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Patient related factors such as BMI, hypertension and gender may influence the number of MSCs reached after in vitro culture expansion.

Background Cardiovascular diseases (CVD) and infections are recognized as serious complications in patients with end stage kidney disease. However, little is known about the change over time in incidence of these complications. This study aimed to investigate temporal changes in CVD and infective diseases across more than two decades in chronic dialysis patients. Methods All patients that initiated peritoneal dialysis (PD) or hemodialysis (HD) between 1996 and 2017 were identified and followed until outcome (CVD, pneumonia, infective endocarditis (IE) or sepsis), recovery of kidney function, end of dialysis treatment, death or end of study (December 31st, 2017). The calendar time was divided into 5 periods with period 1 (1996–2000) being the reference period. Adjusted rate ratios were assessed using Poisson regression. Results In 4285 patients with PD (63.7% males) the median age increased across the calendar periods from 65 [57–73] in 1996–2000 to 69 [55–76] in 2014–2017, (p <  0.0001). In 9952 patients with HD (69.2% males), the overall median age was 71 [61–78] without any changes over time. Among PD, an overall non-significant decreasing trend in rate ratios (RR) of CVD was found, (p = 0,071). RR of pneumonia increased significantly throughout the calendar with an almost two-fold increase of the RR in 2014–2017 (RR 1.71; 95% CI 1.46–2.0), (p <  0.001), as compared to the reference period. The RR of IE decreased significantly until 2009 (RR 0.43; 95% CI 0.21–0.87), followed by a return to the reference level in 2010–2013 (RR 0.87; 95% CI 0.47–1.60 and 2014–2017 (RR 1.1; 95% CI 0.59–2.04). A highly significant (p <  0.001) increase in sepsis was revealed across the calendar periods with an almost 5-fold increase in 2014–2017 (RR 4.69 95% CI 3.69–5.96). In HD, the RR of CVD decreased significantly (p <  0.001) from 2006 to 2017 (RR 0.85; 95% CI 0.79–0.92). Compared to the reference period, the RR for pneumonia was high during all calendar periods (p <  0.05). The RR of IE was initially unchanged (p = 0.4) but increased in 2010–2013 (RR 2.02; 95% CI 1.43–2.85) and 2014–2017 (RR 3.39; 95% CI 2.42–4.75). No significant changes in sepsis were seen. Conclusion Across the two last decades the RR of CVD has shown a decreasing trend in HD and PD patients, while RR of pneumonia increased significantly, both in PD and in HD. Temporal trends of IE in HD, and particularly of sepsis in PD were upwards across the last decades.

Background Streptococcal bloodstream infection (BSI) is a common cause of infective endocarditis (IE), yet prognostic factors for mortality are poorly investigated. Purpose To investigate risk factors associated with in-hospital and one-year mortality in streptococcal IE. Methods All patients with a streptococcal BSI, from 2008 to 2017, were included in a regional population-based setup. Based on microbiological identification of phylogenetic relationship, streptococcal species were classified into eight main subgroups: Anginosus, Bovis, Mitis, Mutans, Salivarius, Pyogenic, nutritionally variant streptococci, and S. pneumoniae. Data were crosslinked with nationwide registries for identification of demographics, concomitant hospitalization with IE, medical history, seasonal variation, and socioeconomic status. Patients were followed up until death or a maximum of 365 days after admittance, whichever came first. Using a multivariable adjusted Cox proportional hazard analysis, independent risk factors associated with in-hospital and one-year mortality were identified. Results Among 6,224 patients with a streptococcal BSI, 435 (7.0%) patients with streptococcal IE (mean age 69.0 (SD 14.8), 66% men) were included. The in-hospital mortality in IE patients was 11% (n=48), while the one-year mortality was 23% (n=100). Patients infected with species from the Bovis group had the lowest crude one-year mortality (13%), while patients infected with the Salivarius group had the highest crude mortality (36%). The proportion of deaths among women with IE were significantly higher than among men, both in-hospital (15% versus 9%, p=0.04) and after one year (29% versus 20%, p=0.02). Further, patients dying within one year had a significantly higher prevalence of ischemic heart disease (IHD) (p=0.02), congestive heart failure (CHF) (p&lt;0.0001), cerebral vascular disease (CVD) (p=0.004), cancer (p=0.04), chronic obstructive pulmonary disease (COPD) (p=0.01), and renal disease (p=0.01) than survivors. In the adjusted analysis, age (Hazard Ratio (HR) 1.03, p=0.036) and renal disease (HR 2.46, p=0.045) were associated with higher in-hospital mortality. Furthermore, three independent significant factors associated with one-year mortality were identified; CHF (HR 2.18 [95% confidence interval (CI) 1.30–3.63]), cancer (HR 1.95 [95% CI 1.01–3.77]), and age (HR 1.03 [95% CI 1.01–1.05]) (Figure 1). However, patients infected with species from the Bovis group, had significantly lower risk of death at one-year (HR 0.30 [95% CI 0.10–0.89]) (Figure 1). Conclusion Having a renal disease at the time of IE diagnosis was associated with a higher in-hospital mortality in patients with streptococcal infective endocarditis. Further, congestive heart failure and cancer were associated with a higher one-year mortality, while the Bovis group was associated with a lower one-year mortality. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Zealand University Hospital Roskilde and Helsefonden (20-B-0340) Figure 1. Adjusted risk of one-year mortality

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Background: Overactive bladder (OAB) is under reported yet distressing symptoms which can be managed effectively by the drugs available. Aim was to study and compare the efficacy of two drugs, mirabegron and darifenacin in controlling the symptoms of overactive bladder.Methods: This prospective study included a total of 120 cases of overactive bladder reported at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar from January 2018 to December 2019. This comparative study was done by giving Mirabegron to first five patients and next five patients were given darifenacin up to 120 patients. The drug treatment with once daily administration of 25 mg mirabegron and 7.5 mg of darifenacin was given for a total of 12 weeks. The signs and symptoms were noted at the beginning of the therapy and then follow up was done at 4, 8, 10 and 12 weeks.Results: Total 54 out of 60 patients (90%) on miragaberon and 59 of 60 patients (98.33%) on darifenacin were relieved of symptom of increased frequency of micturition. 53 of 60 pateints (88.33%) on miragaberon and 59 of 60 patients (98.33%) on darifenacin were relieved of symptom of decreased average voiding volume. 28 of 60 pateints (46.67 %) on miragaberon showed nocturia as compared to 25 of 60 patients (41.67%) on darifenacin.Conclusions: It has been concluded that both mirabegron as well as darifenacin are highly efficacious newer treatment options for the management of OAB. Our study found Darifenacin to be relatively more efficacious in the treatment of OAB at a lesser dose and statistically significant differences were observed between the two drugs.

Background: Urinary bladder lesions are a great health concern as it lies among the top ten most common cancers in the world. These range from benign, harmless lesions that do not recur to life threatening tumors. The present study was undertaken to study incidence of various urothelial cancer in patients undergoing transurethral resection of bladder tumor in tertiary care hospital, as the treatment, follow up and prognosis is highly variable with different subtypes of bladder cancer.Methods: A hospital based descriptive cross-sectional study was conducted on all patients undergoing transurethral resection of bladder tumor from December 2018 to May 2020 in the Department of General Surgery of Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar. Based on World Health Organization (WHO) classification incidence of various urothelial malignancy was calculated.Results: Out of 80 patients with growth urinary bladder, 4 patients (5% of total patient) were diagnosed as case of papilloma, 26 patients (32.5% of total patients) were diagnosed as low grade papillary urothelial carcinoma, 50 patients (62.5% of total patients) were of high grade papillary urothelial carcinoma. There were no case of PUNLMP in our study.Conclusions: It can be concluded that majority of the patient undergoing transurethral resection of bladder tumor are diagnosed with high grade papillary carcinoma.