Genito-urinary tuberculosis revisited - 13 years' experience of a single centre.

Background: Tuberculosis had been declared by the World Health Organization (WHO) as ‘public health emergency’ in 1993. Extra pulmonary tuberculosis (E.P.T.B.) comprises 20-25% total burden of the disease in which genitourinary tuberculosis (G.U.T.B.) is 4%. Timely diagnosis and treatment will prevent the sequelae of this disease. Aims: To know the varied clinical presentations, diagnostic modalities and management of G.U.T.B. Methods: During a 13-year-period, 117 retrospective cases of GUTB were admitted in the tertiary care centre. They were analyzed for clinical presentation, diagnostic modalities and management. Results: Young patients mainly in third decade of life were commonly affected with higher incidence in females. In our study, the most common presentation was irritative voiding symptoms (66.47%) followed by haematuria (47.60%). Although it can affect the entire organ in genito-urinary system but, in the present study, kidney was the most affected organ (64.9%) following ureter (27.35%), urinary bladder (17.09%), prostate (3.4%) and epididymis (5.19%). In this study, we had not encountered any case of testicular and penile tuberculosis. Among the different diagnostic modalities in this study, the diagnostic positivity rate was 41.6% for the urine AFB test, 55.4% for the urine M. tuberculosis culture test and 67.7% for PCR. Chest x-ray was positive in 25.6% (30). ESR was raised in 62.5% and Mantoux test was positive in 61.2% patients. Conclusion: A high index of suspicion and a wide range of investigations may be required to achieve a complete diagnosis of genitourinary tuberculosis. Though short course chemotherapy with four-drug-regimen for sixmonth- duration is the mainstay of treatment, surgical interventions were required in 60% of cases of this study.

Antinociceptive action of GABA-mimetic agent--N-phthaloyl GABA.

N-phthaloyl GABA (P-GABA), a nonselective GABA-ergic drug, showed positive analgesic response in four different models in mice, viz-tail immersion, tail clip, hot plate and writhing-induced by acetic acid. Antinociceptive ED50 (ip in mice) of P-GABA was lowest in tail immersion method (ED50 = 24.27, mg/kg). Though pethidine (10 mg/kg, ip) significantly potentiated the antinociceptive action of P-GABA (20 mg/kg, ip), pretreatment of naloxone (5 mg/kg, im) did not influence the same. Pretreatment with atropine (10 mg/kg, im), picrotoxin (0.08 mg/kg) and 3-mercaptopropionic acid (2 mg/kg) reduced the antinociceptive action of P-GABA significantly. But pretreatment with bicuculline (0.4 mg/kg), a specific GABA antagonist, did not reduce the antinociceptive action of P-GABA.