Research PROPOSAL PROJECT TITLE: Incidence of urinary tract infection in vesico-ureteral reflux Grade 1-111 INTRODUCTION: Vesicoureteral reflux (VUR) is a well known heterogeneous disease. It can be described as a disease process coupled with an anatomical abnormality at the ureterovesical junction…
Under normal circumstances, ureter passes through the detrusor muscle and ends at the ureteral hiatus thus the intramural ureter has an oblique direction and during process of micturition it closes in a flap valve mechanism.(Hunzikar, Kutasi, D’atsa, Puri,2011) If intramural ureter is short and incompetent then it results into failure of the flap-valve mechanism(Aappublications.org, 2011). Secondary VUR is associated with abnormal high pressure build up in the bladder. It follows that a flap-valve mechanism failure at the intramural ureter is due to this high pressure. Posterior urethral valves and neurogenic bladder are normally associated with clinical conditions that lead to secondary reflux. The retrograde flow of urine is checked as the intramural ureter is passively compressed while the bladder fills. The disorder has been subjected to great scrutiny especially in relation to the general importance of the disorder as a clinical entity in renal development and function. Vesicoureteral reflux may present before birth as hydronephrosis or dilatation of ureter which leads to urinary tract infection or acute pyelonephritis. New borns may be lethargic with faltering growth while infants and young children may present with symptoms of urinary tract infection like fever, dysuria, frequent urination and malodorous urine or GI symptoms. An international classification for grading of VUR has been developed. According to this classification, grade 1 VUR is reflux into non dilated ureter, grade 2 is reflux into non dilated renal pelvis and calyces, grade 3 is reflux into mild to moderately dialated renal pelis, calyces and ureter with mild blunting of fornices, grade 4 id dilatation of renal pelvis and calyces with moderate ureteral tortuosity, grade 5 is gross dilatation of ureter, renal pelvis, calyces, ureteral tortuosity, loss of papillary impressions. It is a matter of debate that which grade of VUR is associated with greater risk of complications. Statistics reveal that 1% of normal children are usually affected by this disorder Approximately 30-50% of children with urinary tract infections are also affected (Aappublications.org., 2011). It should also be noted that 10% of children with prenatally diagnosed hydronephrosis have been reported to have the disorder. Chances of renal damage especially in children over one year of age can be reduced through management and identification of VUR. When a child has UTI in close proximity with VUR prevalence then he or she is likely to contract pyelonephritis and UTI. Renal scarring is a clear indicator of pyelonephritis.(Mahant, freedman, 2002).A child is more disadvantaged when he or she has both pyelonephritis and VUR as compared to when he or she only has pyelonephritis. Diagnosis of VUR is based on voiding cystourethregram. The risk of permanent renal injury and morbidity of acute pyelonephritis can be lowered by administering VUR treatment. Three most common methods of treating VUR include curative interventions, continuous antibiotic prophylaxis and observation (Medicaltalking.com, 2011) Endoscopic subureteral injection is a technique which is used to treat VUJ abnormalities. It was first described in 1981 and further supported by O’Donell and Puri in 1984. Several studies have been done that shows its effectiveness, simplicity, safety and 70-90% cure rate. In a study, it was found that 47.4% patients cured after a single injection and 52% after second injection.(Tarcan, Tiney, Temiz, ...
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Basel I was criticized for being inadequate in its assessment of assets to risk categories because assets with different risk composition would be categorized into the same risk groups. A primary issue of the Basel II accords was the practice of securitization were banks combined risky loan assets into asset-backed securities and sold the securities to investors.
VUR can either be unilateral or bilateral and is strongly suspected to be a heritable disorder with a reported incidence rate of 10% in infants and young children (NIH). Primary VUR occurs when a child is born with an abnormally short ureter, a congenital defect.
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