Trimethylamineuria (Fish Odor Syndrome)

Trimethylamineuria (Fish Odor Syndrome)

• autosomal recessive

• A rare clinical entity with an offensive persistent odor that no amount of bathing or washing or perfuming will correct.

Vaginal Discharge

Differential Diagnosis :  Normal : Lactobacillus 70 % and non-Lactobacillus 30 %

• Bacterial Vaginosis  ----- 50 %
• Candida                    ----- 30 %
• Trich                         ----- 15 % 

Visual inspection : Inflammatory response Vaginal discharge e.g thin-thick gray-white-green,frothy

Vaginal pH : Normal: < 4.5 Use Nitrazine paper

Micro-exam : Wet Prep Saline and KOH

Urinary incontinence types and its treatment

Ask your patient about the symptoms ? 

Bladder diary: Name / Date

Fluids

• type and amount of fluids

Urination 

• Strong urge to urinate (Y,N)
• Amount urinated in toilet (S,M,L)

Accidents

• Amount of leakage (S,M,L)
• Activity preceding leakage

Here are the examples of Urinary incontinence

Submaximal Exercise Testing

Cardiovascular Angiography

Safe Motherhood initiative (ACOG)

These images are provided by ACOG (American Congress of Obstetricians and Gynecologists)

First Line Management with Hydralazine

 First Line Management with Labetalol

Allergic Interstitial Nephritis

Allergic Interstitial Nephritis

Etiology :

70 % of cases due to adverse effect to medications

Drugs

1.Penicillins
2.Cephalosporins
3.Sulfa drugs
4.Allopurinol
5.Rifampin
6.Quinolones.

it happens from the first dose.As compared to Aminoglycosides take 5-10 days.
Infections (viruses,bacteria or fungi).Most common causes includes

1.Leptospirosis
2.Legionella
3.CMV
4.Rickettsia
5.Streptococci

Autoimmune disease

1.SLE
2.Sjogren syndrome
3.Sarcoidosis
4.Cryoglobulinemia

Dx: 

1.Rash
2.Fever
3.Joint pain
4.Eosinophilia
5.Increased serum IgE

Best initial test-urinalysis

1.Eosinophiluria (Wright or Giemsa stain)
2.Hematuria
3.Proteinuria (<2g hrs="" p="">
Most accurate test

1.Biopsy
2.Rarely performed

Rx
1.Stop the offending agent
2.+/- corticosteroids