Long-term Patients Research Articles

RECURRENCE RATE AND QUALITY OF LIFE IN OPEN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY OF LICHTENSTEIN VS TRABUCCO REPAIR

Abstract Background The aim of this retrospective observational study with prospective follow-up is to evaluate the clinical outcomes and patients' Quality of Life (QoL) after either a Lichtenstein or a Trabucco inguinal hernia repair. Materials and Methods 532 patients who underwent inguinal hernia repair from 2016 to 2022 were included in this analysis. All the patients' baseline characteristics and data were collected from the hospital medical records. A phone interview was conducted to investigate long-term outcomes and patients’ QoL (EuraHS-QoL questionnaire) was performed between December 2022 and January 2024. The primary endpoint was the evaluation of patients’ recurrence rate and QoL in two technique groups: Lichtenstein (nA = 391) or Trabucco (nB = 141). Results The two groups didn’t show significant differences in main baseline characteristics. With a comparable median follow-up, no differences in complication rate (nA = 10.2% vs. nb= 11.3% p = 0.78) and recurrence rate (nA = 7.9% vs. nb = 4.96% p = 0.08)were detected among the two groups. Patients’ QoL improvement compared to the baseline was statistically significant in both groups. On the other hand, the weight of the mesh appears to have no impact on clinical outcomes (such as recurrence and complications), but it could worsen QoL when a heavier mesh is employed. Conclusion This analysis did not reveal any significant differences in outcomes between the two primary inguinal hernia repair techniques. Based on our experience, the choice of surgical techniques could be made depending on the preferences of the surgeons. It is crucial to select the weight of the mesh carefully.

#3043 Epidemiology of infective endocarditis in long term hemodialysis patients in France, from 2014 to 2019

Abstract Background and Aims Infective endocarditis (IE) is a frequent pathology among patients treated with long-term hemodialysis (HD). Its epidemiology and risk factors are scarcely reported in this specific population in France. This study aims to describe the frequency and characteristics of IE in long-term hemodialysis patients in mainland France. Method From the national Programme de médicalisation des systèmes d'information (PMSI) data, we selected patients initiating a renal replacement therapy by long-term hemodialysis from 2014 to 2017, with a follow up from 2017 to 2019. Within this population, we defined hospitalizations due to IE by using the CIM-10 coding system. We analyzed various comorbidities such as sociodemographic factors, cardiovascular diseases, cancer, diabetes and vascular access, identified within the PMSI during a minimum duration of 4 years, looking for IE risk factors. As the IE incidence has a low frequency for this follow up length, it was analyzed with a Poisson distribution model. Results We studied 38 569 patients, with a 36 month follow up. Fig. 1 shows IE incidence during the follow up, in which we identified 2492 cases of EI. The incidence rate was 6.69, or 7 out of 100 000 at first month and 1.97 out of 100 000 at twelve months. In multivariate analysis we found the following risk factors associated with EI: having a central vascular catheter (CVC) as initial vascular access while starting renal replacement therapy, compared to an arteriovenous fistula, OR 2.49 [2.29-2.71], diabetes OR 1.25 [1.14-1.35], cardiovascular conditions OR 1.35 [1.23-1.48] and increasing age was associated with a reduction of an IE diagnosis odds. Conclusion Our study highlights a high IE frequency among long-term hemodialysis patients. Its incidence is particularly high during the first year and decreases afterwards. The main risk factors were: CVC, preexisting cardiovascular conditions and diabetes.

#1744 Characteristics of patients on long-term dialysis for more than 30 years in our hospital

Abstract Background and Aims In Japan, the prognosis of dialysis patients has improved over the years. The number of patients on dialysis for more than 20 years dramatically increased from less than 1% in 1992 to 8.6% in 2021. We analyzed the factors that contribute to the prolonged prognosis of dialysis patients. Method Of our 117 maintenance dialysis patients, we examine the dialysis profile of 26 (22.2%) long-term dialysis patients who have been on dialysis for more than 30 years. Results The mean age of dialysis induction is 32 years (13-55, ±10), the mean age is 71 years (46-87, ±9), and the longest duration of dialysis is 42 years. 12 patients are male. The majority cause of hemodialysis in them is chronic glomerulonephritis (22 patients). In addition, there are no patients with diabetes complications, 4 patients with hypertension, and 2 patients with coronary artery disease. 12 patients have carpal tunnel syndrome or destructive spondyloarthropathy. On-line HDF is generally used in 19 patients, mean blood flow is 215 ml/min (180-260, ±24), and mean dialysis time is 4.2 hours (3.5-5.0, ±0.4). Mean Kt/V is 1.76 (0.97-2.23, ±0.30), urea removal rate is 75.1% (57.8-84.2, ±6.6), β2-microglobulin is 23.8 μg/L (12.9-31.0, ±5.0). Mean DW is 51.0 kg (36.8-67.0, ±9.2), body mass index is 20.3 kg/m2 (16.1-24.4, ±2.5). Mean inter-dialysis weight gain is DW × 3.5% (2.9-4.9, ±0.9), nPCR is 0.9 g/kg/day (0.6-1.3, ±0.2), mean Albumin is 3.7 g/dl (3.2-4.4, ±0.3), whole-PTH is 160.4 pg/mL (0.0-902.7, ±178.8), Hemoglobin is 10.2 g/dL (7.8-13.9, ±1.4), 4 patients don't use ESA products. Conclusion According to the Japanese statistical survey of dialysis patients in 2020, 2.3% of the patients have been on dialysis for more than 30 years, which means that our hospital has a larger rate of long-term dialysis patients. These patients exceed the Japanese average in terms of both nutritional status and dialysis efficiency. The reasons for this may include the fact that our patients were on dialysis for at least 4 hours, and we intended to adhere to very mild dietary restrictions, specifically, the same diet as the family and that we did not recommend a low-protein diet.

#1167 Examination of subsets of CD4+ lymphocyte subpopulations in long-surviving renal transplant patients

Abstract Background and Aims Subpopulations of CD4+ cells, play a major role in mediation of rejection and tolerance to a renal transplant. This study examined subsets of CD4+ T cells and CD4+CD25+CD127lo Treg in blood of renal graft recipients with grafts surviving >10 years for changes in lymphocyte subpopulations that may indicate transplant tolerance and potentially identify patients who could reduce immunosuppression. Based on CD45RA and CD25/Foxp3 expression, Miyara et al identified five populations (Pop) within CD4+ cells. Pop I, II and III are T regulatory cells (Treg); Pop I as naïve (CD45RA+Foxp3+) Treg, Pop II as activated (CD45RA-Foxp3hi) Treg, and Pop III as cytokine secreting (CD45RA-Foxp3+) cells which also includes activated effector cells. Pop IV are activated T cells (CD45RA-Foxp3−), and Pop V are naïve T cells (CD45RA+Foxp3−). Here, we examined three Treg populations (Pop I-III) within CD4+CD25+CD127lo Treg, and Pop IV and V within CD4+ T cells. To further characterise these subpopulations, we examined chemokine receptor expression (CXCR3, CCR4, CCR6, and CCR7) to identify T helper phenotype (Th-like) of Treg populations. Th1-like Treg were identified as CCR4+CXCR3+CCR6−, Th2-like as CCR4+CXCR3-CCR6−, Th17-like as CCR4+CXCR3-CCR6+, and Th1/Th17-like as CCR4+CXCR3+CCR6+. We also examined expression of activated Treg effector molecules CD39, Class II MHC, and PD-1. Method Peripheral blood mononuclear cells (PBMC) were isolated from fresh blood collected from healthy volunteers (HV) (n = 44) and long-term stable renal transplant patients with grafts surviving >10 yrs (RT) (n = 25). Panels of monoclonal antibodies for Treg (CD4/CD25/CD127/CD45RA/Foxp3), chemokine receptors (CXCR3, CCR4, CCR6, CCR7), and Treg activation and suppression-related molecules (CD39/HLA-DR/PD-1) were also used. Data was acquired on BD FACSCanto II using BD FACSDiva software (v8.0) and analysed using FlowJo. Lymphocyte populations were examined after FSC vs SSC gating and doublets exclusion. T cell and Treg populations were analysed within CD4+ and CD4+CD25+CD127lo T cells. Results RT had lower lymphocyte counts than HV (p = 0.0156) but had a similar percentage of CD4+ T cells. Treg were significantly lower in RT compared to HV (p = 0.0012). RT patients had less naïve Treg (Pop I, p = 0.0083) and naïve effector T cells (Pop V, p = 0.0003), but had higher activated effector T cells (Pop IV, p = 0.0002) than HV. There were no differences in activated Treg Pop II or III between the two groups. There were significantly less cells expressing CXCR3 in RT than HV in Pop I (p = 0.0120), Pop II (p < 0.0001), Pop III (p < 0.0001) and Pop IV (p = 0.0047). Similarly, RT had fewer cells expressing CCR6 compared to HV in Pop II (p = 0.0019), Pop III (p = 0.0015), and Pop V (p = 0.0017). RT had lower proportions of CCR7 expressing cells in Pop I (p = 0.0035), Pop IV (p = 0.0097), and Pop V (p = 0.0002), but higher in Pop II (p = 0.0041) compared to HV. There were similar percentages of cells with Th1 and Th17-like phenotypes in both groups. However, RT had significantly more Th2-like Treg in Pop II (p = 0.0033) and Pop III (p = 0.0100), and significantly less Th1/Th17-like Treg in Pop II (p = 0.0005) and Pop III (p = 0.0017) compared to HV. There were little to no differences in the Treg activation and suppression-related molecules within subpopulations of Treg. Conclusion Long-surviving RT patients had less naïve Treg and naïve effector cells, but increased proportions of activated effector cells. There were little to no differences in the expression of Treg activation or suppression-related molecules in Treg subpopulations. Unexpectedly, activated Treg in RT had significantly higher proportions with a Th2 phenotype and significantly less Treg with a Th1/Th17 phenotype. Whether this is a consequence of immunosuppression, or a biological shift associated with tolerance, remains to be resolved. Further studies are required to investigate the relevance of these changes in identifying induction of transplant tolerance.

Quantification of steal flow on Doppler ultrasound in patients with arteriovenous graft for hemodialysis.

Arteriovenous fistula (AVF) is the preferred treatment for long-term hemodialysis patients to allow reliable vascular access. Arteriovenous graft (AVG) is monitored using Doppler sonography to check a vessel's condition and predict complications such as steal syndrome. In this study, we developed an analysis algorithm and method to quantify steal syndrome using Doppler sonography. Doppler sonography was used to determine the pattern of anterograde and retrograde flow. The ratio of blood volumes was calculated with a vision analysis software. First, performance of the developed algorithm was validated by comparing it with commercial Doppler sonography data. Doppler sonography was performed for an artificial vessel to analyze the steal flow. A total of 58 patients with steal flow were enrolled in this study. Of these patients, 23 did not have a difference in fingertip temperature between both sides. The median difference in temperature of 35 patients was 0.8°C (range, 0.3-1.9°C). The ratio of retrograde flow volume/antegrade flow volume in patients with the presence of temperature difference was significantly higher compared to that in patients without the temperature difference (p < .001). The ROC curve for the difference in flow volume had an AUC of 0.770. The optimal cutoff of difference in the flow volume between the two groups was 0.24 (sensitivity of 91.4 % and specificity of 52.2%). The flow volume difference was significantly positively correlated to temperature difference (r = 0.487, p < .003). Our algorithm could measure steal flow volume of a bidirectional waveform by antegrade arterial flow and retrograde reversal flow.

Association of Psoas Muscle Mass at Intensive Care Unit Admission With Physical Function and Post-discharge Destination in Survivors of Critical Illness.

Survivors of critical illness may have physical impairments, known as post-intensive care syndrome (PICS). Early screening for the risk of PICS is recommended to prevent PICS. Skeletal muscle mass is a clinically important indicator associated with various outcomes. This study aimed to examine the association of psoas muscle mass at intensive care unit (ICU) admission with the destination and physical function at hospital discharge. In this single-center retrospective cohort study, we reviewed the medical records of adult patients who had required emergency ICU admission and who had been intubated and mechanically ventilated. Psoas major muscle was measured as an indicator of skeletal muscle mass from abdominal computed tomography images at ICU admission. Physical function was assessed using the functional status score for the ICU and ICU mobility scale at hospital discharge. Multinomial logistic and multivariable linear regression were used to analyze the associations of the psoas muscle mass with the discharge destination and physical function at discharge. We enrolled 124 patients (79 men and 45 women) with a median (interquartile range) age of 72.0 (62.0-80.0) years; 39 (31.5%) were discharged to home, 50 (40.3%) were transferred to rehabilitation wards, and 35 (28.2%) were transferred to long-term care settings.The psoas muscle area and volume were 16.9 (11.3-20.6) cm2 and228.3 (180.2-282.0) cm3in home discharge patients, 17.5 (11.5-21.5) cm2 and248.4 (162.0-311.4) cm3in rehabilitation ward patients, and 15.9 (10.3-19.5) cm2 and184.0 (137.0-251.1) cm3in long-term care patients. The areas and volumes of the psoas muscle were not significantly different in the three groups. Furthermore, psoas muscle mass was not significantly associated with the discharge destination and physical function. Discharge destination and physical function at hospital discharge were not significantly associated with psoas muscle mass at ICU admission.

NON-INVASIVE CENTRAL BLOOD PRESSURE AND INTRACRANIAL WAVEFORM ASSESSMENT IN HYPERTENSIVE PATIENTS

Objective: Hypertension (HT) remains as the leading cause of death around the globe and brain diseases, such as cognitive decline. The association between HT and cerebrovascular diseases is strong, mainly with stroke and cognitive impairment, but the mechanistic bases remain to be established. The objective of this study is to observe central blood pressure, arterial stiffness and intracranial pressure in long-term chronic hypertensive patients. Design and method: Patients above 18 years were assessed from November 2022 to August 2023 with non-invasive central blood pressure and intracranial pressure waveform measurements in a cross-sectional analysis. Peripheral and central blood pressure parameters were obtained using a validated oscillometric device (Mobil-O-Graph). Non-invasive intracranial pressure measurement was performed with the validated Brain4Care (B4C) sensor. Using the B4C non-invasive evaluation, the cut-off point identified to define ICHT by the P2/P1 ratio was &gt; 1.2, and the cut-off for time to peak (TTP) was &gt; 0.25 seconds. To compare P2/P1 and TTP values between the categories of quantitative variables, the chi-square test was used; the Mann Whitney or ANOVA tests were used for bivariate analyses; and for correlations, the Spearman test was used. It was adopted as significant at p &lt; 0,05. Results: Non-invasive central blood pressure, arterial stiffness, and intracranial pressure waveform assessment were performed in 145 patients with essential long-term hypertension over a period of ten months. The median age was 69.0 (61.8 – 75.7) years, 77.9% were female, and the median BMI was 29.0 (25.4 – 33.1) kg/m2. The average time since the hypertension diagnosis was 20.0 years. The median value of P2/P1 ratio for all cohort was 1.4 (1.2 – 1.5) and TTP 0.24 (0.21 – 0.29) seconds. A bivariate analysis was performed considering ICHT or not and the parameters of central BP and PWV assessments, with findings of higher central SBP, central DBP, and peripheral DBP among patients with ICHT by the parameter of P2/P1. Conclusions: Central systolic blood pressure levels are more linked to intracranial hypertension, while diastolic blood pressure values are similar, raising questions about the most suitable blood pressure assessment method for brain disorders.

The effect of letrozole on liver function and some biochemical parameters in rats

Letrozole (LTZ), is an aromatase inhibitor, that has been widely used in a variety of diseases such as polycystic ovary syndrome, endometriosis, and breast cancer. LTZ is received via the oral route and metabolized in the liver. Therefore, LTZ may have toxic effects like other drugs metabolized in the liver. Based on this, our study aimed to investigate the effect of LTZ on liver function and biochemical parameters. For this purpose, 16 Wistar albino female rats were divided into two groups (n=8): Control and LTZ respectively. The rats in the letrozole group were administered with 2 mL/kg LTZ by oral gavage once a day for 21 days. The Control group received the vehicle once a day for 21 days. Blood samples were collected on the 22nd day of the experiment. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), albumin (ALB), alkaline phosphatase (ALP), direct bilirubin and total bilirubin were measured. Biochemical analysis indicated that ALT, AST, LDH, ALP, and total bilirubin levels were significantly higher in the LTZ administrated group compared to the Control. ALB levels decreased in the LTZ group. In conclusion, it was determined that LTZ has toxic and detrimental effects on the liver. We suggested that long-term LTZ administrated patients should be under control against liver damage and may have liver supporting adjuvant therapies for robust liver functions.

Purple Urine Bag Syndrome: Unveiling the Puzzling Discoloration

Abstract Purple urine bag syndrome (PUBS) is a rare entity first described by Barlow and Dickinson in 1978 characterized by purple discoloration of urine in long-term debilitated patients with chronic indwelling urinary catheters. This syndrome is a result of a breakdown of indole into indoxyl sulfate and further metabolic degradation into indigo by the bacteria in the urinary tract resulting in the characteristic purple hue of the urine. We describe the case of a 60-year-old male, bedridden due to traumatic paraplegia, presenting to us with lower abdominal pain and purple discoloration of urine due to Proteus mirabilis.

COVID-19 in Lung Transplant Recipients: A Report on 10 Recent Cases.

Due to immunosuppression, transplant recipients are at higher risk of infections with SARS-CoV-2 and worse clinical outcomes than immunocompetent hosts. Furthermore, lung transplant patients represent a special group among solid organ recipients, since pneumonia is the main manifestation of COVID-19. However, data on the course of disease and the changes in morbidity and mortality during the course of the pandemic are limited. In our pulmonary rehabilitation clinic, we treat patients shortly after lung transplant as well as long-term transplant patients. Over the last almost 4 years of pandemic, we witnessed several COVID-19 infections in lung transplant patients in our clinic as well as patients who acquired an infection beforehand. In this paper, we aim at retrospectively describing a series of recent COVID-19 cases in our clinic, looking at the clinical course of disease and outcomes in lung transplant patients.

BCG Vaccination-Associated Lower HbA1c and Increased CD25 Expression on CD8+ T Cells in Patients with Type 1 Diabetes in Ghana.

BCG vaccination affects other diseases beyond tuberculosis by unknown-potentially immunomodulatory-mechanisms. Recent studies have shown that BCG vaccination administered during overt type 1 diabetes (T1D) improved glycemic control and affected immune and metabolic parameters. Here, we comprehensively characterized Ghanaian T1D patients with or without routine neonatal BCG vaccination to identify vaccine-associated alterations. Ghanaian long-term T1D patients (n = 108) and matched healthy controls (n = 214) were evaluated for disease-related clinical, metabolic, and immunophenotypic parameters and compared based on their neonatal BCG vaccination status. The majority of study participants were BCG-vaccinated at birth and no differences in vaccination rates were detected between the study groups. Notably, glycemic control metrics, i.e., HbA1c and IDAA1c, showed significantly lower levels in BCG-vaccinated as compared to unvaccinated patients. Immunophenotype comparisons identified higher expression of the T cell activation marker CD25 on CD8+ T cells from BCG-vaccinated T1D patients. Correlation analysis identified a negative correlation between HbA1c levels and CD25 expression on CD8+ T cells. In addition, we observed fractional increases in glycolysis metabolites (phosphoenolpyruvate and 2/3-phosphoglycerate) in BCG-vaccinated T1D patients. These results suggest that neonatal BCG vaccination is associated with better glycemic control and increased activation of CD8+ T cells in T1D patients.

Let's get "real" in sickle cell disease: Real-world data and long-term patients' registries.

Let's get "real" in sickle cell disease: Real-world data and long-term patients' registries.

A description of long-stay patients in forensic psychiatric care in Flanders

ABSTRACT Long-term forensic psychiatric care and its population form a specific group within the forensic psychiatric field. The treatment goals, characteristics, and needs of this group are different from those of the wider forensic population. The focus of treatment for this group changes from risk reduction to quality of life and managing risk in the current context. In Belgium, forensic psychiatric care started slowly. This has resulted in a late onset of long-term forensic care. Consequently, there is a potentially large group of long-term forensic patients. The population of the long-stay unit in Flanders, Belgium, is described in this study. Clinical data of forensic long-stay patients were collected. The result was a description of the population in terms of risk profile and sociodemographic data. Compared to other studies, the results show an older population with more sexual offences and mostly a medium/high risk profile. Our findings suggest that the long-stay forensic population has specific challenges that require specific responses in the form of adapted care.

Nutrition status and incidence of malnutrition in home enteral nutrition patients: A cross sectional study

Home enteral nutrition (HEN) is a long-term, life-sustaining nutrition therapy for patients unable to consume sufficient food orally. Patients rely on a prescribed, manufactured product to provide their full nutrient requirements, although some patients may have supplementary oral intake. Prescribed enteral nutrition is used as a treatment for malnutrition, but may, in the long-term, cause poor nutrition status. This study aimed to investigate the nutrition status (energy, protein, vitamin D, and selenium) and malnutrition incidence in long-term HEN patients in the Counties Manukau region. In this cross-sectional study, 42 adults on HEN for 4+ weeks under the care of Te Whatu Ora Health New Zealand were analysed. Participants’ enteral and oral feeding regimes were tracked using patient records and five non-consecutive 24-hour recalls. Biochemical markers, body mass index (BMI), body composition (BIA), and nutrition focussed physical findings were evaluated using reference standards and the Global Leadership Initiative on Malnutrition (GLIM) malnutrition criteria(1). Independent t-tests and Mann-Whitney tests compared participants based on their enteral and supplementary oral intakes and adherence to their enteral prescription. Dependent t-tests and Wilcoxon tests evaluated nutrients contributions from various feeding methods and sources. Over half (54.7%, n = 23) relied exclusively on enteral nutrition, but 60% did not achieve their full energy prescription. Compared to requirements based on the Oxford equation and 1g/kg of body weight, energy and protein intake was low in 20% of all participants, mean intake of these participants was 1,242 ± 183 kcal and 57.5 ± 13.5 g respectively. Participants with full enteral intake had a significantly higher vitamin D intake (14.9 µg, P&lt;0.05) than those with supplementary oral intake (11.2 µg, P&lt;0.05). However, those with oral intake had significantly higher intake of selenium, energy, and all the macronutrients than those with sole enteral intake. Vitamin D and selenium intakes were significantly greater in participants obtaining their full prescription than those that did not. No participants had low vitamin D or selenium blood concentrations, however 40% and 38.1% respectively were high. There was a significant relationship between meeting their energy prescription and high plasma selenium. Low BMI, mid arm muscle circumference, and fat free mass index were observed in 47.5%, 40.5%, and 44.8% of participants respectively. This was not statistically significant between groups. Fat mass and waist circumference were significantly higher in participants on full enteral nutrition. According to the GLIM malnutrition criteria, 62.5% (n = 25) of all participants were malnourished. In conclusion, while HEN patients maintain good vitamin D and selenium status, energy and protein malnutrition are evident. The types of food consumed by those with oral intake may be responsible for the differences in nutritional status. Further attention to prescription adherence and nutritional balance from HEN and oral intake is necessary for this vulnerable group.

Association between healthy lifestyles and post-COVID-19 syndrome among college students.

Post-COVID-19 syndrome still occurs in some populations. A healthy lifestyle is widely recognized as a first-line treatment to increase the body's antiviral resistance and tissue repair, but it is unclear whether a healthy lifestyle can promote or alleviate the symptoms of post-COVID-19 syndrome. A stratified random sampling method was used to select 498 participants from three universities in Fujian as the target of the questionnaire survey. The survey focused on students' healthy lifestyles and the symptoms of fatigue, anxiety, dyspnea, and depression that are common in post-COVID-19 syndrome. Two months after developing COVID-19, some students continued to experience fatigue, anxiety, dyspnea, and depression, with fatigue being the most prominent symptom. The results of the study showed that there was a significant negative correlation (P < 0.01) between a healthy lifestyle and fatigue, anxiety, dyspnea, and depression among university students. Furthermore, when analyzing the different subdimensions of healthy lifestyles among university students, it was found that all dimensions showed varying degrees of negative correlation with fatigue, anxiety, dyspnea, and depression, except for health-related behaviors and interpersonal behaviors, which showed no relationship with fatigue (P < 0.01). By improving healthy lifestyles, long-term COVID-19 symptoms can be reduced and improved and contribute positively to patient recovery, providing a viable rehabilitation option for long-term COVID-19 patients.

Penile prosthesis in priapism: a systematic review of outcomes and complications.

Priapism is a rare condition characterized by persistent erection of the penis that lasts more than 4 hours in the absence of sexual stimulation and is associated with significant morbidity and complications, including erectile dysfunction and penile fibrosis. Surgical management of priapism can be extremely challenging. We herein provide a comprehensive review that aims to evaluate the role of penile prosthesis (PP) implantation in the management of priapism. A systematic literature search was performed using the following databases: PubMed, Embase, and Scopus to identify studies that evaluated the effectiveness of PP implantation in treating priapism and the long-term complications, outcomes, and patients' satisfaction rate. Out of 717 English-language studies published between 2002 and 2022, 17 were chosen for this review. Majority of patients had a malleable PP (MPP) implant, either early or delayed after the priapism episode. Early placement (EP) of PP is widely defined between studies ranging from less than 72 hours, within 1 week, and within 3 weeks. Most common causes of priapism were sickle cell anemia (SCA), medication-induced, and idiopathic. Studies show a higher satisfaction rate ranging between 80% and 100%, with sexual intercourse achievement ranging between 64.2% and 100%. Based on the GRADE system, included studies rated as very low quality of evidence. Commonly reported complications that arise after PP procedures, include device infection, erosion, curvature, and mechanical malfunction, such as auto-inflation. PP can be an effective treatment option for priapism, particularly in cases of ischemic priapism lasting more than 36 hours or recurrent priapism that is medically refractory. However, due to the very low quality of evidence, larger, well-designed studies are warranted where long-term outcomes, patients' satisfaction, and complications following priapism-related PP implantation are measured as endpoints.

Lithium nephropathy in Bipolar Disorder: a clinical challenge

IntroductionLithium nephropathy can occur in long-term lithium-treated bipolar disorder patients. Key risk factors include duration of lithium exposure, cumulative dose, acute intoxication episodes, advanced age, and comorbidities such as hypertension, diabetes mellitus, hyperparathyroidism, and hyperuricemia, along with concurrent use of antipsychotics. The clinical presentation is gradual, with mild proteinuria, often accompanied by arginine vasopressin resistance. Histological studies show a correlation between interstitial fibrosis and cumulative lithium duration. Approximately 15 to 25 per cent of exposed patients may experience a gradual decline in glomerular filtration rate. The outcome after lithium discontinuation varies.ObjectivesThis case study aims to analyze and document the clinical presentation, diagnosis, and management of lithium nephropathy in a patient with Bipolar Disorder.MethodsWe gathered data on the medical history, lab results, and treatment approach for a patient with Bipolar Disorder.ResultsThe patient, a 50-year-old woman, had been under the care of Psychiatry since 2008 due to a diagnosis of Bipolar Disorder Type I. During this time, she had experienced depressive and manic episodes but had not presented significant symptom decompensation for the past 14 years, successfully managed with lithium at a current dose of 600 mg per day. However, on this occasion, the patient sought hospitalization due to recent behavioural disturbances, including restlessness, disinhibition, abrupt changes in behaviour, pressured speech, sleep problems, agitation, and aggression. The patient also reported an increased sense of polyuria and polydipsia. Evaluation in the emergency department revealed elevated lithium levels of 1.47 mmol/L and hypokalemia, that justified lithium withdrawal. After lithium levels decreased, an estimated glomerular filtration rate remained low. She was diagnosed with lithium nephropathy, an adverse effect of long-term lithium therapy. Treatment with lithium changed to sodium valproate. Treatment with asenapine started and sustained for two months. Over the following two years, the patient experienced four additional hospital admissions in Psychiatry due to manic episodes.Conclusions Long-term lithium therapy can lead to lithium nephropathy with symptoms such as polyuria, polydipsia, and acute kidney failure. Consistent monitoring of patients receiving lithium is crucial to detect potential adverse effects.This case highlights the challenges in managing bipolar patients, as discontinuing lithium exacerbated symptoms despite switching to sodium valproate for nephropathy prevention. Long-term lithium treatment, while effective for bipolar disorder, poses significant renal risks. We emphasize continuous renal function monitoring and assessing the risk-benefit of lithium treatment while actively researching lithium nephropathy and its impact on glomerular function.Disclosure of InterestNone Declared

Post-surgery survival and associated factors for cardiac patients in Ethiopia: applications of machine learning, semi-parametric and parametric modelling

IntroductionLiving in poverty, especially in low-income countries, are more affected by cardiovascular disease. Unlike the developed countries, it remains a significant cause of preventable heart disease in the Sub-Saharan region, including Ethiopia. According to the Ethiopian Ministry of Health statement, around 40,000 cardiac patients have been waiting for surgery in Ethiopia since September 2020. There is insufficient information about long-term cardiac patients’ post-survival after cardiac surgery in Ethiopia. Therefore, the main objective of the current study was to determine the long-term post-cardiac surgery patients’ survival status in Ethiopia.MethodsAll patients attended from 2012 to 2023 throughout the country were included in the current study. The total number of participants was 1520 heart disease patients. The data collection procedure was conducted from February 2022- January 2023. Machine learning algorithms were applied. Gompertz regression was used also for the multivariable analysis report.ResultsFrom possible machine learning models, random survival forest were preferred. It emphasizes, the most important variable for clinical prediction was SPO2, Age, time to surgery waiting time, and creatinine value and it accounts, 42.55%, 25.17%,11.82%, and 12.19% respectively. From the Gompertz regression, lower saturated oxygen, higher age, lower ejection fraction, short period of cardiac center stays after surgery, prolonged waiting time to surgery, and creating value were statistically significant predictors of death outcome for post-cardiac surgery patients’ survival in Ethiopia.ConclusionSome of the risk factors for the death of post-cardiac surgery patients are identified in the current investigation. Particular attention should be given to patients with prolonged waiting times and aged patients. Since there were only two fully active cardiac centers in Ethiopia it is far from an adequate number of centers for more than 120 million population, therefore, the study highly recommended to increase the number of cardiac centers that serve as cardiac surgery in Ethiopia.

Role of endothelial hyaluronan in peritoneal membrane transport and disease conditions during peritoneal dialysis

Peritoneal membrane dysfunction in peritoneal dialysis (PD) is primarily attributed to angiogenesis; however, the integrity of vascular endothelial cells can affect peritoneal permeability. Hyaluronan, a component of the endothelial glycocalyx, is reportedly involved in preventing proteinuria in the normal glomerulus. One hypothesis suggests that development of encapsulating peritoneal sclerosis (EPS) is triggered by protein leakage due to vascular endothelial injury. We therefore investigated the effect of hyaluronan in the glycocalyx on peritoneal permeability and disease conditions. After hyaluronidase-mediated degradation of hyaluronan on the endothelial cells of mice, macromolecules, including albumin and β2 microglobulin, leaked into the dialysate. However, peritoneal transport of small solute molecules was not affected. Pathologically, hyaluronan expression was diminished; however, expression of vascular endothelial cadherin and heparan sulfate, a core protein of the glycocalyx, was preserved. Hyaluronan expression on endothelial cells was studied using 254 human peritoneal membrane samples. Hyaluronan expression decreased in patients undergoing long-term PD treatment and EPS patients treated with conventional solutions. Furthermore, the extent of hyaluronan loss correlated with the severity of vasculopathy. Hyaluronan on endothelial cells is involved in the peritoneal transport of macromolecules. Treatment strategies that preserve hyaluronan in the glycocalyx could prevent the leakage of macromolecules and subsequent related complications.

Identification of survival related key genes and long-term survival specific differentially expressed genes related key miRNA network of primary glioblastoma

Primary glioblastoma(pGBM) is the most malignant tumor of the central nervous system. Radiotherapy, chemotherapy and surgical treatment have little effect on the survival of pGBM patients. The prognosis is often poorly once the tumor recurs. It is urgent to develop new therapies for patients. In recent years, studies have been clarified that miRNA have a powerful regulating effect on the genes. However, the main group of miRNAs in regulating long-term survival specific related genes of pGBM is still unclear. Given that the survival period of most glioma patients is relatively short, studying long-term survival patients with pGBM is of great value for this disease. Our study aim to identify key miRNAs with long-term survival related genes present in pGBM and uncover their potential mechanisms. The gene expression profiles of GSE53733, GSE15824, GSE30563, GSE50161 were obtained from the Gene Expression Omnibus database. Firstly, samples were divided into 3 groups according to its survival time and each group compare to the normal control group. Then we obtained differential expression genes (DEGs) with a long-term survival specific (LTSDEGs) and a short-term survival specific DEGs (STSDEGs). Next, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were conducted with LTSDEGs and STSDEGs together. Moreover, we used the UALCAN database to verify LTSDEGs and STSDEGs, and obtained long-term verified survival specific DEGs(LTVSDEGs) and short-term verified survival specific DEGs(STVSDEGs). Finally, we established the predicted key miRNAs-LTVSDEGs interaction network. The protein expressions of the top 4 LTVSDEGs were verified in the HPA database with immunohistochemical staining. In total, we found 260 genes changed in LTSDEGs and 822 genes changed in STSDEGs. GO and KEGG results shown that the major changes are focused on tumor metabolism. 9 LTVSDEGs and 18 STVSDEGs were verified in UALCAN database. As for protein expression verification in top 4 LTVSDEGs, ZNF630, BLVRB and RPA3 were verified, while TPBG was not detected. We obtained 59 key miRNA from the predicted key miRNAs-LTVSDEGs interaction network. 25 key miRNAs were verified using GSE90603. Finally, we constructed the key miRNAs-LTVSDEGs network using a Sankey diagram, including 25 miRNAs and 7 LTVSDEGs. In conclusion, our study shows that there is a close relationship between metabolic changes and survival in pGBM. Besides, we established a key miRNAs-LTVSDEGs network for pGBM, which could be the key path in prolonging the life of pGBM patients.