Competitive Inoculation as an Effective Prophylaxis Against Recurrent Urinary Tract Infections: A Systematic Review / 대한배뇨장애요실금학회지

Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.

Estimation of heavy metals in the seeds of blue and white Capitulum's of Silybum marianum grown in various districts of Pakistan

About 70-80% of the world population relies on herbal products, especially in the developing countries. Herbal products are available in various dosage forms for different types of ailment. Contamination of medicinal plants with heavy metal is of great concern. Heavy metals are known to affect the normal physiological function when the level of heavy metals exceeds in plants or animals. It can cause various acute and chronic effects in living organisms. Silybum marianum commonly known as milk thistle is used for varieties of liver diseases. Concentration of Fe 375 mg/kg is found high in the blue capitulum's seeds and concentration of Cr 49.80 mg/kg is present high in the white capitulum's seeds from district Sawabi. Less concentration of Zn 32.00 mg/kg is determined in the blue capitulum's seeds from Karak, while high concentration 30.00 mg/kg of Mn is noted in blue capitulum's seeds from Charsadda. Copper concentration 27.15 mg/kg is recorded in blue capitulum's seeds from Charsadda. High concentration of Cd 1.00 mg/kg is present in white capitulum's seeds from Khyber agency, while concentration of Pb is not detected in white capitulum's seeds collected from Karak district

Restoration of glenohumeral motion in erb's palsy by tendon transfers

Children with erb's palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb's palsy. This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L'Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System [HIMS]. Mallet class was recorded preoperatively and postoperatively. Ten patients; seven females [70%] and three males [30%], with average age of 75 months at operation were included in this series. Right shoulder was affected in seven cases [70%] while left in three cases [30%]. Preoperative mallet class for global abduction improved from 3 to 4; for global external rotation from 2 to 4 and for ability to bring the hand to mouth and neck from 1 to 3. Post operatively mallet class improved in all aspects to 4 and 5; statistically significant on paired t-test with p value of less than 0.005. There was a significant improvement in abduction, forward flexion and external rotation as compared to preoperative values; statistically significant on paired t-test with p value of less than 0.005. Tendon transfer improves the functional status of shoulder in late cases of Erb's Palsy with significant improvement in mallet class, cosmesis and patient satisfaction. A motivated patient, compliance and aggressive rehabilitation are important outcome parameters