Remdesivir initially was intravenously administrated to treat the Ebola disease however right now it has been administered to treat COVID-19 in some countries. However it is necessary to find the exact effect of remdesivir in patients with COVID-19. Remdesivir solution is administered with a cyclodextrin carrier that filters solely by the glomeruli; thereby patients with abnormal renal function cannot eliminate it quickly; therefore, remdesivir can lead to renal failure or liver dysfunction during therapeutic process of COVID-19. Assessment of renal function in patients with COVID-19 who have acute kidney injury (AKI) or end-stage renal disease is fundamental.
Objectives: To determine the outcome of combined transobturator tape sling (TOT) and low dose intradetrusor injection of Abobotulinumtoxin-A (Abobot-A, Dysport®) in women with mixed urinary incontinence (MUI). Methods: This randomized, active comparator-controlled, parallel-group, two-part clinical trial was conducted on women who had positive Valsalva leak point pressure (VLPP) + detrusor overactivity (DO), cough-associated DO. In Part 1, 20 women with MUI who had a failure of medical and behavioral therapies to cure MUI, randomized in two groups receiving TOT surgery alone, or in combination with Dysport® injection (n = 10 in each group), and then Part 2 was initiated as a prospective open-label on 40 more patients. We performed cystoscopy and injected 300 U of Dysport®in 20-30 intradetrusor injection sites in each patient.Results: The patient's symptoms in both groups decreased significantly after treatment. The symptoms were improved significantly in the combination therapy group according to the International Consultation on Incontinence Questionnaireoveractive bladder (ICIQ-OAB) questionnaire (p < .001), and International Consultation on Incontinence Questionnaire-urinary Incontinence-short form (ICIQ-UI-SF) (p = .041) in comparing with the TOT group. In Part 2, the mean score was 17.10 (4.75) for ICIQ-UI-SF and 9.22 (2.89) for ICIQ-OAB before the treatment. Twelve weeks after the intervention, the median (interquartile range: IQR) of ICIQ-OAB symptoms (2.0 [3.0]; p < .001) and ICIQ-UI-SF decreased, too (1. 0 [2.0]; p < .001). Considering improvement using Patient Global Impression of Improvement scale, 46 (92.0%) stated that they had significant subjective improvement of their symptoms.Conclusions: Combination therapy was accompanied with a promising effect in the patients with MUI according to the results of standardized questionnaires. However, further studies with controlled arms are recommended.
What is the prevalence of lower urinary tract symptom (LUTS) among public hospitals staff and association with shift working? The aim of the current study was to evaluate the prevalence and bothersomeness of LUTS and the impact of shift working on its symptoms among the staff of public hospitals. Job condition is one of the main risk factors for LUTS, and almost about three-quarters of nurses/nursing assistants do not have time to use the toilet during the shift work. Non-standard shiftwork intensely is associated with various urological complications. Our study reveals new insights on the prevalence of LUTS with more frequency in women shift workers when compared with men. We conducted a descriptive cross-sectional survey from October 2019 to January 2020. The data were collected from three public hospitals.A total of 228 individuals, 148 females (64.9%), and 80 males (35.1%) were enrolled in the study. After considering the inclusion criteria, for women, the validated version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and for men, the validated version of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) were used. LUTS was more prevalent in women (61.1% vs. 44.2%, p = 0.016). In both men and women, the most bothersome symptom was urgency and the most prevalent symptom was nocturia (58.9%, and 43.9%, respectively). A significant relationship was observed between LUTS and shift working in female staff (p = 0.037). Nocturia was found to be the most prevalent symptom in both genders. The highest bothersome issue in men was related to urgency, and in women in addition to urgency, nocturia was another common symptom. However, the bother scores of most symptoms relatively were low. Although the percentage of women with shift working was low the prevalence of LUTS was high in this gender.
Objectives This study aimed to report sacral neuromodulation (SNM) outcomes in detrusor underactivity (DU). Methods A multicentric, multinational, retrospective case series was conducted between March 2017 and June 2021 in three different referral centers. Initial test phase stimulation included either a percutaneous nerve evaluation (PNE) or an advanced lead evaluation test phase (ALTP) before permanent SNM implantation. The test phases were performed under local anesthesia, either in the outpatient (PNE) or operating room (ALTP), in the prone position, which was implanted in the third or fourth sacral foramina under fluoroscopic guidance. Patients with favorable response to the initial test phase during the first 2 weeks underwent the implantable pulse generator (IPG) implantation (Medtronic neurostimulation generator device InterStim™). Favorable response was defined as ≥ 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/or decrease in postvoid residual (PVR), increase in voided volume, or improvement in bladder voiding efficiency (BVE) based on the bladder diary. Results Fifty‐eight patients were recruited with a mean age of 39.95 ± 15.28 years. Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these, 12 patients (30.8%) with non‐neurogenic etiology and nine patients (52.9%) with neurologic etiology did not respond to the initial test phase; thus, they did not undergo full implantation (p = 0.141). Voided volume, PVR, and the median maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes; however, there was no statistical difference between both genders. Most female cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and were candidates for the IPG phase. Among the 35 cases who underwent IPG, 27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable response to IPG. 46.6% of patients had a successful outcome at the end of the study. Conclusion This multicentric study showed that SNM effectively and safely provided symptom improvement in refractory DU in males similar to females which is an important finding as previously it has been suggested that SNM works better in nonobstructive urinary retention in women and not in women.
Introduction: Prophylactic antibiotics are used before or at the beginning of diagnostic or therapeutic intervention to reduce post-intervention infections. Objectives: The aim of this study was to compare the administration of prophylactic antibiotics in urological procedures of Imam Reza hospital in Tabriz with the standard protocol. Patients and Methods: This cross-sectional study was performed on common urological cases including 400 patients who undergo open or endoscopic surgery who received antibiotic prophylaxis before surgery to prevent urinary tract infections. Results: The mean age of the patients was 49.59 ± 17.60 years; 51.5% of the patients were female. The most common cystoscopy procedure was performed with a frequency of 27.25% and the most common antibiotic used was cefazolin with a frequency of 34.25%. It was observed that there was a discrepancy between the type of antibiotic in 4.4% and a discrepancy between the dose of antibiotics used and the standard guideline in 5.5%. The mean duration of drug administration in the studied patients was 3.28±1.59 days with a mean of three days. Regarding duration of antibiotic use, in 26% of cases was contrary to the standard guideline. Additionally, in 11.25% of cases, the continuation of prophylactic antibiotics in the studied patients was contrary to the standard guideline. Conclusion: In the present study, the time of administration of prophylactic antibiotics before urological surgeries was the most consistent with the standard guideline. In addition, most cases of discrepancy between dose and type of antibiotic were related to stent replacement and cystoscopy.
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