IEEE 802.11ax: Evolution and Scope
The evolution of IEEE 802.11ac to 802.11ax, focusing on new use cases, increased throughput, and modifications to the physical and MAC layers. The scope includes improvements in dense deployment scenarios while maintaining power efficiency and backward compatibility. Approval for operation in the 6 GHz band enhances wireless network capabilities.
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CYSTITIS CYSTITIS RENAL BLOCK Dr Dr Ali Somily Ali Somily
Introduction Introduction Anatomically Urinary Tract infection (UTI)divided into upper Anatomically Urinary Tract infection (UTI)divided into upper and lower urinary tract infection and lower urinary tract infection Patient presents with urinary symptoms and significant Patient presents with urinary symptoms and significant bacteriuria bacteriuria 10 105 5CFU/ml CFU/ml Asymptomatic Asymptomatic bacteriuria significant significant bacteriuria bacteriuria but without symptoms bacteriuria when patient present with when patient present with but without symptoms
Prevalence of UTI in different age groups Prevalence of UTI in different age groups 30 25 20 female male 15 10 5 0 0-3 4 14 15-29 30-64 65-85 >85
Classification Classification Lower UTIs: Lower UTIs: Cystitis Cystitis (infection of the bladder; superficial mucosal infections) (infection of the bladder; superficial mucosal infections) Urethritis Urethritis (sexually transmitted (sexually transmitted pathogens) pathogens) Prostatitis Prostatitis and and epididymitis epididymitis Upper UTIs: Upper UTIs: Acute Acute pyelonephritis pyelonephritis C Chronic hronic pyelonephritis pyelonephritis Uncomplicated UTI Uncomplicated UTI (healthy non-pregnant young female) Complicated UTI Complicated UTI ( (nosocomial UTIs, relapses, structural or functional abnormalities, urologic dysfunctionUTI of men)
Cysytitis CysytitisRisk Factors Risk Factors In women In women : Short wide urethra Genetic factors Sexual intercourse Pregnancy (progesterone, obstruction) Decreased estrogen production during menopause. In men In men: persistent bacterial infection of the prostate. In both sexes In both sexes: : - Presence of bladder stone - Urethral stricture - Catheterization of the urinary tract - Diabetes mellitus
Pathogenesis of cystitis Pathogenesis of cystitis Infection results when bacteria ascends to the urinary bladder . These bacteria are residents or transient members of the perineal flora, and are derived from the large intestine flora. Toxins produced by uropathogens. Lead to frequent irritation of the mucosal surfaces of the urethra and the bladder. Condition that create access to bladder are Condition that create access to bladder are: - Sexual intercourse due to short urethral distance.
Pathogenesis of cystitis Pathogenesis of cystitis Uncomplicated UTI Uncomplicated UTI usually occurred in non pregnant young sexual active female without any structural or neurological abnormality Risk factors Risk factors : - Catheterization of the urinary bladder instrumentation - structural abnormalities - obstruction Hematogenous Hematogenous through Blood stream ( less common) from other sites of infection
Etiologic agents Etiologic agents E.coli E.coli is the most common (90%) cause of cystitis. Other Enterobacteria include ( Klebsiella pnumoniae, Proteus spp. Other gram negative rods eg. P.aeroginosa. Gram positive bacteria :Enterococcus fecalis, group B Strept. and Staphylococcus saprophyticus { honeymoon cystitis}. Candida species Venereal diseases ( gonorrhea, Chlamydia) may present with cystitis. Schistosoma hematobium in endemic area.
Pathogens Pathogens involved involved Uncomplicated UTI Uncomplicated UTI Complicated UTI Complicated UTI E. coli E. coli Enterobacteriaceae Enterobacteriaceae Enterococcus Enterococcus spp 64% 64% E. E. coli coli % is not possible to judge 16% 16% 20% 20% Enterobacteriaceae Enterobacteriaceae spp Pseudomonas Pseudomonas spp spp Acinetobacter Acinetobacter spp spp Special cases Special cases ( (S. S. epidermidis epidermidis) ) S. S. saprophyticus saprophyticus Yeasts Yeasts (catheter related result) (catheter related result) Viruses ( Viruses (adeno adeno, , varicella Chlamydia Chlamydia trachomatis trachomatis (often multiresistant strains) varicella) )
Clinical presentation Clinical presentation Symptoms usually of acute onset Dysuria ( painful urination or micturation) Frequency ( frequent voiding) Urgency ( an imperative call for toilet) Hematuria ( blood in urine) in 50% of cases. Usually no fever.
Vaginitis Vaginitis Candida spp T. vaginalis T. vaginalis ( (5%) 5%) Candida spp. . Cystitis Cystitis (80%) E. coli E. coli, , S. S. saprophyticus saprophyticus Proteus Proteus spp spp. . Klebsiella Klebsiella spp (80%) Urethritis Urethritis (10 C. C. trachomatis trachomatis, , N. N. gonorrhoeae gonorrhoeae H. simplex H. simplex O Other ther bacteria? bacteria? (10- -15%) 15%) Dysuria and Dysuria and frequency frequency spp. . Non Non- -infectiou infectious (<1%) Hypoestrogenism Hypoestrogenism Functional Functional obstruction obstruction Mechanical obstruction Mechanical obstruction Chemicals Chemicals s (<1%)
How to differentiate between cystitis and How to differentiate between cystitis and urethritis urethritis ? ? Cystitis is of more acute inset More sever symptoms Pain, tenderness on the supra-pubic area. Presence of Bacteria in urine (bacteriuria) Urine cloudy, malodorous and may be bloody
Differential diagnosis Differential diagnosis ( types of cystitis) ( types of cystitis) Non Non- -infectious cystitis such as infectious cystitis such as: 1. 1. Traumatic cystitis Traumatic cystitis in women 2. 2. Interstitial cystitis Interstitial cystitis ( unknown cause, may be due to autoimmune attack of the bladder) 3. 3. Eosinophilic Eosinophilic cystitis cystitis due to S.hematobium 4. 4. Hemorrahagic Hemorrahagic cystitis chemotherapy. cystitis due to radiotherapy or
Laboratory diagnosis of cystitis Laboratory diagnosis of cystitis 1. 1. Specimen collection: Specimen collection: Most important is clean catch urine [Midstream urine ( MSU contamination by perineal flora and must be before stating antibiotic. MSU)] to bypass Supra Supra- -pubic aspiration pubic aspiration or catheterization catheterization may be used in children. Catheter urine should not be used for diagnosis of UTI.
2- Microscopic examination Microscopic examination: About 90% of patients have > 10 WBCs /mm /mm3 3 > 10 WBCs Gram stain of uncentrifuged sample is sensitive and specific but rarely done. One organism per oil-immersion field is indicative of infection. Blood cells, parasites or crystals can be seen
3- Chemical screening tests: Chemical screening tests: Urine dip stick Urine dip stick rapid detects nitrites released by bacterial metabolism and leukocyte esterase from inflammatory cells. Not specific. 4- Urine culture Urine culture: important to identify bacterial cause and antimicrobial sensitivity . Quantitative culture typical of UTI ( >105 /mm3). Lower count ( <105 or less eg. 1000/mm3 ) is indicative of cystitis if the patient is symptomatic. Quantitative culture
Recurrent cystitis Recurrent cystitis 3 or more episodes of cystitis /year Requires further investigations such as Intravenous Urogram ( IVU ultrasound to detect obstruction or congenital deformity. IVU) or Cystoscopy requires in some cases.
Treatment of cystitis Treatment of cystitis Empiric treatment Empiric treatment commonly used depending on the knowledge common organism and sensitivity pattern. Treatment best guided by susceptibility of the causative Treatment best guided by susceptibility of the causative bacteria. bacteria. Common agents: Ampicillin, Cephradine, Ciprofloxacin, Norfloxacin, Gentamicin ,TRM-SMX or nitrofurantoin .
Duration Duration of treatment: 3-7 days for uncomplicated cystitis 10-14 days for complicated and recurrent cystitis. Prophylaxis Prophylaxis for recurrent cases required by Nitrofurantoin or TRM-SMX. Prevention Prevention : drinking plenty of water and prophylactic antibiotic.
