Background: Vancomycin-induced nephrotoxicity is a well-documented adverse effect, occurring in 5 - 25% of patients, primarily due to the production of free radicals and reactive oxygen species. Objectives: This study aimed to evaluate the potential protective effect of theophylline against vancomycin-induced nephropathy. Methods: A two-group, single-blind randomized clinical trial was conducted at Heshmatieh Subspecialty Hospital in Sabzevar, Iran. Sixty-eight children were randomly assigned to either an intervention group (n = 34) or a control group (n = 34) using permuted block randomization. The primary analysis followed the intention-to-treat (ITT) principle using the last observation carried forward (LOCF) method; a per-protocol (PP) analysis was also conducted for sensitivity. Participants were divided into two groups: The intervention group received theophylline alongside vancomycin, while the control group received vancomycin alone. Serum and urine samples were collected at baseline and on the 3rd, 10th, and 30th days of treatment. Measurements included serum levels of blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and urinary microalbumin. Data were analyzed using the independent t-test, Mann-Whitney U test, and chi-square test. A repeated-measures ANOVA was conducted to assess changes over time, with Greenhouse-Geisser correction applied where sphericity was violated. Results: The mean urinary microalbumin levels on the 3rd, 10th, and 30th days post-treatment in the intervention group showed a notable decrease compared to the control group. The differences were statistically significant on the 10th and 30th days (P = 0.023 and P = 0.048, respectively). Additionally, the mean BUN levels decreased, and the eGFR increased in the intervention group compared to the control group over the same time points. The changes in BUN were significant on the 10th and 30th days (P = 0.031 and P = 0.045, respectively), while the changes in eGFR were significant on the 10th and 30th days (P = 0.016 and P = 0.039, respectively). No significant differences were observed on the 3rd day for BUN (P = 0.683) or eGFR (P = 0.282). It is important to note that urinary microalbumin values remained within the normal range (< 30 mg/g creatinine) in both groups throughout the study, suggesting these changes may reflect subclinical rather than clinically overt kidney injury. Conclusions: The results showed that theophylline may attenuate vancomycin-induced nephrotoxicity, as reflected by improvements in renal biomarkers. However, the clinical relevance of these biomarker changes requires further validation through trials using standardized clinical endpoints such as KDIGO-defined acute kidney injury (AKI).

Background: Primary nocturnal enuresis (PNE) is a common pediatric condition with a multifactorial etiology, involving both neurodevelopmental and nutritional factors. Recent evidence suggests that folic acid may contribute to neural maturation and bladder control. Objectives: The present study aimed to evaluate the therapeutic effect of folic acid supplementation on the frequency and severity of PNE in children. Methods: In a double-blind, randomized controlled trial, 68 children aged 5 - 18 years diagnosed with PNE were assigned to receive either folic acid supplementation or placebo over a sixty-day period. Baseline and post-treatment assessments included enuresis frequency and urinary control parameters. The number of dry nights was recorded at baseline, month 1, and month 2. Group-level means and standard deviations were compared using independent t-tests. Effect sizes (Cohen’s d) and percentage changes from baseline were calculated to assess the magnitude and clinical relevance of the intervention’s impact. Results: At baseline, there was no significant difference in the number of dry nights between groups (intervention: 19.2 ± 3.7; control: 18.9 ± 4.3; P = 0.63). By month 1, the intervention group showed greater improvement (24.5 ± 4.8 vs. 22.4 ± 5.1 dry nights; adjusted mean difference = 2.1, 95% CI: 0.9 - 3.3; P = 0.0004; Cohen’s d = 0.42). At month 2, this difference further increased (26.0 ± 4.6 vs. 23.2 ± 4.6; adjusted mean difference = 2.8, 95% CI: 1.7 - 3.9; P < 0.0001; Cohen’s d = 0.61). The intervention group achieved a 35.4% increase in dry nights from baseline, compared with 22.8% in the control group, indicating a moderate to large and clinically meaningful treatment effect. Conclusions: Folic acid supplementation may offer a safe and effective adjunctive treatment for PNE, potentially through its role in neurodevelopmental regulation. Further studies are warranted to confirm these findings and to explore the underlying mechanisms.

Background and Objectives: This study investigates the relationship between prostate volume, blood prostate-specific antigen (PSA) concentration, and 12 hematological variables in patients with benign prostatic hyperplasia (BPH). Methods: Data for 12 hematological traits were extracted from the records of 166 hospitalized patients at Ashayer Hospital in Khorramabad during 2021 - 2022 and analyzed using correlation and regression procedures in SAS statistical software. Results: Significant correlations were identified between PSA concentration and mean corpuscular volume (MCV), platelet count, and red cell distribution width (RDW). The highest correlation coefficients for PSA were with MCV (0.316) and platelet count (0.305). Multiple linear regression models identified key variables, including patient age, white blood cell (WBC) count, platelet count, and RDW. Models for estimating PSA concentration demonstrated higher statistical validity (R2 = 0.510 to 0.540) than those for prostate volume, likely due to stronger phenotypic associations with hematological traits. Specific hematological traits with the lowest tolerance and highest variance inflation factor (VIF) included neutrophil percentage, lymphocyte percentage, red blood cell (RBC) count, hemoglobin concentration, and hematocrit percentage. Conclusions: Hematological parameters were less effective in predicting prostate volume but valuable for estimating serum PSA concentration, offering potential insights for diagnostic models in BPH. However, these findings should be interpreted cautiously given study limitations, such as the retrospective design.

Background: Vancomycin-associated acute kidney injury (AKI) is a commonly reported adverse event in pediatric patients receiving vancomycin. Objectives: This study evaluated the protective effects of montelukast on vancomycin-induced renal injury in children. Methods: This randomized, double-blind, controlled trial was conducted at Amir Kabir Hospital in Arak, Iran, involving 40 children older than 2 years who were prescribed vancomycin. Participants were randomly assigned (1:1) to receive either montelukast plus standard care or standard care alone. Randomization was performed using a computer-generated sequence, with allocation concealment ensured by sequentially numbered, opaque, sealed envelopes (SNOSE) prepared by an independent researcher. Participants, caregivers, treating physicians, and outcome assessors were all blinded to group assignments. Serum creatinine levels were measured at baseline and three days after starting vancomycin. A change in serum creatinine ≥ 0.3 mg/dL was considered indicative of AKI. This study was funded by Arak University of Medical Sciences (grant No: 6625). Results: Among 40 evaluated cases, the mean ± SD age in the montelukast group was 5.95 ± 3.42 years and in the control group was 5.42 ± 3.50 years. The male-to-female ratio in the montelukast group was 10/10 (50/50%), and in the control group was 8/12 (40/60%). In the montelukast group, creatinine before treatment was 0.68 ± 0.23 mg/dL, and after treatment was 0.39 ± 0.13 mg/dL (P = 0.0001). In the control group, creatinine before treatment was 0.55 ± 0.15 mg/dL, and after treatment was 0.48 ± 0.15 mg/dL (P = 0.080). Conclusions: The results of the present study indicate that montelukast, when administered alongside vancomycin, leads to a decrease in serum creatinine levels in pediatric patients.

Background: Osteoporosis is characterized by decreased bone strength and a higher fracture risk. Objectives: This study aimed to compare computed tomography (CT) scans and bone densitometry for diagnosing osteoporosis and osteopenia. Methods: A descriptive-analytical cross-sectional study was conducted on 322 kidney failure patients admitted to Baqiyatallah Hospital in 2021. Descriptive statistics (mean, standard deviation, frequency, minimum, and maximum) and logistic regression analysis were utilized. Data were collected and entered into SPSS software version 24, and descriptive and inferential statistics were applied. A significance level of 5% was established. Results: The data demonstrated a significant linear relationship between CT scan-based bone density of the L1 vertebra and spine bone density measurement (Pearson’s R = 0.58, P ≤ 0.001). Although a significant linear relationship was observed between L1 bone density via CT scan and femur bone density measurement (Pearson’s R = 0.44, P ≤ 0.001), this correlation was weaker than that of spine bone density measurements. Spearman’s rank correlation test revealed a marginally significant linear relationship between L1 bone density using CT scan and forearm bone density measurement (ρ = 0.20, P = 0.05). After categorizing the data into normal, osteopenia, and osteoporosis groups, Spearman’s test indicated a significant linear relationship between L1 bone density and femur bone density (ρ = 0.48, P ≤ 0.001). Similarly, when the data were grouped into these categories, a marginally significant linear relationship was observed between L1 bone density by CT scan and forearm bone density (Spearman’s ρ = 0.20, P = 0.05). Conclusions: The findings highlight a significant relationship between CT scan-based L1 bone density and bone density measurements of the spine, femur, and forearm, with the strongest correlation observed in spine measurements. Therefore, utilizing L1 bone density assessment via CT scans — a non-invasive method often performed for other clinical purposes — can serve as an opportunistic tool for osteoporosis and osteopenia screening. This approach not only reduces costs but also facilitates early detection of osteoporosis.

Background: Radical hysterectomies are known to affect the lower urinary tract, with the intensity being directly proportional to the radicality of the hysterectomy. Currently, very few studies suggest that a reduction in the radicality of hysterectomy might decrease urological morbidity. Objectives: The present study primarily aimed to compare the uroflowmetry parameters and symptoms score (ICIQ-FLUTS) in patients before and after undergoing open abdominal hysterectomy and secondarily to compare the results in the present study with those in the literature worldwide. Methods: This prospective cohort study was conducted in Belagavi, Karnataka, India, from February 2023 to July 2024 on 30 patients. Uroflowmetry and ICIQ-FLUTS were recorded 1 day preoperatively and postoperatively on days 10, 30, 90, and 180. Data were entered in Excel and analyzed using SPSS version 22.0. Intergroup comparisons of continuous means were performed using one-way ANOVA, and intragroup comparisons were analyzed post hoc using LSD analysis. Results: In the 30 samples collected, the mean age was 51.90 ± 11.98 years, and the mean time for surgery was 1 hour 39 minutes ± 33 minutes. Twenty percent, 43.33%, and 36.7% of patients underwent Wertheim’s hysterectomy, simple hysterectomy, and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) + omentectomy/bilateral pelvic lymph node dissection (PLND), respectively. The mean blood transfusion required was 0.2 pints. Time for surgery and the need for blood transfusion were considered surrogates for the complexity of surgery. No statistically significant difference was noted when the results were compared as per the study protocol. Conclusions: Current nerve-sparing hysterectomies are associated with minimal urological morbidities and provide a good quality of life, and thus should be performed whenever possible. However, the results are not generalizable.

Introduction: Non-obstructive azoospermia (NOA) is often considered the most severe spectrum of male infertility. Focal spermatogenesis that occurs in NOA patients has made successful sperm retrieval very challenging. Testicular mapping biopsy is a minimally invasive sperm retrieval technique that provides significant information concerning focal spermatogenesis in NOA patients. This case series describes the early clinical experience and results of testicular mapping biopsy in Indonesian patients with NOA. It includes patients who have a history of unsuccessful testicular sperm extraction (TESE) procedures. Case Presentation: In this case series, we report the first 6 testicular mapping biopsy cases performed in Indonesia. These patients were previously screened for every possible male infertility etiology. Our patients presented with different underlying pathologies for male infertility, such as hormonal impairment, varicocele, and gr/gr deletion. Thereafter, patients were thoroughly counseled for testicular mapping biopsy. Our first experience with testicular mapping biopsy shows promising results with a 57.2% sperm retrieval rate. There were 2 out of 4 (50%) patients who had successful sperm retrieval by testicular mapping biopsy after previously failed TESE. There were no adverse effects of this procedure in all cases. Discussion: Testicular mapping biopsy is a novel sperm retrieval technique to treat NOA patients. The sperm retrieval rate of this procedure is comparable to TESE/microsurgical testicular sperm extraction (microTESE), with the advantage of minimal invasiveness and providing valuable information concerning focal spermatogenesis. Testicular mapping biopsy can also help treat NOA patients with previously failed TESE/microTESE. This procedure is well tolerated, with mild side effects such as spermatic cord hematoma, painless gross hematospermia, and pain. All complications were resolved within a week. Conclusions: Testicular mapping biopsy is a novel technique for treating NOA. It has a relatively high sperm retrieval rate comparable to TESE and microTESE. Furthermore, testicular mapping biopsy opens the possibility of sperm retrieval for patients with previously failed TESE or microTESE. The procedure is also well-tolerated by patients and does not have the adverse effect of reduced testosterone and potential hypogonadism as is the case with TESE or microTESE.

Background: Pauci-immune crescentic glomerulonephritis (GN) refers to a category of necrotizing GN in which there are no or only a few immune deposits by immunofluorescence. They constitute a distinct yet important cause of rapidly progressive GN. Objectives: To assess the clinical, histological, biochemical, and serological characteristics of patients diagnosed with idiopathic anti-neutrophil cytoplasmic autoantibodies (ANCAs)-negative renal-limited pauci-immune crescentic GN, the treatment outcomes, and the possible role of the alternative complement pathway in etiopathogenesis. Methods: This study included a total of 21 adult patients (≥ 18 years) with renal biopsy-proven pauci-immune crescentic GN with ANCA negativity. Patients with renal biopsy indicating more than 10% crescents were eligible for inclusion, while those with crescentic GN due to secondary causes and individuals who later tested positive for immune markers during the study period were excluded from this study. A complete remission is defined as normalization of serum creatinine, normal serum C3 levels, and 24-hour urine protein excretion of < 300 mg per day. "No remission" is defined as dialysis dependence, failure of serum creatinine, and 24-hour urine protein to decrease by > 50% from the baseline towards the end of the treatment. Anyone who showed a tendency towards remission but didn’t meet the above criteria was said to have attained partial remission. Results: A total of 11 patients (52.4%) achieved either complete or partial remission with Rituximab/plasma exchange or both. The clinical remission was more among patients with cellular and non-circumferential crescents and with crescents less than 25%. Patients who received a combined rituximab and plasma exchange therapy showed a better clinical tendency towards remission, though a statistical significance could not be attached to any of the above parameters and to the outcome, given the smaller sample size. There was involvement of the alternative complement pathway in 38% (8) of the patients. Conclusions: The ANCA-negative idiopathic pauci-immune type accounts for less than five percent of crescentic GN. Patients with cellular, non-circumferential crescents and crescents of < 25% have a better prognosis. Though being referred to as pauci-immune, the alternative complement pathway is implicated in the pathogenesis in a small percentage of this distinctive group.

Background: The most crucial steps of percutaneous nephrolithotomy (PCNL) are the percutaneous access and dilation of the access route. Objectives: This study compared papillary access to the calyx with non-papillary access in patients who underwent PCNL. Methods: This retrospective cohort study reviewed the medical records of patients who underwent PCNL between January 2022 and June 2023. A total of 103 patients (55 with papillary access and 48 with non-papillary access) were included in this study. Collected data included patient demographics, pre- and post-operative laboratory values (hemoglobin and creatinine), and documented surgical complications (intraoperative and postoperative bleeding, pleural injury, colon injury, urinary leakage, and abscess formation). Results: Of the 103 patients, 63 were male and 40 were female. The mean age of all PCNL patients was 42.3 ± 8.6 years (range: 20 - 60). The mean Body Mass Index (BMI) was 28.99 ± 5.34 kg/m2 in the papillary group and 26.73 ± 4.03 kg/m2 in the non-papillary group. The mean operative time was 60.72 ± 15.8 minutes in the papillary group and 56.78 ± 11.33 minutes in the non-papillary group. The mean patient weight was 81.5 ± 12.9 kg in the papillary group and 76.08 ± 14.80 kg in the non-papillary group. No statistically significant differences were observed between the groups for these variables (P > 0.05). Postoperative hemoglobin decrease, pleural injury, colon injury, infection, stone-free rate, and urinary leakage rates between papillary and non-papillary groups reported no statistically significant differences. Conclusions: This study concluded that non-papillary access is a feasible option for PCNL in terms of stone-free status and complication rates.

Background: Neonatal hypernatremic dehydration can lead to severe complications. The primary treatment for this condition is rehydration. However, varied treatment strategies depend on the specific hospital context. Objectives: This study investigated the practical management of hypernatremia in neonates with hypernatremic dehydration to simplify the treatment of these patients. Methods: We conducted a prospective observational cohort study enrolling neonates (≤ 28 days, gestational age ≥ 37 weeks) presenting with dehydration and serum sodium > 150 mEq/L at the neonatal intensive care unit (NICU) of Children's Medical Center from 2022 to 2024. A standardized intervention protocol was implemented, including a resuscitation phase with intravenous normal saline boluses and individualized maintenance fluid therapy. Neonates were stratified into three subgroups based on initial serum sodium concentrations (150 - 165, 166 - 175, and ≥ 176 mEq/L). The primary outcome was the rate of plasma sodium reduction, while secondary and tertiary outcomes included normalization timeframes, adverse events, and mortality. Results: In forty-three included neonates, analysis of variance (ANOVA) showed no statistically significant difference in the rate of sodium decline. Time to achieve serum sodium < 150 mEq/L varied: Group 1 (≤ 4 8 hours), group 2 (≤ 72 hours), and group 3 (≤ 6 days). Rehydration therapy was generally effective; the only complication was a seizure in one of the group 3 patients, who was discharged, and after 4 months of follow-up, he had normal development. Conclusions: Careful monitoring and individualized treatment are crucial for managing sodium levels and preventing adverse events in this vulnerable population. Further studies are warranted to refine rehydration strategies and improve outcomes in neonates with hypernatremia.