Urinary Research Articles

The urinary tract reconstruction in a robot-assisted surgery for rectal malignancy with combined prostate and seminal vesicle resection.

In certain cases of rectal malignancy in which invasion is confined to the prostate and/or seminal vesicles, bladder-sparing surgery may be chosen instead of total pelvic exenteration. However, even if the bladder is preserved, postoperative urinary dysfunction and vesicourethral anastomotic leakage are concern. We employ various techniques based on robot-assisted radical prostatectomy for reconstructing the urinary tract. These techniques include advanced reconstruction of vesicourethral support, total anatomical reconstruction, and a method called anterior reconstruction. In addition, suture fixation of bladder to the anterior abdominal wall, and re-approximation of bladder by peritoneal suture were done. Reliable robot-assisted vesicourethral anastomosis and reinforcement of the anastomotic wall could potentially enhance the self-voiding rate and decrease the risk of anastomotic failure.

Peripheral dopamine suppression and elevated cystatin C in early diabetic nephropathy in spontaneously diabetic rats.

Intrarenal dopamine plays a protective role against the development of diabetic nephropathy during the early stages of the disease. In streptozotocin-induced diabetic mice with renal-specific catechol-O-methyl transferase knockout, intrarenal dopamine was found to suppress glomerular hyperfiltration, reduce oxidative stress and inflammation, and inhibit fibrosis. However, although dopamine activation in streptozotocin-induced diabetic models has been shown to provide renal protection, the role of dopamine in models of naturally induced diabetes mellitus is still unclear. In the present study, we orally administered 10 mg/kg benserazide, a peripheral decarboxylase inhibitor, to spontaneously diabetic Torii rats daily to investigate the activation of the renal dopaminergic system during the progression of diabetic nephropathy. Our findings show that peripheral dopamine decreased urinary 8-iso-prostaglandin F2α and suppressed increases in plasma cystatin C levels. This study demonstrates that a reduction in peripheral dopamine can exacerbate renal dysfunction, even in the early stages of diabetic nephropathy characterized by glomerular hyperfiltration, thereby clarifying the pivotal role of endogenous peripheral dopamine in modulating oxidative stress and kidney performance.NEW & NOTEWORTHY By administering a peripheral decarboxylase inhibitor, we revealed that peripheral dopamine inhibits both the increase in urinary 8-iso-prostaglandin F2α, an oxidative stress marker, and the increase in plasma cystatin C, an early renal dysfunction marker, even in the early stages of diabetic nephropathy characterized by glomerular hyperfiltration. By visualizing renal dopamine precursor distribution, we highlighted the role of endogenous renal dopamine in oxidative stress and renal function following the onset of glomerular hyperfiltration.

The Use of Midazolam as an Antiseizure Medication in Neonatal Seizures: Single Center Experience and Literature Review.

Existing therapeutic alternatives for neonatal crises have expanded in recent decades, but no consensus has been reached on protocols based on neonatal seizures. In particular, little is known about the use of midazolam in newborns. The aim of our study is to evaluate the response to midazolam, the appearance of side effects, and their impact on therapeutic decisions. This is a STROBE-conformed retrospective observational study of 10 patients with neonatal seizures unresponsive to common antiseizure drugs, admitted to San Marco University Hospital's neonatal intensive care (Catania, Italy) from September 2015 to October 2022. In our database search, 36 newborns were treated with midazolam, but only ten children met the selection criteria for this study. Response was assessed both clinically and electrographic. Only 4 patients at the end of the treatment showed a complete electroclinical response; they were full-term infants with a postnatal age greater than 7 days. Non-responders and partial responders are all premature (4/10) or full-term neonates who started therapy in the first days of life (< 7th day) (2/10). Neonatal seizures in preterm show a lower response rate to midazolam than seizures in full-term infants, with poorer prognosis. Liver and renal function and central nervous system development are incomplete in premature infants and the first days of life. In this study, we show that midazolam, a short-acting benzodiazepine, appears to be most effective in full-term infants and after 7 days of life.

Antimicrobial resistance profiles of and associated risk factors for Pseudomonas aeruginosa nosocomial infection among patients at two tertiary healthcare facilities in Lusaka and Copperbelt Provinces, Zambia.

Antimicrobial resistance (AMR) of pathogens such as Pseudomonas aeruginosa is among the top 10 threats to global health. However, clinical and molecular data are scarce in Zambia. We, therefore, evaluated the AMR profiles of P. aeruginosa nosocomial infections (NIs). A year-long hospital-based cross-sectional study was conducted at two large tertiary-level hospitals in Zambia. Patients with current or previous hospital contact were screened for NIs. The current study focused on patients diagnosed with P. aeruginosa NIs. Clinical specimens were collected for bacteriological culture, and PCR amplification of 16S rRNA gene fragments was performed on pure isolates. Hospital or NIs were defined as infections that arise during hospitalization, occurring at least 48 h after admission. The Kirby-Bauer's disk diffusion method was used to evaluate antibiotic resistance patterns. The association between AMR and risk factors was analysed using the χ2 test. Eight hundred and forty-one patients were screened, and clinical specimens were collected and analysed. Of them, 116 (13.7%) were diagnosed with P. aeruginosa NIs. The participants' ages ranged from 15 to 98 years, with a mean of 51 (SD ± 18). Catheter-associated urinary tract infections (57%) were the most common, followed by pressure sores (38.7%). P. aeruginosa isolates were primarily susceptible to amikacin, which had the highest resistance to FEP. We observed a high prevalence of multidrug resistance (73.6%). The AMR was associated with carbapenem-hydrolysing β-lactamase gene blaOXA-51 and surgical care. This study has demonstrated that multidrug-resistant P. aeruginosa is prevalent in hospitals in Zambia's Lusaka and Ndola districts and possibly countrywide.

Self-adjusted Nitrous Oxide During Urodynamic Studies Reduces Patient Pain Without Compromising Study Quality: A Randomized Controlled Trial

Background and objectiveA urodynamic study (UDS) is a routine clinic procedure that can cause significant discomfort for certain patients, with no satisfactory analgesic alternatives currently available. Our aim was to evaluate the effectiveness of low-dose self-adjusted nitrous oxide (SANO), titrated to the patient’s desired effect, on standard metrics for bladder function and on patient-reported pain and anxiety. MethodsWe conducted a single-institution, double-blind, randomized crossover trial in adults undergoing UDS. Each patient underwent two consecutive UDS runs, randomized to receive oxygen during the first run followed by SANO during the second run, or vice versa. UDS outcomes (capacity, detrusor strength, residual volume) and patient subjective outcomes (Visual Analog Scale for pain and anxiety, operator assessment of verbal feedback) were compared between the two runs. Secondary analyses were performed to compare outcomes during the first UDS run and adjust for treatment order. A paired Wilcoxon signed rank-sum test and McNemar’s χ2 test were used to compare continuous and categorical variables, respectively. Adverse events were recorded. Key findings and limitationsNineteen patients were randomized (10 to oxygen for the first run, 9 to SANO for the first run). UDS outcomes did not differ between the two arms. Patients reported significantly less pain during the SANO run than during the oxygen run (p = 0.046). Verbal feedback was significantly better with SANO (p = 0.001). Most patients (15/19, 79%) stated that they would prefer to receive SANO during future UDS. There were no significant complications. Conclusions and clinical implicationsSANO oxide is a safe and effective means of preserving standard adult UDS metrics while significantly reducing patient-reported pain. Patient summaryUrodynamic tests (UDS) for evaluation of lower urinary tract symptoms can cause discomfort and pain. Our study shows that nitrous oxide gas self-adjusted by patients had no effect on UDS test outcomes or on verbal feedback during the procedure, and reduced discomfort and pain in comparison to oxygen. Nitrous oxide may an attractive option for patients who are reluctant to undergo UDS.

PCR Detection of Spreading TEM and CTX-M gene in Klebsiella oxytoca isolate from Urinary Tract Infection

PCR Detection of Spreading TEM and CTX-M gene in Klebsiella oxytoca isolate from Urinary Tract Infection

A Unique Presentation of Excitatory Catatonia Alongside AntiNmda Receptor Encephalitis: A Case Report

Introduction: Anti-NMDA receptor encephalitis, first described in 2007, is a prominent cause of autoimmune encephalitis, predominantly affecting females. Its clinical presentation includes a prodromal phase with flu-like symptoms, followed by psychosis, unresponsiveness, hyperkinesis, and recovery [1]. Catatonia can coexist sounds better than cooccur in patients with anti-NMDA receptor encephalitis, complicating diagnosis and effective treatment. Case Summary: This case report discusses a 41-year-old African American female with a history of seizure disorder, schizoaffective disorder with catatonia, developmental delay, Catatonia in itself is not the diagnosis as per dsm 5. We could use it as a specifier with other diagnosis, be it schizoaffective disorder or seizure disorder here. So we could mention as schizoaffective disorder with catatonia. and recent bereavement. Her symptoms included variable motor hyperactivity, alternating between restlessness and sedation, with an initial Busch Francis Rating Scale score of 18. Initially diagnosed with excitatory catatonia secondary to schizoaffective disorder and treated with benzodiazepines, her condition failed to improve, prompting further investigation. Despite additional treatment for a urinary tract infection and medication adjustment, which included adding valproic acid and amantadine, her condition remained uncontrolled. Subsequent lumbar puncture revealed inflammatory markers, and her anti-NMDA receptor IgG antibody assay was positive at 1:1280, confirming the diagnosis of anti-NMDA receptor encephalitis. Treatment was escalated to include methylprednisolone and intravenous immunoglobulin, alongside six sessions of ECT for management of her catatonia. The patient showed significant improvement, achieving functional recovery and independence in daily activities before discharge. Conclusion: This case emphasizes the importance of considering anti-NMDA receptor encephalitis in patients with unexplained, refractory neuropsychiatric symptoms, such as catatonia, and highlights the value of a multidisciplinary approach in managing and rehabilitating affected individuals. Prompt diagnosis and treatment are crucial to improving outcomes and reducing the risk of persistent cognitive deficits.

Escherichia coli, an important Uropathogen: Characteristics and antimicrobial susceptibility pattern at Prof. Dr. I.G.N.G. Ngoerah General Hospital, period January 2020 – December, 2021

Background: Urinary tract infections (UTIs) are among the most common infections globally, often treated empirically with broad-spectrum antibiotics without prior culture and sensitivity testing. This practice has contributed to the rise in antibiotic resistance. Escherichia coli (E. coli) is the primary pathogen in uncomplicated UTIs, accounting for 70–90% of cases. However, other bacteria such as Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis are also significant, especially in complicated or healthcare-associated UTIs. This study examines the resistance patterns of E. coli in UTI cases. Method: A descriptive cross-sectional study was conducted using secondary data from medical records of UTI patients treated at Prof. Dr. I.G.N.G. Ngoerah General Hospital from January 2020 to December 2021. E. coli isolates were identified, and antibiotic sensitivity tests were performed using the VITEK® 2 compact automatic system, with antimicrobial sensitivity and resistance determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Result: Analysis of 639 UTI patients revealed that E. coli exhibited high resistance to cefixime (13.3%), ciprofloxacin (23.8%), and trimethoprim-sulfamethoxazole (35.2%). The highest levels of susceptibility were observed with Tigecycline, Meropenem, and Ertapenem, with rates ranging from 99.2% to 99.8%. The demographic data showed a higher incidence of UTIs in female patients (70.9%) compared to males (29.1%), with the majority of cases occurring in adults (94.52%). Additionally, 52.26% of the E. coli isolates were ESBL-producing strains, complicating treatment options. Conclusion: The study underscores the urgent need for judicious antibiotic use, guided by culture and sensitivity testing, to combat the rising threat of antibiotic-resistant UTIs. Tigecycline, Meropenem, and Ertapenem should be prioritized in treatment protocols for multidrug-resistant cases. Continuous surveillance and the development of new antimicrobial agents are essential to address this escalating public health challenge

Мультидисциплинарный подход в лечении рецидива рака прямой кишки с вовлечением мочевых путей

Aim. To evaluate immediate and long-term oncological results ofsurgical treatment of recurrent rectal cancer involving the urinary tractsystem to show the need for a multidisciplinary treatment approach for locally advanced recurrent rectal cancer. Material and methods. Retrospective cohort analysis with prospective supported database. Analyzed 14 cases: all patients with locally advanced rectal cancer recurrence involving urinary tract system were operated at the Clinic of Coloproctology and Minimally Invasive Surgery in 2013-2022. Results. The age of the patients was 51.6 ± 13.0 years, 6 men, 8 women. The greatest recurrence number was (88%) finded in group of primary colorectal cancer of the lower and middle parts of the rectum. In 57.2% observations patients received preoperative chemotherapy or combination with radiotherapy. Approximately 64% of primary operations were performed using an open approach. Recurrence of CRC with pT3-T4 invasion was diagnosed in 72% of cases. Metastatic damage of lymphatic nodes after primary surgery were identified in 57.2% of cases. In 2 observations primary surgery was performed with R2 resection margin, relapse in that cases was detected after 11 and 13 months. One histopathological report indicated R1 resection, relapse noted after 6 months. Adjuvant chemotherapy was performed in 10 cases (71.4%), in two cases (14.3%) – postoperative radiation therapy. Average time for recurrence detecting after primary operation was 16.5 [12-28] months. Advanced combined interventions including recurrence removal with colon resection, gynecological and urological stages (RR+CR+GR+UR) amounted to 36%, recurrence removal with resection colon and urological stage (RR+CR+UR) was performed in 43% of cases, recurrence removal without the colonic stage (RR+GR+UR and RR+UR) - 3 (21%) patients. Reconstructive surgery to restore urine derivation were performed in 12 (85.7%) cases. The average duration of the procedures was 412.5[205-490] minutes, intraoperative blood loss - 275 [150-400] ml. Early postoperative complications are classified as Clavien-Dindo III. One patient with SIRS was classified as a complication Clavien-Dindo IV. The duration of the postoperative period was 25.5 [14-30] days. Postoperative mortality was 0%. According pathohistological examination R1 resection was detected in 3 (21.4%) cases. Adjuvant chemotherapy was performed 8 (57.1%) patients, in 1 case (7.1%) combination with a course of radiotherapy. During the period 24 months after surgery the mortality rate was 14.3%, repeated relapses diagnosed in 3 (21.4%) patients, one was reoperated. Distant metastases was noted in 4 (28.6%) patients, of which in 1 case with repeated recurrence. Discussion. Our urogenital bacterial diversity analysisshowed that human testicular tissue is not a microbiologically sterile environment and also presented new data associated with testicular tissue and its possible relations with male infertility. Conclusion. The main treatment method for locally advanced rectal cancer recurrence involving the urinary tract system is surgical. Multidisciplinary approach with the involvement in the surgical team urologist oncologist made it possible to perform a one-stage radical intervention for locally advanced recurrence of rectal cancer with restoration of derivation urine without the need for subsequent reconstructive procedures on the urinary system. Keywords: rectal cancer, urinary tract, multidisciplinary approach, surgical treatment, recurrence.

Оценка эффективности и безопасности применения медицинского изделия «МАВИТ» у пациентов с хроническим простатитом и синдромом хронической тазовой боли

Abstract. Recent studies have shown that chronic prostatitis is one of the most common clinically and socially significant diseases. With chronic prostatitis, mental health suffers no less than with other severe somatic diseases, which sharply reduces the quality of life of men. This was a serious incentive for this study. In outpatient conditions, 50 patients with a confirmed diagnosis of N41 were examined. 1 Chronic prostatitis; R10.2 Pelvic and perineal pain. At the stage of inclusion in the study and treatment, the patient is examined: 1) Study of anamnesis. (NIH-CPS; IPSS; IIEF-5; PHQ-9; GAD-7; EQ–5D–3L) 2) Physical examination (determination of the somatic status of the study subjects) 3) Laboratory examinations were carried out in the laboratories of the clinical bases of the Consultative and Diagnostic Center No2 of the Moscow Health Department, Moscow, 8 Igralnaya Street; Clinical base Central Medical Clinic CMD, Moscow, Perovo metro station, Novogireevskaya st., 3A; Clinical base Clinic «New Medicine», Moscow region, Orekhovo-Zuevo, Lenin st., 44. (urine culture for microflora or urine assessment with a test strip once - before the start of therapy, four-cup test, PSA, CRP, STI screening) 4). Specialized diagnostic tests (ultrasound of the bladder with determination of the volume of residual urine, uroflowmetry, TRUS of the prostate with Doppler mapping). GE LOGIQ V2 ultrasound machine with convex and rectal probe. The obtained research data and interpretation of statistical data allow us to conclude that it is possible to use the MAVIT device according to GIKS.941549.102 TU, manufactured by Yelatma Instrument Plant JSC, according to the selected methods, 7 procedures every 2 months in urological patients with chronic prostatitis and the presence of chronic pelvic pain syndrome in order to relieve pain symptoms, lower urinary tract symptoms. The study also found positive effects on men’s sexual function and a reduction in anxiety disorders. All these positive outcomes in relation to the treatment of the main group of patients allow us to conclude that the MAVIT device may be widely used in the work of a practitioner both on an outpatient basis and in a day hospital.

Ultrasound, contrast-enhanced ultrasound and pyelonephritis: A narrative review

Acute pyelonephritis (APN) is a bacterial infection resulting in kidney inflammation, typically arising as a complication of an ascending urinary tract infection that ascends from the bladder to the kidneys. Clinical diagnosis is generally based on clinical and laboratory findings. Recent guidelines recommend not performing diagnostic imaging unless a complicated APN is suspected or the infection affects high-risk patients such as the elderly, immunocompromised individuals, or diabetics. Contrast-enhanced ultrasound (CEUS) is a valuable tool in both the diagnosis and follow-up of APN. It aids in distinguishing small simple nephritic involvement from abscess complications and monitoring their evolution over time during antibiotic therapy. Given its lack of ionizing radiation and nephrotoxicity, CEUS is a valid diagnostic modality for approaching and monitoring pyelonephritis, improving early identification and characterization of inflammatory lesions. This review aims to summarize the main evidence on the use of ultrasound and CEUS in the diagnosis of APN and its follow-up.

Effectiveness of selective antibiotics use in ESBL-related UTIs

BackgroundUrinary tract infections (UTIs) are the second most common infection, affecting 150 million people each year worldwide. Enterobacteriaceae species expressing extended-spectrum β-lactamases (ESBLs) are on the rise across the globe and are becoming a severe problem in the therapeutic management of clinical cases of urinary tract infection. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to investigate the prevalence of Enterobacteriaceae isolates exhibiting ESBL and their selective oral antibiogram profile at the district general hospital, Polonnaruwa.ResultsA total of 4386 urine specimens received to the Microbiology Laboratory during the study period. Among them, 1081 (24.6%) showed positive results for urine culture while 200/1081 specimens showed ESBL isolates. Out of the selected 200 specimen’s majority (67.5%) of samples received from the In-Patient Department. There were 200 patients and reported that 115 (57.5%) were females and 85 (42.5%) were males. The majority (51%) of the patients belong to the age group of 55–74 years. Among the ESBLs positive specimens, the majority 74.5% (n = 149) identified organisms were E. coli followed by Klebsiella spp.17.5% (n = 35), Enterobacteriaceae 7% (n = 14) and only1% (n = 2) isolate of Proteus spp. Mecillinam (87.92%) and Nitrofurantoin (83.2%) showed higher effectiveness against E. coli. Nitrofurantoin showed the highest effectiveness against Klebsiella spp. (40%), other Enterobacteriaceae spp. (100%). Proteus spp. showed 100% effectiveness and resistance respectively against Ciprofloxacin, Cotrimoxazole and Nitrofurantoin.ConclusionThe most predominant ESBLs producing uro-pathogen was the E. coli in the study setting and E. coli had higher sensitivity rate against Mecillinam. Among currently used oral antibiotics Nitrofurantoin was the best choice for UTIs caused by ESBL producers.

The Evolving Landscape of Onabotulinumtoxin A Use in Pediatric Lower Urinary Tract Dysfunction

The Evolving Landscape of Onabotulinumtoxin A Use in Pediatric Lower Urinary Tract Dysfunction

Prevalence and antibiotic susceptibility patterns of uropathogens in men with prostate cancer and benign prostate hyperplasia from Southwestern Nigeria

BackgroundEpidemiological investigations have revealed an important association between infection, inflammation and prostate cancer. Certain bacterial species, such as Klebsiella spp, Escherichia coli, Pseudomonas spp, Proteus mirabilis, Chlamydia trachomatis have been linked to prostate cancer. This study aimed to examine the microbiota; specifically bacterial species that have been linked to prostate infections in the urine of individuals diagnosed with prostate cancer.ResultsSixty-six prostate cancer patients and forty controls provided midstream urine samples. The urine samples were grown on suitable medium, and bacterial isolates were detected by standard microbiological methods. Additionally, the antibiotic sensitivity pattern of the bacterial isolates was analysed. A total of number of 72 bacterial isolates were obtained from the urine of study participants. The results showed the presence of Escherichia coli (50.0%), Pseudomonas aeruginosa (18.1%), Klebsiella spp (15.3%), Staphylococcus aureus (8.3%), Enterobacter spp (4.2%), and Proteus mirabilis (2.8%) in the urine. The most common bacterial species isolated from prostate cancer patients was Escherichia coli, which was susceptible to levofloxacin (100%), tobramycin (91.7%), and amikacin (62.5%).ConclusionsThis study’s findings established the presence of bacteria previously linked to prostatitis. This report indicates a high prevalence of pro-inflammatory bacteria and uropathogens in the urinary tract of men diagnosed with prostate cancer.

Perfil epidemiológico y microbiológico de la primera infección urinaria en una población pediátrica

Introduction: urinary tract infection (UTI) is the second cause of bacterial infection in children, generates high costs for the health system, may be the first manifestation of urinary tract anomalies and is a risk factor for multiple pathologies. Objective: to characterize the epidemiological and microbiological profile of the first UTI episode in the pediatric population of a referral center in Pereira, Colombia. Methods: a cross-sectional study, conducted during 2016- 2017, including patients aged 2 months to 10 years, with their first UTI episode, based on the American Academy of Pediatrics criteria. Bacterial resistance was defined using current CLSI (Clinical and Laboratory Standards Institute) guidelines. Descriptive statistics and STROBE guidelines were used for reporting this study results. Results: 81 patients were included, 28% were males, most were aged 2 to 12 months (40%), 49% were nitrite-positive, 39% had hematuria and 37% proteinuria, and 87% had a positive Gram stain. Ultrasound imaging revealed urinary tract anomalies in 18%; the most common uropathogens were: Escherichia coli (86%), Proteus mirabilis (5%) and Klebsiella pneumoniae (5%). E. coli showed resistance for trimethoprim-sulfamethoxazole, ampicillin-sulbactam and cephalothin in 51.4%, 32.8% and 17.1%, respectively; 2.8% were extended-spectrum betalactamase/ESBL-positive. The median time of empiric management was 3 days and full treatment was of 10 days. Discussion: high resistance rates were recorded for ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole, which discourage their use. The sensitivity of E coli to cephalothin and amikacin, reported in this study, favors their use as first empirical therapeutic choices in our setting. Conclusion: ultrasound examination of the urinary tract is recommended in patients experiencing their first febrile UTI episode, due to the high prevalence of urinary anomalies identified.

Urinary Stone Formation and Testosterone Supplementation: Insights from a Cross-sectional Study in Athletes

Introduction: The use of exogenous testosterone has become increasingly prevalent in sports fields, raising concerns about its potential risks and benefits. Methods &amp; Materials: This study aimed to investigate the effects of testosterone supplementation on stone formation in the urinary tract and urine composition. A total of 1080 athletes participated in a two-year cross-sectional study, with 495 individuals receiving testosterone supplementation and 585 individuals serving as non-users. Blood and urine samples were collected, and CT scans were performed to assess stone presence. Results: The results revealed a significant increase in crystalluria among testosterone users compared to non-users (38.2% vs. 2.7%, p=0.004). Imaging findings also showed a higher incidence of abnormal results in testosterone users (25.2% vs. 4.3%, p=0.0017), with kidney calcification, pelvic and calyceal stones, ureteral stones, and bladder stones observed. Conclusion: However, further metabolic studies are required to establish a definitive cause-and-effect relationship between testosterone use and stone formation. This study sheds light on the potential risks associated with exogenous testosterone use and highlights the need for evidence-based recommendations in sports and athletic performance.

Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed‐methods study

AbstractBackgroundA prescribing cascade occurs when medication causes an adverse drug reaction (ADR) that leads to the prescription of additional medication. Prescribing cascades can cause excess medication burden, which is of particular concern in older adults. This study aims to identify and quantify potentially problematic prescribing cascades relevant for clinical practice.MethodsA mixed‐methods study was conducted. First, prescribing cascades were identified through literature search. An expert panel (n = 16) of pharmacists and physicians assessed whether these prescribing cascades were potentially problematic. Next, a cohort study quantified potentially problematic prescribing cascades in adults using Dutch community pharmacy data for the period 2015–2020. Additionally, the influence of multiple medications potentially causing the same ADR was evaluated. Prescription sequence symmetry analysis was used to calculate adjusted sequence ratios (aSRs), adjusting for temporal prescribing trends. An aSR &gt;1.0 indicates the occurrence of a prescribing cascade. In a subgroup analysis, aSRs were calculated for older adults.ResultsSeventy‐six prescribing cascades were identified in literature and three were provided by experts. Of these, 66 (83.5%) were considered potentially problematic. A significant positive aSR for the medication sequence was found for 41 (62.1%) of these prescribing cascades. The highest aSR was found for amiodarone potentially causing hypothyroidism treated with thyroid hormones (4.63 [95% confidence interval 4.40–4.85]), based on 565 incident users. The biggest population (n = 34,645) was found for angiotensin converting enzyme‐inhibitors potentially causing urinary tract infections treated with antibiotics. Regarding four potential ADRs, the aSRs were higher for people using multiple medications that cause the same ADR as compared to people using only one of those medications. Among older adults the aSRs remained significant for 37 prescribing cascades.ConclusionAn overview was generated of potentially problematic prescribing cascades relevant for clinical practice. These results can support healthcare providers to intervene and reduce medication burden for older adults.

10 Years of Antenatal Hydronephrosis Experience: Comparing Two Different Guidelines

Abstract Background Antenatal hydronephrosis refers to the dilation of the renal pelvis and/or calyces in the developing fetus. The challenge lies in distinguishing between cases that warrant long-term follow-up or surgical intervention and those with transient hydronephrosis that require minimal invasive investigations. Materials and Methods Our study aimed to assess and contrast the efficacy of the 2015 Congenital Anomalies of Kidney and Urinary Tract Guideline from the Turkish Society of Pediatric Nephrology with the Tepecik Antenatal Hydronephrosis Guideline, which was previously employed in our hospital. We conducted a comparative analysis of demographic data, outcome conditions, additional imaging requirements and quantities, radiation exposures, and rates of surgical interventions between two groups. Results Group 2 had a significantly higher detection rate of Vesicoureteral Reflux via voiding cystourethrogram at 38.5% compared to Group 1's 13.4% (p&lt;0.01). The incidence of abnormal findings with dimercaptosuccinic acid was similar between Group 1 (28.5%) and Group 2 (26.4%) (p&gt;0.01), but Group 2 had a higher rate of obstruction diagnosis at 68.8% versus Group 1's 29.4% (p&lt;0.01). Group 1 had greater median radiation exposure (500 mrem vs. 200 mrem, p&lt;0.01), and a higher proportion of patients underwent surgery (34.2% vs. 21.9%, p&lt;0.01). Conclusion This study showed that the new guideline required fewer tests, was less invasive, and exposed patients to less radiation than the old guideline.

Urolitíase em cão da raça Pug

The objective of this paper was to present a case of urolithiasis in a two-year old Pug weighing ten kilos, with a history of food allergy/atopic dermatitis. Upon physical examination, the animal presented mild abdominal pain upon palpation. The tutor indicated emesis 2 days ago. Upon ultrasound examination, it was possible to identify the presence of a 2.2 cm urolith in the bladder, in addition to cystitis in the urinary tract. The animal underwent surgical treatment, with cystotomy being the most suitable for this type of case. From the case report, it was found that racial or even familial predisposition was the main cause of urolith formation. In addition, the chances of urolithiasis occurring are greater in small breed dogs.

Macrolide resistance outcomes after the Covid-19 pandemic: A one health approach investigation

During the Covid-19 pandemic period, the indiscriminate use of macrolide-class antibiotics was frequent among the Brazilian population due to the lack of knowledge and information with a scientific basis. Thus, the class of drugs that includes azithromycin, clarithromycin, and erythromycin, which alter metabolic reactions in the body and act on the immune system, was widely used without medical prescription. Samples of bacterial strains from hospital environments were obtained during the most extensive spread of Covid-19 and studied in the present article, emphasizing the investigation for macrolide resistance genes (erm and msr) bacteria of the genus Staphylococcus isolated from urinary tract infections. In addition, the physiological, genetic, immunological, and socio-epidemiological aspects were highlighted with a focus on the One Health approach and implications on the gut-brain axis in this integrative research, revealing that the inappropriate use of antibiotics directly affects entire communities, representing a significant concern for public and environmental health.