A novel mortality risk score for emphysematous pyelonephritis: A multicenter study of the Global Research in the Emphysematous Pyelonephritis group.

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality. We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission. Materials and methods: Patients diagnosed with EPN between 2013 and 2020 were retrospectively included. Data from 15 centers (70%) were used to develop the scoring system, and data from 7 centers (30%) were used to validate it. Univariable and multivariable logistic regression analyses were performed to identify independent factors related to mortality. Receiver operating characteristic curve analysis was performed to construct the scoring system and calculate the risk of mortality. A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points. The area under the curve was used to quantify the scoring system performance. An 8-point scoring system for the mortality risk was created (range, 0-7). Results: In total, 570 patients were included (400 in the test group and 170 in the validation group). Independent predictors of mortality in the multivariable logistic regression were included in the scoring system: quick Sepsis-related Organ Failure Assessment score ≥2 (2 points), anemia, paranephric gas extension, leukocyte count >22,000/µL, thrombocytopenia, and hyperglycemia (1 point each). The mortality rate was <5% for scores ≤3, 83.3% for scores 6, and 100% for scores 7. The area under the curve was 0.90 (95% confidence interval, 0.84-0.95) for test and 0.91 (95% confidence interval, 0.84-0.97) for the validation group. Conclusions: Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.

Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different. METHODS: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality. RESULTS: A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, p = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001). CONCLUSIONS: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.

What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms?

Objective: To describe the microbiological characteristics in emphysematous pyelonephritis (EPN), demonstrate the frequency of extended-spectrum beta-lactamase (ESBL) microorganisms, and determine if these microorganisms are associated with the prognosis of patients with EPN. Methods: We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016. Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms. Statistical significance was set with p<0.05. Results: A total of 63 patients were included; 55 (87.3%) of them were females, with a median age of 55 (interquartile range: 45-65) years. Conservative management was indicated in 38.1%; 42.9% were treated with ureteral stent; 12.7% with open or percutaneous drainage; 15.8% with early nephrectomy; and 9.5% with delayed nephrectomy. Reported mortality was 13 (20.6%) cases; 23 (36.5%) cases required admission to the intensive care unit. The most frequent microorganism isolated was Escherichia coli (n=34, 53.9%). ESBL microorganisms were found in 31.7% of the population. No significant association of ESBL was found with admission to the intensive care unit, or with increased mortality. Conclusions: To our knowledge, this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN. Risk factors associated with a poor prognosis in patients with EPN have been described. The microbiological factors, specifically ESBL-producing bacteria, do not seem to influence in the prognosis of these patients.

Collision Tumor of the Kidney: Renal Cell Carcinoma Hidden in a Giant Angiomyolipoma in a Patient With Tuberous Sclerosis Complex.

Background: A renal angiomyolipoma is a mixed mesenchymal benign tumor composed of smooth muscle, adipose tissue, and blood vessels. Malignant transformation of angiomyolipomas is anecdotal. To our knowledge, only 6 cases have been reported, and 4 of the patients had tuberous sclerosis complex diagnosed. Case Report: We present the case of a 29-year-old male with tuberous sclerosis complex who arrived at the emergency room with gross hematuria and a painful right-sided abdominal mass. Imaging studies revealed active bleeding from a giant angiomyolipoma. An emergency nephrectomy was performed. Histopathology evaluation revealed an angiomyolipoma with a focal lesion and clear cell renal carcinoma within the tumor. Conclusion: Limited evidence is available to dictate management of collision tumors of the kidney in the scenario of tuberous sclerosis complex, so a multidisciplinary approach that includes urology, oncology, genetics, and nephrology intervention needs to be considered. No standardized follow-up modality has been established for angiomyolipomas, so patients should be placed under active surveillance, similar to that carried out in cases of renal cell carcinoma.

Emphysematous Pyelonephritis and Emphysematous Cholecystitis: A Result of Uncontrolled Type 2 Diabetes.

Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection that results in the presence of gas in the renal parenchyma, collecting system, and surrounding tissues. Up to 95% of patients with EPN have underlying uncontrolled diabetes mellitus. Emphysematous cholecystitis (EC) is a necrotizing infection defined by the presence of gas in the gallbladder. Concurrent presentation of EPN and EC is limited to anecdotal cases in the literature. Case Report: We present the case of a 44-year-old female who arrived at the emergency department with signs of septic shock and diffuse abdominal pain. Diagnosis of EPN and EC was confirmed. Because the patient did not improve after aggressive medical therapy and percutaneous drainage and cholecystostomy, she was taken to surgery for emergency nephrectomy and cholecystectomy. Conclusion: In unusually extensive and severe cases of EPN, medical and minimally invasive procedures are not enough to control the infection. More aggressive management, including emergency surgery, should be implemented in selected patients who present with refractory septic shock associated with extensive disease.

Steroid 5 alpha-reductase 2 enzyme variants, biomass exposure and tobacco use in Mexican patients with prostate cancer.

The presence of the genetic variants of the steroid 5-alpha reductase 2 enzyme, which is encoded by the SRD5A2 gene, has been associated with an increased risk of developing prostate cancer among certain ethnic groups. However, these molecular studies have not been conducted on the Mexican population. The analysis of the genetic variants, rs9282858 and rs523349, was performed in 101 males with prostate cancer and 100 healthy controls classified as males without prostate abnormalities (n=60) and males with benign prostatic hyperplasia (n=40), to identify a probable association with this cancer type in the Northeast Mexican population. An association was identified between prostate cancer and biomass exposure [P=0.012; odds ratio (OR), 2.89; confidence interval (CI)=1.21-6.88] and tobacco use (P=0.028; OR=1.88; CI=1.07-3.31), while no association was observed between cancer development and the rs9282858 variant, or between a protective effect and the rs523349 variant. Notably, an association was identified between rs523349 and biomass exposure (P=0.013, OR=3.17; CI=1.23-8.17 for the G risk allele, and OR=0.32, CI=0.12-0.81 for the C protective allele) using the dominant genetic model. To the best of our knowledge, the present study was the first of its type to investigate the Mexican population with prostate cancer.

[Relationship between testicular microcalcifications and clinical characteristics in patients with testicular cancer]. / Relación entre microlitiasis testiculares y características clínicas en sujetos con cáncer testicular.

INTRODUCTION: Testicular microlithiasis (TM) is an uncommon finding in general male population. These calcifications are reported by testicular ultrasound performed by some testicular pathology and constitute an incidental finding. The presence of TM is regularly associated to testicular neoplasms. OBJECTIVES: To investigate the relationship between clinical and demographic factors, comorbidities and tumor biomarkers, and the presence or absence of microlithiasis in patients with testicular cancer. MATERIAL AND METHODS: A retrospective study including a total of 66 patients diagnosed with testicular carcinoma from 2012 to 2017 in a hospital in Northeastern Mexico. The total of patients was divided into 2 groups according to the presence or absence of MT and the clinical features of these were analyzed. RESULTS: There was a general prevalence of TM of 31.8%. The main tumor found in the pathology reports corresponded to the non seminomatous germ cells tumor (54.4%). The incidence of metastasis to organs was of 27.3%. No statistically significant differences were found when comparing the variables of interest in the group with and without MT. A relationship was found between the elevation of alpha-fetoprotein and non-seminomatous tumors compared to seminomatous tumors (PY=Y.003). CONCLUSIONS: According to the results obtained, it can be suggested that TM is a clinical finding that is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed in our study.

[Use of alfuzosin for expulsion of stones in the distal third of ureter]. / Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter.

INTRODUCTION: Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. MATERIALS AND METHODS: Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. RESULTS: In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days.The two stones that were not passed where the biggest ones (9 mm and 10 mm). CONCLUSIONS: Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief.

[Penile calciphylaxis: 5-year experience and literature review]. / Calcifilaxis de pene: nuestra experiencia en 5 años y revisión de la literatura científica.

INTRODUCTION: Necrosis of the penis is a rare condition that may occur as a result of infectious dissemination, circulatory disorders, or even in patients with penile prostheses. It has been reported in a few patients on dialysis, usually associated with diabetes mellitus, cholesterol embolism, and calciphylaxis. CASE REPORTS: Three patients with this condition seen at our hospital in the last 5 years are reported. CONCLUSIONS: Calciphylaxis is a rare but often fatal condition occurring in approximately 1% of patients with chronic renal failure. It is characterized by calcification of subcutaneous arteries and infarction of the subcutaneous cellular tissue and overlying skin. It is associated to a high morbidity and mortality, and diagnosis is usually based on clinical signs and symptoms. Management is controversial, particularly with regard to surgery, which may range from penectomy to local care of lesion, debridement, or antibiotic therapy.

[Liposarcoma of the espermatic cord: our experience and review of the literature]. / Liposarcoma del cordón espermático: nuestra experiencia y revisión de la literatura.

INTRODUCTION: The paratesticular tumors represent 7-10% of the intraescrotales masses. Sarcomas includes 90% of the espermatic cord malignant lessons and approximately the 3-7% are liposarcomas. MATERIAL AND METHODS: We presented our experience with two cases of paratesticular liposarcomas. RESULTS: Actually it has been reported near 161 cases of paratesticular liposarcoma. Due to the rarely of this pathology it is difficult to know its natural history and to reach conclusions of the treatment results, which one until the moment continues being radical orchiectomy with wide local resection of the surrounding soft tissues, the value of adjuvant radiation and chemotherapy is even controversial. CONCLUSIONS: Sarcomas of the espermatic cord are rare, their initial treatment is surgical, we recommended the transoperatory valuation of the surgical edges to try to diminish the recurrence frequency.