The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5?F was used in all patients. The mean age of patients was 27.8?years (range 20-39), and the mean gestation duration was 24?weeks (15-34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8?mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.     

An unusual case of renal failure due to solitary plasmacytoma: parenchymal invasion of the kidney

Solitary extramedullary plasmacytoma (EMP) is a rare plasma cell disorder mostly involving the upper airway; however, retroperitoneal infiltration is very rare. Kidney injury associated with EMP is exceptionally rare with only anecdotal reports. Herein we report a case of retroperitoneal EMP causing renal failure by the way of direct renal parenchymal infiltration. Renal parenchymal invasion should be considered in aggressive and refractory plasma cell dyscrasias with unexplained renal failure.     

Early and intermediate term results for surgical correction of total anomalous pulmonary venous connection

Abstract Background: This retrospective study evaluated factors associated with mortality and morbidity in patients having functionally biventricular heart (FBH) and functionally univentricular heart (FUH) undergoing total anomalous pulmonary venous connection (TAPVC) repair. Methods: We reviewed medical records retrospectively and identified 72 patients undergoing TAPVC repair between July 2002 and December 2010; and 62 patients had FBH and 10 patients had FUH. The median age and weight at repair was 9.1 months (range, 8 days–16 years) and 6.7 kg (range, 2.5–57 kg). The TAPVC anatomy was supracardiac in 41 (56.9%), cardiac in 18 (25%), infracardiac in eight (11.1%), and mixed in five patients (6.9%). Results: There were seven early deaths (2 FBH [25%] and 5 FUH [62.5%]) and one late death (FUH). Presence of FUH (p < 0.01), heterotaxy syndrome (p = 0.03), young age (p < 0.01), low weight (p < 0.01) and long CPB time (p = 0.04) at the time of surgery were statistically significant risk factors for mortality. Morbidity was related to long duration of postoperative mechanical ventilation, intensive care unit and hospital stay. Presence of FUH was the only significant risk factor for morbidity (p < 0.01). After a mean follow‐up of 52.1 months (range, 3–74 months), 59 (92%) of 64 survivors were asymptomatic without any medication, and five have mild symptoms with regular physical activity. Conclusion: Operative results of TAPVC have dramatically improved in recent years. However, patients having FUH (especially with concomitant palliative surgery), heterotaxy syndrome, low weight, early age, and long CPB time still have an increased operative mortality. (J Card Surg 2012;27:376‐380)     

Incidence,Prevalence, Costs,and Impact on Disability of Common Conditions Requiring Rehabilitation in the United States: Stroke,Spinal Cord Injury,Traumatic Brain Injury,Multiple Sclerosis,Osteoarthritis, Rheumatoid Arthritis,Limb Loss,and Back Pain

Objective

To determine the relative incidence, prevalence, costs, and impact on disability of 8 common conditions treated by rehabilitation professionals.

Data Sources

Comprehensive bibliographic searches using MEDLINE, Google Scholar, and UpToDate, (June, 2013).

Data Extraction

Two review authors independently screened the search results and performed data extraction. Eighty-two articles were identified that had relevant data on the following conditions: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain.

Data Synthesis

Back pain and arthritis (osteoarthritis, rheumatoid arthritis) are the most common and costly conditions we analyzed, affecting more than 100 million individuals and costing greater than $200 billion per year. Traumatic brain injury, while less common than arthritis and back pain, carries enormous per capita direct and indirect costs, mostly because of the young age of those involved and the severe disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability, is likely second to both arthritis and back pain in its impact on functional limitations.

Conclusions

Of the common rehabilitation diagnoses we studied, musculoskeletal conditions such as back pain and arthritis likely have the most impact on the health care system because of their high prevalence and impact on disability.     

A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal

Aim:

Drug-drug interaction (DDI) is of major concern in patients with complex therapeutic regimens. The involvement of cardiovascular medicines in drug interaction is even higher. However, reports of DDI between these groups of drugs are few. The study aims to identify the potential DDI among hospitalized cardiac patients. Furthermore, we assessed the possible risk factors associated with these interactions.

Subjects and Methods:

The Type of study prospective observational study was conducted from May 2012 to August 2012 among hospitalized cardiac patients. Cardiac patients who were taking at least two drugs and who had a hospital stay of at least 24 h were enrolled. The medications of the patients were analyzed for possible interactions using the standard drug interaction database - Micromedex -2 (Thomson Reuters) × 2.0.

Results:

From a total of 150 enrolled patients, at least one interacting drug combination was identified among 32 patients. The incidence of potential DDI was 21.3%. A total of 48 potentially hazardous drug interactions were identified. Atorvastatin/azithromycin (10.4%), enalapril/metformin (10.4%), enalapril/potassium chloride (10.4%), atorvastatin/clarithromycin (8.3%) and furosemide/gentamicin (6.3%) were the most common interacting pairs. Drugs most commonly involved were atorvastatin, enalapril, digoxin, furosemide, clopidogrel and warfarin. Majority of interactions were of moderate severity (62.5%) and pharmacokinetic (58.3%) in nature. Increased number of medicines, prolonged hospital stays and comorbid conditions were the risk factors found associated with the potential DDI.

Conclusions:

This study highlighted the need of intense monitoring of patients who have identified risk factors to help detect and prevent them from serious health hazards associated with drug interactions.KEY WORDS: Cardiac patient, drug interaction, interaction severity, Micromedex     

A Phase IIb Randomized Controlled Trial Investigating the Effects of Tocotrienol-Rich Vitamin E on Diabetic Kidney Disease

Diabetic kidney disease (DKD) is a debilitating complication of diabetes, which develops in 40% of the diabetic population and is responsible for up to 50% of end-stage renal disease (ESRD). Tocotrienols have shown to be a potent antioxidant, anti-inflammatory, and antifibrotic agent in animal and clinical studies. This study evaluated the effects of 400 mg tocotrienol-rich vitamin E supplementation daily on 59 DKD patients over a 12-month period. Patients with stage 3 chronic kidney disease (CKD) or positive urine microalbuminuria (urine to albumin creatinine ratio; UACR > 20–200 mg/mmol) were recruited into a randomized, double-blind, placebo-controlled trial. Patients were randomized into either intervention group (n = 31) which received tocotrienol-rich vitamin E (Tocovid SupraBio^TM; Hovid Berhad, Ipoh, Malaysia) 400 mg daily or a placebo group which received placebo capsules (n = 28) for 12 months. HbA1c, renal parameters (i.e., serum creatinine, eGFR, and UACR), and serum biomarkers were collected at intervals of two months. Tocovid supplementation significantly reduced serum creatinine levels (MD: −4.28 ± 14.92 vs. 9.18 ± 24.96), p = 0.029, and significantly improved eGFR (MD: 1.90 ± 5.76 vs. −3.29 ± 9.24), p = 0.011 after eight months. Subgroup analysis of 37 patients with stage 3 CKD demonstrated persistent renoprotective effects over 12 months; Tocovid improved eGFR (MD: 4.83 ± 6.78 vs. −1.45 ± 9.18), p = 0.022 and serum creatinine (MD: −7.85(20.75) vs. 0.84(26.03), p = 0.042) but not UACR. After six months post washout, there was no improvement in serum creatinine and eGFR. There were no significant changes in the serum biomarkers, TGF-β1 and VEGF-A. Our findings verified the results from the pilot phase study where tocotrienol-rich vitamin E supplementation at two and three months improved kidney function as assessed by serum creatinine and eGFR but not UACR.     

eNOS Gene Intron 4 VNTR and Exon 7-G894T Polymorphisms in Turkish Men with Erectile Dysfunction: A Case Control Study

IntroductionThe associations between the gene polymorphisms and erectile dysfunction (ED) are limited.AimTo examine a potential association between variable number of tandem repeats (intron 4 VNTR), G894T polymorphisms, and ED in Turkish men.MethodsSixty-four men with ED and 82 healthy men as a control group were included in the study. The patients were evaluated by medical history, International Index of Erectile Function (IIEF), serum glucose, and lipid profiles. VNTR and G894T polymorphism were assessed by isolated DNA blood samples obtained from the patient group with ED and controls.Main Outcome MeasuresAssesment of IIEF and VNTR and G894T polymorphism in the isolated DNA blood samples.ResultsGenotype distributions of endothelial nitric oxide syntase (eNOS) gene intron 4 VNTR polymorphisms in the patient group were similar to those in the healthy group (P > 0.05). The frequency of the eNOS gene intron 4 genotype was found as bb: 55 (67.1%), ab: 26 (31.7%), and aa: 1 (1.2%) in the controls and bb: 43 (67.2%), ab: 19 (29.7%), and aa: 2 (3.1%) in the patient group. The frequency of the G894T was found as gg: 61 (74.4%), gt: 21 (25.6%), and tt: 0 (0.0%) in the controls and gg: 32 (50.0%), gt: 27 (42.1%), and tt: 5 (7.8%) in the patient group (P = 0.002). The frequencies of the “t” allele were 21 (12.8%) in the control group and 37 (28.9%) in the patient group (P = 0.001). Logistic regression analysis showed that G894T polymorphism was an independent risk factor for ED.ConclusionsWe found significant differences in allelic and genotypic frequencies between patients and controls for the G894T eNOS polymorphisms. The presence of 894T allele in carriers increased the risk of ED. No association was found between VNTR polymorphism and in patients with ED. Erol B, Bozdogan G, Akduman B, Dursun A, Bozdogan S, Onem K, and Mungan A. eNOS gene intron 4 VNTR and exon 7-G894T polymorphisms in Turkish men with erectile dysfunction: A case control study. J Sex Med 2009;6:1423–1429.     

Hiding message into DNA sequence through DNA coding and chaotic maps

The paper proposes an improved reversible substitution method to hide data into deoxyribonucleic acid (DNA) sequence, and four measures have been taken to enhance the robustness and enlarge the hiding capacity, such as encode the secret message by DNA coding, encrypt it by pseudo-random sequence, generate the relative hiding locations by piecewise linear chaotic map, and embed the encoded and encrypted message into a randomly selected DNA sequence using the complementary rule. The key space and the hiding capacity are analyzed. Experimental results indicate that the proposed method has a better performance compared with the competing methods with respect to robustness and capacity.