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OBJECTIVES: Posterior urethral valves (PUV) is the commonest obstructive uropathy with varied consequences. Though valve fulguration is the treatment of choice, appropriate bladder management modifies outcome and includes rational use of anticholinergics. Here, we aim to evaluate the effects of oxybutynin on the bladder and urinary tract morphology and function. Concurrently, we document adverse effects encountered, patient compliance, and medication adherence. METHODS: A retrospective study of children below 5 years of age (2012-2017) post fulguration and on oxybutynin for at least 6 months. Patient demographics, clinical features, renal ultrasound, micturating cystourethrogram, dimercaptosuccinic acid scan, adverse effects, and pill count for medication adherence were collated. RESULTS: 48 children below the age of 5 years were included, and 12 were excluded either due to the presence of concomitant problems or were not on oxybutynin. Of the 36, four were lost to follow-up and one had died due to an unrelated condition. Thus, a total of 31 children were analyzed. At follow-up, 28/31 patients were asymptomatic, two had daytime incontinence, and one had recurrent urinary tract infection. All patients except one have preserved renal function tests. On ultrasonography, hydroureteronephrosis worsened in only 1/25 children and two showed significant post void residues. The resolution of vesicoureteral reflux was noted in almost 50%. 4/31 renal units had progressive scars. Only two parents defaulted medication. Urodynamic study done in half of these children showed stable bladder pressures except in two. CONCLUSION: Oxybutynin therapy following adequate valve fulguration aids upper tracts preservation by stabilizing deranged bladder dynamics. The medication is well tolerated with minimal or no side effects.
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INTRODUCTION: Physical inactivity is the fourth leading risk factor for mortality and morbidity as per the World Health Organisation (WHO). The current study was conducted in the city of Erode, Tamil Nadu, South India, to estimate the prevalence and predictors of low physical activity (LPA) and assess their knowledge with regards to being overweight/obesity. METHODS: It was a cross-sectional study conducted over 24 months from July 2015 to June 2017. Multi-stage random sampling was done in 12 randomly chosen corporation wards. All consenting individuals above 18 years of age were included. Data were collected using a semi-structured questionnaire incorporating the validated International Physical Activity Questionnaire (IPAQ). RESULTS: For the study, 489 individuals were screened and 461 were included. Prevalence of LPA was 49.9% (95% confidence interval [CI]:45.34%, 54.46%). The significant predictors (adjusted odds ratio [OR] [95% CI]) of LPA were patient education 1.129 (1.006, 1.2670); unemployment (2.418 [1.610, 3.631]) and knowledge score (5.172 [1.314, 9.423] 27). In the knowledge assessment, 60.3% of the participants scored less than 50%. The significant predictors of poor knowledge were marital status (unmarried) (3.857 [1.341, 11.091]), lower educational status (1.191 [1.009, 1.362]) and low socioeconomic status (SES) (1.050 [1.005, 1.121]). CONCLUSION: Prevalence of LPA in our population is fairly high and there is gross knowledge inadequacy.
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BACKGROUND AND OBJECTIVES: The burden of noncommunicable diseases such as diabetes (type 2 diabetes mellitus [T2DM]) and osteoporosis is increasing with increasing longevity. Uncontrolled T2DM is an independent risk factor for osteoporosis explained by the insulin osteocalcin pathway. Due to limited information on the effect of various commonly used antidiabetic agents (ADA) on bone health, our study aims to analyze the association between the two. METHODOLOGY: This is a case-control study, with 100 cases of clinical osteoporosis and 100 age-, sex-, and dietary status-matched controls in whom osteoporosis was ruled out by dual-energy X-ray absorptiometry scan. Prescription details of T2DM, physical activity levels, and disease status were collected using a pretested questionnaire. Exposure to each ADA was compared using the Chi-squared test. Binary logistic regression was performed to adjust the two main confounders, namely glycemic control and physical activity levels, and adjusted risk estimates were calculated. RESULTS: There were a total of 74 T2DM patients, of whom 45 (60.8%) were cases and 29 (39.2%) were controls. Sulfonylureas (adjusted odds ratio [aOR] = 0.164, P = 0.004) and insulin (aOR = 0.248, P = 0.042) showed a significant protective effect on bone health. Biguanides (OR = 1.994, P = 0.029) and thiazolidinediones (OR: 5.444, P = 0.033), which demonstrated that an increased risk of osteoporosis in univariate analysis became insignificant after multivariate analysis. CONCLUSION: Sulfonylureas and insulin through the insulin osteocalcin pathway show favorable effect on bone health, but the probability of increased fractures secondary to hypoglycemic falls should be borne in mind. We recommend larger prospective studies to confirm this association.
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BACKGROUND: Calcium is the most abundant mineral in our body with varied functions, and its dietary deficiency leads to osteoporosis. Various studies have shown that adequate dietary calcium intake (DCI) and moderately increased physical activity if maintained for long term prevent osteoporosis. The data regarding DCI of people living in Karnataka, south India, are limited. Thus, we aimed to assess DCI, physical activity, and their predictors among people living in Karnataka. METHODOLOGY: A cross-sectional study was done among 250 inpatients and normal relatives of orthopedics department of a tertiary care teaching hospital. Multistage random sampling was performed. DCI and physical activity were measured using validated questionnaires. RESULTS: The mean (standard deviation) DCI was 499.94 (251.5). The prevalence [95 confidence interval (CI)] of poor intakers of DCI [DCI < Recommended Dietary Allowance (RDA)] was 76.6% (70.9, 81.7). However, only 43.52% of all participants with poor DCI were on supplements. Male gender [2.189 (1.125, 4.257)], elderly [1.988 (1.067, 3.705)], and low knowledge score [1.240 (1.093, 1.407)] were significant predictors of low DCI. The proportion (95 CI) of patients who were categorized as having low physical activity (LPA) was 44.0% (37.8, 50.4). The predictors for LPA [adjusted odds ratio (95 CI)] were marital status, being single [1.853 (1.047, 3.282)], and low socioeconomic status class [1.209 (1.002, 1.458)]. CONCLUSION: DCI was below the RDA for three-fourths of our patients with nearly half of them being physically inactive, indicating the need for better education regarding DCI and improving physical activity, all of which can prevent osteoporosis.
