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Myoglobin is a heme protein present in muscle tissues and responsible for binding and delivery of oxygen in the muscle cells for oxidative metabolism. Whenever muscle tissue is injured, that is, rhabdomyolysis occurs free myoglobin enters into circulation along with other enzymes and electrolytes and myoglobinuria occurs when the renal threshold is crossed. There are many causes of rhabdomyolysis including physical damage, infective, inflammatory, toxic, and metabolic problems. Clinically, myoglobinuria presents as muscle pain, weakness, cola colored urine, and laboratory diagnosis is done by elevated serum creatine kinase, urine dipstick positive for blood without RBC in microscopy examination. These myoglobin molecules can cause renal injury by renal vasoconstriction, proximal tubular necrosis, and distal tubular obstruction. Early anticipation of myoglobinuria and aggressive fluid resuscitation during the initial stage of injury is the mainstay of management of myoglobinuric acute kidney injury (AKI). There is lesser role of forced alkaline diuresis and mannitol than diuresis by normal crystalloid solution in myoglobinuric AKI. Renal replacement therapy should be considered in cases with life-threatening dyselectrolytemia and acidosis.

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Objective: Urinary tract infection (UTI) is a common cause of morbidity in patients attending our hospital. Recently UTI has become more complicated and difficult to treat because of appearance of pathogens resistant to the commonly used antimicrobial agents. The main aim of the study was to determine the causative agents and antibiotic susceptibility pattern of UTI patients attending our hospital. Materials and methods: A prospective cross sectional study was conducted in asymptomatic and symptomatic UTI patients attending medicine and nephrology clinics of Jawaharlal Nehru Medical College Hospital, Aligarh from June 2012 to July 2014. A total of 1843 patients were investigated for urinary tract infection. Clean catch mid-stream urine specimens collected were subjected to urine culture and sensitivity tests. Results: Significant bacteriuria was detected in 19.3% and 55.4% of asymptomatic and symptomatic patients, respectively. The overall prevalence of significant bacteriuria in both groups was 33.4% with female sex, diabetes, obstructive uropathy, previous instrumentation and chronic kidney disease being the major risk factors. The most common pathogens isolated were Escherichia coli (52.4%) followed by Klebsiella pneumoniae (12.3%), Citrobacter spp (9.1%), Enterococcus (6.9%), Proteus spp (5.3%), Coagulase negative staphylococcus (5.3%) and Staph Aureus(4.0%). Most susceptible antibiotic was Amikacin, Cefoperazone-sulbactum, Piperacillin-tazobactum and Nitrofurantoin for most of the isolates. E. coli which was the main isolate was found to be most susceptible to Amikacin (78.3%), Cefoperazone-sulbactum 72.8%, Piperacillin-tazobactum (70.5%), Gentamicin (69.3%) and Nitrofurantoin (67.3%). Conclusion: This study highlights the common pathogens causing UTI in our area and their antibiotic sensitivity patterns which could help clinicians in starting rational empirical antibiotic therapy for such patients while awaiting urine culture reports.

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Chronic kidney disease (CKD) is characterized by progressive loss of renal function. Although the burden of CKD in India cannot be assessed accurately, its approximate prevalence is believed to be 800 per million populations (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pmp. Diabetic nephropathy is a leading cause of ESRD worldwide. Another cause of ESRD is dyslipidemia, which is one of the most common quantitative lipid abnormalities in patients with CKD. In diabetes, the total cholesterol and triglyceride levels rise as the albumin excretion rate increases, leading to renal injury. Oxidative stress generated by hyperglycemia increases reactive oxygen species production, which causes cellular dysfunction and damage, and ultimately results in diabetic micro- and macro-vascular complications. Therefore, lipids may represent a useful clinical tool for not only identifying patients at a high risk of developing CVD but also assessing the development and progression of renal disease. In this review, we summarize the effects of lipid abnormalities and oxidative stress in patients with diabetes and nephropathy.

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We report the case of a 49-year-old man presenting with a recurrent penile fracture 1-year after undergoing delayed repair for a previous penile fracture. To the authors' knowledge, this case represents the first documented instance of repeat fracture occurring after delayed repair. Risk factors for repeat penile fracture are not well documented due to the rarity of this condition. A review of literature regarding repeat penile fracture and the impact of delayed repair is discussed.

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Metabolic syndrome is a common global problem. This condition is also multifaceted and potential precursor to significant disturbance of numerous physiologic processes. The interconnected complexities of this disorder may varies from, life threatening risk of cardiovascular atherosclerotic diseases, type 2 diabetes, and hypertension to many of other metabolic diseases like male or female infertility. This review article cogitate the literature regarding metabolic syndrome and male reproductive health. The association between abdominal obesity, insulin resistance, systemic hypertension, and dyslipidemia are each examined with regard to their interconnected deleterious effects on male fertility. At the conclusion of this manuscript, we propose a new metabolic syndrome with male infertility paradigm. Supplementary acquisition particularly addressing the components of metabolic syndrome and their impact on male reproduction will enhance our understanding of the underlying pathophysiology. These studies may also help elucidate the role for therapeutic intervention.

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Primary hypothyroidism refers to a systemic hypometabolic status due to hypothyroxinemia or thyroid hormone resistance caused by pathologic changes to the thyroid gland. The main role of thyroid hormone is to promote energy metabolism and facilitate growth and development processes within the body. In a hypothyroidism state caused by thyroid hormone deficiency, the body's thermogenic effect is down-regulated and metabolisms of protein, sugar, and fat were slowed down, which might further lead to cardiovascular disease, hyperlipidemia, myocardial damage and myxedema, as well as other changes. Hypothyroidism tends to be neglected or misdiagnosed due to its trivial and nonspecific clinical manifestations, and a combined renal dysfunction is rarely reported. Herein a case of kidney dysfunction caused by hypothyroidism is reported and relevant literature was reviewed.

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Purpose: The aim of the study was to identify correlation between DNA damage marker 8-hydroxy 2-deoxy guanosine (8-OHdG) and other prognostic factors such as Gleason's score, serum prostate-specific antigen (PSA), and stage in carcinoma prostate and to assess a probability-correlation between DNA damage and benign prostatic hyperplasia (BPH) and control. Materials and Methods: A study has been carried out prospectively. Forty patients of carcinoma prostate, 34 BPH, and 14 healthy controls were included in the study between the period of July 2010 to July 2012. Serum 8-OHdG level was measured in all subjects as a marker of DNA damage. Results: Serum 8-OHdG level was significantly raised in patient with prostate cancer (313.39 ± 69.48 ng/mL) as compared with BPH patients (204.42 ± 40.97 ng/mL) and control group (198.94 ± 15.74 ng/mL) with P< 0.001. Serum 8-OHdG level in BPH patients was higher than the controls, but the mean difference was statistically insignificant (P = 1.000). The patients with serum PSA >20 ng/mL, Gleason's score >6 had higher mean 8-OHdG levels as compared to serum PSA ≤20 and Gleason score ≤6, as P< 0.05. There was also direct association found between prostate volume and stage of the tumor though it was not significant. Conclusions: These findings suggest that oxidative stress level was significantly raised in prostate cancer patients. It was also observed that a significant direct association exists between oxidative stress and certain clinicopathologic factors, including serum PSA, Gleason score, and metastasis which show that with progression of disease, there was increase in oxidative stress level.

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Cell phones are a relatively novel and evolving technology. Mobile communication is now essentially ruling in our daily activities through better connectivity and intelligent, smart phone services. While the potential benefits of this technology continue to emerge, so do the potential health risks. There is increasing concern that the use of mobile phones may be associated with decreased semen quality and infertility. The most sensitive tissues to the damaging effects of cell phones are testicular tissues through increased oxidative stress, heating and radiation. Cell phone radiation may negatively affect sperm quality in men by decreasing the semen volume, sperm concentration, sperm count, motility, and viability, thus impairing male fertility. This should be supported by mass media to raise awareness among people regarding the possible health effects of radiofrequency emissions from mobile phones and to minimize its exposure. This study is a brief review of the recent data about the effect of cell phones in male infertility.

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Deterioration of renal function is closely related to renal interstitial fibrosis (RIF). With animal models, we can simulate the pathological changes and progression of disease. Various animal models of RIF are pivotal for clinical treatment and investigation of new drugs. Reviewed here are methods of establishment and mechanism of commonly used animal models of RIF to help researchers select the optimal animal model for different research purposes.

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Purple urine bag syndrome is a rare, striking medical phenomenon observed in patients having indwelling urinary catheters having urinary tract infection. It is commonly observed in elderly patients having constipation and long-standing indwelling urinary catheters and indicates bacterial urinary tract infection. The purple discoloration of the urinary bag is reported to be due to the presence of indigo and indirubin pigment produced by tryptophan metabolism by Gram-negative Bacteria. The authors present a case of 67-year-old female with purple discoloration of her urine bag due to urinary tract infection caused by Klebsiella pneumoniae.

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Background and Objective: The ankle-brachial index (ABI) is a noninvasive method used to predict subclinical atherosclerosis in patients with chronic kidney disease (CKD). Studies regarding this are lacking in India, especially in a rural setting. Here, we have tried to determine the prevalence of peripheral arterial disease (PAD) by manual ABI, which is a low-cost diagnostic tool than Doppler ABI. Materials and Methods: This is a prospective observational study carried out over a period of 2 years enrolling 240 patients with CKD within the age group of 17-85 years. All patients and controls underwent thorough clinical examination and required laboratory investigation. Statistical analysis was carried out using statistics using the Z-test for the difference in comparison and calculation of P values. Results: The mean age of presentation was 47.91 ± 14.23 with a male preponderance of 161 (67.08%). The relation between hemodialysis (HD) and peripheral vascular disease and its duration were compared which showed significantly lower ABI values in patients who were on HD −0.87 ± 0.05 (manual), 0.90 ± 0.09 (Doppler); off HD: 0.89 ± 0.07 (manual), 0.93 ± 0.07 (Doppler) with P = 0.008 (manual), 0.007 (Doppler), and longer duration of HD (>6 months), showing lower ABI values which were statistically significant ≤6 months: 0.88 ± 0.05 (manual), 0.90 ± 0.10 (Doppler); >6 months: 0.85 ± 0.05 (manual), 0.88 ± 0.06 (Doppler). Conclusion: The correlation of both methods of ABI was compared with different stages of CKD in detecting PAD that showed that both methods were equally effective in detecting CKD in different stages.

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Objective: To study and describe the utilization pattern of various classes of drugs including antibiotics in patients with chronic kidney disease (CKD). Materials and Methods: A total of 185 CKD patients were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study that was conducted over a period of 6 months in Nephrology Department of a tertiary care teaching hospital. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Mean age of CKD patients was 45.81 ± 11.16 with male predominance (58%). CKD Stage III comprised of the maximum number (28%) of patients. Polypharmacy was executed in 83% of these patients. Hypertension (95%), diabetes (87%), and anemia (86%) are the most common co-morbidities. The five most frequently prescribed drugs were diuretics (100%), anti-ulcer agents like proton pump inhibitors and H ₂ blockers (98%), anti-hypertensives (95%), vitamins and minerals supplements including calcium (92%), and hematinics (85%). Infectious diseases like respiratory tract infection (37%) and urinary tract infection (34%) had shown to have a high prevalence in CKD patients. Cefoperazone, metronidazole, piperacillin + tazobactam were the most prescribed parenteral antibiotics. Azithromycin and levofloxacin were the extensively used oral antibiotics. Conclusion: This study demonstrates the variability of drug utilization in CKD patients. Drug utilization studies on a regular basis give a framework to pharmaceutical companies and healthcare providers and help to build management strategies. However, the right choice of drugs and inappropriate doses will reduce the incidence of nephrotoxicity and ultimately result better clinical outcomes. Managing infections and prescribing antibiotics in CKD are crucial and hence claim rationalization of the use of antibiotics to improve the quality of life of CKD patients.

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Background and Objectives: Acute kidney injury (AKI) is one of the major complications of snake envenomation, especially in the developing countries. The most common renal histology in snakebite-induced AKI is acute tubular injury (ATI), but acute interstitial nephritis (AIN) is rarely reported. Materials and Methods: We did a prospective observational study between January 2012 and May 2017 to analyze the demographic, clinical, and laboratory data, response to treatment, and outcome of patients with snakebite-induced AIN. Results: About twenty patients were included in the study with mean follow-up of 24 ± 6 months. Of them, 6 (30%) were males. Mean age was 50.9 ± 22.1 years. All the patients received anti-snake venom. AKI developed after a mean duration of 24.1 ± 11.2 h and 15 patients were oliguric. Cellulitis was seen in 65% of patients, anemia in 65%, leukocytosis and thrombocytopenia in 40%, and coagulopathy in 80%. Mean peak serum creatinine was 7.8 ± 3.2 mg/dL. Peripheral eosinophilia was seen in 7 (35%) patients. All the patients were managed with hemodialysis and all except one received oral steroids. Six patients (30%) progressed to chronic kidney disease (CKD) with mean follow-up creatinine of 1.49 ± 0.8 mg/dL. Conclusion: It is prudent to do renal biopsy in patients with snakebite-induced AKI when there is a suspicion of pathology other than ATI. Identification and treatment of AIN with steroid will avoid progression to CKD which has an impact on growing health burden in tropical countries.

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Background and Objectives: Prostate cancer is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide. In India, it is the second most common cancer in males as per the Indian Council of Medical Research and various state cancer registries. This study was designed to investigate the effect of dyslipidemia, elevated insulin levels, and insulin resistance on the risk of prostate cancer. Materials and Methods: This case–control study was conducted on a total of 200 individuals. Cases were 100 males under the age of 80 (range, 50–80 years), newly diagnosed with histologically confirmed primary adenocarcinoma of the prostate. Controls were 100 age-matched disease-free males, without any complications. Mean ± standard deviation in case and control groups was compared using the unpaired Student's t-test. Pearson's correlation analysis was used to determine the association between variables of interest and prostate-specific antigen (PSA), Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), and body mass index (BMI) among prostate cancer patients. Unadjusted and adjusted odd ratios with 95% CI were calculated using logistic regression models for prostate cancer risk in relation to dyslipidemia and IR. Results: Data showed that serum PSA significantly positively associated with BMI, total cholesterol, triglycerides (TGs), low-density lipoprotein-cholesterol (LDL-C), insulin, HOMA-IR and significantly negatively associated with high-density lipoprotein-cholesterol (HDL-C). HOMA-IR significantly positively associated with BMI, TGs, glucose, and insulin. The binary logistic regression analysis showed a significant adjusted* Odds Ratio (OR) with 95% confidence interval (P < 0.001) between total cholesterol (5.27 [1.87–14.8]), HDL-C (1.73 [1.02–3.42]), TGs (1.24 [1.05–1.37]), HOMA-IR (2.68 [1.53–4.62]), and prostate cancer. Conclusion: This study confirms the association between dyslipidemia, IR, and increased prostate cancer risk.

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Objectives: The objectives are to study the clinical profile of patients admitted with acute kidney injury (AKI) and to study the determinants of the outcomes of patients with AKI. Subjects and Methods: The study was done in setting of tertiary care hospital in Department of Nephrology. It is a prospective observational study. A total of 220 patients who were admitted with community AKI in a tertiary care hospital were evaluated, and data were collected and analyzed. Patients were evaluated and followed up and if indicated were dialyzed until recovery. Primary outcomes were in-hospital mortality, complete recovery, and dialysis dependency at 3 months. Apart from these etiological profile, mortality of patients with various etiology, their RIFLE staging was assessed. Results: of 220 patients studied, 191 (86.81%) survived and 29 (13.19%) expired, 93 (42.27%) patients required dialysis and 123 (57.7%) did not require dialysis with oligoanuria being the most common (24.5%) indication for dialysis and gastroenteritis was the most common etiology of AKI in 60 (27.3%) reflecting the high incidence of disease in community, followed by sepsis 31 (14.1%), pyelonephritis 27 (12.3%), and snakebite and obstetrics 19 (8.6%) each. Among patients who died, patients with sepsis had highest mortality 11 (35.5%) and gastroenteritis and acute febrile illness had least mortality (1.7% and 0%), respectively, majority of patients (59.5%) were in RIFLE Stage 3 and they had the highest mortality 23 (17.6%). A significant association was observed between the etiology and mortality (P < 0.005). Conclusions: We conclude that underlying cause of AKI is important determinant of the clinical outcome where we found that patients with gastroenteritis had better outcome than other etiology of AKI.

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Background: Infections of urinary tract were considered as the most common hospital-acquired infections in hospitalized patients. Area-specific monitoring studies aimed to assess the prevalence of causative organisms of urinary tract infections (UTIs) and their responsiveness to different available antimicrobials in a sample of Arab children, which may help the clinician to choose the correct empirical treatment. We aimed to study the type of urinary pathogens isolated from hospitalized patients with first-episode UTI in our locality and its antibiotic susceptibility pattern. Materials and Methods: Urine samples were collected from 320 clinically suspected cases of UTI from inpatient wards and outpatient clinic of Pediatric Department of Tanta University Hospital during the period from June 2016 to June 2017. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly used antibiotics by disc diffusion method according to hospital policy. Results: Significant bacteriuria was present in 75% of the samples, 16.25% were sterile, and 8.75% showed insignificant bacteriuria. The most common pathogens were Escherichia coli (55%), Klebsiella spp. (26.6%), and Proteus mirabilis (14.2%). The mean susceptibility was high for amikacin (85%), ceftriaxone (82%), cefotaxime (80%), nitrofurantoin (80%), and nalidixic acid (78%) but low for ampicillin (21%), cephalexin (30%), and sulfamethoxazole + trimethoprim (37%). Conclusions: The antibiotics which are commonely used in UTIs such as trimethoprim/sulphamethoxazole,ampicillin and cephalexin are not appropriate for embrical treatment of common UTIs.This may be attributed to high rate of bacterial resistance .Regular monitering of these patients is recommended to establish reliable information about patterns of urinary pathogens aiming optimal embrical therapy for children with UTI.

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Although renal disease has been present for over 200 millennia of Homo sapiens' existence, knowledge of the causes and management of these disorders has only emerged during the last 4000 years. Brilliant insights into human disease probably emerged from time to time over the long period of human existence, but observations could only be advanced after writing began in 3200 BC. Humans could then make observations, record these thoughts, and have others in their present and future critique them leading to improvement in this information. This discussion selectively considers some of the medical giants who led the way to clinical nephrology of the 21^st century. It reflects on who taught us basic principles of renal disease that led to our current knowledge. Attention is given to the ancient Egyptians, Ancient Greeks, Galen of Pergamon, the Byzantine Greeks of the 5^th-9^th centuries, the Arab/Persian Physicians of the 9^th-12^th centuries, Moses Maimonides of the 12^th century, selective Renaissance Physicians, and the father of modern nephrology - Richard Bright MD. This reflection celebrates au courant renal sagacity by celebrating the past clinicians who led the way from their eras to ours.

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Penile epithelioid hemangioma is a very rare benign vascular neoplasm of unclear etiology. To the best of our knowledge, only 28 cases in the literature have been reported to date. We report a case of epithelioid hemangioma of the penis in a 41-year-old man with a painful penile mass. The presented case exemplifies the importance of establishing a correct diagnosis through appropriate histologic analysis, as epithelioid hemangiomas are often misdiagnosed as two highly malignant tumors, epithelioid hemangioendothelioma and epithelioid angiosarcoma. Establishing benignancy is crucial in order to avoid inappropriate and overly aggressive treatment.

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A 40-year-old lady, a known case of hypothyroidism, presented with 1-day history of progressive weakness in all four limbs and reported a history of similar episodes since 3 years. Clinical examination revealed grade 2 hyporeflexic quadriparesis without any bulbar involvement. Workup revealed hypokalemia, non-anion gap hyperchloremic metabolic acidosis and alkaline urine suggestive of distal renal tubular acidosis (RTA). Antiperoxidase and antithyroglobulin antibodies were positive, suggestive of an autoimmune basis for hypothyroidism. She was managed with intravenous potassium chloride, thyroid replacement and bicarbonate therapy, following which remarkable recovery was noted. One week later, she was discharged on oral thyroxine and oral sodium bicarbonate and she remained weakness-free for a follow-up period of over 1 year. RTA presenting in a setting of autoimmune hypothyroidism is a rare occurrence and the possible role of immunological mechanisms and thyroxine deficiency in the pathogenesis of acidification defect seems most likely.

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The placement of artificial urinary sphincters (AUSs) is a common procedure for stress incontinence following treatment for prostate cancer. Complications are relatively rare, and the most common reasons for device removal and revision are cuff erosion, infection, and mechanical failure. We present a case of a 66-year-old male with a history of radiation therapy for prostate cancer that developed a deep venous thrombosis (DVT) and pulmonary embolism (PE) following his second AUS due to compression by a pressure regulating balloon (PRB). Compression of the femoral vein was not originally diagnosed as the cause for DVT on initial hospitalization, and there was an additional hospitalization due to worsening symptoms prior to identification of PRB compression. This is the first published case of migrating PRB causing femoral DVT and PE following the placement of a second AUS in an irradiated tissue field, and one of two published cases of DVT due to PRB compression.

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We report a case of a 55-year-old female diabetic patient admitted with uremia. An attempt for insertion of a temporary dialysis into right internal jugular vein was not successful. Next day, the patient developed hoarseness of voice. Indirect laryngoscopy showed that right vocal cord was in paramedian position suggestive of palsy due to injury to recurrent laryngeal nerve. Vocal cord palsy, as a complication of central vein catheterization, is very rare.

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Background and Objective: The prevalence of benign prostatic hyperplasia (BPH) in Shanghai, China, has not been updated in over 20 years. Here, we conducted a study in the community health system to get current BPH prevalence. Materials and Methods: All males older than 50 years old with lower urinary tract symptoms (LUTS) in five randomly selected communities in Shanghai were included in this study and were grouped according to their age. Group A was men with ages between 50 and 59, Group B 60-69, Group C 70-79, and Group D over 80. Results of international prostate symptom scores (IPSS), urinalysis, digital rectal examination, ultrasound scan, uroflowmetry, prostate specific antigen level, and any complications related to BPH were collected and analyzed. Results: The ages ranged from 50 to 92 (68.7 ± 9.6, mean ± standard deviation). The average IPSS in each group increased with aging, from 15.13 ± 2.87 in Group A to 19.95 ± 7.43 in Group D. However the quality of life scores (QoL) did not correlate with IPSS in Group A (r = 0.263, P < 0.001). The prevalence rate of BPH increased with aging. The growth rate of the prostate slowed from 27.86% to 8.84% from Group A to Group D. Conclusions: The overall prevalence rate of BPH in our study is 11.99%, LUTS symptoms develop with aging, and the result of the single-question QoL questionnaire should be carefully considered while dealing with patients in Shanghai older than 60.

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The vacuum erectile device (VED) uses negative pressure to increase blood inflow and oxygen into the corpora cavernosum, with a ring at the base of the penis to maintain the erection for intercourse or without a ring for penile rehabilitation. As the limitation of phosphodiesterase 5 inhibitors (PDE5I) showed in the treatment of refractory erectile dysfunction (ED), the use of VED resurged and is becoming the first-line therapy in treatment of ED after radical prostatectomy. Currently, the combination therapy of VED and PDE5I and of VED and intracavernous injection are advocated. Furthermore, there has been increasing interest in the use of VED to preserve penile length in inflatable penile prosthesis preoperation procedure and Peyronie's disease. Hereby, we reviewed the underlying mechanisms, the status of VED in penile rehabilitation, the combination therapy and the expanded use of VED.

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