Infective discitis with concurrent calcific discitis masquerading as renal colic

Objective: The present study was conducted to investigate the effect of intradermal administration of sterile water compared to intravenous morphine on patients with renal colic. Methods: This double-blind, randomized clinical trial study was conducted in 2017 to compare the therapeutic effects of intradermal sterile water with those of intravenous morphine on patients with renal colic presenting to the emergency departments (ED) of Imam Khomeini and Golestan Hospitals in Ahvaz, Iran. The first group received 0.5 ml of intradermal sterile water, and the second group 0.1mg/kg of intravenous morphine plus 0.5 ml of intradermal sterile water in the most painful area or the center of the painful area in the flank. The pain severity was measured using a visual analogue scale (VAS), and the medication side-effects were recorded at the beginning of the study and minutes 15, 30,45 and 60. Result: A total of 94 patients were studied in two groups. The mean severity of pain was 2.97 ± 1.51 in the sterile water group and 2.34 ± 1.89 in the morphine group at minute 30 (P=0.042), 2.58 ± 1.43 in the sterile water group and 1 ± 1.23 in the morphine group at minute 45 (p<0.001), and 1.89 ± 1.7 in the sterile water group and 0.52 ± 0.79 in the morphine group at minute 60 (p<0.001). Conclusion: Morphine reduces pain faster and more effectively than intradermal sterile water; nevertheless, treatment with intradermal sterile water can be used as an appropriate surrogate or adjunct therapy for pain control, particularly in special patients or in case of medication scarcity.

Download Full-text

Visnagin: A New Perspective of Medicinal Importance, Physiological Functions, Phytochemistry, Pharmacology and Analytical Aspects of Active Phytoconstituents of Ammi visnaga

The Natural Products Journal ◽

10.2174/2210315508666180327154245 ◽

2019 ◽

Vol 9 (3) ◽

pp. 197-206

Author(s):

Kanika Patel ◽

Mahfoozur Rahman ◽

Vikas Kumar ◽

Amita Verma ◽

Dinesh Kumar Patel

Keyword(s):

Angina Pectoris ◽

Renal Colic ◽

Whooping Cough ◽

Analytical Techniques ◽

Epileptic Seizures ◽

Coronary Insufficiency ◽

Ammi Visnaga ◽

Low Blood Pressure ◽

Annual Herb ◽

New Perspective

Background: Ammi visnaga commonly known as ‘honey plant, tooth pick fruit, bisnaga and khella’ is an important plant of Apiaceae family. It is an annual herb found in Europe, Asia, North Africa, Latin America and in India. Carrot, parsnip, celery, coriander, anise, caraway, cumin, parsley and dill are some other plants of the same family i.e., ‘Apiaceae’. Fruits of Ammi visnaga (A. visnaga) are medicinally used as a strong photosensitizer, diaphoretic, carminative and antispasmodic agents. Objective: A. visnaga has been used for the treatment of bronchial asthma, coronary insufficiency, angina pectoris, psoriasis, renal colic and ureteric stones. Visnagin (C13H10O4) is a ‘furanochromone derivative’ which is the main active constituent’s of A. visnaga. Visnagin is used for the treatment of low blood-pressure, angina pectoris and kidney stone. It also has neuroprotective and antiinflammatory activity. Moreover, visnagin also treat whooping cough, ureter and bile duct, gall bladder and renal colic, tumors and epileptic seizures. Methods: This review summarizes data’s regarding the biological importance, pharmacological uses and medicinal importance of A. visnaga and their important active constituent’s “visnagin”. Moreover, the detailed pharmacological aspects of visnagin were presented in this review. Further various analytical techniques used for the extraction and isolation of visnagin were also discussed. Studies related to the pharmacological profile of the plants and their active phytoconstituents are one of the leading areas of research. Conclusion: This review will be beneficial to the scientific society to understand the importance of A. visnaga plant and their active constituents ‘visnagin’for the development of alternative tools to treat disorders in the future.

Download Full-text

Symptomatic kidney stones in an anuric patient on dialysis: A case report

Urologia Journal ◽

10.1177/03915603211035927 ◽

2021 ◽

pp. 039156032110359

Author(s):

Hossein Dialameh ◽

Farshad Namdari ◽

Mehrdad Mahalleh ◽

Mohammad Lotfi ◽

Zoha Ali

Keyword(s):

Renal Colic ◽

Chest Ct ◽

Chief Complaint ◽

Flank Pain ◽

The Past ◽

Extracorporeal Shock Wave ◽

Stage Renal Disease ◽

End Stage ◽

Prompt Diagnosis ◽

Chest Ct Scan

Introduction: Renal colic is a colicky-type of flank pain that can commonly be presented in patients undergoing dialysis especially if they are anuric considering the fact that there are multiple controversies and little published experience on this topic, we found it very important to report this case. We also aimed to increase awareness and emphasize the importance of renal colic in anuric patients on dialysis. Case description: We herein report a case of a 42-year old man with a chief complaint of bilateral colic flank pain, He had developed end stage renal disease due to ADPKD and was on hemodialysis since the past 5 years. Previously, he went through a series of workup but was left undiagnosed. Abdomen-pelvic and chest CT scan without contrast was performed showing bilateral renal pelvic stones and some nephrocalcinosis in both kidneys. bilateral ureteroscopy was performed and bilateral DJ was installed for a total of 6 weeks and extracorporeal shock wave lithotripsy was done. With prompt diagnosis, the patient was pain free and stone free before discharge. The patient is also reported to be stone free 6 months after the procedure. Conclusion: Patients on dialysis are still capable of forming symptomatic renal tract stones even if they are anuric.

Download Full-text

A study of crystalluria: effectiveness of including hygienic-dietary recommendations in laboratory reports

Advances in Laboratory Medicine / Avances en Medicina de Laboratorio ◽

10.1515/almed-2020-0124 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Paula Sienes Bailo ◽

María Santamaría González ◽

Silvia Izquierdo Álvarez ◽

Raquel Lahoz Alonso ◽

Patricia Serrano Frago ◽

...

Keyword(s):

General Population ◽

Observational Study ◽

Renal Colic ◽

Incidence Rates ◽

Retrospective Observational Study ◽

Dietary Recommendations ◽

Group A ◽

Group B

Abstract Objectives To assess the effectiveness of incorporating hygienic-dietary recommendations in laboratory reports in reducing the incidence of renal colic (RC). A study was performed to compare the incidence of RC in two groups of patients who had suffered at least a crystalluria event associated with the risk of urolithiasis. Recommendations were only incorporated in the laboratory reports of one group. Methods A retrospective observational study. The study sample was composed of patients who had at least an episode of crystalluria associated with a higher risk of urolithiasis. The laboratory reports of patients in Group A (n=1,115), treated in 2017, did not include any hygienic-dietary recommendations, whereas patients in Group B (n=1,692), treated in 2018, received hygienic-dietary recommendations through their laboratory reports. χ2 and Mann-Whitney U test were used to assess differences based on sex, age, and type of urinary crystals. Results The incidence of RC was 2.02 times higher in group A (2.24%) than in group B (1.12%). No significant differences were observed in the incidence of RC based on the type of urinary crystal. The incidence of RC was substantially higher in patients who suffered at least an event of crystalluria associated with a higher risk for urolithiasis as compared to the general population during the same period (0.46%, consistently with the incidence rates reported in the literature). Conclusions The incorporation of messages alerting on the risk of urolithiasis and the inclusion of hygienic-dietary recommendations in laboratory reports may be useful for reducing the incidence of RC.

Download Full-text

Reported and unreported potentially important incidental findings in urgent nonenhanced abdominal CT for renal colic

Medical Principles and Practice ◽

10.1159/000515852 ◽

2021 ◽

Author(s):

Elena Belloni ◽

Stefania Tentoni ◽

Ilaria Fiorina ◽

Chandra Bortolotto ◽

Olivia Bottinelli ◽

...

Keyword(s):

Emergency Department ◽

Health Status ◽

Pleural Effusion ◽

Incidental Findings ◽

Renal Colic ◽

Legal Issues ◽

Abdominal Ct ◽

Significant Difference ◽

Original Report ◽

The Difference

PURPOSE: To retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. METHOD: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January through December 2017 on adult patients from the Emergency Department with the specific request of urgent evaluation for renal colic, searching for potentially important incidental findings. RESULTS: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported potentially important incidental findings between the original report and re-evaluation was significant (P<.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the three shifts neither in the original report nor in the re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopaties and liver nodules. CONCLUSIONS: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to under report potentially important incidental findings even in the urgent setting because of the possible consequences on the patient’s health status and in order to avoid legal issues, while satisfying the need for timely and efficient reporting.

Download Full-text

P125: Low dose intravenous ketorolac in renal colic, a pilot randomized controlled trial

CJEM ◽

10.1017/cem.2020.330 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S109-S110

Author(s):

J. Chao ◽

P. Brasher ◽

K. Cheung ◽

R. Sharma ◽

K. Badke ◽

...

Keyword(s):

Dose Group ◽

Low Dose ◽

Renal Colic ◽

Standard Dose ◽

Controlled Trial ◽

Pain Reduction ◽

Primary Objective ◽

Recruitment Rate ◽

Convenience Sample ◽

Increased Risk

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are first-line analgesics for emergency department (ED) patients with renal colic. Lower doses of intravenous (IV) ketorolac may provide similar pain relief to standard dosing in patients with acute pain. Patients with renal colic may be at increased risk of acute kidney injury; exposing them to lower doses of NSAIDs may put them at lower risk while providing equally effective analgesia. We conducted a pilot study to determine the feasibility of a randomized trial comparing the effectiveness and safety of low with standard ketorolac dosing in ED patients with suspected renal colic. The primary objective was to demonstrate the ability to achieve an enrolment target of 2 patients per week. Methods: We enrolled a convenience sample of adults presenting to an academic urban ED with unilateral flank pain suspected to be renal colic. We randomized patients to 10 mg (low dose, intervention) or 30 mg (standard dose, control). Participants, treating physicians and nurses, and researchers were blinded to treatment allocation. Our main feasibility outcome was the recruitment rate. Secondary outcomes were changes in pain scores (0-10) at 30 and 120 minutes post-ketorolac administration, vital signs, adverse events and ED length of stay. Results: We approached 82 patients, of whom 47 (57.3%) were eligible. Of these, 36 consented to participating and 30 were randomized. The proportion of screened patients who were enrolled was 36.6% (30/82). We completed enrolment over a 21-week period, with an average recruitment rate of 1.5 patients/week (range 0-4). The average baseline pain score for all participants was 6.9 (SD = 2.1). At 30 minutes post-ketorolac administration, the low dose group had a mean pain reduction of 2.0 points compared to a pain reduction of 1.7 in standard dose group (difference = 0.3, 90% CI: -0.7 to 1.4). Conclusion: These preliminary results support the possibility that low dose ketorolac may be efficacious in this patient population. We did not meet our target recruitment of 2 patients per week as this was primarily due to restricted recruitment hours. To successfully conduct a larger trial, we would need to expand both recruitment hours and the number of sites.

Download Full-text