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(SJAMS) Studies on the Prevalence of Urolithiasis and Chemical Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online) Abbreviated Key Title: Sch. J. App. Med. Sci. ISSN 2347-954X (Print) ©Scholars Academic and Scientific Publisher A Unit of Scholars Academic and Scientific Society, India Chemistry www.saspublisher.com Studies on the Prevalence of Urolithiasis and Chemical Composition of Urinary Stones in Purnia Division of Bihar, India T.V.R.K. Rao*, GunjaKumari, NilamKumari Department of Chemistry, Purnea College, Purnia-854301, Bihar, India Abstract:Prevalence of urinary stone disease in Purnia division of Bihar province of Original Research Article India has been studied over a period of three years (2014 to 2016). Chemical composition of 165 surgically removed urinary stones from the division has also been *Corresponding author studied. A month wise data of urolithiasis cases reported and diagnosed during the T.V.R.K. Rao period of work were collected from the government hospitals, private nursing homes and diagnostic centers located within Purnia division. The data were collected with the Article History help of a carefully structured questionnaire. One hundred sixty five surgically removed Received: 16.09.2018 urinary stones were collected at random from the hospitals and private nursing homes Accepted: 26.09.2018 of Purnia division. The stones were analyzed qualitatively for their chemical Published: 30.09.2018 composition, adopting standard methods. Results revealed a gradual increase in the number of urolithiasis cases in the division over the years. District wise too, there has DOI: been a gradual rise in the cases. Male to female ratio of urolithiasis cases was found to 10.21276/sjams.2018.6.9.71 be approximately 3:1. Maximum prevalence of the disease was observed in middle age (35 to 44 years) group. The months of June and July were seen to be the peak period when maximum number of cases surfaced. A predominance of the upper urinary tract calculi, particularly in males, was observed. Most of the calculi (81.8%) were found to be of mixed crystalloid composition, with calcium, oxalate and phosphate radicals, dominating. Uric acid/urate, ammonium, magnesium and carbonate were detected in rather less number of stones. Cystine was not found in any stone. Our observations in the present work would serve as a guide to the local physicians and surgeons to assess the factors behind the disease, and also to plan for combating/minimizing the incidence of urolithiasis in this region. Keywords:Urolithiasis, Nephrolithiasis, Urinary stones, Urinary calculi, Renal calculi, Epidemiology of urolithiasis, Urinary stone composition, Purnia division. INTRODUCTION constituents are virtually restricted to only a few Urinary stone disease is related to a number of compounds, the slight variations might reflect the risk factors[1]. It is also a recurrent disease. Once an differences in urine biochemistry .The urine individual has had a stone, he/she has 35-50% chance biochemistry, in turn, is remotely related to the of having recurrent stone at some time later in life geographical and ecological factors of the zone. [2].The rates of urinary stone formation have also been found to vary geographically [3]. Certain geographical With the above views in mind, we have regions have been identified as endemic stone belts [1]. presently studied the prevalence of urolithiasisdisease The regional variation in the prevalence of the disease inPurnia division of Bihar (India). We have also studied as well as in the risk factors might be due to a variation the chemical composition of surgically removed urinary in the climate, water quality, food habits etc. Review of stones from the region. Purnia division is located in the literature in urolithiasis in the recent past indicates that northeastern region of Bihar province of India. This the disease is prevalent in India [4-16], as well as, in region has recently been witnessing an increasing many other countries [17-28]. In India, there is an number of urolithiasis cases [14]. In fact, we had earlier increased prevalence of the disease in the northern and conducted similar studies in this region, way back in the western regions [4-11,13,15], with some pockets period, 1999-2001. However, over the years, there have located in Kerala, Maharashtra, Tamil Nadu, Assam, been many changes in this region. Population has Manipur, Bihar and Jharkhand. increased sizeably with a parallel increase in the medical facilities. Patients earlier used to move out to Chemical composition of urinary stones from a the bigger cities for treatment. But now a days, a large zone also reflect the type of stones with reference to chunk of patients, owing to the improved which the zone is a stone belt .Though the stone medical/surgical facilities, prefer to get treated locally. Available online: http://saspublisher.com/sjams/ 3590 T.V.R.K. Raoet al.,Sch. J. App. Med. Sci., Sept, 2018; 6(9): 3590-3595 As such, after a lapse of more than one decade of our centers of Purnia would reflect the level of any disease previous study, we thought of reinvestigating the in the entire zone with a fair degree of accuracy. scenario of urolithiasis in this region in order to understand the changes, if any, in the increase/decrease A month wise data of urolithiasis reports, for of the cases, location site in the urinary tract and the period 2014-2016, was collected along with the chemical nature of the stones. patient-details.One hundred sixty five surgically removed urinary stones were collected at random from MATERIALS AND METHODS hospitals and private nursing homes of Purnia division. A survey was conducted through a carefully The stones were analyzed qualitatively for their structured questionnaire, at the government hospitals, chemical composition, adopting standard methods [5]. private nursing homes and diagnostic centers of Purnia division to collect information about the number of RESULTS urolithiasis cases being reported and diagnosed. Results obtained in the present work are Surveys were conducted in Purnia town (the divisional recorded in Tables 1 to 4. A gradual increase in the total headquarter), as well as, in other district headquarters of number of urolithiasis cases in the division was this division. observed over the years. In the year, 2014 the no. of Since Purnia is a medically important town in cases were 584, whereas it rose to 772 in 2016. District the Kosi region of Bihar and is also the divisional wise too, there has been a gradual rise in the cases. headquarter, large number of private nursing homes as Male to female ratio of urolithiasis cases was found to well as practicing surgeons are available; mostly the be approximately 3:1. Maximum prevalence of the patients prefer to get treatment here, particularly for disease was observed in middle age (35 to 44 years) surgery requiring diseases. The division of Purnia, group. A predominance of the upper urinary tract being comparatively under-developed, has little medical calculi, particularly in males, was observed. Most of the facilities in the interior places. People prefer Purnia for calculi were found to be of mixed crystalloid the treatment of chronic and complicated diseases. As composition, with calcium, oxalate and phosphate such, a wider survey at the hospitals and diagnostic radicals, dominating. Table-1: Year and month wise distribution of Urolithiasis cases reported from different districts of Purnia division (Bihar) in the period 2014-2016 District year Month Total Jan Feb Mar April May June July Aug Sept Oct Nov Dec Purnia 2014 1 3 2 4 8 20 36 42 30 2 3 1 152 2015 4 2 6 10 10 24 40 38 26 8 6 2 176 2016 2 5 8 8 12 26 33 48 42 6 7 4 201 Katihar 2014 3 2 4 7 15 20 36 30 23 10 4 2 156 2015 5 1 8 12 16 18 29 42 28 3 6 2 170 2016 2 4 10 8 12 28 41 32 40 8 3 1 189 Araria 2014 3 6 5 10 13 26 23 24 18 6 4 3 141 2015 2 5 4 12 17 32 38 40 23 5 2 2 182 2016 2 4 6 9 18 43 32 48 25 7 3 1 198 Kishanganj 2014 2 5 4 13 15 28 30 14 18 4 2 0 135 2015 0 3 8 12 22 33 26 21 26 10 4 2 167 2016 3 5 9 14 19 36 31 28 21 6 8 4 184 Total 29 45 74 119 177 334 395 407 320 75 52 24 2051 Table-2 Age, Sex and Urinary tract location wise distribution of urolithiasis cases reported from Purnia division (Bihar) in the period, 2014-2016 Age Group Male Females Male+Female UUT LUT TOTAL UUT LUT TOTAL UUT LUT TOTAL 0-4 00 00 00 00 00 00 00(0.0) 00(0.0) 00(0.0) 5-14 17 28 45 12 08 20 29(1.4) 36(1.8) 65(3.2) 15-24 64 73 137 20 10 30 84(4.1) 83(4.0) 167(8.1) 25-34 286 62 348 42 15 57 328(16.0) 77(3.8) 405(19.7) 35-44 397 84 481 71 28 99 468(22.8) 112(5.5) 580(28.3) 45-54 278 21 299 129 78 207 407(19.8) 99(4.8) 506(24.7) 55 & above 181 23 204 89 35 124 270(13.2) 58(2.8) 328(16.0) Total 1223 291 1514 363 174 537 1586(77.3) 465(22.7) 2051(100.0) Figures in Parentheses indicate percentage. UUT =Upper Urinary Tract, LUT =Lower Urinary Tract. Available online: http://saspublisher.com/sjams/ 3591 T.V.R.K.
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