Hemoglobinuria paroxística nocturna / Paroxysmal nocturnal hemoglobinuria

ResumenLa hemoglobinuria paroxística nocturna es una anemia hemolítica crónica, adquirida, poco común, que afecta con igual frecuencia ambos sexos. Se manifiesta a cualquier edad y con mayor incidencia en países del sudeste asiático. Es el resultado de la expansión clonal no maligna de células progenitoras hematopoyéticas. Se caracteriza por anemia hemolítica intravascular, tendencia a la trombosis y un componente variable de insuficiencia medular.Se asocia a otras patologías hematológicas como anemia aplásica y síndrome mielodisplásico. La citometría de flujo es el método de elección para diagnóstico. El eculizumab y el trasplante de médula ósea alogénico son las únicas terapias efectivas.

Abstract:Paroxysmal nocturnal hemoglobinuria is a rare acquired chronic hemolytic anemia, which affects both sexes with equal frequency. It occurs at any age and more frequently in Southeast Asian countries. It is the result of non malignant clonal expansion of hematopoietic progenitor cells. It is characterized by intravascular hemolytic anemia, recurrent thrombosis and a variable component of bone marrow failure. It is associated with other hematologic disorders such as aplastic anemia and myelodysplastic syndrome. Flow cytometry is the method of choice for diagnosis. Eculizumab and allogeneic bone marrow transplantation is the only effective therapies.

Prevalence and complications of asymptomatic bacteriuria during pregnancy

To study the prevalence and complications of asymptomatic bacteriuria during pregnancy. Descriptive Study [Cross. Sectional]. October 2001 to March 2002. There were 3000 houses in Satellite town and extension Behari colony Bahawalpur. Taking 40% of total, 1200 houses were selected by systemic random sampling and pregnant residents of these houses were included in the study. 580 ladies fulfilling the inclusion criteria were interviewed and tested for bacteriuria by Dip Stick test. 28 women had bacteriuria giving prevalence of 4.8%. Culture and sensitivity tests showed E-Coli to be the causative organism in 78.6% while 21.4% cases were due to other organisms. 35.7% bacteriuric women had positive past history of UTI compared to only 9.7% non-bacteriuriac women giving significant result regarding risk of recurrent infection [p<0.05]. Prevalence of anaemia was not much different in the two groups, 85.7% compared with 82.6%. [p>0.05]. Development of PIH was not found to be affected by bacteriuria as 10.7% bacteriuric and 8.9% non bacteriuric women developed PIH [p >0.05]. Similarly number of low birth weight babies was not much different in the two groups, 7.1% compared with 6.2% [p>0.05]. Bacteriuria was found to be a causative factor for preterm labour as 21.4% bacteriuric women compared with 4.9% non-bacteriuric women went into preterm labour [p<0.05]. Bacteriuria was found to increase the risk of symptomatic UTI as 14.2% bacteriuric and 2.7% non-bacteriuric women developed cystitis. [p<0.05]. Asymptomatic bacteriuria is a common infection during pregnancy and it increases the risk of symptomatic UTI and preterm birth

Covert bacteriuria in nephrotic syndrome.

Prevalence of covert bacteriuria in patients of nephrotic syndrome admitted for kidney biopsy was studied in 205 patients. Age ranged from 10 years to 65 years. 148 patients were male and 57 were female. Prevalence of covert bacteriuria was found in 38 patients (18.53%). In bacteriuric patients 30 were male, 8 were female. Escherichia coli was the commonest organism grown in bacteriuric patients (30 or 78.9%). Serum albumin was low and 24-hour urinary protein excretion was high in bacteriuric patients in comparison to abacteriuric patients. In bacteriuric patients membranous nephropathy was the commonest histopathological finding present in 15 patients (39.47%).

Covert bacteriuria in nephrotic syndrome.

Prevalence of covert bacteriuria in patients of nephrotic syndrome admitted for kidney biopsy was studied in 205 patients. Age ranged from 10 years to 65 years. 148 patients were male and 57 were female. Prevalence of covert bacteriuria was found in 38 patients (18.53%). In bacteriuric patients 30 were male, 8 were female. Escherichia coli was the commonest organism grown in bacteriuric patients (30 or 78.9%). Serum albumin was low and 24-hour urinary protein excretion was high in bacteriuric patients in comparison to abacteriuric patients. In bacteriuric patients membranous nephropathy was the commonest histopathological finding present in 15 patients (39.47%).

Bacteriuria asintomática en la diabetes mellitus / Asymptomatic bacteriuria in diabetes mellitus

Con el objetivo de investigar la relación entre la bacteriuria y la diabetes mellitus se realizó un estudio descriptivo transversal en 180 pacientes diabéticos e igual número de sujetos controles no diabéticos con correspondencia en edad y sexo, en el Hospital General Docente "Martín Chang Puga" de Nuevitas desde enero de 1994 a enero de 1995. La incidencia de bacteriuria en los pacientes diabéticos fue de 6,1 por ciento significativamente superior a 1,7 por ciento encontrada en los sujetos no diabéticos. Siendo más frecuente en la diabetes mellitus insulino dependiente (19,4 por ciento), en los pacientes de edad superior a los 50 años (71 por ciento), con un tiempo de evolución entre 10 y 19 años y con un mayor deterioro del control metabólico. El residuo vesical constituyó un factor importante (72,7 por ciento) asociado a la bacteriuria en diabéticos. Se recomienda el pesquisaje de la bacteriuria en los diabéticos para prevención de las infecciones urinarias y su posible repercusión en el deterioro de la función renal

Frecuencia de bacteriurea asintomática en embarazadas de la consulta prenatal ambulatorio urbano Tipo III Cabudare marzo-junio 1996 / Frecuency of asintomatic bacteriurea in pregnancy of prenatal consult urban Ambulatory Type II Cabudare marz-june 1996

Se realizó un estudio descriptivo transversal con el objeto de determinar la frecuencia de Bacteriurea Asintomática en las embarazadas que acudieron a la consulta prenatal del Ambulatorio de Cabudare en el lapso Marzo-Junio de 1996. Se estudiaron cuarenta y cinco (45) pacientes gestantes entre 9 y 37 semanas de embarazo, asintomáticas desde el punto de vista urinario. Se evaluaron los antecedentes obstétricos, examen funcional y físico de las gestantes. Entre los resultados más relevantes se destacan que el 28 por ciento de las pacientes que presenteron Bacteriurea Asintomática se ubicaron en el grupo etáreo entre 14 y 24 años de edad igualmente las primeras relaciones sexuales se encontraron a predominio en este grupo. Todas las pacientes de Bacteriurea Asintomática eran procedentes del área urbana y en el mayor porcentaje (19 por ciento) realizaron oficios del hogar. Respecto a la paridad se evidenció una mayor participación (28 por ciento) las primigestas, mientras que las multíparas fue 15 por ciento. Los resultados de este estudio permitirán al médico en la primera consulta la detección precoz de esta patología estableciendo pautas de tratamiento adecuados

Socio-biological associations of bacteriuria in pregnancy

The prevalence and socio-biological relations of bacteriuria was found to be 16.7 per cent and it was more common in the 30-39 age group, among parous women, among negroes, and in patients with a low family income and overcrowded living conditions. Symptoms were present in 19 per cent of bacteriuric patients and almost one-third gave a past history of urinary tract infection. Only 10 per cent had been previously exposed to sexually transmitted diseases such as syphilis, gonorrhoea and herpetic genital infections. Because of the serious consequences to mother and foetus, we advocate quantitative urine cultures for all antenatal patients, especially those from disadvantaged socio-economic conditions

Prevalence of bacteriuria in febrile infants.

Urine samples from 129 admitted febrile infants were collected using the suprapubic aspiration technique, and subjected to routine urinalysis, culture, and antibiotic sensitivity testing. Most of the infants suffered from respiratory tract infections (n = 80) and gastroenteritis (n = 25). Sixty nine patients were male and sixty female. In all, 7 patients had positive cultures (5.4%), indicating a high yield (> 5%). Six of these were female and occurred in patients with gastroenteritis (p < 0.05 for both by chi 2 and Z test). Four patients showed pus cells and organisms on smear, and all of them were culture positive. Another three had only pus cells, but were also culture positive. One patient each, who had pus cells only or organisms only on smear had no growth on culture. E. coli was grown in 6 of these cases, and Klebsiella in one. All cultures were sensitive to ciprofloxacin. Variable sensitivity was seen with gentamicin, streptomycin, and furadantin. The organisms were uniformly resistant to ampicillin and chloramphenicol. The procedure of suprapubic aspiration was safe with no complications. Our findings indicate that bacteriuria is not uncommon in febrile infants even with clinical evidence of other illnesses and that female children, especially those with gastroenteritis, are at most risk. Routine urine cultures in such patients would appear justified.

Bacteriuria following vaginal delivery

Freshly voided midstream urine specimens from 100 females during the first stage of normal labor, 24 hours postpartum and 2 weeks after delivery were seeded on blood agar plates aerobically and Mac Konkey's plates. Bacteriuria was found in 7% during the first stage of labor and was recently acquired in 4.3% and 9.4% 24 hours and 2 weeks postpartum, respectively. Though E. coli was the most common causing organism B-hemolytic Streptococci, Staphylococci and Klebsiella were also present. Maternal age and parity had insignificant effect on bacteriuria, while there was increased incidence of bacteriuria if premature rupture membrane, prolonged labor or perineal tears happened. Postpartum bacteriuria should be routinely assessed and treated to prevent the dangerous sequel of long st and ing urinary tract infection

Frequency of symptomatic bacteriuria in pregnant diabetics

Bacteriuria was assessed in clean mid stream urine specimens using the biotest uricount dip slide method and reference procedure in 100 pregnant females with diabetes mellitus and 100 non-diabetic pregnant females, all had no urinary troubles. The frequency of significant asymptomatic bacteriuria [SAB] was significantly higher in the diabetic [44%] than in the non-diabetic pregnant females [12%], in poorly controlled cases [75%] than in adequately controlled cases [27%], in non-glucosuric diabetic [67.74] than in non- glucosuric non- diabetic cases [11.7%] and in non-glucosuric [67.74%] than in glucosuric diabetic cases [33.3%]. The age, parity, duration of pregnancy and pH had no significant effect on the frequency of SAB among the diabetic and non-diabetic groups or among the cases of each group. Escherichia coli was the most common microorganism in both groups. By comparison, the dip slide method detected 53 of the 56 significant asymptomatic bacteriuria found by culture in both groups

Bacteriuria asitomatica en el embarazo / Asymptomatic bacteriuria in pregnancy

Se analiza la epidemiologia, diagnostico, manejo y pronostico de la Bacteriuria Asintomatica en las pacientes que asistieron a control prenatal en el Instituto Materno Infantil de Bogota y Clinica Hospital Fray Bartolome de las Casas, desde el 1 de mayo de 1987 hasta el 30 de abril de 1988. La frecuencia de Bacteriuria Asintomatica en la mujer embarazada fue del 3%. El 80% de las pacientes estaban entre los 20 y 35 anos. El 60% eran multiparas; la totalidad de raza blanca y mestiza y el 97% de nivel socioeconomico bajo y medio. El 33% tenian factores de riesgo como anemia, preeclampsia, enfermedad renal cronica y flujo gential. En el 64% se hizo el diagnostico en el primero y segundo trimestre, siendo el E. Coli el genero mas frecuente (73%) y el tratamiento se hizo de acuerdo con el antibiograma, teniendo en cuenta las drogas que se pueden utilizar durante el embarazo, con una persistencia del 4% y una recidiva del 4.1% y ninguna paciente presento pielonefritis. La morbilidad materna fue del 26%. Amenaza del parto pretermino, preeclampsia y RPM. La morbilidad perinatal fue del 23%: pretermino y retardo del crecimiento intrauterino.