Pityriasis
Urinary Bladder
Urinary Tract Infections
Urinary Tract
Urinary Incontinence
Urinary Calculi
Urinary tract infections in adults. (1/205)
Urinary tract infections remain a significant cause of morbidity in all age groups. Recent studies have helped to better define the population groups at risk for these infections, as well as the most cost-effective management strategies. Initially, a urinary tract infection should be categorized as complicated or uncomplicated. Further categorization of the infection by clinical syndrome and by host (i.e., acute cystitis in young women, acute pyelonephritis, catheter-related infection, infection in men, asymptomatic bacteriuria in the elderly) helps the physician determine the appropriate diagnostic and management strategies. Uncomplicated urinary tract infections are caused by a predictable group of susceptible organisms. These infections can be empirically treated without the need for urine cultures. The most effective therapy for an uncomplicated infection is a three-day course of trimethoprim-sulfamethoxazole. Complicated infections are diagnosed by quantitative urine cultures and require a more prolonged course of therapy. Asymptomatic bacteriuria rarely requires treatment and is not associated with increased morbidity in elderly patients. (+info)A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. (2/205)
The study was undertaken to compare the safety and efficacy of twice-daily ciprofloxacin for 3 days with standard 7 day therapy with either co-trimoxazole or nitrofurantoin in the treatment of women with acute, uncomplicated urinary tract infections (UTI). This multicentre, prospective, randomized, double-blind trial compared oral ciprofloxacin (100 mg bd) for 3 days with co-trimoxazole (160/800 mg bd) or nitrofurantoin (100 mg bd) for 7 days. Bacteriological and clinical evaluations were performed at study entry, during therapy and 4-10 days and 4-6 weeks after the completion of therapy. The primary efficacy parameter was eradication of the causative organism 4-10 days following treatment. Of 713 women enrolled and evaluable for safety, 521 were evaluable for efficacy (168 ciprofloxacin, 174 co-trimoxazole, 179 nitrofurantoin). Escherichia coli (83%) was the most frequently isolated pathogen in all treatment groups. Bacteriological eradication was reported in 88% of ciprofloxacin patients, 93% of co-trimoxazole patients and 86% of nitrofurantoin patients. At the 4-6 week follow-up, ciprofloxacin had statistically significantly higher eradication rates (91%) than co-trimoxazole (79%; 95% confidence limit (CL) = -20.6%, -3.9%) and nitrofurantoin (82%; 95% CL = -17.1%, -0.9%). Clinical resolution 4-10 days after therapy and at the 4-6 week follow-up was similar among the three treatment groups. The overall incidence of treatment-emergent adverse events was not significantly different (P = 0.093) among the three drug regimens, although co-trimoxazole was associated with a greater number of adverse events than ciprofloxacin (P < or = 0.05). Ciprofloxacin also caused fewer episodes of nausea than either of the other agents (P < or = 0.01). (+info)Risk factors for resistance to "first-line" antimicrobials among urinary tract isolates of Escherichia coli in children. (3/205)
BACKGROUND: There are increasing concerns regarding antimicrobial resistance in Canada. Data are limited on the prevalence, patterns of resistance and risk factors associated with resistant organisms, including coliforms, in children. This study was done to address these issues as they relate to urinary tract isolates of Escherichia coli in a tertiary care pediatric centre in Ottawa. METHODS: A surveillance study was conducted from December 1992 to December 1994. Susceptibility testing of urinary tract isolates of E. coli was performed using a panel of antimicrobial agents. A case-control study was also conducted for subjects with isolates resistant to trimethoprim-sulfamethoxazole (T-S), this drug being used a representative "first-line" agent. RESULTS: A total of 1636 consecutive isolates were obtained from 967 subjects. Of the 1636 isolates, 736 (45.0%) were resistant to ampicillin, 514 (31.4%) were resistant to T-S, 363 (22.2%) were resistant to both ampicillin and T-S, and 27 (1.7%) were resistant to both ampicillin and gentamicin. In the case-control study 274 children with isolates resistant to T-S were matched with 274 children who had T-S-sensitive isolates obtained during the study period or the preceding or subsequent 6 months. Multivariate analyses indicated that subjects who had received antimicrobials for more than 4 weeks in the previous 6 months were about 23 times more likely to have isolates resistant to T-S than were subjects without this risk factor (odds ratio [OR] 23.4, 95% confidence interval [CI] 12.0-47.6). Children with genitourinary tract abnormalities were 2.4 times more likely to have resistant isolates than those without such abnormalities (95% CI 1.2-4.5). Compared with children who had no hospital admissions in the previous year, those with 1 admission in that period were more likely to have resistant isolates (OR 2.3, 95% CI 1.4-7.5), as were those with 2 or more admissions in that period (OR 3.2, 95% CI 1.1-4.8). Compared with children aged 2-6 years, children under 2 years of age were less likely to have resistant isolates (OR 0.3, 95% CI 0.2-0.8). INTERPRETATION: Selective antimicrobial pressure and multiple admissions to hospital were among the risk factors associated with antimicrobial resistance. The finding of a low but definite level of resistance to both ampicillin and gentamicin is important for the selection of empiric therapy for sepsis in neonates. The role of inexpensive first-line agents in the outpatient treatment and prevention of urinary tract infections requires re-examination, particularly in children who have recently received antimicrobial therapy. (+info)Recurrent cystitis in nonpregnant women. (4/205)
Consistent evidence from RCTs shows that antibiotic prophylaxis (either continuous or postcoital), using trimethoprim TMP-SMZ, nitrofurantoin, or a quinolone, reduces infection rates in women with high rates of recurrent cystitis (at least two per year). Limited evidence suggests that intermittent patient-administered treatment (taken at the onset of symptoms) is an effective alternative management strategy to continuous antibiotic prophylaxis in women with high rates of infection (at least two per year). Limited evidence suggests that long-term prophylaxis is likely to benefit women with a baseline rate of more than two infections per year over many years. However, long-term treatment has not yet been evaluated in RCTs. In women who experience recurrent, uncomplicated cystitis, there is no evidence to support routine investigation of the urinary tract with excretory urography, ultrasonography, cystoscopy, or voiding cystourethrography. No specific subgroups of women who would clearly benefit from investigation have yet been adequately defined. (+info)Factors associated with trimethoprim-resistant bacteria isolated from urine samples. (5/205)
Urine samples with trimethoprim-resistant or trimethoprim-sensitive Gram-negative bacteria and samples with no bacterial growth (NG) were identified. Age-sex matched community controls were generated with each trimethoprim-resistant case. These four groups were evaluated for exposure. Prior trimethoprim use was significantly more common in the trimethoprim-resistant group when compared with the trimethoprim-sensitive or the NG group. Prior hospitalization was significantly less common in the trimethoprim-resistant than the trimethoprim-sensitive group, but not with the NG group. Prior oestrogen exposure was associated with trimethoprim resistance. There were no associations found for diabetes or prior corticosteroid exposure. Community controls were found to be inappropriate controls for the study of trimethoprim-resistant bacteria in urine samples. (+info)Antimicrobial resistance patterns in urinary isolates from nursing home residents. Fifteen years of data reviewed. (6/205)
The antibiotic resistance patterns of gram-negative bacteria isolated from nursing home patients between 1983 and 1997 were analysed. Escherichia coli was the most prevalent isolate (48%) followed by Proteus spp. (26%) and other Enterobacteriaceae (20%). During the study period, the susceptibility of E. coli decreased for co-trimoxazole (79% to 62%), increased for nitrofurantoin (79% to 91%) and remained unchanged for amoxycillin (41%). Susceptibility to norfloxacin, available from 1990, decreased from 87% to 71%. Similar trends were observed when the susceptibilities of all gram-negative urinary pathogens were combined. The changes in susceptibility can probably be attributed to the empirical prescribing practices in the nursing homes studied. (+info)Variation by specialty in the treatment of urinary tract infection in women. (7/205)
To determine practicing physicians' strategies for diagnosing and managing uncomplicated urinary tract infection, we surveyed physicians in general internal medicine, family practice, obstetrics and gynecology, and emergency medicine in four states. Responses differed significantly by respondents' specialty. For example, nitrofurantoin was the antibiotic of first choice for 46% of obstetricians, while over 80% in the other specialties chose trimethoprim-sulfamethoxazole. Most surveyed said they do not usually order urine culture, but the percentage who do varied by specialty. Most use a colony count of 10(5) colony-forming units or more for diagnosis although evidence favors a lower threshold, and 70% continue antibiotic therapy even if the culture result is negative. This survey found considerable variation by specialty and also among individual physicians regarding diagnosis and treatment of urinary tract infection and also suggests that some of the new information from the literature has not been translated to clinical practice. (+info)Trimethoprim-sulfamethoxazole resistance among urinary coliform isolates. (8/205)
OBJECTIVE: A large majority of urinary tract infections are caused by coliform organisms. Trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens is increasing in many areas. The objective of this study was to determine risk factors for TMP-SMX-resistant coliforms in patients with urinary tract infections. DESIGN: Retrospective case-control study. SETTING: Emergency department of a tertiary care university hospital. PATIENTS: We studied 448 emergency department patients aged 14 years or older with a urinary tract infection caused by a coliform organism. Cases consisted of all patients with a culture-documented urinary tract infection caused by a TMP-SMX-resistant coliform, while control patients were those with a TMP-SMX-sensitive organism. MEASUREMENTS AND MAIN RESULTS: A univariate analysis of clinical variables associated with TMP-SMX resistance was performed. Multiple logistic regression was performed to determine independent predictors of TMP-SMX resistance. Resistance to TMP-SMX was seen in 15% of isolates. Numerous variables were associated with TMP-SMX resistance on the univariate screen. Independent predictors of resistance were diabetes (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.2, 8.4), recent hospitalization (OR 2.5; 95% CI 1.1, 5.7), current use of antibiotics (OR 4.5; 95% CI 2.0, 10.2), and recent use of TMP-SMX (OR 5.1; 95% CI 2.2, 11.5). When those with recent hospitalization were excluded from analysis, independent predictors were current use of any antibiotic (OR 3.5; 95% CI 1.4, 8. 4) and recent use of TMP-SMX (OR 5.9; 95% CI 2.4, 14.3). CONCLUSIONS: Coliforms resistant to TMP-SMX are common in our emergency department. Diabetes, recent hospitalization, and the use of antibiotics, particularly the use of TMP-SMX, are independent risk factors for TMP-SMX resistance. Clinicians should consider these findings when deciding on antimicrobial therapy for patients with urinary tract infections. (+info)Pityriasis is a general term used to describe a group of skin conditions characterized by scaling. It includes several specific types, the most common being Pityriasis rosea and Pityriasis simplex capillitii (also known as dandruff).
1. Pityriasis rosea: This is a temporary skin rash that often begins with a single, round, scaly patch on the chest, abdomen, or back. A few days to weeks later, more patches appear. These patches are oval and scaly, and they may be pink, red, or tan. The rash usually lasts about 6-8 weeks.
2. Pityriasis simplex capillitii: This is a very common condition characterized by flaking or scaling of the scalp, which is often referred to as dandruff.
The term "pityriasis" comes from the Greek word "pitýrios," which means "bran."
The urinary bladder is a muscular, hollow organ in the pelvis that stores urine before it is released from the body. It expands as it fills with urine and contracts when emptying. The typical adult bladder can hold between 400 to 600 milliliters of urine for about 2-5 hours before the urge to urinate occurs. The wall of the bladder contains several layers, including a mucous membrane, a layer of smooth muscle (detrusor muscle), and an outer fibrous adventitia. The muscles of the bladder neck and urethra remain contracted to prevent leakage of urine during filling, and they relax during voiding to allow the urine to flow out through the urethra.
Urinary Tract Infections (UTIs) are defined as the presence of pathogenic microorganisms, typically bacteria, in any part of the urinary system, which includes the kidneys, ureters, bladder, and urethra, resulting in infection and inflammation. The majority of UTIs are caused by Escherichia coli (E. coli) bacteria, but other organisms such as Klebsiella, Proteus, Staphylococcus saprophyticus, and Enterococcus can also cause UTIs.
UTIs can be classified into two types based on the location of the infection:
1. Lower UTI or bladder infection (cystitis): This type of UTI affects the bladder and urethra. Symptoms may include a frequent and urgent need to urinate, pain or burning during urination, cloudy or strong-smelling urine, and discomfort in the lower abdomen or back.
2. Upper UTI or kidney infection (pyelonephritis): This type of UTI affects the kidneys and can be more severe than a bladder infection. Symptoms may include fever, chills, nausea, vomiting, and pain in the flanks or back.
UTIs are more common in women than men due to their shorter urethra, which makes it easier for bacteria to reach the bladder. Other risk factors for UTIs include sexual activity, use of diaphragms or spermicides, urinary catheterization, diabetes, and weakened immune systems.
UTIs are typically diagnosed through a urinalysis and urine culture to identify the causative organism and determine the appropriate antibiotic treatment. In some cases, imaging studies such as ultrasound or CT scan may be necessary to evaluate for any underlying abnormalities in the urinary tract.
The urinary tract is a system in the body responsible for producing, storing, and eliminating urine. It includes two kidneys, two ureters, the bladder, and the urethra. The kidneys filter waste and excess fluids from the blood to produce urine, which then travels down the ureters into the bladder. When the bladder is full, urine is released through the urethra during urination. Any part of this system can become infected or inflamed, leading to conditions such as urinary tract infections (UTIs) or kidney stones.
Urinary incontinence is defined as the involuntary loss or leakage of urine that is sufficient to be a social or hygienic problem. It can occur due to various reasons such as weak pelvic muscles, damage to nerves that control the bladder, certain medications, and underlying medical conditions like diabetes, multiple sclerosis, or Parkinson's disease.
There are different types of urinary incontinence, including stress incontinence (leakage of urine during physical activities like coughing, sneezing, or exercising), urge incontinence (a sudden and strong need to urinate that results in leakage), overflow incontinence (constant dribbling of urine due to a bladder that doesn't empty completely), functional incontinence (inability to reach the bathroom in time due to physical or mental impairments), and mixed incontinence (a combination of any two or more types of incontinence).
Urinary incontinence can significantly impact a person's quality of life, causing embarrassment, social isolation, and depression. However, it is a treatable condition, and various treatment options are available, including bladder training, pelvic floor exercises, medications, medical devices, and surgery.
Urinary calculi, also known as kidney stones or nephrolithiasis, are hard deposits made of minerals and salts that form inside the urinary system. These calculi can develop in any part of the urinary system, which includes the kidneys, ureters, bladder, and urethra.
The formation of urinary calculi typically occurs when there is a concentration of certain substances, such as calcium, oxalate, uric acid, or struvite, in the urine. When these substances become highly concentrated, they can crystallize and form small seeds that gradually grow into larger stones over time.
The size of urinary calculi can vary from tiny, sand-like particles to large stones that can fill the entire renal pelvis. The symptoms associated with urinary calculi depend on the stone's size, location, and whether it is causing a blockage in the urinary tract. Common symptoms include severe pain in the flank, lower abdomen, or groin; nausea and vomiting; blood in the urine (hematuria); fever and chills; and frequent urge to urinate or painful urination.
Treatment for urinary calculi depends on the size and location of the stone, as well as the severity of symptoms. Small stones may pass spontaneously with increased fluid intake and pain management. Larger stones may require medical intervention, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy (PCNL) to break up or remove the stone. Preventive measures include maintaining adequate hydration, modifying dietary habits, and taking medications to reduce the risk of stone formation.
Urinary catheterization is a medical procedure in which a flexible tube (catheter) is inserted into the bladder through the urethra to drain urine. This may be done to manage urinary retention, monitor urine output, or obtain a urine sample for laboratory testing. It can be performed as a clean, intermittent catheterization, or with an indwelling catheter (also known as Foley catheter) that remains in place for a longer period of time. The procedure should be performed using sterile technique to reduce the risk of urinary tract infection.
Urinary retention is a medical condition in which the bladder cannot empty completely or at all, resulting in the accumulation of urine in the bladder. This can lead to discomfort, pain, and difficulty in passing urine. Urinary retention can be acute (sudden onset) or chronic (long-term). Acute urinary retention is a medical emergency that requires immediate attention, while chronic urinary retention may be managed with medications or surgery. The causes of urinary retention include nerve damage, bladder muscle weakness, prostate gland enlargement, and side effects of certain medications.