Pelvic actinomycosis: urologic perspective

PURPOSE: Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli. This paper reviews the etiology and clinical presentation associated with Actinomycosis that often presents as a pelvic mass that mimics a pelvic malignancy. MATERIALS AND METHODS: A combination of patients treated by the authors in the recent past and a literature review of patients with pelvic Actinomycosis were assessed for diographic, clinical and predisposing co-factors. An analysis is made of age distribution, gender, diagnostic methods and treatment concepts. RESULTS: Thirty-three patients were included in the study that included 2 current patients and 31 obtained from literature review. There were 27 fiales (age range 16 - 69 years, mean 38 years) and 6 males (16 - 55 years, mean 36 years). Presenting signs and symptoms were lower abdominal mass in 28 (85%); lower abdominal pain in 21 (63%); vaginal discharge or hiaturia in 7 (22%). Two patients developed fistulae (entero-vesico 1; vesico-cutaneous 1). Nineteen (70%) of the 27 fiale patients had intra-uterine contraceptive devices (IUD). Four patients (12.5%) (3 males and 1 fiale) had urachus or urachal rinants. Cystoscopy in 12 patients noted an extrinsic mass effect, bullous edia and in one patient vegetative proliferation proven to be a chronic inflammatory change. Exploratory laparotomy was performed in 32 of the 33 patients who had excision of mass and involved organs. Diagnosis was established by histologic examination of rioved tissue. Penicillin (6 weeks) therapy was utilized to control infections. CONCLUSION: Pelvic actinomycosis mimics pelvic malignancy and may be associated with the long-term use of intra-uterine contraceptive devices, and persistent urachal rinants. Rioval of infected mass and antibiotic therapy will eradicate the inflammatory process

Prevalence of low dietary calcium intake in patients with epilepsy: A study from South India

Background: The effects of antiepileptic drugs (AED) on bone health are well documented. Inadequate dietary intake of calcium and vitamin D plays a vital role and further compromises the bone health. Objective: To assess the dietary pattern with special reference to calcium and related minerals in people with epilepsy (PWE) on AED. Materials and Methods: The dietary assessment in PWE was documented by dietary recall method. Patients were categorized according to age: group I: < 14 years; group II: between 15-20 years; group III: between 21-45 years; group IV:> 46 years. From the raw weights, total energy, dietary calcium, dietary phosphorous intake and phytate calcium ratio was calculated using a food composition table by Indian Council of Medical Research (ICMR) and analyzed statistically. Results: A total of 362 patients with mean age of 29 + 15 years were studied. There were 190 women. The mean duration of AED treatment was 4 + 3 yrs, 64% on monotherapy 64% and 36% on polytherapy. The mean dietary intake of the total chohort was 2,007 + 211 Kcal/day, carbohydrate 335 + 33 gm/day; protein 31 + 7 gm/day; fat 18+2 gm/day; calcium 294 + 40 mg/day; phosphorus 557 + 102; phytates 179 + 30 mg/day; and phytate/calcium ratio 0.56+0.2. Milk and milk products were consumed by 42% of the total cohort. The daily dietary calcium (301 + 40 mg/day) intake of men was significantly higher than women (287 + 39 mg/day) (P < 0.001). This was more evident in group II (P < 0.01) and group III (P < 0.03). There was a positive correlation between dietary calcium and dietary phytates (P < 0.001), dietary proteins (P < 0.001), dietary fat (P < 0.001), and total energy (P < 0.001). Conclusions: The dietary consumption of calcium of all the patients was far below the recommended daily dietary allowance (RDA) by Indian Council of Medical Research (ICMR). Low dietary calcium could have a confounding effect on PWE on AED in all age groups. There is a need to formulate consensus guidelines to supplement dietary calcium to PWE