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1.
J Pak Med Assoc ; 73(12): 2488-2490, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38083940

RESUMO

The urinary bladder primarily functions as a reservoir for urine. Apparently, it serves only a mechanical and passive role in the urinary tract, but closer scrutiny reveals that it has several meaningful endocrine interactions. This vital organ has an intricate plexus of neurons that release neurohormones concerned with the functioning of the bladder. Endocrine disorders, most notably diabetes, can cause a broad spectrum of bladder dysfunction. The current review explores the bladder as a source of neurotransmitters, a target for organ damage due to uncontrolled endocrinopathy, a beneficiary of hormonal therapy, and a tool to improve endocrine health.


Assuntos
Endocrinologia , Sintomas do Trato Urinário Inferior , Bexiga Urinária Hiperativa , Doenças Urológicas , Humanos , Bexiga Urinária , Pelve , Urodinâmica , Bexiga Urinária Hiperativa/etiologia , Sintomas do Trato Urinário Inferior/etiologia
2.
World J Urol ; 34(7): 1019-24, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26394625

RESUMO

AIMS AND OBJECTIVES: Transverse preputial onlay island flap urethroplasty (TPOIF) was described initially for distal hypospadias, but has seen extended application for proximal hypospadias. We describe a set of modifications in the technique and results in a large series of proximal hypospadias. MATERIALS AND METHODS: All children who underwent TPOIF repair for proximal hypospadias (proximal penile, penoscrotal and scrotal) from June 2006 to June 2013 by a single surgeon were prospectively followed till June, 2014. A standard technique and postoperative protocol were followed. Salient points to be emphasized in the technique: (1) dissection of the dartos pedicle till penopubic junction to prevent penile torsion, (2) incorporation of the spongiosum in the urethroplasty, (3) midline urethral plate incision in glans (hinging the plate), (4) Dartos blanket cover on whole urethroplasty. RESULTS: Out of 136 children with proximal hypospadias, 92 children who underwent TPOIF formed the study group. Out of 92 children, 48 (52 %) children required a tunica albuginea plication for chordee correction. In total, 16 (17 %) patients developed 24 complications and 11 children (12 %) required second surgeries: fistula closure in 7 (with meatoplasty in 5), glansplasty for glans dehiscence in 2 and excision of diverticulum in 2. Two children required a third surgery. Only 5 children had a noticeable penile torsion (less than 30 degree), and 7 had a patulous meatus. CONCLUSIONS: Transverse preputial onlay island flap urethroplasty can deliver reliable cosmetic and functional outcomes in proximal hypospadias.


Assuntos
Prepúcio do Pênis/cirurgia , Hipospadia/cirurgia , Retalhos Cirúrgicos , Uretra/cirurgia , Adolescente , Criança , Pré-Escolar , Humanos , Hipospadia/patologia , Lactente , Masculino , Estudos Prospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
3.
Andrologia ; 48(6): 708-13, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26666590

RESUMO

Recent studies have suggested that maternal characteristics can affect reproductive health of offspring, possibly through pre-natal hormonal influence. Anogenital distance (AGD) is an anthropometric measure which is a sensitive reproductive endpoint of masculinisation. It provides a read-out of pre-natal androgen exposure and has been associated with several reproductive health outcomes in humans. We studied AGD and stretched penile length (SPL) in a large, racially homogenous sample of consecutive newborns to understand their association with maternal and infant characteristics. A prospective cross-sectional study involving measurement of AGD and SPL at birth was performed by a single trained observer. A total of 1077 newborns (553 males and 524 females) were included in final anthropometric analysis. The mean AGD of males was 2.56 ± 0.31 cm, and the mean AGD of females was 1.54 ± 0.17 cm. The mean SPL of males was 3.31 ± 0.38 cm. On multiple regression analysis, for both males and females, birthweight (ß = 0.229, P < 0.001 and ß = 0.135, P < 0.001, respectively) was modest but significant predictor for AGD. For SPL, only gestational age (ß = 0.054, P < 0.001) was found to be statistically significant predictor. There was no significant association observed for gravidity, parity and maternal age with both AGD and SPL. Thus, no maternal characteristics (age, gravidity, parity) influence AGD or SPL in human infants.


Assuntos
Canal Anal/anatomia & histologia , Pênis/anatomia & histologia , Períneo/anatomia & histologia , Vagina/anatomia & histologia , Antropometria , Peso ao Nascer , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos
4.
Hum Reprod ; 28(9): 2343-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23838161

RESUMO

STUDY QUESTION: Are the anogenital distance (AGD) and stretched penile length (SPL) shorter in human newborn males with cryptorchidism? SUMMARY ANSWER: AGD is significantly shorter in boys with undescended testis (UDT) and this correlation may indicate that both have a common antecedent early in gestation. WHAT IS KNOWN ALREADY: Animal studies have reported a critical time period during early gestation termed the male programming window (MPW) where androgen deficiency results in reduced AGD and penile length, as well as cryptorchidism and hypospadias. Two pilot human studies have explored this association but these studies were small and heterogeneous with regard to age, race and had selection bias. STUDY DESIGN, SIZE, DURATION: A prospective descriptive study involving measurement of AGD and SPL at birth in a racially homogenous sample of 1154 consecutive newborns was performed over a period of 6 months. All measurements were taken by a single trained observer (V.J.). PARTICIPANTS/MATERIALS, SETTING, METHODS: All consecutively born male infants at a community hospital were classified as having descended and or UDT. Testicular position in the undescended group was graded as high scrotal, inguinal or non-palpable. AGD (from the centre of anus to the junction of the smooth and rugated skin of scrotum) and SPL were measured. The AGD index (AGDi) was calculated by dividing AGD by cube root of birthweight. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 1154 infants examined, 624 were males and 71 had UDT. AGD was significantly shorter in infants with UDT when compared with infants with descended testis (mean ± SD; 2.21 ± 0.36 versus 2.56 ± 0.31 cm; P < 0.001). AGDi was also significantly shorter in infants with UDT (mean ± SD; 1.68 ± 0.27 versus 1.81 ± 0.20 cm/kg⁻³; P < 0.001). Significance was maintained even when preterm (P < 0.001) and low birthweight boys (LBW) (P < 0.001) were excluded. SPL was also significantly shorter in infants with UDT (Mean ± SD; 3.08 ± 0.52 versus 3.31 ± 0.38 cm; P < 0.001) but the significance was not maintained when preterm (P = 0.119) and LBW boys (P = 0.666) were excluded. Birthweight, gestational age and length adjusted regression models showed significantly shorter AGD in infants with UDT, but SPL was not different. Infants with higher position of testis appeared to have a shorter AGD and SPL but the correlation did not reach statistical significance. No difference in AGD or SPL was noted between boys with unilateral and bilateral UDT. LIMITATIONS, REASONS FOR CAUTION: The present study did not include data pertaining to maternal or newborn health status. Also parental drug exposure or occupational exposures to endocrine-disrupting chemicals was not studied. These may possibly affect genital anthropometric measurements. WIDER IMPLICATIONS OF THE FINDINGS: The study strengthens the hypothesis of existence of MPW in humans. Shorter AGD in cryptorchid infants may reflect the effect of androgen disruption or deficiency during MPW. AGD may be a more reliable non-invasive marker of androgen action during MPW than SPL to predict reproductive outcomes in humans.


Assuntos
Anormalidades Múltiplas/epidemiologia , Criptorquidismo/epidemiologia , Hipospadia/epidemiologia , Anormalidades Múltiplas/patologia , Algoritmos , Biomarcadores , Peso ao Nascer , Estatura , Estudos de Coortes , Criptorquidismo/patologia , Desenvolvimento Fetal , Idade Gestacional , Hospitais Comunitários , Humanos , Hipospadia/patologia , Incidência , Índia/epidemiologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
5.
JMIR Diabetes ; 8: e43292, 2023 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-37133922

RESUMO

BACKGROUND: Digital therapeutic platforms facilitate health care through patient-centered strategies based on multidisciplinary teams and shared decision-making. Such platforms can be used for developing a dynamic model of diabetes care delivery, which can help in improving glycemic control by promoting long-term behavior changes in people with diabetes. OBJECTIVE: This study aims to evaluate the real-world effectiveness of the Fitterfly Diabetes CGM digital therapeutics program for improving glycemic control in people with type 2 diabetes mellitus (T2DM) after the completion of 90 days in the program. METHODS: We analyzed deidentified data of 109 participants in the Fitterfly Diabetes CGM program. This program was delivered through the Fitterfly mobile app coupled with continuous glucose monitoring (CGM) technology. This program consists of 3 phases: the first phase is observation, wherein the patient's CGM readings are observed for 7 days (week 1); the second phase is the intervention; and the third phase aims at sustaining the lifestyle modification introduced during the second phase. The primary outcome of our study was the change in the participants' hemoglobin A1c (HbA1c) levels after program completion. We also evaluated the changes in participant weight and BMI after the program, changes in the CGM metrics in the initial 2 weeks of the program, and the effects of participant engagement in the program on improving their clinical outcomes. RESULTS: At the end of the 90 days of the program, the mean HbA1c levels, weight, and BMI of the participants were significantly reduced by 1.2% (SD 1.6%), 2.05 (SD 2.84) kg, and 0.74 (SD 1.02) kg/m2 from baseline values of 8.4% (SD 1.7%), 74.45 (SD 14.96) kg, and 27.44 (SD 4.69) kg/m2 in week 1, respectively (P<.001). The average blood glucose levels and time above range values showed a significant mean reduction by 16.44 (SD 32.05) mg/dL and 8.7% (SD 17.1%) in week 2 from week 1 baseline values of 152.90 (SD 51.63) mg/dL and 36.7% (SD 28.4%), respectively (P<.001 for both). Time in range values significantly improved by 7.1% (SD 16.7%) from a baseline value of 57.5% (SD 25%) in week 1 (P<.001). Of all the participants, 46.9% (50/109) showed HbA1c reduction ≥1% and 38.5% (42/109) showed weight loss ≥4%. The average number of times the mobile app was opened by each participant during the program was 108.80 (SD 127.91) times. CONCLUSIONS: Our study shows that participants in the Fitterfly Diabetes CGM program showed a significant improvement in their glycemic control and reduction in weight and BMI. They also showed a high level of engagement with the program. Weight reduction was significantly associated with higher participant engagement with the program. Thus, this digital therapeutic program can be considered as an effective tool for improving glycemic control in people with T2DM.

6.
Gulf J Oncolog ; 1(32): 63-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32342921

RESUMO

A 5-year old boy presented with a picture of communicating hydrocele and was discovered to have an abdominoscrotal lymphangioma after undergoing hydrocele surgery. Upon initial presentation the lymphangioma was missed and the child underwent inguinal approach surgery for hydrocele. The lymphangioma was then noticed as an abdominal lump due to a rapid increase in size within 1 week following the hydrocele surgery. The sudden enlargement of the lymphangioma was due to intra-cystic hemorrhage post-operatively. The lymphangioma was then completely excised with no recurrence noted after 1 year of follow up. This is a rare case of a retroperitoneal, abdominoscrotal lymphangioma masquerading as a communicating hydrocele. Keywords: Communicating Hydrocele, Abdominoscrotal lymphangioma, Scrotal Swelling.


Assuntos
Linfangioma/diagnóstico , Hidrocele Testicular/diagnóstico , Pré-Escolar , Humanos , Linfangioma/patologia , Masculino , Hidrocele Testicular/patologia
7.
Pediatr Surg Int ; 25(12): 1117-21, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19727770

RESUMO

PURPOSE: Congenital primary bladder diverticulum is a rare condition and may present with urinary infection; other forms of presentation are rare. We present a series of infants who presented with urinary retention secondary to large primary bladder diverticulum. METHODS: Seven infants were evaluated for symptoms of lower urinary tract obstruction. All seven were infant boys; three were neonates. Investigations included ultrasonogram, voiding cystourethrogram (VCUG) and cystoscopy. RESULTS: Six infants had single large diverticulum while one had bilateral diverticula. VCUG was diagnostic in all cases demonstrating the mechanism of obstruction clearly except one where bilateral diverticula was diagnosed only on cystoscopy prior to definitive surgery. Five children (including one neonate) underwent successful definitive repair consisting of diverticulectomy and ureteral re-implant while two neonates were planned for a staged correction. One neonate later in the series underwent definitive primary repair as bladder was good sized. All five children have done well after definitive repair at a follow-up of 6-72 months. CONCLUSION: Primary bladder diverticulum in infants may present with lower urinary obstructive symptoms indistinguishable from posterior urethral valves. A carefully done VCUG can help in diagnosis. Primary definitive repair can be undertaken even in first few months of life with good results.


Assuntos
Divertículo/congênito , Obstrução do Colo da Bexiga Urinária/etiologia , Cistoscopia , Diagnóstico Diferencial , Divertículo/complicações , Divertículo/diagnóstico , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Fatores de Tempo , Doenças da Bexiga Urinária/complicações , Doenças da Bexiga Urinária/congênito , Doenças da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/cirurgia , Urografia , Procedimentos Cirúrgicos Urológicos/métodos
8.
Gulf J Oncolog ; 1(30): 81-84, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31242987

RESUMO

Neuroblastoma is the most common extracranial solid tumor in childhood. Stage 4S is a special stage of neuroblastoma in which majority of cases may have spontaneous regression; however, in some cases the tumor is rapidly progressive with poor prognosis and thus requires aggressive therapy. Dilemmas in its management and therapy will be discussed. We report two cases of stage 4S neuroblastoma exemplifying these two extreme behaviors. The first case is of a four-month-old baby who initially presented with a thigh lump, labial and foot nodules as well as hepatic and adrenal involvement. Following the confirmation of stage 4S Neuroblastoma with favorable histology and N-MYC negative amplification, a watchful observation approach was elected. Currently, the patient has completed two years of uneventful follow-ups with normal development. The second case is of a full-term new born baby who presented with abdominal distention and respiratory distress. Stage 4S Neuroblastoma was confirmed with an unfavorable histology and metastasis to the liver and the left adrenal gland. Due to the deterioration of the patient's condition, chemotherapy with carboplatin and etoposide was initiated for six cycles with a good and rapid response. The patient completed two years of follow up without recurrence.


Assuntos
Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias Hepáticas/secundário , Neuroblastoma/patologia , Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carboplatina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Lactente , Recém-Nascido , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Estadiamento de Neoplasias , Neuroblastoma/tratamento farmacológico , Resultado do Tratamento
10.
Arch Dis Child ; 98(1): 77-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23178396

RESUMO

Undescended testis (UDT) is seen in 3% to 5% of all newborn boys. Complications such as infertility and malignant transformation have been well documented in UDT. However, torsion of a UDT can also occur and the diagnosis is often missed or delayed, leading to loss of testis. This event may occur even before the currently recommended age for surgery, which is at 6-9 months. We present a case series of six children with torsion of undescended testes and their subsequent diagnosis and management. The risk of torsion of UDT is understated. Paediatricians should be educated about this complication and torsion should be included in the differential diagnosis when a boy with an empty scrotum presents with acute abdomen or red and tender swelling in the groin, as early detection and intervention can help salvage the testes.


Assuntos
Criptorquidismo/complicações , Testículo/patologia , Anormalidade Torcional/diagnóstico , Pré-Escolar , Criptorquidismo/diagnóstico , Criptorquidismo/cirurgia , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Risco , Anormalidade Torcional/cirurgia
12.
J Pediatr Surg ; 44(2): e5-7, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19231521

RESUMO

Preduodenal portal vein (PDPV) is a rare anomaly in which the portal vein passes anterior to the duodenum rather than posteriorly. Generally asymptomatic, PDPV may rarely cause duodenal obstruction or may coexist with other anomalies. We report a neonate who presented with duodenal obstruction and was found out to have 3 coexisting anomalies, each of which can lead to duodenal obstruction independently-PDPV, midgut malrotation, and duodenal web. A duodenoduodenostomy and a Ladd procedure were done, and the child recovered uneventfully. The mechanism of obstruction, interesting metabolic aberrations observed, outcome, and relevant literature are presented.


Assuntos
Anormalidades Múltiplas , Duodeno/anormalidades , Veia Porta/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Duodeno/cirurgia , Feminino , Humanos , Recém-Nascido , Intestinos/anormalidades , Intestinos/cirurgia , Radiografia
14.
Ann Thorac Surg ; 82(1): 330-2, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16798247

RESUMO

Communicating bronchopulmonary foregut malformations are rare anomalies. The complex anatomy requires innovative surgical techniques. We report a child with bilateral sequestrations communicating with the lower esophagus. The sequestrations were excised through a single thoracotomy incision and the esophagus was repaired. Postoperatively the child has remained asymptomatic.


Assuntos
Anormalidades Múltiplas/patologia , Brônquios/anormalidades , Sequestro Broncopulmonar/cirurgia , Esôfago/anormalidades , Anormalidades Múltiplas/cirurgia , Brônquios/embriologia , Sequestro Broncopulmonar/patologia , Esôfago/cirurgia , Insuficiência de Crescimento/etiologia , Feminino , Refluxo Gastroesofágico/etiologia , Humanos , Lactente , Pulmão/irrigação sanguínea , Pulmão/embriologia , Pneumonia/etiologia , Recidiva , Toracotomia
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