The Effectiveness and Safety of Calcium Carbonate Use in Chronic Kidney Disease Patients with Normophosphatemia

Background: Patients with early and moderate stages of chronic kidney disease (CKD) have normal serum phosphate levels. Increased fibroblast growth factor-23 (FGF23) levels in these patients are responsible for maintaining normophosphatemia status by increasing the excretion of phosphate through urine. However, an increased serum FGF23 level is related to cardiomegaly, vascular calcification, CKD progression, and mortality. This study aimed to examine the effectiveness and safety of calcium carbonate use in stage 3 or 4 CKD patients with normophosphatemia. Methods: This double-blind randomized controlled trial (ClinicalTrials.gov identifier NCT03550534) included stage 3 or 4 CKD patients with normophosphatemia who visited the nephrology or endocrinology clinic at Dr. Cipto Mangunkusumo Hospital. Forty-six subjects were randomized to receive either calcium carbonate or placebo over a 12-weeks period. Urine phosphate, serum phosphate, serum calcium, and serum intact FGF23 levels were measured before and after the intervention. Results: The baseline characteristics of the two groups were similar, except for the higher prevalence of dyslipidemia in the placebo group. The CaCO3 group had shown reduced levels of FGF23 compared to the placebo group, -8.03 vs. 0.15 pg/ml respectively (p = 0.019). The median level of FGF23 showed a significant decrease only in the CaCO3 group. An increase in eGFR and a slightly decrease in urine phosphate were observed in the CaCO3 group; however, the data was found to be statistically not significant. No significant changes were noted in the serum calcium levels in both groups. Conclusion: The administration of calcium carbonate has been shown to be effective and safe for moderate CKD patients with normophosphatemia due to its effect in lowering FGF23 levels without escalating the serum calcium level.

Effect of Intravesical Chemotherapy on the Survival of Patients with Non-Muscle-Invasive Bladder Cancer Undergoing Transurethral Resection: A Retrospective Cohort Study Among Older Adults

Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on the survival of older patients with NMIBC that have undergone TURBT.

Evaluation of Erectile Dysfunction in Nonobese, Nondiabetic Men with Obstructive Sleep Apnea

Background: Erectile Dysfunction (ED) has affected people suffering from Obstructive Sleep Apnea Syndrome (OSAS) and multiple studies have confirmed this correlation. Objective: The objective of the is to identify the association between ED and Obstructive Sleep Apnea (OSA) in nonobese, nondiabetic men based on the International Index of Erectile Function (IIEF). Methods: This retrospective cross-sectional study included 143 nonobese, nondiabetic men with OSA (age, ≥20 years) who visited the Sleep Outpatient Clinic of the Otorhinolaryngology Department at Hospital Naval Marcílio Dias from May 2017 to August 2018. Patient age, body mass index (BMI), drinking, smoking, laboratory diagnosis of hypogonadism based on total testosterone levels, and sleep parameters (e.g., apnea–hypopnea index, rapid eye movement density, and minimum Oxygen Saturation [SatO2]) were considered. Analysis of variance was used to evaluate means. The chi-squared test and Fisher’s exact test were used to compare variables and Person’s correlation coefficient was used to analyze numerical variables. Results: The mean minimum SatO2 was 78.89%, and 46% of patients exhibited minimum SatO2 <80%. Moreover, minimum SatO2 of <80% and increasing age were associated with ED complaints based on IIEF scores,. A laboratory diagnosis of hypogonadism was associated with increased BMI, and aging was associated with SatO2. Conclusion: The results of the study revealed that oxygen desaturation of <80% was related to complaints of ED from the IIEF. Moreover, a relationship between laboratory hypogonadism and increased BMI values, aging, and oxygen desaturation has been demonstrated. Therefore, we recommend polysomnography in patients with ED complaints.

Bacillus Calmette-Guérin Perfusion Treatment via Cutaneous Ureterostomy for Carcinoma in Situ of the Upper Urinary Tract

Introduction: Bacillus Calmette-Guérin instillation is an established therapy for the treatment of carcinoma in situ of the upper urinary tract. Case Presentation: A 72-year-old woman underwent radical cystectomy with cutaneous ureterostomy for invasive bladder cancer with carcinoma in situ of both ureters. For the treatment of upper urinary tract carcinoma in situ, an infusion of 40 mg bacillus Calmette-Guérin through each ureterostomy was performed once weekly for 5 times. Urine cytology of the left upper urinary tract became negative, with a recurrence-free survival of 4 months. On the other hand, the right upper urinary tract became temporarily negative but turned positive after 3 months. Conclusion: Bacillus Calmette-Guérin perfusion therapy via cutaneous ureterostomy is considered as one of the useful therapies for carcinoma in situ of the upper urinary tract. Furthermore, there are several factors to be discussed, including the treatment duration, dosage and secondary therapeutic options.

Top 100 Cited Articles on Peritoneal Dialysis: A Bibliometric Analysis

Background: The purpose of this study is to broaden the understanding of peritoneal dialysis by presenting the most-cited articles pertaining to this subject. Methods: We searched articles on the Web of Science and selected 100 articles according to the frequency of citations. Next, we reviewed the contents of the articles and identified the characteristics of these articles. Results: There are 21 journals in which the top-100 cited articles were published. The names of the journals, in the order in which the articles are cited, are as follows: Kidney International (25 articles), Nephrology Dialysis Transplantation (13 articles), and Journal of the American Society of Nephrology (12 articles). The top 100-cited articles were published in 15 countries. The country with the greatest number of publications was the United States of America (19 articles). The institution with the greatest number of articles (7 articles) was the University Health Network of Toronto. The author who wrote the most number of articles (5 articles) was Davies SJ. Conclusion: This study is the first in the field of nephrology to provide a list of the top-100 cited articles dedicated to peritoneal dialysis. Through this study, the research trends and major academic interests pertaining to peritoneal dialysis would be identified.

Porosity in Microtomography and Determination of Hounsfield Units do not Predict Calculi Fragmentation in Extracorporeal Lithotripsy: Analysis of an In-vitro Study

Background: Extracorporeal Shock Wave Lithotripsy (SWL) remains one of the most popular methods for treating urinary lithiasis. Objective: To evaluate structural and microtomographic characteristics associated with urinary calculi fragmentation in an experimental model of SWL. Methods: Samples consisting of at least two calculi fragments obtained from patients were submitted to urological procedures. All calculi were analyzed by X-ray diffraction and a morphological evaluation (weight, length, width, and volume measurements) was conducted along with microtomographic and conventional tomographic assessments in vitro. Thereafter, each sample was submitted to SWL in a ballistic gelatin model. The fragments were separated, using a granulometric sieve, into specimens larger than 4 mm and 2 mm, which were subsequently weighed. Results: Altogether, 48 urinary calculi were analyzed and were composed of whewellite (54%), struvite (22%), apatite (11%), uric acid (7%), cystine (4%), and whitlockite (2%). The fragmentation rate was 77.5% and 69.6% for samples > 4 mm and > 2 mm in size, respectively. Factors associated with a reduction in the effectiveness of SWL were volume, dry mass, and width of the calculus. The radiodensity and porosity of the samples evaluated by microtomography were not associated with the fragmentation of calculi. Conclusion: The volume, dry mass, and width of urinary calculi were positively correlated with the number of fragments larger than 4 and 2 mm in size obtained post-SWL.

The Effectiveness of N-acetylcysteine in Alleviating Kidney Dysfunction in Ifosfamide-treated Rats

Background: Renal damage and dysfunction are possible complications of pharmacotherapy with ifosfamide (IF), which also manifests urotoxic properties. A routine drug used to reduce the risk of IF-induced cystitis is mesna. Compounds with effect expected to be similar to mesna include N-acetylcysteine (NAC). Objective: The objective of the paper was histopathological verification of the uroprotective effect of NAC and assessment of whether this effect is accompanied by a potential nephroprotective effect. Methods: The experiment was conducted on 3 groups: 1 – control, sham-treated rats, 2 – animals treated with 5 times the IF dose administered i.p. (50 mg/kg b.w.) and 3 – rats treated with 5 times the IF dose administered i.p. + NAC administered p.o. (200 mg/kg b.w.). The renal function was evaluated analysing classical and new protein parameters (cystatin C - CysC, kidney injury molecule-1 – KIM-1 and nephrin - NPH) in blood and urine. Furthermore, histopathological analysis of bladders and kidneys was carried out. Results: Treatment with IF resulted in the development of cystitis, with no significant histopathological disturbances in the kidneys, and caused an increase in concentration and 24-hour excretion of CysC, KIM-1 NPH in the urine. Additional NAC administration caused a reduction of the said biochemical disturbances as well as improvement of the histopathological image of the urinary bladders. Conclusion: The IF therapy caused cystitis and kidney dysfunction of functional tubulopathy and early glomerulopathy character. Additional administration of NAC entailed improvement in the urinary bladder morphology and renal function. NAC is, thus, a compound exerting both uro- and nephroprotective effects.

A Successful Management of Supra-Renal Inferior Vena Cava Injury Following Penetrating Trauma: A Case Report

Penetrating trauma of the abdominal Inferior Vena Cava remains a life-threatening injury. Nearly half of patients with an injury of abdominal Inferior Vena Cava die before reaching the hospital. This makes injuries of IVC often fetal and the management of these injuries is usually challenging. Early hospital transfer, prompt diagnosis, rapid bleeding control and diminishing shock period remain significantly important factors that improve the survival rate. We report a successful surgical management of suprarenal inferior vena cava injury case and associated organ injuries following a stab knife wound.

Evaluation of Human Chorionic Gonadotropin (HCG) Therapeutic Results in Patients With Unilateral cryptorchidism (Undescended Testis)

Background: Cryptorchidism or undescended testis is an evolutionary defect where one or both testes fail to descend into the scrotum. HCG causes the testes to fail, possibly due to weight gain, an increase in testicular vasculature, and stimulating the testosterone and di-hydro-testosterone. The present study has been conducted to evaluate the therapeutic effects of HCG on patients with unilateral cryptorchidism. Methods: In a prospective descriptive study, 211 patients of 8 months to 7 years old with unilateral cryptorchidism whose parents refused surgery received HCG therapy. The patients were followed up 1 month, 3months, and 12 months after the first injection. They were examined in terms of the location of testes, possible relapses, sides of undescended testes, treatment complications, and HCG therapeutic results. Results: Four weeks after the first injection, 160 patients (75.12%) out of 211 cases had the descent of testes into the inguinal canal and the scrotum. 69.5% of non-palpable abdominal testes descended into the inguinal canal, 69.7% of patients with inguinal testes, 78% of patients with supra inguinal testes and 100% of patients with retractile testis experienced the descent of testes into the scrotum. Conclusion: The therapeutic response to HCG was successful in more than 50% of the cases in all the groups. Therefore, the need for performing surgical procedures on children with unilateral cryptorchidism would be decreased and they can be treated by a cost-effective and less invasive method. Moreover, at least one-year follow-up of the patients is required to ensure outcomes of the treatment.