Clinical characteristics and short-term outcomes of adult patients with urolithiasis: first report from Somalia

OBJECTIVE

This study aimed to investigate the data of adult patients admitted to the only tertiary care center in Somalia with the diagnosis of urolithiasis and to present the first report from this Sub-Saharan African country.

PATIENTS AND METHODS

This study was designed as a retrospective single-center study conducted in Somalia Turkiye Training and Research Hospital. Adult patients who received the diagnosis of urolithiasis and who were admitted to the urology department constituted the target population. Reviewed data included demographic parameters, stone features, type of surgical procedure, intraoperative and early postoperative complications, and inpatient mortality.

RESULTS

Overall, 3,680 patients were admitted during the study period. Among these, 620 (17%) patients were admitted due to urolithiasis. There was a significant male predominance with a male-to-female ratio of 3.4:1. Urinary bladder was the most common stone location (n=253, 40.8%), followed by the kidney (n=223, 35.9%). The mean stone diameter was 22.41 (5-64); most (39.4%) of the patients had a stone diameter between 20 and 30 mm, while 27.5% had stones with diameters between 10 and 20 mm. Minimally invasive procedures were the primary surgical modality in 52.6% (n=326) of our patients. However, 45.9% (n=285) of the patients underwent open surgery.

CONCLUSIONS

The rate of adults with urolithiasis is relatively high in Somalia, as in many other African countries, with a significant male predominance. Although open surgery is rarely used for treating adult urolithiasis in industrialized countries, this approach is still commonly used in Somalia, similar to other parts of Africa.

Our kidneys and teeth may be closer than we think: relationship between dental calculi and renal stone burden grading in a patient series from Somalia

OBJECTIVE

This study investigated the correlation between dental calculi grading and renal stone burden grading.

PATIENTS AND METHODS

This study was designed as an observational single-center study and included consecutive patients with radiologically confirmed renal stones at our center between January 2022 and July 2022. These patients were referred to the dentistry clinic for a dental examination to assess dental calculi and oral hygiene. Investigated parameters included demographic characteristics, renal stone location and diameter, urine pH, and dental evaluation findings (teeth brushing habits, oral hygiene, and dental calculi). Renal stone burden grade and dental calculi grade were calculated, and Spearman's rank-order correlation analysis was used for correlation analyses.

RESULTS

Overall, 204 patients were included. The mean patient age was 36.3±15.2. Approximately half of the patients (49.2%) had multiple stones. About 36% of the participants had high-grade dental calculi, while 29.4% had intermediate low-grade dental calculi. Oral hygiene was significantly associated with dental calculi grade (p<0.001). The dental calculi grade was positively and moderately correlated with the renal stone diameter (Spearman's rho=0.493, p<0.001). Among patients with a renal stone diameter greater than 20 mm, intermediate to high-grade dental calculi were found in 88.4%. This proportion was 49.1% for those with a renal stone diameter smaller than 20 mm.

CONCLUSIONS

Dentists should consider the presence of undiagnosed kidney stones in patients with especially intermediate or high-grade dental calculi. Urologists should know that patients with large and multiple kidney stones may have dental calculi.

Does Post-COVID-19 Erectile Dysfunction Improve over Time?

BACKGROUND

Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase in the frequency of erectile dysfunction among individuals with a history of COVID-19, and, if there was, whether their condition improved over time.

MATERIALS AND METHODS

In this study, a total of 125 healthy male healthcare workers, 95 with and 30 without a history of COVID-19, were evaluated in terms of erectile function. Four study groups were formed. The first three groups consisted of individuals with a history of COVID-19 confirmed by the polymerase chain reaction (PCR) test at different times, who recovered from the disease (time elapsed since COVID-19 positivity: <6 months for Group 1, 6 to 12 months for Group 2, and >12 months for Group 3). The individuals in Group 4 did not have a history of COVID-19 diagnosis. In order to evaluate the erectile function of the participants, they were asked to complete the five-item International Index of Erectile Function questionnaire (IIEF-5). Then, statistical analyses were performed to evaluate whether there was a difference between the groups in terms of the IIEF-5 scores.

RESULTS

There was a statistically significant difference between the groups in terms of the IIEF-5 scores (p < 0.001), and this difference was determined to be caused by the significantly higher IIEF-5 scores of Groups 3 and 4 compared to Group 1 (p = 0.004 and p < 0.001, respectively). In addition, the IIEF-5 score of Group 4 was statistically significantly higher than that of Group 2 (p < 0.001). However, the IIEF-5 scores did not statistically significantly differ between Groups 1 and 2, Groups 2 and 3, and Groups 3 and 4 (p > 0.999, p = 0.204, and p = 0.592, respectively).

CONCLUSION

There may be deterioration in erectile function after COVID-19; however, this tends to improve over time, especially from the first year after active infection. Given that vascular, hormonal, and/or psychogenic factors may lead to the development of erectile dysfunction after COVID-19, we consider that in order to easily manage this process, it is important to determine the underlying cause, initiate appropriate treatment, and inform couples that this situation can be temporary.

Epidemiological and Histopathological Characteristics of Renal Cell Carcinoma in Somalia

Background

Objective

Methods

Results

Conclusion

Antimicrobial Susceptibility Profile of Fosfomycin and Nitrofurantoin despite Dissemination of Fluoroquinolones and Trimethoprim/ Sulfamethoxazole Resistant Urinary Tract Isolates

The widespread growth  of multidrug-resistant (MDR), extended drug resistant (XDR) uropathogens and the shortage of new antimicrobials are the most significant obstacles challenging the treatment of urinary tract infections. The study is aimed to identify the antimicrobial susceptibility profile against MDR and XDR uropathogens. A total of 2485 urine samples were processed from 2267 patients, 361 uropathogens were grown. The antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method, following the Clinical and Laboratory Standards Institute’s guidelines. Eighty-nine percent of the samples had Multidrug-resistant microorganisms, while 32% had XDR uropathogens. In comparison to fluoroquinolones and trimethoprim/sulfamethoxazole, fosfomycin and nitrofurantoin demonstrated a significantly higher sensitivity rate against uropathogens, including MDR and XDR uropathogens, in both gender groups with community-acquired and nosocomial UTIs (P<0.001). Fosfomycin revealed the highest sensitivity rate, about 94.8%. Klebsiella pneumonia and E. coli showed the highest resistance rate against fosfomycin in 3.7% and 3.4% of the cases. Nitrofurantoin showed a similar sensitivity rate both in community and hospitalized patients in 86.1%. Fluoroquinolones (61%) and trimethoprim/sulfamethoxazole (86.6%) revealed the highest resistance rate against uropathogens. The prevalence of extended-spectrum beta-lactamases producing pathogens was 10.2%. Fosfomycin and nitrofurantoin revealed a higher sensitivity rate against gram-negative MDR uropathogens in community and nosocomial UTIs compared to fluoroquinolones and trimethoprim/sulfamethoxazole.

Factors affecting the effectiveness and success of retrograde holmium laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults

PURPOSE

To evaluate the factors affecting the effectiveness, safety, and success of retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults.

METHODS

Adult patients who underwent retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction between January 2012 and June 2016 at our clinic were retrospectively analyzed. Success was defined as the relief of symptoms and the resolution of obstruction, as assessed via radiography. Factors affecting success were analyzed, such as the clinical characteristics, procedural outcomes, complications, and the type of ureteroscopy used in the procedure.

RESULTS

Procedural success was achieved in 29 (74.4%) out of 39 patients, with a mean age of 38.3 ± 12.3 years during a median follow-up duration of 44 (33-65) months. Failure occurred at a median of 4.5 (3-22) months. It was detected that the presence of primary obstruction, ipsilateral kidney function being >30% of normal, and the length of obstruction being <1 cm positively affected procedural success (p = 0.009, p = 0.011, and p = 0.019, respectively). In the postoperative period, two Grade I and four Grade II complications were observed according to the Clavien-Dindo classification. There was a difference only in the operation time between semirigid (24) and flexible ureteroscopes (15), with the operation time being shorter with the use of a semirigid ureteroscope than with the use of a flexible uteroscope (p < 0.001).

CONCLUSION

Retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy is a minimally invasive method that can be used effectively and safely as the primary treatment of patients with ureteropelvic obstruction, when long-term results are also taken into consideration. The decision of performing laser endopyelotomy should be made after a detailed evaluation of the characteristics of the patient as well as of the obstruction.

Successfully managed grade IV renal injury and retained bullet in third-trimester pregnant woman

Gunshot injury to the kidney in pregnant women is extremely rare describing a significant cause of maternal and fetal morbidity and mortality. This case report demonstrates the management of renal trauma by presenting 24years old third-trimester pregnant women who sustained gunshot wounds to the abdomen. Renal trauma management has evolved in the last decades from immediate surgical exploration to non-operative management (NOM). Based on our patient's outcome, we review the role of conservative management to a high grade of penetrating renal trauma which is potentially life-threatening describing the safety of this approach.

Synthesis and pharmacology of new dithiocarbamic acid esters derived from phenothiazine and diphenylamine

2-Methylthio-10-[(N,N-disubstituted-thiocarbamoylthio)acetyl]- phenothiazines (4a-g) and N-(3-methylthiophenyl)-N-[(N,N-disubstituted- thiocarbamoylthio)acetyl]phenylamines (5a-g) were synthesized by subsequent treatment of 2-methylthio- 10-chloroacetylphenothiazines (1) and N-(3-methylthiophenyl)-N-chloroacetylphenylamine (2) with potassium salts of N,N-disubstituted dithiocarbamic acid derivatives (3a-i). The structures of the compounds were determined by analytical and spectral (IR, 1H NMR, 13C NMR, EIMS) methods. The antihistaminic and anticholinergic activities of 4a, 4c, 4e-g, 5a-c, 5e, and 5 g were evaluated in comparison with H1-receptor antagonist mepyramine and nonselective cholinergic antagonist atropine. In the first series of experiments, the cumulative concentration-response curves to histamine (10(-8)-10(-4) M) and acetylcholine (10(-8)-10(-4) M) were constructed in seperate fundus strips. The test compounds exhibited marked antihistaminic activity at 10(-6) M concentration but compounds did not influence acetylcholine induced contractions. Concentration-related experiments carried out on 4 g and 5 g revealed that a moderate antihistaminic activity was present at 10(-7) M concentration of the compounds and became strong at higher concentrations. In the second series of experiments, the cumulative concentration-response curve to histamine (10(-9)-10(-4) M) was constructed in guinea-pig ileum segments. Maximal responses were obtained by 10(-6)-3 x 10(-6) M concentrations of histamine in ileum segments. Similar inhibitions of histamine contractions were also obtained with the test compounds. Their inhibitory effectiveness was evaluated by comparing the pA2 values.

Subtypes of muscarinic receptors in rat duodenum: a comparison with rabbit vas deferens, rat atria, guinea-pig ileum and gallbladder by using imperialine

The specific binding of [3H]QNB to rat duodenum smooth muscle membranes was a saturable process and Scatchard transformation of the saturation curves indicated a linear plot (nH = 1.017+/-0.071). The K(D) and Bmax values were 0.168+/-0.025 nM and 46.7+/-8.6 fmol/mg protein, respectively. Analyses of competition curves using pirenzepine and guanylpirenzepine indicated more than one class of binding site. A minor population of muscarinic binding sites showed high affinity (M1) for both pirenzepine (19.3+/-1.2%; pKi = 8.29+/-0.36) and guanylpirenzepine (29.4+/-2.0%; pKi = 7.28+/-0.11). The antagonistic affinity values of pirenzepine and guanylpirenzepine for the remaining low affinity binding sites, and that of methoctramine indicated the presence of both M2 and M3 subtypes. McN-A-343 produced relaxations in rat duodenum and inhibited twitch contractions of rabbit vas deferens induced by electrical stimulation in a concentration dependent manner. Carbachol (Cch) exerted concentration-dependent negative inotropic effect in rat atria and contractile effects in guinea-pig gallbladder and ileum longitudinal muscle-myenteric plexus preparation. Imperaline displaced the concentration-response curves to McN-A-343 and Cch to the right in parallel, without affecting the maximum responses in all tissues studied. The rank order of the pA2 values was rabbit vas deferens > rat atria > guinea-pig gallbladder = guinea-pig ileum > rat duodenum. The presynaptic muscarinic receptors at the rat duodenum and rabbit vas deferens were concluded to be of M1 and M4 subtypes, respectively.

Functional hyperemia in striated muscle is reduced following blockade of ATP-sensitive potassium channels

This study was designed to determine the role of ATP-sensitive potassium channels in the control of the arteriolar diameter during functional hyperemia. The hamster cremaster muscle was prepared for in vivo microscopy and stimulated electrically for 1 min before and after topical application of 10 microM glibenclamide to block ATP-sensitive potassium channels. Glibenclamide treatment resulted in a small, though not significant, decrease in resting arteriolar diameter (P > 0.05). Glibenclamide almost completely inhibited the vasodilation of the first-order and the third-order arterioles in response to topical application of 1 microM cromakalim (P < 0.05). During muscle stimulation, the first-order arterioles dilated from 69 +/- 3 to 89 +/- 3 microns (n = 7), and the third-order arterioles dilated from 16 +/- 1 to 35 +/- 2 microns (n = 7). In this set of experiments glibenclamide treatment resulted in a significant decrease (approximately 4 microns) in the resting diameters of the first-order arterioles, but had no significant effect on the resting diameter of third-order arterioles. Glibenclamide treatment significantly attenuated the vasodilation associated with muscle contraction to 72 +/- 3 and to 21 +/- 3 microns, respectively (P < 0.05). These results suggests that ATP-sensitive potassium channels are an important mediator in the vasodilatory response to muscle stimulation in the hamster cremaster muscle.

Role of endothelium-derived relaxing factors in arteriolar dilation during muscle contraction elicited by electrical field stimulation

OBJECTIVE

To determine the contribution of either endothelium-derived nitric oxide (EDNO) or prostaglandins in the functional vasodilation of first-order arterioles of the hamster cremaster muscle.

METHODS

First-order arterioles dilated from 72 +/- 3 microns to 93 +/- 4 microns in response to contraction of the cremaster muscle for 1 min (n = 7). After EDNO inhibition by topical application of 10 microM NW-nitro-L-arginine methyl ester (L-NAME), the resting diameter decreased to 66 +/- 3 microns and functional dilation was attenuated to 75 +/- 3 microns (P < 0.05). When the arteriolar diameter was returned to the control values by the addition of sodium nitroprusside, an NO donor, into the superfusion solution (n = 7), functional dilation was similar to that observed before EDNO inhibition (91 +/- 3 microns vs. 89 +/- 3 microns, P > 0.05). To evaluate whether the vasoconstrictor effect of L-NAME on functional dilation is same as other vasoconstrictors, norepinephrine was applied on the cremaster muscle to induce a vasoconstriction (72 +/- 2 to 66 +/- 1 micron, n = 7) equivalent to L-NAME.

RESULTS

Norepinephrine treatment attenuated functional dilation to 77 +/- 3 microns which was to a level similar to L-NAME treatment (P > 0.05). Inhibition of prostaglandin synthesis by topical application of indomethacin (28 microM) resulted in no significant changes in the resting diameter but functional vasodilation was attenuated from 89 +/- 2 to 81 +/- 3 microns (n = 7, P < 0.05).

CONCLUSIONS

These results suggest that EDNO is important for the resting tone of arterioles and that prostaglandins are important in modulating the functional dilation of the first-order arterioles in the hamster cremaster muscle.

Role of venular endothelium in control of arteriolar diameter during functional hyperemia

This study was designed to determine the importance of the venular endothelium in the vasodilation of adjacent arterioles during functional hyperemia. The hamster cremaster muscle was prepared for in vivo microscopy. Two silver-silver chloride electrodes were placed across the pedicle of the cremaster muscle, and a square-wave pulse (10 V amplitude, 1 ms duration, and 1 Hz frequency) was used to elicit muscle contraction. Muscle stimulation for 1 min resulted in a vasodilation of the first-order arterioles from 74 +/- 2 to 91 +/- 2 microns (n = 9, P < 0.05). After perfusion of the venule with air to disrupt the venular endothelium, there was no significant effect on the resting diameter, 73 +/- 3 microns, but the vasodilation associated with the muscle stimulation was significantly attenuated to 82 +/- 3 microns (P < 0.01). After completion of these experiments, the disruption of venular endothelium was confirmed by electron microscopy. The functional vasodilation of arterioles adjacent to venules with an intact endothelium (venules in which air did not enter) was retained after air perfusion (n = 6). These results suggest that the presence of the venular endothelium is important for the arteriolar vasodilation during functional hyperemia. We propose that the venular endothelium releases a relaxing factor responsible for a portion of the functional arteriolar vasodilation.

Role of EDRFs in the control of arteriolar diameter during increased metabolism of striated muscle

This experiment was designed to determine the role that the release of endothelium-derived relaxing factors (EDRFs), endothelium-derived nitric oxide (EDNO), or prostaglandins have in the control of arteriolar vasodilation during an increased metabolic rate in striated muscle. A silicone stopcock grease dam was placed across the distal portion of the cremaster muscle of pentobarbital-anesthetized hamsters to localize the application of the metabolic stimulator 2,4-dinitrophenol (DNP). Application of DNP (10 mM) to the distal region resulted in significant increases in red cell velocity (from 6 +/- 1 to 10 +/- 2 mm/s) and arteriolar diameter (from 75 +/- 3 to 91 +/- 5 microns) (P < 0.05; n = 6) in the first-order arterioles located approximately 11 mm upstream from the silicone dam. Administration of N omega-nitro-L-arginine methyl ester (L-NAME; 2 mg iv) resulted in significant vasoconstriction of the first-order arterioles and a significant decrease in the vasodilator response to acetylcholine (1 microM). Addition of sodium nitroprusside (380 microM) to the superfusion solution during L-NAME treatment resulted in a return of arteriolar diameter to control levels. DNP treatment during L-NAME and sodium nitroprusside treatment did not inhibit the arteriolar vasodilation [75 +/- 3 to 87 +/- 4 microns (P > 0.05)] after a significant increase in red cell velocity from 7 +/- 1 to 11 +/- 1 mm/s. Before indomethacin treatment, DNP treatment resulted in an increase in arteriolar diameter from 72 +/- 3 to 90 +/- 3 microns, preceded by an increase in red cell velocity from 6 +/- 1 to 10 +/- 1 mm/s.(ABSTRACT TRUNCATED AT 250 WORDS)

Importance of venular flow in control of arteriolar diameter in hamster cremaster muscle

These experiments tested the hypothesis that an intact venular flow is important for the control of upstream arteriolar diameter during an increase in metabolism. A silicone stopcock grease dam was placed across the distal portion of the cremaster muscle to localize treatment of the metabolic stimulator 2,4-dinitrophenol (DNP). Thus only the distal area would have an increased metabolic rate, with the proximal area of the cremaster having a normal metabolic rate. During DNP treatment, the first-order venule, approximately 5 mm proximal to the Silastic dam, was occluded to prevent the transport of metabolites. DNP treatment (10 mM) resulted in a significant increase in the arteriolar diameter from 75 +/- 3 to 90 +/- 4 microns (n = 7, P < 0.05), 12.1 +/- 0.3 mm upstream from the distal region. After venular occlusion, arteriolar diameter decreased to 78 +/- 3 microns (P < 0.05). As an additional test of our hypothesis we altered the experimental sequence. DNP treatment during venular occlusion did not affect arteriolar diameter, but after release of the occlusion there was a significant increase in arteriolar diameter from 78 +/- 3 to 91 +/- 4 microns (P < 0.05). These results suggest that an intact venular flow is necessary for control of arteriolar diameter during an increased metabolic rate caused by DNP treatment, providing evidence for the significance of the venular-arteriolar diffusion of vasoactive metabolites.

Differences in EDNO contribution to arteriolar diameters at rest and during functional dilation in striated muscle

This study was designed to determine the physiological role of endothelium-dependent nitric oxide (EDNO) in the control of arteriolar diameter during rest and muscle stimulation. Diameters of first-, second-, and third-order arterioles in the superfused hamster cremaster muscle were measured before and throughout 1 min of field stimulation before and after inhibition of EDNO release. ENDO inhibition by intravenous N omega-nitro-L-arginine methyl ester (L-NAME) significantly attenuated the arteriolar vasodilation in response to 1 microM acetylcholine. First-order arterioles averaged 65 +/- 5 microns at rest and dilated to 86 +/- 6 microns during muscle stimulation (n = 9), second-order arterioles averaged 45 +/- 6 microns and dilated to 72 +/- 3 microns during muscle stimulation (n = 6), with third-order arterioles averaging 29 +/- 2 microns, and dilating to 53 +/- 3 microns during muscle stimulation (n = 7). EDNO inhibition significantly decreased both the resting diameter of first-order arterioles (57 +/- 4 microns) and functional dilation (68 +/- 3 microns; P < 0.05). EDNO inhibition had no effect on the resting diameter of second-order arterioles (45 +/- 5 microns) yet significantly attenuated the functional dilation (64 +/- 4 microns; P < 0.05). EDNO inhibition had no effect on either the resting diameter of third-order arterioles (30 +/- 2 microns) or the functional dilation (49 +/- 2 microns).(ABSTRACT TRUNCATED AT 250 WORDS)