Introduction Medical Device Reports (MDRs) for Benign Prostatic Hyperplasia (BPH) treatment devices in the Federal Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database were evaluated for safety and patient experience outcomes in the context of the total number of procedures performed. Materials and Methods MAUDE was searched using the terms “UroLift,” “Rezum,” and “Aquabeam” for entries between January 1, 2019, and December 31, 2022. An independent physician arbitrator adjudicated relevant entries and assigned severity scores using the Gupta and Clavien-Dindo (CD) scales. An independent market model using Medicare data and Current Procedural Terminology (CPT) codes yielded estimates of the total number of Prostatic Urethral Lift (PUL), Water Vapor Thermal Therapy (WVTT), and Aquablation (AQB) procedures performed in the US in 2019, 2020, 2021, and 2022. Results PUL was the most frequently performed procedure in all years analyzed. In the first year (2019), 15% of AQB patients experienced a serious post-operative event. The rate of serious events for PUL (2 per 10,000) was significantly lower than AQB (4 per 1,000, p <0.0001) or WVTT (1 per 1,000, p < 0.0001) in 2022. Between 2019 and 2022, the rate of mild to moderate events (CD 1-2) was lowest for PUL (2019: 2.0 per 10,000; 2022: 1.7 per 10,000) compared to WVTT (2019: 5 per 1,000; 2022: 4 per 1,000) and AQB (2019: 5 per 100; 2022: 3 per 1,000). Discussion MAUDE surveillance shows that PUL has the lowest complication rate, WVTT is intermediate, and AQB has the highest, even after procedural refinements. These findings emphasize the need for volume-adjusted, real-world data to complement clinical trials in assessing BPH device safety. Conclusion The yearly rates of mild, moderate, and severe events recorded during this period are significantly higher for AQB than the minimally invasive surgical therapies analyzed. PUL has the lowest complication rates in the MAUDE database.
Introduction Patients on maintenance hemodialysis are at an increased risk of SARS-CoV-2 infection and mortality. This study aimed to determine the prevalence of COVID-19 antibodies in a large sample of patients on dialysis in PSN-Accredited Nephrology Training Institutions. Methods This retrospective cohort study was conducted in partnership with eighteen medical centers with PSN-Accredited Nephrology Training. Adult patients who had RT-PCR confirmed COVID infection from March 2020 to March 2022 were included. Patient records were then collected, and pertinent data were collected using a standardized form. It was then transferred to an electronic database for further analysis. Results There were 785 hemodialysis patients who developed COVID-19 during the mentioned period, having an overall prevalence of 5.1%. Of these, 171 patients (22%) died during their hospitalization. There was a higher proportion of hypertensive patients and dyspnea on presentation in the mortality group. The mortality group also has significantly higher hematocrit and inflammatory markers (D-dimer, Ferritin, CRP). Based on multivariate analysis, the presence of cytokine storm, sepsis, higher D-dimer values, use of extracorporeal circuit, and tocilizumab were significant factors of mortality. Discussion This study has the largest number of centers involved in any COVID studies done locally. It showed variations in terms of complications and how the patients were managed. Conclusion This study found that the prevalence and mortality rate of COVID-19 infections are higher among patients receiving hemodialysis than in the general population. These findings highlight the importance of vaccination and other preventive measures to protect this vulnerable population.
Background: Luteinizing hormone-releasing hormone (LHRH) agonists and GnRH antagonists are the most widely used androgen deprivation therapy to achieve castration levels of serum testosterone (T). Adherence to dosing schedules is important to avoid treatment failure. A recent analysis found a high non-adherence rate of 84% for LHRH agonist injections based on dosing schedules used in pivotal trials. Method: Narrative review of LHRH therapy and evaluation of which offers optimal efficacy, safety, and practicality. Results: 6-month LHRH agonist formulations require fewer appointments for injections than shorter-acting formulations. Therefore, the frequency of late/missed doses and overall non-adherence may be reduced compared to options requiring frequent dosing ( e.g ., oral therapies and shorter-acting injections). This flexibility may be preferable for patients who live in multiple locations throughout the year, live long distances from clinics, and/or lack access to reliable transportation. 6-month formulations may also have cost benefits compared to shorter-acting doses. Despite similar levels of T suppression during the labeled dosing period, individual 6-month LHRH agonist formulations appear to have unique profiles, e.g ., 6-month subcutaneous leuprolide acetate (LA) results in lower T escape rates compared to 6-month intramuscular LA, if dosing is late. Conclusion: The efficacy and practicality offered by 6-month LHRH formulations suggest these could reduce opportunities for late injections by requiring fewer office visits and provide greater confidence that efficacy will be maintained should there be extenuating circumstances leading to delays in therapy administration, as experienced during the recent pandemic.
Aim To evaluate the factors that affect the immune response to Hepatitis B vaccination in the Stage 5 chronic kidney disease population (Haemodialysis and Predialysis). Methods Eligible Stage 5 chronic kidney disease patients on haemodialysis (Cohort A: N= 39) and Predialysis (Cohort B: N=56) in an outer metropolitan renal service in Western Australia with no prior Hepatitis B infection or vaccination between Jan 2015 to Dec 2021 were involved in this retrospective cohort study. Serological response to Hepatitis B vaccination (H-B-VAX II 40 mcg intramuscularly at 0, 1 and 6 months) was evaluated six-eight weeks post-vaccination. Factors such as age, gender, diabetes mellites, cardiovascular disease, hypertension, chronic obstructive airway disease, serum albumin, and erythropoietin stimulating agent dependence were studied for their influence on immune responses in these cohorts. Results There were 95 eligible respondents in the study. Cohort B (Predialysis) showed a significantly higher response than Cohort A (Haemodialysis) (66.1% vs 53.8%) ( p =0.003). Different factors affecting the vaccine response were identified in the two cohorts. Serum albumin <35g/L was associated with negative response in 61.1% (p =0.0023)Cohort A HD patients. In the Predialysis Cohort B, 84.2%(p=0.026) were male gender, 63.2%(p=0.028) with the presence of cardiovascular disease, and 57.9%(p=0.001) who were Erythropoietin dependent showed a negative response to the vaccine. Conclusion This study showed that the Hepatitis B vaccine response was lower in HD patients than in Predialysis patients with stage 5 chronic kidney disease. Clinical factors of serum albumin, cardiovascular disease, and patient factors of gender and erythropoietin dependence were identified as factors that affected vaccine response in these two cohorts. We postulate these factors to be considered in the hepatitis B vaccination management to enhance immunological response strategies and extend to earlier stages of chronic kidney failure.
Background Hepatorenal Syndrome (HRS) is a severe complication of end-stage liver disease characterized by functional renal impairment. This study aimed to assess the efficacy of norepinephrine compared to midodrine/octreotide in managing patients diagnosed with hepatorenal syndrome type 1. Materials and Methods In this double-blind Randomized Clinical Trial, 50 patients with hepatorenal syndrome type 1 were randomly assigned to the norepinephrine and midodrine/octreotide groups. The norepinephrine group received an initial dose of 1 mg/h (up to a maximum of 4 mg/h) along with daily intravenous injections of 20% albumin (20-40 grams per day) throughout the study period. The control group received midodrine (maximum dose of 15 mg three times a day), octreotide (maximum dose of 200 micrograms intravenously three times a day), and 20 to 40 mg of 20% albumin daily. The primary efficacy measure was the percentage of patients achieving a complete response, defined by the restoration of serum creatinine levels to within 0.3 mg/dl of the baseline by the end of treatment. Results There was no significant difference in the rate of complete response between the norepinephrine group (7/25, 28%) and the midodrine/octreotide group (3/25, 12%) (p=0.15). The mortality rate was 10 (40%) in the norepinephrine group and 12 (48%) in the midodrine/octreotide group. Although the mortality rate was higher in the midodrine/octreotide group (12/25, 48%) compared to the norepinephrine group (10/25, 40%), this difference was not statistically significant (p=0.77). Conclusion The study findings suggest that the norepinephrine treatment regimen can be as effective as or more effective than the midodrine/octreotide regimen in treating hepatorenal syndrome in cirrhotic patients. Therefore, these two treatment regimens can be used interchangeably. Clinical Trial Registration Number IRCT20230228057568N1
Objective: In the past, infectious agents were assumed to be the leading cause of staghorn stones. The metabolic factors were thought to be a secondary cause. However, recent research has shown that any stone can fill the pelvis and calyces in the same manner as a staghorn stone. This retrospective study investigated the relationship between the staghorn stone’s chemical composition and patients’ demographic characteristics by analyzing the stone samples. Methods: The medical records of 170 patients with staghorn stones were studied from a tertiary referral center in central Iran. Then, the specimens of their stones were sent to the laboratory for infrared spectroscopy and x-ray powder diffraction analyses. Results: The mean age and body mass index were 49.66 years and 29.1 kg/m2, respectively. Men comprised the majority of patients. Of the entire cohort, 13.6% had diabetes, and 28.6% had hypertension. Sixty-eight of the stones were pure stones. Calcium oxalate and uric acid constituted the majority of the pure stones. Only 1.7% of the pure stones were composed of struvite. Most of the non-pure or mixed stones were composed of uric acid plus a small composition of calcium oxalate or phosphate. Discussion: However, 16.% of the mixed stones were struvites, confirming a metabolic background. In the adjusted model (age, BMI, presence of hypertension), patients with diabetes have a 14-fold higher chance of developing a mixed stone (P= 0.018; OR:14.113; CI=1.582-125.924). Conclusion: The complete staghorn stone forms for the same reasons as other kidney stones. It appears that infectious background is not the predominant cause in the current era. Alterations in living conditions and nutrition might also be a reason which requires further investigation.
Aims: The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with end-stage renal disease (ESRD) in Ilorin, Kwara State. Background: Chronic kidney disease (CKD), also known as chronic kidney failure, is the persistent decline in glomerular filtration rate (GFR) for more than three months and it often progresses to (ESRD) with permanent loss of kidney function and increased mortality. Objective: The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with ESRD in Ilorin, Kwara State. Methods: Total population and purposive sampling techniques were used to guide the recruitment of 80 participants. The research design was descriptive and cross-sectional research designs using quantitative strategy. Socio-demographic data and compliance level for haemodialysis regimen were determined using standardized questionnaire while biophysical measurements and laboratory investigations were used to determine treatment outcomes. Descriptive and inferential statistics were used for data analysis. Results: Findings from the study revealed that 66.3% of the participants were 41 years and above, 45% had up to tertiary education while 76.3% of the participants relied on family members for treatment funding. Regarding treatment compliance, 58.8% and 47.5% had moderate compliance to fluid and diet, respectively. Barriers to compliance were transportation logistics (50%), haemodialysis side effects with machine malfunction (52.2%), changes in lifestyle (50%) and cost (41.3%). Conclusion: Exorbitant nature of haemodialysis treatment militated against good outcomes. Thus, nephrology nurses and other healthcare professionals should intensify efforts to promote treatment adherence among patients with ESRD. Government and other policymakers could assist in subsidizing the cost of haemodialysis therapy to aid compliance and improve treatment outcomes. Thereby, promoting patients’ quality of life with a reduction in mortality rate.
Purpose: This study evaluated the early postoperative complications in Circumplast ® and Plastibell ® techniques for infant male circumcision in two community clinics. Materials and Methods: We retrospectively reviewed the outcome of infant male circumcision (n=649) over 1 year (Jan 2021 to Feb 2022) performed under local anaesthesia by a single urologist. The technique was non-randomly selected. Data were collected retrospectively, and early postoperative complications were compared between Circumplast ® and Plastibell ® circumcisions. Both parents consented to the procedure. The 24-telephone support and follow-up were provided if required. Results: All records of infants were reviewed with Circumplast ® circumcision (CC) n=302 and Plastibell ® circumcision (PC) n=347 during this period. The mean age was 52.33 +/- 44.16 days in CC and 38.64 ± SD 30.39 days in PC. Three infants were excluded. There was no major complication and minor complications were lower in CC (0.99% n=3/302) versus PC (2.9% n=10/347). Delayed ring separation happened in PC (2.3% n=8/347), which was separated by a bone cutter in the clinic and no ring impaction occurred in CC. One infant in CC had bleeding after 24 hours, which was managed by removal of the ring and revision of circumcision. Two infants required separation of coronal adhesions in CC and two required revisions of circumcision in PC. Discussion: This is the first study to report the results of early experience involving the use of Circumplast ® ring to perform pediatric circumcision. Our findings reflect the use of this device as a safe alternative to Plastibell ® . A randomised controlled trial (RCT) would be required to document the relative superiority of either device. The reduced number of ring impactions among CC may be attributed to its unique design. Conclusion: Infant male circumcision by the Circumplast ® device has a lower risk of early postoperative minor complications especially migration/impaction and may offer a safe alternative.
Background: Despite the enormous strides in haemodialysis technology and patient care in high-income countries, patients still experience a lot of symptoms which impair their quality of life (QoL). Data on symptom burden is lacking in low-income countries where the haemodialysis population is younger and access to care is limited. Objectives: To assess the symptom burden in patients on maintenance haemodialysis, its associated factors, patients’ attitude, and practice. Materials and Methods: All consenting patients on maintenance haemodialysis for at least 3 months in 2 referral hospitals in Yaoundé, Cameroon, were screened for symptoms. We excluded patients with dementia or those with acute illness. We used the Dialysis symptom index (DSI) and the modified Subjective Global Assessment tool to assess symptom burden and nutritional status, respectively. We analysed the data using Statistical Package for Social Science (SPSS) 26.0. A dialysis symptom index above the 75th percentile was considered a higher symptom burden. Results: we enrolled 181 participants (64.1% males) with a mean ±SD age of 46.46±14.19years. The median (IQR) dialysis vintage was 37[12-67.5] months and 37% (n=67) were on recombinant erythropoietin. All patients experienced at least a symptom with a median (IQR) of 12[8.0 – 16.0] symptoms per patient. Feeling tired/lack of energy (79%, n=143), decreased interest in sex (73.5%, n=133), dry skin (70.2%, n=127), difficulty becoming sexually aroused (62.4%, n=113), worrying (60.2%, n=109), bone/joint pain (56.4%, n=102), feeling nervous (50.8%, n=92), muscle cramps (50.8%, n=92) and dry mouth (50.3%, n=91) were the most frequent symptoms. The median (IQR) DSI severity score was 41[22.5-58.5] with 24.9% (n=45) having a higher symptom burden. Diabetes mellitus (AOR 5.50; CI 4.66-18.28, p=0.005), malnutrition (AOR 17.68; CI 3.02-103.59, p=0.001), poorly controlled diastolic blood pressure (AOR 4.19; CI 1.20-14.62, p=0.025) and less than 2 weekly sessions of dialysis (AOR 9.05, CI 2.83-28.91, p=<0.001) were independently associated with a higher symptom burden. Out of every 10 patients, 3 did not report their symptoms to the physicians with cost concern as the most reason (70.4%, n=38). Conclusion: In this young population where access to dialysis is limited, the symptom burden is high (100%). Active screening and management of enabling factors may reduce symptom burden and cost concern is the frequent reason symptoms are not reported to physicians.
Background: Bloodstream infections are a potentially devastating complication of hemodialysis. This study aimed to elucidate the rates of CLABSI (Central Line Associated Blood Stream Infections)in a south Indian dialysis cohort and determine the catheter care and hygiene practices in the dialysis unit which might contribute to CLABSI Methods: A prospective observational study involving in-center dialysis patients with temporary access was conducted from June 2019 to December 2019. The catheter insertion and line handling techniques were monitored using a proforma adapted from the CDC (Center for Disease Control) guidelines. Adherence to infection control practices, rates of CLABSI identified using CDC surveillance definitions, and organisms identified were reported. Results and Discussion: The median rate of CLABSI in this dialysis unit was 1.68 per 1000 catheter days. Gram-positive organisms were the majority – 69.2% and 72.27% were drug-resistant pathogens. The adherence to infection control practices in hand sterility, use of barriers, and sterile insertion technique were 100% with respect to existing CDC guidelines. The use of sterile semi-transparent dressings, however, was 98.2%. 65% of all patients had soiled dressings on arrival to the hospital. Line handling protocols were followed in accordance with CDC guidelines in 97.1% of cases Conclusion: CLABSI rates in this institute are in keeping with those around the world. There is a predominance of gram-positive organisms causing CLABSI. Drug-resistant organisms represent an alarming 72.27%of all infections. Soiled dressing and home care of the dialysis catheters represent a neglected aspect of catheter care and should be addressed.
Background: Pelvic floor muscle training (PFMT) with biofeedback is used widely in treating patients with stress urinary incontinence (SUI), despite unclear evidence. We conducted a meta-analysis of the literature to evaluate the efficacy of treatment after PFMT with and without biofeedback in SUI patients. Methods: We searched PubMed, CENTRAL, CINAHL, and Science Direct for randomized controlled trials (RCTs) of PFMT with and without biofeedback for SUI. RCTs were screened with our eligibility criteria, and the risk of bias was assessed according to the Cochrane risk of bias tool for randomized trials. The outcomes analyzed were pelvic floor muscle (PFM) strength, incontinence episode, daytime micturition, and nighttime micturition, all measured as mean difference (MD) with 95% confidence intervals (CIs). Heterogeneity and publication bias were analyzed using the I2 test and a funnel plot, respectively. Results and Discussion: Pooled analysis of five RCTs involving 207 patients showed that the difference in PFM strength and nighttime micturition between both groups was significant. Although PFM strength improvement favors biofeedback-assisted pelvic floor muscle training (BPFMT) (MD 12.29, 95% CI 2.33, 22.25, p=0.02), in contrast, nighttime micturition was significantly reduced in the PFMT group (MD 0.44, 95% CI 0.12 to 0.77, p=0.007). Differences in incontinence episode and daytime micturition were not significant (MD -0.08, 95% CI -0.57 to 0.41, p=0.75 and MD 0.55, 95% CI -0.36 to 1.46, p=0.24, respectively). Conclusion: This meta-analysis showed that BPFMT had a better outcome in improving PFM strength, while nighttime micturition was, on the contrary, better in PFMT only. Meanwhile, no significant differences in incontinence episodes and daytime micturition outcomes were noted between both groups. With the present evidence, routine use of BPFMT is not necessary for current clinical practice.
Background: Idiopathic membranous nephropathy (IMN) is a rare disease in children. The incidence is 1.5% in children with nephrotic syndrome. A few studies have also investigated the M-type phospholipase A2 receptor’s (PLA2R) potential role in pediatric IMN, reporting a low positive rate in pediatric kidneys. Objective: Therefore, we conducted immunofluorescence staining using an anti-PLA2R antibody in the renal biopsy specimens of eight pediatric patients with IMN. Methods: We studied the glomerular expression of PLA2R using tissues from children with IMN, and searched for papers on PLA2R staining in pediatric IMN on PubMed. Results and Discussion: Clinical characteristics of patients diagnosed with IMN in this study and the other three studies: A total of 20 pediatric (aged 2–12 years; mean age 7.4 ± 2.8 years) patients and 25 adolescent (aged 13–19 years; mean age 15.9 ± 2.0 years) patients, comprising 25 male (55.6%) and 20 female (44.4%) patients, with 23 (51.1%) patients with IMN being PLA2R-positive, were found to be eligible for this study. Furthermore, we found three papers through our online search. Conclusion: PLA2R expression can be approximately half positive in children with IMN, and it is useful to investigate the causative antigen of PLA2R in children. The intensity of anti-PLA2R antibody expression reflected the disease activity (urinary protein level) of the patients in this study. It is possible to adjust the drug dose in immunosuppressive therapy with reference to the expression intensity of PLA2R.
Background: The COVID-19 pandemic has led to an increase in critically ill patients with renal failure, with many requiring renal replacement therapies. Unfortunately, many of them are too critically ill to tolerate intermittent hemodialysis. In the setting of limited resources, we did bedside acute intermittent peritoneal dialysis for critically ill COVID-19 patients with hemodynamic instability with or without ventilator support admitted to our intensive care unit. Objective: The aim of the study was to determine the outcome of intermittent peritoneal dialysis in critically ill COVID-19 patients. Methods: Our retrospective observational study included 91 patients with critically ill SARS-CoV2 infection and renal failure admitted to the intensive care unit of our hospital from July 2020 to September 2021, who underwent acute intermittent peritoneal dialysis. Results: The demographic, laboratory, and treatment parameters were compared between survivors and non-survivors. Variables, like increased mean age (49.88 vs. 59.07 years), presence of diabetes mellitus (36.4% vs. 63.8%), increased lung involvement (57.3% vs. 75.0%), mechanical ventilation (15.2% vs. 70.7%), systolic (84.3 vs. 77.5 mm of Hg) and diastolic (59.09 vs. 42.93 mm of Hg) blood pressures, were associated with poor outcomes. The use of hypertonic PD (63.6% vs. 37.9%), better urea reduction ratios (44.33 vs. 39.84), and increased PD cycles (66.52 vs. 44.26) were associated with a better outcome. Complications, like haemorrhage and peritonitis, occurred in 10.9%. Conclusion: PD is a cost-effective bedside RRT that can be considered an effective option in critically ill COVID-19 patients. Good urea clearance, hemodynamic stability, and minimal resource requirements are also the features that favour peritoneal dialysis.
Background: Despite the advent of dialysis technology, the survival of patients on hemodialysis (HD) is not encouraging. There is little information available regarding the prognostic factors of HD, its population characteristics, or outcomes in India. Objectives: We attempted to describe the profile of patients on HD, estimate the mean days of their survival and to determine the various factors associated with their survival. Materials and Methods: It was a retrospective cohort study conducted on patients who were on maintenance HD, registered during the five-year period between 1st January 2014 and 31st December 2018 in a tertiary care teaching hospital in Rural Puducherry, South India. Demographic, hematological, biochemical, electrocardiographic, echocardiographic parameters and death during follow-up were extracted from the dialysis database after de-identification. The survival rate was calculated using Kaplan- Meir Curves and Cox Regression analysis was done to estimate the adjusted hazard ratio. Results: The median survival of the 229 eligible patients on HD was 819 days. Cardiac pathology accounted for 25.7% of those deaths and 33.9% was sudden death. Adjusted Cox proportional model showed the presence of Left Ventricular Hypertrophy (LVH) (HR: 78.1), increase in phosphorus (HR: 1.26), decrease in haemoglobin (HR: 0.78), and decrease in serum albumin (HR: 0.52) were significant bad prognostic factors. Conclusion: Screening for LVH, anemia, hypoaluminemia and hyperphosphatemia amongst HD patients and managing them to prevent these bad prognostic factors has the potential to improve their survival.
Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on survival of older patients with NMIBC that have undergone TURBT.
Background: Erectile Dysfunction (ED) has affected people suffering from Obstructive Sleep Apnea Syndrome (OSAS) and multiple studies have confirmed this correlation. Objective: The objective of the is to identify the association between ED and Obstructive Sleep Apnea (OSA) in nonobese, nondiabetic men based on the International Index of Erectile Function (IIEF). Methods: This retrospective cross-sectional study included 143 nonobese, nondiabetic men with OSA (age, ≥20 years) who visited the Sleep Outpatient Clinic of the Otorhinolaryngology Department at Hospital Naval Marcílio Dias from May 2017 to August 2018. Patient age, body mass index (BMI), drinking, smoking, laboratory diagnosis of hypogonadism based on total testosterone levels, and sleep parameters (e.g., apnea–hypopnea index, rapid eye movement density, and minimum Oxygen Saturation [SatO2]) were considered. Analysis of variance was used to evaluate means. The chi-squared test and Fisher’s exact test were used to compare variables and Person’s correlation coefficient was used to analyze numerical variables. Results: The mean minimum SatO2 was 78.89%, and 46% of patients exhibited minimum SatO2 <80%. Moreover, minimum SatO2 of <80% and increasing age were associated with ED complaints based on IIEF scores,. A laboratory diagnosis of hypogonadism was associated with increased BMI, and aging was associated with SatO2. Conclusion: The results of the study revealed that oxygen desaturation of <80% was related to complaints of ED from the IIEF. Moreover, a relationship between laboratory hypogonadism and increased BMI values, aging, and oxygen desaturation has been demonstrated. Therefore, we recommend polysomnography in patients with ED complaints.
Background: Patients with early and moderate stages of chronic kidney disease (CKD) have normal serum phosphate levels. Increased fibroblast growth factor-23 (FGF23) levels in these patients are responsible for maintaining normophosphatemia status by increasing the excretion of phosphate through urine. However, an increased serum FGF23 level is related to cardiomegaly, vascular calcification, CKD progression, and mortality. This study aimed to examine the effectiveness and safety of calcium carbonate use in stage 3 or 4 CKD patients with normophosphatemia. Methods: This double-blind randomized controlled trial (ClinicalTrials.gov identifier NCT03550534) included stage 3 or 4 CKD patients with normophosphatemia who visited the nephrology or endocrinology clinic at Dr. Cipto Mangunkusumo Hospital. Forty-six subjects were randomized to receive either calcium carbonate or placebo over a 12-weeks period. Urine phosphate, serum phosphate, serum calcium, and serum intact FGF23 levels were measured before and after the intervention. Results: The baseline characteristics of the two groups were similar, except for the higher prevalence of dyslipidemia in the placebo group. The CaCO3 group had shown reduced levels of FGF23 compared to the placebo group, -8.03 vs. 0.15 pg/ml respectively (p = 0.019). The median level of FGF23 showed a significant decrease only in the CaCO3 group. An increase in eGFR and a slightly decrease in urine phosphate were observed in the CaCO3 group; however, the data was found to be statistically not significant. No significant changes were noted in the serum calcium levels in both groups. Conclusion: The administration of calcium carbonate has been shown to be effective and safe for moderate CKD patients with normophosphatemia due to its effect in lowering FGF23 levels without escalating the serum calcium level.
Coronavirus Disease (COVID-19) has resulted in a pandemic affecting more than a hundred countries worldwide [1].Limited worldwide supply of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV) requires policymakers to prioritize high-risk populations for inoculation.Several clinical risk factors have been suggested to increase infection risk [2].However, it is less well-known how pre-morbid, outpatient clinical variables influence COVID-19 risk of death.We retrospectively analyzed outpatient risk factors for death in the UK Biobank (UKBB), a large-scale prospective cohort comprising over 500,000 subjects aged 40-69 years recruited in 2006-2019 [3].In this study, subjects with recorded mortality before 31 st January 2020 (N = 28,930) were excluded since it was the date for the first recorded COVID-19 case in the UK.We performed a comprehensive study on primary care data and their associations with COVID-19 mortality in UKBB, controlling for possible confounding factors.To our knowledge, this is the broadest analysis of outpatient clinical factors and associations with COVID-19 to date.COVID-19 outcome data were downloaded from the UKBB data portal on 23 rd February 2021.Clinical Events were obtained from the Primary Care data for COVID-19 research in UKBB.In UKBB, we set a time window of 5 years before death with COVID-19 to identify active medical diagnoses that may be risk factors with COVID-19 death.The estimated glomerular filtration rate (eGFR) was calculated by the UKBB using the Chronic Kidney Disease Epidemiology Collaboration
Introduction: Bacillus Calmette-Guérin instillation is an established therapy for the treatment of carcinoma in situ of the upper urinary tract. Case Presentation: A 72-year-old woman underwent radical cystectomy with cutaneous ureterostomy for invasive bladder cancer with carcinoma in situ of both ureters. For the treatment of upper urinary tract carcinoma in situ, an infusion of 40 mg bacillus Calmette-Guérin through each ureterostomy was performed once weekly for 5 times. Urine cytology of the left upper urinary tract became negative, with a recurrence-free survival of 4 months. On the other hand, the right upper urinary tract became temporarily negative but turned positive after 3 months. Conclusion: Bacillus Calmette-Guérin perfusion therapy via cutaneous ureterostomy is considered as one of the useful therapies for carcinoma in situ of the upper urinary tract. Furthermore, there are several factors to be discussed, including the treatment duration, dosage and secondary therapeutic options.
Background: Complications of Chronic Kidney Disease (CKD) lead to low bone mass and osteoporosis. Objective: To review the prevalence of osteopenia and osteoporosis among CKD patients. Methods: Potential studies were identified through a systematic search of recognized databases using keywords “prevalence,” “osteopenia,” “osteoporosis,” “Chronic Kidney Disease,” “CKD patients,” “Chronic Renal Failure,” “CRF patients,” “Bone Mineral Density,” and “low bone mass” to identify relevant articles. An article was included in the review if the study met the following criteria: 1) conducted in CKD patients aged 18 years and above, 2) Osteopenia and osteoporosis were determined through Bone Mineral Density (BMD) testing, and 3) T scores were determined for all patients. The studies including transplant patients were not included in this review. Results: A total of 2142 titles were retrieved and of these 8 studies, based on the prevalence of osteopenia and osteoporosis in CKD patients were included in the final review. The review found that the prevalence of osteopenia reported in the studies was between 33.3% and 81% with an average of 45.91% and the prevalence of osteoporosis was between 2.24% and 31.3% with an average of 23.29%. Higher prevalence rates were observed among female gender and CKD patients with low Body Mass Index. Lumbar spine (LS) was found to be the most vulnerable site for osteoporosis among the majority of the studies. Conclusion: The review found a high prevalence rate of osteopenia and osteoporosis among CKD patients. The review further identified that BMD testing at the LS site is more reliable and suitable to determine the risk of fracture and osteoporosis.
