36 research outputs found

    An experimental study to find out the significance of sterile pyuria and evidence of inflammation in Overactive Bladder

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    Purpose: It has been reported that over 33 % of patients with OAB present with pyuria (≥10 wbc μl-1) on urine microscopy, but under a third of these have bacteriuria. To clarify this situation, an accomplished comparative scrutiny of the inflammatory state of the urothelium in OAB, was carried out. Materials and Methods: This was a prospective, blinded, observational study of idiopathic OAB patients compared with controls. CSU samples were obtained and submitted to fresh urine microscopy, routine culture and microscopic examination of spun sediment. Another sample of OAB patients and asymptomatic controls provided cystoscopic bladder biopsies for histopathology and electron microscopy. Results: 178 OAB patients and 21 controls provided spun sediment samples. 75 (42 %) of these OAB patients had microscopic pyuria (.1 wbc ƒÊl-1) with 25 of which (33 %) were culture-positive. None of the controls had pyuria, nor bacteriuria. In a 20 mm2 spun deposit there was an average of 48 wbc (95 % CI 26 to 589) in OAB with pyuria; 12 wbc (95 % CI 10 to 15) in OAB without pyuria; and 4 wbc (95 % CI 3 to 7) in controls. Biopsies from 79 OAB patients, showed chronic inflammation and hyperplasia in 69 (87 %; 95 % CI=78 to 92: only 20 % had pyuria) and none in 5 controls. EM of 22 OAB patients showed increased basement membrane thickness compared to 2 controls (H=48, df=2, p<0.001). Conclusions: The study shows evidence of chronic cystitis and urothelial hyperplasia associated with OAB irrespective of pyuria or bacteriuria. The phenomenon has been confirmed by 3 different methods

    Tubercular Sinus of Labia Majora: Rare Case Report

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    Tuberculosis of the female external genitalia is unusual and primary infection is rare. We report a 50-year-old female patient admitted to Department to Surgery with swelling over left inguinal area with discharging sinus from labia majora to left inguinal crease which was found to be tubercular sinus on histopathology

    Cerebral Small Vessel Disease and Functional Outcome Prediction after Intracerebral Haemorrhage

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    OBJECTIVE: To determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH), and whether these biomarkers improve the performance of pre-existing ICH score. METHODS: We included 864 patients with acute ICH from a multicentre, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH]; lacunes; brain atrophy; and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale [mRS] score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers. RESULTS: In multivariable models (adjusted for ICH score components), WMH presence (OR 1.52, 95%CI 1.12-2.06), cortical atrophy presence (OR 1.80, 95%CI 1.19-2.73), deep atrophy presence (OR 1.66, 95%CI 1.17-2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95%CI 1.36-2.74) were independently associated with poor functional outcome. For the ICH score, the AUROC was 0.71 (95%CI 0.68-0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy) the AUROC was 0.73 (95%CI 0.69-0.76). These results were confirmed when considering lobar and non-lobar ICH, separately. CONCLUSIONS: The ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome but adding them does not significantly improve ICH score discrimination

    Baseline factors associated with early and late death in intracerebral haemorrhage survivors

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    Background and purpose: The aim of this study was to determine whether early and late death are associated with different baseline factors in intracerebral haemorrhage (ICH) survivors. Methods: This was a secondary analysis of the multicentre prospective observational CROMIS‐2 ICH study. Death was defined as ‘early’ if occurring within 6 months of study entry and ‘late’ if occurring after this time point. Results: In our cohort (n = 1094), there were 306 deaths (per 100 patient‐years: absolute event rate, 11.7; 95% confidence intervals, 10.5–13.1); 156 were ‘early’ and 150 ‘late’. In multivariable analyses, early death was independently associated with age [per year increase; hazard ratio (HR), 1.05, P = 0.003], history of hypertension (HR, 1.89, P = 0.038), pre‐event modified Rankin scale score (per point increase; HR, 1.41, P &lt; 0.0001), admission National Institutes of Health Stroke Scale score (per point increase; HR, 1.11, P &lt; 0.0001) and haemorrhage volume &gt;60 mL (HR, 4.08, P &lt; 0.0001). Late death showed independent associations with age (per year increase; HR, 1.04, P = 0.003), pre‐event modified Rankin scale score (per point increase; HR, 1.42, P = 0.001), prior anticoagulant use (HR, 2.13, P = 0.028) and the presence of intraventricular extension (HR, 1.73, P = 0.033) in multivariable analyses. In further analyses where time was treated as continuous (rather than dichotomized), the HR of previous cerebral ischaemic events increased with time, whereas HRs for Glasgow Coma Scale score, National Institutes of Health Stroke Scale score and ICH volume decreased over time. Conclusions: We provide new evidence that not all baseline factors associated with early mortality after ICH are associated with mortality after 6 months and that the effects of baseline variables change over time. Our findings could help design better prognostic scores for later death after ICH
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