Urinary Research Articles

The Incidence of Bacterial Urinary Tract Infections and Associated Risk FactorsamongPatientsofControlledandUncontrolledDiabetesMellitusin Sana'a City- Yemen

Thehighprevalenceof UTIs amongDM patients, whichattributetovarious impairmentsintheimmunesystem (lowurinaryconcentrationof interleukin -8andinterleukin -6,lowerurinaryleucocytecellcount). Inaddition, poormetaboliccontrolandincompletebladderemptyingdueto autonomicneuropathymayall contributetotheenhancedriskof UTIsinthesepatientsDM isassociatedwithUTIs throughitseffectonthehostimmunesystem .Therefore detect the incidence of bacterial UTIs in controlled and uncontrolled DM patients in Sana'a City- Yemen, Determine the suitable antibioticssusceptibilityagainstbacterial UTIsin controlledanduncontrolledDMpatients, ExploretherelationshipbetweenbacterialUTIs and the main risk factorsin controlledanduncontrolledDMpatients. In this cross- sectional study , urine sample were collected from 225 participants fromProf. Mohammed Bamashmous Internal Medicine,Republication Authorized Teaching, Al-Olaqi Specialized Laboratories and Baghdad Laboratories The sample was processed by physical, chemical and microscopic examination andcultured in CLED agar, Maconky agar and blood agar, afterincubation the sample in 370C aerobicallywas proceed by Gram stain and biochemical test . Amongthe225 analyzed samples, 49 (21.8%) were showing sterile urine samples, while 9 (4.0%) showed mixed growth of bacteria possibly due to improper collection of the sample.The remaining 122 (54.2%) samples were positive(significant)with colony count 105CFU|ml, 34 (15.1%)ware positive(suspected) with colony count 103-104 CFU\ml , 11(4.9%)ware non-significant withcolonycount-less than102for The number of subjects withUTI was clearlyhigher intheuncontrolled glycemic group (𝑛 =158, 89.8%) incomparisontothecontrolledglycemic group (𝑛 =18, 10.2%).Ourresults showedthatT2DM was moreprevalent (145,78.7%)thanT1DM (39,17.3%)and GDM (9,4%) in uncontrolled DM than controlled DM .The women’s show high spread of UTIs than men especially in uncontrolled DM than controlled DMthis was significant < 0.05 .The prevalence and the distribution of Gram- negative more than Gram-positive bacteria isolated from the clinical samples for both controlled and uncontrolled glycemia groups. E.coli (77,49.4%) was the dominant and significant in UTIs <0.01 The high prevalence of UTI confirms that uncontrolled DM is significantly associated with more UTIand regulation of glucose helped to reducing the complications and urinary tract infection. Diabetic patients especially uncontrolled women, are recommended to subuit mid-streamurinespecimens at regular intervals for cultureand routine investigations even the absence of any urinary tract symptoms

Post-COVID-19 neurogenic lower urinary tract dysfunction in pediatrics: A case series of clinical manifestations resembling Elsberg syndrome

Background: Among the numerous complications associated with post-coronavirus disease 2019 (COVID-19) syndrome, neurogenic lower urinary tract dysfunction (NLUTD) has been rarely reported, particularly in the pediatric population. Case Presentation: This report presented three pediatric cases of NLUTD that developed following severe acute respiratory syndrome coronavirus 2 infection, with clinical features resembling Elsberg syndrome. These cases were notable for the severity of their urinary symptoms, which required specialized and individualized bladder management strategies. This case series aims to raise awareness of this emerging clinical condition, which may be underdiagnosed in children recovering from COVID-19. Pediatricians, general practitioners, and urologists should be vigilant in considering NLUTD as a potential diagnosis in children presenting with new or unexplained urinary symptoms. Early diagnosis and timely management are crucial to address these symptoms effectively and prevent potential complications, such as irreversible upper urinary tract damage or long-term bladder dysfunction. Conclusion: Further investigations are warranted to clarify the pathophysiological mechanisms underlying post-COVID-19 NLUTD. Moreover, long-term follow-up studies are needed to better understand the natural history and implications of this condition in the pediatric population, as well as to develop effective strategies for prevention and treatment.

Elimination of Large Bladder Stone-Obstructing Pelvic Canal in African Spurred Tortoise (Centrochelys sulcata) with Per-Cloacal Bladder Stone Removal Method without Utilizing an Endoscope

Bladder stone formation in reptiles arises from the accumulation and subsequent solidification of uric acid in the urinary bladder. The bladder stones vary in size and can migrate from the bladder to the pelvic canal. In cases where larger bladder stones enter the pelvic canal, they pose a risk of obstructing the digestive and urinary tracts of the tortoise. This study discusses managing bladder stone elimination in sulcata tortoises (Centrochelys sulcata) located in the pelvic canal without utilizing an endoscope. In 2023, four sulcata tortoises were presented at the Teaching Veterinary Hospital Universitas Brawijaya with diagnoses of large bladder stone-blocking pelvic canals that had been causing digestive and urinary tract obstruction. All of the tortoises have similar clinical signs, such as lethargy, anorexia, inability to defecate, and anuria. Physical examinations and radiography revealed the presence of bladder stones in the pelvic canal, exceeding the dimensions of the pelvic outlet and hindering passage through the cloaca. Treatment involved per-cloacal bladder stone removal. This procedure begins by anesthetizing the sulcata tortoise using ketamine and medetomidine combination, followed by fragmentation and extraction of the bladder stones from the pelvic canal through the cloaca. All procedures were performed without utilizing an endoscope. The success of the treatment was evidenced by radiographic examination, confirming the absence of bladder stones in the pelvic canal, and the recovery of normal defecation, urination, appetite, and activity levels.

AN INTEGRATIVE APPROACH TO MANAGEMENT OF REACTIVE ARTHRITIS WITH RESPECT TO VATARAKTA - A CASE REPORT

"Reactive arthritis” manifests as a sudden, non-infectious inflammatory joint condition triggered by a preceding infection that originates elsewhere in the body. This condition frequently implicates pathogens associated with the genitourinary and gastrointestinal systems, including Chlamydia, Salmonella, Shigella, Campylobacter, and Yersinia, particularly affecting individuals susceptible to such triggers. Recognition of this association may be complicated by the non-specific presentation of diarrhoea, the interval between gastrointestinal and arthritic symptoms, and the wide differential in mono- and oligo-arthritis. An ayurvedic approach to such cases can be correlated with diseases such as vatarakta or Amavata. A 46-year-old female patient recently treated for gastrointestinal infection developed sudden, non-traumatic, bilateral knee pain and swelling. She was diagnosed with vatarakta and treated with Panchakarma procedures like Snehana, Swedana and Ksheera basti along with Shaman aushadi’s (oral medications) and Physiotherapy. The treatment outcome is summarised in terms of a reduction in the signs and symptoms of reactive arthritis concerning vatarakta, along with an improvement in the quality of life.

Antibiogram Profile of Patients Having Urinary Tract Infection Treated with Most Commonly Used Antibiotics

Background: Urinary tract infections (UTIs) are the most common infections in humans, primarily caused by bacteria, with Escherichia coli (E. coli) responsible for 75-90% of cases. The rise in bacterial resistance is largely due to inappropriate antibiotic use, posing significant public health concerns. This study investigated UTI prevalence and antibiotic resistance to inform optimized treatment guidelines. This study aimed to identify the bacterial pathogens causing UTIs and assess their antimicrobial sensitivity and resistance to commonly used antibiotics. Method: A descriptive cross-sectional study was conducted over six months at Khyber Teaching Hospital's Microbiology Department to assess the antibiogram profile of uropathogens from urine cultures. Urine samples were cultured on CLED media, and biochemical tests were used to identify the uropathogens. Antimicrobial susceptibility testing was performed on the isolates using the Kirby-Bauer disk diffusion method on Mueller Hinton Agar (MHA), following CLSI guidelines. A total of 384 patients' urine samples were collected through a convenient technique and processed as per standard guidelines. The collected data was analyzed using SPSS-22 and shown in tables. Results: Escherichia coli was the most common uropathogen, found in 48.17% (n=185) of cases, with a higher prevalence in females at about 48.4% (n=125). Fosfomycin was the most frequently prescribed antibiotic (31.5%) and showed the highest sensitivity (50.2%). Cefotaxime exhibited the highest resistance (38.45%), followed by Amoxicillin-clavulanic acid (34.8%). Conclusion: Escherichia coli remains the dominant pathogen, with Fosfomycin proving generally effective, while resistance to cefotaxime is notable. These reports show the importance of antibiotic use responsibly. By selecting appropriate antibiotics, we can minimize the resistance rate of uropathogens.

TREATMENT OF VATASHTHILA (BENIGN PROSTATIC HYPERPLASIA) THROUGH AYURVEDIC MEDICINES- A CASE REPORT

Background: A prevalent issue affecting older men is Benign Prostatic Hyperplasia. Even though prostatectomy is the most effective course of action, conservative management is always favoured. Ayurvedic medicines can help such folks live better lives and relieve their symptoms. In Ayurvedic Samhitas, urinary disorders are mentioned as Mutraghata (Suppression or obstruction of urinary flow). The words Mutra (which refers to urine) and Aghata (which denotes obstruction of the urinary passage) are combined to form the term Mutraghata. Vatashthila is one of the types of Mutraghata. The symptoms of BPH are similar to those of Vatashthila caused by an imbalance of Vata Dosha. In this case study, we demonstrate how Ayurvedic medicines reduced the size of the prostate and the International Prostatic Symptoms Score. Main Clinical Findings: A 65-year-old patient reached the hospital with a complaint of intermittent pain in the suprapubic region and frequent micturition. He disclosed further lower urinary tract symptoms (LUTS), including urgency, dysuria, and nocturia (more than four urinations in the night). Conclusion: BPH is an age-linked disease. Even though surgery is the most effective form of treatment, using Ayurvedic medicines may help to lessen the symptoms and improve overall quality of life. After taking Ayurvedic treatment, the patient was relieved from symptoms, and the prostate became normal in size.

Technological innovation of HoLEP: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

The purpose of this study was to investigate the efficacy of Transurethral Holmium Laser of the Prostate (HoLEP) with Double-n Technology in the treatment of benign prostatic hyperplasia (BPH), with a focus on preserving sexual function postoperatively. Conducted as a multicenter, prospective, single-blind randomized controlled trial, this study enrolled sexually active male patients with BPH. Participants were randomized into three groups: standard HoLEP (Group A), single-n technology (Group B), and innovative double-n technology (Group C), which emphasizes the preservation of the urethral mucosa and nearby structures. The primary endpoints included maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF). Of the 180 initial participants, 139 completed the study. All groups showed significant improvements in Qmax and IPSS. Initial declines in IIEF scores were noted across all groups, stabilizing to baseline by 3 months without further improvement. Group A had modest antegrade ejaculation rates, starting at 15.4% at 3 months and reaching 23.1% at 12 months. Group B showed a significant improvement, with AE rates rising from 31.8% at 3 months to 45.5% at 12 months, significantly higher than Group A (p < 0.05). Group C had the highest AE rates, starting at 57.8% at 3 months and reaching 77.8% at 12 months, significantly surpassing both Group A and B (p < 0.05). Regarding semen reduction, Group A had 100% reduction at 3 months, which decreased to 77.8% at 12 months. Group B followed a similar trend, from 100% at 3 months to 68.2% at 12 months. Group C showed a more pronounced decline, starting at 84.6% at 3 months and dropping to 37.1% at 12 months, with values significantly lower than both Groups A and B (p < 0.05). The double-n HoLEP technique shows promising results in improving urinary symptoms while better preserving ejaculatory function and sexual quality of life in BPH patients. This technique could offer a significant advancement in the surgical management of BPH, particularly for sexually active patients.

Predictive models and determinants of mortality among T2DM patients in a tertiary hospital in Ghana, how do machine learning techniques perform?

BackgroundThe increasing prevalence of type 2 diabetes mellitus (T2DM) in lower and middle – income countries call for preventive public health interventions. Studies from Africa including those from Ghana, consistently reveal high T2DM-related mortality rates. While previous research in the Ho municipality has primarily examined risk factors, comorbidity, and quality of life of T2DM patients, this study specifically investigated mortality predictors among these patients.MethodThe study was retrospective involving medical records of T2DM patients. Data extracted included mortality outcome (dead or alive), sociodemographic characteristics (age, sex, marital status, educational level, occupation and location), family history of diseases (diabetes, cardiovascular disease (CVD), or asthma), lifestyle (smoking and alcohol intake), comorbidities (such as skin infections, sickle cell disease, urinary tract infections, and pneumonia) and complications of diabetes (CVD, nephropathy, neuropathy, foot ulcers, and diabetic ketoacidosis) were analyzed using Stata version 16.0 and Python 3.6.1 programming language. Both descriptive and inferential statistics were done to describe and build predictive models respectively. The performance of machine learning (ML) techniques such as support vector machine (SVM), decision tree, k nearest neighbor (kNN), eXtreme Gradient Boosting (XGBoost) and logistic regression were evaluated using the best-fitting predictive model for T2DM mortality.ResultsOf the 328 participants, 183 (55.79%) were female, and the percentage of mortality was 11.28%. A 100% mortality was recorded among the T2DM patients with sepsis (p-value = 0.012). T2DM in-patients were 3.83 times as likely to die [AOR = 3.83; 95% CI: (1.53–9.61)] if they had nephropathy compared to T2DM in-patients without nephropathy (p-value = 0.004). The full model which included sociodemographic characteristics, family history, lifestyle variables and complications of T2DM had the best prediction of T2DM mortality outcome (ROC = 72.97%). The accuracy for (test and train datasets) were as follows: (90% and 90%), (100% and 100%), (90% and 90%), (90% and 88%) and (88% and 90%) respectively for the various ML classification techniques: logistic regression, Decision tree classifier, kNN classifier, SVM and XGBoost.ConclusionThis study found that all in-patients with sepsis died. Nephropathy was the identified significant predictor of T2DM mortality. Decision tree classifier provided the best classifying potential.

Diagnostic evaluation and management of recurrent urinary tract infections in the spinal cord injury population - a retrospective evaluation at a tertiary care center.

Retrospective review. While most individuals with spinal cord injury (SCI) are expected to have 1-2 urinary tract infections (UTIs) per year, there is a subset with higher incidence. We evaluate our practice to characterize common causes of recurrent UTIs, hypothesizing that more frequent infections typically have addressable risk factors. Tertiary urology clinic, San Jose, CA. We reviewed patients with SCI referred to a tertiary urology clinic for evaluation and management of "recurrent UTIs" during the years 2015-2020. Following workup, the suspected cause of recurrent UTIs and number of post-specialty evaluation UTIs (patient reported) were noted. Forty persons with SCI with a mean of 4.8 UTI treatments in the prior year comprised our cohort with most performing CIC (80%). After workup, 37/40 (92.5%) had a likely cause for their reported recurrent UTIs. In 16/40 (40%), careful questioning determined that the patient was not having UTIs based on guideline definitions. In those with confirmed recurrent UTIs, a bladder diary (62.5%) or urodynamic study (64%) was more likely to identify a cause compared to imaging (2.6%) or cystoscopy (8%). With a minimum 1-year follow-up, 90% of our population had a 50% or more reduction in UTI incidence, mostly using non-antibiotic strategies. In a referral SCI population with a chief complaint of "recurrent UTIs", over a third were not having UTIs. In addition to detailed history, a bladder diary +/- urodynamics are most useful in finding the cause and improving UTI.

Probiotics in Mitigating Adverse Effects of Intestinal Resection and Chemotherapy: A Meta-analysis

Introduction: Colorectal cancer (CRC) imposes a significant burden on global healthcare systems, particularly in Europe, where it ranks among the most diagnosed cancers and leading causes of cancer-related deaths. With an estimated 50,000 deaths attributed to CRC in 2023 alone, a pressing need for innovative approaches to prevention, early detection, and treatment is evident. While chemotherapy and surgical resection remain crucial therapeutic strategies, they often entail significant adverse effects, such as chemotherapy-induced diarrhea and post-surgical complications. Methods: Recent research underscores the role of the microbiota in modulating these side effects, with dysbiosis associated with increased risks. Probiotics, known for their ability to restore microbial balance, have emerged as a promising adjunctive therapy for mitigating treatment-related complications in CRC patients. However, the efficacy of probiotics remains debated, necessitating a metaanalysis to provide a comprehensive assessment. Hence, this study aimed to evaluate the efficacy of probiotics in reducing complications in CRC patients undergoing chemotherapy and intestinal surgery. For this purpose, thirteen randomized controlled trials (RCTs) meeting strict inclusion criteria were included in the meta-analysis. Results: Probiotic administration was associated with significant reductions in postoperative infections, including surgical site infections (SSI), pneumonia, urinary tract infections (UTI), and central line infections, showing a Risk Ratio (RR) of 0.74 with a Confidence Interval (CI) of 95%. Moreover, probiotics demonstrated efficacy in mitigating chemotherapy-induced diarrhea and postsurgical complications, such as anastomosis loosening and abdominal disorders, with an RR of 0.35 and 0.74, respectively, with a CI of 95%. While promising, further research is needed to optimize probiotic interventions and address potential interactions with concurrent therapies. Integrating probiotics into perioperative care protocols presents a convincing opportunity to enhance surgical outcomes and improve patient prognosis following CRC resection. Conclusion: Future randomized controlled trials should focus on identifying optimal probiotic strains, dosages, and administration timing to maximize therapeutic benefits.

Strychni Semen and two alkaloidal components cause apoptosis in HK-2 cells through TRADD-MAPK/NF-κB Pathway.

Strychni Semen is the dried ripe seeds of the plant Strychnos nux-vomica L, and has great medicinal value and developmental potential.However, Strychni Semen is severely toxic, with adverse effects on the central nervous system, urinary system, and other organ systems, and severe cases can be life-threatening. The present study was to reveal the mechanism of nephrotoxicity induced by Strychni Semen and its alkaloid components using experiments. HK-2 cells were randomly divided into control, experimental, and inhibitor groups. The experimental group was divided into Strychni Semen (SS, 10 mg/mL), brucine (B, 8 μg/mL) and strychnine (S, 4 μg/mL) groups,and the inhibitor group was treated with 1 μm/L Apostatin-1. To detect the effects of each group of drugs on the expression of inflammatory cytokines, KIM-1 and TRADD downstream pathway-related proteins. Network pharmacology predicted that nephrotoxicity caused by Strychni Semen may be related to MAPK. Cell experiments showed that Strychni Semen and its alkaloids could induce the activation of the JNK and p38 pathways in the NF-κB and MAPK pathways, upregulate the activation and expression of caspase-3, promote the apoptosis of HK-2 cells, and enhance the production of the cytokines IL-6, IL-1β, and TNF-α and KIM-1. Apostatin-1 antagonises the apoptosis of HK-2 cells induced by Strychni Semen and its alkaloids and reduces the production of the above-mentioned cytokines. The results showed that Strychni Semen and its alkaloids can induce apoptosis of HK-2 cells by activating TRADD-mediated MAPK and NF-κB pathways, showing cytotoxicity to HK-2 cells. Thus, inhibiting TRADD can reduce apoptosis.

Associations between per-and polyfluoroalkyl substances (PFAS) and county-level cancer incidence between 2016 and 2021 and incident cancer burden attributable to PFAS in drinking water in the United States.

Exposure to per- and polyfluoroalkyl substances (PFAS) has been linked with various cancers. Assessment of PFAS in drinking water and cancers can help inform biomonitoring and prevention efforts. To screen for incident cancer (2016-2021) and assess associations with PFAS contamination in drinking water in the US. We obtained county-level age-adjusted cancer incidence (2016-2021) from the Surveillance, Epidemiology, and End Results (SEER) Program. Data on PFAS levels in public drinking water systems were obtained from the Third (UCMR3; 2013-2015) and Fifth (UCMR5; 2023-2024) Unregulated Contaminant Monitoring Rule. UCMR3 measured PFOS, PFOA, PFNA, PFHxS, PFHpA, and PFBS. UCMR5 expanded measurements to include PFBA, PFHxA, PFPeA, and PFPeS. We created indicators of PFAS detection and, for UCMR5, concentrations above Maximum Contaminant Levels (MCLs). MCLs for PFOA and PFOS are 4 ng/L, and for PFNA and PFHxS are 10 ng/L. We used Poisson regression models to assess associations between PFAS detection or MCL violation and cancer incidence, adjusting for potential confounders. We estimated the number of attributable cancer cases. PFAS in drinking water was associated with increased cancer incidence in the digestive, endocrine, oral cavity/pharynx, and respiratory systems. Incidence rate ratios (IRRs) ranged from 1.02 to 1.33. The strongest association was observed between PFBS and oral cavity/pharynx cancers (IRR: 1.33 [1.04, 1.71]). Among males, PFAS was associated with cancers in the urinary, brain, leukemia, and soft tissues. Among females, PFAS was associated with cancers in the thyroid, oral cavity/pharynx, and soft tissue. PFAS in drinking water is estimated to contribute to 4626 [95% CI: 1,377, 8046] incident cancer cases per year based on UCMR3 data and 6864 [95% CI: 991, 12,804] based on UCMR5. The ecological study examined the associations between PFAS in drinking water measured in two waves (2013-2015 and 2023-2024) and cancer incidence between 2016 and 2021. We found that PFAS in drinking water was associated with cancers in the organ system including the oral cavity/pharynx, lung, digestive system, brain, urinary system, soft tissue, and thyroid. Some cancers have not been widely studied for their associations with PFAS. We also observed sex differences in the associations between PFAS and cancer risks. This is the first ecological study that examined PFAS exposure in drinking water and various cancer risks.

Study protocol for a single-centre non-inferior double-blinded randomised controlled trial in China comparing the efficacy and safety of high-frequency irreversible electroporation with transurethral resection of the prostate in treating lower urinary tract symptoms and benign prostatic obstruction (the GIANT trial)

IntroductionTransurethral resection of the prostate (TURP) is the gold standard surgical treatment to lower urinary tract symptoms and benign prostatic obstruction (LUTS/BPO). Although it has been proven to have substantial...

Evidence based Management of Pittaj Mutrakruchhra (Urinary Tract Infection) through Ayurvedic Medicine – A Single Case Report

Evidence based Management of Pittaj Mutrakruchhra (Urinary Tract Infection) through Ayurvedic Medicine – A Single Case Report

Epithelial and mesenchymal compartments of the developing bladder and urethra display spatially distinct gene expression patterns.

The lower urinary tract is comprised of the bladder and urethra and develops from the cloaca, a transient endoderm-derived structure formed from the caudal hindgut. After cloacal septation to form the urogenital sinus and anorectal tract, the bladder gradually develops from the anterior portion of urogenital sinus while the urethra elongates distally into the genital tubercle. The bladder is a target for regenerative and reconstructive therapies but engineering an impermeable bladder epithelial lining has proven challenging. Urethral epithelial function, including its role as an active immune barrier, is poorly studied and neglected in regenerative therapy. A deeper understanding of epithelial patterning of the urogenital sinus by the surrounding mesenchyme, also accounting for sex-specific differences, can inform regenerative therapies. In this study, we identified spatially distinct genes in the epithelial and mesenchymal compartments of the developing mouse bladder and urethra that could be potential drivers of patterning in the lower urinary tract. Our data revealed spatially restricted domains of transcription factor expression in the epithelium that corresponded with bladder or urethra-specific differentiation. Additionally, we identified the genes Wnt2, Klf4 and Pitx2 that localize to the mesenchyme of the developing bladder and could be potential drivers of bladder differentiation. Our data revealed an increase in the expression of several chemokine genes including Cx3cl1 and Cxcl14 in the developing urethral epithelium that correlated with an increase in epithelial-associated macrophages in the urethra. A survey of sex-specific differences in epithelial and mesenchymal compartments revealed several differentially expressed genes between the male and female urethra but few sex-specific differences in bladder. By comparing spatially distinct gene expression in the developing lower urinary tract, our study provides insights into the divergent differentiation trajectories of the fetal bladder and urethra that establish their adult functions.

Prediction of urinary tract infection using machine learning methods: a study for finding the most-informative variables

BackgroundUrinary tract infection (UTI) is a frequent health-threatening condition. Early reliable diagnosis of UTI helps to prevent misuse or overuse of antibiotics and hence prevent antibiotic resistance. The gold standard for UTI diagnosis is urine culture which is a time-consuming and also an error prone method. In this regard, complementary methods are demanded. In the recent decade, machine learning strategies that employ mathematical models on a dataset to extract the most informative hidden information are the center of interest for prediction and diagnosis purposes.MethodIn this study, machine learning approaches were used for finding the important variables for a reliable prediction of UTI. Several types of machines including classical and deep learning models were used for this purpose.ResultsEighteen selected features from urine test, blood test, and demographic data were found as the most informative features. Factors extracted from urine such as WBC, nitrite, leukocyte, clarity, color, blood, bilirubin, urobilinogen, and factors extracted from blood test like mean platelet volume, lymphocyte, glucose, red blood cell distribution width, and potassium, and demographic data such as age, gender and previous use of antibiotics were the determinative factors for UTI prediction. An ensemble combination of XGBoost, decision tree, and light gradient boosting machines with a voting scheme obtained the highest accuracy for UTI prediction (AUC: 88.53 (0.25), accuracy: 85.64 (0.20)%), according to the selected features. Furthermore, the results showed the importance of gender and age for UTI prediction. ConclusionThis study highlighted the potential of machine learning strategies for UTI prediction.

Cardiovascular, kidney and safety outcomes with canagliflozin in older adults: A combined analysis from the CANVAS Program and CREDENCE trial.

SGLT2 inhibitors may be underused in older adults with type 2 diabetes due to concerns about safety and tolerability. This pooled analysis of the CANVAS Program and CREDENCE trial examined the efficacy and safety of canagliflozin according to age. Pooled individual participant data from the CANVAS Program (n = 10 142) and CREDENCE trial (n = 4401) were analysed by baseline age (<65 years, 65 to <75 years, and ≥75 years). A range of adjudicated clinical outcomes were assessed, including major adverse cardiovascular events and CKD progression, as well as safety outcomes. Cox proportional hazards models and Fine and Gray competing risk analysis were used. Among the 14 543 participants, 7927 (54.5%) were <65 years, 5281 (36.3%) were 65 to <75 years and 1335 (9.2%) were ≥75 years. Older participants had higher rates of atherosclerotic cardiovascular disease and heart failure, longer diabetes duration and lower mean eGFR. Reductions in cardiovascular and kidney outcomes with canagliflozin were consistent across age categories (all p trend >0.10), although there was some evidence that effects on cardiovascular death and all-cause death were attenuated with older age (p trend = 0.02 and 0.03, respectively). Although the incidence of adverse events increased with age, effects of canagliflozin on safety outcomes including acute kidney injury, volume depletion, urinary tract infections and hypoglycaemia, were not modified by age (all p trend >0.10). In patients with varying degrees of kidney function, canagliflozin reduced cardiovascular and kidney outcomes, regardless of age, with no additional safety concerns identified in older patients.

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

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

Effects of COVID-19 on short-term outcomes of hip arthroplasty: a multicenter, retrospective, propensity score matched study

PurposeThe Coronavirus Disease 2019 (COVID-19) pandemic delayed elective procedures such as total joint arthroplasty. As surgical volumes return to prepandemic levels, understanding the implications of COVID-19 becomes imperative. This study explored the effects of COVID-19 on the short-term outcomes of hip arthroplasty.MethodsThis multicenter, retrospective, case–control study included patients who had undergone hip arthroplasty between 2020 and 2022. Propensity score matching (PSM) was performed to compare demographic characteristics, primary outcomes, and secondary outcomes between patients with a history of COVID-19 (COVID-19 cohort) and those without it (control cohort). The primary outcomes were surgical site infection, periprosthetic joint infection (PJI), dislocation, prosthesis loosening, deep vein thrombosis, and pulmonary embolism. The secondary outcomes were intraoperative blood loss, nerve injury, renal injury, urinary tract infection (UTI), pneumonia, and acute coronary syndrome.ResultsThe COVID-19 and control cohorts comprised 153 and 4925 patients, respectively. After PSM, significant between-cohort differences were observed in the incidence of pneumonia (p < 0.001) and UTI (p = 0.0424). The odds ratio for PJI was 1.62, which is not significant (p = 0.3238) but the culture-negativity rate is higher in the COVID-19 cohort (25%).ConclusionOur findings suggest that COVID-19 only elevated risks of postoperative pneumonia and UTI after hip arthroplasty. This disease significantly increases the risk of postoperative pneumonia but not of 90-day mortality or any major perioperative complication. On the other hand, PJI still remains a concern because its treatment is challenging owing to its culture-negativity, often necessitating the Girdlestone procedure.

Evidence for targeting autonomic dysfunction in systemic sclerosis: A scoping review.

Autonomic dysfunction is a common and early complication among patients with systemic sclerosis, suggesting that it may play a role in the pathogenesis of the disease and be a potential target for therapeutic interventions. Although the true prevalence of autonomic dysfunction among patients with systemic sclerosis is still unclear, it is estimated that as many as 80% of patients may be affected. Autonomic dysfunction may lead to widespread multi-organ dysfunction through its effects on the cardiovascular system, gastrointestinal tract, urinary tract, sweat and salivary glands, and pupils. Early identification of systemic sclerosis associated with dysautonomia may guide prompt diagnosis in this complex patient population and lay the groundwork for future research in this area. Furthermore, the current landscape of targeted interventions for autonomic dysfunction is rapidly expanding; therefore, prioritizing patients who may benefit from such interventions or candidates for related clinical trials is paramount. Our scoping review details timely updates in the extant literature, including findings from recent studies on autonomic dysfunction in systemic sclerosis, and integrates these updates to identify critical gaps in the field.