Passage Of Urine Research Articles

Gender, gestation, and birthweight-based differences in the timing of passage of first urine and meconium in neonates: A prospective observational study

ABSTRACT Introduction: The cut-off for referral to a higher center and further investigations for the delayed passage of first urine and meconium by a neonate have been traditionally kept after 48 hours of birth. There are very few studies regarding this in Indian neonates, and previous studies have relied primarily on the mother’s recall of the event which may have led to recall bias. Therefore, through this study, we wanted to use hospital intake/output records to identify the risk factors that affect the timing of passage of first urine and stool in neonates delivered at our center and to find out if the cut-off of 48 hours to call it a delay is justifiable. Methodology: This was a single-center, prospective observational study conducted in Eastern India. After obtaining ethics committee approval, the eligible neonates delivered at the center were prospectively enrolled between June 2020 to December 2022. The timing of passage of first urine and meconium was noted using 3 hourly collected information from the input/output charts maintained by the nursing staff in the postnatal wards. The median time of passage of first urine and meconium was compared across gender, gestation, and birth weight. To find the factors associated independently with delayed passage of meconium, multivariable logistic regression was used. Result: A total of 330 neonates were enrolled prospectively in the study. Approximately two-thirds of them passed first urine (69.7%) and meconium (62.7%) within 6 hours after delivery. The median and interquartile range (IQR) of the time of passage of the first urine was 4 (1-7) hours of life. This did not vary significantly for gender, gestation, and birthweight categories. The median (IQR) of time of passage of meconium was 4 (1-8) hours of life, which was significantly higher for male [5 (2-8.5), (P = 0.029)] and preterm neonates [6.3 (2.5-12), (P = 0.001)], but did not vary significantly for birthweight categories. On multivariable logistic regression, twin gestation [OR 4.15 (95% CI 1.09-15.76); P = 0.036] and preterm birth [OR 2.97 (95% CI 1.18-7.43); P = 0.02] increased the odds of passage of meconium beyond 12 hours’ postnatal age. 99.39% and 98.77% of the neonates passed urine and meconium respectively within 24 hours. Conclusion: The median time of passage of first urine was not influenced by gender, gestation at birth, and birthweight categories. The median time of passage of meconium was significantly higher for male and preterm neonates. Also, with early initiation of direct breastfeeding and good feeding support most neonates pass their first urine and stool by 24 hours of life. So, maybe it’s time to revise the cut-off for referrals or investigations from 48 hours to 24 hours of life. However, further studies with larger sample sizes will be required to confirm this cut-off.

Right Orchiopexy to Correct Undescended Testicle and Circumcision to Correct Phimosis

Cryptorchidism is a condition in which one or both testicles fail to descend to its normal position in the scrotum. The testicle may reside in the retroperineum, in the internal inguinal ring, in the inguinal canal, or even at the external ring. The exact cause is unknown but several risk factors have been linked to this condition such as premature birth, low birth weight, family history, Down syndrome, alcohol use, and cigarette smoking. Undescended testis occurs in approximately 30% of preterm infants and 1-3% of term infants. Diagnosis is made during examination at birth or shortly thereafter, and timely recognition and management of this condition prevents adverse consequences. The goal of treatment is to relocate the undescended testicle to its proper location in the scrotum. Treatment before 1 year of age lowers the risk of complications such as infertility, testicular cancer, inguinal hernia, and testicular torsion. Treatment can be hormonal, surgical or a combination of both. Hormones such as hCG can sometimes induce descent of the testicle; however, surgery is the preferred option. Orchiopexy is the surgical procedure to free an undescended testicle and implant it in the scrotum. Phimosis is the inability to retract the foreskin covering the glans of the penis. It may appear as a tight ring of the foreskin around the tip of the penis preventing full retraction. Phimosis can be physiologic or pathologic. Physiologic phimosis is seen in children born with tight foreskin at birth and separation occurs naturally overtime while pathologic phimosis is caused by scarring, infection or inflammation. A tight foreskin can interfere with the passage of urine as seen as ballooning of the foreskin during urination. This can lead to inflammation of the penis called balanitis or inflammation of the penis and foreskin called balanoposthitis. Physiologic phimosis does not require intervention and will resolve with daily gentle retraction while pathologic phimosis is treated with topical steroid cream or circumcision. Here we present the case of a young male with an undescended right testicle and phimosis. The right testicle was located in the right inguinal area and was brought down into the scrotum. Circumcision was also done to resolve the phimosis.

The Onerous task of managing paroxysmal nocturnal hemoglobinuria in a Low resource setting: a case report. A hematologist’s experience

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is a form of red cell membrane defect characterized by increased sensitivity to complement-mediated cell lysis, resulting in intravascular hemolytic anemia, passage of hemoglobin-containing urine, a high risk of venous thrombosis and progression to pancytopenia.The diagnosis of PNH is based on the flow cytometric (FCM) detection of peripheral blood cell clones. Such clones lack expression of the surface molecules linked to the glycosylphosphatidylinositol (GPI) anchors. The underlying defect is a somatic mutation of the short arm of the phosphatidylinositol glycan class A gene (PIG-A). Case report: We report a case of a 34-year-old male, with recurrent hemolytic anemia and dural venous sinus thrombosis found to have PNH by flow cytometry. He is currently on anticoagulation, iron and folate supplements, intermittent steroids for hemolytic episodes as we await complement inhibitors. Conclusion: As part of the diagnostic workup for patients presenting with recurrent hemolytic anemia and thrombosis in unusual sites, clinicians should include PNH on the list of differential diagnoses. Effort should be taken to characterize the red urine reported on the urine dipstick as blood/hemoglobin by microscopy to differentiate hematuria and hemoglobinuria and order for flow cytometry as this has implications on patient management. Keywords: Thrombosis; hemolysis; complement; paroxysmal nocturia; hemoglobinuria.

Beyond the womb: pontine hemorrhage’s impact on maternal and fetal outcomes: a case report from Nepal

Introduction: Strokes cause 37% of cardiovascular-related deaths in women, with 40% during delivery and 50% postpartum. Pontine hemorrhage, a rare cerebrovascular disease, can occur during pregnancy and postpartum, requiring complex diagnosis and management. Case presentation: A 33-year-old primipara female presented with headache, vomiting, and altered consciousness at 15 weeks and 5 days gestation. She had no history of head trauma, involuntary urine passage, cough, shortness of breath, palpitation, or per vaginal bleeding. Psychiatric and neurology consultations were conducted to address her symptoms. Discussion: Pontine hemorrhage is a rare condition affecting pregnant women, causing mild symptoms like vertigo, ataxia, and dysphagia. Our patient underwent an initial blood investigation with imaging of her brain (CT and MRI) to establish the diagnosis of pontine hemorrhage. It is believed to be caused by hormonal fluctuations, but studies have not proven it. Stroke during pregnancy is rare, with only 10% occurring during the antepartum period. Diagnosis requires a multidisciplinary approach with history, clinical examination, and radiological imaging like CT and MRI. Treatment involved antiplatelet therapy, which ensured favorable maternal and fetal outcomes for our patient. Conclusion: In summary, this case demonstrates the rare incidence of pontine hemorrhage during pregnancy. It highlights the diagnostic challenges and successful treatment with antiplatelet therapy, emphasizing the necessity for a comprehensive approach to ensure favorable maternal and fetal outcomes.

Epispadias, a correctable cause of structural infertility in a middle-aged man: a case report

BackgroundEpispadias is a rare form of genito-urinary congenital anomaly and presentation in the middle-ages is even rarer. The reproductive outcome of treatment which was almost immediate, highlights the life changing effect of appropriate treatment for this condition in a middle-aged patient. We hereby report this rare case of a middle-aged man presenting with complete male epispadias with background infertility and the outcome of effective treatment. (Reviewer #1. Comment 1).Case presentationOur patient is a 54-year-old security guard who presented to our facility in February 2022 (Reviewer #1. Comment 3) with passage of urine from an abnormal opening since birth. Examination revealed a middle-aged man having ammoniacal smell. He had a spade like glans penis, ventral hooding, urethral meatus at the root of the penis dorsally with no chordee. He was diagnosed to have complete male epispadias (CME) for which he eventually had a modified Cantwell–Ransley procedure under general anaesthesia. About 3 months after the procedure, patient was able to impregnate his wife, a feat he will be achieving for the first time in his life.ConclusionsThe right treatment irrespective of age at presentation could significantly improve the quality of life of patients as evidenced by our patient whom after surgery was able to impregnate his wife for the first time at 54 years of age.

Acute disseminated encephalomyelitis in a five-year-old girl: a case report

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating central nervous system disorder with a predilection to early childhood. ADEM is generally considered a monophasic disease. However, recurrence has been described and defined as multiphasic disseminated encephalomyelitis (MDEM). ADEM often occurs after infection or immunization and is clinically defined as acute polyfocal neurological deficits, including encephalopathy. Many times, ADEM is a diagnosis of exclusion, and early diagnosis and treatment are the keys to favorable outcomes. Magnetic resonance imaging (MRI) typically demonstrates reversible, large, ill-defined white matter lesions of the brain and often also the spinal cord, along with frequent involvement of thalami and basal ganglia. CSF analysis may reveal mild pleocytosis and elevated protein but is generally negative for intrathecal oligoclonal bands. We report a case of five years six-month- old girl who presented with fever, vomiting, headache, and cough for seven days. She had one episode of involuntary passage of urine. The child was lethargic at presentation and was unable to stand or walk. Clinical features and investigations, including MRI brain and spine, were suggestive of ADEM. She was started on Inj. Methylprednisolone followed by oral prednisolone in tapering dose for four weeks. Clinical improvement was seen in the form of improvement in activity and power in limbs. The child improved with normal neurological function on day three of inj methylprednisolone. On follow-up for six months, the child did not have any relapse and had complete neurological and radiological recovery.

Thermal transport characteristics of fluid-particle suspension in a vertical uniform tube: A computational study on Rabinowitsch fluid with uniform heat source

Problem statement The thermal transport of fluid-particle suspension in Rabinowitsch fluid is discussed theoretically in a vertical uniform tube under the consideration of a uniform heat source. Methodology The fluid and particle phase models are used to develop the mathematical model in the form of partial differential equations which are solved through the symbolic software MATHEMATICA version 12.0 and present the exact solution of temperature distribution, velocity of fluid and particle phases, wall shear stress, pressure gradient, pressure rise, and stream function, etc. Computational results and findings The volume fraction density of the particles slows down the motion of the fluid particles. The velocity of Newtonian fluid is maximum as compared to pseudo-plastic and Dilatant fluids. The fluid phase velocity is superior to particle phase velocity distribution for all pertinent parameters of the analysis. The pressure rise increases in the case of Newtonian and pseudo plastic fluid and decreases in Dilatant fluid. The trapping phenomena are strongly associated with the volume fraction density of the particle. The shear stress shows a decreasing trend against the volume fraction density of the particles, Grashoff number, and heat source parameter. Special case The current fluid model (Rabinowitsch fluid) can be reduced in Newtonian, pseudo plastic, and Dilatant fluid for taking κ → 0 , κ < 0 , and κ > 0 , respectively. Applications The current analysis can be useful in biomedical engineering to observe the blood supply through the arteries, the removal of kidney stones, and also the passage of urine to the bladder from the ureter. Originality The present research is original and has not been published before.

ROLE OF MADANPHALA IN MANAGEMENT OF MUSHIKA VISHA - A REVIEW ARTICLE

An ingredient that is used in various formulations in the treatment of Vishas (poisons). Many formulations for the management of various poisons like snake bite, keetavisha (insect poisons), etc. have been explained in Ayurveda treatise that contains it as an ingredient.in the present article we are discussing regarding the Madanphala and ghrita of Tanduliyaka in management of Mushika visha. Madanphala is having properties of Laghu, Ruksha Guna, Kashaya, Katu, Tikta Rasa and Ushna Veerya. It acts as a Vranashodhan and Ropan properties. Paste of Madanphala applied over skin and wounds helps in Vranashodhan therefore used in the Mushika visha effectively. Tanduliya (Amaranthus spinosus) prepared in the form of Ghrita (Ghee) is said to reduce the bastivedana (pain in urinary system) and anaha (Distension of abdomen due to obstruction to passage of urine and stools) in the complications caused because of visha

Case Report: Intrahepatic cholestasis: a diagnostic dilemma

Cholestasis is an impairment of bile formation or bile flow. The mechanisms of cholestasis can be broadly classified into intrahepatic and extrahepatic. Most of the time, etiology can be determined with proper history, physical examination, and diagnostic testing including laboratory and imaging tests. This is a case report of a patient with severe cholestasis who underwent extensive evaluation to determine the etiology of intrahepatic cholestasis. This Case Report details a 28-year-old male who presented with seven days’ history of yellowish discoloration of eyes, the passage of dark-colored urine, generalized body itching, and the passage of clay-colored stool. The patient had no similar episode in the past. Laboratory investigations showed unconjugated hyperbilirubinemia and increased alkaline phosphatase. Magnetic resonance cholangiopancreaticography was unremarkable and liver biopsy was suggestive of cholestatic pattern and negative for acute hepatitis. The bilirubin level started decreasing after a month. The etiology of intrahepatic cholestasis remained unknown. Genotyping could not be done due to limited available resources. It may have helped to diagnose familial hepatocellular cholestasis such as benign recurrent intrahepatic cholestasis (BRIC) and progressive familial intrahepatic cholestasis. Gamma-glutamyl transferase is normal or mildly elevated in patients with BRIC. A similar picture was seen in our case as well. If the patient presents again with similar symptoms and findings, we can consider the diagnosis of BRIC.

Redo Surgeries in Anorectal Malformations: A Single-center Experience.

Complications following posterior sagittal anorectoplasty (PSARP) for ARM are well known. In this article, we present our experience of managing five patients who required major redo surgeries for complications resulting from previous attempts to correct ARM. We reviewed all patients who underwent major redo surgeries in our hospital for complications from previous repairs for ARM, from June 2013 to June 2019. Data was obtained from hospital records and analysed. Five patients whose ages ranged from 5 months to 14 years were included in the study. Four were boys and 1 was a girl. All patients had undergone PSARP in other hospitals. The presentations were retained distal bowel causing urinary retention and constipation (n=1), pulled through proximal urethra and bladder neck presenting as passage of urine from neo-anus (n=1), retained common channel (of cloaca) causing a 'H' type configuration (n=1), mispositioned neo-anus (n=1) following a primary PSARP and lastly undivided recto-urethral fistula causing fecaluria (n=1). All of them underwent redo repairs by posterior sagittal approach with documented improvement in their symptoms. Two of them required total bowel management to remain clean. All the complications reported here have been described in literature nevertheless, this report will add to the body of experience. Posterior sagittal approach (PSA) has proved to be very successful technique in correcting these complications.

Complicated supravesical obstruction in patients with urolithiasis: multifactorial analysis of risk factors

Introduction. Urolithiasis (UL) is a common disease observed in a huge number of people around the world. Supravesical obstruction (SVO) is a less frequent but potentially dangerous phenomenon that occurs when the urinary tract is blocked above the bladder, often resulting in impaired urinary passage and requiring surgery in most cases.Objective. To determine the risk factors of complicated supravesical obstruction in patients with urolithiasis.Materials &amp; methods. We have conducted a retrospective study of diagnostic and treatment results of patients with SVO suffering from UL. Inclusion criteria: patients with established UL and SVO. Exclusion criteria: cancer and/or specific infection leading to SVO. From 2017 to 2019, 6250 patients with SVO were screened and treated at our centre. After assessing compliance with the inclusion and exclusion criteria, 1106 patients were selected for the study. We studied the risk factors leading to complicated course of SVO.Results. We evaluated the risk factors for the development of complicated SVO in patients with UL. All results are presented by EXP(B), with a 95% confidence interval in square brackets: complex kidney stones — 5,326 [2,247 – 9,296], ureteral stones — 12,251 [7,256 – 21,226], double-sided stones — 7,256 [2,158 – 9,255], disease length — 4,324 [1,782 – 8,256], urinary tract infection — 19,258 [4,258 – 26,248], blood leukocytosis — 15,116 [3,985 – 21,256], high serum creatinine — 10,244 [5,269 – 16,254], high serum glucose — 5,226 [3,145 – 11,254].Conclusion. The results of the study suggest that blocking renal and ureteral stones, double-side stones, upper urinary tract infection, low creatinine clearance, diabetes mellitus and disease length are significant risk factors for complicated course of SVO.

Prevalence of nocturnal enuresis among children aged 05 to 10 years

Background: Enuresis is common and considered to be normal among children younger than 3 years of age. Nocturnal enuresis is involuntary passage of urine during sleep among children five years of age or older. It is not a serious health problem, and children usually develop control over the bladder as they grow older but it can be upsetting for children as well as parents. India estimates 7 to 15 % prevalence rate among children and the numbers drop to 3 to 5% by the age of ten years. Objectives were to identify the children with Nocturnal Enuresis and assess their clinical profile. Methods: A descriptive survey was conducted among the children age 05 to 10 years. Data were collected from two villages of Aurangabad district and the information was gathered from parents of 413 with the use of structured questionnaire. The first section included the socio- demographic characteristics of the children and their parents. The second section included variables related to the clinical profile and history of nocturnal enuresis in the family. Results: The prevalence of nocturnal enuresis was 10.91% in which 06.94% were males and 03.97% females. With regard to severity 55% children were found to be in moderate category while 09% belonged to severe category of nocturnal enuresis. Conclusions: The prevalence rate was higher in selected villages. Most of the parents consider nocturnal enuresis as social stigma. Counseling and education of parents would help in improving general health of children in rural area.

A Comparative Clinical Study to Evaluate the Effect of Haritakyadi Kwatha and Eladi Churna in the Management of Pittaj Mutrakrichha w.s.r. to Urinary Tract Infection

Mutrakrichha is a disorder of Mutravahastrotas, The term ‘Mutrakrichha’ means pain and difficulty during passage of urine. Vitiated Pitta and Pratiloma Gati of Apana Vayu are considered to be the two major factors for the pathogenesis of the disease “Mutrakrichha”. The symptoms of Pittaj Mutrakrichha such as Saruja/Krichha Mutrapravrutti (dysuria), Sarakta Mutrata (haematuria), Sadaha Mutrata (burning micturition), Muhurmuhu Mutrapravrutti (increased frequency or urgency of micturition) are coincide with the symptoms of lower urinary tract infection. Clinical presentation of Pittaj Mutrakṛichha shows close resemblance to UTI's as described in modern texts especially with lower urinary tract infections i.e., Urethritis and Cystitis. Globally UTI affect 150 million people worldwide annually. Urinary tract infection is a broad term that encompasses both asymptomatic microbial colonization of the urine and symptomatic infection with microbial invasion and inflammation of urinary tract. E.coli is the most common causative organism to cause UTI. 32 patients who were diagnosed with Pittaj Mutrakrichha w.s.r to urinary tract infection were allocated randomly into two groups. The trial drugs i.e., Haritakyadi Kwatha 50ml was given to 16 patients of group-I and Eladi Churna 3gm was given to 16 patients of group-II for duration of 4 weeks.

«Forgotten» encrusted ureteral stents

The article presents a rare clinical observation of patient S., 50 years old, a long-term sufferer of urolithiasis, who was admitted to the urological department of the hospital with a clinical picture of renal colic on the leſt side, exacerbation of chronic pyelonephritis. From the anamnesis: in 2021, internal stenting of both ureters was performed as indicated. Despite detailed recommendations at discharge, the patient did not consult doctors or take any medications until 2023. The examination revealed that the cause of exacerbation of chronic pyelonephritis and impaired urine outflow were encrusted (“forgotten”) stents in both ureters, in the leſt of which there was a concrement obstructing urine outflow. Ureteroscopy on the right side, stent fragments extraction; ureteroscopy on the leſt side, contact lithotripsy, removal of the encrusted ureteral stent; urinary passage and independent urination were restored. Despite technical difficulties during the surgical intervention, the postoperative period proceeded without complications.

Ethnobotanical Study of Plants Used in the Management of Benign Prostate Hyperplasia in Ilorin, Nigeria

Background: Benign Prostate Hyperplasia (BPH) is a prevalent illness in older men. It is a condition where the prostate becomes enlarged and blocks the ease of urine passage out of the bladder. Around 50% of the male population develops symptoms of BPH around 51- 60 years of age. Current therapeutic management options come with undesirable side effects like weight gain, dizziness, and impotence, hence, the need to source for safer alternatives initiated by the acquisition, recording, and preservation of traditional knowledge of medicinal plants.&#x0D; Objective: This study aims to preserve indigenous knowledge by documenting medicinal herbs in use as therapy for BPH.&#x0D; Materials &amp; method: Ethnobotanical survey was carried out in the study areas through interviews using a semistructured questionnaire. Respondents included elderly members of the communities, herbalists, and practitioners of traditional medicine. Quantitative ethnobotany index (Use value index) and descriptive statistics were used to analyse data.&#x0D; Results: 50 respondents were interviewed, 64% were Herb sellers, 22% TMPs, Others 14%. 37 plants belonging to 24 plant families were mentioned in the survey. Methods of preparation of recipes mentioned includes: maceration (37%), decoctions (52%), juice (7%), infusions and paste/powder (4%). Method of administration were majorly oral route. The plant family Fabaceae (19%) had the highest representation. This was followed by the families Annonaceae (8%), Euphorbiaceae (6%), Curcubitaceae, Menispermaceae, Combretaceae, Apocynaceae and Rutaceae with 5% each. Other plant families represented 42% of the total number of plants mentioned.&#x0D; Conclusion: The study areas are endowed with abundant flora which serves as a repository for researchers in the quest to develop less toxic drugs with little or no side-effect for the management of BPH

A 2-year-old boy with Glucose-6-Phosphate Dehydrogenase Deficiency Following Naphthalene Ingestion: a Case Report

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common hereditary enzyme disorder in the world and more than 400 million people have a deficiency in this enzyme. G6PD deficiency is an X-linked disorder, and one of its important signs is the presence of hemolytic anemia. It is a worldwide important cause of neonatal jaundice and causes life threatening hemolytic crisis in childhood. Here a 2- year- old boy was admitted into department of pediatrics of Sylhet Women’s Medical College Hospital with fever for 2 days &amp; passage of dark color urine for 1 day. There was history of accidental naphthalene ingestion present prior to develop symptoms. The boy was clinically febrile, severely pale, anicteric. No organomegaly was present. It was confirmed by G6PD level assay. Symptomatic &amp; supportive treatment was given with packed cell volume transfusion and avoidance of triggering factors was advised. Genetic counseling was also done.

Wax-Induced Episodic Hemolysis in a Patient with Co-Inheritance of Sickle Cell Anemia and G6PD Deficiency

Both sickle cell anemia (SCA) and glucose-6-phosphate dehydrogenase (G6PD) deficiency are common genetically transmitted disorders associated with hemolytic anemia, with a high prevalence in sub-Saharan Africa. Co-inheritance of both diseases has been reported in Nigeria where the prevalence of each disease is high. However, a high index of suspicion is needed to diagnose the co-existence of both disorders in the same individual. Here, we present an unusual case of a 32-year-old dentistry student who was known to have SCA since the age of one year. He presented with episodic exacerbation of jaundice and passage of dark-colored urine following skin and inhalational exposure to wax (polycyclic aromatic hydrocarbons) used for reconstructive dental practical sessions. After investigations, he was found to have G6PD deficiency. This report underscores the importance of screening for G6PD deficiency in male patients with SCA presenting with episodic symptoms of hemolysis.

Cross-fused dystopia of the right kidney with cystic dysplasia of the non-functioning left kidney associated with an ureterocele

Cross-dystopia is a rare type of congenital anomaly and is characterized by a displacement of the kidney to the opposite side; as a result, they are both located on the same side, and in approximately 85% of such cases, a fusion of the parenchyma of two kidneys can be observed. We have not found reports of cases in which a nonfunctioning orthotopic cystic dysplastic kidney associated with ureterovesical segment pathology (ureterocele) was fused with the lower pole of a cross-dystopian normally formed kidney in the literature. The patient, 8 days old, had a preliminary diagnosis of agenesis of the right kidney, doubling of the left kidney, cystic dysplasia, doubled left kidney with an ureterohydronephrosis in the lower half and ureterocele. To restore the urine outflow and function of the lower half of the presumably doubled left kidney, a cystourethroscopy was performed. In a typical place on the right, there was a correctly formed ureteral orifice, i.e., an ureterocele on the left, which occupies half of the bladder volume. With a holmium laser, an artificial orifice was formed in the ureterocele to restore the urine passage. At 9 months old, tomography urinary tract was performed, which revealed cross-dystopia of the right kidney with a fusion of the lower pole and a cystic dysplastic orthotopic left kidney. Laparoscopic nephroureterectomy of a non-functioning orthotopic kidney was performed.&#x0D; The control examination indicated complete clinical remission and social adaptation of the patient after discharge. Cross-dystopia of the kidney with fusion, cystic dysplastic kidney, and a ureterocele are rare congenital anomalies that require timely examination in a specialized clinic and drawing up an individual treatment plan. The surgical method should focus on a symptomatic urological problem, emphasizing preserving kidney function.

Clinical manifestations of delayed reaction following mass hornet envenomation: a case report.

The authors present a case of a 24-year-old male from eastern Nepal, who presented following mass envenomation by hornet stings. He had progressive yellowish discoloration of skin and sclera, myalgia, fever, and dizziness. He had passage of tea-coloured urine followed by anuria. Laboratory investigations suggested acute kidney injury, rhabdomyolysis, and acute liver injury. The authors managed the patient with supportive measures and haemodialysis. There was complete recovery of liver and renal function in the patient. The findings in this patient were similar to other cases reported in the literature. These patients must be managed supportively, with few requiring renal replacement therapy. Most of these patients recover completely. In low-middle-income countries like Nepal, delay in seeking care and delay in reaching care is associated with severe clinical manifestations. Delayed presentation can lead to renal shutdown and mortality; hence, early intervention is simple, and, crucial. This case highlights the occurrence of delayed reaction following mass envenomation by hornets. Also, the authors show an approach to managing such patients, similar to managing any other case with acute kidney injury. In these cases, an early simple intervention can prevent mortality. It is crucial to train healthcare workers regarding toxin induced acute kidney injury and the importance of early identification and intervention.

Medical Therapy to Facilitate Urinary Stone Passage

Background: Urinary stones are now a worldwide problem due to a rise in occurrence over the past few decades. All racial and cultural groups have experienced this. Complex metabolic and environmental risk factors are both involved in the pathogenetic pathways of stone production. This disease affects roughly 12% of the world's population. Its recurrence rate is about 70% in men and 47% in women. Urinary stones have significantly increased in prevalence over the past 20 years, becoming a global disease. Aim: This review covers literature on the medical therapy of urolithiasis to facilitate urinary stone passage and their mechanism of action in the light of the new data on the diagnosis and different types of urinary tract stones. Method: A preliminary search of related articles was obtained from three online databases PubMed, Sci.hub and Google scholar whichwere used to conduct a systematic evaluation of the literature. Inclusion and exclusion criteria screened the initial search results, and 67 papers were chosen to be appropriate for this literature review following careful reading, analysis, and evaluation. Results: Different methods of medical therapy (phosphodiesterase-5 inhibitors, alpha blockers, calcium blockers, non-steroidal anti-inflammatory drugs and different types of surgical procedures (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy,ureteroscopy)were thoroughly reviewed but among all of them the expulsion rate to remove the urinary stone was found to be larger and faster in calcium channel blocker (CI 1.33-1.66) and alpha blockers(CI 1.152–7.45). Practical implications: Medical therapies facilitate the urinary-stone passagebut these therapies are not generally used. The choices for treating urinary stones are expanded by these techniques. Patients with big ureteral stones have had better results with medical expulsive therapy.Removing the urinary stones also decreases the chances of other diseases which happened as a result of urinary stone. There are many benefits of medical expulsive therapy which are diverse in nature andthis therapy minimizes the exposure to anesthesia and radiations. Conclusion: Different surgical procedures are used to remove the stones from the urinary passage. Despite of surgical procedures, medical expulsive therapy are more helpful. Alpha-blockers and calcium channel blockers are the main medical expulsive therapies for primary evacuation of urinary tract stones. Keywords: Urolithiasis, Urinary tract stones, Medical expulsive treatment.