Effectiveness of Slow Breathing on Blood Pressure and Quality of Life in Patients with Hypertension: A Randomized Trial

Background: Hypertension constitutes a significant cardiovascular burden globally. Non-pharmacological interventions arehighly sought either as an adjunct or primary means of managing hypertension. Slow breathing (SB) is one of such approachwhich gains attention in recent times due to its multiple physiological benefits in lowering blood pressure (BP). However, thereis a gap in literature testing the ability of SB training on quality of life (QOL) of hypertensive (HT) patients.Aim of the Study: This study aims to find out the effectiveness of SB on reduction of BP and improvement in the health-relatedQOL in HT patients.Materials and Methods: It was a randomized, open, and parallel-group trial design carried out at the Outpatient Departmentof Medicine in Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India. The studyconsists of 60 HT patients assigned equally to either study or control group. The study group was trained with SB training for4 weeks, whereas no specific treatment was given for controls.Results: The mean drop in systolic BP (SBP) for the study group was 14.24 ± 3.30 mmHg, whereas the mean drop was only5.28 ± 2.26 mmHg for controls. The mean drop in diastolic BP (DBP) was 6.20 ± 2.69 mmHg for the study group, whereasit was only 3.12 ± 2.05 mmHg for controls. There was significantly higher drop in systolic as well as DBP in the study group.Likewise, the World Health Organization QOL-BREF (WHOQOL-BREF) was improved to 10.79 ± 5.47 in the 0–100 scale forthe study group, whereas the mean improvement in the WHOQOL-BREF for control was 5.95 ± 0.01 in the 0–100 point scale.Conclusions: It was concluded that 4 weeks of SB training were effective in reducing BP and improving QOL in patients with HT.

The fate of antenatal renal pelvis dilatation: a prospective postnatal cohort study

Background: To assess the outcome of fetal hydronephrosis, based on antenatal sonography and to find the best cutoff APD of renal pelvis which lead to surgical outcome.Methods: All patients diagnosed with isolated fetal renal pelvic dilatation (RPD) were prospectively followed between January 2016 and December 2018. RPD was classified according to SFU grading into four grades and by APD classification to 3 groups. Group I (5-9.9 mm), group II (10-14.9 mm) and group III (?15 mm).Results: Among a total of 57 patients, group I had 32 renal units, none required surgery; group II had 19 renal units, 5 (7.04%) required surgery; group III had 20 units, 11 (15.49%) required surgery. The difference in outcome between the groups was statistically significant (p=0.001). The causes of fetal hydronephrosis was transitional in 33.33%, pelvi ureteric junction obstruction in 33.33%, vesico ureteral reflux in 29.82%, and 3.5 % had posterior urethral valves. Of the 38 infants with RPD, urinary tract infection was seen in 36.84%. Thirty-four patients had MCUG of whom 29.82% had VUR. In 38 patients DTPA was performed with following results: 10.53% had partial obstruction and 14.04% showed complete obstruction.Conclusions: Fetal hydronephrosis less than 5mm runs a benign course. In APD greater than 15 mm and bilateral disease thorough postnatal evaluation and regular follow-up is necessitated for timely intervention. The best cutoff point of anteroposterior renal pelvis diameter that led to surgery was 15 mm, with sensitivity 91% and specificity 73.5%.

Forming a stone in pelviureteric junction obstruction: cause or effect?

ABSTRACT Objectives To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. Materials and Methods A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. Results Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. Conclusions Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.

Revised Guidelines on Management of Antenatal Hydronephrosis.

Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux. Infants with vesicoureteric reflux should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow up investigations and indications for surgery in these patients.

Endopielotomía con acucise / Acucise endopyelotomy

La técnica de la endopielotomía con Acucise® se basa sobre el principio de la dilatación e incisión simultánea de una estrechez ureteral bajo control endoscópico sin necesidad de la ureteroscopia. Este procedimiento atrajo a muchos urólogos porque es fácil de aprender y puede realizarse como procedimiento ambulatorio con una experiencia endourológica mínima. La tasa de éxito para las distintas series es de 66% a 84% y la tasa de complicaciones graves en la mayoría de las series es baja (hemorragia,0 a 4%). El dispositivo Acucise de nueva generaciónes más pequeño y por lo tanto su inserción es más fácil en ambos sexos. Aunque la endopielotomía con el dispositivo Acucise no iguala la tasa de éxito de la pieloplastia a cielo abierto, sigue siendo preferida por los urólogos como opción terapéutica alternativa en la obstrucción de la unión pieloureteral por su menor tiempo quirúrgico, menor morbilidad, hospitalización más corta y menor costo hospitalário.

Acucise® endopyelotomy technique is based on theprinciple of simultaneous dilatation and incision of aureteral narrowing under fluoroscopic guidance withoutthe need for ureteroscopy. This procedure appealed tomany urologists, as it is easy to learn, can be performedas an outpatient procedure with minimal endourologicalexperience. The success rates for various series reportsfrom 66-84% and serious complication rates for mostseries is low (bleeding-0-4%). The new generation acucisedevice is smaller and is therefore easy to insert in bothsexes. Although acucise endopyelotomy does not matchthe success rate of open pyeloplasty, it is still preferredby urologists as an alternative treatment option in ureteropelvicjunction obstruction because of its reducedoperative time, less morbidity, shorter hospitalisation anddecreased cost to the hospital.