The incidence of ureteric calculus as a cause for severe abdominal pain in children is mounting, especiallyin the tropical country. The course of illness may be non-specific but a swift detection via non-invasiveimaging modalities singly or in combination may avert unnecessary radiation hazard and futile surgery ina young child. In this paper, we discussed a case of an 11 year-old boy who was presented with a suddenonset of the right side severe abdominal colic whose a bedside ultrasound was positive for hydronephrosisfor which localisation of stone was further confirmed via a low dose limited intravenous urography (IVU).It is important to note that data available on the value of a combined ultrasound and the limited IVU inan emergency setting when urolithiais is being suspected in children with abdominal pain are particularlyscarce. Hence, this case documented the potential value of a combined ultrasound and a limited IVUstudy as a unique combined armamentarium used in a suspected childhood urolithiasis in the tropics.
A study was undertaken to identify the oral health status and treatment needs of 403 drug abusers enrolled in a drug rehabilitation center in Perak, Malaysia. The prevalence of dental caries was 97.0%. Calculus was present in 82.1% of the dentate individuals, but only 14.6% had pockets greater than 3mm. The mean DMFT observed was 11.7, with missing teeth (MT=9.6) constituting the major component. Denture needs were high (67.2%), but only 11.4% of individuals had prostheses.
In this paper, we consider a low initial population model. Our aim is to study the periodicity computation of this model by using neutral differential equations, which are recognized in various studies including biology. We generalize the neutral Rayleigh equation for the third-order by exploiting the model of fractional calculus, in particular the Riemann-Liouville differential operator. We establish the existence and uniqueness of a periodic computational outcome. The technique depends on the continuation theorem of the coincidence degree theory. Besides, an example is presented to demonstrate the finding.
Objective: this study was carried out to evaluate the relationship between smoking and periodontal status in a selected Malaysian population. The sample for this cross-sectional study involved 39 subjects who were smokers. Each subject was required to answer the guided questionnaire followed by clinical examination. The questionnaires had 11 questions and were set in English and Bahasa Melayu. Basically, the questionnaire consisted of 3 sections: socio-demographic data, smoking status and subject's knowledge on periodontal health. The clinical parameters used in this study were: Community Periodontal Index, Visible Plaque score, Gingival Bleeding Index and Calculus Surface Index. Results showed that out of 39 subjects, 28 subjects (71.8%) were current smokers, followed by 6 subjects (15.4%) and 5 subjects (12.8%) who were former and who never smoked respectively. From the 216 sextants examined, 42 sextants (19.4%) were healthy gingival, 127 sextants (58.8%) suffered from gingivitis and 47 (21.8%) sextants suffered from periodontitis. There were positive relationships between smoking and periodontal status.
Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.
Urolithiasis considered as a disease condition that is neglected in terms of research because of its perceived low prevalence and possibly the seemingly good prognosis associated with it. However, in recent years, the prevalence of urolithiasis is increasing in both developed and developing countries and the disease is associated with significant burden and healthcare cost from patients’ caregivers, and society’s perspective. All healthcare providers (including pharmacists) have an important role to play in the management of this disease and it deserves more attention in terms of clinical practice and research. This review aims to provide a comprehensive understanding of patient satisfaction, from the aspect of defining satisfaction of patients, perceptions toward disease management, and a review of literature of satisfaction of patients with kidney stones and its magnitude in healthcare provided. The medical literature has many articles about urolithiasis management options. However, there have been no sufficient published studies discussing patient-reported outcomes of kidney stone management to evaluate their satisfaction, preferences, treatment expectations, and quality of life. Future studies are needed to spot the light on kidney stones patients’ preferences and reported outcomes.
216 patients were found to have had surgery for urinary calculi In a retrospective analysis of surgical records of the two general hospitals in Kelantan over a two year period. Excluding 11 patients from Terengganu and 2 patients resident in Kelantan for less than 1 year, this amounts to an annual incidence for calculus surgery of 10 per 100,000 residents per year. Lower urinary tract (LT) calculi (143) were more common than upper urinary tract (UT) calculi (71). There was an overwhelming majority of males among patients operated on for LT calculi (ratio of males:females = 1.2:1). The mean age of patients with UT calculi was 44 years, while that of LT calculi was 51 years.
Emphysematous pyelonephritis is a rare but life threatening infection of kidney that is characterized by gas formation within or around the kidney. We describe a case of emphysematous pyelonephritis as a consequence of inadequately treated pelvic-ureteric stone in a diabetic man and complement this with a brief review of the literature pertaining in particular to the management of this condition.
Kidney stone samples of the types calcium oxalate, uric acid, and xanthine were analyzed for their elemental contents by neutron activation analysis to study both the elemental correlation and influence of element on stone precipitation processes. Elements, such as Al, Au, Br, Ca, Cl, Co, Cr, Fe, Hg, I, K, Mg, Na, Sb, Se, Sr, and Zn, were determined quantitatively. Calcium oxalate stones contained higher concentration of all the elements analyzed compared to uric acid or xanthine stones. The concentrations of Cl, Fe, K, Na, Sr, and Zn were relatively higher than Au, Co, Cr, and Sb. A positive correlation exists between Ca and Zn, whereas a negative correlation exists between Sr and Ca. Zinc may play an important role in the formation of calcium oxalate stone.
Three hundred and ninety five cases in 358 consecutive patients (male-232, female-126) with renal and ureteric stones were treated with extracorporeal shockwave lithotripsy (ESWL) from March to November 1988. They either had ESWL alone, or in combination with stone manipulation or debulking percutaneous nephrolithotripsy (PCNL). Seventy five percent of the stones were found in the pelvicalyceal system and 25% in the ureter. Seventy-six percent of the stones were less than 25mm size. Two hundred and ninety (79%) cases were followed up to three months. Two hundred and forty nine (85.9%) cases were stone free and 36 (12.4%) had residual sand less than 3mm size. Five (1.7%) cases failed to fragment with ESWL monotherapy and were salvaged by either percutaneous or ureteroscopic intervention. None of the cases required any open surgery intervention.
Sixty eight consecutive cases of percutaneous renal surgery, percutaneous nephrolithotripsy (PCNL), were performed on 64 patients (male-41, female-23) at the Subang Jaya Medical Centre from April 1988 to July 1989. All the cases were done as a one stage procedure. Fifty eight stones were large renal or staghorn and ten were ureteric. Thirty cases (41%) were stone free after PCNL alone. Thirty eight cases had residual fragments needing extracorporeal shockwave lithotripsy (ESWL). Mean operating time was 109.6 +/- 36.0 minutes. Mean hospital stay was 4.5 +/- 1.8 days. At three months follow-up, 86% of the cases were stone free. The remaining had residual sand (less than 3mm). Minor complications occurred in six patients. None required major surgical intervention post PCNL.
Urinary tract infection (UTI) is one of the most common presentations in general practice and, in most instances, occurs in a single episode and is easily treated with a course of anti-microbial therapy. In the case of recurrent urinary tract infections, it is important to consider evaluation for any underlying causes. We report the case of a 32 year old female who had recurrent UTIs; this was a case of recurrent UTI secondary to xanthogranulomatous pyelonephritis from renal stones with resultant reno-colic fistula formation.
Incidence of urolithiasis is on the rise due to climatic changes especially global warming.The pain due to presence of ureteric stone is a well known identity but many times it may be asymptomatic or even masked by concurrent presence of backache. In the present article, we describe the case of a 43-year-old male who came to the clinic for treatment of backache persisting for more than two years. The patient complained of backache two years back for which he was treated with analgesics and physiotherapy which relieved his pain. No X-ray was taken earlier because the attending clinician thought the backache to be musculo-skeletal in origin. Recently, one day a sudden episode of backache in the midst of night compelled him to seek medical treatment. However, this time a X-ray was performed and it showed the presence of calculi in the right upper pelvis of ureter which measured 1.9 cm vertically. An ultrasound confirmed the diagnosis. The patient was treated with two episodes of shock wave therapy which failed to crush the stone. A Double-J stent was inserted under general anaesthesia. The stone was crushed using a ureteroscope guided laser. The present case report describes how backache in professionals cannot be lightly attended. Even the characteristic groin to loin pain may be absent. All cases of backache should be properly investigated with an X-ray to rule out renal or ureteric calculi.
Objective: To determine the epidemiological, clinical and laboratory features of the patients with gout, on follow up in Rheumatology Outpatient Clinic, Hospital Seremban.
Methods: This was a retrospective study. Case notes of all our existing gout patients were reviewed, and data on demography, clinical features, associated conditions, and laboratory findings were noted.
Results: 54 patients were studied, 48 (89%) were male and 6 (11%) were female at the ratio of M : F = 8:1, 30 (57%) of them had the onset of symptoms at their 3rd and 4th decades of life. The majority were the Malays 39 (72%), followed by the Indians 11 (20%) and the Chinese 4 (8%). Commonly associated conditions were hypertension in 37 (68.5%), obesity (BMI of 30 and above) in 36 (66.7%) and hyperlipidaemia in 36 (66.7%) of them. Mixed hyperlipidaemia (High TG and LDL cholesterol) were found in 19 (53%). Underlying history of diabetes mellitus 7 (13%), alcohol consumption 8 (15%), smoking habits 22 (40%) and family history of gout 18 (33%). Half of our patients 27 (50%) had at least 2 or more joints involvement. 28 (52%) of them had tophaceous gout. Among those with tophaceous gout, 18 (64%) had renal impairment with serum creatinine of .150mmol/l. 6 (31.5%) of the patients with renal impairment found to have renal calculi on ultrasonography.
Conclusion: There was male predominance in our group of patients which was consistent with other reported epidemiological studies. Hypertension, mixed hyperlipidaemia and obesity were common associated conditions while diabetes mellitus, smoking and family history of gout were not. The majority of gout patients in our clinic were Malays and due to religious reasons, alcohol was not a common associated factor. Half of our patients had multiple joints involvement and more than half also had tophaceous gout. There was high incidence of renal impairment seen in patients with tophaceous gout. These could be due to delay in seeking medical treatment, present of renal calculi and possibly contributed by associated hypertension and diabetes mellitus.
Bladder stones in men are thought to be almost exclusively due to outflow obstruction. We studied the incidence of operations for urinary outflow obstruction and bladder stone to establish the relationship between these two conditions in Kelantan. In only 48 (31%) of 154 men undergoing removal of bladder stones was a procedure for outflow obstruction performed. Thus the remaining 69% had no clinical obstruction to account for their stones. Bladder stones were more common in prostatectomy patients than expected (42/193: 22%). We suggest that other causes may be important in the aetiology of bladder stones in Kelantan.