Urinary Catheter Research Articles

The Effect of Life Activity Levels of Palliative Care Patients on the Caregivers’ Perception of Caregivers Burden

Objective(s): Studies show the effects of dependent patients’ caregivers on the caregiving burden. Knowing the effects of maintenance of movement, especially in life activities, on the factors affecting the caregiving burden is important for the quality of care, ensuring that the caregiver's capacity is preserved. Methods: This descriptive and cross-sectional study research was carried out to determine the effect of life activity levels of palliative care patients on the care burden of caregivers. The number of individuals to be sampled was calculated according to the sample formula with a known population. The sample of the consisted of 108 patients and their caregivers in a district state hospital between June and December 2022. Data were collected using the Barthel Index of Patient Activities of Daily Living (ADL) and Caregiver Burden Scale. Descriptive statistical methods, quantitative data analyses, and correlation analyses were used in the analysis of the data. Results: The average age for patient was 78.13 ± 10.25 and for caregivers was 54.64 ± 13.22 years. Barthel ADL Index score of the patients was 35.05, and 38% of the patients were completely dependent. Caregiver Burden Scale scores was 50.80, and 76.8% of the caregivers had moderate caregiver burden. Patients with increasing age, with diabetes mellitus and dementia diagnosis, not using glasses, or having urinary catheters and gastrostomy tubes had lower activity levels. The caregiver burden of caregivers was higher in those who spent 3 to 4 h for daily patient care, who had sleep problems, who thought that their health deteriorated compared to those who did not. It was determined that as the patients’ ability to perform their daily activities decreased, the caregiver burden increased ( r = −0.417; P < .01). Conclusions: It might be recommended that nurses can implement the nursing interventions completely and severely dependent patients’ caregivers psychological and social support.

Acylase-Based Coatings on Sandblasted Polydimethylsiloxane-Based Materials for Antimicrobial Applications

Indwelling medical devices, such as urinary catheters, often experience bacterial colonization, forming biofilms that resist antibiotics and the host’s immune defenses through quorum sensing (QS), a chemical communication system. This study explores the development of antimicrobial coatings by immobilizing acylase, a quorum-quenching enzyme, on sandblasted polydimethylsiloxane (PDMS) surfaces. PDMS, commonly used in medical devices, was sandblasted to increase its surface roughness, enhancing acylase attachment. FTIR analysis confirmed that acylase retained its three-dimensional structure upon immobilization, preserving its enzymatic activity. The antibacterial efficacy of the coatings was tested against Pseudomonas aeruginosa (P. aeruginosa) (a common biofilm-forming pathogen), Staphylococcus aureus (S. aureus), and Escherichia coli (E. coli). The results showed that sandblasted PDMS surfaces had improved bacterial adhesion due to increased focal adhesion points, but acylase-functionalized surfaces had significantly reduced bacterial attachment and biofilm formation. Notably, the coatings inhibited P. aeruginosa growth by 40% under static conditions, demonstrating the potential of acylase-functionalized PDMS for medical applications. This approach offers a promising strategy for creating antimicrobial surfaces that prevent biofilm-related infections in urinary catheters and other medical devices. The findings highlight the dual role of surface roughness in enhancing enzyme attachment while reducing bacterial adhesion through effective QS inhibition.

Clamping Catheter Versus Free Drainage for Patients With Neurogenic Bladder With Indwelling Urinary Catheter: A Meta-Analysis.

Background: In the clinical setting, individuals with neurogenic bladder dysfunction commonly utilize indwelling urinary catheters for urinary management. The comparative efficacy of catheter clamping versus continuous free drainage in this patient population is yet to be established. This meta-analysis aims to explore the efficacy and safety of catheter clamping versus natural drainage in patients with neurogenic bladder, to provide evidence to support the treatment and nursing care of these patients. Methods: Two researchers conducted a literature search in Clinicaltrials et al. databases for Randomized Controlled Trials (RCTs) comparing clamping of the catheter to free drainage in patients with neurogenic bladder who have indwelling urinary catheters. The RCT bias risk assessment tool recommended by the Cochrane Handbook was used for quality assessment. RevMan 5.3 software were used for meta-analysis. Results: A total of 8 RCTs involving 772 patients with neurogenic bladder were enrolled. Catheter clamping significantly increased the volume of first urination in patients [MD = 52.86, 95%CI (42.30, 63.41), p < .001]. The difference in time to first urination [SMD = 0.10, 95%CI (-0.68, 0.89), p = .80], residual urine volume [MD = -5.18, 95%CI (-17.27, 6.90), p = .40], incidence of urinary retention [MD = 1.07, 95%CI (0.30, 3.87), p = .92], the incidence of urinary tract infection [RR = 1.38, 95%CI (0.64, 2.97), p = .42] between the catheter clamping group and the natural drainage group were not statistically significant. The results of Egger's regression analysis indicated no evidence of statistical publication bias. Conclusion: In light of the existing body of evidence, the routine practice of catheter clamping in catheterized patients with neurogenic bladder is not recommended.

Exploring the undergraduate medical students’ satisfaction with the urinary catheterization workshop and the factors affecting it; A Cross-sectional Survey.

Objective: To assess the satisfaction level of final year medical students with urinary catheterization workshop and the factors affecting it. Study Design: Cross-sectional study. Setting: Wah Medical College, Wah Cantonment. Period: October 15th, 2023 to January 15th, 2024. Methods: Satisfaction level and factors for its improvement were assessed by using a questionnaire after conducting a mandatory workshop on the skill of urinary catheterization. All the 90 final-year MBBS students present on the day of the workshop were included in the study using purposive sampling technique. The data was analyzed by using SPSS version 25. Fisher's exact test was applied to assess the association of gender with satisfaction level of students considering a p-value lesser than 0.05 as significant. For the open-ended questions, quantitative content analysis was performed. Results: The mean age of the students was 23.6+1.1 years. 82.2% of the participants had a very high satisfaction level with the workshop. Difference was observed when the satisfaction level of the students was assessed across gender (p-value=0.02). 45.6% of the students rated the workshop as good in all domains. The identified factors that can improve satisfaction with the workshop include the provision of refreshments, making smaller batches for teaching, providing feedback after skill performance and giving more time for practice. Conclusion: The majority of the students were highly satisfied with the workshop. Around half of the participants regarded the workshop as good in all domains but the students identified some factors for the improvement of satisfaction level with the workshop.

A Spectroscopic Methodology to Early Detection of Urinary Tract Infections

Healthcare-associated infections (HAI) are a critical public health problem, with 30 to 40% of infections related to the urinary tract system. These urinary tract infections (UTIs) are considered one of the most common microbial infections in hospital settings and everyday community contexts, where approximately 80% are highly correlated with urinary catheter insertion, i.e., catheter-associated urinary tract infections (CAUTIs). Considering that 15 to 25% of hospitalised patients need to be catheterised during their treatments and most CAUTIs are asymptomatic, it results in a tremendous challenge to provide an early diagnosis of CAUTI and therefore initiate its treatment. The lack of standardised methods as a first step for urine monitoring and early detection of UTIs is the driving force of this work, which aims to explore the potential of absorption and fluorescence spectroscopic methodologies to detect UTIs. Urine samples were used without any previous treatment to target the most straightforward testing protocol possible. In this work, we successfully developed a powerful methodology that combines ratiometric fluorescence spectroscopy measurements and transmittance at 600 nm to distinguish healthy urine from infected urine. The complementary use of fluorescence spectroscopy and transmittance is what makes the new methodology we propose such a powerful approach to monitor urine samples and provide early detection of UTIs since it provides a quantitative analysis of both healthy and infected urine.

Creation and validation of an extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) clinical risk scoring tool for select Enterobacterales in non-urinary isolates.

Infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are increasing in the United States. Although many risk factor scoring tools exist, many are specific to bloodstream isolates and may not represent all patient populations. The purpose of this study was to create and validate an institution-specific scoring tool for select ESBL-E of non-urinary origin based on previously identified risk factors. This retrospective, case-control analysis included inpatient adults at an academic medical center from July 2021 through August 2023 with a documented ESBL-E or non-ESBL-E infection of non-urinary origin. Patients with ESBL-E isolates were matched in a 1:1 ratio to non-ESBL-E isolates by organism and specimen type. Points for each risk factor were assigned by dividing their respective regression coefficient by half of the smallest regression coefficient and rounding to the nearest integer (prior ESBL-E within the past 12 months: 6 points, urinary catheter: 3 points, central venous catheter: 2 points, cirrhosis: 2 points). Sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) were calculated for each score, and discriminatory power was assessed via the receiver operating characteristic (ROC)-area under the curve (AUC). Of the 1139 identified cultures, 140 patients met the criteria for inclusion into the ESBL-E case arm, thus 140 patients with non-ESBL-E cultures were matched as controls. Baseline characteristics were relatively similar between the groups. A score of 0 was associated with low risk of ESBL-E (PPV 0.31, NPV 0.36), whereas scores between 2 and 5 were considered moderate risk (PPV 0.56, NPV 0.55), and scores ≥6 were associated with high risk (PPV 0.91, NPV 0.56). The ROC curve AUC was 0.705. The majority of ESBL-E risk factor scoring tools are specific to isolates causing bloodstream infections. This institution-specific scoring tool may be used to tailor empiric antimicrobial regimens and decrease unnecessary exposure to carbapenems in non-ESBL-E infections of non-urinary origin.

Patient satisfaction and feasibility with a novel drug-injectable urethral catheter set for hyaluronic acid administration: a multicenter randomized trial

Reducing the risk of urethral strictures after transurethral surgery for patients with bladder cancer requires effective strategies. We compared the clinical outcomes of a novel drug-injectable urethral catheter set (NIUS) with hyaluronic acid (HA) with those of the conventional intraurethral HA injection method. This six-center, prospective, randomized, single-blind trial included 192 male patients aged ≥ 20 years scheduled to undergo transurethral surgery. The primary outcome was patient-reported satisfaction. Secondary outcomes were patient-reported pain intensity, clinician-reported convenience, and urethral strictures. Cystourethroscopy was performed under direct visualization. Outcomes of the experimental (NIUS with HA) and control (HA) groups were compared using the chi-square test and t-test. The post-transurethral surgery rate was significantly higher in the experimental group than in the control group (p < 0.001). Overall, 40% and 21.7% of patients in the experimental and control groups, respectively, were very satisfied (p < 0.001). The experimental group had lower postoperative pain intensity scores (p < 0.001), higher clinician-reported convenience scores (p < 0.001), and fewer urethral strictures within 3 months postoperatively (p < 0.001) than the control group. The NIUS with HA after transurethral surgery significantly enhanced patient satisfaction, reduced pain, improved clinician convenience, and was associated with a reduction in grade 1 urethral strictures. Thus, NIUS with HA enhances post-surgery outcomes through improved patient satisfaction and reduced urethral strictures.Trial registration: Cris.nih.go.kr (KCT0007010).

Ultrasound-guided Transperineal Prostate Thermal Ablation (TPTA) for Benign Prostatic Hyperplasia: Feasibility of an Outpatient Procedure using Radiofrequency Ablation.

To evaluate the feasibility, safety, and short-term (3-month) results of transperineal prostate thermal ablation (TPTA) as a minimally invasive outpatient treatment for benign prostatic hyperplasia (BPH). A prospective nonrandomized study of 25 patients with lower urinary tract symptoms secondary to BPH seeking care at 2 interventional radiology centers between March and July 2024. TPTA was performed using a 17G radiofrequency needle with a 10-mm active tip under unconscious sedation combined with bilateral perineal and periprostatic nerve blocks. The primary outcome measure was technical success, defined as successful bilateral ablation of the prostate transition zone. Secondary outcome measures included changes of international prostate symptom score (IPSS), quality of life (QoL), prostate volume, intravesical prostatic protrusion (IPP), prostate-specific antigen (PSA), post-void residual volume (PVR), maximum urinary flow rate (Qmax), and need for BPH medical therapy at 3months relative to baseline. All procedures were technically successful (100%). The median patient age was 69.4years (IQR 54-74), and all were discharged within 3h of the end of the procedure. Sixteen patients (64.0%) were discharged without a urinary catheter, and 6 patients (24.0%) reported mild complications. At 3-month follow-up, there were significant reductions in IPSS (79.1%), QoL score (70.3%), prostate volume (36.9%), IPP (70.8%), PSA (54.7%), and PVR (51.1%), whereas Qmax increased significantly (102.3%). Twenty-four patients (96.0%) reported discontinuation of medical therapy after TPTA. Ultrasound-guided TPTA using radiofrequency ablation is feasible and safe in the outpatient setting, with significant clinical improvements after 3months of the procedure. Level 3 [non-randomized prospective cohort study].

Effect of Older Age on Postoperative Urinary Retention After Prolapse Surgery.

Postoperative urinary retention (POUR) is common after reconstructive pelvic surgery. Little is known about the relationship between older age (≥70 years) and POUR after pelvic organ prolapse surgery. We aimed to investigate the relationship between age ≥70 years and POUR. Secondarily, we aimed to determine if duration of urinary catheterization differed by age in women with POUR. This was a secondary analysis of a dual-center retrospective study on perioperative adverse events in biologic females aged ≥61 years undergoing prolapse surgery. The primary outcome was POUR, defined as a failed retrograde voiding trial requiring bladder catheterization. The secondary outcome was duration of temporary bladder catheterization. We developed a stepwise multivariable logistic regression model, which included relevant variables with P < 0.10 on univariate analyses and a forced age variable. In this cohort of 2,665 women, mean ± standard deviation age was 71.2 ± 6.7 years, and 54.6% were ≥70 years, POUR occurred in 830 (31.1%) patients. Women with POUR had a lower body mass index and were more likely to have undergone a vaginal prolapse surgery and concomitant hysterectomy/incontinence procedure (P < 0.05). They had higher estimated blood loss (75 vs 50 mL, P < 0.001). On multivariable logistic regression, age ≥70 years was not associated with POUR (adjusted odds ratio 1.02, 95% CI [0.83-1.26]). Age ≥70 years was associated with longer duration of catheterization (5 vs 4 days, P < 0.01). Age was not associated with POUR when controlling for other clinical factors (body mass index, surgical approach, concomitant hysterectomy/incontinence surgery, and estimated blood loss). These factors may affect POUR in older women and should be considered in perioperative management.

A stable dual functional superhydrophobic coating to inhibit Proteus mirabilis colonization, migration, and encrustation formation for urinary catheter applications.

Catheter-associated urinary tract infections are some of the most common hospital-acquired infections. Proteus mirabilis, a common pathogen associated with urinary tract infections, has swarming motility and has pili on its surface for adhesion and flagella for upward movement. Migration of P. mirabilis along the catheter surface can lead to ascending urinary tract infection. However, there is currently a lack of effective strategies to inhibit or delay the colonization, migration, and encrustation formation of P. mirabilis in urinary catheters. This study developed a method for constructing a stable superhydrophobic coating on the surface of urinary catheters using a layer-by-layer approach. The adhesion and deposition of polydopamine were enhanced by pre-coating a liquid bandage film on the polydimethylsiloxane surface, resulting in a multilayer micro-nano composite structure on the catheter surface. This structure was combined with copper ions and superhydrophobic modifiers, ultimately resulting in a highly stable superhydrophobic coating. The coating retains its superhydrophobic properties after prolonged incubation, friction tests, and tape peeling tests. Importantly, the coating demonstrates excellent efficacy in inhibiting P. mirabilis colonization, migration, and encrustation formation. This study offers novel insights into developing biomedical superhydrophobic coatings with enhanced stability and efficacy in inhibiting urinary tract bacterial infections.

Robot-assisted ureteral reconstruction for managing kidney transplant patients with ureteric complications.

To evaluate the feasibility of robot-assisted ureteral reconstruction as a minimally invasive alternative to open surgery for managing ureteric complications in transplanted kidneys. From January 2020 to December 2023, robot-assisted ureteral reconstruction was performed on fifteen kidney transplant patients with vesicoureteral reflux (VUR) or ureteral stricture who had previously failed endoscopic treatments. Twelve females and three males, with a mean age of 48.6±6.6 years, were included in the study. Nine patients (60.0%) underwent surgery due to VUR (grade III or higher) of the transplanted kidney, and six patients (40.0%) had transplanted ureteral strictures. Postoperative voiding cystourethrogram (VCUG) was performed at 3.2±1.6 months. Seven patients (77.8%) became VUR-free, while two patients (22.2%) had VUR regression from grade IV to I. All six patients who underwent reconstruction due to anastomosis site stricture became stenosis-free without the need for an indwelling ureteral catheter. In cases where the ureter was too short for reimplantation, a Boari flap or end-to-end anastomosis with the native ureter was performed. The mean hospital stay was 5.9±4.5 days. The urethral catheter was removed after 15.1±5.4 days, and the ureteral catheter was removed after 4.9±1.5 weeks. The mean follow-up period was 23.9±6.8 months, with no additional interventions required after surgery. No complications above Clavien-Dindo grade I were recorded. Robotic ureteral reconstruction is technically feasible and offers an effective, minimally invasive treatment for ureteric complications in kidney transplant patients, serving as an alternative to open surgery.

A novel multilayer antimicrobial urinary catheter material with antimicrobial properties.

Urinary catheters are commonly used in medical practice to drain and monitor urine of patients. However, urinary catheterisation is associated with the risk of developing catheter-associated urinary tract infections (CAUTIs), which can result in life-threatening sepsis that requires antibiotics for treatment. Using the layer-by-layer (LbL) technique, we assembled a multilayer catheter comprising nine quadruple layers (9QL) of alginate, chlorhexidine (CHX), alginate and poly(β-amino ester) (PBAE) built upon an amino-functionalised silicone. The prepared catheter materials were tested for pre-packaged storage conditions and sterilisation techniques. The daily release of CHX was measured at pH 7.4 and pH 5 and simulated urine at 37 °C, which was used to determine the antimicrobial affect. CHX release was detected for a minimum of 14 days in PBS (pH 7.4), pH 5 release media, and simulated urine for the samples tested against storage conditions and sterilisation techniques. Incubation of the prepared material with bacterial cultures for 24 hours restricted bacterial growth compared to incubation with the standard material. The minimum inhibition concentration of CHX for clinically isolated urinary tract infection (UTI) bacterial strains was in the range of 19.4-77.4 µM, at which the released CHX could indirectly prevent bacterial growth for up to 14 days. Based on the daily CHX release from the samples, the hydrolysis of PBAE at pH 5 was gradual, resulting in a greater number of days of preventing bacterial growth, followed by pH 7.4 and then simulated urine. To the best of our knowledge, this is the first report on the use of PBAE in association with a urinary catheter material for the release of an antimicrobial drug.

Clinical Profile and Antibiotic Susceptibility Patterns of Cronobacter sakazakii in the Northern Region of Oman

Abstract Background: Cronobacter sakazakii is an opportunistic pathogen that mostly affects neonates, infants, and elderly people with weakened immune systems. No study has reported the frequency and antibiotic susceptibility patterns of C. sakazakii from Oman, and thus this study was conducted to fill this gap in the literature. Materials and Methods: This single-center retrospective study included C. sakazakii isolates identified from different clinical samples of patients treated at Sohar Hospital, Oman, between January 2017 and December 2023. Bacterial identification and antibiotic susceptibility testing were done using the VITEK II automated microbiological system in accordance with the Clinical Laboratory Standards Institute (CLSI) guidelines. Results: A total of 185 C. sakazakii isolates were included, most commonly from patients aged &gt;60 years (42.7%) and &lt;1 year (11.4%). C. sakazakii strains had high susceptibility (&gt;80%) to most of the tested antibiotics; however, for beta-lactam antibiotics, it ranged from 0% to 50%. Approximately 26.5% of the strains were multidrug resistant. Independent risk factors for increased frequency of multidrug-resistant strains were urinary catheterization (P = 0.002), surgery (P = 0.021), previous antibiotic therapy (P = 0.047), and critical care unit admission (P = 0.048). About one-fifth of the patients experienced life-threatening C. sakazakii infections such as septicemia (15%) and pneumonia (4.7%). All deaths due to septicemia occurred in the &gt;60 years (n = 12) and &lt;1 year (n = 4) age groups. Conclusions: Cronobacter sakazakii isolates from the North Batinah region of Oman were most frequently isolated from elderly and infant patients and had high antibiotic susceptibility; however, the significant resistance against beta-lactams suggests their low effectiveness. The high number of multidrug-resistant strains coupled with the independent risk factors suggests the need for following stricter antibiotic stewardship protocols and infection control practices.

Molecular Epidemiological Characteristics of bla IMP-4-Carrying Klebsiella pneumoniae ST-11 in Hospitalized Patients.

To investigate the molecular epidemiology and risk factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. Patient's clinical data and CRKP strains were collected from November 2017 to December 2018 at a tertiary hospital in Wuhan, China. The antimicrobial susceptibilities, carbapenem-resistant genes, multi-locus sequence typing (MLST), homologous analysis, and risk factors for CRKP were determined. A total of 203 CRKP strains were isolated, and 98.5% (200/203) of patients were nosocomially infected. The mortality rate was 17.7% (36/203). All 203 strains were confirmed as carbapenemases -producing strains. The most predominant carbapenemase gene was bla IMP-4 (81.3%, 165/203), followed by bla KPC-2 (25.1%, 51/203) and bla NDM-1 (23.2%, 47/205). Of the 203 strains, 28 (13.8%) had both bla KPC-2 and bla IMP-4 genes, 23 (11.3%) had both bla IMP-4 and bla NDM-1 genes, 20 (9.9%) had bla KPC-2, bla IMP-4 and bla NDM-1 three genes. MLST analysis showed that there were 48 ST typologies (including 7 new STs), of which ST-11 was the most prevalent (59.6%, 121/203). Phylogenetic analysis showed that 203 CRKP isolates came from 7 clusters and exhibited a strong correlation with the isolation source. eBURST analyses indicated that CRKP isolates have undergone different evolutionary processes. Patients with ST-11 CRKP underwent more mechanical ventilation (50% vs 32.9%, P=0.020) and gastric catheterization (15.7% vs 6.1%, P=0.042) within 3 months before sample collection, and also had higher drug-resistance rate than non-ST-11 CRKP. Comparing with CSKP (carbapenem-sensitive Klebsiella pneumoniae), gastrointestinal disease (odds ratio [OR]=6.168, P=0.003), nosocomial infection (OR=5.573, P=0.012), antibiotic exposure (OR=4.131, P=0.004), urinary catheterization (OR=3.960, P=0.031) and venous/arterial catheterization (OR=2.738, P=0.026) within the preceding 3 months were independent risk factors for CRKP infection. The IMP-4 was the most predominant carbapenemase and bla IMP-4 bearing Klebsiella pneumoniae ST-11 was spreading in the hospital. Nosocomial infections, antibiotic exposure, and urinary and venous/arterial catheterization within 3 months were the risk factors for developing CRKP infection.

Bioavailability of rumen-protected histidine, lysine, and methionine assessed using different in vivo methods.

The objective of this experiment was to estimate the bioavailability (BA) of rumen-protected (RP) His, RPLys, and 2 RPMet products using 3 in vivo methods: area under the curve (AUC), plasma dose-response (PDR), and fecal free AA (FFAA) methods. We used 8 rumen-cannulated cows in a replicated 4 × 4 Latin square experiment with 16-d periods. Treatments were (1) abomasal infusion of water (control), (2) abomasal infusion of free His, Lys, and Met (FAA), (3) administration of RPHis + RPLys + RPMet1 (rumen-protected methionine protected with ethyl cellulose; RPAA1), and (4) administration of RPHis + RPLys + RPMet2 (rumen-protected methionine protected with a pH-sensitive polymer; RPAA2). On d 7 of each experimental period, a pulse-dose of water (control) or FAA were infused into the abomasum of the cows, or RPAA were placed directly in the rumen, and blood samples were taken from the jugular vein through a catheter 11 times over a 24-h period for the AUC method. Following the AA pulse-dose, infusion lines were installed into the abomasum for continuous infusion of FAA for the PDR method, or RPAA were fed from d 12 to d 16 and cows were fitted with urinary catheters for total collection of feces for the FFAA method. Fecal collection and blood sampling were conducted from d 14 to 16. Due to technical issues likely leading to unrealistic BA estimates, data for the PDR method are reported in the supplemental material. Relative BA based on the AUC method (computed as AUC of RPAA treatment plasma AA concentration divided by AUC of FAA treatment plasma AA concentration) was lower for RPMet1 compared with RPMet2 (43% vs. 61%) and was 45% (SEM = 3.35) and 72% (SEM = 5.99), for RPHis and RPLys, respectively. Rumen escape fractions of RPAA, estimated in a previous study using an in situ method, and digestibility data from the current study were used for calculations of BA for the FFAA method. Bioavailability based on the FFAA method was lower for RPMet1 (67%) compared with RPMet2 (91%) and was 87% (SEM = 0.71) and 75% (SEM = 2.75) for RPHis and RPLys, respectively. The relative differences in estimated BA based on both the AUC and FFAA methods between the RPMet products were as expected, based on literature, and data for all 4 RPAA products corresponded well with previously estimated BA using the FFAA method. The unrealistic data for the PDR method were likely caused by technical deviations from the original method (e.g., once-daily dosing of RPAA and inability to capture representative plasma concentration data with the sampling time points). Therefore, comparison of the PDR method with the AUC and FFAA methods were not possible in this study. Further comparisons are needed without deviations from the original PDR method. Variability in BA data and differences in estimated BA between the in vivo methods highlight the current challenges for accurate measurements of relative in vivo BA of RPAA products. Different protection technologies may call for different methodology to be used for BA estimations. Further research and standardization of in vivo BA methods are warranted.

Safety and efficacy of low-powered holmium laser enucleation of the prostate in comparison with plasma kinetic resection of prostate.

To compare the efficacy and safety of low-power holmium laser enucleation of the prostate (LP-HoLEP) with plasma kinetic resection of prostate (PKRP). Sixty-three patients treated with transurethral LP-HoLEP (observation group) and 68 patients treated with transurethral PKRP (control group) at Beijing Hospital of Traditional Chinese Medicine from November 2019 to November 2022 were retrospectively compared with regard to operation duration, intra-operative blood loss, prostate resection ratio, postoperative bladder irrigation time, postoperative indwelling urinary catheter time, postoperative urinary incontinence incidence, International Prostate Symptom Scale (IPSS), maximum urine flow rate (Qmax), and residual urine volume (RUV). In both groups, postoperative IPSS, Qmax, and RUV were significantly improved compared to preoperative values (P < 0.05). Comparing the observation group to the control group, the intra-operative blood loss were (59.6 ± 18.1) and (173.1 ± 85.3) ml, respectively (t = -10.350, P < 0.01); the prostate resection ratios were (81.2 ± 4.6) % and (56.7 ± 9.7)%, respectively (t = 18.230, P < 0.01); the postoperative bladder irrigation time was (39.1 ± 9.6) h and (49.7 ± 6.0) h, respectively (t = -7.623, P < 0.01); and the postoperative indwelling urinary catheter time was (111.5 ± 19.4) h and (120.4 ± 12.8) h, respectively (t = -3.125, P < 0.01). Comparing the observation group to the control group, the operation duration was (76.2 ± 18.6) and (83.0 ± 32.4) min, respectively, with no statistical difference (t = -1.226, P = 0.208); the postoperative urinary incontinence incidence was 12.7% and 8.8%, respectively and there was no statistical difference (χ² = 0.514, P = 0.473). LP-HoLEP offers excellent surgical efficacy and safety. LP-HoLEP is superior to PKRP in intra-operative blood loss, postoperative bladder irrigation time, and postoperative indwelling urinary catheter time, and can enucleate more hyperplastic glands.

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

Covalent Grafting of Quaternary Ammonium Salt-Containing Polyurethane onto Silicone Substrates to Enhance Bacterial Contact-Killing Ability

Catheter-associated urinary tract infection (CAUTI) induced by rapid bacterial colonization and biofilm formation on urinary catheters is a key issue that urgently needs to be addressed. To prevent CAUTI, many contact-killing, non-leaching coatings have been developed for the surfaces of silicone catheters. However, due to the chemical inertness of the silicone substrate, most current coatings lack adhesion and are unstable under external forces. Thus, the aim of this study was to develop a surface coating that has both good antibacterial ability and a high affinity toward silicone substrates. To achieve high affinity, a pre-coating layer with abundant surface vinyl groups, named SI-vinyl, was prepared on the silicone substrate by moisture curing using a mixture of α,ω-dihydroxy polydimethylsiloxane and vinyltrimethoxysilane as the painting agent. To endow the surface with contact-killing ability, a series of polyurethanes with different contents of quaternary ammonium salt groups in their main chain and two vinyl end groups were synthesized and covalently grafted onto the surface of SI-vinyl, resulting in corresponding bactericidal coatings with different surface contents of quaternary ammonium salt groups (SI-QAS). Of these bactericidal coatings, SI-QAS-2, with a surface QAS content of 2.1 × 1016 N+ cm−2, was selected as the best coating based on the consideration of stability, compatibility, and antibacterial ability. The SI-QAS-2 coating demonstrated high contact-killing performance, rapidly inactivating 72.8%, 99.9%, and 98.9% of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa within 30 min. Furthermore, even after being exposed to a high concentration of bacteria (106 CFU/mL) for 4 days, the SI-QAS-2 coating still maintained a high bactericidal ratio of over 80%. In summary, we developed a novel contact-killing coating that reduces the risk of bacterial infections caused by catheter implantation, demonstrating that it has high affinity toward silicone substrates, excellent contact-killing efficiency, a facile preparation method, and potential for further application.

Progressively complex neurorehabilitation: from a severe coma to a vegetative state, minimal consciousness ... and the Phoenix bird survives and is reborn from its ashes

Romania has the highest rate of car accidents and deaths per million inhabitants in the European Union, primarily due to poor driving and substandard road conditions. Victims of car accidents often present with complex medical cases involving multiple injuries across various organs, frequently leading to severe complications. Case report. With the approval of the patient's family and the Ethics Committee (no. 19348/25.04.2024) at the Neuromuscular Rehabilitation Clinic, Emergency Hospital "Bagdasar-Arseni," a case study was conducted. A 22-year-old man without a previous medical history suffered severe polytrauma as a result of a road accident. He was transferred to the Neuromuscular Rehabilitation Clinic in a vegetative state (after multiple fractures of the skull base and visceral cranium, with 3 points GCS), atlantoaxial subluxation (requiring cervical collar immobilization), rib fractures, drained hemothorax, near-complete atelectasis of the left lung, status post-pericardial effusion. The medical intervention involved a multifaceted pharmacological approach. Focal intramuscular injections of botulinum toxin targeted specific muscles significantly alleviated spasticity. Special robotic orthoses were used to correct postural abnormalities and maintain the favorable effects of the botulinum toxin. The patient received a personalized and complex nursing rehabilitation program including tracheal stoma management, nutritional support through IV infusions and percutanous gtrostomy (PEG) feeding, re-education of deglutition, intermittent urinary catheterization, and positioning on a special mattress to prevent pressure ulcers. The kinesiotherapy was progressively adapted to the neurologic and general condition. The patient had slight improvements in motor and cognitive abilities, resulting in simple voluntary gestures and affective response schemes. In time, he progressed to a minimally conscious state; he responded to verbal stimuli through blinking and reactive adequate affective mimic in the context of persistent expressive aphasia. He was safely discharged at home. Our main functional objective is the patient’s reinsertion into his family. Ad vitam prognosis and ad functionem outcomes are guarded. Ad laborem prognosis is nil. The patient was periodically reassessed for further rehabilitative care. This case emphasizes the importance of a complex multidisciplinary and patient-centered approach in managing post-traumatic vegetative status following a road traffic accident. The Phoenix symbolically takes steps toward fulfilling its destiny - to survive and gradually rise from its ashes.

Aldehyde free - Bovine Pericardium - A New Option of Graft in Urethral Stricture Treatment.

The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, bladder mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material) (1, 2). In the present video, we present a case where we used a new option of graft to treat urethral strictures: the L-Hydro® tissue treatment technology 100% aldehyde free, VIVENDI graft. The present study was approved according to the ethical standards of the hospital's institutional committee on experimentation with human beings. A 57 year-old male patient developed a urethral stricture due to prolonged use of a urinary catheter during a previous hospitalization. A cystourethrogram was performed, which revealed a stenosis of the penile urethra measuring 2.5 cm in length. Urethroplasty was proposed for the surgical treatment in this case. We used a longitudinal penile incision with a ventral sagittal urethrotomy in the penile stricture. A free VIVENDI graft was placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. The patient will receive post-operative follow-up for 3 months for clinical assessment through symptoms, uroflowmetry, urethroscopy and residual urine volume after urination. No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the three-month follow-up. Four weeks after surgery, he underwent urethroscopy, which revealed a good appearance of the urethra, with no stenosis or signs of infection. In the present case the use of bovine pericardium graft for the treatment of penile urethral stricture had a good result and can be an option to repair complex urethral strictures. However, the results presented require a larger population group in addition to multicenter studies with longer follow-up time to ensure the findings obtained. Available at: http://www.intbrazjurol.com.br/video-section/20249928_Vieiralves_et_al.