DR WEBBY

03/10/2024

Good morning breast cancer advocates!

Coldness can increase risk of developing breast cancer, men it is your duty to prevent it by massaging on such days!

19/04/2023

UTI Series: Pathogenesis, risk factors and diagnosis

The following parts can be infected in an UTI:
- Kidney
- Urinary bladder
- Ureter

Infections of urethra is known as Urethritis, which is dealt under different clinical syndromes. Infection of the urethra is mainly caused by N. gonorrhoeae, C. trachomatis, M. genitalium. T. va**nalis, HSV, and adenovirus can also cause urethritis.

Pathogens

Escherichia coli - It is the most common urinary pathogen.

Proteus, Klebsiella, Pseudomonas species and Staphylococcus aureus are associated with hospital acquired infections because their resistance to antibiotics favor their selection. Catheterization and gynecological surgery increase risk for these infections.

Proteus infections are associated with renal stones. Proteus produces a potent urease which acts on ammonia, rendering the urine alkaline.

S. saprophyticus infections are found in s*xually active young women.

Candida infection is usually seen in diabetic patients and in the immunosuppressed.

M. tuberculosis is carried in blood to kidney from another site of infection. (eg. respiratory TB)

Polymicrobial bacteruria is due to fistulas, urinary retention, infected stones or catheters.

Pathogenesis of UTI

1. COLONIZATION - Pathogens colonizes the periurethral area and ascends through urethra upward towards the bladder.

2. UROEPITHELIUM PE*******ON - Fimbria allow bladder epithelial cell attachment and pe*******on. Bacteria continue to replicate and may form biofilm.

3. ASCENSION -Bacterial toxins may also play a role by inhibiting peristalsis (reducing the flow of urine)

4. PYELONEPHRITIS

5. ACUTE KIDNEY INJURY

Risk factors of UTI

IATROGENIC/DRUGS-
Indwelling catheter
Antibiotic use
Spermicides

BEHAVIOURAL-
Voiding dysfunction
Frequent or recurrent s*xual in*******se

ANATOMIC/PHYSIOLOGIC-
Vesicoureteral reflux
Female s*x (short urethra ~4cm)
Pregnancy (progesterone mediated smooth muscle relaxation to the bladder and ureters and compression of ureters by the uterus)

GENETIC-
Familial tendency
Susceptible uroepithelial cells
Vaginal mucus properties
Route of spread
Ascending route
Hematogenous
Lymphatic

Signs & Symptoms of Urinary Tract Infection

Urinary tract affected:
1. Urethra – cause urethritis
-Burning and pain with urination
(Urethritis is classified as an STI and not UTI by many textbooks)

2. Bladder – cause cystitis
-Painful urination
-Frequent and persistent urge to urinate
-Lower abdomen discomfort
-Cloudy/Strong-smelling urine

3. Kidneys – cause pyelonephritis
-Flank pain (Upper back and side)
-Fever
-Chills
-Nausea and vomiting

Diagnostic Testing for Urinary Tract Infections:

Types of urine Samples
-Mid stream Urine sample
-Catheter specimen of urine during cystoscopy
-Suprapubic aspirate
-Early morning urine (TB of urinary tract)
-Initial flow (Urethritis, prostatitis)

Test
1. Urine microscopy
-Pyuria (pus presented in urine + elevated white blood cells in urine)
-Hematuria (red blood cells in urine)
RBCs may be found in the urine during menstruation in a woman’s urine sample, thus leading to a false positive result.
-Motile bacteria – E.Coli, Proteus, Pseudomonas
-Non-motile bacteria – Klebsiella
-Presence of cocci – Staphylo-, Strepto-, Enterococci
**Presence of WBC casts indicates pyelonephristis rather than cystitis
**If urine sample contains abundant squamous epithelial cells - sample is contaminated and results are not reliable.

2. Urine dipsticks
-Use different chemicals reagants on a strip that is dipped in urine to diagnose urinary tract diseases
-E.g. of dipstick result (positive leukocyte esterase, positive nitrite, positive haemoglobin)

3. Urine culture
-Culture of mid-stream urine – Blood agar, Mac Conkey agar
-Midstream void - ≥1 × 105 CFU/μL is consistent with infection
-Samples collected via catheterization -≥1 × 102 CFU/μL is consistent with infection
**Contamination of samples may occur when urine passes through outer third of urethra
**Therefore, numeric threshold of colony-forming units (CFU) per millilitre is used to confirm infection.

4. Imaging test:-
It is not routinely done in case of UTI.

Ultrasonography is indicated
-Obstruction in urinary flow
-Stones
-Measurement of bladder residual volume in BPH
-Recurrent UTI
-Pyelonephritis or hematuria.

KUB is most useful in suspected case of urolithiasis.

Computed tomography urography is used to view the kidneys and adjacent structures, and may be considered to further evaluate patients with possible abscess, obstruction, or suspected anomalies when ultrasonography is not diagnostic.

If urinalysis is unrevealing, cystoscopy can be performed to evaluate for bladder cancer, hematuria, and chronic bladder symptoms.

Urodynamic studies can be performed for persistent voiding symptoms.

Intravenous urography - for hematuria evaluation if CT urography is not available.

Men with UTI
US with abdominal X-RAY and flow rate
No abnormality detected - no further imaging
Abnormal upper tract
Abnormal lower urinary tract - further investigation (e.g.cystoscopy,urodynamics or transrectal US)

That's all!!

13/04/2023

17/03/2023

Infact, the va**na can literally fall off and hang between your legs! This is a rare condition called va**nal prolapse.
Fortunately, it can be fixed.

03/01/2023

TYPES OF SCAMS IN ZAMBIA 😏

1. Send me your CV - Scam.

2. We'll get back to you - Scam.

3. I love you more than I love my wife - Scam.

4. Police is your friend - Scam.

5 The youths are the future leaders - Scam.

6. Airtel Data bundles - Scam.

7. Your vote counts - Scam.

8. Send me money to visit you - Scam.

9. I have a boyfriend but it's complicated - Double Scam.

10. This is not a scam - Scam.

11. Our school is the best - Scam.

12. Come over I want to show you
something - Scam.

13. Oh, he’s just a childhood friend - Scam.

14. He's like a brother to me - Outstanding Scam.

15. I'm with the boys - Scam

15. I promise I won't tell anyone - Scam.

16. I saw you in my dreams giving you a ring - Pure Scam.

18. A: Lets do a video call...
B: Sorry my network is bad, my battery is low, my room is dark - Chief Scam

19. This year I see you buying a car - Spiritual Scam

20. Baby, you are the most beautiful girl I have ever seen - 5G Scam.

21. Why didn’t I meet you before marrying my wife? -Scammest Scam of them all.

Bonus scam!!!

22. I have never loved someone like this before - Greatest Scam

In fact, you're all SCAMMERS 😌
Goodmorning 🤭🤭
[Copyright to the originator]

18/10/2022

A mango tree does not worry when the Orange tree is producing fruits in its season. When you see me sitting in a restaurant without food on my table don't feel pity for me, I am waiting for my order. When your season comes nothing will stand in your way, the slow movement of a Lion doesn't show weakness or tiredness but rather calculated steps to get it's prey.... Never bother how fast people are moving. Move at your own pace and trust God. Remember it's not how fast you build your house but it's how firm and strong your house will be when the storms comes. Keep walking by Faith, Jesus is with you always..

21/09/2022

While Going For Work This Morning, I Met This YOUNG BOY Struggling To Push the Two Bags of Charcoal On His Way To The Market.
DESPITE Carrying Them On The Bicycle, He Was Unable to Ride His Bicycle Because The Bags Were Too Heavy for His Age.
Seeing This, I Felt Really Bad.
I Kept On Thinking How Much He Is Going to Sale The Two Bags at The Market.
By The Way, In My Area a 25Kilogram Of Malasha is Usually Sold at k50. So X2 =K100.
I Kept Wondering To Myself; All This Struggle For a K100?
What Guarantee Is There That He Is Going to Successfully Sale The Bags?
And What Time Will He Be Returning Home?
Is He Going To Buy Lunch From The Same K100?
What Happens If He Doesn't Sale The Malasha, Will He Return Home With The Bags?
What If He's Been Sent By The Parents to Go and Sale Malasha, Have They Considered What He Is Going to Eat While Looking For Customers?
The Thoughts Really Bothered Me.
May God Be With This Hardworking Boy.

19/09/2022

If you are a sickler and are dating a fellow sickler, unless you are not planning to have kids. That relationship is not worth it.

10/09/2022

THIS is why you wait in the emergency room when you go without an emergency. THIS is why you had to wait for your water to be refilled. THIS is why you had to wait for your discharge papers, meds, blanket, any other material object. THIS is the room you DON'T want to be in, and the room you need to be praying for, and hard. THIS is what it takes to save a life, which is what you come to us for. You are sick. You are tired. You are uncomfortable. We know. Stop bashing your healthcare providers for not "being on time with meds," and "taking too long for a water refill." Because we are trained to drop all of those things in a blink of an eye and save THIS person's life. You wait because you can. We rush to them, because their chance of survival decreases every second we are not at✌️🙌

21/08/2022

Back pain

Back pain is a common problem, affecting up to two-thirds of adults at some point, and as such is a common presenting complaint placing a considerable burden on health services. The majority of cases are less serious, non-specific and will resolve within a few weeks; up to 85% of patients will not receive a precise diagnosis. However, there are many significant causes and detecting those that need further investigation and treatment is an important skill.

Patients with back pain frequently develop chronic pain, and the effective management of this problem is often a challenge.

Back pain can be due to three sources.
1. Mechanical or structural back pain.
2. Inflammatory conditions, infections and cancer.
3. Referred pain from abdominal and pelvic organs.

Back pain may be acute or it may progress into a chronic back pain.

Management of back pain

1. The knowledge about back pain is important to the patient so that you understand different possibilities on the cause, stay active and avoid bed rest & heavy exercises.

2. Physiotherapy including group exercise programmes, manual therapy (e.g muscle/joint manipulation, massage).

3. Psychosocial problems should be addressed and consider psychotherapy (e.g: cognitive behavioral therapy).

4. Analgesia (pain killers) : Non steroidal anti-inflammatory drugs (e.g diclofenac, ibuprofen)are 1st line but long-term use carries risks. Further options are decided by a health practitioner depending on the severity of the pain.

Back pain is not a disease itself, it is a sign that there might be a disease, however like I said in the beginning, 85% of back pain cases will go without a precise diagnosis.

Most of the times, patients have a tendency of self medication which is actually a big risk because the pain can come from a serious illness, and treating pain will not get rid of the main problem.

If you have a back pain with even one yellow or red flag (check the flags in the comments), I advise you talk to a health practitioner or visit the clinic/hospital for further investigations.

18/08/2022

Chronic recurrent tonsillitis is a chronic recurrent infection of the faucial tonsils with at least 4 to 6 attacks of acute tonsillitis in a year.