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Dirie NI, Ahmed MM, Olad OM, Shire IH, Mohamud AK, Garba B, Mohamoud JH, Asowe HA, Orey FAH, Hassan J, Adam MH. Urolithiasis Burden in Somalia: Associated Factors and Regional Distribution Among Patients Undergoing CT Scan in Selected Centers in Mogadishu. Res Rep Urol 2025; 17:105-118. [PMID: 40196425 PMCID: PMC11974579 DOI: 10.2147/rru.s507836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/29/2025] [Indexed: 04/09/2025] Open
Abstract
Background Urolithiasis is a significant global health burden with varying prevalence rates across different regions. In Somalia, data on the prevalence and risk factors associated with urinary stone disease are limited. This study aimed to investigate the prevalence and associated factors of urolithiasis among patients undergoing CT scans at selected centers in Mogadishu. Methods This cross-sectional study was conducted between January and May 2024 at three medical facilities in Mogadishu, Somalia. This study included 211 patients who underwent non-contrast abdominopelvic CT scans. Data were collected using a structured questionnaire that covered sociodemographic characteristics, lifestyle habits, dietary patterns, and clinical data. Statistical analysis was performed using R statistical software version 4.4.0, employing descriptive statistics, bivariate analyses, and logistic regression. Results The study revealed a prevalence of 26.07% (95% CI: 20.28-32.54%) for urolithiasis. Significant associations were found with marital status (married individuals showing higher risk, AOR 30.42, 95% CI 3.32-278.58) and education level (higher education showing a protective effect). Dietary factors played a crucial role, with irregular dairy consumption (AOR 37.05, 95% CI 3.44-398.62) and occasional meat consumption (AOR 3.58, 95% CI 1.41-9.08) showing increased risk. Previous diagnosis of urolithiasis (AOR 5.2, 95% CI 1.19-22.81) and history of UTIs (AOR 3.43, 95% CI 1.7-6.95) were significant risk factors. Conclusion This study identified a substantial prevalence of urolithiasis in Mogadishu, with significant associations between sociodemographic factors, dietary habits, and medical history. These findings emphasize the need for comprehensive screening programs and targeted interventions, particularly for high-risk individuals.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Dr. Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | | | - Omar Mohamed Olad
- Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Iqra Hassan Shire
- Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Abdirahman Khalif Mohamud
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Bashiru Garba
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Jamal Hassan Mohamoud
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Hodo Aideed Asowe
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Fartun Abdullahi Hassan Orey
- Department of Pediatrics and Child Health, Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Jihaan Hassan
- Department of Pediatrics and Child Health, Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Mohamed Hussein Adam
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
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Nsair A, Mullerad M, Goldin O, Amiel GE, Reumi M, Malshy K, Hoffman A. Risk factors for urinary septic shock following ureteroscopy for stone disease. J Perioper Pract 2025:17504589251318120. [PMID: 39927499 DOI: 10.1177/17504589251318120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2025]
Abstract
OBJECTIVE We aimed to identify risk factors associated with urinary septic shock following ureteroscopy. METHODS A retrospective review was conducted on patients who underwent ureteroscopy between 2010 and 2021. Data collected included demographics and preoperative variables. Septic shock was defined as the need for vasopressors for sepsis. A comparison was made between patients who developed septic shock and a randomly selected control group (N = 115). Multivariate logistic regression was used to identify independent risk factors. RESULTS Of 5000 ureteroscopy procedures, 20 cases of septic shock were identified. These patients were older, had a higher median body mass index, more hypertension, higher preoperative urinary drainage, longer drainage duration and positive preoperative urine cultures. On multivariate analysis, age over 55 years, body mass index above 26 and positive preoperative urine culture were significant predictors of septic shock. CONCLUSION Consistent with findings reported in previous studies, older age, higher body mass index and positive preoperative urine cultures are key risk factors for postureteroscopy septic shock. Enhanced safety measures are essential for high-risk patients.
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Affiliation(s)
- Ameer Nsair
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
- Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | | | - Oleg Goldin
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
| | - Gilad E Amiel
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
- Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Michael Reumi
- Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Kamil Malshy
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Azik Hoffman
- Department of Urology, Rambam Health Care Campus, Haifa, Israel
- Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
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Jiang Y, Zhang J, Ainiwaer A, Liu Y, Li J, Zhou L, Yan Y, Zhang H. Development and validation of a predictive model for acute kidney injury in patients with ureterolithiasis. Ren Fail 2024; 46:2394634. [PMID: 39177235 PMCID: PMC11346321 DOI: 10.1080/0886022x.2024.2394634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES This study aims to identify risk factors for acute kidney injury (AKI) in patients with ureterolithiasis and to develop a predictive model for early AKI detection in this population. METHODS A retrospective analysis was conducted on data from 1,016 patients with ureterolithiasis who presented to our outpatient emergency department between January 2021 and December 2022. Using multifactorial logistic regression, we identified independent risk factors for AKI and constructed a nomogram to predict AKI risk. The predictive model's efficacy was assessed through the area under the ROC curve, calibration curves, Hosmer-Lemeshow (HL) test, and decision curve analysis (DCA). RESULTS AKI was diagnosed in 18.7% of the patients. Independent risk factors identified included age, fever, diabetes, hyperuricemia, bilateral calculi, functional solitary kidney, self-medication, and prehospital delay. The nomogram demonstrated excellent discriminatory capabilities, with AUCs of 0.818 (95% CI, 0.775-0.861) for the modeling set and 0.782 (95% CI, 0.708-0.856) for the validation set. Both calibration curve and HL test results confirmed strong concordance between the model's predictions and actual observations. DCA highlighted the model's significant clinical utility. CONCLUSIONS The predictive model developed in this study provides clinicians with a valuable tool for early identification and management of patients at high risk for AKI, thereby potentially enhancing patient outcomes.
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Affiliation(s)
- Yufeng Jiang
- School of Medicine, Tongji University, Shanghai, China
- Department of Urology, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | | | | | - Yuchao Liu
- School of Medicine, Tongji University, Shanghai, China
| | - Jing Li
- Department of Urology, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liuliu Zhou
- Medical Department, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Yan
- Department of Urology, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haimin Zhang
- Department of Urology, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Kurtz M, Pey PBM, Mortier J, Manassero M, Da Riz F, Canonne‐Guibert M, Maurey C, Benchekroun G. Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation. J Vet Intern Med 2024; 38:1542-1552. [PMID: 38669563 PMCID: PMC11099735 DOI: 10.1111/jvim.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed. HYPOTHESES Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases. ANIMALS A cohort of 125 cats (149 observations). METHODS This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis. RESULTS Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]). CONCLUSIONS AND CLINICAL IMPORTANCE Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.
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Affiliation(s)
- Maxime Kurtz
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Pascaline Bénédicte Marie Pey
- Antech Imaging ServicesIrvineCaliforniaUSA
- Veterinary Hospital “I Portoni Rossi,” Anicura, Zola Predosa (BO)BolognaItaly
| | - Jérémy Mortier
- Ecole Nationale Vétérinaire d'Alfort, CHUVAService D'Imagerie MédicaleMaisons‐AlfortFrance
| | - Mathieu Manassero
- École Nationale Vétérinaire d'Alfort, CHUVAService de ChirurgieMaisons‐AlfortFrance
| | - Fiona Da Riz
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Morgane Canonne‐Guibert
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'Alfort, CHUVAService D'Imagerie MédicaleMaisons‐AlfortFrance
| | - Christelle Maurey
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
| | - Ghita Benchekroun
- École Nationale Vétérinaire d'Alfort, CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'AlfortUniv Paris Est Créteil, INSERM, IMRBMaisons‐AlfortFrance
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Singh GK, Deshpande AV, Schlegel G, Starkey MR, Taghavi K. The rationale for bladder washouts in children with neurogenic bladder. Neurourol Urodyn 2024; 43:1019-1024. [PMID: 38516982 DOI: 10.1002/nau.25450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are at risk of colonization and development of antibiotic resistance. Bladder washouts with non-antibiotic electrochemically activated solutions are a potential new prophylactic option for patients with bladder dysfunction when clean intermittent catheterization has resulted in chronic bacteriuria.
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Affiliation(s)
- Gopal-Krsna Singh
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Aniruddh V Deshpande
- Department of Urology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- School of Public Health, Westmead, New South Wales, Australia
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gemma Schlegel
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Ronald Starkey
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kiarash Taghavi
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
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Tan S, Yuan D, Su H, Chen W, Zhu S, Yan B, Sun F, Jiang K, Zhu J. Prevalence of urolithiasis in China: a systematic review and meta-analysis. BJU Int 2024; 133:34-43. [PMID: 37696625 DOI: 10.1111/bju.16179] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To estimate the pooled prevalence, as well as the spatial and temporal distribution, of urolithiasis among subjects in China. MATERIALS AND METHODS We conducted a comprehensive search of both Chinese and English databases to retrieve literature pertaining to the prevalence of urolithiasis in the indigenous Chinese population. A random-effects meta-analysis model was employed to calculate the pooled prevalence of urolithiasis. Subgroup analyses were conducted based on factors such as time, region, gender, and sample size. Prevalence and spatial distribution maps were created based on provinces and latitude/longitude coordinates. RESULTS A total of 46 studies conducted in 22 provinces across China were included in this meta-analysis and the pooled prevalence of urolithiasis, kidney stones, ureteric calculi, urethral and bladder stones were 8.1% (95% confidence interval [CI] 5.6-11.1%), 7.8% (95% CI 5.8-10.0%), 3.2% (95% CI 0.6-5.7%), 0.5% (95% CI 0.1-0.9%). Most of the urolithiasis prevalence screening in China was concentrated between 100° E and 120° E, with higher rates observed in low latitude areas. Subgroup analysis of kidney stones revealed that Guangdong (12.7%) and Guangxi (10.3%) had the highest prevalence, with the eastern developed area exhibiting higher rates compared to the west. The prevalence in males was higher than in females (odds ratio 1.67, 95% CI 1.46-1.92), although the gender gap has significantly reduced since 2006. Moreover, a greater sample size is associated with a decreased prevalence of urolithiasis. CONCLUSIONS The prevalence of urolithiasis is increasing in China, and there are noteworthy regional or provincial disparities in occurrence. It is worth noting that the current number of screening studies in some areas is insufficient. Additional investigations with appropriate sample sizes should be supplemented in time.
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Affiliation(s)
- Songsong Tan
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Dongbo Yuan
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Hao Su
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Weihong Chen
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Siqi Zhu
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Bo Yan
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Fa Sun
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Kehua Jiang
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
| | - Jianguo Zhu
- Department of Urology, Guizhou Provincial People's Hospital, Guizhou, China
- Medical College of Guizhou University, Guiyang, Guizhou, China
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Yoo MJ, Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Infected urolithiasis. Am J Emerg Med 2024; 75:137-142. [PMID: 37950981 DOI: 10.1016/j.ajem.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence. DISCUSSION Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care. CONCLUSIONS An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Michael J Yoo
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT, Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Akpakli EA, Asante E, Kyei MY, Klufio K, Toboh B, Mensah JE. Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:94-101. [PMID: 38486658 PMCID: PMC10936895 DOI: 10.4103/jwas.jwas_86_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 03/17/2024]
Abstract
Background Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana. Materials and Methods This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches. Results The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30-39 years - 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1-2 days) with P < 0.0001. Conclusions Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.
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Affiliation(s)
| | - Emmanuel Asante
- Department of Surgery, University of Ghana Medical Centre, Accra, Ghana
| | | | - Kenneth Klufio
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bernard Toboh
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
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Ripa F, Massella V, Ong A, Mani Sinha M, Pietropaolo A, Somani BK. Role of Ureteroscopy (URS) and Stone Treatment in Patients with Recurrent UTIs: Outcomes over a 10-Year Period. J Clin Med 2023; 12:jcm12103591. [PMID: 37240697 DOI: 10.3390/jcm12103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Background. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. Methods. We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, with either a history of recurrent UTIs (rUTIs), urosepsis or pre-operative positive urine culture (UC). Data included patient demographics, microbiological data, stone parameters, stone-free and infection-free rates (SFR and IFR, respectively) at follow-up, defined as fragments <2 mm at imaging and the absence of symptoms and urine-culture-proven UTI. Results. Overall, 178 patients were selected. The median age was 62 years. The median cumulative stone size was 10 mm (7-17.25), and the commonest locations were the lower pole (18.9%) and proximal ureter (14.9%). The overall stone-free rate at follow-up was 89.3%. The IFR at 3 months was 88.3%. As follow-up duration increased, the IFR reduced to 85.4%, 74.2%, 68% and 65% at 6, 12, 18 and 24 months, respectively. Patients who had infection recurrence were more likely to present stone persistence or recurrence compared to those who were infection-free at follow-up (20% vs. 4.4%, p = 0.005). Conclusions. SFR after URS is a significant predicting variable for the likelihood of infection-free status at follow-up in patients with an rUTI or positive UC at the time of URS.
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Affiliation(s)
- Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Virginia Massella
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Andrea Ong
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Mriganka Mani Sinha
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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Shakoor S, Durojaiye OC, Collini PJ. Outcomes of outpatient parenteral antimicrobial therapy (OPAT) for urinary tract infections – A single center retrospective cohort study. CLINICAL INFECTION IN PRACTICE 2023. [DOI: 10.1016/j.clinpr.2022.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Lee J, Kottooran C, Hinojosa-González D, Yaghoubian A, Uppuluri N, Hanson K, Borofsky M, Eisner BH. Diabetes mellitus is associated with increased risk of positive qSOFA score but not with increased ICU admission in patients undergoing ureteral stent placement for ureteral stone and suspected infection. Can Urol Assoc J 2022; 16:430-434. [PMID: 36656692 PMCID: PMC9851227 DOI: 10.5489/cuaj.7896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Patients presenting with an obstructing ureteral stone and urinary tract infection (UTI) are at risk for severe infectious complications. Historically, diabetes mellitus (DM) was considered a risk factor for the development of septic shock in these patients. This study aimed to evaluate DM's impact on risk of septic shock in ureteral stent placement for ureteral stone and presumed UTI. METHODS An institutional review board-approved, retrospective review was performed at two institutions. All patients who met the following criteria from July 2016 to April 2020 were included in the study: emergency department visit with obstructing ureteral stone, concern for UTI, and ureteral stent placement. The primary outcome of interest was the development of postoperative septic shock defined by sepsis with hypotension requiring vasopressor support for at least one hour. RESULTS The study cohort was made up of 187 patients. Median age was 61 (range 16-91). Males represented 40.1% (n=75) of the population, while DM was present in 26.2% (n=49). Thirty-five of 143 patients (18.7%) met the criteria for postoperative septic shock. Quick Sequential Organ Failure Assessment (qSOFA) criteria were met by 11 (22.4%) patients with DM compared to 13 (9.5%) of patients without DM (p=0.026). This difference did not translate into significant differences in use of vasopressors, with DM cohorts requiring pressors in 11 (22.4%), and 241 (17.5%) in non-DM (p=0.523). Purulent urine was more frequently described in patients with DM (22 [44.9%] vs. 342 [4.8%], p=0.011). Intensive care unit (ICU) admissions were similar between DM and non-DM at 13(27.1%) vs. 29 (21.2%), respectively (p=0.543). ICU stay and length of stay were similar between cohorts. CONCLUSIONS In this multicenter study of patients who underwent ureteral stenting for ureteral stone and presumed UTI, DM was not associated with an increased risk of development of septic shock but was associated with an increased risk of positive qSOFA score.
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Affiliation(s)
- Jason Lee
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
| | - Christina Kottooran
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Alan Yaghoubian
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
| | - Nikkil Uppuluri
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Kate Hanson
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Micheal Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Brian H. Eisner
- Department of Urology, Massachusetts General Hospital, Boston, MA, United States
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Acute kidney injury secondary to urinary tract infection in kidney transplant recipients. Sci Rep 2022; 12:10858. [PMID: 35760823 PMCID: PMC9237017 DOI: 10.1038/s41598-022-15035-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/16/2022] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) in kidney transplant recipients (KTRs) is a common, yet poorly investigated, complication of urinary tract infections (UTI) and urosepsis. A retrospective comparative analysis was performed, recruiting 101 KTRs with urosepsis, 100 KTRs with UTI, and 100 KTRs without history of UTI or sepsis. The incidences of AKI in the urosepsis and UTI groups were 75.2% and 41%, respectively. The urosepsis group has also presented with a significantly higher prevalence of AKI stage 2 and 3 than the UTI group. The rates of recovery from AKI stages 1, 2 and 3, were 75,6%, 55% and 26.1%, respectively. Factors independently associated with renal recovery from AKI were: AKI severity grade (AKI stage 2 with OR = 0.25 and AKI stage 3 with OR = 0.1), transfusion of red blood cells (RBC) (OR = 0.22), and the use of steroid bolus in the acute phase of treatment (OR = 4). The septic status (urosepsis vs UTI) did not influence the rates of renal recovery from AKI after adjustment for the remaining variables. The dominant cause of RBC transfusions in the whole population was upper GI-bleeding. In multivariable analyses, the occurrence of AKI was also independently associated with a greater decline of eGFR at 1-year post-discharge and with a greater risk of graft loss. In KTRs with both urosepsis and UTI, the occurrence of AKI portends poor transplantation outcomes. The local transfusion policy, modulation of immunosuppression and stress ulcer prophylaxis (which is not routinely administered in KTRs) in the acute setting may be modifiable factors that significantly impact long-term transplantation outcomes.
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Ukashi O, Barash Y, Klang E, Zilberman T, Ungar B, Kopylov U, Ben-Horin S, Veisman I. Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection. J Clin Med 2022; 11:jcm11051359. [PMID: 35268450 PMCID: PMC8911438 DOI: 10.3390/jcm11051359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.
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Affiliation(s)
- Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Correspondence: ; Tel.: +972-35-305-000; Fax: +972-35-304-408
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Tal Zilberman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
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Hsiao CY, Chen TH, Lee YC, Wang MC. Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection. Sci Rep 2021; 11:23333. [PMID: 34857804 PMCID: PMC8639828 DOI: 10.1038/s41598-021-02647-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022] Open
Abstract
To identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on AKI in patients with UTI. This retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to April 2019. Of the 1113 participants enrolled, 191 (17.2%) had urolithiasis and 76 (6.8%) had ureteral stone complicated with hydronephrosis. Multivariate logistic regression analysis showed that in UTI patients with urolithiasis, the presence of ureteral stone with concomitant hydronephrosis was an independent risk factor for AKI (odds ratio [OR] 2.299, 95% confidence interval [CI] 1.112–4.755, P = 0.025). In addition, urolithiasis was associated with an increased risk for AKI (OR 2.451, 95% CI 1.369–4.389, P = 0.003) in UTI patients without hydronephrosis. The presence of ureteral stone with hydronephrosis increases the risk for AKI of UTI patients with urolithiasis, and urolithiasis remains a risk factor of AKI in UTI patients without hydronephrosis.
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Affiliation(s)
- Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Dimke H, Winther-Jensen M, Allin KH, Lund L, Jess T. Risk of Urolithiasis in Patients With Inflammatory Bowel Disease: A Nationwide Danish Cohort Study 1977-2018. Clin Gastroenterol Hepatol 2021; 19:2532-2540.e2. [PMID: 33007511 DOI: 10.1016/j.cgh.2020.09.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease (IBD) are suggested to be at increased risk of urolithiasis, but the magnitude of risk and the impact of medical and surgical treatment on this risk remain unknown. We therefore aimed to determine overall and treatment-related risk of urolithiasis in patients with IBD in a nationwide population-based cohort study. METHODS Using national registers, we identified all patients with IBD and all cases of urolithiasis in Denmark during 1977-2018. We obtained information on all IBD medications and surgical procedures during 1995-2018. IBD cases were matched 1:10 on age and sex to non-IBD individuals. RESULTS In total, 2,549 (3%) of 75,236 IBD patients and 11,258 (2%) of 767,403 non-IBD individuals developed urolithiasis, resulting in a 2-fold increased risk of urolithiasis (HR, 2.27; 95% CI, 2.17-2.38) in patients with IBD. The patients were also at increased risk of repetitive urolithiasis events (RR, 1.09; 95% CI: 1.04-1.15) and had increased risk of urolithiasis prior to IBD diagnosis (OR, 1.42; 95% CI: 1.34-1.50). After IBD diagnosis, risk of urolithiasis was associated with anti-TNF therapy and surgery. CONCLUSION Patients with IBD had a 2-fold increased risk of urolithiasis after IBD diagnosis and a 42% increased risk prior to IBD diagnosis. Risk was increased in anti-TNF exposed patients, and after surgery, suggesting that IBD severity per se and surgery, with altered intestinal absorption, increase risk of urolithiasis. Since stone formation is associated with adverse outcomes including sepsis, subpopulations of IBD patients, especially those undergoing strong immunosuppression might benefit from additional urolithiasis screening.
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Affiliation(s)
- Henrik Dimke
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Odense, Denmark.
| | - Matilde Winther-Jensen
- Section for Clinical Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Section for Clinical Epidemiology, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Lund
- Research Unit for Urology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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16
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Cui H. Distribution and drug resistance of pathogens causing urinary tract infection in patients with urinary calculi. Am J Transl Res 2021; 13:10554-10561. [PMID: 34650726 PMCID: PMC8507078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study set out to clarify the distribution and drug resistance of pathogens causing urinary tract infection (UTI) in patients with urinary calculi. METHODS Pathogens were isolated from urine samples of patients with urinary calculi also complicated with UTIs, during the period from 2015 to 2019, and the samples were cultured for drug sensitivity testing to study the drug resistance of pathogens. The results were analyzed by SPSS 22.0 software. RESULTS Gram-negative bacteria were the main pathogens found in patients with urinary calculi complicated with UTI (84.52%). Escherichia coli, Enterococcus faecalis and Monilia albicans were the most common Gram-negative bacteria (48.84%), Gram-positive bacteria (34.78%) and fungus (29.41%), respectively. The UTI rates were higher in female patients than in male patients, and were higher in patients ≥ 60 years old compared with those < 60 years old. Escherichia coli and Klebsiella pneumoniae had the highest resistance to ampicillin and the lowest resistance to imipenem. Enterococcus faecalis Enterococcus Faecium had the highest resistance to penicillin and ampicillin, but the lowest resistance to vancomycin and linezolid. CONCLUSION The present study found that the pathogenic bacteria found in patients with urinary calculi complicated with UTI are mainly Gram-negative bacteria; and Escherichia coli is the main pathogenic bacteria causing the infection. Gender and age may be risk factors for urinary calculi complicated with UTI. Antibiotics should be selected reasonably according to the drug resistance pattern of pathogenic bacteria in clinical anti-infection management.
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Affiliation(s)
- Haijun Cui
- Department of Urology Surgery, Tangshan Workers Hospital Tangshan 063000, Hebei Province, China
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17
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Huang H, Li M, Fan H, Bai R. Temporal Trend of Urolithiasis Incidence in China: An Age-Period-Cohort Analysis. Int J Gen Med 2021; 14:2533-2539. [PMID: 34163221 PMCID: PMC8214536 DOI: 10.2147/ijgm.s313395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Urolithiasis is one of the commonest disease of the urinary system. This study aimed to assess the long-term urolithiasis incidence trends in China between 1990 and 2019. Patients and Methods The incidence data of urolithiasis were extracted from Global Burden of Disease Study 2019, and an age–period–cohort framework was used to estimate the age, period, and cohort effects. Results We found that the net drift was −2.72% (95% CI: −2.84% to −2.60%) per year for men and −2.14% (95% CI: −2.24% to −2.05%) per year for women, and except men in age group 0–4, the local drift values were below 0 in all age groups (P<0.05 for all) in both sexes during the period of 1990 to 2019. In the same birth cohort, the risk of incidence from urolithiasis rose first and then decreased with age for both sexes after controlling for period deviations, and in addition, after 20 years old, the risk of incidence of urolithiasis in men was higher than that in women (significantly with P<0.05). In general, the estimated period and cohort relative risks were found in similar downward patterns for both sexes. Conclusion In the past 30 years, the age-standard incidence of urolithiasis in both sex of Chinese people has decreased, but the crude incidence of urolithiasis in Chinese women has increased. Considering the aging of population structure in China, the overall number of female urolithiasis patients may increase, contributes to higher crude incidence rate. The problem of urolithiasis in Chinese women needs to be paid more attention.
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Affiliation(s)
- Hui Huang
- Department of Dermatology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Minmin Li
- Department of Nutrition and Food Hygiene, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi, People's Republic of China
| | - Hourui Fan
- Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Ruhai Bai
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing, Jiangsu, People's Republic of China
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18
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Zhang L, Zhang F, Xu F, Wang Z, Ren Y, Han D, Lyu J, Yin H. Construction and Evaluation of a Sepsis Risk Prediction Model for Urinary Tract Infection. Front Med (Lausanne) 2021; 8:671184. [PMID: 34095176 PMCID: PMC8175780 DOI: 10.3389/fmed.2021.671184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/27/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Urinary tract infection (UTI) is one of the common causes of sepsis. However, nomograms predicting the sepsis risk in UTI patients have not been comprehensively researched. The goal of this study was to establish and validate a nomogram to predict the probability of sepsis in UTI patients. Methods: Patients diagnosed with UTI were extracted from the Medical Information Mart for Intensive Care III database. These patients were randomly divided into training and validation cohorts. Independent prognostic factors for UTI patients were determined using forward stepwise logistic regression. A nomogram containing these factors was established to predict the sepsis incidence in UTI patients. The validity of our nomogram model was determined using multiple indicators, including the area under the receiver operating characteristic curve (AUC), correction curve, Hosmer-Lemeshow test, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision-curve analysis (DCA). Results: This study included 6,551 UTI patients. Stepwise regression analysis revealed that the independent risk factors for sepsis in UTI patients were congestive heart failure, diabetes, liver disease, fluid electrolyte disorders, APSIII, neutrophils, lymphocytes, red blood cell distribution width, urinary protein, urinary blood, and microorganisms. The nomogram was then constructed and validated. The AUC, NRI, IDI and DCA of the nomogram all showed better performance than traditional APSIII score. The calibration curve and Hosmer-Lemeshow test results indicate that the nomogram was well-calibrated. Improved NRI and IDI values indicate that our nomogram scoring system is superior to other commonly used ICU scoring systems. The DCA curve indicates that the DCA map of the nomogram has good clinical application ability. Conclusion: This study identified the independent risk factors of sepsis in UTI patients and used them to construct a prediction model. The present findings may provide clinical reference information for preventing sepsis in UTI patients.
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Affiliation(s)
- Luming Zhang
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Feng Zhang
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Zichen Wang
- Department of Public Health, University of California, Irvine, Irvine, CA, United States
| | - Yinlong Ren
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Haiyan Yin
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
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AL-Nasser K, Neel A, Alyami F, Al-Barraq K, Alsheheli M, Alomar M, Althunayan A, Binsaleh S, Almannie R. Demographic variability of urinary tract stones in Saudi Arabia. JOURNAL OF NATURE AND SCIENCE OF MEDICINE 2021. [DOI: 10.4103/jnsm.jnsm_106_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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