Week 3

Despite the fourth of July weekend, this week was a bit more productive in terms of shadowing.
Up until July 4th, I have been shadowing Dr. Dadhania in the nephrology department. Together we routinely visited Kidney transplant patients, discussed their condition, recent lab results to access the kidney physiology. These visits were very informative for me at the beginning. However, after a while things seemed a bit repetitive. 
To avoid falling in a repetition loop, I decided to look at other options available that would still be relevant to my interests. Staying in the urinary tract, I decided to shadow Dr. Chughtai in the urology department during some of his procedures. Those were in fact the first invasive clinical procedures I saw while in NYC, with the majority being cystoscopies. In combination with cystoscopy, some patients had to get another procedure. The most memorable were:
Transurethral laser ablation to remove scarred tissue at the urethral opening of the bladder after prostate removal.
Bladder Botox injection to treat overreactive bladder syndrome
Prostate ultrasound and bladder ultrasound
Fig: Endoscope during cleaning; the camera and adapter tubes are mechanically cleaned with a brush before being soaked in an antimicrobial solution.

These procedures were somewhat relevant to my projects in Ithaca as they are for the most part looking into the urinary tract. I also got to see how sample collection is done for my future project. I found it interesting that the endoscopes  were reusable. The cleaning process of those is tenuous and consists of chemical and physical cleaning. Hypothetically, cleaned endoscopes are supposed to be sterile. However, although rare, some patients do get nosocomial infections after the cystoscope. This makes me a bit interested in how truly sterile reusable endoscopes are after cleaning. If compared to single use endoscopes, despite the performance issues would there be a noticeable difference in terms of cleanliness? 
Bladder urine samples are collected with the endoscope during the cystoscopy, and do get contaminated between the collection and processing in the labs, it would be good to know how much of the contaminants are from the collection method and how much are from lab manipulation. 
Outside of the clinic, I stayed in the medical library to read more about microbiology and infections of the urinary tract. 
For the upcoming week, I'm planning to spend more time in the library for some literature review, continue analyzing UTI questionnaire responses and well as shadow the urologists during the scheduled procedures.

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