Urogenital Tract Research Articles

Analysis of the problem of molecular identification of wild (wtCT), plasmidless (p-CT) and Swedish (SE-nvCT) variants of Chlamydia trachomatis in Belarus

To date, it is known that the population of Chlamydia trachomatis is genetically heterogeneous. Along with the originally described wild type (wtCT), mutant variants (mtCT) have been found in the world: plasmidless (p-CT), Swedish (SE-nvCT), Mexican (MX-nvCT), Finnish (FI-nvCT), with different virulence and tropicity to various organs and tissues. These variants may escape PCR diagnostics due to the absence of targets or the occurrence of changes in them, which makes it ineffective to use a number of diagnostic test systems for pathogen detection.Isolates of C. trachomatis collected on the territory of the Republic of Belarus during the period 2013–2022 in reproductive age persons with inflammatory urogenital tract diseases were analyzed. It was found that the dominant pathogen genovariant is the wild type wtCT ‒, approximately 93 %. Mutant strains that make up about 7 % of the pathogen population are represented by p-CT and SE-nvCT genovariants. There were no cases of identification of MX-nvCT and FI-nvCT genovariants in the analyzed sample of C. trachomatis isolates.It is necessary to further optimize the tactics of molecular biological identification of various C. trachomatis genovariants for effective microorganism detection and study of the chlamydial urogenital infection pathogenesis.

Cavernous Sinus Thrombosis Secondary to Streptococcus Constellatus Pharynges

Streptococcus constellatus pharyngis is a gram-positive commensal bacterium commonly found in the oropharynx, gastrointestinal and urogenital tracts. It might be an aggressive opportunistic pathogen causing invasive pyogenic infections in sterile areas, mostly as peritonsillar and orofacial abscesses. We report the case of a 6-year-old girl, who presented multiple head and neck abscesses and bilateral cavernous sinus thrombosis secondary to Streptococcus constellatus pharyngis. Cavernous sinus thrombosis, consequent to this microorganism, has not been reported to date in the literature. Due to the invasive features of this pathogen, a long-term antibiotherapy (up to 9 months) is required. Additionally, a surgical drainage is indicated in case of head and neck, or brain abscesses, larger than 20 or 25 mm respectively. Anticoagulation should be considered in case of venous thrombosis. The interest of this case is not only based on the rarity and severity of the disease, but also on the success of medical and surgical therapy (including long- term antibiotics, anticoagulation and two surgical procedures). This experience may serve as a guide to treat future cases.

Diagnosis and treatment strategies for pediatric urogenital tract foreign bodies: A retrospective study

BackgroundForeign bodies in the pediatric urogenital tract are rare but urgent clinical conditions that can cause severe symptoms and complications. The current management remains challenging. ObjectiveThis study aims to provide an in-depth understanding of the clinical characteristics, diagnostic challenges, and treatment strategies for pediatric urogenital tract foreign bodies. Through a retrospective analysis of patient data, valuable insights into the management of this condition are offered to facilitate the development of more effective management strategies. MethodsA single-center retrospective study design was employed, reviewing clinical data of 30 pediatric patients with urogenital tract foreign bodies admitted to Anhui Children's Hospital from October 2016 to May 2023. This included 16 cases of urethral and bladder foreign bodies and 14 cases of vaginal foreign bodies. Among them, there were 14 males and 16 females, with a median age of 6.3 years. Treatment methods included transvaginal endoscopic removal, cystoscopic removal, pneumovesicum laparoscopy removal, and perineal incisional foreign body removal. Surgical time, blood loss, hospitalization days, and postoperative follow-up results were recorded. ResultsKey clinical presentations included vaginal bleeding, abnormal vaginal discharge, hematuria, dysuria, urinary retention, and perineal pain. Preoperative routine examinations included ultrasound, abdominal radiography, and, in some cases, CT scans. All 30 patients underwent successful surgery, with a median surgical time of 30.5 min (IQR 16.8–50.8), minimal intraoperative bleeding, and a median postoperative hospital stay of 2 days (IQR 2–3). Follow-up from 3 months to 1 year revealed no abnormalities in the urogenital system, no residual foreign bodies, and no occurrence of severe complications. No cases of recurrent foreign body insertion were observed. ConclusionEarly diagnosis and treatment of pediatric urogenital tract foreign bodies are crucial to reduce patient suffering and the risk of complications. The choice of surgical method depends on the type, size, and location of the foreign body, with endoscopy being the preferred option. Laparoscopic cystoscopy and open surgery are also effective treatment modalities.

Mycoplasma and Neisseria Prevalence in Asymptomatic Women and Investigation of their Susceptibility to Tamarindus indica and Syzygium aromaticum Aqueous Extracts

Neisseria and Mycoplasma are two prevalent bacteria in the female urogenital tract leading to gynecological infections and infertility. The aim of this study was to assess the antibacterial activity of Tamarindus indica and Syzygium aromaticum extracts against Neisseria and Mycoplasma isolates. It was a cross cectional study on 60 asymptomatic women at the Protestant and Regional Hospital of Ngaoundere. For this reason, a large consecutive sample of patients with several well-defined characteristics was assembled and urine and cervical-vaginal swab were collected using standard procedures. After being isolated on a specific medium, several strains of Neisseria and Mycoplasma were identified based on their morphological and biochemical characteristics. The antibacterial activity of the plant extracts was tested using the agar-well diffusion method. It was discovered that 70% of asymptomatic women had overall infection, with varying prevalence rates. The prevalence rates of Neisseria and Mycoplasma were 14.29% and 85.71% respectively. The aqueous extracts of Syzygium aromaticum against Neisseria produced inhibitory diameters of 43 mm, 40 mm and 32 mm at doses of 20 mg/mL, 10 mg/mL, and 5 mg/mL, respectively while, at the same doses, the aqueous extract of Tamarindus indica produced inhibitory diameters of 16 mm, 14 mm and 13 mm, respectively. The combined extract of Syzygium aromaticum and Tamarindus indica exhibits inhibitory diameters of 25, 23, and 30 mm at 20 mg/mL, 10 mg/mL, and 5 mg/mL, respectively. Syzygium aromaticum extract alone showed efficacy against Mycoplasma, with diameters of 16.5 mm, 13 mm and 10.5 mm at concentrations of 20 mg/mL, 10 mg/mL, and 5 mg/mL respectively. Inhibition diameters of 18 mm (for fosfomycin and ofloxacin), 22 mm (for chloramphenicol and ceftriaxone) and 26 mm (for levofloxacin) were found using Neisseria isolates. The only drugs that demonstrated efficacy against Mycoplasma were Minocycline and Josamycin. Given these findings, extracts of Syzygium aromaticum and Tamarindus indica can be investigated and used to treat infections caused by Niesseria and Mycoplasma.

Changes in microbial composition and interaction patterns of female urogenital tract and rectum in response to HPV infection

BackgroundPrevious studies have shown that changes in the microbial community of the female urogenital tract are associated with Human papillomavirus (HPV) infection. However, research on this association was mostly focused on a single site, and there are currently few joint studies on HPV infection and multiple sites in the female urogenital tract.MethodsWe selected 102 healthy women from Yunnan Province as the research object, collected cervical exfoliation fluid, vaginal, urethral, and rectal swabs for microbial community analysis, and measured bacterial load, and related cytokine content. The link between HPV, microbiota, and inflammation was comprehensively evaluated using bioinformatics methods.FindingsThe impact of HPV infection on the microbial composition of different parts varies. We have identified several signature bacterial genera that respond to HPV infection in several detection sites, such as Corynebacterium, Lactobacillus, Campylobacter, and Cutibacterium have been detected in multiple sites, reflecting their potential significance in cross body sites HPV infection responses. There was a solid microbial interaction network between the cervix, vagina, and urethra. The interrelationships between inflammatory factors and different bacterial genera might also affect the immune system's response to HPV infection.InterpretationIt might be an effective strategy to prevent and treat HPV infection by simultaneously understanding the correlation between the microbial changes in multiple parts of the female urogenital tract and rectum and HPV infection, and controlling the microbial network related to HPV infection in different parts.

A novel cysteine-rich adaptor protein is required for mucin packaging and secretory granule stability in vivo

Mucins are large, highly glycosylated extracellular matrix proteins that line and protect epithelia of the respiratory, digestive, and urogenital tracts. Previous work has shown that mucins form large, interconnected polymeric networks that mediate their biological functions once secreted. However, how these large matrix molecules are compacted and packaged into much smaller secretory granules within cells prior to secretion is largely unknown. Here, we demonstrate that a small cysteine-rich adaptor protein is essential for proper packaging of a secretory mucin in vivo. This adaptor acts via cysteine bonding between itself and the cysteine-rich domain of the mucin. Loss of this adaptor protein disrupts mucin packaging in secretory granules, alters the mobile fraction within granules, and results in granules that are larger, more circular, and more fragile. Understanding the factors and mechanisms by which mucins and other highly glycosylated matrix proteins are properly packaged and secreted may provide insight into diseases characterized by aberrant mucin secretion.

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 .....

Haematopoietic innate interleukin 17A production drives immunopathology in female mouse genital Chlamydia muridarum infection.

Chlamydia trachomatis infection is the leading cause of bacterial urogenital infection and has been demonstrated to drive inflammation and scarring of the reproductive tract. Recent studies have identified key triggers of proinflammatory adaptive immune responses driven by innate leukocytes and epithelia driving immunopathology. Utilizing chimeric mouse models, we investigated the definitive source and role of IL17 and IL17 signalling receptors during early Chlamydia muridarum infection of the female urogenital tract. Bone marrow transplants from wild-type (WT) and IL17A-/- mice to recipients demonstrated equivocal infection kinetics in the reproductive tract, but interestingly, adoptive transfer of IL17A-/- immune cells to WT recipients resulted in no infertility, suggesting a haematopoietic (as opposed to tissue) source of IL17 driving immunopathology. To further delineate the role of IL17 in immunopathology, we infected WT and IL17 receptor A (IL17RA)-/- female mice and observed a significant reduction in immunopathology in IL17RA-/- mice. WT bone marrow transplants to IL17RA-/- recipient mice prevented hydrosalpinx, suggesting signalling through IL17RA drives immunopathology. Furthermore, early chemical inhibition of IL17 signalling significantly reduced hydrosalpinx, suggesting IL17 acts as an innate driver of disease. Early during the infection, IL17 was produced by γδ T cells in the cervico-vagina, but more importantly, by neutrophils at the site of infertility in the oviducts. Taken together, these data suggest innate production of IL17 by haematopoietic leukocytes drives immunopathology in the epithelia during early C. muridarum infection of the female reproductive tract.

A discussion on gonorrhoea

Gonorrhoea, a sexually transmitted disease (STD) caused by bacterium Neisseria gonorrhoea.It’s also sometimes called “the clap” or “drip.” It is the second most common STI and commonly co-occurs with other STIs (especially chlamydia trachomatis). It mostly affects the genital tract and genital area, also if the organism comes in contact with mucous membrane this can lead to infection, such as infections in lower urogenital tract, pharynx, anus/rectum, conjunctiva (eyes). Gonorrhoea is spread through sexual fluids, including vaginal fluid and semen. Often, gonorrhoea doesn’t cause symptoms, especially in people assigned female at birth. When present, symptoms differ. It could lead to long-term health problems and infertility, but antibiotics can cure it and reduce the chance of complications.

Palliative urologic surgery for metastatic prostate cancer: what needs to be considered in the future?

Androgen deprivation in combination with novel hormonal agents, docetaxel or the combination of abiraterone/prednisone plus docetaxel or darolutamide plus docetaxel represent the standard therapeutic approach in metastatic hormone-sensitive prostate cancer (mHSPC). Patients with low-risk prostate cancer also benefit from additional radiation therapy or radical prostatectomy in terms of progression-free and overall survival. Despite favourable response rates, basically all patients will develop castration-resistant prostate cancer (CRPC) within 2.5 to 4 years. Systemic chemotherapy, second-line hormonal treatment or systemic application of radionuclides such as Radium-223 or 177Lu-PSMA represent salvage management options. As the new medical treatment options have led to an improved oncological outcome with significantly prolonged survival times, about 50% to 65% of patients will develop symptoms due to local progression of prostate cancer. The management of such symptomatic local progression will become more important in upcoming years, which means that all uro-oncologists need to be aware of the various surgical management options. If complications of the lower urogenital tract occur, for example repetitive gross haematuria with or without bladder clotting and with the necessity for red blood cell transfusions, subvesical obstruction, acute urinary retention or rectourethral or rectovesical fistulas, these may be managed by palliative surgery such as palliative TURP, radical cystectomy, radical cystoprostatectomy with urinary diversion, and pelvic exenteration. Symptomatic or asymptomatic obstruction of the upper urinary tract can be managed by endoluminal or percutaneous urinary diversion, ureteral reimplantation, ileal ureter replacement, or implantation of a Detour system. However, an individualised and risk-adapted treatment strategy needs to be developed for each single patient to achieve an optimal therapeutic outcome with improvement of both symptoms and quality of life. In specific clinical situations, best supportive care may be an adequate option.

Evaluation of host factors leading to the progression of urinary tract infections to urosepsis: a retrospective analysis from a tertiary care centre in Southern India

Context: Urinary tract infections (UTIs) are one of the recurrently occurring disease caused by bacteria that poses a major public health concern globally. Among the well studied host factors that predispose to urosepsis are the anatomical risk factors of the urinary tract including stones, tumours and interventions involving the urogenital tract such as an indwelling catheter or transrectal prostate biopsy. Aims: To evaluate the host factors leading to the progression of UTI to urosepsis. Settings and design: Clinical and laboratory data available from patient records as per the inclusion criteria were analysed retrospectively by using a detailed proforma. Methods and materials: Patient records were screened using the ICD code provided from the Medical Records department. Data of patients with clinically confirmed UTI were retrieved and included in the study. Statistical analysis used: Patient data was analysed using SPSS software version 20. Categorical and continuous data were summarized as percentages and means ± SD or median (P25, P75) respectively. Univariate analysis was performed using the chi-square test or Fisher's exact test for categorical variables. Results: A total of 94 patient records were included in the study. Demographic data showed that majority (53.19%) of the patients (n = 94) were female individuals. The results of univariate analysis showed that gender, frequent UTI, diabetes mellitus, presence of an indwelling urinary catheter and hospitalization more than 6 months were significantly associated with urosepsis. In addition, results of multivariate analysis identified the independent risk factors for urosepsis associated with urinary tract pathogens. Conclusion: This study showed that there is significant association between risk factors that determine the outcome of UTI and its progression to urosepsis.

Assessing the Effects of One-Time Praziquantel Treatment on Urogenital Lesions Detected by Ultrasound in Schistosoma haematobium-Infected Individuals in Chad.

The objective was to determine the impact of a single dose of praziquantel on urogenital lesions caused by Schistosoma haematobium. Ultrasound (US) was performed on three age groups of subjects with a positive test for hematuria, with the first examination performed in November 2017 and a follow-up visit 7 months later. None of the subjects had previously received treatment. The participants were categorized into three distinct age groups: group 1 = 1-15 years, group 2 = 15-30 years, and group 3 = ≥ 30 years. A total of 250 people from these three groups underwent screening: 99 in group 1, 90 in group 2, and 61 in group 3, among whom 131 (52.4%) had at least one detectable lesion of the urogenital tract on US. Follow-up US after 7 months was possible in 60%, 67%, and 77% of the respective groups (with lesions). The anomalies disappeared in 80% of individuals in group 1, 76% of those in group 2, and 65% in group 3. With the exception of calcifications, most visible anomalies had been resolved. The total number of anomalies is low. Severe obstructive uropathy was not detected. We can conclude that single treatment with praziquantel is able to cure visible anomalies, with the exception of calcifications. The low rate of anomalies, compared with levels in the literature, is speculated to be due to undetected death by obstructive uropathy caused by S. haematobium. This requires further investigation.

Verification of the Morphofunctional Disorders Level of the Hepatorenal System during the Feline Tripelphosphate Urolithiasis

Introduction. The available information referring to the feline urolithiasis pathogenesis does not fully reflect the nature of changes taking place in the body, because it does not take into account the existing liver-kidney interrelationship. A systemic approach to studying this problem enables development of the targeted diagnostic strategies, increase of the subsequent therapeutic efficacy, as well as reduction of the possible clinical harm of polypragmasia. The aim of this article is to study the interrelationship between the nature of the hepatorenal system morphofunctional disorders and the level of metabolic processes in cats sick with struvite urolithiasis with the signs of cystolithiasis.Materials and Methods. The objects of the research were cats: the 1st experimental group consisted of the outbred female cats with tripelphosphate urolithiasis with signs of cystolithiasis, the 2nd experimental group — outbred castrated male cats with tripelphosphate urolithiasis with signs of cystolithiasis, the control group was mixed of the clinically healthy male and female animals. During the research, the results of the sick animals' clinical study, morphological and biochemical blood serum tests, hepatorenal system transabdominal ultrasonography were used, the urine macroscopic and biochemical examinations as well as urine sediment microscopy were carried out.Results. Against the background of hyperazotemia in sick animals (UREA — 14.70±1.30 mmol/L and 17.05±1.60 mmol/L; CREA — 173.90±6.06 μmol/L and 182.30±7.54 μmol/L; URIC ACID — 69.30±4.50 μmol/L and 73.48±4.83 μmol/L) and water-electrolyte metabolism disorder (Ca+2 — 2.89±0.05 mmol/L and 3.04±0.12 mmol/L; P+3 — 3.12±0.06 mmol/L and 3.20±0.09 mmol/L; iCa+2 — 1.39±0.03 mmol/L and 1.42±0.02 mmol/L; Cl- — 125.58±1.19 mmol/L and 129.90±1.06 mmol/L) there were observed: a disorder in the hepatobiliary system functioning due to elevation of the main hepatic transaminase activity (AST — 41.74±5.35 unit/L and 49.30±6.74 unit/L; ALT — 85.82±6.15 unit/L and 90.05±6.50 unit/L; ALКP — 45.61±3.10 unit/L and 48.16±2.86 unit/L; AAR — 0.49±0.03 and 0.54±0.02), elevation of total bilirubin level (BILT — 5,76±0,15 μmol/L and 6,08±0,24 μmol/L) and bilirubin direct (BILD — 1,40±0,03 μmol/L and 1,62±0,02 μmol/L), as well as elevation of the gamma-glutamyl transpeptidase (GGT — 6,67±1,01 unit/L and 7,90±0,90 unit/L) and lactate dehydrogenase (LDH — 215,47±10,30 unit/L and 219,04±9,27 unit/L) activity level. The acoustic shadowing of the hepatorenal system organs confirmed the signs of acute hepatitis against the background of cystolithiasis due to the existing anatomical relationship between kidneys and liver.Discussion and Conclusion. The results of the sick animals’ blood serum examination indicated the progression of the hematopoietic dysfunction during the tripelphosphate urolithiasis, which contributed to the development of the circulatory tissue hypoxia in the liver-kidney system. The development of the hyperazotemia contributed to the elevation of the main hepatic transaminase activity and building-up of the functional disorders in the hepato-biliary system of sick cats in response to the acute inflammatory process going on in the urogenital tract. The carbohydrate and lipid metabolism disorders indicated the liver metabolic activity disorder and its parenchymal damage on the background of urolithiasis. The electrolyte and water metabolism disorders, the development of the hyperproteinemia in test cats with the tripelphosphate urolithiasis contributed to the damage of the hepatorenal system organs due to development of the compensated metabolic acidosis and hyperchloremia.

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Tuberculosis (TB) is an infectious disease caused by acid-fast bacilli Mycobacterium tuberculosis (MTB). The lung remains the most common site involved by it. Extrapulmonary sites of TB are lymph nodes, pleura, bone, joints, urogenital tract, and meninges. Isolated Cystic Duct Tubercular Lymphadenitis (CDL TB) without involving the gallbladder is an uncommon manifestation of TB that primarily affects the lymph nodes around the cystic duct. A multidisciplinary approach is essential for accurate diagnosis and successful management of such cases. The authors hereby present a case of a 28-year-old female, without any evidence of TB elsewhere and an incidental finding of CDL TB. “The patient was sent with a clinical diagnosis of Chronic Calculus Cholecystitis (CCC)”. This highlights the need for comprehensive clinical evaluation and diagnostic investigations to avoid misdiagnosis or delayed management. This underscores the significance of maintaining a high index of suspicion for extrapulmonary TB, particularly in regions where the disease remains endemic. Healthcare practitioners should be vigilant when encountering unusual clinical presentations or when dealing with atypical combinations of gallbladder pathologies, as illustrated by the concurrent occurrence of CDL TB with CC with evidence of Pyloric Metaplasia (PM) and cholesterolosis without cholelithiasis, as in the patient of the present case report.

The Persistent Cloaca

Normally, at birth, females have separate perineal orifices for the urinary, reproductive and digestive tracts, while males have individual openings for the urogenital and digestive tracts. However, during fetal development, both sexes pass through a stage when all the systems empty into a common chamber, the cloaca. The cloaca opens to the exterior through a solitary opening until it divides into the various systems. Occasionally, the tracts do not separate and the baby is born with a persistent cloaca. It is a complex anomaly that is often associated with abnormalities in other systems that have to be taken into consideration to manage the patient appropriately.

Identification and characterization of calcium binding protein, spermatid-associated 1 (CABS1)# in selected human tissues and fluids.

Calcium binding protein, spermatid associated 1 (CABS1) is a protein most widely studied in spermatogenesis. However, mRNA for CABS1 has been found in numerous tissues, albeit with little information about the protein. Previously, we identified CABS1 mRNA and protein in human salivary glands and provided evidence that in humans CABS1 contains a heptapeptide near its carboxyl terminus that has anti-inflammatory activities. Moreover, levels of an immunoreactive form of CABS1 were elevated in psychological stress. To more fully characterize human CABS1 we developed additional polyclonal and monoclonal antibodies to different sections of the protein and used these antibodies to characterize CABS1 in an overexpression cell lysate, human salivary glands, saliva, serum and testes using western blot, immunohistochemistry and bioinformatics approaches exploiting the Gene Expression Omnibus (GEO) database. CABS1 appears to have multiple molecular weight forms, consistent with its recognition as a structurally disordered protein, a protein with structural plasticity. Interestingly, in human testes, its cellular distribution differs from that in rodents and pigs, and includes Leydig cells, primary spermatogonia, Sertoli cells and developing spermatocytes and spermatids, Geodata suggests that CABS1 is much more widely distributed than previously recognized, including in the urogenital, gastrointestinal and respiratory tracts, as well as in the nervous system, immune system and other tissues. Much remains to be learned about this intriguing protein.

Hypospadias Repair: Outcome and Objective Evaluation with Hypospadias Objective Scoring Evaluation (HOSE), Hypospadias Objective Penile Evaluation (HOPE) and Pediatric Penile Perception Score (PPPS) from Parents Perspective and Preference in COVID-19 Era

Introduction. Hypospadias is a common congenital abnormality. It may also be associated with other urogenital tract abnormalities. Literature has described more than 300 techniques being used. An objective evaluation is useful for attending doctor and parents to ensure both understands detection of complication and to assess post operative satisfaction from both sides are similar. Thus study sought to assess the outcome of hypospadias repair with objective scoring evaluation from parents’ perspective during COVID-19 era. Methods. This was a retrospective study of all patient post-hypospadias repair in Urology Unit, Hospital Universiti Sains Malaysia from January 2020 to December 2022 during the Covid-19 period. All patient medical records were reviewed. Data analyzed for demographic, surgical treatment, complications, and objective evaluation with HOSE, HOPE and PPPS questionnaire and parents preferred questionnaire to be used using Microsoft Excel for Windows 2003 and qualitative variables were presented as frequencies and simple percentages. Result. Hypospadias A total of 21 pediatric patients operated. The mean age during surgery was 7.2 years old. Distribution of glanular 6 patients, distal 3 patients and majority are proximal hypospadias with 12 patients (57.2%). Proximal hypospadias, 6 proximal penile and 6 penoscrotal. Single stage repair 18 patients and 2 patients had scrotoplasty performed and 3 patients had two stage repairs. Majority of single stage surgery performed was TIP and two stage repairs done with Bracka’s technique. Overall mean follow-up time 16.78 month. Three patients had UCF with 14.3%. Questionnaire with HOSE showed mean score 14.38. The HOPE questionnaire showed mean score of 54.71 and PPPS mean score was 10.2. Majority of parents preferred to use HOPE with 66.7% as compared to HOSE 14.3% and PPPS 19%. Discussion. This study has a small sample size possible due to very low rate for hypospadias in Malaysia and Covid-19 pandemic. Due to the pandemic, European Association of Urology recommended for repair before 18 months. However, if done after 2 years old showed significant predictor for complications. Validated questionnaires are useful and comparable to assess objectively both functional and patient satisfaction. However, HOPE might overestimate quality of cosmetic outcome compared with PPPS. Despite many available evaluation scoring systems were compared, reports show similar conclusions with none being more superior. Conclusion. Hypospadias requires complex surgery and complications are expected but should be within acceptable standards. In COVID-19 era, hypospadias repair had to be delayed and causes negative impact to patients. Despite many various techniques available, surgeons experience and technique preference are very important. There is no evaluation score more superior than another. It has its advantages and disadvantages. Parents satisfaction and functional outcome after repair should be routinely done for objective assessment.

Activation of murine macrophages by membrane proteins from Tritrichomonas foetus grown on iron- and calcium-rich conditions.

Tritrichomonas foetus is a protozoan parasite that causes a venereal disease in cattle limiting reproduction by abortions and sterility. The immune response against this parasite is poorly understood. Since the iron and calcium ions are important regulators of the microenvironment of the urogenital tract in cattle, we decided to evaluate the role of these divalent cations on the antigenicity of membrane proteins of T. foetus on macrophage activation as one of the first inflammatory responses towards this pathogen. Colorimetric methods and ELISA were used to detect the nitric oxide and oxygen peroxide production and expression of cytokines in culture supernatant from macrophage incubated with membrane proteins from T. foetus cultured in iron- and calcium-rich conditions. qRT-PCR assays were used to evaluate the transcript expression of genes involved in the inflammatory response on the macrophages. The membrane proteins used for in vitro stimulation caused the up-regulation of the iNOS and NOX-2 genes as well as the generation of NO and H2 O2 in murine macrophages on a dependent way of the metal concentrations. Additionally, after stimulation, macrophages showed a considerable rise in pro-inflammatory cytokines and a downregulation of anti-inflammatory cytokines, as well as up-regulation in the transcription of the TLR4 and MyD88 genes. These data suggest that membrane proteins of T. foetus induced by iron and calcium can activate an inflammatory specific macrophage response via TLR4/MyD88 signalling pathway.

Study of Methicillin-resistant Staphylococcus aureus Isolated from Various Clinical Specimens from Tertiary Care Hospital

ABSTRACT Introduction: Staphylococci are Gram-positive bacteria, with a diameter of 0.5–1.5 μm and individual cocci, which are divided in more than one plane from the grape-like cluster. In the genus staphylococci, 32 species and 8 subspecies are present in many of which are present as a commensal in the human body. Staphylococci are frequently found as a normal flora of skin mucosal, surface of respiratory, upper elementary, and urogenital tract of the human body. In immunocompromised condition, the infection can be spread by skin-to-skin contact and also by excretion such as saliva aerosol releasing during sneezing and coughing. Infection of staphylococci may also spread from the animal product such as nonpasteurized milk and milk products. Over the last few decades, Staphylococcus aureus has emerge as the most dangerous organism, which is known as methicillin-resistant S. aureus (MRSA). Some strains show vancomycin resistance by S. aureus in hospitalized patients. The present study was conducted to study the prevalence and antibiogram of MRSA isolates in a clinical sample from Acharya Vinoba Bhave Rural Hospital. Materials and Methods: This study was conducted in the Department of Microbiology at Jawaharlal Nehru Medical College (Datta Meghe Institute of Higher Education and Research), Wardha, from August 2020 to December 2021. The samples received in the microbiology laboratory were inoculated on blood agar and MacConkey’s agar, and incubated for 24 h at 37°C for staphylococcal isolation. A total of 145 Staphylococcal aureus were isolated and confirmed by Gram stain and various biochemical tests such as catalase test, oxidase test, coagulase test, and mannitol salt agar. Antibiotic susceptibility test was examined on the Mueller–Hinton agar plate using the modified Kirby–Bauer disc diffusion method. Screening of methicillin resistant was performed by cefoxitin (30 μg) disc diffusion method and interpreted according to CLSI guideline. Results: The prevalence of MRSA was 76 (52.41%) to methicillin-susceptible S. aureus. The highest MRSA was found in the age group >50 years (26.31%). Out of 76 MRSA isolates from different departments, the medicine and orthopedic departments show maximum MRSA as 19.74% each followed by pediatrics (17.11%) and surgery (13.16). Out of 76 MRSA isolates, vancomycin showed 93.42% sensitivity followed by linezolid (85.52%), Gentamicin (71.05%), tetracycline (56.57%), clindamycin (46.05%), and erythromycin (31.57%). Conclusion: With the advancement of new therapeutic agent, MRSA is also being easily resistant. Due to increasing cases of MRSA, there is an increase in the rate of morbidity and mortality. Moreover, except vancomycin, other drugs are resistant, as their MIC is not in the susceptible range. Thus, the results of this study indicate that vancomycin is a suitable medication to take when MRSA cases rise. In such cases, MRSA can be controlled by regular monitoring and checking the irrational use of antibiotics.

2023 Korean sexually transmitted infections guidelines by the Korean Association of Urogenital Tract Infection and Inflammation: Human papillomavirus vaccination.

The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII) and the Korea Disease Control and Prevention Agency updated the guidelines for human papillomavirus (HPV) vaccine against sexually transmitted HPV infections in Korea to respond to changing epidemiologic trends, evolving scientific evidence, and advances in laboratory diagnostics and research. Main purpose and recommendation of vaccination against HPV are as follows: (1) the purpose of HPV vaccine is to reduce the risk of genital warts and HPV-related cancers including cervical and vulvar cancer, head and neck cancer, anal cancer, and penile cancer; (2) in Korea, bivalent (16, 18) vaccines, quadrivalent vaccines (6, 11, 16, 18), and 9-valent vaccines (6, 11, 16, 18, 31, 33, 45, 52, 58) are used depending on the type of HPV; (3) bivalent and quadrivalent vaccines are national immunizations targeting girls aged 11-12 years and low-income young females aged 18-26 years (age and range of inoculation: routinely administered at 11 or 12 years of age, 2 doses at 0 and 6 months for 12-14 years of age; for females aged 15-26 years, 3 doses depending on the type of vaccine; vaccination can be given to those aged up to 45 years through consultation with a clinician); (4) in the case of administering 2 doses, at least 5 months apart; in the case of administering 3 doses, it is recommended to keep 4 weeks between the 1st and 2nd doses, 12 weeks between the 2nd and 3rd doses, and 5 months between the 1st and 3rd doses; (5) immunocompromised patients such as those with HIV, malignant neoplasms, and autoimmune diseases, and those undergoing transplantation or immunosuppressive therapy should receive 3 doses. HPV vaccine is not recommended during pregnancy.