Urinary Tract Infections - Science topic

Without fully knowing what your methodology is, it's difficult to make a full recommendation. "a" appears that your population is comatose ICU patients in KFMMC, and that you'll be doing some sort of non-experimental design and only looking for a correlation. If all that is correct, it is a good title.

"b" is a bit less clear. It sounds like you're doing a quasi-experimental design looking for cause and effect, since you say "the effect of...". I guess quasi-experimental because you will probably not randomly assign people to groups. Instead, the groups will be either "had a visitor" or "did not have a visitor". Your population appears to be hospitalized patients at KFMMC. The word "fewer" is confusing. I think your independent variable is "complaints", so you're examining the effect of visitors on complaints. I would remove the word "fewer", since that identifies your results, not the variable.

"The Effect of Daily Visitors on Somatic Complaints among Hospitalized patients in Medical Male Ward, King Fahd Military Medical Complex, Hospital."

Good luck.

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First I would contact the author. Best wishes, David Booth

Yes, there is ... the American, Europian, and British Pharmacopoeia

I agree with the excellent and comprehensive answers from Mary CR Wilson.

Just to add recurrent UTI's occurring in the context of an incomplete course of antibiotics, and /or resistance to the prescribed antibiotic, anatomical bladder abnormalities (diverticulae, calculus), functional -vesico-urethral reflux, renal calyx- pyelonephrosis, calculi, underlying co-morbidities (diabetes) and perimenopausal changes in estrogen levels.

Hello! There are numerous species of bacteria that can cause UTI including: Klebsiella pneumoniae which is a pathogen most often identified in a compromised host including UTI infected patients, Proteus mirabilis identified as an opportunistic pathogen that causes wound and urinary tract infections, Enterococcus faecalis which is a Gram-Postive bacteria found in urine cultures of UTI patients along with Escherichia coli, and Staphylococcus saprophyticus which is associated with UTIs in young women.

The severity of the UTI depends on the pathogen present in the urinary tract as well as the clinical state of the patients. Risk factors such as sex (women have shorter urethra than men leading the bacteria to reach the urinary tract faster than men), age (geriatric patients are more susceptible to UTI because of pre-existing conditions as well as increased risk to infections due to decreased immunity), existing clinical state of the patient (immunosuppressed), and other less common causes such as indwelling catheters (Catheter Associated - Urinary Tract Infection). It is also important to note that taking antibiotics are associated with increasing the resistance of bacteria such as Escherichia coli making it harder to treat UTI.

References:

Dear Zara,

I worked with these cell lines for several years. These two cells grow very well, Initially it is slow, but later it grow very well if not contaminated with mycoplasma. So far I remember, I used RPMI 1640 for 5736 and DMEM for T24 cells. 10% serum is fine and you don't need anything else. 5736 cells is very sticky to culture plate, very careful for passaging!!! If you need any further help, please mail me: provash2000@gmail.com

The pathogenesis is controversial. According to the most popular hypothesis , dietary tryptophan is converted to indole by gut bacteria, which is further metabolized in the liver to indoxyl sulphate and then excreted in the urine. Constipation favors conversion of tryptophan to indole by gut bacteria.

Once excreted, indoxyl sulphate can be processed by bacteria colonizing the urinary catheter to indoxyl, which is further converted to indigo (blue) and indirubin (red). ( Initially had red tinged urine which became orange as urine flowed)

The most commonly involved

bacteria are Providencia stuartii, Providencia rettgeri, Escherichia coli, Klebsiella pneumoniae,( like our patient) Proteusmirabilis, Morganella morganii, Pseudomonas aeruginosa, and Enterococcus species [4]. These bacteria produce indoxyl phosphatase and sulphatase enzymes.

so it solves our puzzle!!

I would culture urine for ureaplasma urealyticum.

At next cystoscopy, culture stone or stones removed for aerobic, anerobic and ureaplasma organisms.

Consider staph epidermidis that occasionally is a urea splitter.

 Dear stephen:

In my opinion you should concrete the question: which mathematical model are you searchirng for?: an epidemiological model based on the propagation of an outbreak of UTI among a determined populationd population or a risk factor model based on the determination of variables which influence the appearance of a UTI.

 Never found any in follow up outdoors, no such complaints

I would suggest ensuring that urine samples are centrifuged and then frozen in aliquots at -80 C. It is not recommended to add anything to urine samples for metabolomics analysis because this can interfere greatly with measurement of metabolites. If you are not able to freeze the samples, then you will have to sterile-filter the samples and store them in sterilized aliquots. Note that if you filter the samples, you will get significant glycerol contamination (glycerol is a universal chemical found in almost all filters) which can substantially interfere with metabolite measurements, particularly NMR measurement. I am not sure about whether these additives will interfere with other metabolomics methods.

You should not have to add protease inhibitors if you are only measuring metabolites.

Hope this helps!

Paige

I never use tranexamic acid in bladder surgery. Clot formation/organization in bladder can be dangerous for the patient.

I think it is important to point out that the relationship between infection and onset of renal calculi hasn't been totally explained even for struvite nephrolithiasis. In fact, there are data suggesting that even other bacteria, in addiction to the urease-producing ones, may have a role in the onset of the struvite nephrolithiasis. Very recent data show that in the cases of staghorn nephrolithiasis, traditionally considered as infective, is possible to detect a metabolic origin and the role of possible infective agents remains unclear. And I agree with Dr Forray: "More detailed study on the stones can be carried out by electron micro-probe investigation, like elemental mapping".

There is not a clear understanding of this phenomenon but the following two articles might have some clues:

1.Ohno N, Ota Y, Hatakeyama S, Yanagimoto S, Morisawa Y, Tsukada K, Koike K, Kimura S. A patient with E. coli-induced pyelonephritis and sepsis who transiently exhibited symptoms associated with primary biliary cirrhosis. Intern Med. 2003 Nov;42(11):1144-8.

Smyk DS, Bogdanos DP, Kriese S, Billinis C, Burroughs AK, Rigopoulou EI.Urinary tract infection as a risk factor for autoimmune liver disease: from bench to bedside.

Clin Res Hepatol Gastroenterol. 2012 Apr;36(2):110-21. 

I totally agree with Dr Mohamed Elkoushy and would like to add that recommendations for pregnant women are to be screened by urine culture by the end of first trimester. If asymptomatic bacteruria detected, then antibiotic is given and further screening during whole pregnancy is recommended. If no asymptomatic bacteruria is detected by screening at then end of first trimester, then no further screening is recommended during the whole course of pregnancy.

Check this article on Audit on UTI

The first thing you need to do is to submit your research protocol to any research ethics committee closest to you. The committee must of course be recognized and approved bu the government. After obtaining and approval then you can know approach any hospital of your choice with your approval letter so that the clinical and laboratory staffs can asist you. You will then need to recruit participants into the study by explaning your study to the target subjects and seeking their consent before obtaining their samples.

The antibacterial spectrum of fosfomycin includes staphylococci, Haemophilus sp. and most of the enteric gram-negative bacteria, but with a considerably higher MIC for Klebsiella sp., Enterobacter sp. and Serratia sp. Fosfomycin is moderately active against Pseudomonas aeruginosa with variable MICs ranging from 4 to >512 mg/L.

research is done according to the age group. pregnant not pregnant.   Curious where you are going with this.

I have not seen allergy to that but flatulence and increasing of Na and blood pressere and edema may be done.

As a possible urea-splitting bacteria it more commonly originates struvite stones instead of calcium phosphate stones. Beware that not all apatite 

other foods like apple juice, grape juice and green tea contain proanthocyanidins (PACs), cranberries are the only food that contain PACs with A-type linkages (as opposed to B-type linkages). The unique molecular structure explains why cranberries are the only food associated with urinary tract health.

as demonstrated in the link down

It depends on your aims and objectives. Adhesive UPEC is more typical for lower UTIs and lower UTIs are more intrinsic to females. In male gender UTIs are considered as complicated as default and microbial pattern may be more compex. But for ex-vivo experiments it IMHO doesn't matter what gender will you choose.

Several papers present research on this topic. Many state an antimicrobial coating, whether an antibiotic or metal, does not reduce the instances of CAUTI's

Some extra reading for you

Poisson Regression

It depends upon culture results, I wouldnt start him on either antibiotic empirically.If it is a female patient with uncomplicated cystitis I would start with Trimethoprim.

I was wondering whether the systemic uptake of oestrogen would be, following bladder installation, as the low systemic uptake from vaginal application is one of the benefits of local use.

You are probably aware of the following publications but I have included the references: 

In a Cochrane Review, the work of Kurz et al. 1993 (RCT) is discussed when intravesical estrogen was used 'Intravesical application of estriol in sensory urge incontinence - a prospective study'. (Ref for the Cochrane Review: Cody, June D., et al. "Oestrogen therapy for urinary incontinence in post-menopausal women." Cochrane Database Syst Rev 4 (2009).) The work of Kurz et al. was also included in the 2012 update (ref: Cody, June D., et al. "Oestrogen therapy for urinary incontinence in post-menopausal women." Cochrane Database Syst Rev 10 (2012).) The concept of intravesical estrogen is also mentioned in "Legendre, Guillaume, et al. "Menopause, hormone treatment and urinary incontinence at midlife." Maturitas 74.1 (2013): 26-30" but no detail is given. 

First some questions:

Is the dribbling during daytime with or without urinary urgency?

Further urological history? Childhood urological problems?

What is his maximum flowrate? Is flowcurve normal or with a (very) prolonged end?

Is the postmicturition dribbling depending on voiding position (standing or sitting)?

How does the voiding drinking diary look like, including the report of dribbling?

Which prescriptions have been unsuccesful?

Note: 5 drops (is 0,25mL) give already a large wet spot on cotton!

I think that will be best to use praziquantel as it is the drug of choice recommended by WHO, high effective against all schistosome species and easly accessible. Futhermore, improving water supply, sanitation people awareness regarding the the disease are important measures to reduce the infection.

Sorry, I guess I misunderstood. I don't believe that it is necessary two antibiotics for treatment of complicated or uncomplicated UTI. That seems like an overuse of antibiotics.

I treat only symptomatic patients, I did not understand you were talking about asymptomatic bacteriuria. this is another situation

Is not commom,but not impossible.S.mansoni eggs in sperma is not very rare.Eggs has been found in all tissues and organs:lungs,ovary,kidney,brain,skin,etc,etc

The definition of "new" is questionnable. There are some relatively newer drugs used in some parts of the world, not available in other parts. For example, most of the former USSR countries enjoy the benefits (much better bioavailability and lesser toxicity and side-effects) of soluble Nitrofuran derivate Furazidin (trade name Furamag), first synthesized in Latvia in late 1970's, but those are not available in the Western Europe. I am not aware of the new classes of drugs for treating UTI, sorry

Hi Alejandro,

As a general rule, we get very few prostatitis cases in my part of the world. However as you mentioned either ciprofloxacin 400mg/12h (IV)/ Levofloxacin 500mg/24h (IV) or cotrimoxazole 160/800/12h (some authors say 6 hourly) would be ideal. Continue till there is clinical improvement and switch to oral therapy with the same drugs (cipro-500mg/12h, levoflox-750mg/24h and cotrimox-160/800/12h) for 2 weeks. Bio-availability of the above drugs are good.

Drug of choice for E. faecalis is ampicillin 500mg/6h. For E. faecium the choice would be vancomycin, daptomycin, linezolid, etc.

I too was working related to uti infection. u working with human or animal model??. or only lab work

There really is no universal "best or proper" procedure for fixation. Every fixation procedure does lead to some change in the tissue being fixed. As can be seen from all the replies above the fixation procedure will depend on what you need to do with the tissue later. From your question you have mentioned histological examination. For most histological procedures fixation in 10% buffered formalin give adequate morphological preservation for routine H&E as well as most commonly used histochemical staining procedures. But if you are planning Immuohistochemistry / immunofluorescence or any other immunological procedure then it really depends on the antigenic epitope that is being studied and the available antibodies. You may then have to look at the best fixation procedure and if any antigen retrieval etc would be required later. I do not think storing in PBS is a good idea esp since you plan to study UTI. The bacterial growth that is invariably likely esp if your tissue are already infected may vitiate the results.

what about a cutaneous urostomy on the lower ureter and secondary reimplant in 1 year. I thing that tapered reimplantation on a six moths old baby has quite a lot of complications.