scholarly journals Understanding failures in getting it up: The prevalence and predictors of failed ureteral access in ureteroscopy

2020 ◽  
Vol 15 (3) ◽  
Author(s):  
Callum A. Lavoie ◽  
Max Levine ◽  
Trevor D. Schuler ◽  
Timothy A. Wollin ◽  
Shubha De
Keyword(s):  
Outcome Data ◽  
Ureteral Stones ◽  
Stone Size ◽  
Chi Square ◽  
Test Analysis ◽  
Significant Difference ◽  
Stone Treatment ◽  
Treatment Use ◽  
Improve Patient ◽  
First Diagnosis

Introduction Failed Access ureteroscopy (FA) describes the inability to gain adequate access to a stone to allow for treatment. The purpose of this study was to identify the prevalence of, and factors predicting FA in patients presenting with renal and ureteral stones. Methods: We performed a retrospective review of all uretersocopies for ureteral stones performed by three endourologists over a six month period. All patients who underwent URS for the purpose of stone treatment were included.  Patients were excluded if they underwent ureteroscopy for non-stone diagnosis or treatment. FA was investigated in relation to demographics, medical history, stone specific characteristics, procedure specific characteristics etc. Statistical analysis consisted of descriptive statistics as well as chi-square and t-test analysis using SPSS statistical software version 23.0. Results: 188 cases were reviewed, with 8% of patients experiencing FA. Patient age, gender, BMI, ASA score, emergency cases, previous stone treatment, use of CT imaging, presence of hydronephrosis, and surgeon did not differ significantly between FA and successful access (SA) groups. Stone size (9.88±5.8 vs 8.76±4.3mm; p=0.361) was also not significantly different. However, a significant difference was noted in time from first diagnosis to ureteroscopy (128 vs 65 days; p=0.044) and in stone location 62.5% vs 22.0% proximal ureter; p=0.043; OR=4.77 (1.05-21.64) Conclusions:  Proximal ureteric stones were more likely to result in failed access ureteroscopy, and FA procedures were more likely to be preceded by extended time from first diagnosis to ureteroscopy. Further investigation is necessary, and all endourology centres should track their own personal outcome data in order to allow for more meaningful analysis to be performed to improve patient outcomes.  

Abstract 11119: Real-Time Nanopore Sequencing for Bacterial Pneumonia After Out-of-Hospital Cardiac Arrest, a Pilot Proof-of-Concept Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra Weissman ◽  
Mariam Bramah Lawani ◽  
Thomas Rohan ◽  
Clifton W CALLAWAY
Keyword(s):  
Patient Care ◽  
Pathogen Detection ◽  
Bacterial Pathogen ◽  
Improve Patient Care ◽  
Antibiotic Administration ◽  
Nanopore Sequencing ◽  
Proof Of Concept ◽  
Chi Square ◽  
Significant Difference ◽  
Improve Patient

Introduction: Pneumonia is common after OHCA but is difficult to diagnose in the first 72 hours following ROSC, this results in early untargeted antibiotic administration based on non-specific imaging and laboratory findings. Antibiotic resistance is rising, is influenced by untargeted antibiotic administration, and can increase patient morbidity and mortality as well as healthcare costs. Precision methods of bacterial pathogen detection in OHCA patients are needed to improve patient care. This proof-of-concept pilot study aimed to assess feasibility of bacterial pathogen sequencing and comparability of sequencing results to clinical culture after OHCA. Methods: Blood and bronchoalveolar lavage (BAL) were obtained from residual clinical specimens collected within 12 hours of ROSC. Bacterial DNA was extracted using the Qiagen PowerLyzer PowerSoil DNA kit, sequenced using the MinION nanopore sequencer, and analyzed with Oxford Nanopore Technologies’ EPI2ME bioinformatics software. Sequencing results were compared to culture results using McNemar’s chi-square statistic. Study-defined pneumonia was based on presence of at least two characteristics within 72 hours of ROSC: fever (temperature ≥38°C); persistent leukocytosis >15,000 or leukopenia <3,500 for 48 hours; persistent chest radiography infiltrates for 48 hours per clinical radiology read; bacterial pathogen cultured. Results: We enrolled 38 consecutive OHCA subjects: mean age 61.8 years (18.0); 16 (42%) female; 25 (66%) White, 7 (18%) Black, 6 (16%) “Other” race; 7 subjects (18%) survived and 31 (82%) died; 16 (42%) subjects had pneumonia. Sequencing results were available in 12 hours while culture results were available in 48-72 hours after collection. There was a non-significant difference in the proportion of the same pathogens identified for each method per McNemar’s chi-square: p = 0.38, difference of 0.095 (-0.095, 0.286). Conclusions: Nanopore sequencing detects pathogenic bacteria comparable to clinical microbiologic culture and in less time. This technology can produce a paradigm shift in early bacterial pathogen detection in OHCA survivors, which can improve patient care. The technology is applicable to other patient populations and for viral and fungal pathogens.

Detection of Ureteral Stones in Kidney Ureter Bladder Radiography: Usefulness of Digital Post-processing

2021 ◽  
Vol 17 ◽  
Author(s):  
Sang Lim Choi ◽  
Sung Bin Park ◽  
Seungwook Yang ◽  
Eun Sun Lee ◽  
Hyun Jeong Park ◽  
...  
Keyword(s):  
Detection Sensitivity ◽  
Ureteral Stones ◽  
Data Sets ◽  
Post Processing ◽  
Stone Size ◽  
Data Set ◽  
Detection Rates ◽  
Exact Test ◽  
Significant Difference ◽  
Exact Size

Purpose: Kidney, ureter, and bladder radiography (KUB) has frequently been used in suspected urolithiasis, but its performance is known to be lower than that of computed tomography (CT). This study aimed to investigate the diagnostic performance of digitally post-processed kidney ureter bladder radiography (KUB) in the detection of ureteral stones. Materials And Methods: Thirty patients who underwent digital KUB and CT were included in this retrospective study. The original digital KUB underwent post-processing that involved noise estimation, reduction, and whitening to improve the visibility of ureteral stones. Thus, 60 digital original or post-processed KUB images were obtained and ordered randomly for blinded review. After a period, a second review was performed after unblinding stone laterality. The detection rates were evaluated at both initial and second review, using CT as reference standard. The objective (size) and subjective (visibility) parameters of ureteral stones were analyzed. Fisher’s exact test was used to compare the detection sensitivity between the original and post-processed KUB data set. Visibility analysis was assessed with a paired t-test. Correlation of stone size between CT and digital KUB data sets was assessed with Pearson’s correlation test. Results: The detection rate was higher for most reviewers once stone laterality was provided and was non-significantly better for the post-processed KUB images (p > 0.05). There was no significant difference in stone size among CT and digital KUB data sets. In all reviews, visibility grade was higher in the post-processed KUB images, irrespective of whether stone laterality was provided. Conclusion: Digital post-processing of KUB yielded higher visibility of ureteral stones and could improve stone detection, especially when stone laterality was available. Thus, digitally post-processed KUB can be an excellent modality for detecting ureteral stones and measuring their exact size.

scholarly journals Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

2009 ◽  
Vol 66 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Slobodan Radulovic ◽  
Aleksandra Vuksanovic ◽  
Dragica Milenkovic-Petronic ◽  
Bozo Vavic
Keyword(s):  
Therapeutic Approach ◽  
Ureteral Stone ◽  
Treatment Success ◽  
Ureteral Stones ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Proximal Ureteral Stone

Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

scholarly journals Pop-Q Components Comparison among Multiparous and Nulliparous Women

2016 ◽  
Author(s):  
Lucy Lisa
Keyword(s):  
Physical Work ◽  
Hormonal Contraceptives ◽  
Chi Square ◽  
Cross Sectional ◽  
Test Analysis ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Multiparous Women ◽  
Heavy Physical Work ◽  
Chi Square Test

Objective: To compare the measurement of POP-Q components between multiparous and nulliparous women. Method: This study is a cross-sectional research conducted in several hospitals in Makassar during the period of June to October 2012, with 270 women as the subjects. Subjects were divided into three groups: nulliparous, parity 1-2, and parity 3 (multiparous). We analyzed the mean POP-Q components results between 3 groups using t-test, analysis of prolapse based on POP-Q components measurement, and analysis of correlation between risk factors with prolapse was done using Chi-square test. Result: There is a significant difference in POP-Q components measurement between multiparous and nulliparous women, consecutively for: Aa point -2.14 and -2.97 cm, Ba point -2.11 and -2.99 cm, C point -5.69 and -6.86 cm, gh 3.33 and 2.70 cm, pb 2.60 and 3.27 cm, TVL 8.65 and 9.06 cm, Ap point -2.35 and -2.93 cm, Bp point - 2.61 and -2.96 cm, D point -6.61 and -7.42 cm. In multiparous women, points Aa, Ba, C, D, Ap and Bp became more prolapsed, gh became longer, while pb and TVL became shorter. Conclusion: The proportion of prolapse is higher in multiparous women with significant associations with age, body mass index, education level, and history of heavy physical work, delivering a large baby and use of hormonal contraceptives. [Indones J Obstet Gynecol 2014; 4: 204-210] Keywords: multiparous women, nulliparous women, parity, POP-Q

scholarly journals Can negative ureteroscopy be predicted in ureteral stone treatment?

2019 ◽  
Vol 14 (5) ◽  
Author(s):  
Mehmet Oguz Sahin ◽  
Volkan Sen ◽  
Bora Irer ◽  
Guner Yildiz
Keyword(s):  
Multivariate Analysis ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Ureteral Stones ◽  
Imaging Procedure ◽  
Significant Difference ◽  
Small Stone ◽  
Stone Treatment ◽  
History Of ◽  
Distal Localization

Introduction: We aimed to evaluate factors predictive of negative ureteroscopy (URS) in ureteral stones. Methods: Patients who underwent URS between January 2007 and June 2018 were included in the study. Patients were divided into two groups; group 1: positive URS (841 patients) and group 2: negative URS (75 patients). These two groups were compared in terms of demographic data, stone characteristics, and postoperative outcomes. Results: The mean age of the study patients was 44.5±15.1 years. The absence of collecting system dilatation due to the present stone was found to be a significant predictive factor for negative URS in univariate analysis, but there was no significant difference in multivariate analysis. In the multivariate analysis, low body mass index (BMI), no history of stone surgery, stone located in the distal ureter, small stone area, longer time between the last imaging procedure and URS, and medical expulsive therapy (MET) application were statistically significant in predicting negative URS. Conclusions: In this study, the parameters that significantly predicted negative URS were found to be low BMI, no history of stone surgery, distal localization of the stone, small stone area, longer time between the last imaging procedure and URS, and MET applied for the current stone. These parameters should be considered to avoid negative URS and patients should be informed of the possibility of negative URS prior to operation.

scholarly journals Single centre study of stone clearance with ureterorenoscope & lithoclast for ureteric calculi; our experience.

2019 ◽  
Vol 26 (08) ◽  
pp. 1296-1299
Author(s):  
Qazi Adil Inam ◽  
Furqan Arshad ◽  
Nabeel Naeem Baig ◽  
Khadijah Abid
Keyword(s):  
Ureteral Stones ◽  
Ureteric Stone ◽  
Single Centre ◽  
Stone Size ◽  
Stone Clearance ◽  
Ureteric Calculi ◽  
Single Centre Study ◽  
Stone Treatment ◽  
Study Setting ◽  
Clearance Study

To decide the adequacy of ureterorenoscope by utilizing lithoclast for distal ureteric stone clearance. Study Design: Longitudinal study. Setting: Department of urology Aziz Bhatti Shaheed Teaching Hospital. Period: Feb 2014 to Dec 2016. Materials and Methods: 32 patients from medical record who underwent for stone clearance with ureteroscopy followed by lithoclast. The patients with larger upper ureteral stones were enrolled in the study though patients with stone size<1cm and co-morbidities were not included in the study. The characteristic of patients and stone, treatment modality & outcome i.e. efficacy in terms of “successful stone clearance” were determined. Results: The average age of 32 patients was 34.28±10.11 years. 18 (56.3%) of the patients were females whereas 14 (43.7%) were males. Ureteric stones were present on both right and left sides in 17 (54%) and 15(46%) patients. Bilateral ureteric stone was present in 2 (6.25%) patients. The efficacy was reported as 96% for the stone size of 1-1.5cm and 92% for the stone size of 1.6-3cm. Conclusions: We concluded that Ureterorenoscope followed by Lithoclast is the useful and safest procedure for stone clearance.

scholarly journals Evaluation of Stain Penetration by Beverages in Demineralized Enamel Treated With Resin Infiltration

2016 ◽  
Vol 41 (1) ◽  
pp. 93-102 ◽  
Author(s):  
J Lee ◽  
J-W Chen ◽  
S Omar ◽  
SR Kwon ◽  
M Meharry
Keyword(s):  
Methylene Blue ◽  
Grape Juice ◽  
Distilled Water ◽  
Chi Square ◽  
Human Teeth ◽  
Test Analysis ◽  
Resin Infiltration ◽  
Demineralized Enamel ◽  
Significant Difference ◽  
Control Surfaces

SUMMARY Purpose To evaluate stain penetration by different beverages in artificially demineralized human teeth treated with resin infiltration. Methods and Materials Sixty extracted human permanent molars were demineralized, treated with resin infiltration (Icon), and immersed in four different beverages (coffee, grape juice, iced tea, and distilled water; N=15) for four weeks. After aging, teeth in the distilled water group were stained with 2% methylene blue for 24 hours. All teeth were sectioned, and stain penetration was evaluated under light microscopy. Chi-square test, independent and paired sample t-test, analysis of variance with the Fisher least significant difference post hoc test, and the Kruskal-Wallis test were used to analyze the results (p&lt;0.05). Results Resin infiltration–treated surfaces (Icon surfaces) had statistically significant fewer samples with presence of stain penetration compared to untreated surfaces (control surfaces) (p&lt;0.001). There was also a significant decrease in depth of stain penetration in Icon surfaces compared to the control surfaces (p&lt;0.001). Among tested beverage groups, iced tea showed significantly greater depth of stain penetration (0.134±0.029 mm), followed by grape juice (0.118±0.047 mm), methylene blue (0.022±0.019 mm), and coffee (0.008±0.017 mm; p&lt;0.001). Conclusion Both Icon and control surfaces exhibit stain penetration by different beverages (iced tea, grape juice, and coffee). However, resin-infiltrated enamel surfaces allow significantly less depth of stain penetration compared to untreated surfaces. The iced tea group presents greatest depth of stain penetration, followed by grape juice, methylene blue, and coffee.

scholarly journals The Potential of Seaweed Salt as an Alternative Low Natrium Salt: Safety and Sensory Test

2021 ◽  
Vol 5 (1) ◽  
pp. 47
Author(s):  
Lindarsih Notowidjojo ◽  
Purwantyastuti Ascobat ◽  
Saptawati Bardosono ◽  
Jana Tjahjana
Keyword(s):  
Health Sector ◽  
Magnesium Content ◽  
Second Phase ◽  
Red Seaweed ◽  
Metal Mold ◽  
Chi Square ◽  
Test Analysis ◽  
Sensory Test ◽  
Significant Difference ◽  
Chi Square Test

Indonesia is one of the largest producers of red seaweed in the world, but there is very little research done on the role of red seaweed in the health sector. This study is about red seaweed type Euchema cottoni and it’s potential as seaweed salt that has lower natrium and rich in other minerals.This research was divided into two phases and conducted from December 2016 to March 2017. The first phase is a safety analysis in terms of metal, mold and bacteria contamination of seaweed from three different places of Indonesia: Saumlaki, Maluku; Nusa Dua, Bali and Flores, Nusa Tenggara Barat. After the seaweed safety was selected, the seaweed was made into powder at Industrial Research and Development Agency (BPPT), Tangerang. The seaweed powder mixed with ordinary salt with four type of concentrations were subjected to a salty sensory test by nine panellists who have been working at the food production at Hospital for at least one year. The second phase was to do acceptance sensory test of the seaweed salt product taste against a concentration that was selected in first phase to first-degree hypertensive subjects aged 25–59 years by using soup as the meal-media. Chi-square test was used to analyse the difference.Seaweed from Saumlaki, Maluku was selected as the safest seaweed due to it’s lowest content of metal, mold and bacterial contaminations. The ratio of seaweed powder to ordinary salt powder 1:1 was selected by nine panellists in salty sensory test. Analysis of minerals from the seaweed salt product found that besides the lower sodium and Iodium content, it’s potassium and magnesium content were much higher than ordinary salt. Salty taste test by 62 respondents with first degree hypertension with age 25-59 years showed no significant difference in saltiness between seaweed salt and ordinary salt.In conclusion, the seaweed salt product with a 1:1 ratio to ordinary salt powder is safe and acceptable to be used as an alternative low Na salt.

scholarly journals Availability and Use of Information and Communication Technology by Oil Palm Farmers in the Akyemansa District, Ghana

2020 ◽  
pp. 1-10
Author(s):  
F. K. M. Swanzy ◽  
E. K. M. Sosu ◽  
W. O. Danso
Keyword(s):  
Information And Communication Technologies ◽  
Oil Palm ◽  
Agricultural Sector ◽  
Organizational Structures ◽  
Primary Data ◽  
Chi Square ◽  
Test Analysis ◽  
Significant Difference ◽  
Information And Communication ◽  
The Right

The use of ICTs forms part of efforts to achieve the Sustainable Development Goals (SGDs) especially ensuring inclusive and equitable quality education and promote life-long learning opportunities for all. In the agricultural sector, access to the right knowledge and information in a timely manner enhances agricultural production and thus increase food production. In Ghana, several studies have reported on the access and use of ICT tools by farmers in food crop and poultry sectors, however, much work has not been done in the tree crop sector, especially the oil palm subsector. This study sought to determine the availability and use of Information and Communication Technologies (ICTs) by oil palm farmers in the Akyemansa District of Ghana. The primary data used in the study were collected through focus group discussions and structured questionnaires administered to 150 randomly selected oil palm farmers. Both descriptive and inferential statisticswere employed in analyzing the data. Results show that 99.00% of farmers have access to radio with very low availability and access to a computer. Chi-square test analysis showed that there was a significant difference p= (0.00 and 0.00) between farmers’ extent of access to ICTs and their use for oil palm production activities. However, there was no significant relationship p= (.8137, and .2233) between farmers extent of access to the mobile phone, radio and how often farmers used them for oil palm production. There is a need to improve organizational structures, technical and infrastructural facilities regarding ICT availability to allow more access to and use of these facilities.

scholarly journals Serum c-reactive protein as a predictive factor for spontaneous stone passage in patients with 4 to 8 mm distal ureteral stones

2018 ◽  
Vol 5 (4) ◽  
pp. 1195
Author(s):  
Ehab Jasim Mohammad ◽  
Kanaan Mahdi Abbas ◽  
Anas Falah Hassan ◽  
Alaa Abdulqader Abdulrazaq
Keyword(s):  
Predictive Factor ◽  
Ureteral Stone ◽  
Ureteral Stones ◽  
C Reactive Protein ◽  
Ureteric Stone ◽  
Stone Size ◽  
Reactive Protein ◽  
Significant Difference ◽  
Serum Crp ◽  
Stone Passage

Background: Ureteral stones are common problems in daily emergency department practice. Ureteric stone is responsible for 20%. Ureter obstruction caused by a ureteral stone triggers inflammatory changes in the proximal submucosal layer and prevents passage of the stone.  C reactive protein (CRP) was found to be an indicator of ureteral stone outcome. The objective of this study was to measure serum CRP for patients with 4-8 mm distal ureteric stone and use its level as predictive factor for spontaneous stone passage.Methods: A prospective study was designed on a total of 73 patients (M=34; F=39) who were in the age group (18-50) years, who presented with ureteral colic secondary to a solitary unilateral, 4 to 8 mm distal ureteral stone. Patients were grouped according to spontaneous stone passage. The patients were selected at the urology unit, in Ghazi AL Hariri Hospital for Specialized Surgery, Medical City Complex in Baghdad from October 2014 till October 2016. The follow up continued until the stone spontaneously passed, as reported by the patient, or for a maximum period of 4 weeks.Results: Age, BMI, and gender did not show significant difference between the two groups ;30 have spontaneous stone passage (SSP), and 43 no spontaneous stone passage (no SSP). Stone size is significantly higher in the group without SSP their median is 6 mm compared to 4 mm for SSP group. CRP is significantly elevated in no SSP group compared to SSP.  CRP, stone size and previous history of stone passage was the only significant and independent predictors of SSP (low CRP, low stone size, and positive history predict SSP).  Conclusions: Stone size, CRP, previous Hx of stone passage are independent predictors for SSP.  Measuring serum CRP levels is useful for predicting whether spontaneous ureteral stone passage will be successful. More aggressive treatment methods such as URS should be considered when serum CRP levels is high.

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