Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.

All patients admitted with pregnancy related acute renal failure (PRAKI) from June 2005 to May 2007 were studied with respect to etiology, clinical features, and outcome of PRAKI. Of 569 cases of acute kidney injury (AKI), 40 (7.02%) cases were related to gestational problems; the age of the patients ranged from 15 to 45 years. Septic abortion was the most common cause of PRAKI, accounting for 20 (50%) cases of which 15 (75%) cases occurred in the first and five (25%) in the second trimester. Other causes were antepartum hemorrhage: six cases (15%), toxemia of pregnancy: six cases (15%), acute gastroenteritis: three cases (7.5%), postpartum hemorrhage: two cases (5%), acute pyelonephritis: two cases (5%), and postpartum, acute kidney injury: one case (2.5%). Dialysis was needed in 60% of the cases and mortality was observed in 20% of the cases. PRAKI continues to be a major concern in our society, causing a high maternal mortality. Septic abortion which has virtually disappeared from developed countries, continues to be a major cause of PRAKI in our society. Hence, there is a need to halt the practice of illegal abortions and improve antenatal care.

We present case series of four patients with an important syndrome known as Herlyn-Werner-Wunderlich syndrome. Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly characterised by uterus didelphys with blind hemivagina and ipsilateral renal agenesis. It usually presents after menarche with progressive pelvic pain during menses secondary to haematocolpos. Awareness is necessary to diagnose and treat this disorder properly before complications occur. Magnetic resonance imaging is the preferred modality for the delineation of uterine malformation. When renal anomalies are encountered, a screening should also be made for congenital abnormalities of the reproductive tract and vice versa.

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Background: Hypertensive disorders represent the most common medical complication of pregnancy affecting between 7-15% of all gestations and accounts for approximately a quarter of antenatal admissions.Methods: A case-control study was conducted over a period of 1 year. A total of 200 subjects were enrolled in the study and were divided into two groups; 100 cases and 100 controls. Serum uric acid levels were measured in cases and controls. The serum uric acid levels were correlated with the severity of PIH and maternal and fetal complications.Results: It was observed that the mean serum uric acid level in cases (5.0±1.74 mg/dl) was significantly higher compared to 2.66±0.39 mg/dl in controls. Serum uric acid levels also tended to increase with increasing severity of PIH, increasing from 3.69±0.95 mg/dl in gestational hypertension to 6.36±1.38mg/dl in severe PE. Maternal complications during antepartum and postpartum period were higher once SUA≥5mg/dl was taken as a cut-off. Protienuria(p=0.00), coagulopathy(p=0.007), need for blood/platelet transfusion(p=0.01) and eclampsia (p= 0.007) were significantly more. Similarly, complications were found to be higher, in babies born to mothers having serum uric acid more than 5 mg/dl compared to others in case group.Conclusions: Higher serum uric acid levels may indicate higher risk of progression to preeclampsia and development of adverse maternal/infant conditions.

Background: Hypertensive disorders of pregnancy greatly influence the maternal and foetal outcome in terms of morbidity and mortality. Complications include involvement of the kidney and progression of the disease which leads to deterioration of renal parameters and function. If left unattended, oliguria and renal shutdown are serious sequelae. Hence the importance of monitoring serum concentrations of cystatin C, creatinine and uric acid. The present study was designed to understand the variations of these markers in pregnant women in this part of India.Methods: Serum levels were therefore determined in samples from 75 healthy women at term as well as in 38 samples of patients with Gestational hypertension and in 30 patients with pre-eclampsia (PE). The values were analysed after tabulation and results subjected to statistical analysis using SPSS software programme.Results: The levels of all three components were significantly higher in pre-eclamptic patients when compared to healthy controls with the mean±SD being 1.86±0.82 vs. 1.08±0.33 for cystatin C, 0.93±0.18 vs. 0.62±0.07 for creatinine and 7.02±1.92 vs. 4.04±1.06 for uric acid respectively. In gestational hypertension, cystatin C was significantly higher, 1.42±1.1 unlike creatinine, 0.84±0.16 and uric acid, 5.26±1.40.Conclusions: In view of significant increase in serum cystatin C, creatinine and uric acid in hypertensive disorders of pregnancy compared to those of healthy pregnant women, in our study, we conclude that these parameters are of significant value if used as markers to predict the onset of GH/PE. This can be established after further and larger clinical trials.

To study clinical features, indications and histopathological diagnosis of elective abdominal hysterectomy in our region. Patients and Methods: Patients presenting to our department were worked up for age, presenting symptoms, indications for hysterectomy and histopathology reports of the specimens were analysed. The study was done over a period of two years. Results: A total of 237 elective abdominal hysterectomies were performed. About 99% of indications of hysterectomy were for benign disease. Peak age incidence was 45-55 years. 40.92 % of patients presented with menstrual abnormalities, followed by postmenopausal bleeding in 31.22 %. On histopathology of uterus 40 % of the patients had leiomyoma, which was most common and 31.22% had adenomyosis, being second most frequent disease. Endometrial carcinoma in 3 (1.26%) patients was least common pathology. There was no mortality associated with the procedure. Conclusion: Hysterectomy remains acceptable and a successful procedure for management of various uterine pathologies especially in the low resource setting but with proper indication and specific patient counseling. Menstrual disturbance is leading indication of hysterectomy and leiomyoma is the commonest pathology in our study in our population studied.

Fibroids are a common malady in the category of benign tumours of the uterus. Symptoms range from none to menorrhagia and pelvic pain to neurological deficits1. We have here an interesting case of a young woman who presented to us with a giant fibroid of the uterus and surprisingly was asymptomatic. She was operated on and a 6 kg tumour was removed. She did well post operatively. JMS 2013; 16(2):95-96