IntroductionThrombocytopenia can increase during Continuous Kidney Replacement Therapy (CKRT) in critically ill patients. This is the first systematic review that assesses whether thrombocytopenia during CKRT is clinically relevant. MethodsThe authors comprehensively evaluated CKRT-related thrombocytopenia data. Qualitative and quantitative tools were used to assess quality and risk of bias, epidemiology, causality, clinical outcomes, and possible mitigation and management strategies in the included publications. A subset analysis using Hedges’ g was conducted to assess the impact of the various parameters of interest. ResultsIndependent review of over 9,273 records by three authors produced 119 that met the inclusion criteria, and 85 full-text articles involving 29,217 patient samples were evaluated. A descriptive analysis is provided. Most studies were of poor quality (RCTs: 50%; Cohorts: 71%; Systematic Reviews/Meta-analyses: 66%; Cases: 67%). Case studies were fair (67%) to good (33%) quality. The level of certainty of the evidence was moderate for device-related, non-anticoagulant drugs, underlying conditions, and risk factor effects. A high level of evidence certainty was established for anticoagulant drugs, clinical outcomes (mortality/survival, bleeding risk, and filter life), and management and prevention. The subset analysis revealed small to large effect sizes for 19 parameters. DiscussionWhile platelet reductions exceeding 40% are associated with increased morbidity, the impact of CKRT on thrombocytopenia was reversible following treatment cessation in many patients. ConclusionThis systematic review is the first to conclude that CKRT-induced thrombocytopenia appears reversible and may not be clinically significant unless affected by additional risk factors, including medications and existing comorbid conditions.
IntroductionAminophylline, a non-selective phosphodiesterase inhibitor with smooth muscle relaxant effects, is established in pulmonary medicine but has not been systematically reviewed as an adjunct in ureteroscopic lithotripsy. This review assesses its efficacy and safety when administered either intravesically or intravenously. MethodsPubMed, Cochrane Library, EBSCO, and Google Scholar were searched to June 2025. Eligible studies were Randomized Controlled Trials (RCTs) or semi-experimental trials assessing aminophylline during ureteroscopic lithotripsy. Outcomes included Stone-Free Rate (SFR), operative time, ureteral access, stent requirement, pain, hematuria, Catheter-Related Bladder Discomfort (CRBD), and adverse events. Risk of bias was assessed with RoB 2.0 for RCTs and ROBINS-I for non-RCTs. ResultsEight studies (596 patients) were included. Intravesical aminophylline consistently improved ureteral access and reduced operative time; Lubana et al. showed higher success (82% vs 44%, p = 0.002) and less stenting (38% vs 68%, p = 0.011). Shabayek and Saafan reported reductions in intraureteral pressure, hematuria, and pain. Intravenous aminophylline showed mixed results: Barzegarnezhad found higher SFR (97.6% vs 84%), Ghadyan reported lower procedural success but less stenting, while Rehab et al. observed reduced CRBD (26% vs 59%, p = 0.025) and analgesic use. Adverse events were mild and transient. DiscussionEvidence is limited by small samples, heterogeneous designs, and variable definitions of “success.” Effect sizes may vary with stone size, location, and lithotripsy modality. Sensitivity analysis was not feasible, lowering certainty. ConclusionAminophylline may be a safe, low-cost adjunct to ureteroscopic lithotripsy, enhancing access, reducing operative time, and lowering morbidity. However, evidence remains low-certainty and hypothesis-generating, warranting larger multicenter RCTs.
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 Renal vascular embolization (RVE) is an advanced, minimally invasive procedure frequently employed in the clinical management of recurrent haematuria, particularly in patients with underlying vascular abnormalities contributing to this condition. Although renal vascular embolization (RVE) has demonstrated considerable efficacy in mitigating the symptoms associated with haematuria, it can pose substantial challenges. Case Presentation The case report shows a patient with a history of nephrolithiasis who underwent open nephrolithotomy for a right renal calculus. After the procedure, the patient developed haematuria and underwent renal vascular embolization. Three weeks post-procedure, the patient returned with severe haematuria and the second renal vascular embolization procedure was performed. The condition indicates undetected vascular abnormalities during the procedure, which resulted in an incomplete embolization. This comprehensive analysis of the case report underscores the critical importance of conducting thorough pre-procedural imaging, ensuring precise catheter placement throughout the intervention, and the urgent need to identify all pertinent vascular structures that may relate to the patient's condition. Furthermore, this case illustrates the potential implications of overlooking anatomical variations in the renal vasculature, which can adversely affect treatment efficacy and patient recovery. Conclusion Pre-embolization CT angiography is essential in managing recurrent hematuria following nephrolithotomy to identify all potential sources of hemorrhage and all feeding vessels, including accessory arteries. Selective angiography may further enhance the accuracy of vascular mapping.
Introduction Short-term randomized trials suggest that intraoperative systemic heparin improves arteriovenous fistula (AVF) patency, but long-term outcomes remain unclear. This study reports the five-year follow-up of a previously published double-blinded randomized trial on systemic heparin during AVF creation. Methods Eighty-eight patients from the original trial (July 2015–July 2016) were included, equally randomized into the heparin and control groups. Long-term outcomes (July 2016–July 2022) were obtained from electronic hospital records, dialysis centers, and telephone follow-up. Primary endpoints were AVF patency, secondary interventions, mortality, and renal transplantation. Results Seventy-two patients were available for final analysis. The median age was 57.5 years. Primary patency was superior in the heparin group during the first two years, with borderline significance at year 1 (p-value = 0.06) and statistical significance at year 2 (p-value = 0.019). Beyond year 2, no significant differences were observed. Mortality was higher in the control group (12 vs. 9 deaths), with cardiac events accounting for 32% of all deaths. Secondary interventions were more frequent in the control group, although the difference was not statistically significant. Discussion Intraoperative systemic heparin demonstrated a clear benefit in early AVF patency, which may improve uninterrupted dialysis access in patients with end-stage renal failure. However, the effect diminished after two years, and long-term outcomes were influenced by mortality and loss to follow-up. Conclusion Systemic heparin improves primary AVF patency during the first two years, supporting its role in early access preservation. Larger multicenter studies are warranted to validate these findings.
Introduction Urinary tract infections (UTIs) are among the most common bacterial infections in children, with recurrent episodes posing risks for renal scarring and long-term kidney damage. This study aimed to evaluate the utility of artificial intelligence (AI)-based models in predicting pediatric UTI recurrence, especially in low-resource settings. Methods A retrospective cohort study of 211 pediatric UTI cases was conducted between 2010 and 2025 at a single center in Iraq. Data included demographics, laboratory and imaging findings, and clinical outcomes. Four predictive models were developed: Logistic Regression, Random Forest, XGBoost, and Deep Learning. Models' performance was assessed using ROC-AUC, for accuracy, sensitivity, and specificity. SHapley Additive Explanations (SHAP) were used for interpretability. Results The Deep Learning model achieved the highest performance (AUC-ROC: 0.94, accuracy: 90.2%), followed by XGBoost (AUC-ROC: 0.92), and Random Forest (AUC-ROC: 0.89). Logistic Regression performed the lowest (AUC-ROC: 0.78). SHAP analysis identified vesicoureteral reflux (VUR) grade ≥3, renal scarring, female sex, and rural residence as the most influential predictors of recurrence. Discussion This study confirms that AI models significantly outperform traditional statistical methods in predicting recurrent pediatric UTIs. Key risk factors identified through SHAP align with established clinical knowledge, supporting the validity of AI predictions. The study also highlights healthcare disparities, particularly the elevated risk in rural populations. Limitations include its single-center design and lack of external validation. Conclusion AI-based predictive models, especially Deep Learning and XGBoost, offer high accuracy and clinical relevance for early risk stratification in pediatric UTIs. Their integration into digital health systems could enhance personalized care and reduce recurrence-related complications.
Introduction Varicocele, characterized by abnormal dilation of the testicular veins, is a common condition affecting male fertility. The role of the neutrophil-to-lymphocyte ratio (NLR) as a predictive prognostic marker for varicocelectomy outcomes in improving male fertility remains uncertain. This systematic review aims to explore the association between pre-operative NLR levels and varicocele surgery outcomes. Methods A systematic literature search was performed following PRISMA guidelines, utilizing electronic databases such as PubMed, EMBASE, and Cochrane. Studies published between 2018 and 2024 were included if they examined varicocelectomy surgical outcomes and NLR levels as predictive factors. Data extraction and quality assessment were carried out independently. Results Four studies met the inclusion criteria, collectively involving 442 patients. Elevated NLR levels were associated with varicocele surgery failure, indicating the potential impact of inflammation on treatment efficacy. Pre-operative assessment of NLR levels showed promise in identifying candidates likely to benefit from varicocelectomy, thereby optimizing treatment outcomes. This is the first systematic review evaluating the prognostic utility of NLR in varicocelectomy outcomes. Elevated pre-operative NLR levels were associated with poorer surgical outcomes, highlighting their potential for pre-surgical patient stratification. Discussion The findings suggest that incorporating NLR into the pre-operative assessment of infertile men with varicocele could enhance treatment decision-making and improve overall fertility prospects. Elevated NLR levels were associated with varicocele surgery failure, suggesting the detrimental impact of inflammation on treatment efficacy. Conclusion Pre-operative assessment of NLR levels may aid in identifying candidates likely to benefit from varicocelectomy, optimizing treatment outcomes.
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.
Introduction This study aimed to analyze the industry relationships and industry payments for the American Urological Association (AUA) 2023 annual meeting plenary speakers. We focused on the financial contributions of these opinion leaders to urology. Materials and Methods We used the Centers for Medicare and Medicaid Services (CMS) Open Payments Database, cross-referencing it with the 2023 AUA plenary speakers list, covering payments from 2015-2022, focusing on 2022. The analysis included categorization by provider training, geographic section, subspecialty, H-index, and guideline panel involvement, using median, interquartile range, frequency, and proportion for statistical analysis. Results An analysis of 171 U.S.-based AUA 2023 plenary speakers identified medical oncology as the highest-compensated subspecialty in 2022. Notably, 24% received over $100,000 between 2015-2022, and 7% exceeded $50,000 in 2022. Among AUA or National Comprehensive Cancer Network (NCCN) guideline panel members, 48% received over $50,000 over seven years, and 34% received over $10,000 in 2022. Conclusion The study revealed substantial financial relationships between the industry and AUA 2023 plenary speakers, especially those on guideline panels, with most payments in the form of consulting fees. The findings highlighted the importance of transparency and ethical considerations in urology, given the potential influence of these financial ties on medical decision-making and guideline development.
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
Introduction The objective of this study was to describe the results and associated factors of anterior and posterior traumatic urethral stricture after end-to-end anastomotic urethroplasty. Methods Medical records were used to retrieve clinical data. We included men over 18 years old who had a traumatic urethral stricture and were treated with end-to-end anastomotic urethroplasty. The data collection period was from January 2015 to December 2021, with at least 12 months follow-up period. After data screening, the data were divided into anterior and posterior strictures. Results Fifty patients were included in the study. The overall mean age was 42.06 (SD 12.4; 95% CI) years old, with a 21 (12-77) month median follow-up. %). The overall restricture rate was 36%. Furthermore, restricture rate in anterior stricture was 21.1%, while in posterior stricture was 45.2%. A significant association with restricture rate was found in the BMI category (p = 0.041) and etiology (p=0.03). There were 19 patients with anterior strictures and 31 patients with posterior strictures. Straddle injury was the most prevalent cause of anterior strictures (63.2%), whereas pelvic injury was the most common cause of posterior strictures (80.6%). For anterior and posterior groups, the majority of patients were normoweight (78.9% & 61.3%), entirely obliterated (63.2% & 64.5%), primary cases (84.2% & 80.6%), and done by reconstructive consultants (84.2% & 80.6%). Conclusion One-third of the patients experienced restricture arter end-to-end anastomotic urethroplasty, a higher restricture rate was found in posterior stricture. Restricture rate was associated with body mass index (BMI) and etiologies. End-to-end anastomotic urethroplasty may give durable patency if appropriately performed, especially in partial anterior traumatic urethral strictures.
Background: Chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD) are major public health problems around the world. In Asia, the incidence of ESRD is increasing and consuming more health expenditures. Prevention of ESRD is essential. Objective: This study aims to assess for factors associated with a rapid decline of estimated glomerular filtration rate(eGFR) among the Thai CKD population. Methods: This was a retrospective cohort study of 1,263 CKD patients in a tertiary university hospital from July 2013 to December 2021. Patients were categorized into 2 groups based on their annual rate of eGFR decline: the rapid group (>5 ml/min/1.73 m2 /year) and the non-rapid group (≤5 ml/min/1.73 m2 /year). All baseline and follow-up variables were assessed to identify predictors of rapid eGFR decline. Results: The median rate of eGFR decline was 3.0 ml/min/1.73m2/year in the non-rapid group (362 patients) and 6.6 ml/min/1.73m2/year in the rapid group (901 patients). Patients in the rapid group had a longer median follow-up time than in the non-rapid group (7.7 years versus 7.1 years respectively). In multivariate logistic analysis, diabetic mellitus, high baseline serum total carbon dioxide (TCO2), NSAID usage, and ACEI usage predicted rapid eGFR decline, but serum albumin during follow-up protected rapid eGFR decline. Conclusion: The main predictors for rapid kidney function deterioration were diabetic mellitus, high serum TCO2 during follow-up, NSAID usage, and ACEI usage. Serum albumin during follow-up protected kidney function.
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 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: 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.
