Academic literature on the topic 'Cystitis. eng'

Cystitis is a urinary bladder disease with many causes and symptoms. The severity of cystitis ranges from mild lower abdominal discomfort to life-threatening haemorrhagic cystitis. The course of disease is often chronic or recurrent. Although cystitis represents huge economical and medical burden throughout the world and in many cases treatments are ineffective, the mechanisms of its origin and development as well as measures for effective treatment are still poorly understood. However, many studies have demonstrated that urothelial dysfunction plays a crucial role. In the present review we first discuss fundamental issues of urothelial cell biology, which is the core for comprehension of cystitis. Then we focus on many forms of cystitis, its current treatments, and advances in its research. Additionally we review haemorrhagic cystitis with one of the leading causative agents being chemotherapeutic drug cyclophosphamide and summarise its management strategies. At the end we describe an excellent and widely used animal model of cyclophosphamide induced cystitis, which gives researches the opportunity to get a better insight into the mechanisms involved and possibility to develop new therapy approaches.

The expression of acid-sensing ion channel (ASIC) isoforms, ASIC1, ASIC2a, and ASIC3, was examined in the urinary bladder after cyclophosphamide (CYP)-induced cystitis of varying duration (4 h, 48 h, and chronic). Immunohistochemical, Western blot, and quantitative PCR approaches were used to evaluate channel expression and effects of CYP-induced cystitis in whole urinary bladder and split-bladder preparations from control (no inflammation) and CYP-treated rats. Quantitative PCR demonstrated significant ( P ≤ 0.01) increases in ASIC2a and ASIC3 transcripts with CYP-induced cystitis (48 h and chronic) in the urothelium but no changes (e.g., ASIC3) or modest changes (e.g., ASIC2a) in detrusor smooth muscle. ASIC1 mRNA expression in the urothelium or detrusor was not affected by CYP-induced cystitis. Immunohistochemistry for ASIC2a and ASIC3 protein expression revealed significant ( P ≤ 0.01) increases in ASIC immunoreactivity in the urothelium and suburothelial plexus with CYP-induced cystitis at all time points examined. Western blotting for ASIC2a and ASIC3 protein expression was complementary and revealed significant ( P ≤ 0.01) increases in ASIC immunoreactivity. For the first time, these studies demonstrate that CYP-induced cystitis alters ASIC2a and ASIC3 expression in the urinary bladder; ASIC1 transcript expression is not altered by CYP-induced cystitis. Future studies are necessary to determine ASIC isoform contributions to micturition reflexes in control and inflamed urinary bladder.

Introduction: Urinary tract infections are one of the common diseases in the primary health care. Aim: To analyse patterns of ambulatory antibiotic use in acute cystitis. Method: Antibiotic use data was based on national-level prescription turnovers. Patterns of antibiotic use were evaluated by prescribing quality indicators. The content of different national guidelines for treatment of acute cystitis and adherence to these guidelines were also evaluated. Results: For the treatment of acute cystitis quinolones were used predominantly. Norfloxacin (26%) and ciprofloxacin (19%) were prescribed most commonly. The use of internationally recommended agents such as sulphonamides, nitrofurans and fosfomycin shared 15%, 7% and 2%, respectively. The average adherence rate to national guidelines was 66% and certain weak points (e.g. controversial content) of the national guidelines were also identified. Conclusions: Antibiotic use in acute cystitis seems to be suboptimal in Hungary. Considering actual local antibiotic resistance patterns, a new national guideline should be worked out for acute cystitis treatment. Orv. Hetil., 2014, 155(15), 590–596.

3033 Background: Alemtuzumab is a humanized monoclonal antibody against CD52 resulting in profound, prolonged T-cell depletion that may be associated with opportunistic infections and reactivation of latent viruses (e.g., CMV). BK virus is a polyomavirus that infects most humans during childhood and remains latent in the urinary tract. Reactivation of BK virus is an important cause of tubular nephropathy following renal transplantation and hemorrhagic cystitis after allogeneic stem cell transplant. Methods: A single institution pilot trial of alemtuzumab and Dose-Adjusted (D-A) Etoposide, Prednisone, Doxorubicin, Vincristine, and Cyclophosphamide (EPOCH) investigating efficacy and toxicity in chemotherapy naïve aggressive T- and NK-cell lymphomas was undertaken. BK virus was detected in urine by polymerase chain reaction (PCR) methods to quantify genomic copies in pts with dysuria and hemorrhagic cystitis. Results: Four of 20 pts treated with alemtuzumab and DA-EPOCH developed five episodes of hemorrhagic cystitis. One had grade 1 and 2 cystitis, two had grade 2 cystitis and one had grade 3 cystitis. In contrast, only one of over 200 pts treated with EPOCH alone or in combination with rituximab developed hemorrhagic cystitis. Hemorrhagic cystitis occurred at a median of 88 days after initiation of therapy and lasted a median of 22 days. Even if considered an unlikely cause, steps to minimize cyclophosphamide toxicity were taken; in one, mesna was given during the fifth cycle and cyclophosphamide was withheld from the final cycle of therapy. Another received a reduced dose of cyclophosphamide during the final cycle of therapy and the third did not receive the final cycle of therapy altogether. The fourth pt developed hemorrhagic cystitis after completion of therapy. PCR for BK virus showed a median of 8.87 x 108 (range 2.3 x 105-8.7 x 109) genomic copies per ml. Conclusions: Hemorrhagic cystitis secondary to BK virus reactivation may occur following Alemtuzumab therapy. Symptoms tend to abate after 1 to 7 weeks with conservative measures alone. [Table: see text] No significant financial relationships to disclose.

High expression of VEGF is associated with immature angiogenesis within the urinary bladder wall and bladder afferent nerve sensitization, leading to visceral hyperalgesia and pelvic pain. Research suggests a shift in VEGF alternative splice variant (VEGF-Axxxa and VEGF-Axxxb) expression with several pathologies (e.g., neuropathic pain and inflammation) as well as differing effects on pain. Translational studies have also demonstrated increased total VEGF expression in the bladders of women with interstitial cystitis/bladder pain syndrome. In the present study, we quantified VEGF alternative splice variant expression in lower urinary tract tissues under control conditions and with cyclophosphamide (CYP)-induced cystitis. Using conscious cystometry and intravesical instillation of a potent and selective VEGF receptor 2 (VEGFR2) tyrosine kinase inhibitor (Ki-8751, 1 mg/kg) in Wistar rats (male and female) with acute and chronic CYP-induced cystitis and control (no CYP) rats, we further determined the functional effects of VEGFR2 blockade on bladder function. With VEGFR2 blockade, bladder capacity increased ( P ≤ 0.01) in male and female control rats as well as in male and female rats with acute ( P ≤ 0.05) or chronic ( P ≤ 0.01 or P ≤ 0.05, respectively) CYP-induced cystitis. Void volume also increased in female control rats ( P ≤ 0.01) and female rats with acute ( P ≤ 0.05) or chronic ( P ≤ 0.05) CYP-induced cystitis as well as in male control rats ( P ≤ 0.05) and male rats with chronic CYP-induced cystitis ( P ≤ 0.01). These data suggest that VEGF may be a biomarker for interstitial cystitis/bladder pain syndrome and that targeting VEGF/VEGFR2 signaling may be an effective treatment.

Background. The structure of lower urinary tract infections has clear sex-based differences. The vaginal microbiota is a key factor in the pathogenesis of lower urinary tract infections: aerobic vaginitis predisposes to infection and increases the incidence of cystitis by 2.9 times. Aim. To determine the effectiveness of Nifuratel as monotherapy in patients with chronic cystitis and concomitant bacterial vaginosis (BV). Materials and methods. Study design: an open-label, non-comparative, pilot, single-center, prospective study, which included 23 patients with recurrent cystitis and BV. All women received monotherapy with Nifuratel (Macmiror manufactured by Doppel Farmaceutici S.r.l., Italy) in tablets of 200 mg 3 times a day for 7 days. Control visits were performed in 7.90 and 180 days. Results. BV was diagnosed in all patients; 19 (82.6%) women also had vaginal candidiasis. At the end of therapy, 17 (73.9%) patients showed an excellent outcome, 4 (17.4%) a significant improvement, 2 (8.7%) no effect. After the end of three-month therapy, 18 (81.8%) out of 22 patients who left in the study had no complaints of urinary disorders or vaginal discharge. Their urinalyses were normal. Molecular genetic analysis of the vaginal biocenosis showed moderate dysbiosis; Candida spp. was revealed only in 3 (13.6%) cases. 18 patients came for the 4th visit. Within six months after the end of monotherapy with Nifuratel, the patients had no complaints. They all achieved the recovery of vaginal normocenosis with a sufficient amount of Lactobacillus spp. Conclusion. Monotherapy in patients with recurrent cystitis and BV is highly effective for both diseases: 73.9% of women achieved stable normalization of urine and vaginal microbiota analyzes, removal of bacteriuria. The bi-directional action of Nifuratel allows to avoid polypharmacy in this category of patients.

Introduction. Strontium salts are anti-irritants for chemically induced sensory irritation. Interstitial cystitis is a painful disease without definitive therapy. The aim of the study was to determine the effect of strontium in bladder with experimental interstitial cystitis model. Material and Methods. Rats’ bladders in control group were instilled with NaCl. Second group was instilled with E. coli LPS. Third group was instilled with strontium. Fourth group was initially instilled with strontium and then LPS. Fifth group was instilled with LPS initially and then strontium. Urine of rats was collected at the beginning and end of the study. Results. Histamine and TNF-α changes were statistically significant in the second group but were not significant in the third group. When we compared the histamine levels of second via fourth and fifth groups the changes were statistically not significant. When we compared the TNF-α levels of second via fourth and fifth groups the changes were statistically significant. Conclusions. In our model, strontium did not make any significant changes in histopathology or histamine levels; however, it significantly reduced the levels of TNF-α. Given the role of TNF-α in the physiopathology of interstitial cystitis, these results suggested that further studies are required to evaluate the potential use of strontium in the management of interstitial cystitis.

Orientador: Luiz Fernando de Oliveira e Silva Carvalho
Banca: Maria Cristina Thomaz
Banca: Geraldo Camilo Alberton
Resumo: As infecções urinárias (IU) em porcas estão entre as principais causas de falhas reprodutivas que influem na produtividade do rebanho, proporcionando grandes prejuízos econômicos. No presente trabalho foram testados dois acidificantes urinários - o ácido cítrico e o cloreto de amônio e cloreto de sódio, de modo a comparar a atividade destes produtos, no controle de cistites em matrizes suínas. Utilizaram-se 53 porcas adultas, gestantes ou não, de linhagens comerciais, portadoras ou não de cistite, sendo identificados os animais sadios ou afetados com base nos resultados de urinálises e cultivos bacterianos. O primeiro ensaio foi constituído de duas fases - fase 1 - realizada com 25 fêmeas em início de gestação (20 com cistite e 5 sadias), alimentadas com ração de gestação e fase 2 - realizada com 20 animais em final de gestação (16 com cistite e 4 sadias), alimentadas com ração de lactação. O pH, a densidade e a contagem bacteriana nas amostras de urina foram as variáveis estudadas. No segundo ensaio foram utilizadas 8 porcas, todas com cistite e não gestantes. A quatro delas administrou-se ração com cloreto de amônio e outras quatro receberam ração não suplementada com o produto. Avaliou-se o consumo de água, a produção de urina, os pH da urina e do sangue. Os resultados demonstraram que o ácido cítrico determinou diminuição do número de unidades formadoras de colônias, porém não interferiu no pH e densidade urinária dos animais. O cloreto de amônio reduziu o pH urinário demonstrando ação acidificante mesmo colhendo a urina 24 horas após o arraçoamento, porém não interferiu nas densidade e contagem bacteriana. Com relação o cloreto de sódio (1,5% ou 52,5 g/Kg de ração) não se observou qualquer efeito sobre os parâmetros estudados (pH urinário, densidade e contagem bacteriana).
Abstract: The urinary infections(IU) in sows are among the main causes of reproductive imperfections that influence in the productivity of the flock, providing great economic damages. In the present work two acidifiers were tested out - acid citric and the chloride of ammonium and sodium chloride, in order to compare the activity of these products, in orther to control the cystitis in swine. 53 adult, pregnants and non pregnant sows were used , of tradeable ancestries, bearing, donþt bearing cystitis being identified the healthy or affected animals on the basis of the bacterial results of urinalysis culture. The first assay was carried out into two phases - phase 1 - carried through with 25 females in theirs early gestation (20 with cystitis and 5 healthy ones), fed gestation diet and phase 2 - carried through with 20 animals in gestation end (16 with cystitis and 4 healthy ones), fed with lactation ration. pH, the density and the number of CFUs in the urinary samples were the studied. As the assay 8 sows had been held envolving, all cystitis and not pregnant. Four out of 8 sows were fed with chrolide ammonium based rations. The remnants 4 were fed with no supplemented feed. The consumption of water, urinary output, urinary pH and the blood were also evaluated. The results showed that the citric acid determined a decrease in the CFU. However, it didnþt interfere at both pH and urinary density in the animals. The ammonium chloride reduced the urinary pH showing acidifying action even while collecting the urine after a period of 24 hours after the feeding time. Both density and CFU were not changed. Regarding the sodium chloride (1.5% or 52.5g/kg) nothing was found out within the complying parameters (pH urinary, dendity and CFU).
Mestre

The urinary system is the primary target of Schistosoma haematobium infection, which leads to granuloma formation in the lower urinary tract that heals with fibrosis and calcification. While the early lesions may be associated with distressing acute or subacute symptoms, it is the late lesions that constitute the main clinical impact of schistosomiasis. The latter include chronic cystitis, ureteric fibrosis, ureterovesical obstruction or reflux which may lead to chronic pyelonephritis. Secondary bacterial infection and bladder cancer are the main secondary sequelae of urinary schistosomiasis.The kidneys are also a secondary target of S. mansoni infection, attributed to the systemic immune response to the parasite. Specific immune complexes are responsible for early, often asymptomatic, possibly reversible, mesangioproliferative lesions which are categorized as ‘class I’. Subsequent classes (II–VI) display different histopathology, more serious clinical disease, and confounding pathogenic factors. Class II lesions are encountered in patients with concomitant salmonellosis; they are typically exudative and associated with acute-onset nephrotic syndrome. Classes III (mesangiocapillary glomerulonephritis) and IV (focal segmental sclerosis) are progressive forms of glomerular disease associated with significant hepatic pathology. They are usually associated with immunoglobulin A deposits which seem to have a significant pathogenic role. Class V (amyloidosis) occurs with long-standing active infection with either S. haematobium or S. mansoni. Class VI is seen in patients with concomitant HCV infection, where the pathology is a mix of schistosomal and cryoglobulinaemic lesions, as well as amyloidosis which seems to be accelerated by the confounded pathogenesis.Early schistosomal lesions, particularly those of the lower urinary tract, respond to antiparasitic treatment. Late urological lesions may need surgery or endoscopic interventions. As a rule, glomerular lesions do not respond to treatment with the exception of class II where dual antiparasitic and antibiotic therapy is usually curative. Patients with end-stage kidney disease may constitute specific, yet not insurmountable technical and logistic problems in dialysis or transplantation. Recurrence after transplantation is rare.

Palliative care is an integrated approach that focuses on quality of life of ‘patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and treatment of other problems, physical, psychosocial, and spiritual’. This embraces the concept that quality care is embedded not only in individual health, but also the environment and setting of care and touches the domains included in the previous World Health Organization (WHO) definition. Palliative care focuses caregivers on the important goals of medicine—alleviating pain and suffering (at all levels), improving the experience of daily living, supporting psychological transitions with changing physical abilities, and advancing the patient’s and family’s understanding of the nature of the disease facing an individual and the outcomes. With that in mind, it represents a basic tenet of care for all patients, particularly those with diseases that lead to significant loss of quality of life and function. While this chapter focuses more on oncological palliative care, the tenets of palliative care and the research about symptom management can extend to the care of women with chronic conditions such as chronic pelvic pain, severe endometriosis, interstitial cystitis, untreatable pelvic prolapse, and other conditions. Palliative care, then, can be a focus for fatal and non-fatal diseases, and can and should be provided to address diminished quality-of-life issues as a part of ongoing treatment of a disease process, not just at the end of life.