Discoloration Of Urine Research Articles

Purple urine bag syndrome: An unusual manifestation of urinary tract infection, our experience at a tertiary care center.

Purple urine bag syndrome (PUBS) is an unusual condition in which a purple discoloration of urine and bag occurs in people with urinary catheters. People with purple urine usually do not complain of any symptoms. The purple discoloration of the urine bag is often the only finding, frequently noted by caregivers. This prospective observational study was conducted at our tertiary care institute from June 2018 to May 2020. A total of 46 patients with PUBS were included in this study. The objective of our study was to record the prevalence of each predisposing factor and to correlate the pathological mechanism through which the PUBS is manifested. The mean age of PUBS patients was 67.4years and 67.4% were males. Most patients of PUBS (60.9%) had a urethral catheter, while there was percutaneous nephrostomy in 26.1% patients and 13% patients had a percutaneous suprapubic cystostomy catheter. Among the patients, 69.65% were bedridden or in an institutionalized situation, 73.9% were suffering from chronic constipation, 21.7% were associated with dementia, and 47.8% were cerebrovascular accidents with hemiparesis patients. In addition, 93.5% of patients presented with alkaline urine and 3 patients with acidic urine. The most common bacteria isolated in urine culture were E coli and Pseudomonas. Urinary catheter associated urinary tract infection and PUBS is most commonly documented in females, but our study showed that it is more common in males. The appearance of a purple bag does not depend on the material and type of the catheter or the catheterization method. In addition, no correlation was found between the microorganisms isolated from the environment and patients' urine.

Rifampicin versus Doxycycline in Prevention of recurrent Boils (A Comparative Therapeutic Study)

Background: Suffering from recurrent boils (furunclosis) is a common problem in our locality as it is noticed by many dermatologists especially in association with increasingly hot weather. The most common causative organisms are staphylococci. Objective: The aim of the study was to shed the light upon this problem and compare two systemic therapeutic agents for the prevention of recurrence, doxycycline and rifampicin. Patient and method: One hundred thirty-five (135) Patients with recurrent boils from Al-Yarmouk teaching hospital dermatology outpatient department were included in this study; age ranged from 10 to 64 years old and out of total patients 32 were males and 103 were females. Patients were assessed by full history and clinical examination done by dermatologist. An aspirate from the content of the boil was taken from 30 patients for bacteriological culture. The patients were treated by topical with or without systemic anti-staph antibiotics followed by a preventive protocol of doxycycline100mg twice daily for two months duration in 50 patients and rifampicin 600mg for ten days in the other 85 patients. Both groups used topical sodium fucidate 2% ointment twice daily in nostrils, axilla and perineum for ten days. All were followed up for 2 years to assess the recurrence after treatment. Results: Out of 135 patients treated, 3 (2.22%) patients defaulted from follow up (they were from doxycyclin group) and out of the remainder 132, only 9 (6.8%) patients had recurrence after treatment; 7 (14.89%) patients from the doxycycline group and 3(3.52%) patients from rifampicin group. Forty 40 (85.1%) patients responded well to doxycycline without recurrence for 2 years compared to 83 (97.65%) patients treated with Rifampicin with no recurrence during the 2 years of follow up. The noticed side effects were gastric upset in doxycycline and urine discoloration in rifampicin. Conclusion: Rifampicin regimen in prevention of recurrent boils significantly showed higher effectiveness in addition to more tolerable, easier, shorter course, and fewer side effects than doxycyclin.

Purple Urine Bag Syndrome: A Rare Clinical Entity in a Female Patient with a Long-term Indwelling Urethral Catheter

Background: Discoloration of urine is commonly encountered in clinical practice and this at times may indicate significant pathology. Nevertheless, the majority of instances are benign. Blue and purple dye discoloration of the urinary catheter drainage system israre and can be alarming to both patients and health care workers who are not aware of the condition which is called Purple-Urine-Bag-Syndrome (PUBS). PUBS, is associated with urinary tract infections occurring in catheterised patients, generally elderly females with significant co-morbidities and constipation. The urine is usually alkaline. Gram-negative bacteria that produce sulfatase and phosphatase are involved in the formation of pigment, indigo which gives a blue coloration and indirubin which gives a purple coloration. Tryptophan metabolism is involved in the pathogenesis. Case Report: A 60-year-old lady who had a long-term urethral catheter for four years went to see her General Practitioner on few occasions with a report that her urine has been draining blue dye into her urine bag which was followed by drainage of purple dye into the catheter bag. The General practitioner did not know the cause of the problem but gave the patient antibiotic on each occasion and the blue/purple dye urine discoloration cleared each time she was given empirical antibiotic treatment. Her urine culture grew E coli at the time of the discoloration.Conclusion: PUBS occurs in long-term catheterised patients; is associated with UTI; presents with symptom-less blue/purple discoloration of urine; resolves with appropriate antibiotic treatment.

Use of Raman Spectroscopy, Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy in a Multi-Technique Approach for Physical Characterization of Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare condition characterized by purple discoloration of urine and urine bags. Although it is benign, it represents an alarming symptom to the patients and their relatives because of purple discoloration. We have physically characterized urine and urine bags belonging to a patient suffering from PUBS using an approach that combines Raman spectroscopy (RS) and scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX). Five “blue” discolored bags and one sterile urine bag, representing the control, were cut into 1 cm2 square samples and analyzed by using RS and SEM + EDX technique. RS enabled us to identify the presence of indigo, a metabolite of tryptophan, while SEM analysis showed the biofilm deposit, probably due to the presence of microorganisms, and the EDX measurements exhibited the elemental composition of the bags. In particular, urine bags before and after the presence of PUBS urine showed an increase of ~32% of Cl, ~33% of O, ~667% of Ca, ~65% of Al and Mg, while C decreased by about 41%. Our results, to be taken as a proof-of-principle study, are promising for the aim to characterizing the urine bags in a flexible, inexpensive, and comprehensive manner.

Clinical and Epidemiological Spectrum of Acute Viral Hepatitis Due to Hepatitis A and E in Children: A Descriptive, Cross-Sectional, Hospital-Based Study.

Objective: Acute viral hepatitis (AVH) in children is a serious and major public health concern globally and in developing countries such as Pakistan. We conducted this study to determine the clinical and epidemiological spectrum of AVH due to hepatitis A virus (HAV) and hepatitis E virus (HEV) infection in children.Methodology: This cross-sectional study was conducted at the Pediatric Medicine Department of a tertiary care hospital from February 20, 2020, to February 20, 2022. A total of 200 children 1-12 years of age who presented with symptoms and signs of AVH were enrolled. Demographic and clinical characteristics were noted, and venous blood was drawn for the assessment of HAV IgM and HEV IgM using an enzyme-linked immunosorbent assay (ELISA). Descriptive statistics are run, and the results are presented as tables.Results: Of the children, 75% were diagnosed with acute HAV infection. The median duration of illness was six days (range: 2-21 days). The most common age group affected was 6-10 years (43.5%), of which 56.5% were males. Most of the children belonged to low and middle socioeconomic status (86.5%), and 41.5% consumed underground water for drinking. Fever was the most common symptom, followed by appetite loss and yellow discoloration of urine. Alanine aminotransferase (ALT) was significantly high in HEV compared to HAV infection (2060.2±1036.7 versus 1730.7±957.5 IU/L) (P=0.04).Conclusion: Acute HAV was more prevalent. Those who are male, 6-10 years of age, from lower and middle socioeconomic status, and using underground drinking water were more affected by acute viral hepatitis. The clinical and biochemical presentation of HAV and HEV did not differ significantly.

Co-infection of Hepatitis A Virus with Salmonella Typhi

Waterborne diseases are very common in developing countries like Bangladesh due to intake of contaminated water from local water supply authority, along with inadequate sewage and water drainage systems. Multiple infections can occur with contaminated water. Viral hepatitis and typhoid fever are endemic in our country. Both are transmitted feco‐orally and are associated with poor sanitation, poor hygiene. Sometimes more than one type of infection along with coexisting febrile illness makes the diagnosis and management a challenging task. We report a case of 10 years young girl came to us with 10 days history of low grade intermittent fever, yellow discoloration of sclera and urine and right upper abdominal pain and final diagnosis was confirmed as co-infection of Hepatitis A and Salmonella typhi infection. KYAMC Journal. 2022;12(04): 250-251

COMT Inhibitors in the Management of Parkinson's Disease.

Levodopa treatment remains the gold standard for Parkinson's disease, but shortcomings related to the pharmacological profile, notably, oral administration and the consequent occurrence of motor complications, have led to the development of several add-on levodopa treatments or to research to improve the method of delivery. Motor fluctuations, and to a lesser extent non-motor fluctuations, concern half of the patients with Parkinson's disease after 5 years of disease and patients identified them as one of their most bothersome symptoms. Catechol-O-methyl transferase inhibitors (COMT-Is) are one of the recommended first-line levodopa add-on therapies for the amelioration of end-of dose motor fluctuations in patient with advanced Parkinson's disease. Currently, two peripheral COMT-Is are considered as first-line choices - entacapone (ENT), which was approved by the US Food and Drug Administration in 1999 and the European Committee in 1998; and opicapone (OPC), which was approved by the European Committee in 2016. A second-line COMT-I that requires regular hepatic monitoring, tolcapone (TOL), was approved by the Food and Drug Administration in 1998 and the European Committee in 1997. Of note, OPC also received Food and Drug Administration approval in 2021, but it is still only marketed in a few countries, including Germany, UK, Spain, Portugal, Italy, Japan, and USA, while ENT and TOL have a wider market. Our narrative review summarizes the pharmacokinetic/pharmacodynamic properties, clinical efficacy in terms of motor fluctuations, motor/non-motor symptoms, quality of life, and safety data of these three COMT-Is, as evidenced by randomized clinical trials, as well as by real-life observational studies. Overall, a phase III non-inferiority trial showed a similar effect between ENT and OPC on off-time (-60.8 min/day and -40.3 min/day, vs placebo, respectively), with a possible additional off-time reduction of 39 min/day, obtained when there is a switch from ENT to OPC. Concomitantly, TOL can reduce off-time by an average of 98 min/day. A significant though discrete concomitant reduction on the Unified Parkinson's Disease Rating Scale motor section (2-3 points) is obtained with all three drugs vs placebo. Data on quality of life are fewer and more heterogeneous, with positive results obtained especially in open-label studies. Effects on non-motor symptoms were investigated as secondary outcome only in a few studies, frequently by means of non-specific scales and a benefit was observed in open-label studies. Dopaminergic adverse effects were the most frequent, dyskinesia being the most common for the three drugs eventually requiring levodopa dose reductions. No urine discoloration and a very low incidence of diarrhea were found with OPC compared with ENT and TOL. Regular hepatic monitoring is needed only for TOL. A combination of COMT-Is with new formulations of levodopa, including the subcutaneous, intrajejunal, or new extended-release formulation, merits further exploration to improve the management of both mild and severe motor fluctuations.

Urine Discoloration After Voiding in a Boy With Ulcerative Colitis Using Mesalamine.

Urine Discoloration After Voiding in a Boy With Ulcerative Colitis Using Mesalamine.

Relevance of COMT inhibitors in the treatment of motor fluctuations

Catechol O‑methyltransferase (COMT) inhibitors have been established in the treatment of Parkinson's disease for more than 20years. They are considered the medication of choice for treating motor fluctuations. The available COMT inhibitors, entacapone, opicapone and tolcapone, differ pharmacokinetically in terms of their half-lives with implications for the dose frequency, in their indication requirements and in their spectrum of side effects, including diarrhea and yellow discoloration of urine. Many patients with motor fluctuations are currently not treated with COMT inhibitors and are, therefore, unlikely to receive individually optimized drug treatment. This manuscript summarizes the results of aworking group including several Parkinson's disease experts, in which the value of COMT inhibitors was critically discussed.

EFFECT OF AN UNANI REGIMEN IN THE TREATMENT OF 'YARAQĀN' (JAUNDICE): A CASE REPORT

Jaundice due to hepatitis viruses is considered to be a most prevalent disease worldwide. In Unani literature, it is referred as 'yaraqān' which is caused by inflammatory diseases of liver, intra or extra-hepatic obstructions, and poisoning due to drugs or animals. Several Unani drugs including Ma'jun Dabid al-Ward, syrup Jigreen, Araq-iMako, Araq-i-Kasni, etc are frequently used for the treatment of jaundice and liver disorders including infective hepatitis. A 16 year old male patient suffering from yellowish discoloration of sclera, skin, mucous membranes and urine, nausea, vomiting, loss of appetite and fever for one week admitted in the male ward of RRIUM, Chennai. The laboratory investigations revealed severe hyperbilirubinemia, raised serum transaminases, alkaline phosphatase and negative HBsAg. On the basis of history, clinical observations and laboratory investigations, the patient was diagnosed as a case of 'yaraqān' (jaundice) which may be due to acute viral hepatitis. A Unani regimen comprising Ma'jun Dabid al-Ward (5 g twice a day), syrup Jigreen (10 ml twice a day), Araq-i-Mako (75 ml twice a day), Araq-iKasni (75 ml twice a day) for 25 days, Sharbat-i-Khaksi (10 ml twice a day for 7 days), and Habb-i-Tursh Mushtahi (1 g twice a day) for 15 days were given by oral route. The fever has subsided after 7 days and the appetite improved after 15 days of the treatment. The yellow discoloration of sclera and mucous membranes started to reduce gradually th from 7 day onwards. At the end of the treatment, the laboratory reports revealed that the total bilirubin, direct bilirubin, indirect bilirubin, SGOT, SGPT and ALP were within normal range. The core objective of this case report is to re-emphasize the effectiveness of Unani medicine particularly in the treatment of jaundice. Thus, this data may be helpful to increase awareness amongst the common people and scientific community for the popularity of Unani medicine in general and for the treatment of jaundice and liver disorders in particular.

Role of Ayurveda treatment in the management of hepatitis B (Ubhayapatha Ashrita Swatantra Kamala)- A case report.

Hepatitis B is one of the most common causes of liver disease, and due to unawareness of the safety measures, more prone to spread. As per the World Health Organization, for the South East Asia region, its prevalence is 2%. Yellowish discoloration of the eyes, body, and urine, abdominal discomfort, and vomiting is its cardinal symptoms. In Ayurveda, this set of symptoms is known as Kamala. This case report illustrates the effectiveness of the Ayurveda treatment modality in a patient with a viral load of 3705.71 IU/ml, and the values of AST (aspartate aminotransferase) and alanine transaminase (ALT) were 140 IU/ml and 173 IU/ml, respectively. A 40-year-old female patient with a complaint of yellowish discoloration of urine, eyes, and skin with fatigue and irritability was diagnosed with Ubhayapatha Ashrita Swatantra Kamala. The patient was treated with Ayurveda drugs and Virechana Karma (therapeutic purgation). After the treatment for 13 months, the disease was cured. Improvement was observed based on hepatitis B virus deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) (hepatitis B DNA PCR) (decreased from 3705.71 IU/ml to <50.0 IU/ml) and the values of AST (decreased from 140 IU/ml to 19.0 IU/ml) and ALT (decreased from 173 IU/ml to 28 IU/ml). The patient was stable and asymptomatic during the follow-up period of 4 months.

SIADH as the initial manifestation of acute intermittent porphyria: A case report

Acute intermittent porphyria (AIP) is a rare autosomal dominant and the most severe form of the inherited hepatic porphyrias, affecting mainly young women. We present the case of an 18-year-old female who presented with severe abdominal pain, purple urine, autonomic dysfunction, and severe hyponatremia, seizures on further evaluation came out to be a case of AIP. This case report is a reminder to keep AIP among the differentials in young female patients with a classic constellation of abdominal urine discoloration syndrome of inappropriate secretion of antidiuretic hormone and autonomic dysfunction.

A Young Man With Dysuria

A previously healthy 19-year-old man presented with a 2-month history of intermittent suprapubic pressure-like abdominal pain, dysuria, and 1-week history of pink discoloration of urine. His vital signs, WBC count, lactate level, and creatinine level were within normal limits. Physical examination revealed a soft abdomen with suprapubic tenderness. Urinalysis result was significant for cloudy, pink urine with >300 mg/dL proteinuria, >100 WBCs per high-power field, large red blood cells with >20 RBCs per high-power field, >1 bacteriuria, and positive for the presence of leukocyte esterase.

Species composition and distribution of dangerous scorpions of Hemiscorpius genus and clinical symptoms due to envenomation in high-risk regions of southern Iran

Abstract. Shahi M, Moosavy SH, Hanafi-Bojd AA, Akbari M, Rafinejad J. 2021. Species composition and distribution of dangerous scorpions of Hemiscorpius genus and clinical symptoms due to envenomation in high-risk regions of southern Iran. Biodiversitas 22: 2945-2951. The southern regions of Iran, including Hormozgan province, are high risk areas for scorpion stings. This study aimed to determine the distribution and species diversity of dangerous scorpions of Hemiscorpius and also to determine the clinical symptoms of their bites in the high-risk areas of Hormozgan province. Scorpion sampling was carried out from Shahid Mohammadi and Koodakan hospitals in Bandar Abbas also filed areas of Bandar Abbas and Khamir counties by searching the scorpion's shelter throughout the day and using ultraviolet light at night. To determine the clinical symptoms, the data recorded in the patient's file were extracted and recorded in the sting checklists. Five species of the Hemiscorpius genus were identified. H. gaillardia and H. persicus are reported for the first time from Hormozgan province. Specific clinical symptoms after several hours of delayed were pain, swelling, itching, warmth, and edema, necrosis of the sting site, nausea, vomiting, dizziness, and fever. Complications such as urine discoloration, hemoglobinuria, severe hemolysis, and acute renal failure were observed. The results showed that envenomation with Hemiscorpius Scorpions should be considered as an urgent medical issue.

A rare case of metabolic disorder- Alkaptonuria

Alkaptonuria is a rare genetic disorder of tyrosine metabolism, due to deficiency of the enzyme homogentisate 1, 2 dioxygenase. This results in characteristic features like blackish urine discoloration, ochronosis, arthropathy, cardiac valve deterioration. In this paper, the authors presenta case report of a 4-month-old boy who was brought by his mother to the well-baby clinic, with a chief complaint of black staining of nappy, a few hours after voiding. A qualitative examination of urine after an hour of the collection showed dark black discoloration, Quantitative examination reveals the presence of homogentisic acid to the extent of200mg/dl. The Diagnosis of Alkaptonuria was confirmed and the infant was started on Vitamin C and put under regular follow-up.

Emergency open surgery with a duodenotomy and successful removal of an impacted basket following a complicated endoscopic retrograde cholangiopancreatography procedure: a case report

BackgroundCurrent management of choledocholithiasis entails the use of endoscopic retrograde cholangiopancreatography (ERCP) and clearance of the common bile duct. A rare complication of this procedure is the impaction of the basket by a large stone, which necessitates lithotripsy. Here we report a case of an impacted basket during ERCP, which was managed by open surgery with a duodenotomy and the manual removal of the basket.Case presentationA 79-year-old Caucasian man was admitted to our department with yellowish discoloration of urine, skin and eyes. Abdominal ultrasonography showed a slightly thickened gallbladder, multiple gallbladder stones, dilated intrahepatic bile ducts and extrahepatic bile extending to 1.1 cm. A computed tomography (CT) scan demonstrated a stone in the common bile duct, which caused dilation of the biliary ducts. The patient was diagnosed with obstructive jaundice secondary to choledocholithiasis; and underwent an ERCP, a sphincterotomy and stone extraction. Four days following discharge, the patient was readmitted with jaundice, abdominal pain, vomiting and fever. He was diagnosed with ascending cholangitis and treated initially with antibiotics. A second ERCP revealed a dilated common bile duct and choledocholithiasis. Stone removal with a basket failed, as did mechanical lithotripsy. Finally, the wires of the basket were ruptured and stacked in the common bile duct together with the stone. During exploratory laparotomy, adhesiolysis, a Kocher maneuver of the duodenum and a subtotal cholecystectomy were performed. Choledochotomy did not succeed in removing the impacted wires together with the stone. Therefore, a duodenotomy and an extension of the sphincterotomy were performed, followed by high-pressure lavage of the common bile duct to remove additional small biliary stones. The choledochotomy and duodenotomy were closed by a one-layer suture, and a prophylactic gastroenterostomy was performed to prevent leakage from the common bile duct and the duodenum. The postoperative course was satisfactory.ConclusionsThis is the first report in the literature of removal of an impacted Dormia basket through the papilla by performing a duodenotomy and an extension of the sphincterotomy, followed by gastroenterostomy.

A Prospective Study on Maternal and Fetal outcome in Jaundice complicating Pregnancy

A Prospective Study on Maternal and Fetal outcome in Jaundice complicating Pregnancy

A 90-day Sub-chronic Oral Toxicity Assessment of Mulberry Extract in Sprague Dawley Rats.

Mulberry extract from Fructus Mori contains an anthocyanin pigment and has been widely used as a food additive in China and other Eastern Asian countries. Only few research has been done on toxicological profiling of mulberry extract for its safety evaluation; however, the data is inconclusive. In the current study, mulberry extract of 4200, 1400, or 466 mg/kg were orally administrated to Sprague Dawley rats for 90 consecutive days followed by a recovery period of 28 days. No abnormalities were detected in body weights, food intake, ophthalmological, hematological, coagulation, clinical chemistry, and organ weights parameters. Discoloration of urine (red, purple, and brown) and feces (black), along with bedding material (purple) were observed in the 4200 mg/kg group. Further, microscopic examination revealed brown granules in the renal tubular cells for rats in 4200 and 1400 mg/kg groups. Since these changes were associated with excretory effect of the extract, the No Observed Adverse Effect Level was determined to be 4200 mg/kg, which was equivalent to the 1058.5 mg/kg of anthocyanin.

Yoğun Bakımda Hastamın İdrarı Niçin Yeşil Oldu ?

Introduction: Urine analysis is an important part of patient follow-up in intensive care unit (ICU). In this case report we aimed to examine the green colored urine image we see in our ICU and the conditions that may cause this. Case: A 70-year-old male patient was admitted to our ICU due to multilobar pneumonia. During the follow-up, he was intubated due to respiratory distress and15 mcg-1kg-1min propofol infusion was started for sedation. It was observed that the urine was green after 16 hours. Factors that could cause color change in urine were evaluated. Infusion was stopped due to similar cases in the literature. The total amount of propofol administered to the patient was 1200 mg. It was observed that the urine color returned to normal 8 hours after the drug was discontinued. Conclusion: A rare side effect of propofol is urine discoloration. Urine color may change when the excretion of phenolic metabolites exceeds hepatic clearance. It is reported that it can be seen even in anesthesia induction or sedation doses. It is important to know that the application of propofol may change the color of the urine, that this will not be an important problem and that the color may return to normal with the discontinuation of the drug, in order to prevent unnecessary tests.

A Case of Intrahepatic Biliary Atresia in Pediatrics

The chief objective of this case report is to give a overview of how Biliary atresia (BA) occurs, presents, and management. Biliary atresia is a congenital abnormality with mostly affects the biliary tract (intrahepatic or extrahepatic) and often presents with symptoms of jaundice, the prevalence of this disease is more in Asian females than males. This case demonstrates a male patient of 6 months 8 days old he presented with fever, abdominal distension, severe anemia, and also yellowish discoloration of skin sclera and urine, he was diagnosed with intrahepatic biliary atresia, It is important to diagnose if it is intra hepatic or extrahepatic biliary atresia as the treatment Caries for both, Treatment in case of extrahepatic biliary atresia is Kasai procedure but the diagnosis in his case is intrahepatic biliary atresia Kasai procedure is not done, the patient is given symptomatic treatment and is enlisted for a liver transplant.