Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data

BACKGROUND

We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene.

MATERIAL AND METHODS

A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated.

RESULTS

Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ± 2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality.

CONCLUSION

Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes

Background

The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT).

Methods

Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded.

Results

98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group.

Conclusion

Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study

OBJECTIVES

Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients.

DESIGN

In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given.

PARTICIPANTS

Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients.

MEASUREMENTS

Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group.

RESULTS

The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both).

CONCLUSION

Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

Evaluation of Retinal and Choroidal Microcirculation Alterations After a Single Dose of Oral 5-mg Tadalafil: A Prospective Pilot Optical Coherence Tomography Angiography Study

Purpose: To evaluate the effects of a single dose of oral 5-mg tadalafil on macular microcirculation as measured using optical coherence tomography (OCT) and angiography (OCTA) in healthy volunteers. Methods: Twenty-two healthy, middle-aged, sexually active, and male health care worker volunteers were included in this prospective study. All volunteers have a history of occasionally using off-label 5 mg tadalafil to enhance sexual performance. Superficial and deep capillary plexus vascular densities, foveal avascular zone parameters, outer retina, and choriocapillaris flow areas were performed using the OCTA, and subfoveal-choroidal thickness (CT) was performed by using the OCT. Measurements were performed preintake, 30 min, 1, 4, 24 h, 2, 3, 4, and 7 days after the intake of tadalafil off-label. Results: Twenty-two eyes of 22 male volunteers were included in the study. The mean age was 37.16 ± 4.52 years. At 30 min, 1 h, and 4 h after intake, a statistically significant increase was observed in the choriocapillaris flow area and CT compared with preintake (Friedman test, P = 0.034 and P < 0.001, respectively). Conclusion: This study showed that a single dose of oral 5-mg tadalafil causes an increase in choriocapillaris flow and CT. To evaluate the effects of tadalafil on the retina and choroid, an OCTA assessment may be helpful.

Does the duration between urine culture and percutaneous nephrolithotomy affect the rate of systemic inflammatory response syndrome postoperatively?

This study aimed to evaluate the preoperative and intraoperative factors that may cause systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to investigate the effect of the duration between urine culture (UC) and operation on postoperative SIRS. Three hundred and fifty-six patients who had PCNL between January 2015 and June 2019 were retrospectively included in the study. UC was obtained from all patients before the operation and during the puncture at the beginning of the operation. Postoperatively, patients were closely monitored for fever and other signs of SIRS. The post-PCNL SIRS incidence was 7%. In univariable and multivariable analyses, the rate of ipsilateral PCNL history, recurrent urinary tract infection (UTI) history, operation time and the length of hospital stay were significant predictive factors for SIRS. The duration between UC and PCNL was not a statistically significant variable in both univariable and multivariable analysis. Our study concluded that the duration between UC and PCNL is not an influential factor for post-PCNL SIRS. Clarifying this issue may be possible with prospective studies in which the effects of factors such as ipsilateral PCNL history and recurrent urinary tract infection history which has been proven to be risk factors for post-PCNL SIRS are restricted.

The role of fetuin-A in cardiac functions and metabolism in peritoneal dialysis patients

AIM

Fetuin-A is a member of protease inhibitors that act as an inhibitor of vascular calcification. In our study, the relationship of fetuin-A with metabolic and echocardiographic parameters in peritoneal dialysis (PD) patients has been investigated.

METHODS

Besides demographic, clinical and laboratory data, fetuin-A level was recorded. Echocardiographic examinations were performed by the same operator.

RESULTS

Fifty-two chronic PD patients (mean age: 52.7 ± 15.4 years) and 31 healthy volunteers (mean age: 41.3 ± 10.7 years) were included. Fetuin-A levels were significantly lower in the patient group (57.5 ± 31.5 ng/mL vs. 72.5 ± 34.0 ng/mL, P = 0.002). There was a significant relation between age and fetuin-A levels (P = 0.025). Four patients with chronic heart failure had significantly lower fetuin-A levels compared with those without. There was no relation between fetuin-A levels and the presence of diabetes mellitus, left ventricular hypertrophy and ischemic heart disease. No relationship was detected between fetuin-A level and any echocardiographic parameter. Age and hematocrite were correlated negatively, and serum albumin positively with fetuin-A levels. On linear regression analysis, fetuin-A level was related with age, hematocrite and presence of heart failure.

CONCLUSION

PD patients with heart failure have significantly lower fetuin-A levels. Age is a main determinant of fetuin-A level and fetuin-A may act as a negative acute phase reactant in PD patients.

An Abandoned Copper Mining Site in Cyprus and Assessment of Metal Concentrations in Plants and Soil

Mining is an important source of metal pollution in the environment and abandoned mines are extremely restricted habitats for plants. Some plant species growing on metalliferous soils around mine tailings and spoil-heaps are metal-tolerant and accumulate high concentrations of metals. In this investigation, we aimed to perform a research in the CMC-abandoned copper mining area in Lefke-North Cyprus to assess the recent metal pollution in soil and plant systems. We collected 16 soil samples and 25 plant species from 8 localities around the vicinity of tailing ponds. Some concentrations of metals in soil samples varied from 185 to 1023 mg kg(-1) Cu, 15.2 to 59.2 mg kg(-1) Ni, 2.3 to 73.6 mg kg(-1) Cd and metals for plants ranged from 0.135 to 283 mg kg(-1) Cu, 0.26 to 31.2 mg kg(-1) Ni, 0.143 to 277 mg kg(-1) Cd. Atriplex semibaccata, Acacia cyanophylla, Erodium spp., Inula viscosa, Juncus sp., Oxalis pes-caprea, Pistacia lentiscus, Senecio vulgaris and Tragopogon sinuatus accumulated higher concentrations. BCF for Atriplex semibaccata was found very high, for this reason this plant can tentatively be considered as a hyperaccumulator of Cu and Cd, but it needs further investigation for its potential in phytoremediation.

The Relationship between Plasma Soluble Tnf-like Weak Inducer of Apoptosis Level and Inflammatory Markers in Patients with Type 2 Diabetes Mellitus

Soluble TNF-like weak inducer of apoptosis (sTWEAK) is a member of the TNF super family with many biological activities. There is a limited number of studies on the role of sTWEAK in chronic kidney disease. We aimed in this study to examine the relation of sTWEAK with albuminuria and inflammatory markers in patients with type 2 diabetes mellitus (DM). One hundred and eighteen diabetic patients with varying levels of albuminuria were included. Group 1 comprised patients with albuminuria less than 30 mg/day, while Group 2 and Group 3 were composed of patients with albuminuria between 30–300 mg/day or more than 300 mg/day, respectively. Groups were compared for sTWEAK levels besides demographic, clinical and biochemical data. There was no difference between groups regarding sTWEAK and TNF-α levels. IL-1 levels in Group 1 were higher than in Group 3. hsCRP levels were significantly higher in Group 3 compared to other groups. Use of a renin angiotensin system blocker did not have any effect on sTWEAK, TNF-α and hsCRP levels, while IL-1 level was significantly lower in patients using a renin angiotensin blocker. A statistically significant positive correlation was detected between sTWEAK and IL-1 levels (r=0.245; p=0.008). The groups were found to be similar regarding sTWEAK and TNF-α level. This finding may be interpreted as there being no effect of proteinuria on sTWEAK levels. But the close correlation between proteinuria and IL-1, and between IL-1 and sTWEAK may be a clue for an indirect relationship. Lack of difference between groups regarding sTWEAK levels may be due to involvement of patients with GFR more than 60 ml/minute only.

The Relationship between Soluble Tumor Necrosis Factor-like Weak Inducer of Apoptosis Levels and Cardiac Functions in Peritoneal Dialysis Patients

Tumor necrosis factor (TNF)-like weak inducer of apoptosis (sTWEAK) levels has been reported to be decreased in patients on hemodialysis (HD) and patients with heart failure. We aimed to study the relationship between sTWEAK levels and cardiac functions in peritoneal dialysis (PD) patients. This cross-sectional study was carried out on patients on chronic PD programs for more than three months. Patients aged under 18 or over 80 years, patients with overt cardiac disease, overt hypervolemia, active systemic infection, malignancy, peritonitis within the last month were excluded. The patient group was compared with the control group including healthy adults aged 24–61 years. Fifty-two PD patients were included in the study (mean age: 52.7±15.4 years; female/male ratio: 30/22). The corresponding data of the control group were 41.3±10.7 years and 17/14. There was no statistically significant difference between demographic parameters of the groups except age. The mean sTWEAK level of the patient and the control groups were similar (564±17 pcg/ml vs 535±126 pcg/ml, p=0.419). No correlation was detected between any of the demographic variables and sTWEAK levels. Among the echocardiographic parameters, only ejection fraction was found to be correlated negatively with sTWEAK levels. Patients with ischemic heart disease (IHD) and heart failure had significantly higher sTWEAK levels compared with the patients without these diseases. With linear regression analysis, only age and the presence of heart failure were found to be the independent determinants of sTWEAK levels. Level of sTWEAK is significantly high in PD patients with heart failure and IHD. sTWEAK may be a marker of cardiac functions in PD patients.

Is Pentraxin-3 Stronger Than C-Reactive Protein to Determine Inflammation in Peritoneal Dialysis Patients?

Pentraxin-3 (PTX-3) is the prototype of long pentraxins and is produced by many tissues and organs including vascular endothelial cells in response to pro-inflammatory signals. It is thought to be an independent indicator of disease activity. We analyzed the correlation of PTX-3 with other markers of inflammation in peritoneal dialysis (PD) patients. Non-diabetic patients on chronic PD program who meet the dialysis adequacy criteria and who had no active infectious/inflammatory disease were included. Demographic and clinical parameters were recorded as well as hsCRP, fibrinogen, interleukin-6 (IL-6) and PTX-3 levels; and the correlation between them were studied. Twenty-five patients (mean age: 45.7±12.5 years; female/male ratio: 16/9) were included. Mean PTX-3 level was 2.16±2.76ng/ml. PTX-3 was found to be correlated positively with only IL-6 among inflammatory markers (r=0.827; p<0.001) but not with hsCRP. With linear regression model, IL-6 was the only independent determinant of PTX-3 levels. PTX-3 may be a more valuable marker of inflammation than CRP in patients on PD.

Effectiveness of acupuncture in patients with category IIIB chronic pelvic pain syndrome: a report of 97 patients

OBJECTIVE

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is of significant interest in urology and unfortunately, the therapy modalities recommended are not fully effective. Therefore, we undertook a pilot study to determine whether acupuncture improves the pain, voiding symptoms, and quality of life in men with category IIIB CP/CPPS.

DESIGN

Prospective, one-group trial, cohort study.

SETTING

Outpatient urology clinic.

PATIENTS AND INTERVENTIONS

Ninety-seven CP/CPPS patients received six sessions of acupuncture to the BL-33 acupoints once a week. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was completed by each patient before and after the treatment and on 12th and 24th weeks following the treatment.

OUTCOME MEASURES

Mean values of total CPSI score, pain subscore, urinary subscore, and quality of life subscore after the treatment and on follow-up after the treatment were compared with the baseline values.

RESULTS

There was a statistically significant decrease in all of the subscores evaluated at all periods compared with the baseline. Eighty-six patients out of 93 (92.47%) were NIH-CPSI responders (more than 50% decrease in total NIH-CPSI score from baseline) at the end of the treatment.

CONCLUSIONS

The results of this study suggest that acupuncture appears to be a safe and potentially effective treatment in improving the symptoms and quality of life of men clinically diagnosed with CP/CPPS.