Posterior urethral valve is a congenital obstruction of the urethra that prevents normal urine flow from the bladder. It develops early in gestation from failed regression of the mesonephric duct, exposing the urinary tract to elevated pressure and risk of injury. Diagnosis is made via ultrasound and voiding cystourethrogram showing characteristic tapering of the urethra. Treatment involves catheterization and endoscopic ablation of the valves. Complications include incontinence, infections, and renal failure.
Presentation delivered at a paediatric clinical meeting of the Federal Medical Center, Lokoja. Nigeria
This presentation doesn't serve as a substitute for texts and/or journals.
Presentation delivered at a paediatric clinical meeting of the Federal Medical Center, Lokoja. Nigeria
This presentation doesn't serve as a substitute for texts and/or journals.
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Vesicoureteral Reflux Causes, Symptoms And Treatments by Dr. Prashant Jain-co...Dr. Prashant Jain
Kidneys are important organ for urine formation. Normally, urine flows into the bladder through ureters. However, in some children, urine from the bladder flows back through the ureters. This condition is known as Vesicouretral reflux (VUR) and is common in infants and children. It can be unilateral or bilateral. This could cause infections and damage your kidneys. VUR affects about 10% of children. Although most can grow out of this condition, people who have severe cases may need surgery to protect their kidneys.
This condition should not be ignored as it damages the function of kidneys and can lead to high blood pressure later in life. The risk of kidney damage is greatest during the first 6 years of life.
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Vesicoureteral Reflux Causes, Symptoms And Treatments by Dr. Prashant Jain-co...Dr. Prashant Jain
Kidneys are important organ for urine formation. Normally, urine flows into the bladder through ureters. However, in some children, urine from the bladder flows back through the ureters. This condition is known as Vesicouretral reflux (VUR) and is common in infants and children. It can be unilateral or bilateral. This could cause infections and damage your kidneys. VUR affects about 10% of children. Although most can grow out of this condition, people who have severe cases may need surgery to protect their kidneys.
This condition should not be ignored as it damages the function of kidneys and can lead to high blood pressure later in life. The risk of kidney damage is greatest during the first 6 years of life.
In this presentation nuclear medicine application in nephrology is explained in detail based on UPTODATE evidence based recommendations.
Different examples were given.
Vesicoureteric Reflux in Children—Current ConceptsApollo Hospitals
Urinary tract infection (UTI) is a common problem in infants and young children affecting about 2–5% of all small
children. Almost a third to half of infants who are inflicted with urinary infection are likely to have an abnormal urinary
tract, commonest of which is vesicoureteric reflux (VUR). Around 10–20% of children with VUR end with hypertension
or end stage renal disease stressing the need to diagnose and manage these children early. This article reviews
current status of clinical manifestations, diagnosis, and management of children with VUR.
Criteria for preterm labor, evaluation, diagnosis and management of preterm labor. Very summarized and very informative. MSF's guidelines and uptodate recommendations.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Posterior urethral valve, vesico-urethral reflex and nephrolithiasis
1. Posterior urethral valve
Introduction
Posterior urethral valve is the most common cause of severe obstruction uropathy in male
infants. Posterior urethral valves are congenital obstruction of posterior urethra. As this disorder
develops early in gestation, the bladder and upper urinary tract are exposed to elevated pressure
throughout development, leading to far-reaching changes to bladder function and renal injury.
There are obstructing flaps of tissue in the urethra that prevents the normal urine flow from the
bladder.
Pathology
Posterior urethral valves result from the formation of a thick, valve-like membrane from a tissue
of Wolffian duct origin (failure of regression of the mesonephric duct ) that courses obliquely
from the verumontanum to the most distal portion of the prostatic urethra. This is thought to
occur in early gestation (5-7 weeks). The valve is a diaphragm with a central pinhole, however as
it is more rigid along its line of fusion it gradually distends and becomes distended into a bilobed
sail-like or windsock-like structure
Classification
Dr. Hugh Hampton Young, M.D classified it into tree types:
Type 1:
Obstructing membrane that extends distally from each side of the verumontanum towards the
membranous urethra where they fuse anteriorly. (most common)
Type 2:
It described as folds extending cephalad from the verumontanum to the bladder neck.
Type 3:
Represent a diaphragm or ring-like membrane with a central aperture just distal to the
verumontanum. Thought to represent incomplete dissolution of the urogenital membrane.(least
commom)
Presentation
The severity of symptoms and age at presentation depend on the degree of obstruction that the
valves cause in the urinary tract. The most common typical presentation is detection of
hydronephrosis during routine prenatal ultrasound. The symptoms vary from mild cases that
2. present at a later age to severe cases that are detected prenatally with low levels of amniotic fluid
and problems with lung and kidney development. In severe cases a newborn child may have
difficulty balancing fluids and electrolytes and require mechanical ventilation due to difficulty
with breathing.
Diagnosis
The diagnosis of posterior urethral valves is made by radiographic imaging with ultrasound and
voiding cystourethrogram. Ultrasound will usually show a dilated urethra, bladder, and kidneys;
it is supportive of the diagnosis of posterior urethral valves, but not confirmatory. Voiding
cystourethrogram is the most definitive study for diagnosis and will show a characteristic
tapering of the urethra. Occasionally, confirmation of valves with cystoscopy (small camera is
inserted into the urethra for direct visualization of valves) is required.
Treatment
Shortly after delivery a catheter will be placed into the urethra to continuously drain the urine
from the bladder. Once your child is stable the posterior urethral valves are treated. This is done
inserting a camera into the urethra. The valves are cut from the inside using the camera
(endoscopic valve ablation). Occasionally the urethra is too small for the camera to fit. In this
case the bladder is temporarily brought up to the skin on the belly so that the urine can directly
drain into the diaper and not have to flow through the urethra. Fetal intervention is possible at
specialized centers if amniotic fluid levels are dangerously low and the fetus is between 20-32
weeks gestation.
Complication
Incontinence
Urinary tract infection
Renal failure
Vesicoureteral reflux
Chronic kidney disease
3. Vesico-urethral reflex
Introduction
Vesicoureteral reflux (VUR) is the abnormal retrograde flow of urine from the bladder into the
ureter and possibly the kidney. It can be primary in which VUR presents at birth and arises due
to defect in the development of ureter. Primary VUR is more common as compared to the
secondary VUR and it can be detected shortly after birth. In secondary VUR, it occurs when
obstruction in the bladder or the urethra forces the urine to flow back to the kidney it may occur
in children with posterior urethral valves or neurogenic bladders. Secondary reflux also occurs in
children who have complete ureteral duplication as well as due to injury, surgery or post-
infection. And it can occur at any age.
Causes
In healthy people the ureters enter the urinary bladder obliquely and run submucosally for some
distance. These phenomena as well as the ureter's muscular attachments, helps secure and
support them posteriorly. Together these features produce physiologic valve that occludes the
ureteric opening during storage and voiding of urine. In people with VUR, failure of this
mechanism occurs, with resultant backward flow of urine to the kidney,
Clinical features
Most children with vesicoureteral reflux are asymptomatic. Vesicoureteral reflux may be
diagnosed as a result of further evaluation of dilation of the kidney or ureters draining urine from
the kidney while in utero as well as when a sibling has VUR (even though it’s somehow
controversial). Reflux also increases risk of acute bladder and kidney infections, so testing for
reflux may be performed after a child has one or more infectionsVUR is associated with two
related consequences: UTI and renal scarring. In infants, the signs and symptoms of a urinary
tract infection may include only fever and lethargy, with poor appetite and sometimes foul-
smelling urine, while older children typically present with discomfort or pain with
urination and frequent urination.
Grades
International reflex study in children grades vesico-urethral reflex into five grades based on it’s
severity:
Grade I: VUR does not reach the renal pelvis.
4. Grade II: VUR extends up to the renal pelvis without dilation.
Grade III: Mild or moderate dilation of the ureter and the renal pelvis. No or slight
blunting of the fornices.
Grade IV: there are moderate dilation of the ureter, renal pelvis, and calyces. Complete
obliteration of the sharp angle of the fornices but maintenance of the papillary impression
in most calyces.
Grade V: there is gross dilation and tortuosity of the ureter, as well as gross dilation of the renal
pelvis and calyces. The papillary impressions are not visible in most calyces.
Diagnosis
Whenever suspected for the presence of vesico-urethral reflex through history or clinical
presentation, there are different procedures that can be used to diagnose it. these modalities
include: A urine culture, to check for a UTI, cystography, fluoroscopic voiding
cystourethrogram (VCUG), abdominal ultrasound and technetium-99m dimercaptosuccunic,
acid (DMSA) Scintigraphy. A voiding cystourethrogram (VCUG) is the standard diagnostic
approach, with the advantages of allowing grading of VUR and providing excellent
anatomicdetails.
Management
Because VUR has a high rate of spontaneous resolution, conservative nonoperative treatment of
VUR grades I–III is the standard initial approach. The goal is to prevent UTIs and consequent
renal scarring until the VUR resolves. The aim of the treatment is mostly to minimize infection by
the use of anti-biotic. This is how it’s recommended:
Amoxicillin or ampicillin – infants younger than 6 weeks
Trimethoprim-sulfamethoxazole (co-trimoxazole) – 6 weeks to 2 months
After 2 months the following antibiotics are suitable:
Nitrofurantoin {5–7 mg/kg/24hrs}
Nalidixic acid
Bactrim
Trimethoprim
Cephalosporins
5. Endoscopic injection involves applying a sugar containing gel around the ureteral opening to
create a valve function and stop urine from flowing back up the ureter. Surgical approaches that
are indicated four grades IV & V as well as infections refractory to the drugs include ;
endoscopic (STING/HIT procedures); laparoscopic; robotic-assisted laparoscopic; and open
procedures.
Complications
Renal scaring, hypertension and kidney failure are among its complications.
Nephrolithiasis
Introduction
Nephrolithiasis also known as kidney stone, urolithiasis or renal calculi is the formation of solid
crystal minerals in the kidney. Kidney stones usually form in the kidney but pass to the outside
world if it’s less than 5cm. it’s one of the most common cause of hematuria and abdominal pain.
It’s believed to arise from the interaction of genetic (susceptible people) and the environment
(food/fluid and life style).
Pathophysiology
Even though kidney stones are common, it only arises in the presence of many factors together.
Nephrolithiasis occurs in change of urine saturation, absence of protective roles absence of
inhibitors of stone formations, change in urine ph and infection with certain bacteria. The
stimulant of the stone formation is the supersaturation of the urine which may be due to
increased mineral concentrations in the urine of dehydration. The most common mineral
compounds that causes kidney stone is calcium-oxalate (monohydrate or dihydrate), in acidic
urine, uric acid, in purine-rich food struvite (magnesium ammonium phosphate), after infection
with proteus mirabilis, Proteus vulgaris and morganella morganii, calcium phosphate, in
alkaline urine and cystein. This helped by the decrease or absence of inhibitory factors like
citrate, magnesium, calgranulin (a calcium-binding protein), glycosaminoglycans and
prothrombin F1 peptide.
6. Clinical features
While some kidney stones may not produce symptoms (known as "silent" stones), people who
have kidney stones often report the sudden onset of excruciating, cramping pain in their low back
and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The
abdominal, groin, and/or back pain typically waxes and wanes in severity, characteristic of
colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often
accompanied by nausea and vomiting. The pain has been described by many as the worst pain of
their lives, even worse than the pain of childbirth or broken bones. Kidney stones also
characteristically cause bloody urine. If infection is present in the urinary tract along with the
stones, there may be fever and chills. Sometimes, symptoms such as difficulty urinating, urinary
urgency, penile pain, or testicular pain may occur due to kidney stones.
Diagnosis
The diagnosis of kidney stones is suspected when the typical pattern of symptoms is noted and
when other possible causes of the abdominal or flank pain are excluded. The different modalities
that can be used for the diagnosis include: ultrasound –high-yield test and cost-effective. Plain x-
ray- 80% yield. A noncontrast spiral computed tomography (CT) scan-high yield test. Check serum
and urine calcium. Urine analysis and urine culture (to hunt urease producing bacteria- exclude H.
pylori) ,IV pylegrram and CBC.
Management
Analgesia, hydration and bed rest are the mainstays of treatment.
Shockwave lithotripsy for stones <2 cm but fragments can themselves cause obstruction.
Uretroscopy
Percutaneous removal
Borderline-sized stones 5-7 mm can be expelled by using nifedipine and tamsulosin.