Neglected alkaptonuric patient presented with low back pain and radiculopathy: A case report

Background: Alkaptonuria (AKU) is a rare hereditary disorder in which excess homogentisic acid (HGA) deposits in connective tissues (ochronosis). Here, we report the unusual presentation of a lumbar disc herniation occurring in a patient with AKU warranting surgical intervention. Case Description: A 28-year-old male presented with 1 year of low back pain. The lumbar magnetic resonance imaging showed an extruded disc at the L4-L5 level accompanied extensive disc space narrowing and osteophyte formation. At surgery, the interspinous ligaments, facet joints, and disc herniation were black. In addition, the postoperative re-examination revealed a black discoloration of the nasal and ear cartilage. Finally, the diagnosis of AKU was confirmed when the urine specimen was positive for HGA. Conclusion: Rarely, younger patients with AKU who develop excess black deposits of HGA in connective tissues (i.e., ochronosis) may present with lumbar disc herniations and spondylosis.

Biomarkers Predicting Treatment-Response in Nephrotic Syndrome of Children: A Systematic Review

Purpose: Nephrotic syndrome (NS) is the most common form of glomerulopathy in children. Most pediatric patients respond to glucocorticosteroid treatment (steroid-sensitive NS, SSNS), while approximately 10–15% will remain unresponsive or later become steroid-resistant. There has been a long-standing effort to find biomarkers that may predict steroid responsiveness.Methods: We systematically reviewed current studies which investigated clinically relevant biomarkers for predicting steroid responsiveness in pediatric NS. We performed a PubMed and EMBASE search to identify eligible articles. We collected data on urinary markers, blood/serum markers (including cellular phenotypes and mRNA expression), genotypes and HLA allele frequency.Results: A total of 659 articles were identified following electronic and manual searches. After reviewing the titles, abstracts, and full texts, 72 eligible articles were finally included. Vitamin D-binding protein (VDBP) seemed to be significantly elevated in SRNS than in SSNS, in both serum and urine specimen, although further validation is required.Conclusions: The present paper narratively illustrates current understandings of potential biomarkers that may help predict steroid responsiveness. Further investigation and collaboration involving a larger number of patients are necessary.

Pathogens and antimicrobial resistance amongst stroke patients in the intensive care unit: A five years review from Benin City, Nigeria

Severe stroke may necessitate intensive care unit admission, but there is a heightened risk of acquiring infection with use of ICU devices. Data regarding infection, pathogens and microbial resistance amongst stroke patients admitted into the ICU is scanty in Nigeria. This study aims to describe the infections, pathogens and antibiotics resistance pattern amongst stroke patients admitted into the ICU. It was a retrospective study. The ICU admission records of all stroke patients at the University of Benin Teaching Hospital from January 2014 to September 2019 were reviewed. The data obtained were the demographics, the types of stroke, results of microbiological studies on endotracheal aspirates, urine specimen, blood specimen, wound swab, vascular catheters, urinary catheters and the antibiogram pattern. One hundred and eight stroke patients were admitted into the ICU during the 5-year under review. The mean age was 61.8 with 51% being females and 52% having ischemic stroke. Seventy-five percent of the stroke patient had hospital acquired infection. Ventilator associated pneumonia accounted for 67.1% of infections, urinary tract infection was 22.8%, and blood stream infection 6.3% while 3.7% had infected decubitus ulcers. Microbial isolates were, Enterobacter sakazakii, accounting for 43.5%, Klebsiella pneumonia 13%, Escherichia coli 11.1%, and Proteus mirabilis 7.4% while 48% had Plasmodium falciparum infection. The micro-bacteria isolates were multi-antibiotics resistant, with the highest resistance for cotrimazole, cefuroxime and ceftazidime. The stroke patient in the ICU is susceptible to developing drug resistant hospital acquired infections, which could increase mortality. Ensuring minimal cases of ICU infection with continuous antimicrobial surveillance and robust antibiotics policy should be the goal.

Pre-operative pyuria predicts tumor recurrence in patients undergoing transurethral resection of bladder tumor with post-operative instillation of BCG

BACKGROUND & OBJECTIVE: In Pakistan, urinary bladder cancer is one of the top ten malignancies. The most important concern after its treatment is tumor recurrence. Recent literature claimed that pre-operative pyuria in patients undergoing transurethral resection of bladder tumor was associated with significantly higher frequency of recurrence. However, there was controversy in existing literature and no such local published material was available which necessitated the present study. To determine the frequency of pre-operative pyuria in patients undergoing transurethral resection of bladder tumor for non-muscle invasive bladder cancer (NMIBC) with post-operative instillation of Bacillus Calmette Guerin (BCG) and to compare the frequency of tumor recurrence in patients with and without pre-operative pyuria. METHODOLOGY: It was a comparative study. This study involved 280 patients of both genders aged between 20-80 years. Pre-operative pyuria was diagnosed if early morning midstream urine specimen showed ≥10 white blood cells/HPF. Outcome variable was frequency of recurrence after 12 weeks of treatment on check cystoscopy. RESULTS: The mean age of the patients was 57.1±8.5 years. There were 236 (84.3%) male and 44 (15.7%) female patients in the study. 155 (55.4%) patients were tobacco smoker. Pre-operative pyuria was diagnosed in 127 (45.4%) patients while tumor recurrence was observed in 183 (65.4%) patients. The frequency of tumor recurrence was significantly higher in patients with pre-operative pyuria (85.8% vs. 48.4%; p<0.001). CONCLUSION: Pre-operative pyuria was a frequent finding in patients with non-muscle invasive bladder tumor and was associated with higher frequency of tumor recurrence which warrants routine screening of such patients for pyuria and increased frequency of tumor recurrence.

Association between Bisphenol A Urine Level with Low-Grade Albuminuria in Egyptian Children and Adolescents

The glomerulus is the accessible window to visualize the endothelial status of the whole body. Minimal level of albuminuria even below the cutoff point of microalbuminuria might be a marker of endothelial dysfunction. Exposure to Bisphenol A may be a risk factor of developing low-grade albuminuria in pediatrics. Aim: This study investigated the association of exposure to Bisphenol A and the presence of low-grade albuminuria. Methods: A cross-sectional study enrolling 158 children; 91 boys and 67 girls. Children with hepatic disease, kidney disease and endocrinopathies were excluded from the study. Urinary albumin and creatinine were measured in a first morning urine specimen. Urinary albumin/creatinine ratio was calculated in mg/gm and was stratified into: macroalbuminuria of ˃300mg/gm, microalbuminuria of 30-300mg/gm and low grade albuminuria of ˂30mg/gm. Urinary Bisphenol A was measured by high performance liquid chromatography using florescent detector. Results: Low grade albuminuria was detected in 141 participants (89.24%), while microalbuminuria and macroalbuminuria were detected in 15 (9.5%) and 2 (1.26%) participants, respectively. The total urinary Bisphenol A in candidates with low grade albuminuria was categorized into four quartiles (<0.285, 0.285–0.599, 0.600–1.215, >1.215) ng/mL and similarly their low grade albuminuria into (<2.0404, 2.0404–4.0385, 4.0386–7.3870, >7.3870) mg/gm. Children with the highest compared to the lowest quartile of urinary Bisphenol A had comparable mean of low grade albuminuria with insignificant P value. Conclusion: low grade albuminuria was found in 141 out of 158 children. A direct cause effect of exposure to Bisphenol A could not be proved. Further studies are needed to investigate the pathophysiology of low grade albuminuria and its significance

Preparation of human biological fluid for studies by Laser Doppler Spectroscopy

The paper presents a method for preparing the human biological fluid by the example of urine specimen for studies by Laser Doppler Spectroscopy. The time and storage conditions of the specimen acceptable for correct research are determined. The optimal parameters for measuring and calculating dimensions - temperature, viscosity, refractive index – are identified. The need to filter samples before testing is noted. The centrifugation parameters are determined.

A study on Asymptomatic Bacteriuria in Women with Diabetes Mellitus

Background: Diabetes is the common predisposing factor for Urinary Tract Infection. In diabetic patients, asymptomatic bacteriuria is more prevalent in females compared to male patients. Bacteria count for similar species over 10^5 per ml in urine specimen of mild stream clean catch without urinary infection is known as Asymptomatic bacteriuria (ASB). Asymptomatic bacteriuria appears to be incurable, recurring in diabetic patients. Aim: The current study aim to determine the outcomes of asymptomatic bacteriuria in patients with diabetes mellitus. Materials and Methods: This cross-sectional study was carried out on 85 women of diabetes mellitus in the department of General Medicine, Qazi Hussain Ahmad Medical Complex Nowshera and Jinnah Medical College Peshawar for duration of six months from June 2020 to December 2020. Detailed and follow-up histories of all the patients were studied, compared, and reported. Individuals who met the inclusive criteria were enrolled in this study. Women on steroid therapy, with immunodeficiency, and incomplete follow-up history were excluded. The outcome of symptomatic and asymptomatic patients was followed for positive culture in a time span of 3 and 6 months. SPSS version 20 was used for data analysis purposes. Results: The mean age of the patients was 57+15.3. Of the total, 13 (15.3%) UTI were symptomatic women with diabetes, and UTI in asymptomatic patients was 72 (84.7%). In symptomatic cases, the prevalence of hypertension, Macroalbuminuria, and Microalbuminuria were 7 (53.4%), 3 (23.3%), and 3 (23.3%) respectively. HbA1C and eGFR (ml/min/1.732) level was 8.5+0.85 and 92.07+10.3 respectively. Conclusion: Our study concluded that urinary culture detected significant bacteriuria without symptoms such as fever, painful micturition, and urgency, frequent micturition, flank pain, burning micturition, and suprapubic pain. Symptomatic and asymptomatic bacteriuria is more common in females. Also, asymptomatic bacteriuria appears to be incurable, recurring in diabetic females. Keywords: Asymptomatic, Bacteriuria, Diabetes mellitus

Genetic and Phenotypic Characterization of the Novel Metallo-β-Lactamase NDM-29 From Escherichia coli

Objectives: The New Delhi metallo-β-lactamase (NDM) can hydrolyze almost all clinically available β-lactam antibiotics and has widely spread all over the world. NDM-29, a novel carbapenemase, was discovered in an Escherichia coli (19NC225) isolated from a patient with biliary tract infection in 2019 in China.Methods: Conjugation, transformation, cloning test, fitness cost, PacBio Sequel, and Illumina sequencing were performed to analyze the genetic and phenotypic characterization of blaNDM–29.Results: The susceptibility testing results showed 19NC225 was resistant to cephalosporins, carbapenems, combinations of β-lactam and β-lactamase inhibitors, and levofloxacin. Conjugation and transformation were performed to verify the transferability of NDM-29-encoding plasmid, and cloning test was conducted to prove the function of blaNDM–29 to increase carbapenem resistance. Furthermore, fitness cost test confirmed that the presence of NDM-29 exerts no survival pressure on bacteria. PacBio Sequel and Illumina sequencing were performed to analyze the genetic characterization of 19NC225, which contains two plasmids (pNC225-TEM1B and pNC225-NDM-29). pNC225-NDM-29, exhibiting 99.96% identity and 100% coverage with pNDM-BTR (an IncN1 plasmid from an E. coli in urine specimen from Beijing in 2013), showed responsibility for the multidrug-resistant (MDR) phenotype. Compared with blaNDM–1, blaNDM–29, located on pNC225-NDM-29, carries a G388A (D130N) mutation. The region harboring blaNDM–29 is located in an ISKpn19-based transposon, and two Tn6292 remnants are symmetrically located upstream and downstream of the transposon. The sequence results also indicated several important virulence genes.Conclusion: The findings of the novel carbapenemase NDM-29 could pose a threat to the control of antimicrobial resistance and arouse attention about the mutation of bacteria.