BackgroundWith COVID-19 leading to several isolation measures for preventative care, health care utilization, especially within urology, decreased substantially. The impact of COVID-19 on the population's interests in urologic conditions remains to be established. By using the platform of Google Trends, which allows search behaviors and interest in healthcare topics to be quantified over time, we investigated the impact of COVID-19 on online search behaviors relating to common urologic conditions in the US. MethodsThe platform of Google Trends was utilized to analyze online interest in twelve common urologic conditions in the US from October 1, 2018 to August 1, 2021 (divided into "pre-COVID" and "COVID" periods at March 1, 2020). Search volume index (SVI), a measure of relative search volume on Google, data sets for the US, top queried and populated states, rising queries, and top queries were retrieved and analyzed for all conditions. Pre-COVID and COVID median SVIs were compared using the Mann Whitney U test, and correlations were analyzed using Spearman's rank-order correlation test. ResultsFor all twelve urologic conditions, rising and top queries were often related to symptoms, treatments, and COVID-19. COVID showed higher SVIs for erectile dysfunction (p=0.04) and lower SVIs for bladder cancer (p<0.01), hematuria (p<0.01), kidney cancer (p<0.01), kidney stones (p=0.03), and prostate cancer (p<0.01). Correlations to COVID-19 searches were seen for bladder cancer (R S =-0.36, p<0.01), erectile dysfunction (R S =0.20, p=0.04), hematuria (R S =-0.31, p<0.01), overactive bladder (R S =-0.23, p=0.04), and prostate cancer (R S =-0.33, p<0.01). No correlations were found for benign prostatic hyperplasia, interstitial cystitis, low testosterone, urinary incontinence, and urinary tract infections. ConclusionsOnline interest in many urologic conditions, especially cancers, decreased during COVID. Given the internet's increasing role in healthcare, a reduced interest could translate to delayed diagnosis and treatment of these conditions. Only erectile dysfunction showed increasing interest, potentially due to research or misinformation linking it to COVID-19.
Aims: Refractory ketamine-induced uropathy (KU) (RKU) has devastating effects on the lower urinary tract leading to ureteral obstruction and even renal failure. The only effective treatment for RKU is major surgical reconstruction or urinary diversion.Nevertheless, there is a paucity of awareness about this destructive condition; the aim of this study is to conduct a narrative systemic review of all surgical outcomes of RKU.Methods: This is an English language literature review of surgical outcomes in KU patients who underwent reconstructive lower urinary tract surgery or urinary diversion through 5 August 2022. Two independent researchers assessed the relevance of each paper and disputes were settled by a third party. In-vitro, animal studies, letters to the editor and papers that did not evaluate surgical outcomes were excluded.Results: Of the 50 763 identified articles, 622 were relevant based on title, 150 based on abstract, but only 23 papers were relevant by content. In all, 875 patients were documented as having KU, of whom 193 (22%) underwent reconstructive surgery.The data were disconcerting, as the apparent rapid progression from the beginning of KU to end-stage bladder was only a 1-year difference of ketamine abuse between those patients who required surgery (4.4 years) and those that did not (3.4 years).Conclusions: The data suggest that the time interval from the beginning of ketamineinduced uropathy to the end-stage bladder may be measured in months, confounding decision making. There is a dearth of literature about KU, and more research is needed to better understand this pathology.
The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms (LUTS) grouped by 24-h urine output determined from a bladder voiding diary.Methods: An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2week period. Additional data, including maximum uroflow (Q max ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Q max ), and PVR were compared between those with oliguria and polyuria.Results: A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Q max and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55 years) and had lower MVV (260 vs. 470 mL), fewer voids/24 h (8 vs. 13), and lower Q max (8.5 vs. 18.3 mL/s). Conclusions: These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction
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The 2020 novel Covid-19 variant is believed to have first infected humans in Wuhan, China (Shereen, 2019), has since spread globally, and was declared a global pandemic by the World Health Organization (WHO) in 2020. A survey by Research Dive (2020) explored the impact of the coronavirus pandemic on the global medical tourism market. The results found that the pre-pandemic compounded annual growth rate (CAGR) was projected at 12.4% globally but declined to 8.6% in 2020. Tatum (2020) further reports that the global medical tourism market would likely continue to decline until the end of 2021 siting statistics regarding one of the hospitals in Thailand where the projected number of medical tourists is expected to decline by 28% because of the pandemic. The medical tourism industry has indeed experienced significant adverse effects and its recovery could take up to three years to reach the pre-pandemic levels. However, for the industry to effectively and sustainably recover, countries must employ integrated marketing strategies of not only enhancing their image but also assuring the medical tourists of safety their country.
Malnutrition is a leading cause of immunodeficiency worldwide; in particular, vitamin A and protein malnutrition seem to wreak devastating effects on various types of white blood cells. This research paper undertakes a primarily qualitative approach, curating and summarizing the most cited published findings on the effects of vitamin A and protein deprivation on leukocytes, neutrophils, eosinophils, lymphocytes, monocytes, macrophages, B cells, and T cells. All were found to be decreased in serum levels and/or have diminished efficacy in those that were malnourished, statistically significant to a p 0.05. This research is relevant as it may provide another compounding variable when regarding why those of lower socioeconomic class – especially those living in food deserts and food swamps – seem to experience disease at a greater incidence and burden than their more affluent age and sex matched counterparts.
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