Characteristics of genitourinary tuberculosis in Sri Lanka: A retrospective cohort study

Abstract BackgroundAlthough genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains very low. Furthermore, the characteristics of GUTB in Sri Lanka have not been published due to paucity of data. Therefore, we aimed to study the clinical and imaging characteristics, treatment modalities and outcomes of GUTB in Sri Lanka. MethodsA retrospective analysis was performed based on patients treated by a single urological surgeon in two consecutive centres over a period of 21 years. All patients (n=82, males = 45 (54.9%), median age: 51 years; range: 26 - 75) with a microbiological and/or histological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6- 96). Data were obtained from direct patient interview, hospital notes and clinic files. ResultsCommonest prominent symptoms at presentation included haematuria (n=13, 15.8%) and scrotal manifestations (n=12, 14.6%). Mantoux was either positive (>10mm) (n=62/70) or equivocal (>5mm) (n=8/70). Erythrocyte sedimentation rate (ESR) was available in 69 patients and was >30 in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent a cystoscopy and 73.8% (n=31) had abnormal findings. Microbiological diagnosis was feasible in 42 (51.2%) and rest were diagnosed histologically. Commonest organs involved were kidney (64.6%, n=53), ureters (51.2%, n=42), bladder (43.9%, n=36) and testis/epididymis (14.6%, n=12). One patient had prostate TB. All were treated primarily with anti-TB drugs however, 50 (61%) had indications for some form of therapeutic intervention. The majority of interventions were reconstruction surgeries (n=20, 24.4%) followed by excision surgeries (n=19, 23.2%) and drainage procedures (n=11, 13.4%).Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder and 3 patients developed end-stage renal failure. Two patients had relapse of infection. ConclusionCT-Urography, cystoscopy and histopathology are essential adjuncts to diagnose GUTB. Most ureteric strictures, non-functioning kidneys and epididymal masses needed surgical treatment. Long-term follow up is essential to detect progressive renal dysfunction.

Download Full-text

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

BMC Infectious Diseases ◽

10.1186/s12879-021-06990-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Umesh Jayarajah ◽

Milan Gunawardene ◽

Munipriya Willaraarachchi ◽

Shirani Chandrasiri ◽

Perumal Udayakumaran ◽

...

Keyword(s):

Renal Function ◽

Sri Lanka ◽

Mantoux Test ◽

Histopathological Diagnosis ◽

Ct Urography ◽

Genitourinary Tuberculosis ◽

X Ray ◽

Progressive Deterioration ◽

Specific Symptoms

Abstract Background Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. Methods Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6–96). Results There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26–75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. Conclusions The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

Download Full-text

Esophageal Resection for End-Stage Achalasia

The American Surgeon ◽

10.1177/000313481808400422 ◽

2018 ◽

Vol 84 (4) ◽

pp. 506-511 ◽

Cited By ~ 1

Author(s):

Alberto Aiolfi ◽

Emanuele Asti ◽

Gianluca Bonitta ◽

Stefano Siboni ◽

Luigi Bonavina

Keyword(s):

Balloon Dilation ◽

Esophageal Resection ◽

Treatment Modalities ◽

Morbidity Rate ◽

Safe Alternative ◽

Thoracoscopic Approach ◽

Long Term Follow Up ◽

End Stage ◽

Surgical Treatments

Achalasia is a rare disease characterized by impaired lower esophageal sphincter relaxation loss and of peristalsis in the esophageal body. Endoscopic balloon dilation and laparoscopic surgical myotomy have been established as initial treatment modalities. Indications and outcomes of esophagectomy in the management of end-stage achalasia are less defined. A literature search was conducted to identify all reports on esophagectomy for end-stage achalasia between 1987 and 2017. MEDLINE, Embase, and Cochrane databases were consulted matching the terms “achalasia,” “end-stage achalasia,” “esophagectomy,” and “esophageal resection.” Seventeen articles met the inclusion criteria and 1422 patients were included in this narrative review. Most of the patients had previous multiple endoscopic and/or surgical treatments. Esophagectomy was performed through a transthoracic (74%) or a transhiatal (26%) approach. A thoracoscopic approach was used in a minority of patients and seemed to be safe and effective. In 95 per cent of patients, the stomach was used as an esophageal substitute. The mean postoperative morbidity rate was 27.1 per cent and the mortality rate 2.1 per cent. Symptom resolution was reported in 75 to 100 per cent of patients over a mean follow-up of 43 months. Only five series including 195 patients assessed the long-term follow-up (>5 years) after reconstruction with gastric or colon conduits, and the results seem similar. Esophagectomy for end-stage achalasia is safe and effective in tertiary referral centers. A thoracoscopic approach is a feasible and safe alternative to thoracotomy and may replace the transhiatal route in the future.

Download Full-text

Fertility and Pregnancy in End Stage Kidney Failure Patients and after Renal Transplantation: An Update

Transplantology ◽

10.3390/transplantology2020010 ◽

2021 ◽

Vol 2 (2) ◽

pp. 92-108

Author(s):

Maurizio Salvadori ◽

Aris Tsalouchos

Keyword(s):

Renal Transplantation ◽

Time Lapse ◽

Sexual Life ◽

End Stage Kidney Disease ◽

Correct Evaluation ◽

Functional Aspects ◽

Long Term Follow Up ◽

End Stage

Sexual life and fertility are compromised in end stage kidney disease both in men and in women. Successful renal transplantation may rapidly recover fertility in the vast majority of patients. Pregnancy modifies anatomical and functional aspects in the kidney and represents a risk of sensitization that may cause acute rejection. Independently from the risks for the graft, pregnancy in kidney transplant may cause preeclampsia, gestational diabetes, preterm delivery, and low birth weight. The nephrologist has a fundamental role in correct counseling, in a correct evaluation of the mother conditions, and in establishing a correct time lapse between transplantation and conception. Additionally, careful attention must be given to the antirejection therapy, avoiding drugs that could be dangerous to the newborn. Due to the possibility of medical complications during pregnancy, a correct follow-up should be exerted. Even if pregnancy in transplant is considered a high risk one, several data and studies document that in the majority of patients, the long-term follow-up and outcomes for the graft may be similar to that of non-pregnant women.

Download Full-text

Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection

Viruses ◽

10.3390/v13050904 ◽

2021 ◽

Vol 13 (5) ◽

pp. 904

Author(s):

Ramin Raul Ossami Saidy ◽

Irina Sud ◽

Franziska Eurich ◽

Mustafa Aydin ◽

Maximilian Paul Postel ◽

...

Keyword(s):

Liver Transplantation ◽

Overall Survival ◽

Hepatitis B ◽

Graft Function ◽

Passive Immunization ◽

Standard Regimen ◽

Long Term Follow Up ◽

Hdv Infection ◽

End Stage

Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.

Download Full-text

Chronic Plantar Heel Pain: Treatment with a Short Leg Walking Cast

Foot & Ankle International ◽

10.1177/107110079601700109 ◽

1996 ◽

Vol 17 (1) ◽

pp. 41-42 ◽

Cited By ~ 24

Author(s):

Christopher L. Tisdel ◽

Marion C. Harper

Keyword(s):

Complete Resolution ◽

Surgical Intervention ◽

Pain Treatment ◽

Heel Pain ◽

Treatment Modalities ◽

Plantar Heel Pain ◽

Long Term Follow Up

The efficacy of a short leg walking cast in the treatment of chronic plantar heel pain was assessed for 32 patients with 37 involved extremities treated over a 2-year period. All patients had failed numerous other treatment modalities and had been symptomatic for an average of 1 year. Long-term follow-up for 24 patients with 28 involved extremities revealed complete resolution of pain for 7 extremities (25%), improvement for 17 (61%), and no improvement for 4 (14%). Ten (42%) patients were completely satisfied with cast treatment, 3 (12%) were satisfied with reservations, and 11 (46%) were dissatisfied. Casting appears to be a reasonable option for patients with recalcitrant heel pain and should be offered before surgical intervention.

Download Full-text

Evaluation of the Child with Asymptomatic Proteinuria

Pediatrics in Review ◽

10.1542/pir.5.8.248 ◽

1984 ◽

Vol 5 (8) ◽

pp. 248-254

Author(s):

Leonard G. Feld ◽

Morris J. Schoeneman ◽

Frederick J. Kaskel

Keyword(s):

Routine Examination ◽

End Stage Renal Failure ◽

Persistent Proteinuria ◽

Orthostatic Proteinuria ◽

Long Term Follow Up ◽

End Stage ◽

Age And Sex ◽

Asymptomatic Proteinuria

Asymptomatic proteinuria is defined as the discovery of proteinuria on a routine examination without evidence of clinical disease. The prevalence is dependent on the age and sex of the child, as well as the circumstances under which the testing is performed. In the majority of cases, patients have transient or orthostatic proteinuria. The physician can assure the patient and parents that the prognosis is excellent. However, appropriate long-term follow-up is essential. On the other hand, persistent proteinuria represents a spectrum from a benign disorder to a disease which can progress to end-stage renal failure.

Download Full-text