Urinary Research Articles

Recent advances in the diagnosis of bladder outlet obstruction in men

Background: Bladder outlet obstruction (BOO) represents a common cause of lower urinary tract symptoms in men, frequently resulting from benign prostatic hyperplasia. Key symptoms include both obstructive and irritative urinary tract symptoms, such as dysuria, increased frequency and urgency of urination, and recurrent urinary tract infections. BOO can also cause upper urinary tract dilation (hydronephrosis), damage structure, and impair function of the bladder. Objective: Early diagnosis of BOO is essential to the protection of kidney and bladder functions. The gold standard for diagnosing BOO is urodynamic studies (UDS), which measure detrusor pressure and urinary flow. However, UDS is an invasive test and is associated with risks for urinary tract infections, bothersome urinary symptoms, and hematuria. Given the invasiveness and discomfort associated with UDS, non-invasive diagnostic methods have been developed. Nevertheless, the main limitation of these techniques is the variability in threshold values, highlighting the need for further standardization of measurement protocols. This article reviews the current diagnostic approaches for BOO in men and explores their clinical utility. Conclusion: Various non-invasive diagnostic methods are promising; yet, UDS remains the primary diagnostic approach.

Incidence of Thrombocytopenia With Different Continuous Renal Replacement Systems and Modalities in a Cardiac Intensive Care Unit.

Background: Thrombocytopenia is due to multifactorial causes in critically ill patients. One etiology is continuous renal replacement therapy (CRRT); however, it is unknown if different modalities impact the incidence. Objectives: To compare the incidence of thrombocytopenia with the NxStage CRRT system using continuous venovenous hemodialysis (CVVHD) compared to the Prismaflex system using continuous venovenous hemodiafiltration (CVVHDF). Methods: This was a retrospective cohort study at a large academic medical center in the United States. Individuals aged 18 or older admitted to the cardiovascular ICU between June 1, 2016 and September 30, 2022, and received CRRT for at least 48hours were identified. Results: One hundred and forty-seven patients met inclusion criteria. Sixty-one patients received CVVHD with the NxStage system, while 86 received CVVHDF with the Prismaflex system. Thrombocytopenia occurred in 57.4% of patients treated with NxStage vs 19.8% treated with Prismaflex (OR 5.46; 95% confidence interval [CI], 2.62-11.39). These results were consistent in an adjusted model (OR 5.57; 95% CI, 2.34-13.28). There was no difference in the time to thrombocytopenia between groups. Patients treated with the NxStage system had lower platelet nadirs, more heparin-induced thrombocytopenia testing, more direct thrombin inhibitor use, and more blood transfusions. Conclusions: A greater incidence of thrombocytopenia occurred in cardiovascular ICU patients treated with CVVHD using the NxStage system vs CVVHDF with the Prismaflex system.

Study of Antibiotic Sensitivity of Pseudomonas aeruginosa Isolated from Women with Urinary Tract Infection

Study of Antibiotic Sensitivity of Pseudomonas aeruginosa Isolated from Women with Urinary Tract Infection

Chronic corticosteroid use does not increase short-term complications following carpometacarpal arthroplasty.

Chronic steroid use has been found to be significantly associated with postoperative complications following total joint arthroplasty. The purpose of this study was to investigate the relationship between chronic steroid and immunosuppressant use and postoperative complications following carpometacarpal (CMC) arthroplasty. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all records of patients who underwent carpometacarpal (CMC) arthroplasty between 2015 and 2020. The initial pool of records was divided into two cohorts: chronic steroid and no chronic steroid use. Patient demographics and comorbidities were compared between cohorts using bivariate logistic regression. A total of 6624 records of CMC arthroplasty were identified in NSQIP from 2015 to 2020. Of the 6432 records remaining after exclusion criteria, 223 (3.5%) were chronic steroid use and 6209 (96.5%) were without chronic steroid use. The patient demographics and comorbidities significantly associated with chronic steroid use were ASA classification ≥ 3 (p < 0.001), insulin-dependent diabetes mellitus (p = 0.032), and COPD (p < 0.001). Compared to no chronic steroid use, chronic steroid use had higher rates of any complication (2.24% vs. 2.01%), superficial incisional SSI (1.35% vs. 0.63%), urinary tract infection (0.45% vs. 0.31%), sepsis (0.45% vs. 0.05%), and mortality (0.45% vs. 0.05%). However, these differences in complication rates were not statistically significant. Chronic preoperative steroid use was not significantly associated with any increased postoperative complication within 30days following CMC arthroplasty. Level III; Retrospective Cohort Comparison; Prognosis Study.

Infections in sickle cell disease.

Sickle cell disease (SCD) is one of the commonest severe inherited disorders in the world. Infection accounts for a significant amount of the morbidity and mortality, particularly in sub- Saharan Africa, but is relatively poorly studied and characterized. Patients with SCD have significant immunodeficiency and are more likely to suffer severe and life-threatening complications of infection, and additionally infections can trigger complications of SCD itself. Those with more severe forms of SCD have functional asplenia from a very early age, which accounts for much of the morbidity in young children, particularly invasive infections from encapsulated bacteria including Streptococcus Pneumoniae, Haemophilus Influenzae, Salmonella Typhi and meningococcal disease. Additionally, there are other defects in immune function in SCD, associated with anemia, tissue infarction and impaired adaptive immunity. Complications of infections in SCD include acute chest syndrome (ACS), acute painful episodes, osteomyelitis, meningitis, urinary tract infections, overwhelming sepsis and death. Viral infections cause significant morbidity, particularly severe anemia associated with Parvovirus, and to a lesser extent other infections such as influenza and COVID19. The relationship between malaria and SCD is complicated and discussed in this review. Unlike many of the genetic risk factors for poor outcomes in SCD, it is theoretically possible to modify the risks associated with infections with established public health measures. These include the provision of vaccinations, prophylactic antibiotics and access to clean water and mosquito avoidance, although current financial restraints and political priorities have made this difficult.

Association of Serum Vitamin D Level with Symptomatic Urinary Tract Infection in Pregnant Women

Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Pregnant women in Bangladesh often suffer from UTIs due to a lack of knowledge regarding proper hygiene practices. Adequate vitamin D levels have the potential to enhance the innate immune response, thereby can reduce susceptibility to bacterial infections. Therefore, vitamin D deficiency in pregnant women could increase the risk of urinary tract infections. Aim: To determine the association between maternal serum vitamin D levels and urinary tract infection in pregnancy. Method: This was a case-control study among purposively selected pregnant women attending the inpatient and outpatient department of Obstetrics and Gynaecology, ICMH, Matuail, Dhaka. A total 80 pregnant women between 18-40 years of age were included in this study at their 6-28 weeks of gestation. Among them 40 women who had urinary tract infection, confirmed by presence of ≥105/HPF pus cell in urine routine microscopic examination and a positive urine culture report, were considered as the cases and the rest of the 40 age and gestational age-matched healthy pregnant women without UTI were enrolled as the controls. Aseptically, 5 mL of venous blood was drawn to measure maternal serum vitamin D levels. Statistical analysis was done using the latest version of analytic software SPSS, where required. Results: Among 40 case respondents, Escherichia coli was found to be the most prevalent (60.0%) cause of UTI, with an average maternal serum vitamin D level of 20.5±11.94 ng/ml among those cases. The overall mean (±SD) vitamin D level was much lower among the cases than the controls, 21.1±11.25 ng/mL and 27.9±9.58 ng/ml, respectively. This difference was found statistically significant p=0.004). Considering vitamin D level of 30 ng/mL as the cut-off value, odd’s ratio calculation showed the mother with serum vitamin D level &lt;30 ng/mL had 3.2 times more risk to develop UTI compared to those ...

Modified robot-assisted laparoscopic dismembered pyeloplasty for adult patients with horseshoe kidney: techniques and medium-term outcomes.

The aim of this study was to report our technique and medium-term outcomes of modified robot-assisted laparoscopic dismembered pyeloplasty (RALDP) in the Lithotomy Trendelenburg position for treating adult ureteropelvic junction obstruction (UPJO) with horseshoe kidney (HSK). Between March 2021 and March 2023, 11 adult patients with UPJO and HSK underwent modified RALDP in the lithotomy Trendelenburg position. Patient demographic characteristics, perioperative parameters, and follow-up outcomes were collected prospectively and analyzed. A detailed description of the technique and medium-term outcomes were reported. The median (range) age was 33 (23-50) years. The mean preoperative serum creatinine and preoperative estimated glomerular filtration rate (eGFR) were 74.72±16.20 μmol/L and 100.4±16.5 mL/min/1.73 m2, respectively. One patient (9.1%) required an additional right pyelolithotomy. The mean operative duration was 208±70 min. The median (range) estimated blood loss was 20 (20-100) mL. The median (range) drainage-tube removal time was 3 (2-4) days postoperatively. The median (range) postoperative hospitalization period was 5 (3-6) days. No open conversions or intraoperative complications occurred. Postoperative urinary tract infections (Clavien-Dindo grade II) occurred in two patients, managed with oral antibiotics. The median (range) follow-up of 25 (12-36) months achieved an overall success rate of 100%. The mean postoperative serum creatinine and postoperative eGFR were 74.96±17.43 μmol/L and 98.14±18.39 mL/min/1.73 m2, respectively. Our medium-term outcomes indicate that the modified RALDP in the Lithotomy Trendelenburg position was safe and feasible for adult HSK patients. Further prospective studies of larger sample sizes and randomized controlled trials are warranted.

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.

Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days. Antibiotic selection, dosing, and route were at the discretion of the treating team. We excluded patients with severe immunosuppression, foci requiring prolonged treatment, single cultures with possible contaminants, or cultures yielding Staphylococcus aureus. The primary outcome was death from any cause by 90 days after diagnosis of the bloodstream infection, with a noninferiority margin of 4 percentage points. Across 74 hospitals in seven countries, 3608 patients underwent randomization and were included in the intention-to-treat analysis; 1814 patients were assigned to 7 days of antibiotic treatment, and 1794 to 14 days. At enrollment, 55.0% of patients were in the ICU and 45.0% were on hospital wards. Infections were acquired in the community (75.4%), hospital wards (13.4%) and ICUs (11.2%). Bacteremia most commonly originated from the urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%). By 90 days, 261 patients (14.5%) receiving antibiotics for 7 days had died and 286 patients (16.1%) receiving antibiotics for 14 days had died (difference, -1.6 percentage points [95.7% confidence interval {CI}, -4.0 to 0.8]), which showed the noninferiority of the shorter treatment duration. Patients were treated for longer than the assigned duration in 23.1% of the patients in the 7-day group and in 10.7% of the patients in the 14-day group. A per-protocol analysis also showed noninferiority (difference, -2.0 percentage points [95% CI, -4.5 to 0.6]). These findings were generally consistent across secondary clinical outcomes and across prespecified subgroups defined according to patient, pathogen, and syndrome characteristics. Among hospitalized patients with bloodstream infection, antibiotic treatment for 7 days was noninferior to treatment for 14 days. (Funded by the Canadian Institutes of Health Research and others; BALANCE ClinicalTrials.gov number, NCT03005145.).

Spineless cactus (Nopalea cochenillifera (L.)) as an exclusive or partial source of water for goats: histomorphological changes in the digestive, hepatic and renal systems

Spineless cactus (<i>Nopalea cochenillifera (L.)</i>) as an exclusive or partial source of water for goats: histomorphological changes in the digestive, hepatic and renal systems

Renal Collecting System Calcified Hematoma Following Parenchymal Perforation by Ureteral Stent in Kidney Transplantation: A Case Report

Introduction: Renal parenchymal perforation by ureteral stent placement is a rare but serious complication. There is also a paucity of data regarding collecting system hematomas and potential calcification in renal allografts. Case presentation: We report a unique case of a 51-year-old male who underwent unrelated living-donor kidney transplantation with stent incorporation during ureteroneocystostomy. Post-operatively he was found to have renal parenchymal perforation by the ureteral stent resulting in a pelvicalyceal hematoma with subsequent calcification and obstruction. At the time of guidewire introduction for percutaneous nephrolithotomy one year later, a nephrostogram and passage of a hydrophilic guidewire resulted in improved contrast drainage into the bladder, so the invasive surgery was no longer needed. Discussion: There are few reported cases of renal parenchymal perforation by a ureteral stent, none of which resulted in a collecting system hematoma. The calcification of urinary tract hematomas is also rare and attributed to metabolic abnormalities, prolonged stagnation of blood, and infection. Conclusions: We suspect the nephrostogram and guidewire introduction created enough antegrade pressure and mechanical disruption to force the calcified hematoma into the bladder.

Efficacy and intrarenal pressure analysis of flexible and navigable suction ureteral access sheaths with flexible ureteroscopy in modified surgical positions for 2-6 cm upper urinary tract stones: a multicenter retrospective study.

This multicenter retrospective study aimed to assess the efficacy, intrarenal pressure (IRP), and complications of retrograde intrarenal surgery (RIRS) using a flexible and navigable suction ureteral access sheaths (FANS-UAS) in the reverse Trendelenburg lithotomy position (RTLP) for treating kidney and upper ureteral stones measuring 2-6 cm. Conducted at six medical centers in Fujian Province from 2022 to 2024, the study included 231 patients with a median stone size of 26 mm. The immediate stone-free rate (ISFR) was 90.48%, while the SFR at postoperative day 30 was 95.67%. Only two patients developed postoperative fever, two patients had ureteral laceration and most experienced mild pain. Although surgical time increased with stone size, factors such as sex, infundibulopelvic angle (IPA), and stone density had little effect on duration, and there was no significant difference between ISFR and 30-day SFR. Importantly, all IRP measurements remained within normal limits. These findings suggest that RIRS with FANS-UAS in RTLP is a safe and effective approach for managing upper urinary tract stones of 2-6 cm, especially in 2-4 cm stones.

Clinical and microbiological profile of patients with urinary tract infection visiting general outpatient department, National Referral Hospital

Background: Urinary Tract Infection (UTI) is one of the most common infections encountered in outpatient settings. The random use of antibiotics, particularly in resource-limited settings, has contributed to the emergence of antibiotic resistance. This study aimed to identify common uropathogens and assess their antibiotic sensitivity patterns among patients with symptoms of UTI attending the General Outpatient Department (GOPD) at Jigme Dorji Wangchuck National Referral Hospital in Thimphu. Method: A cross-sectional study was conducted from September 2021 to August 2022, involving patients over the age of 13 years with symptoms of UTI. Midstream urine collected via proper technique was analyzed by the laboratory. Once there was growth on the urine culture media, antibiotic sensitivity testing was performed against the commonly used antibiotics in the GOPD. Result: Amongst 351 participants, 77.8% were female, and the most common symptoms reported were dysuria (93.4%) and increased urinary frequency of micturition (92.3%). Patient’s age, sex and previous episodes of UTI were significantly associated with the occurrence of UTI (p &lt; 0.05). The overall urine culture positivity rate was 50.53%, with Escherichia coli (84.7%) identified as the predominant uropathogen, followed by Klebsiella pneumoniae (7.3%). Among the antibiotics tested, gentamicin and nitrofurantoin exhibited the highest sensitivity, while amoxicillin and ampicillin were the least effective antibiotics against Escherichia coli. Conclusion: UTI predominantly affected females. Escherichia coli was the commonest causative agent and nitrofurantoin could be the potential drug of choice for UTI treatment. The irrational use of antibiotics, as a contributing factor to resistance should be addressed.

The relationship between neuropathic pain and lower urinary tract symptom scores in patients with primary Sjögren's syndrome.

To evaluate the effect of neuropathic pain on lower urinary tract symptoms (LUTS) scores in patients with primary Sjögren's syndrome (pSS). Seventy-two patients diagnosed with pSS were included in the study. The patients with pSS were divided into two groups according to the presence/absence of neuropathic pain. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire was recorded assess neuropathic pain. LUTS was evaluated using the International Prostate Symptom Score (IPSS), International Incontinence Consultation Questionnaire Short Form (ICIQ-SF) and Overactive Bladder Questionnaire (OAB-V8). The mean age of the patients was 52.4 ± 11.2 years. Neuropathic pain was recorded in 21 (29.2%) patients. Among the patients, the number of patients with mild symptoms was recorded as 41 (56.9%), moderate symptoms in 25 (34.7%), and severe symptoms in 6 (8.3%) according to IPSS. IPSS and IPSS voiding subscores were statistically significantly higher in patients with neuropathic pain than non-neuropathic pain group (p = 0.035; p = 0.001, respectively). Although ICIQ-SF, OAB-V8 and IPSS storage subscores were found to be higher in patients with neuropathic pain group, there was no statistically significant difference between the groups (p = 0.299; p = 0.283; p = 0.237, respectively). Neuropathic pain concomitant with PSS patients may negatively affect bladder voiding functions.

Outcomes and costs of home hospitalisation compared to traditional hospitalisation for infectious diseases in Israel: a cohort study

ObjectivesThis study aims to evaluate and compare health outcomes and costs between home hospitalisation and traditional hospitalisation for three common diagnoses—cellulitis, urinary tract infection (UTI) and pneumonia.DesignA retrospective cohort study.SettingPrimary...

Prevalence of bacteriuria and bacterial resistance in adolescents from the center of the state of Tlaxcala, Mexico.

Urinary tract infections and bacteriuria are common in the pediatric population, and antibiotic resistance is increasing significantly. Recurrent urinary infections, symptomatic or asymptomatic, are a risk factor for developing chronic kidney disease in adolescents and young adults. This study aimed to assess the prevalence of bacteriuria diagnosed by culture to identify the main causal agents and sensitivity to antibiotics in adolescents from the central region of the state of Tlaxcala. A cross-sectional study was carried out among 905 adolescents from 11 to 18 years old who lived in the central region of the state of Tlaxcala, Mexico. Bacteriuria was evaluated by positive nitrites and leukocyte esterase, and urine culture with antibiogram. Multivariate logistic regression models were executed to evaluate the risk of presenting bacteriuria, with a confidence level of 95%. A total of 31 participants had a positive urine culture, with a bacteriuria prevalence of 3.4%, of which 29 cases were asymptomatic. The most frequent agent was Escherichia coli) in both sexes (28.6% in men and 29.7% in women) and regarding bacterial resistance: E. coli presented greater resistance to ampicillin, trimethoprim/sulfametoxazol and ceftriaxone. The risk factors associated with bacteriuria were female sex, sexual activity, use of contraceptives, and greater consumption of sweetened beverages. Bacteriuria is common in this adolescent population, so its early identification is necessary to treat it, and to prevent its complications.

Effect of a Hydration Game-Based Learning Program in Improving Fluid Intake and Hydration Status in Institutional Residents.

Approximately 50% of residents living in institutions have insufficient fluid intake, and 20%-30% experience dehydration. Implementing strategies that effectively increase fluid intake is crucial to preventing dehydration-related complications and reducing complications and comorbidities in this population. This study was designed to explore the effects on fluid intake and hydration status of a hydration game-based learning program in institutional residents. A single-blind, cluster, randomized controlled trial was conducted. Sixty-four subjects from five long-term care facilities in northern Taiwan were randomly assigned to either an experimental or control group. The experimental group received a 40-minute game-based hydration care program intervention twice weekly for 8 weeks. The control group received routine care. The data obtained were analyzed using generalized estimating equation analysis to verify changes in observed variables in the two groups at 4 and 8 weeks (during and immediately after the intervention). The results showed a significant improvement in fluid intake in the experimental group at 4 and 8 weeks (p = .002 and p < .001, respectively). In terms of dehydration-related indicators, although total body water was significantly improved at 8 weeks in the experimental group (p = .009), no significant improvement was found in urine-specific gravity. In terms of signs of possible urinary tract infection, the experimental group showed significant improvement in urine leukocytes (p = .029) and nitrites (p = .004) at 8 weeks. The findings of this study support the positive effects of applying the concept of uncertain rewards and game-based learning in institutional group activities. Specifically, the interventions increased social interaction and enhanced enjoyment of drinking. The findings call for nursing professionals at institutions to offer similar hydration game-based learning programs as part of residents' daily activities to improve fluid intake.

Sickle Cell Disease and Sickle Cell Trait on Curaçao: Pregnancy‐Related Outcomes and Complications: A Retrospective Cohort Study From a Single Centre

ABSTRACTObjectivesTo describe the pregnancy‐related outcomes and complications as well as neonatal outcomes among patients with sickle cell disease (SCD) and sickle cell trat (SCT) on Curaçao over the past half decade.MethodsA retrospective cohort study was conducted. Patients with SCD and SCT were included who gave birth from 1 December 2016 to 9 November 2019 in St. Elisabeth Hospital and from 10 November 2019 to 1 November 2023 in Curaçao Medical Center, Curaçao. Various data regarding participant characteristics, pregnancy‐related outcomes and complications and neonatal data were gathered and analysed. Descriptive statistics were utilized and p values calculated.ResultsThe most common pregnancy‐related complications in patients with SCD were pre‐eclampsia (4; 23.5%), vaso‐occlusive crisis (10; 58.8%), anaemia (15; 88.2%) and urinary tract infection (6; 35.3%). Intrauterine growth restriction was recorded in four (22.2%) pregnancies, five (29.4%) patients delivered preterm and eight (44.4%) neonates had a birth weight below 2500 g. The need for blood transfusion was significantly higher in patients with HbSS compared to patients with HbSC (88.9% HbSS vs. 12.5% HbSC, p = 0.002) and significantly more neonates from patients with HbSS were admitted to the neonatal intensive care unit (66.7% HbSS vs. 11.1% HbSC, p = 0.016). Regarding SCT, anaemia occurred in 78 (25.2%) patients and 73 (23.5%) times the amniotic fluid was stained with meconium.ConclusionThe data of this study support the results of previous studies, displaying a high rate of maternal and neonatal complications and adverse outcomes during pregnancy in patients with SCD. Close observation and a multidisciplinary approach are essential. SCT does not appear to be associated with adverse effects on maternal or foetal outcomes and complications, except for a high rate of meconium‐stained amniotic fluid.

Operative complications of open and minimally invasive adnexal surgery compared with cases with hysterectomy: A narrative review.

The decision to add hysterectomy to planned adnexectomy is often nuanced and likely increases the complexity of the planned procedure; however, these risks are not well characterized in practice. We conducted a comprehensive search in the PubMed database for English-language articles from 1997 to 2022, identifying studies reporting complication rates for open and minimally invasive surgery (MIS) hysterectomy and adnexal surgeries. We calculated medians and first and third quartiles for each complication and used a Mann-Whitney U test to calculate differences between complications for minimally invasive hysterectomy and adnexal case data. We identified 135 appropriate studies for inclusion. There were higher prevalences of blood loss requiring transfusion (1.70% versus 0.13%, P = 0.01) and urinary tract injury (0.80% versus 0.20%, P = 0.001) in MIS hysterectomy cases compared with MIS adnexal surgery, respectively. MIS hysterectomy cases were similar to MIS adnexal surgery cases in the risk of surgical site infection (1.20% versus 1.49%, P = 0.74), bowel injury (0.50% versus 0.35%, P = 0.45), vascular injury (0.20% versus 0.9%, P = 0.82), and conversion to laparotomy (1.95% versus 3.84%, P = 0.49). There were not enough data on open adnexal surgery complications to make a meaningful comparison between complications of open hysterectomy and adnexal-only cases. Patients should be counseled that the addition of hysterectomy to planned MIS adnexal surgery likely increases the risk of blood loss requiring transfusion and urinary tract injury. The increased comorbidity associated with adding hysterectomy to planned open adnexal removal is less clear.

Evolving Clinical Features of Diabetic Ketoacidosis: The Impact of SGLT2 Inhibitors.

Background/Objectives: The antidiabetic effect of SGLT2 inhibitors (SGLT2-is) is based on their ability to increase glucose excretion through urine by inhibiting the kidney-resident SGLT2 protein. Euglycemic diabetic ketoacidosis (EuDKA) is an uncommon but potentially life-threatening adverse effect of these medications, which are notable for their antidiabetic, cardiovascular, and renal protective properties. This study aimed to clarify the impact of SGLT2-is on demographic, clinical, and biochemical characteristics in patients with DKA. Methods: A total of 51 individuals with a diagnosis of DKA were included in the trial; 19 of these patients were treated with SGLT2-is, while 32 were not. Patients diagnosed with DKA and treated with SGLT2-is were compared to those not treated with the medication in terms of clinical, biochemical, and laboratory characteristics. Results: The age of patients utilizing SGLT2-is was statistically considerably greater than that of non-users (p < 0.001). EuDKA was exclusively noted in the SGLT2-is cohort (p = 0.005). Urinary tract infections, vulvovaginitis, and genitourinary infections were substantially more prevalent among SGLT2-i users compared with non-users among both women and the overall patient group (p = 0.036, p = 0.001, p = 0.005, p = 0.003, respectively). Plasma glucose concentrations were significantly higher in SGLT2-i non-users (p = 0.006). Chloride (Cl-) concentrations were elevated among SGLT2-i users (p = 0.036). Conclusions: The study findings indicate that SGLT2 inhibitors may substantially influence age, serum chloride, EuDKA, and the occurrence of genitourinary infections in individuals with DKA.

Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children.

The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs). We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition. A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively. Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ∼20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.