Pub Date : 2024-07-26DOI: 10.2174/011874303x316281240722045029
Retta Catherina Sihotang, Haryo Satrio Muhammad, Irfan Wahyudi, G. A. Irdam
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. 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. 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%). 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.
{"title":"End-to-End Anastomotic Urethroplasty Outcome in Anterior and Posterior Traumatic Urethral Stricture: A Single-Center Experience","authors":"Retta Catherina Sihotang, Haryo Satrio Muhammad, Irfan Wahyudi, G. A. Irdam","doi":"10.2174/011874303x316281240722045029","DOIUrl":"https://doi.org/10.2174/011874303x316281240722045029","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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%).\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"29 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141800680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.2174/011874303x304324240529133609
Casey Light, Karen Heslop, Hemant Kulkarni
To evaluate the factors that affect the immune response to Hepatitis B vaccination in the Stage 5 chronic kidney disease population (Haemodialysis and Predialysis). 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. 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. 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.
{"title":"Comparison of Factors Affecting the Immune Response to Hepatitis B Vaccination in Patients with Stage 5 Chronic Kidney Disease-haemodialysis and Predialysis","authors":"Casey Light, Karen Heslop, Hemant Kulkarni","doi":"10.2174/011874303x304324240529133609","DOIUrl":"https://doi.org/10.2174/011874303x304324240529133609","url":null,"abstract":"\u0000 \u0000 To evaluate the factors that affect the immune response to Hepatitis B vaccination in the Stage 5 chronic kidney disease population (Haemodialysis and Predialysis).\u0000 \u0000 \u0000 \u0000 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.\u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"17 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-29DOI: 10.2174/011874303x237036231011055409
Jason M. Hafron, Stuart Atkinson, D. Boldt‐Houle, Joseph F. Renzulli
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. Narrative review of LHRH therapy and evaluation of which offers optimal efficacy, safety, and practicality. 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. 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.
{"title":"6-month Formulations of Androgen Deprivation Therapy for Advanced Prostate Cancer: Effectiveness and Rationale for Extended Dosing","authors":"Jason M. Hafron, Stuart Atkinson, D. Boldt‐Houle, Joseph F. Renzulli","doi":"10.2174/011874303x237036231011055409","DOIUrl":"https://doi.org/10.2174/011874303x237036231011055409","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 Narrative review of LHRH therapy and evaluation of which offers optimal efficacy, safety, and practicality.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"61 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140486833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.2174/1874303x-v16-e230120-2022-14
O. Akpor, Monsurat O. Yakubu, O. B. Akpor
The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with ESRD in Ilorin, Kwara State. 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 end-stage renal disease (ESRD) with permanent loss of kidney function and increase mortality. The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with ESRD in Ilorin, Kwara State. 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. 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%). 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 reduction in mortality rate.
{"title":"Compliance to Haemodialysis Regimen among End-Stage Renal Disease Patients: A Case Study of three Selected Hospitals in Kwara State, Nigeria","authors":"O. Akpor, Monsurat O. Yakubu, O. B. Akpor","doi":"10.2174/1874303x-v16-e230120-2022-14","DOIUrl":"https://doi.org/10.2174/1874303x-v16-e230120-2022-14","url":null,"abstract":"\u0000 \u0000 The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with ESRD in Ilorin, Kwara State.\u0000 \u0000 \u0000 \u0000 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 end-stage renal disease (ESRD) with permanent loss of kidney function and increase mortality.\u0000 \u0000 \u0000 \u0000 The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with ESRD in Ilorin, Kwara State.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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%).\u0000 \u0000 \u0000 \u0000 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 reduction in mortality rate.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125910548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-09DOI: 10.2174/1874303x-v16-e230109-2022-15
F. Sharifiaghdas, M. Taheri, N. Nikravesh, Mohadese Ahmadzade, Mehdi Dadpour, B. Narouie
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. The medical records of 170 patients with staghorn stones were studied from a tertiary referral center in central of Iran. Then, the specimens of their stones were sent to the laboratory for infrared spectroscopy and x-ray powder diffraction analyses. 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% 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. However, 16.% of the mixed stones were struvites, confirming a metabolic background. In 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). 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 require further investigation.
{"title":"Clinical Characteristics and Stone Types of Patients with Kidney Staghorn Stone in a Tertiary Referral Center in Iran","authors":"F. Sharifiaghdas, M. Taheri, N. Nikravesh, Mohadese Ahmadzade, Mehdi Dadpour, B. Narouie","doi":"10.2174/1874303x-v16-e230109-2022-15","DOIUrl":"https://doi.org/10.2174/1874303x-v16-e230109-2022-15","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 The medical records of 170 patients with staghorn stones were studied from a tertiary referral center in central of Iran. Then, the specimens of their stones were sent to the laboratory for infrared spectroscopy and x-ray powder diffraction analyses.\u0000 \u0000 \u0000 \u0000 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% 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.\u0000 \u0000 \u0000 \u0000 However, 16.% of the mixed stones were struvites, confirming a metabolic background. In 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).\u0000 \u0000 \u0000 \u0000 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 require further investigation.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115870885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-27DOI: 10.2174/1874303x-v16-e221227-2022-9
Ravi Kumar P, V. Vinayagmoorthy, A. Dongre, P. Deshmukh
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. 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. 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- Meier Curves and Cox Regression analysis was done to estimate the adjusted hazard ratio. 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. 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.
{"title":"Survival and Analysis of Predictors of Mortality in Patients Undergoing Hemodialysis in a Rural Hospital in Puducherry, India: A Retrospective Cohort Study","authors":"Ravi Kumar P, V. Vinayagmoorthy, A. Dongre, P. Deshmukh","doi":"10.2174/1874303x-v16-e221227-2022-9","DOIUrl":"https://doi.org/10.2174/1874303x-v16-e221227-2022-9","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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- Meier Curves and Cox Regression analysis was done to estimate the adjusted hazard ratio.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126456258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-04DOI: 10.2174/1874303x-v15-e2208180
Nisha K Jose, M. S, K. John, R. Prasad, M. Jayakumar
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 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. 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 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.
{"title":"CLABSI in Hemodialysis– New Face to an Old Foe; A Look at Current Trends and a Review of Literature","authors":"Nisha K Jose, M. S, K. John, R. Prasad, M. Jayakumar","doi":"10.2174/1874303x-v15-e2208180","DOIUrl":"https://doi.org/10.2174/1874303x-v15-e2208180","url":null,"abstract":"\u0000 \u0000 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\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114118188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-19DOI: 10.2174/1874303x-v15-e2208181
K. Leonardo, Farhanur Rahman, R. Ardaya
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. 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. 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). 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.
生物反馈骨盆底肌肉训练(PFMT)被广泛用于治疗压力性尿失禁(SUI)患者，尽管证据不明确。我们对文献进行了荟萃分析，以评估SUI患者在有生物反馈和没有生物反馈的PFMT治疗后的疗效。我们检索了PubMed、CENTRAL、CINAHL和Science Direct，寻找PFMT治疗SUI的随机对照试验(rct)，包括有无生物反馈。根据我们的入选标准筛选随机对照试验，并根据Cochrane随机试验偏倚风险工具评估偏倚风险。结果分析为盆底肌(PFM)强度、尿失禁发作、白天排尿和夜间排尿，均以95%置信区间(ci)的平均差(MD)测量。异质性和发表偏倚分别采用I2检验和漏斗图进行分析。对涉及207例患者的5项随机对照试验的汇总分析显示，两组之间PFM强度和夜间排尿的差异具有显著性。虽然PFMT力量改善有利于生物反馈辅助盆底肌肉训练(BPFMT) (MD 12.29, 95% CI 2.33, 22.25, p=0.02)，但相比之下，PFMT组夜间排尿明显减少(MD 0.44, 95% CI 0.12至0.77,p=0.007)。尿失禁发作和日间排尿的差异无统计学意义(MD为-0.08,95% CI为-0.57 ~ 0.41,p=0.75, MD为0.55,95% CI为-0.36 ~ 1.46,p=0.24)。该荟萃分析显示，BPFMT在改善PFM强度方面有更好的结果，而夜间排尿仅在PFMT中更好。同时，两组在尿失禁发作和日间排尿结局方面无显著差异。根据目前的证据，常规使用BPFMT在目前的临床实践中是没有必要的。
{"title":"Pelvic Floor Muscle Training for Stress Urinary Incontinence, with and without Biofeedback: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"K. Leonardo, Farhanur Rahman, R. Ardaya","doi":"10.2174/1874303x-v15-e2208181","DOIUrl":"https://doi.org/10.2174/1874303x-v15-e2208181","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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).\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"201 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132855891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-17DOI: 10.2174/1874303x-v15-e2208100
Hiroshi Tamura, Keishiro Furuie, S. Kuraoka, T. Kawano, H. Nakazato
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. Therefore, we conducted immunofluorescence staining using an anti-PLA2R antibody in the renal biopsy specimens of eight pediatric patients with IMN. 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. 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. 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.
{"title":"PLA2R Staining is Useful for the Diagnosis and Treatment of Membranous Nephropathy in Pediatric Patients","authors":"Hiroshi Tamura, Keishiro Furuie, S. Kuraoka, T. Kawano, H. Nakazato","doi":"10.2174/1874303x-v15-e2208100","DOIUrl":"https://doi.org/10.2174/1874303x-v15-e2208100","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 Therefore, we conducted immunofluorescence staining using an anti-PLA2R antibody in the renal biopsy specimens of eight pediatric patients with IMN.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 PLA2R expression can be approximately half positive in children with IMN, and it is useful to investigate the causative antigen of PLA2R in children.\u0000 The intensity of anti-PLA2R antibody expression reflected the disease activity (urinary protein level) of the patients in this study.\u0000 It is possible to adjust the drug dose in immunosuppressive therapy with reference to the expression intensity of PLA2R.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"124 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114087274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-19DOI: 10.2174/1874303x-v15-e2207050
Teuwafeu Denis Georges, Ako Carol Shenelle Mbeng, M. Mahamat, V. Bandolo, Mukwelle Karla Acha, K. François, A. Gloria
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. To assess the symptom burden in patients on maintenance haemodialysis, its associated factors, patients’ attitude, and practice. 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. 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). 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.
{"title":"Symptom Burden in Patients on Maintenance Haemodialysis: Magnitude, Associated Factors, Patients’ attitude and Practice","authors":"Teuwafeu Denis Georges, Ako Carol Shenelle Mbeng, M. Mahamat, V. Bandolo, Mukwelle Karla Acha, K. François, A. Gloria","doi":"10.2174/1874303x-v15-e2207050","DOIUrl":"https://doi.org/10.2174/1874303x-v15-e2207050","url":null,"abstract":"\u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 To assess the symptom burden in patients on maintenance haemodialysis, its associated factors, patients’ attitude, and practice.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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).\u0000 \u0000 \u0000 \u0000 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.\u0000","PeriodicalId":213268,"journal":{"name":"The Open Urology & Nephrology Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134471791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：