Hasil untuk "Diseases of the genitourinary system. Urology"

Fahri Yavuz İlki, Emre Bülbül, Yusuf Kadir Topçu et al.

Objective: Artificial intelligence (AI)-based large language models (LLMs), such as ChatGPT-4.0, are increasingly being considered for clinical decision-making support. However, their reliability in providing clinical recommendations for varicocele-related infertility remains to be thoroughly evaluated. This study aimed to evaluate the reliability of ChatGPT-4.0 in providing clinical recommendations for patients with varicocele-related infertility. Materials and Methods: A standardized clinical scenario was created involving a 32-year-old male with varicocele and oligoasthenoteratozoospermia, including details from physical examination, hormonal profile, and semen analysis based on the World Health Organization 6th edition criteria. Sixteen diagnostic and therapeutic questions were developed and submitted to ChatGPT-4.0. The AI-generated responses were reviewed by 24 experienced urologists specializing in varicocele management, who rated the recommendations using a 5-point Likert scale. Results: The urologists demonstrated an 80.2% agreement, 10.7% disagreement, and 9.1% neutrality with ChatGPT-4.0 recommendations. For 14 of the 16 questions, the majority of urologists either agreed or strongly agreed with ChatGPT-4.0. Recommendations regarding varicocelectomy indication, antioxidant usage, the female partner age greater than 35, follow-up after varicocelectomy, testosterone deficiency, and normospermic varicocele showed the highest consensus. However, lower agreement rates were noted for microsurgical varicocelectomy (54.1%) and preoperative sperm cryopreservation (16.7%). Conclusion: ChatGPT-4.0 demonstrates reliability in providing clinical recommendations in most scenarios related to varicocele treatment, showing strong agreement with expert clinicians. However, specific “gray zone” scenarios requiring individualized decision-making highlight limitations; emphasizing the importance of experienced clinical judgment. ChatGPT-4.0 can serve as a reliable informational tool regarding varicocele treatment but should be used with caution in complex clinical decisions requiring personalized evaluation.

Michel Perez-Garzon, Ana Castillo-Castillo, Maria Ferro-Peñuela et al.

Abstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a therapeutic strategy for refractory cardiogenic shock. However, it is associated with a high risk of complications, including acute kidney injury (AKI), which increases the need of renal replacement therapy (RRT) and is linked to worse clinical outcomes. Objective To identify clinical and biochemical factors independently associated with the initiation of renal replacement therapy (RRT) in adult patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods A retrospective case–control study that included patients who received VA-ECMO and were admitted to the intensive care unit between 2019 and 2023. The incidence of RRT, along with associated severity and mortality scores, was analyzed using multivariate analysis. Results A total of 279 patients were included, among whom 98 received VA-ECMO support. Of these, 26.5% required RRT, and the mortality rate was 57.7%. The majority of patients were male (62.2%), with a mean age of 45.3 years (SD ± 13.8). Factors associated with the need for RRT included the duration of mechanical ventilation (OR, 1.03; 95% CI, 1.00–1.06), history of hypothyroidism (OR, 4.05; 95% CI, 1.27–12.86), and elevated creatinine levels prior to ECMO initiation (OR, 1.54; 95% CI, 1.12–2.09). Additionally, the APACHE II score (OR, 1.04; 95% CI, 0.98–1.10) and renal angina index (OR, 5.29; 95% CI, 1.77–15.77) were predictors of mortality. Conclusions Patients undergoing VA-ECMO who require RRT have a high mortality risk. Associated factors include hypothyroidism, elevated creatinine levels before ECMO initiation, and a higher renal angina index. The early identification of these factors may facilitate the early detection of AKI risk and optimize clinical management. Clinical trial number Not applicable.

Katherine Clark, Rossetta Cole, Kathryn Dalrymple et al.

Mohamed Wishahi, Ahmed El Feel, Amr Elkhouly et al.

Abstract Background To compare the efficacy and safety of standard percutaneous nephrolithotomy (PCNL) with mini- PCNL for kidney stones 2–4 cm. Methods Eighty patients were enrolled in a comparative study, they were randomly divided into mini-PCNL group (n = 40) and standard-PCNL (n = 40). Demographic characteristics, perioperative events, complications, stone free rate (SFR) were reported. Results Both groups showed no significant difference in clinical data about age, stone location, back pressure changes, and body mass index. The mean operative time was (95 ± 17.9 min) in mini-PCNL, and (72.1 ± 14.9 min). Stone free rate were 80% and 85% in mini-PCNL and standard-PCNL respectively. Intra-operative complications, post-operative need for analgesia, hospital stay were significantly higher in standard-PCNL compared to mini-PCNL (85% vs. 80%). The study followed CONSORT 2010 guidelines for reporting parallel group randomization. Conclusion Mini-PCNL is an effective and safe treatment of kidney stones 2–4 cm, it has the advantage over standard-PCNL being has less intra-operative events, less post-operative analgesia, shorter hospital stay, while operative time and stone free rate are comparable when considering multiplicity, hardness, and site of stones.

Ibrahima Cissé, Modou Ndiaye, Rokhaya Désirée Niang et al.

Adult renal neuroblastoma is a rare condition, and a few cases have been previously described in the literature. Its prognosis is variable and the treatment suffer the lack of specific guidelines due to the low incidence. We report a case of adult renal neuroblastoma managed with nephrectomy and adjuvant chemotherapy. The purpose of this report is to update the knowledge available on this disease.

Sahil Kumar, Elise Bertin, Cormac O'Dwyer et al.

Transmasculine individuals, considering whether to undergo total hysterectomy with bilateral salpingectomy, have the option to have a concomitant oophorectomy. While studies have evaluated hormone changes following testosterone therapy initiation, most of those patients have not undergone oophorectomy. Data are currently limited to support health outcomes regarding the decision to retain or remove the ovaries. We performed a retrospective chart review of transmasculine patients maintained on high-dose testosterone therapy at a single endocrine clinic in Vancouver, British Columbia, Canada. Twelve transmasculine individuals who underwent bilateral oophorectomy and had presurgical and postsurgical serum data were included. We identified 12 transmasculine subjects as controls, who were on testosterone therapy and did not undergo oophorectomy, but additionally matched to the first group by age, testosterone dosing regimen, and body mass index. There was a statistically significant decrease in the estradiol levels of case subjects postoophorectomy, when compared to presurgical estradiol levels (P = 0.02). There was no significant difference between baseline estradiol levels between control and case subjects; however, the difference in estradiol levels at follow-up measurements was significant (P = 0.03). Total testosterone levels did not differ between control and case subjects at baseline and follow-up (both P > 0.05). Our results demonstrate that oophorectomy further attenuates estradiol levels below what is achieved by high-dose exogenous testosterone alone. Correlated clinical outcomes, such as impacts on bone health, were not available. The clinical implications of oophorectomy versus ovarian retention on endocrinological and overall health outcomes are currently limited.

Aref Moshayedi, Stephen J. Malachowski, Justin Haught

Abstract Reactive infectious mucocutaneous eruption (RIME) is a newly proposed clinical entity characterised by post‐infectious mucositis involving two or more mucous membranes. The term expands the previously described Mycoplasma pneumoniae‐induced rash and mucositis to include additional infectious agents. We report a case of RIME secondary to SARS‐CoV2 and Influenza A coinfection with subsequent reactivation of varicella zoster virus on the lips. RIME can have significant clinical overlap with Stevens‐Johnson Syndrome and differentiation is key in limiting unnecessary future medication restrictions on patients. This report serves to increase awareness of RIME, including to coinfections and possible reactivation of Human Herpes Viruses.

Zhongyuan Wang, Baochao Li, Jiajun Xing et al.

Abstract Background After the introduction of cisplatin-based chemotherapy, the survival time of testicular cancer (TC) patients has improved dramatically. However, the overall risk of death in patients with TC remains significantly higher than in the general population. The aim of this study was to assess and quantify the causes of death after TC diagnosis. Method In total, 44,975 men with TC in the United States diagnosed and registered by the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2018 were studied. In this study, standardized mortality rates (SMRs) were calculated for each cause of death in TC individuals and further analyzed in strata according to age and race. Result Of the included participants, 3,573 (7.94%) died during the follow-up period. The greatest proportion of deaths (38.20%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from TC itself and other cancers. For non-malignant conditions, the most common causes of death within 1 years after diagnosis were accidents and adverse effects (53, 4.75%) followed by diseases of heart (45, 4.04%). However, > 1 years after diagnosis, the most common noncancer causes of death were heart diseases. Results of stratified analysis show that non-Hispanic White TC participants have a lower SMR (0.68, 95% CI, 33.39–38.67) from Cerebrovascular Diseases than the general U.S. population. Conclusions Although TC remains the most common cause of death after TC diagnosis, other non-TC causes of death represent a significant number of deaths among TC men. These findings help TC survivors understand the various health risks that may occur at different follow-up periods.

Shigeo Negi, Tatsuya Wada, Naoya Matsumoto et al.

Abstract Acute kidney injury (AKI) is an emerging public health problem worldwide and is associated with high morbidity and mortality. The high mortality rate can be attributed to the lack of pharmacological therapies to prevent and treat AKI. Renal replacement therapy (RRT) plays a pivotal role in the treatment of patients with severe AKI. However, the mortality rate of patients with AKI requiring RRT exceeds 50%. Although studies on RRT for AKI have begun to resolve some of the associated problems, many issues remain to be addressed. Notably, the optimal timing of the initiation of RRT for AKI is still being debated. Recently, new therapeutic strategies for AKI have been developed. Angiotensin II and recombinant alkaline phosphatase treatment are expected to improve the clinical outcomes of patients with distributive and vasodilatory shock. Moreover, mitochondrial-targeted agents have been developed for the treatment of patients with AKI. This review is focused on the optimal timing of RRT for AKI and the new pharmacological interventions and therapies for AKI.

M. Dolores Sánchez de la Nieta García, Lucía González López, Paz Castro Fernández et al.

A. Mitra, U. Mukherjee, Suman Mazumder et al.

Patients with multiple myeloma (MM), an age-dependent neoplasm of antibody-producing plasma cells, have compromised immune systems and might be at increased risk for severe COVID-19 outcomes. This study characterizes risk factors associated with clinical indicators of COVID-19 severity and all-cause mortality in myeloma patients utilizing NCATS' National COVID Cohort Collaborative (N3C) database. The N3C consortium is a large, centralized data resource representing the largest multi-center cohort of COVID-19 cases and controls nationwide (>16 million total patients, and >6 million confirmed COVID-19+ cases to date). Our cohort included myeloma patients (both inpatients and outpatients) within the N3C consortium who have been diagnosed with COVID-19 based on positive PCR or antigen tests or ICD-10-CM diagnosis code. The outcomes of interest include all-cause mortality (including discharge to hospice) during the index encounter and clinical indicators of severity (i.e., hospitalization/emergency department/ED visit, use of mechanical ventilation, or extracorporeal membrane oxygenation (ECMO)). Finally, causal inference analysis was performed using the propensity score matching (PSM) method. As of 05/16/2022, the N3C consortium included 1,061,748 cancer patients, out of which 26,064 were MM patients (8,588 were COVID-19 positive). The mean age at COVID-19 diagnosis was 65.89 years, 46.8% were females, and 20.2% were of black race. 4.47% of patients died within 30 days of COVID-19 hospitalization. Overall, the survival probability was 90.7% across the course of the study. Multivariate logistic regression analysis showed histories of pulmonary and renal disease, dexamethasone, proteasome inhibitor/PI, immunomodulatory/IMiD therapies, and severe Charlson Comorbidity Index/CCI were significantly associated with higher risks of severe COVID-19 outcomes. Protective associations were observed with blood-or-marrow transplant/BMT and COVID-19 vaccination. Further, multivariate cox proportional hazard analysis showed that high and moderate CCI levels, International Staging System (ISS) moderate or severe stage, and PI therapy were associated with worse survival, while BMT and COVID-19 vaccination were associated with lower risk of death. Finally, matched sample average treatment effect on the treated (SATT) confirmed the causal effect of BMT and vaccination status as top protective factors associated with COVID-19 risk among US patients suffering from multiple myeloma. To the best of our knowledge, this is the largest nationwide study on myeloma patients with COVID-19.

I. Migdalis, N. Papanas, I. Ioannidis et al.

(1) Background: Type 2 diabetes mellitus (T2DM) is the main cause of chronic kidney disease (CKD). In Greece, in a population from hospital-based diabetes clinics (n = 1759), the overall prevalence of diabetic chronic kidney disease (DCKD) was 45% including mild, moderate, and severe CKD. The aim of this study was to describe and analyze how T2DM patients with mild-to-severe CKD are managed by diabetologists in Greece and assess the achievement rates in glycemic, blood pressure and low-density lipoprotein-cholesterol (LDL-C) control. (2) Methods: This cross-sectional multicenter study took place from June 2015 to March 2016 and collected data from diabetes centers in public hospitals all over Greece. (3) Results: With regard to the anti-diabetes treatment, most participants were on metformin, DPP-4 (Dipeptidyl Peptidase-4 inhibitors) inhibitors and insulin. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were the most prescribed medications for hypertension. For the management of dyslipidemia, most participants were on statins. For patients with DCKD, the levels of HbA1c, blood pressure and LDL-C were 7.2%, 137.7/76.9 mmHg and 95.9 mg/dL, respectively (mean values). (4) Conclusions: The outcomes of this study suggest that management of DCKD can be further improved and should be enhanced. These results may contribute to the whole health care system in Greece. In addition, the better understanding of therapeutic strategies used by diabetologists treating these patients offers educational benefits to primary care physicians, which can result in an overall more successful and efficient management of subjects with T2DM and DCKD.

Lauren M Sanders, Jason H. Yang, Ryan T. Scott et al.

M. Salinas, E. Flores, M. López-Garrigós et al.

Magnesium is an important electrolyte for many cell functions as it is involved in more than 600 enzymatic reactions [1]. Hypomagnesemia is relatively common and often associated with hypocalcemia and hypokalemia [2]. Hypomagnesemia is a negative outcome predictor for cardiovascular and renal disorders [3] and has been implicated in the pathogenesis of hypertension [4]. There is an overall prevalence of hypomagnesemia of around 30% in patients with diabetes [5]. Magnesium should be assessed in many relevant clinical conditions such as arrhythmia, hypokalemia, hypocalcemia, diarrhea and chronic alcoholism and in critically ill patients and those on drugs known to cause hypomagnesemia. Despite its importance, however, this marker is often known as the forgotten cation, and many cases of hypomagnesemia remain undiagnosed. We hypothesized that – given asymptomatic magnesium depletion is often associated with hypokalemia and hypocalcemia, diabetes and hypertension – hypomagnesemia could be detected by measuring serum magnesium test in the above situations [6, 7]. We also hypothesized that the elderly population – likely to have more comorbidity – would be more prone to magnesium deficiency. Our laboratory is located at the public University Hospital of San Juan (Alicante, Spain), a 370-bed suburban community hospital that serves a population of 234,551 inhabitants, including nine different primary care centers. Laboratory requests are made through an electronic system that includes a field regarding the reason for the laboratory request by means of the International Classification of Diseases, Ninth Revision, Clinical Modification (CIE-9-MC) codes [8]. First, we evaluated the GPs’ request pattern for serum magnesium from January 2017 to August 2019, to study the demand for serum magnesium in primary care. After that, two cross-sectional studies were designed: one involving calcium and potassium for the same period as above and another one regarding diabetes, hypertension and elderly from March 1, 2019 to May 31, 2019. In consensus with GPs, we decided that the laboratory information system (LIS) would automatically add serum magnesium order (if it had not been requested by GPs) when calcium <7.5 mg/dL (1.9 mmol/L) or potassium <2.5 mEq/L (2.5 mmol/L). In a second meeting, we decided to screen for hypomagnesemia in primary care patients with diabetes (ICD-9: 250.0), hypertension (ICD-9: 401.0) and those older than 65 years living at home and institutionalized. The LIS would automatically register a serum magnesium order in such cases, to be measured on the original blood sample. In both strategies, an automatic comment is added in case the magnesium is low: “Patient with hypomagnesemia”. For all requests where magnesium test was automatically registered, we collected the patients’ *Corresponding author: Maria Salinas, PhD, Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, 03550 San Juan de Alicante, Alicante, Spain; and Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain, Phone: +34 965169463, Fax: +34 965169460, E-mail: salinas_mar@gva.es Emilio Flores: Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, Alicante, Spain; and Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain Maite López-Garrigós and Rosa Carbonell: Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, Alicante, Spain Francisco Pomares: Department of Endocrinology and Nutrition, Hospital Universitario de San Juan, San Juan de Alicante, Spain Carlos Leiva-Salinas: Department of Radiology, University of Missouri, Columbia, MO, USA Clin Chem Lab Med 2020; 58(10): e221–e223

The Fellows of the Collegium Ramazzini

Background: Workers whose occupations put them in contact with infected persons and the public are at increased risk of COVID-19 infection. Recommendations: The Collegium Ramazzini calls on governments at all levels to protect worker health by strengthening public health systems; maintaining comprehensive social insurance systems; establishing policies that presume all COVID-19 infections in high-risk workers are work-related; enforcing all occupational health standards; and developing pandemic preparedness plans. The Collegium Ramazzini calls on all employers – large and small, public and private – to protect the health of all workers by developing disease preparedness plans; implementing basic infection control measures; establishing disease identification and isolation policies; reducing hazardous exposures; supporting personal protective equipment (PPE) programs; and restricting unnecessary travel. Conclusion: Governments and employers have legal obligations to protect worker health. They are not relieved of these duties during pandemics.

Michael Jonas, Maayan Kagan, Gal Sella et al.

Abstract Background Chronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents. Drug-eluting balloons are used for in-stent restenosis and selected cases of de-novo coronary lesions. Little is known regarding the outcomes of individuals with CKD who undergo PCI with drug-eluting balloons. The goal of this study was to assess outcomes of PCI with drug-eluting balloons in individuals with CKD. Methods In a retrospective analysis, outcomes of PCI with drug-eluting balloons were compared between 101 patients with CKD and 261 without CKD. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73m2. We compared demographics, procedure data and clinical outcomes in the first and second years following the procedure. Results Rates of major adverse cardiac events (MACE) and myocardial infarction were higher in patients with than without CKD: 23.8% vs. 13.8%, P < 0.005 and 15.9% vs. 3.8%, P < 0.001, respectively. Rates of target lesion revascularization were similar, 14.9 and 11.5%, respectively, P = 0.4. Shorter duration of dual anti-platelet therapy was observed among patients with than without CKD (10.0 + 3.4 vs. 10.9 + 3.7 months, P < 0.05). First-year hemorrhage episodes were similar in the two groups (0.08 ± 0.4 and 0.03 ± 0.2, respectively, P = 0.2). In a multivariate regression analysis, CKD was associated with increased risks of first year MACE (OR 2.1; 95% confidence interval 1.0-4.3, P < 0.001). Conclusions PCI with drug-eluting balloons was associated with increased cardiovascular morbidity and mortality in patients with than without CKD. However, rates of target lesion revascularization were similar in the two groups. Shorter duration of dual anti-platelet therapy was observed in the CKD group.

N. Leva, H. Copp

* Abbreviations: GBS — : Group B Streptococcus UTI — : urinary tract infection Prescribing the appropriate duration of antibiotic therapy is at the top of mind for the Centers for Disease Control and Prevention, hospital systems, and individual providers alike because it has a resounding impact on antimicrobial resistance.1 In this month’s issue of Pediatrics , Desai et al2 have taken on the duration of parenteral antibiotics for infants ≤60 days old with bacteremic urinary tract infection (UTI). This is a critical piece of a complicated puzzle that not only includes minimum duration of parenteral antibiotic treatment but also involves bioavailability of antimicrobial agents in infants and total treatment duration, which includes parenteral and oral antibiotic therapy. They have written a methodologically sound multicenter study and propose that a short course of parenteral antibiotics is no less effective than a long course in infants ≤60 days old with bacteremic UTIs. This study uniquely affords granularity with respect to the patient population, including a physician’s documented clinical assessment providing information such as temperature, ill appearance, or presence of a known genitourinary condition, which allowed for ascertainment of critical clinical information that influenced management decisions. Ultimately, … Address correspondence to Hillary L. Copp, MD, MS, Department of Pediatric Urology, University of California, San Francisco, Mission Hall Global Health Sciences Building, 550 16th St, 6th Floor, Box 1695, San Francisco, CA 94143. E-mail: hillary.copp{at}ucsf.edu

J. Falke, J. Parkkinen, L. Vaahtera et al.

Bülent Yiğit, İbrahim BERBER, Emre Erişkon et al.

Abstract Introduction: The incidence of acquired renal cystic disease (ARCD) in end stage renal disease patients treated by long term hemodialysis is reported to be 30-95%. Patients with ARCD may present with hemorrhage of the cyst and retroperitoneal hematoma, and renal cell carcinoma develops in 1.5% of ARCD patients. Worldwide experience to date in combined pathology and radiology series of patients undergoing hemodialysis demonstrates that acquired cystic disease, ‘tumor’ (usually adenoma or oncocytoma) and renal carcinoma occur at respective rates of 47.1, 4.8 and 1.5 per cent. The aim of this study is to question the necessity of serial investigation of the native kidneys in hemodialysis and renal transplant patients (RTx). Materials and Methods: Native kidneys of 19 patients on long term hemodialysis and 28 patients with RTx after long term hemodialysis were evaluated and followed serially by ultrasonography (US). In equivocal cases, computed tomography (CT) and/or magnetic resonans imaging (MRI) were added to evaluation. Results: The mean age of the hemodialysis group was 34±12.8 (range: 17-60) years and the mean hemodialysis priod was 47.3±16.8 (range: 27-84) months. In this group, US revealed cysts in 62.5% of the patients of whom the cyst were bilateral in 70%. In one case (6.1%), a retroperitoneal hematoma was found. In 5 patients, CT and/or MRI were needed additionally. Renal cell carcinoma was found in one patient (6.1%). The mean age of the RTx group was 33±10.7 (range: 14-55) years and the mean pretransplant hemodialysis period was 32±18.2 (range: 6-84) months. In this group, ARCD was diagnosed by US in 32% of the patients of whom the disease was bilateral in 80%. Additionally, CT and/or MRI were required in 4 patients of whom one (3.6%) was proved to be a renal carcinoma. Conclusion: The incidence of ARCD is quite high in patients who received long term hemodialysis. Since patients with ARCD are usually young and asymptomatic, it might therefore be necessary to follow the disease by US for early detection of complications. CT and/or MRI are helpful diagnostic tools for detecting malignancy in suspected cases