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Research has demonstrated that hypertension can lead to an exaggeration in the renal functional and histological changes caused by ureteral obstruction. These changes were particularly observed shortly after the release of a relatively brief period of unilateral ureteral obstruction (UUO). However, the long-term impact of hypertension on the recovery of renal functions has not been investigated beyond the immediate period after UUO reversal. In order to investigate this effect, a group of spontaneously hypertensive rats (G-SHR, n = 11) and a group of normotensive Wistar Kyoto rats (G-NTR, n = 11) were subjected to a 48 h reversible left UUO. The impact of UUO was then examined 45 days after the reversal of obstruction. The glomerular filtration rate, renal blood flow, and the fractional excretion of sodium in the post-obstructed left kidney (POK) showed similarities to the non-obstructed right kidney (NOK) in both groups. However, the changes in the albumin creatinine ratio, renal injury markers, pro-apoptotic markers, and histological changes in the G-SHR were much more pronounced compared to the G-NTR. We conclude that hypertension continues to have a significant impact on various aspects of renal injury and function, even several weeks after UUO reversal.
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Hipertensión , Obstrucción Ureteral , Ratas , Animales , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/patología , Ratas Endogámicas SHR , Riñón/patología , Tasa de Filtración GlomerularRESUMEN
Both ureteral obstruction (UO) and hypertension are common conditions that affect kidney functions. Hypertension and chronic kidney disease are closely associated with an overlapping and intermingled cause-and-effect relationship. The effect of hypertension on the renal dysfunction following reversible UO has not been studied previously. To study this effect, spontaneously hypertensive (G-HT, n = 10) and normotensive Wistar (G-NT, n = 10) rats underwent 48-h reversible left unilateral UO (UUO), and the effect of UUO was studied 96 h following UUO reversal. The glomerular filtration rate, renal blood flow, and renal tubular functions such as the fractional excretion of sodium in the post-obstructed left kidney (POK) in both groups were significantly altered compared with the non-obstructed right kidney (NOK). However, the alterations in the G-HT were significantly more exaggerated when compared with the G-NT. Similar findings were observed with the histological features, gene expression of kidney injury markers, pro-inflammatory, pro-fibrotic and pro-apoptotic cytokines, and pro-collagen, as well as tissue levels of apoptotic markers. We conclude that hypertension has significantly exaggerated the alterations in renal functions and other parameters of renal injury associated with UUO.
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Hipertensión , Enfermedades Renales , Obstrucción Ureteral , Ratas , Animales , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/patología , Ratas Wistar , Riñón/patología , Enfermedades Renales/patologíaRESUMEN
Efforts to decrease the deleterious effects of renal ischemia-reperfusion injury (IRI) are ongoing. Recently, there has been increasing interest in using natural phytochemical compounds as alternative remedies in several diseases. Nerolidol is a natural product extracted from plants with floral odors and has been proven to be effective for the treatment of some conditions. We investigated the effect of nerolidol in a rat model of renal IRI. Nerolidol was dissolved in a vehicle and administered orally as single daily dose of 200 mg/kg for 5 days prior to IRI and continued for 3 days post IRI. G-Sham (n = 10) underwent sham surgery, whereas G-IRI (n = 10) and G-IRI/NR (n = 10) underwent bilateral warm renal ischemia for 30 min and received the vehicle/nerolidol, respectively. Renal functions and histological changes were assessed before starting the medication, just prior to IRI and 3 days after IRI. Nerolidol significantly attenuated the alterations in serum creatinine and urea, creatinine clearance, urinary albumin and the urinary albumin-creatinine ratio. Nerolidol also significantly attenuated the alterations in markers of kidney injury; proinflammatory, profibrotic and apoptotic cytokines; oxidative stress markers; and histological changes. We conclude that nerolidol has a renoprotective effect on IRI-induced renal dysfunction. These findings might have clinical implications.
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Lesión Renal Aguda , Daño por Reperfusión , Ratas , Animales , Lesión Renal Aguda/patología , Creatinina , Riñón , Daño por Reperfusión/complicaciones , Daño por Reperfusión/tratamiento farmacológico , Daño por Reperfusión/patología , Albúminas/farmacologíaRESUMEN
The response of the kidney and its recovery following unilateral ureteral obstruction (UUO) depend on several factors including the duration of obstruction, the species involved and the age of the individual. In neonates, there is compelling evidence to indicate that even short periods of reversible UUO might lead to long-term renal impairment. In adults, the glomerular filtration rate returns to baseline values soon after the release of short periods of UUO. Despite this return to normal, experimental data have demonstrated that short periods of reversible UUO could lead to long-term renal functional alterations including tubular atrophy, interstitial fibrosis and urinary albumin leakage in addition to alterations in pro-inflammatory and pro-fibrotic cytokines. The concentrating ability of the kidney and its response to stimuli such as renal nerve stimulation and physiological doses of angiotensin-II were also shown to be affected at least in the intermediate-term following UUO reversal. In humans, epidemiological studies have also demonstrated a clear association between long-term renal impairment and ureteral obstruction. However, in clinical studies, it is usually difficult to precisely determine the degree and the time of onset of ureteral obstruction and more studies are required in this field. In conclusion, the available experimental and clinical data indicate that even short periods of UUO can cause long-term renal dysfunction. These findings might have clinical implications related to the early intervention following acute onset of UUO and to the need for long-term monitoring of renal functions particularly in patients with underlying chronic renal disease.
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Recently, there has been a growing interest in using natural products as treatment alternatives in several diseases. Nerolidol is a natural product which has been shown to have protective effects in several conditions. The low water solubility of nerolidol and many other natural products limits their delivery to the body. In this research, a drug delivery system composed of alginate and chitosan was fabricated and loaded with nerolidol to enhance its water solubility. The chitosan-alginate nanoparticles were fabricated using a new method including the tween 80 pre-gelation, followed by poly-ionic crosslinking between chitosan negative and alginate positive groups. Several characterization techniques were used to validate the fabricated nanoparticles. The molecular interactions between the chitosan, alginate, and nerolidol molecules were confirmed using the Fourier transform infrared spectroscopy. The ultraviolet spectroscopy showed an absorbance peak of the blank nanoparticles at 200 nm and for the pure nerolidol at 280 nm. Using both scanning and transmission electron microscopy, the nanoparticles were found to be spherical in shape with an average size of 12 nm and 35 nm for the blank chitosan-alginate nanoparticles and the nerolidol-loaded chitosan-alginate nanoparticles, respectively. The nanoparticles were also shown to have a loading capacity of 51.7% and an encapsulation efficiency of 87%. A controlled release profile of the loaded drug for up to 28 h using an in vitro model was also observed, which is more efficient than the free form of nerolidol. In conclusion, chitosan-alginate nanoparticles and nerolidol loaded chitosan-alginate nanoparticles were successfully fabricated and characterized to show potential encapsulation and delivery using an in vitro model.
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BACKGROUND: Urinary incontinence (UI) in women is a common problem worldwide. It has a major impact on the physical and social activities and interpersonal relationships. The societies in the Gulf countries are conservative and favours large families, high parity and short inter-pregnancy intervals. Moreover, there is a high prevalence of gestational diabetes with many macrosomic babies. This study aimed to review the published literature on UI among women in this region. METHODS: All published literature which investigated the prevalence, social impact and help-seeking behavior in women with UI in the Gulf countries was reviewed. RESULTS: Nine studies met the criteria and were very heterogeneous. None of them was a true population-based study and all except one, investigated subjects from healthcare facilities. The prevalence of UI ranged from 20.3% to 54.5%. Stress UI was the main type reported. The main predisposing factors were chronic respiratory diseases and constipation. There was a large impact on the quality of life with major interference with prayers (34-90%) and sexual relationships (18-57%). The main reasons for not seeking medical advice were embarrassment to see doctors especially male doctors and the belief that UI is common, normal or incurable disease. CONCLUSIONS: There is a need for true whole population-based studies of UI in this region with the use of validated international questionnaires. UI was shown to have a major impact on the act of prayers and sexual relationships. A large proportion of women are still embarrassed to discuss the issue with doctors especially male doctors.
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Conducta de Búsqueda de Ayuda , Incontinencia Urinaria , Femenino , Humanos , Masculino , Embarazo , Prevalencia , Calidad de Vida , Cambio Social , Encuestas y Cuestionarios , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/terapiaRESUMEN
The natriuretic peptide (NP) system counter-regulates the renin-angiotensin system (RAS), so enhancing the activity of natriuretic peptides (NPs) may be beneficial in conditions when RAS is activated such as ischemia-reperfusion injury (IRI). Neprilysin is the key enzyme responsible for the degradation of NPs. The effects of neprilysin inhibition or the combination of neprilysin inhibition and RAS inhibition on renal IRI-induced renal dysfunction have not been investigated yet. To investigate this, rats underwent sham surgery or bilateral IRI for 20 min. G-Als, G-Scb, and G-Als+Scb underwent similar protocol but received aliskiren (renin inhibitor), sacubitril (neprilysin inhibitor) or a combination of both pre- and post-IRI, respectively. IRI caused significant alterations in all renal functional parameters, markers of acute renal injury, pro-inflammatory and pro-fibrotic cytokines, and histological features. All these alterations were significantly attenuated in G-Als, G-Scb, and G-Als+Scb. The attenuations in the alterations in serum creatinine, creatinine clearance, and histological features were larger in G-Als+Scb compared to either G-Als or G-Scb. We conclude that RAS blockade by a renin inhibitor (aliskiren) or neprilysin inhibition by sacubitril separately led to significant attenuation in the renal IRI-induced renal dysfunction. The combination of aliskiren and sacubitril was more effective than either one alone.
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Enfermedades Renales/metabolismo , Enfermedades Renales/patología , Neprilisina/metabolismo , Renina/metabolismo , Daño por Reperfusión/metabolismo , Daño por Reperfusión/patología , Animales , Enfermedades Renales/complicaciones , Masculino , Neprilisina/antagonistas & inhibidores , Ratas Wistar , Renina/antagonistas & inhibidores , Sistema Renina-AngiotensinaRESUMEN
Spontaneous JJ stent fragmentation can occur as early as 3 weeks post-insertion. This could be due to a hostile urine environment and might be avoided by strict dietary modification, adequate hydration, and close follow-up.
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BACKGROUND: Postoperative urinary leak is a well-documented complication following partial nephrectomy. It usually presents as persistent discharge from the retroperitoneal drain, nephrocutaneous fistula, urinary collection, systemic manifestations, or abdominal symptoms. Herein, we report for the first time on a case of urinary leak postlaparoscopic partial nephrectomy which did not heal and led to the formation of ureterocalyceal fistula. Case Presentation. A 41-year-old male presented with a coincidental renal mass at the inferiomedial aspect of the right kidney. He underwent laparoscopic partial nephrectomy. On the third postoperative day, he developed fever. CT scan showed minimal urine leak from the tumor site and a JJ stent was inserted. Due to severe bladder symptoms, the stent was removed and a perirenal drain was inserted and removed in few days. He did well initially but in two weeks, he started to develop urinary tract infections. Repeat CT scan showed ongoing urinary leak from the site of the previous surgery. Retrograde pyelography demonstrated a complete UPJ stenosis with an ureterocalyceal fistula. Trial for reanastomosis failed due to severe adhesions and small intrarenal pelvis. An ureterocalyceal anastomosis has to be performed to another calyx. CONCLUSION: We report for the first time on an ureterocalyceal fistula following laparoscopic partial nephrectomy. This complication might be prevented by a careful dissection of the area close to the ureter or by an insertion of a JJ stent for an adequate time if a ureteric injury is suspected.
RESUMEN
Following the release of short periods of unilateral ureteral obstruction (UUO), glomerular filtration rate (GFR) recovers by time. However, research in experimental animal models has demonstrated the presence of an ongoing element of renal interstitial fibrosis a few weeks following UUO reversal. Interstitial fibrosis can cause deterioration in GFR, and it is not known whether it leads to an ongoing slow deterioration in other renal functions despite the apparent initial recovery postreversal. To investigate this, rats underwent a 72-h reversible UUO. Renal functions of nonobstructed and previously obstructed kidneys were measured 1, 4, and 18 mo postreversal. GFR in nonobstructed and previously obstructed kidneys was similar up to 18 mo postreversal. However, there was ongoing tubulointerstitial fibrosis, and the degree of tubular atrophy and dilatation deteriorated by time. This was associated with an increase in urinary albumin leakage and alterations in renal injury markers, proinflammatory and profibrotic cytokines, and p53 from 4 mo onward despite the recovery in GFR. In conclusion, several aspects of renal functions continue to deteriorate following reversal of relatively short periods of UUO despite the initial recovery in GFR. This might stimulate further research in this area and might have clinical implications in terms of determining the best time for intervention following acute ureteral obstruction and long-term monitoring of these individuals.
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Tasa de Filtración Glomerular , Enfermedades Renales/etiología , Obstrucción Ureteral/patología , Animales , Peso Corporal , Creatinina/orina , Regulación de la Expresión Génica , Riñón/patología , Glomérulos Renales/patología , Túbulos Renales/patología , Masculino , Tamaño de los Órganos , Ratas , Ratas Wistar , Albúmina Sérica Humana/orinaRESUMEN
BACKGROUND: Injury of the renal collecting system is a well-known complication of percutaneous nephrolithotomy (PNL). Large injuries may cause excessive bleeding and fluid extravasation and require adequate drainage using several modalities such placement of JJ stents. Herein, we report on two cases in which the upper coil of the JJ stent got buried in the fibrous tissues which formed due to an injury of the collecting system during PNL. CASE PRESENTATION: 40 years old male and 32 years old female underwent standard PNL for partial and total staghorn calculi, respectively. During the procedure in both cases, the renal pelvis was injured. In both cases, JJ stent was used to drain the collecting system. Trial to remove the JJ stent 6 weeks following the procedure failed because the upper coils of the stents were embedded in the fibrous tissues at the perforation site. Laser incision of the fibrous tissues and releasing the upper coil of the stents were performed using percutaneous approach in the first case and flexible ureterorenoscopy (fURS) in the second patient. The procedures were uneventful in both cases. CONCLUSION: This is the first report of embedded JJ stents which got buried by fibrous tissues at the site of collecting system injury that occurred during PNL. To prevent this complication in such cases, we suggest draining the collecting system using nephrostomy tube instead of JJ stent. Alternatively, the upper coil of the stent should be placed away from the injury site.
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Pelvis Renal/lesiones , Nefrolitotomía Percutánea , Complicaciones Posoperatorias/etiología , Falla de Prótesis , Stents/efectos adversos , Adulto , Femenino , Humanos , Masculino , Diseño de PrótesisRESUMEN
Background: The presence of intra-calcular gas might indicate the coexistence of gas-forming bacterial infections, which are potentially severe and life threatening. Gas-containing renal stones are rare. Herein, we present a case of gas-containing renal matrix stone that was associated with emphysematous pyelitis and reflect on its management. Case Presentation: A 30-year-old woman, with no underlying comorbidities, presented at 30 weeks of pregnancy with symptoms of pyelonephritis. Imaging showed no renal stones. Postdelivery, she presented again with similar symptoms in addition to pneumaturia. Imaging showed several large gas-containing renal matrix stones associated with emphysematous pyelitis, pneumoureter, and pneumobladder. She improved with oral antibiotics and underwent percutaneous nephrolithotomy 6 weeks later. Conclusion: The presence of intra-calcular gas does not necessarily indicate a serious condition and the treatment can be planned according to the patient's symptoms and the presence and type of any emphysematous renal infection.
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BACKGROUND: Flexible ureterorenoscopy (FURS) and holmium laser lithotripsy is currently considered as one of the treatment options for large renal calculi. It has been shown to be safer than percutaneous nephrolithotomy. The latter can sometimes be complicated by the formation of intrarenal arteriovenous malformation (AVM). AVM is extremely rare following FURS and laser lithotripsy. Indeed only one case has been reported on reviewing the literature up to June 2018. We report on the second case illustrating the possibility of developing this major complication following this procedure. CASE PRESENTATION: A 79 years old diabetic and hypertensive male with stage-4 chronic kidney disease who previously had left extracorporeal shockwave lithotripsy and FURS with Holmium laser lithotripsy, presented with bilateral large renal calculi. He underwent simultaneous bilateral FURS and Holmium laser lithotripsy and was discharged home the following day with almost clear urine. Four days post-discharge, he presented with gross hematuria for which he required hospitalization and blood transfusion. CT scan demonstrated left subcapsular, perinephric and retroperitoneal hematoma. Angiography showed contrast extravasation from pseudoaneurysms in two small branches of left renal artery. Both were selectively embolized with micro-coils and this led to the cessation of the hematuria. CONCLUSIONS: Despite the relative safety of FURS and Holmium laser lithotripsy, it can be associated with major complications like intrarenal AVM. This can probably be prevented by careful and judicious use of laser energy in patients with large stone burden and premorbid conditions.
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Malformaciones Arteriovenosas/cirugía , Cálculos Renales/cirugía , Láseres de Estado Sólido/uso terapéutico , Litotripsia por Láser/métodos , Ureteroscopía/métodos , Anciano , Malformaciones Arteriovenosas/diagnóstico por imagen , Humanos , Cálculos Renales/diagnóstico por imagen , MasculinoRESUMEN
Arabic gum (AG) has antioxidant and anti-inflammatory properties. However, the effect of AG in ureteric obstruction (UO) has not been investigated yet. Male rats underwent reversible left unilateral UO (UUO) for 72 h. Group AG-1 (n = 12) received AG 15 g/kg/day dissolved in drinking water starting seven days before and continuing throughout the period of the UUO, whereas group Vx-1 (n = 8) had only water. Group AG-2 (n = 12) and Vx-2 (n = 8) had similar protocols as AG-1 and Vx-1, respectively, but underwent terminal experiments to measure renal functions, six days post-UUO reversal. Arabic gum significantly attenuated the UUO-induced increase in the tissue level of malonedialdehyde and superoxide dismutase and the rise in the gene expression of TNF-α, TGF-ß1, and p53 in AG-1 compared to Vx-1. It also attenuated the severity of tubular dilatation. However, AG did not affect the alterations in the renal blood flow or glomerular filtration rate. The fractional sodium excretion was lower in AG-2 but did not reach statistical significance (0.40 ± 0.11 vs 0.74 ± 0.12, p = 0.07). AG attenuated the UUO-induced rise in oxidative stress markers and proinflammatory and profibrotic cytokines and the degree of renal tubular dilatation, indicating a protective effect in obstructive nephropathy.
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Antioxidantes/farmacología , Goma Arábiga/farmacología , Riñón/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Obstrucción Ureteral/patología , Animales , Antioxidantes/uso terapéutico , Regulación de la Expresión Génica/efectos de los fármacos , Tasa de Filtración Glomerular , Goma Arábiga/uso terapéutico , Riñón/metabolismo , Riñón/patología , Masculino , Malondialdehído/metabolismo , Ratas , Ratas Wistar , Superóxido Dismutasa/metabolismo , Factor de Crecimiento Transformador beta1/genética , Factor de Crecimiento Transformador beta1/metabolismo , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/metabolismo , Obstrucción Ureteral/tratamiento farmacológico , Obstrucción Ureteral/metabolismoRESUMEN
BACKGROUND: Following reversal of short periods of ureteral obstruction (UO), glomerular and tubular renal dysfunction recovers with time. Diabetes mellitus (DM) affects glomerular function; thus, the ability of diabetic kidneys to recover from UO may be impaired. This study investigated the effects of long-term DM on the recovery of glomerular and tubular function, as well as permeability of the glomerular filtration barrier (GFB), after unilateral UO (UUO) reversal. METHODS: Diabetes mellitus was induced in Wistar rats by intraperitoneal streptozotocin. All diabetic and age-matched control rats underwent reversible 24-hour left UUO. The renal function of both kidneys was measured using clearance techniques 3 hours and 7 and 30 days after UUO reversal. Glomerular permeability was assessed by measuring the glomerular sieving coefficients for fluorescein isothiocyanate-conjugated Ficoll (molecular radius: 20-90 Å). RESULTS: Unilateral UO induced transient changes in the size selectivity of GFB small pores. However, the size selectivity function of large pores had not returned to baseline even 30 days after UUO reversal. Diabetes mellitus caused exaggerated early alterations in glomerular hemodynamic and tubular function, as well as size selectivity dysfunction of both small and large pores. At 30 days after UUO reversal, despite glomerular hemodynamic and tubular function and the size selectivity of small pores returning to normal in both diabetic and non-diabetic rats, the residual size selectivity dysfunction of large pores was more severe in diabetic rats. CONCLUSION: Unilateral UO caused long-term dysfunction in the size selectivity of large pores of the GFB. In addition, DM significantly exaggerated this dysfunction, indicating a more ominous outcome in diabetic kidneys following UUO.
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Permeabilidad de la Membrana Celular , Diabetes Mellitus Experimental/fisiopatología , Tasa de Filtración Glomerular , Enfermedades Renales/patología , Glomérulos Renales/patología , Obstrucción Ureteral/fisiopatología , Animales , Hemodinámica , Enfermedades Renales/etiología , Masculino , Ratas , Ratas WistarRESUMEN
Renal ischemia-reperfusion injury (IRI) induces the production of aldehydes which are detoxified by aldehyde dehydrogenases (ALDHs). Alda-1 is a selective ALDH2 agonist and its protective effect was demonstrated in several conditions. The effect of Alda-1 on the kidney or on renal IRI was not investigated. We investigated the effect of Alda-1 on the renal dysfunction following IRI. Wistar rats underwent left IRI for 40 min. Group-Alda (n = 11) received Alda-1 starting 24 h before IRI and continued for 7 days thereafter when renal functions were measured. Group-Vx (n = 11) underwent similar protocol but received the dissolvent. Alda-1 did not affect renal blood flow or glomerular filtration rate in the left ischemic kidney in Group-Alda compared to Group-Vx (3.05 ± 0.50 vs. 3.53 ± 0.70, and 0.40 ± 0.06 vs. 0.51 ± 0.08, respectively, p > .05 for both). However, left renal fractional sodium excretion was higher in Group-Alda (2.80 ± 0.43 vs. 1.37 ± 0.36, p = .02). Alda-1 also adversely affected the gene expressions of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin (217 ± 38 vs. 99 ± 13 and 49 ± 13 vs. 20 ± 5, respectively, p < .05 for both) and the alterations in tumor necrosis factor-α, transforming growth factor-ß1, plasminogen activator inhibitor-1, fibronectin 1 and p53 (4.4 ± 0.9 vs. 2.1 ± 0.3, 1.5 ± 0.1 vs. 1.1 ± 0.1, 30.0 ± 2.7 vs. 11.7 ± 2.3, 3.6 ± 0.4 vs. 2.1 ± 0.2 and 1.3 ± 0.1 vs. 0.9 ± 0.07, respectively, p ≤ .05 for all). This was associated with intratubular crystal deposition suggestive of crystalline nephropathy. Alda-1 exacerbated the IRI-induced renal tubular dysfunction and alterations in markers of acute kidney injury, biomarkers of inflammation, fibrosis and apoptosis and this was associated with intratubular crystal deposition suggestive of crystalline nephropathy.
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Aldehído Deshidrogenasa Mitocondrial/metabolismo , Benzamidas/toxicidad , Benzodioxoles/toxicidad , Enfermedades Renales/inducido químicamente , Enfermedades Renales/metabolismo , Daño por Reperfusión/metabolismo , Animales , Cristalinas/metabolismo , Enfermedades Renales/patología , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar , Daño por Reperfusión/patologíaRESUMEN
OBJECTIVE: To report on a case of intravesical explosion during transurethral resection of the prostate (TURP) which was managed laparoscopically and to review the relevant literature. CLINICAL PRESENTATION AND INTERVENTION: During TURP, a loud explosion was heard, and a jolt was felt in the abdomen. A bladder tear was seen endoscopically. Systematic laparoscopic exploration showed no injury to abdominal organs apart from the irregular large bladder tear which was repaired laparoscopically. The patient had an uneventful recovery. CONCLUSION: Bladder explosion during TURP is an extremely rare and serious complication. It should be considered as a blast injury and systematic exploration of abdominal organs and vessels should be performed. The severity and urgency of the condition should not preclude the use of laparoscopy for exploration and repair.
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Traumatismos por Explosión/etiología , Laparoscopía/efectos adversos , Próstata/cirugía , Resección Transuretral de la Próstata/efectos adversos , Vejiga Urinaria/lesiones , Humanos , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: The healthcare-seeking behaviour of women with pelvic organ prolapse (POP) is affected by several factors including the cultural background. There is limited number of studies which addressed the healthcare-seeking behaviour in women with POP. The aim of this study was to determine the degree of bother, social impact and healthcare seeking behaviour of symptoms of POP in one of the Gulf countries and compare the results to published data from other areas. METHODS: All women who attended the three family development centres in our city between January 2010 and January 2011 and who had symptoms suggestive of POP were included in the study. The data was collected by well-trained interviewers. RESULTS: One hundred twenty-seven women reported symptoms of POP (mean age: 38.2 years; range: 18-71). Out of these, 111 (87.4%) had at least one activity (physical, social or prayers) or sexual relationship affected by POP symptoms. In 49 women (38%), the effect on at least one of these activities or relationships has been described as moderate and in 18 women (14%), the effect was severe. Sixty-nine women (54%) did not seek medical advice due to: embarrassment to see medical doctors (51%), the belief that POP is normal among women (51%), hope for spontaneous resolution (48%), embarrassment to see male doctors (33%) and unawareness of the existence of medical treatment (30%). On univariate analysis, the need to insert the finger in the vagina to empty the bladder or bowel and the interference of symptoms with physical activities, had significantly determined healthcare seeking attitude (P < 0.05 for all). However, on multivariate analysis interference with physical activities was the only significant determinant (P = 0.04). CONCLUSIONS: Although POP had affected the quality of life in the majority of the affected women, unlike some other societies, more than half failed to seek healthcare advice mainly due to shyness and embarrassment and lack of proper knowledge about the condition. Interference of symptoms with physical activities was the main significant determinants of healthcare-seeking behaviour. Additional teaching campaigns designed according to cultural backgrounds in each society are required to address these sensitive issues.
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Conductas Relacionadas con la Salud , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Prolapso de Órgano Pélvico/psicología , Prolapso de Órgano Pélvico/cirugía , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , Anciano , Países en Desarrollo/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Prolapso de Órgano Pélvico/diagnóstico , Calidad de Vida , Adulto JovenRESUMEN
INTRODUCTION: Renal ischemia-reperfusion injury (IRI) causes renal functional alterations which may lead to permanent renal impairment. ß-caryophyllene (BCP), a natural bicyclic sesquiterpene, is an important constituent of many edible plants including spices. It is an FDA-approved food additive which possesses potent anti-inflammatory and antioxidant activities and has been shown to protect against chemotherapeutics-induced organ toxicities and against ischemic injuries to heart, liver and brain. Oxidative stress and inflammation is a main accompaniment of renal dysfunction, however, the effect of BCP on IRI-induced renal dysfunction has not been investigated yet and therefore the aim of this study was to investigate the effect of BCP on IRI-induced renal dysfunction. METHODS: Wistar rats underwent left renal warm ischemia for 40 minutes. G-BCP (n=13) received oral BCP (50 mg/kg/day) dissolved in a vehicle starting 7 days prior to IRI and continued 7 days thereafter when the renal functions of both kidneys and the markers of oxidative stress and pro-inflammatory cytokines were measured. G-Vx (n=13) underwent similar protocol but received vehicle only. RESULTS: IRI affected hemodynamic (renal blood flow and glomerular filtration rate) and tubular (urine volume, total and fractional urinary sodium excretion) parameters in the left ischemic kidney in G-Vx. Though, BCP did not affect any of these alterations in the ischemic kidney (P>0.05 for all). However, it attenuated the alterations in malondialdehyde (MDA) and glutathione (GSH) in the left ischemic kidney in G-BCP compared to G-Vx (9.3±2.1 vs. 4.8±1.0, P=0.047 and 18.1±2.5 vs. 13.6±1.7, P=0.09, respectively). CONCLUSION: Our study results demonstrate that BCP attenuated the alterations in some of the oxidative stress markers. However, these were not translated in to the protective effects on the haemodynamic and tubular glomerular functions when measured seven days post-IRI. This suggests that BCP has a weak reno-protective effect under ischemic conditions.