Objective To evaluate whether urodynamic voiding risk factors can be predictive of failure of postprostatectomy urinary incontinence (PPI) treatment with adjustable transobturator male system (ATOMS). Materials and Methods We carried out a longitudinal study on 77 males treated for PPI with ATOMS. Patients were submitted preoperatively to a urodynamic study. The postoperative outcome was checked by pad‐test. Treatment success was defined as daily pad‐test below 10 mL. Statistical analysis used were Fisher exact test, χ2 lineal by lineal test, Student t test, and logistic regression analysis. The signification level was set at 95% bilateral. Results Treatment was successful in 54 patients (70%) achieving continence. The urodynamic parameters that related to postoperative continence outcome were the cystometric bladder capacity (direct relationship with continence (P = .019), type of voiding (more probability to achieve continence in patients who voided voluntarily followed by patients with involuntary voiding and abdominal straining voiding) (P = .034), Bladder Outlet Obstruction Index (BOOI) (inversely related with continence) (P = .025), and maximum voiding abdominal pressure (inversely related with continence) (P = .049). Multivariate analysis showed that cystometric bladder capacity (odds ratio [OR], 1.01; confidence interval [CI], 1.02‐1.00), BOOI (OR, 0.97; CI, 0.99‐0.94), and maximum abdominal bladder pressure (OR, 0.97; CI, 0.98‐0.94) were independent risk factors to predict treatment success after ATOMS implant. Conclusions The study of functional voiding parameters is useful to know the risk factors that influence postoperative outcome of PPI with ATOMS device. These findings could be of primary importance to facilitate optimum patient selection for this implant and therefore improve operative results.
Background. Data on the incidence, etiology, and prognosis of non-ventilator-associated pneumonia in hospitalized patients with solid tumors are scarce. We aimed to study the characteristics of non-ventilator-associated pneumonia in hospitalized patients with solid tumors. Materials and Methods. This was a prospective noninterventional cohort study of pneumonia in patients hospitalized in an oncology ward in a tertiary teaching hospital. Pneumonia was defined according to the American Thoracic Society criteria. Patients were followed for 1 month after diagnosis or until discharge. Survivors were compared with nonsurvivors. Results. A total of 132 episodes of pneumonia were diagnosed over 1 year (9.8% of admissions to the oncology ward). They were health care-related (67.4%) or hospital-acquired pneumonia (31.8%). Lung cancer was the most common malignancy. An etiology was established in 48/132 episodes (36.4%). Knowing the etiology led to changes in antimicrobial therapy in 58.3%. Subsequent intensive care unit admission was required in 10.6% and was linked to inappropriate empirical therapy. Ten-day mortality was 24.2% and was significantly associated with hypoxia (odds ratio [OR], 2.1). Thirty-day mortality was 46.2%. The independent risk factors for 30-day mortality were hypoxia (OR, 3.3), hospital acquisition (OR, 3.1), and a performance status >1 (OR, 2.6). Only 40% of patients who died within 30 days were terminally ill. Conclusion. Pneumonia is a highly prevalent condition in hospitalized patients with solid tumors, even with nonterminal disease. Etiology is diverse, and poor outcome is linked to inappropriate empirical therapy. Efforts to get the empirical therapy right and reach an etiological diagnosis to subsequently de-escalate are warranted. The Oncologist 2020;25:e861-e869Implications for Practice: The present study shows that pneumonia is a prevalent infectious complication in patients admitted to oncology wards, with a very high mortality, even in non-terminally ill patients. Etiology is diverse, and etiological diagnosis is reached in fewer than 40% of cases in nonintubated patients. Intensive care unit admission, a marker of poor outcome, is associated with inappropriate empirical therapy. These results suggest that, to improve prognosis, a more precise and appropriate antimicrobial empirical therapy for pneumonia in patients with solid tumors is necessary, together with an effort to reach an etiological diagnosis to facilitate subsequent de-escalation.
Introduction: Frailty (F) refers to the cumulative organic damage caused by aging, as a consequence of a diminished physiological reserve. Frailty’s prevalence is 73% in dialysis. Objectives: Our aim was to identify the prevalence of F in patients starting hemodialysis (HD) or hemodiafiltration online (HDF) treatment. To asses change in frailty during a six-month period of dialysis Patients and Methods: This prospective cohort study evaluated 67 incident patient starting-HD or HDF at one year, with a follow-up period of at least six months. The frailty was assessed by the Fried frailty method. According to this test, we divided the population in two groups: Pre-frail (0-2) and frail (3-5). Results: Mean age was 64 years, 64% were male and 92% were treated with HD. A total of 35.8% of the patients were admitted to dialysis with a prosthetic or native fistula. The prevalence of F at the beginning of dialysis was 65.7%. The mean value of Charlson index (CHI) was 5.2 ± 2. There was a significant correlation between CHI and frailty test (P<0.0001). Basal F score (n=67) improved after 6 month (n=52): 3 (2-4) versus1 (1-2) (P<0.0001). Hematocrit (28 versus 32% P=0.05) and calcium levels (8.6 and 8.9 mg/dL, P<0.002) also increased after sixth-month. Global mortality was 7.5%. In the multivariate analysis CHI (P<0.001) and albumin (P=0.003) were frailty predictors. Conclusion: The prevalence of F in patients who start dialysis therapy is high. There was an improvement in F score after six-month of dialysis treatment. Patients with higher F score had higher mortality with higher CHI
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