The California Cancer Registry was analyzed for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance types. Survival analyses were performed for 72,452 cases to determine the prognostic significance of racial and socioeconomic factors. Black race, low SES, and Medicaid insurance portend poorer outcomes. These findings reflect a multifaceted socioeconomic and public health conundrum.Purpose: To examine the California Cancer Registry (CCR) for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance in California patients. Patients and Methods:The CCR was queried for bladder cancer cases in California from 1988 to 2012. The primary outcome was disease-specific survival (DSS), defined as the time interval from date of diagnosis to date of death from bladder cancer. Survival analyses were performed to determine the prognostic significance of racial and socioeconomic factors.Results: A total of 72,452 cases were included (74.5% men, 25.5% women). The median age was 72 years (range, 18-109 years). The racial distribution among the patients was 81% white, 3.8% black, 8.8% Hispanic, 5.2% Asian, and 1.2% from other races. In black patients, tumors presented more frequently with advanced stage and high grade. Medicaid patients tended to be younger and had more advanced-stage, higher-grade tumors compared to patients with Medicare or managed care (P < .0001). Kaplan-Meier analysis demonstrated significantly poorer 5-year DSS in black, low SES, and Medicaid patients (P < .0001). When controlling for stage, grade, age, and gender, multivariate analysis revealed that black race (DSS hazard ratio = 1.295; 95% confidence interval, 1.212-1.384), low SES (DSS hazard ratio = 1.325; 95% confidence interval, 1.259-1.395), and Medicaid insurance (DSS hazard ratio = 1.349; 95% confidence interval, 1.246-1.460) were independent prognostic factors (P < .0001).
We found that the proportion of patients who considered electronic questionnaires to be equivalent to or better than paper versions was higher than those who preferred paper questionnaires regardless of age, gender or education level.
Objective: To evaluate the use of percutaneous tibial nerve stimulation (PTNS) in an elderly population, as PTNS is a third-line treatment in the management of overactive bladder (OAB) and affects 10-26% of adult males and 8-42% of adult females, increasing in prevalence with age. Patients and methods: We performed a chart review of patients aged ≥ 65 years undergoing PTNS at a single institution over 6 years. We examined clinicopathological variables potentially associated with the outcomes of interest. Results: In total, 52 patients aged ≥ 65 years underwent an induction course of PTNS between 2011 and 2017, comprising 23 men and 29 women. The mean age of the patients was 75.75 years and the mean body mass index (BMI) was 26.33 kg/m 2. In all, 36 patients used anticholinergic treatments prior to PTNS, five used a β 3-adrenoceptor agonist, and three had Botox injections. After PTNS, 37 patients reported improvement of their symptoms, with 21 using combined therapy during PTNS. Only seven patients used an anticholinergic after PTNS, six used a β 3adrenoceptor agonist, five had Botox injections, and two had sacral neuromodulation. When looking at variables such as age, gender, race, BMI, and comorbidities, we found that an obese BMI was the only statistically significant variable predicting failure of response. A sub-analysis of only women did not demonstrate any predictors of failure. Conclusion: Our subjective response rate of 70% was within the success rates reported in literature. In all, 39% of patients used a concomitant treatment during PTNS and 13.2% required alternative treatment after PTNS.
Introduction: Flexible ureteroscopy (fURS) is an endoscopic procedure for the minimally invasive treatment of ureteral and renal calculi. Due to improvements in technique and ureteroscopic instrumentation over the past two decades, complications associated with URS are infrequent. However, in the event of an unexpected device malfunction or failure, the operating surgeon must employ prompt, resolute decision-making to resolve any intraoperative complications and avoid significant injury to the kidney or ureter.Case Presentation: The patient was a 53-year-old male with a 7 mm left upper pole renal stone managed by fURS and laser lithotripsy. A ureteral access sheath (UAS) was not deployed during the procedure. During fragmentation of the stone, we were unexpectedly unable to retract the ureteroscope from the ureter. Herein, we describe the procedural details leading up to the complication and the careful maneuvering required to remove the ureteroscope without damaging the ureter or the instrument.Conclusions: We recommend use of a UAS during fURS for the treatment of ureteral and renal calculi, if not using ureter access sheath, not advancing the ureteroscope above the stone, leaving it behind the tip of the instrument, while in the ureter. Utilization of a ureter access sheath could have possibly avoided this kind of complication.
Introduction Risk factors for the mortality of COVID-19, such as cardiovascular and lung disease, are commonly seen in patients with obstructive sleep apnea (OSA). Patients with OSA experience approximately 8-fold greater risk for COVID-19 infection compared to a similar age population. Among patients with COVID-19 infection, OSA was associated with an increased risk of hospitalization and approximately doubled the risk of developing respiratory failure. However, there is little information on whether COVID-19 can directly develop OSA. To the best of our knowledge, we describe the first case-presentation of a positive COVID-19 patient who developed sudden-onset OSA. Report of case(s) NL is a 47-year-old female who complains of new-onset snoring, excessive daytime sleepiness, and witnessed apnea events after testing positive for COVID-19 seven months prior after developing mild symptoms. Her ESS score is 12/24, neck circumference is 14.75 cm, BMI is 27.9, and Mallampati II. She has no pertinent PMH and is not a tobacco user. In regards to her sleep, she has no symptoms of restless legs, narcolepsy, or periodic limb movements. She denies any physical disturbances, psychiatric conditions, environmental factors, or medical issues that might affect her sleep. There is no family history of sleep apnea, snoring, or other sleeping disorders. The patient's presentation at the initial sleep visit prompted a home sleep study. Results of her home sleep study revealed 131 total number of sleep-related respiratory events, with an apnea-hypopnea index of 11.9 per hour. Mean oxygen saturation was 94% and the minimum oxygen saturation was 83%. Total estimated sleep time was 7 hours, 59 mins, and sleep quality and duration were deemed adequate. The results from NL's sleep study gave the final diagnosis of mild OSA. Conclusion Besides having a slightly overweight BMI, NL had relatively few risk factors for developing OSA (no family history, no comorbidities, and normal physical exam findings). The link between the virus and the development of OSA in healthy individuals is not readily apparent. We recommend sleep studies for healthy patients who develop OSA like-symptoms after being infected with COVID-19 to prevent unwanted health risks associated with OSA. Support (if any):
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