RESUMO
Background: Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). UI has a devastating effect on women's quality of life in the physical, social, sexual and psychological spheres. Women restrict or diminish their activity and social participation, with serious implications. In SUI, there is an association between physical exertion and urinary loss. Increased intra-abdominal pressure triggered by physical exertion leads to increased intra-vesical pressure and, if it exceeds intraurethral pressure, in the absence of contraction of the detrusor muscle, the resulting urinary leakage is referred to as SUI. Aim of the study: To identify the protocol and/or most effective training parameters in the treatment of female SUI. Materials and methods: 100 patients with stress urinary incontinence attending the out-patient department were thoroughly evaluated and randomized into 2 groups of 50 patients each, both groups were taught Kegels exercises and instructions to perform them at home. The experimental group (A) received additional strategies to enhance the efficacy of PFME in the form of reminder bindis to be placed in areas of the home frequented by the patient like the kitchen and its appliances. Patients in the control group (B) did not receive any additional reminders. Both groups were asked to maintain an T. Srikala Prasad, Jessima Subahani, B. Amirtha. Assessment of efficacy of home available reminders to aid in the adherence and effectiveness of home-based pelvic floor muscle training in the management of stress urinary incontinence. IAIM, 2019; 6(9): 7-12. Page 8 exercise diary and allowed to continue their routine medications for comorbidities if any. They were reviewed on Day 15, Day 30 and physiotherapy sessions are given. Later on Day 90 the patients of both groups were reviewed and evaluated with a questionnaire for improvement in symptoms and adherence to PFME. Results: Among the total 100 patients who were trained to do PFME, 23 (14 from group A and 9 from group B) were completely dry by 90 days, 51 (29 from group A and 22 from group B) patients had reduction in the leak and 26 (7 from group A and 19 from group B) patients showed no improvement. Assessment from the exercise diary showed good adherence and symptom relief in most patients in the trial group. Conclusions: Adherence to PFME was better in the trial group in whom indigenous reminders were used which in turn translated into clinical improvement. In this time and era as PFMT is the first management modality in patients with stress and mixed incontinence implementation of such strategies to improve adherence to treatment is suggested especially in tertiary care setups.
RESUMO
Background: A urinary tract infection (UTI) is a common infection that can affect any part of the urinary system, including the kidneys, bladder, and urethra (the tube through which urine exits the body). The most common cause of UTIs is the transfer of bacteria from the rectum or vagina to the urethra. Around 80 percent are caused by E. coli bacteria commonly found in the gut or feces. Others, like Staphylococcus saprophyticus, are naturally found in the vagina and can be transferred to the urethra. The aim of the study: The study objectives were to assess the knowledge of adolescent girls regarding urinary tract infection and determine the association between knowledge regarding urinary tract infection and selected demographic variables. Materials and methods: This observational study was done in 2017-2018 at Department of Urogynecology, Institute Of Social Obstetrics, Government Kasturba Gandhi Hospital, Chennai. 200 female adolescents were included in the study. BMI was calculated from height and weight. Height, weight, and BMI were considered for assessing malnutrition in adolescent girls. Urine samples were collected from 23 girls for microscopic examination for pus cells. The faculty members followed the investigators and guided them during the survey. The survey was completed within two days. Any girl complaining of three criteria of the case definition of UTI viz: increased frequency of micturition with; burning during micturition and pus cells in the urine were considered as a case of UTI for the purpose of the study. Results: There was a significant association between prevalence of UTI and improper perineal washing technique (CI = 95%, p< 0.001), malnutrition (CI = 95%, p< 0.001), presence of vaginal discharge (CI = 95%, p< 0.001) and use of unsanitary pads during menses (CI = 95%, p< 0.001). T. Srikala Prasad, Jessima Subahani. Prevalence of urinary tract infection among school going adolescent girls in rural part of Chennai. IAIM, 2019; 6(3): 278-282. Page 279 Misconception included not taking bath during periods and not eating certain foods. Low socioeconomic status was chiefly responsible for frequent use of the same piece of cloth as sanitary pads during menstrual bleeding leading to urinary tract infection. UTI was more (7.7%) in malnourished girls than in those with normal nutritional status. Significantly more (7.7%) girls having symptoms of vaginal discharge were suffering from a urinary infection. Conclusion: For the short term, the need is to give immediate health education about the causes, prevention, and treatment of UTI among adolescent girls of both the villages and treatment of the identified cases with the urinary antibiotics etc. Long term measures include a periodical screening of the adolescent girls for UTI.
RESUMO
Background: Acute renal colic during pregnancy is associated with significant potential risks to both mother and fetus. Diagnosis is often challenging because good imaging options without radiation use are limited. Management of diagnosed nephrolithiasis is unique in the pregnant population and requires multi-disciplinary care. Aim: To study the metabolic alterations during pregnancy that may promote kidney stone formation, the complications associated with acute renal colic in the pregnant state, and our proposed diagnostic and management algorithms when dealing with this clinical scenario. Materials and methods: This observational study was done in 2017-2018 at, Department Of Urogynecology, Institute of Social Obstetrics, Government Kasturba Gandhi Hospital, Chennai. Totally 22 pregnant women were included in the study. Charts of the patients were retrospectively reviewed and observations included age, presenting symptoms, diagnostic methods, urologic intervention, calculi location, stone size, trimester of diagnosis, and postpartum treatment. Results: The diagnosis of urolithiasis was two (11.1%) in the first trimester, six (33.3%) in the second trimester, and 10 women (55.5%) in the third trimester. Of the 20 stones, nine were on the right side and 11 were on the left; two patients had bilateral urinary stones detected. Flank pain was the most common clinical presentation in 17 women, gross hematuria in five, fever in four, and urinary frequency in one patient. In laboratory tests, microscopic hematuria was found in 10 cases, pyuria in six, and leukocytosis (leukocyte cell count > 10,000/mm3 ) in five. Diagnostic imaging was based on the transabdominal US. In 14 cases, renal or ureteral stones were detected by the US. The other four patients had hydronephrosis on the US without definite detection of the ureteralstones. Conclusion: Women, in general, appear to be developing urolithiasis with increasing frequency. Consequently, it is expected that the incidence of pregnant women with stones may also increase. A T. Srikala Prasad. A study on diagnosis and management of urinary calculi in pregnancy. IAIM, 2019; 6(3): 248-252. Page 249 diagnostic and therapeutic approach that takes into account the individual patient’s symptoms, stage of pregnancy and stone characteristics should be the intent in each case.
RESUMO
Background: Urinary stone constitutes one of the commonest diseases in our country. In India, approximately 5-7 million population suffer from stone disease and at least 7-10 per 1000 of Indian population needs hospitalization due to a kidney stone. It has been proposed that comorbidity with essential hypertension, overweight and Type 2 Diabetes Mellitus predispose to kidney stone disease. Few lithogenic risk factors like urinary calcium, oxalate and uric acid excretion, are known to be influenced by the rich animal protein diet, which in turn is frequently related to overweight. In a female patient with basal metabolic index (BMI), 40% higher than standard, there was an (89%) increase in the prevalence of kidney stone. The aim of the study: To diagnosis the different biochemical composition in women who were diagnosed with urolithiasis. Materials and methods: This observational study was done in 2018 at, Department of Urogynecology, Institute of Social Obstetrics, Government Kasturba Gandhi Hospital, Chennai. Chemical methods were used to perform stone analysis. Calculi were thoroughly washed with tap water to remove attached debris. Then they were rinsed with deionized water and air dried for two weeks in a plastic container. Once the calculi were dry, they were weighed and then grounded to a fine powder using mortar and pestle. These powdered calculi were used for qualitative and quantitative analysis. Results: According to the results, all calculi had oxalic acid and uric acid which were the commonest components in calculi. Calcium and phosphorous were the next common components followed by T. Srikala Prasad, A. Anandi. A study on biochemical composition in females with urolithiasis in southern part of Chennai. IAIM, 2019; 6(3): 243-247. Page 244 magnesium. Ammonium ion was detected in 59.5% renal calculi. None of the calculi contained carbonate or cysteine. Conclusion: Factors like diet and lifestyle plays an important role in the changing epidemiology of kidney stone. Changes in two of the most important environmental factors, diet, and climate, are the significant impact on these trends. Patients who had raised serum calcium and serum uric acid level had larger and multiple calculi bilaterally. There is strong evidence that diminished fluid and dietary calcium consumption is a risk factor and an increase in animal protein intake has an equal impact on kidney stone risk.