in ICU and emergency wards, respectively, showed the highest antibiotic resistance. Out of 633 UPEC, the rate of Multi Drug Resistant (MDR) isolates were 343 (54.2%). Conclusion: The result of this study highlighted the role of UPEC as one of the important cause of UTI in individuals. Also, nitrofurantoin then gentamicin are the most effective antibiotics against UPEC infections. Logical prescription of antibiotics and infection control strategies are needed for prevention and control of nosocomial infections especially urinary tract infection.

Multidrug resistance of uropathogens as a risk factor in providing medical care to patients from central Bulgaria

The emergence of resistance to multiple antimicrobial agents in uropathogenic bacteria has become a significant public health problem. These microorganisms are the cause of urinary tract infections, which are among the most frequently treated diseases in the outpatient medical care. A cross-sectional study was conducted among 353 outpatients over 18 years of age with positive urine sample culture. It involved measuring the index of multiple antibiotic resistance of uropathogens causing infections among individuals. The research was conducted in the period January – June 2023 at a private clinical laboratory center located in Stara Zagora, Bulgaria. One third of the isolates of E. coli and more than a half of those of Klebsiella pneumoniae had a measured MAR index greater than 0.2, with confirmatory high rates of resistance to aminopenicillins and cephalosporins. Alarmingly high MARI values were measured in all representatives of Enterococcus faecalis, Enterobacter species and Pseudomonas aeruginosa. These strains were also established to have high levels of resistance (varying from 58.3 to 100 %) to some of antimicrobial medicines most commonly prescribed in the outpatient healthcare. Findings of this study emphasize the importance and seriousness of the existing problem with the increasing prevalence of uropathogenic microorganisms with multiple resistance to oral antibiotics. This creates elevated risks of failure to provide effective treatment for patients.

Bioinformatics analysis of clinical isolates of Escherichia coli from Nigeria and other countries for quinolone and fluoroquinolone resistance

Quinolones were the drugs of choice for the treatment of bacterial infections, especially, infections caused by Gram negative bacteria. Unfortunately, these drugs have been resisted by the microbial agents including Escherichia coli, known to be the leading cause of Urinary Tract Infection (UTI) globally. This study therefore was aimed at detecting all the genes involved in Quinolone resistance by the E. coli pathogen isolated from Nigeria and from other geographical regions, using robust techniques. Twenty-three sequence data files of Escherichia coli from various countries of the world were retrieved from the National Centre for biotechnology Information (NCBI) database and sent for genome assembly for processing of the short reads into long reads. The outcome was config. fasta files which were comprehensively annotated and characterized for genetic functions and mechanisms. A total of 208 antibiotic resistance genes were detected, out of which 27(13.0%) were linked to quinolone resistance and 14(6.7%) to multi- drug resistance. The result of this study significantly implicated many genes in quinolone resistance; notably were the efflux pump genes and their high percentage abundance. We recommend in-depth study of the genes for their expression capabilities, also the structure and features of the efflux pump genes to enable proper redesigning of drugs by integrating anti efflux pump substances that will selectively prevent the expression of the genes for antibiotic resistance, without any harm to the host, or that can destabilize the positive regulation of the operon for antibiotic resistance.

Product evaluation of the Luja Micro-hole Zone Technology in clean intermittent self-catheterisation.

Clean intermittent self-catheterisation is a common procedure undertaken by people with bladder dysfunction. However, it is not without its complications, the main one being urinary tract infection. The most common causes of urinary tract infections are poor hygiene, technique and adherence, excessive post-void residual urine and bladder trauma. A catheter with new Micro-hole Zone Technology has been developed, which can potentially improve bladder emptying and minimise these complications. A case study is used to illustrate its effects in practice.

Antimicrobial resistance and ESBL production in uropathogenic Escherichia coli: a systematic review and meta-analysis in Ethiopia.

Antimicrobial resistance (AMR) is a serious threat to global health systems. Escherichia coli is a major cause of urinary tract infections (UTIs). Understanding the AMR patterns of uropathogenic E. coli (UPEC) is crucial for effective public health interventions worldwide. This systematic review and meta-analysis aimed to consolidate existing research and provide a comprehensive information on AMR UPEC in Ethiopia. We systematically searched databases such as PubMed, Web of Science, and Science Direct, along with including articles from Google Scholar. Data were extracted into Microsoft Excel and analysed using STATA 17.0. Cohen's kappa was computed to assess reviewer agreement, while the I2 statistic evaluated heterogeneity. Egger's tests were conducted to detect publication bias, and random-effects models were utilized to estimate the pooled resistance, with AMR rates for each antibiotic pooled separately. UPEC showed resistance rates, ranging from 3.64% (95% CI: -4.38% to 11.67%) for amikacin to 85.32% (95% CI: 78.6%-92.04%) for ampicillin. Highest resistance was to ampicillin (85.32%), followed by amoxicillin at 82.52% (95% CI: 74.3%-90.74%), tetracycline at 60.67% (95% CI: 51.53%-69.81%) and trimethoprim/sulfamethoxazole at 57.17% (95% CI: 49.93%-64.42%). Conversely, resistance rates were lower for amikacin at 3.64% and meropenem at 5.26% (95% CI: 2.64%-7.88%). UPEC demonstrated a pooled MDR rate of 79.17% (95% CI: 70.32%-88.01%) and a pooled ESBL production rate of 29.16% (95% CI: 22.36%-38.55%). High levels of AMR were observed in UPEC strains, highlighting a critical public health issue requiring urgent action through robust antimicrobial stewardship and surveillance to preserve effective UTI treatment options.

Prevalent Bacterial Etiologies of Urinary Tract Infections in Febrile Children Under Five Years of at Federal Medical Centre, Owerri, Imo State, Nigeria

Urinary Tract Infections (UTIs) in children under five years old pose a significant health concern, influenced by various factors like bacterial agents, anatomy, immunity, and genetics. The study aimed to identify prevalent bacterial causes of UTIs in febrile children under five at a medical center in Nigeria. Among 170 participants, E. coli was the most frequently isolated bacteria (37.5%), followed by Klebsiella spp (18.8%) and Staphylococcus aureus (15.6%). The research underscores E. coli as the primary uropathogen, aligning with global trends, while acknowledging local variations in UTI causative agents. Keywords: Urinary Tract Infections, Febrile Children, Bacterial Etiologies and Pediatric UTI.

Plant phenolics inhibit focal adhesion kinase and suppress host cell invasion by uropathogenic Escherichia coli.

Traditional folk treatments for the prevention and management of urinary tract infections (UTIs) and other infectious diseases often include plants and plant extracts that are rich in phenolic compounds. These have been ascribed a variety of activities, including inhibition of bacterial interactions with host cells. Here, we tested a panel of four well-studied phenolic compounds-caffeic acid phenethyl ester (CAPE), resveratrol, catechin, and epigallocatechin gallate-for the effects on host cell adherence and invasion by uropathogenic Escherichia coli (UPEC). These bacteria, which are the leading cause of UTIs, can bind and subsequently invade bladder epithelial cells via an actin-dependent process. Intracellular UPEC reservoirs within the bladder are often protected from antibiotics and host defenses and likely contribute to the development of chronic and recurrent infections. In cell culture-based assays, only resveratrol had a notable negative effect on UPEC adherence to bladder cells. However, both CAPE and resveratrol significantly inhibited UPEC entry into the host cells, coordinate with attenuated phosphorylation of the host actin regulator Focal Adhesion Kinase (FAK or PTK2) and marked increases in the numbers of focal adhesion structures. We further show that the intravesical delivery of resveratrol inhibits UPEC infiltration of the bladder mucosa in a murine UTI model and that resveratrol and CAPE can disrupt the ability of other invasive pathogens to enter host cells. Together, these results highlight the therapeutic potential of molecules like CAPE and resveratrol, which could be used to augment antibiotic treatments by restricting pathogen access to protective intracellular niches.IMPORTANCEUrinary tract infections (UTIs) are exceptionally common and increasingly difficult to treat due to the ongoing rise and spread of antibiotic-resistant pathogens. Furthermore, the primary cause of UTIs, uropathogenic Escherichia coli (UPEC), can avoid antibiotic exposure and many host defenses by invading the epithelial cells that line the bladder surface. Here, we identified two plant-derived phenolic compounds that disrupt activation of the host machinery needed for UPEC entry into bladder cells. One of these compounds, resveratrol, effectively inhibited UPEC invasion of the bladder mucosa in a mouse UTI model, and both phenolic compounds significantly reduced host cell entry by other invasive pathogens. These findings suggest that select phenolic compounds could be used to supplement existing antibacterial therapeutics by denying uropathogens shelter within host cells and tissues and help explain some of the benefits attributed to traditional plant-based medicines.

Antibiotic Profiling of E. coli Borne UTI Infection in Tertiary Healthcare Settings.

Introduction In general, with frequent recurrence of urinary tract infections (UTIs), long-term antibiotic therapy is stipulated at a low dose. With this type of situation and with easy access to several classes of antibiotics in tertiary health care settings, the use of such drugs results in the development of resistant bacteria in patients.Escherichia coliis a frequent cause of UTI observed. Hence, it was proposed in the present study to assess the antimicrobial resistance status ofE. coliin UTI-infected patients. Methods This study was conducted among female patients diagnosed with UTI.About 80 urine samples were collected in an aseptic condition, Under the process of culture identification 44 samples were found to be positive for UTI infection. The positive samples were plated on blood agar. Out of 44 samples, 18 samples were found to be positive, and 26 samples were negative for E. coli infection. The 18 samples were screened on MALDI-TOF for identification. Further, the samples were assessed for susceptibility to antibiotic medication within the study area. Result The study identified different strains ofE. coli,and the CHB geneE. coli wasfound in eight samples. The sample showed pink oval-round spots in the culture medium and was resistant to nitrofurantoin, cephalosporin, and cephalexin antibiotics. Hence, antimicrobial susceptibility tests arenecessaryfor managing and treating bacterialE. coliinfections. Conclusion E. coliis a common bacterium found in the vaginal region of patients, suggesting a potential infection.E. colican be associated with UTIs in women. The results from this study conclude thatE. coliis rapidly becoming multidrug-resistant, as only higher antibiotics can inhibit its growth. To effectively manage infections caused byE. coliproper diagnosis, laboratory testing, and antibiotic treatment are required.

Antibiotic Resistance of Uropathogenic Escherichia coli (UPEC) among Iranian Pediatrics: A Systematic Review and Meta-Analysis.

Uropathogenic Escherichia coli is a major cause of urinary tract infections (UTIs). This systematic review and meta-analysis was conducted to determine the prevalence of antibiotic-resistant uropathogenic E. coli among Iranian children with confirmed bacterial UTIs from 2012 to 2022. A systematic review was performed by searching PubMed, Scopus, Google Scholar, Web of Science, MagIran, Iranian Scientific Information Database, IranMedex, and Iranian Research Institute for Information Science and Technology. The antibiotic-specific pooled prevalence estimates were calculated by applying a random-effects model. Freeman-Tukey Double Arcsine transformation was applied. I-squared statistic, and Cochran's Q test were computed and meta-regression was conducted on latitude of sampling location. The literature search retrieved 2159 articles, among which 19 articles were included. The highest antibiotic resistance was related to doxycycline, ticarcillin-clavulanic acid, cefazolin, cefuroxime, and amoxycillin-clavulanic acid, 59%, 57%, 54%, 53%, and 52%, respectively. Meta-regression on the latitude was statistically significant for nitrofurantoin (P=0.05). Resistant uropathogenic Escherichia coli strains were observed in the majority of confirmed bacterial UTIs among Iranian children. The most effective antibiotics for uropathogens were colistin, meropenem, and imipenem.

Identification of complex III, NQR, and SDH as primary bioenergetic enzymes during the stationary phase of Pseudomonas aeruginosa cultured in urine-like conditions.

Pseudomonas aeruginosa is a common cause of urinary tract infections by strains that are often multidrug resistant, representing a major challenge to the world's health care system. This microorganism has a highly adaptable metabolism that allows it to colonize many environments, including the urinary tract. In this work, we have characterized the metabolic strategies used by stationary phase P. aeruginosa cells cultivated in urine-like media to understand the adaptations used by this microorganism to survive and produce disease. Our proteomics results show that cells rely on the Entner-Duodoroff pathway, pentose phosphate pathway, the Krebs cycle/ glyoxylate shunt and the aerobic oxidative phosphorylation to survive in urine-like media and other conditions. A deep characterization of the oxidative phosphorylation showed that the respiratory rate of stationary phase cells is increased 3-4 times compared to cells in the logarithmic phase of growth, indicating that the aerobic metabolism plays critical roles in the stationary phase of cells grown in urine like media. Moreover, the data show that respiratory complex III, succinate dehydrogenase and the NADH dehydrogenase NQR have important functions and could be used as targets to develop new antibiotics against this bacterium.

Combined functional genomic and metabolomic approaches identify new genes required for growth in human urine by multidrug-resistant Escherichia coli ST131.

Uropathogenic Escherichia coli (UPEC) cause ~80% of all urinary tract infections (UTIs), with increasing rates of antibiotic resistance presenting an urgent threat to effective treatment. To cause infection, UPEC must grow efficiently in human urine (HU), necessitating a need to understand mechanisms that promote its adaptation and survival in this nutrient-limited environment. Here, we used a combination of functional genomic and metabolomic techniques and identified roles for the metabolism of small peptides, amino acids, nucleotides, and L-lactate, as well as the stringent response pathway, lipopolysaccharide biosynthesis, and fluoride resistance, for UPEC growth in HU. We further demonstrated that pathways involving nucleotide metabolism and the stringent response are required for UPEC colonization of the mouse bladder. The UPEC genes and metabolic pathways identified in this study represent targets for the development of innovative therapeutics to prevent UPEC growth during human UTI, an urgent need given the rapidly rising rates of global antibiotic resistance.

Severe Bacterial Balanitis in Circumcised Adult Males

Balanitis is the inflammation of the glans penis while balanoposthitis involves both the glans penis and prepuce and occurs only in uncircumcised males. Balanitis is more common in uncircumcised males due to the occlusive effect of the foreskin, which facilitates smegma retention and bacterial and fungal overgrowth. Therefore, balanitis is rare after circumcision and severe balanitis is even rarer. In patients with recurrent balanoposthitis, circumcision is indicated, and the presence of diabetes should be ruled out. Diabetes mellitus is a frequent predisposing factor for Candida balanoposthitis and has been associated with male genital lichen sclerosus, which in progressive stages leads to phimosis. Circumcision is also indicated in the treatment of lichen sclerosus associated with phimosis. Candida albicans stands as the primary culprit in cases of acute infectious balanoposthitis, with aerobic bacteria constituting the second most common etiological factor. Among these bacteria, streptococci particularly groups B and D and staphylococci, notably S. aureus, are prevalent. Mixed infections may also occur. The typical clinical manifestations involve erythema and oedema accompanied by itching and/or pain. In instances of painful, erosive streptococcal balanoposthitis, severe balanopreputial oedema with purulent exudate can be observed. Staphylococcus haemolyticus, a prominent member of the coagulase-negative staphylococci of the skin microbiota, causes infections in the male urogenital tract, such as urinary tract infections, chronic prostatitis and epididymo-orchitis. However, it had not been associated with balanitis. Enterococcus faecalis is part of the normal gastrointestinal microflora and is also a frequent cause of urinary tract infections and of chronic prostatitis. Enterococcus has been associated with mild balanoposthitis in adults and E. faecalis has been described to cause balanoposthitis in young children, but its association with severe balanitis .....

Deep-learning-based diagnosis and grading of vesicoureteral reflux: A novel approach for improved clinical decision-making

Background/Aim: Vesicoureteral reflux (VUR) is a condition that causes urine to flow in reverse, from the bladder back into the ureters and occasionally into the kidneys. It becomes a vital cause of urinary tract infections. Conventionally, VUR’s severity is evaluated through imaging via voiding cystourethrography (VCUG). However, there is an unresolved debate regarding the precise timing and type of surgery required, making it crucial to classify VUR grades uniformly and accurately. This study’s primary purpose is to leverage machine learning, particularly convolutional neural network (CNN), to effectively identify and classify VUR in VCUG images. The aspiration is to diminish classification discrepancies between different observers and to create an accessible tool for healthcare practitioners. Methods: We utilized a dataset of 59 VCUG images with diagnosed VUR sourced from OpenI. These images were independently classified by two seasoned urologists according to the International Reflux Classification System. We utilized TensorFlow, Keras, and Jupyter Notebook for data preparation, segmentation, and model building. The CNN Inception V3 was employed for transfer learning, while data augmentation was used to improve the model’s resilience. Results: The deep-learning model attained exceptional accuracy rates of 95% and 100% in validation and training, respectively, after six cycles. It effectively categorized VUR grades corresponding to the global classification system. Matplotlib tracked loss and accuracy values, while Python-based statistical analysis assessed the model’s performance using the F1-score. Conclusion: The study’s model effectively categorized images, including those of vesicoureteral reflux, which has significant implications for treatment decisions. The application of this artificial intelligence model may help reduce interobserver bias. Additionally, it could offer an objective method for surgical planning and treatment outcomes.

DERMATITIS ARTEFACTA WITH Proteus mirabilis INFECTION IN COINCIDENCE WITH PYODERMA GANGRENOSUM IN SCHIZOPHRENIC PATIENT

Dermatitis artefacta (DA) is a psychiatric disorder with secondary manifestations on the skin. One of the most common skin lesions in DA is chronic ulcer which also can be caused by pyoderma gangrenosum (PG). There are some bacteria found in chronic ulcer such as Proteus mirabilis. A forty-one years old female with chronic wounds on her chest and left leg. Based on history taking of present illness, physical examinations, laboratory tests and histopathology of the skin lesions, the patient was diagnosed with DA and PG. She was also diagnosed with schizophrenia catatonic type. Chest x-ray showed pneumonia while the swab culture showed growth of Proteus mirbabilis. She was given an oral cefadroxile 500 mg three times daily, cetirizine 10 mg once daily, wound dressing and gentamycin ointment twice daily. She also received oral risperidone 0.5 mg twice daily combined with behavioral therapy from Psychiatric Outpatientclinic. Dermatitis artefacta is a psychocutaneous disorder with uncommon morphology. The most common psychological condition related to DA is schicophrenia. There are some specific histopathology features of DA such as dominant destruction of epidermal layer, multinucleated epidermal keratinocytes or destruction of keratinocytes. Chronic ulcers in DA might be mimicking with PG, which is a chronic recidive neutrophilic dermatoses. Proteus mirabilis is one of the most common causes of urinary tract infection, meanwhile it can also cause chronic ulcers and respiratory tract infection as pneumonia.