Retraction: Vesicourachal Diverticulum: A Rare Cause of Recurrent Urinary Tract Infections.

[This retracts the article DOI: 10.7759/cureus.20118.].

The Needs of Orthopaedic Patients in Discharge Planning.

Introduction: Patients' transition from hospital to home could be challenging for patients and caregivers. This is of utmost importance for patients requiring special or long-term care such as post-orthopaedic surgery. Effective discharge planning is required to ensure that patients are prepared to and get continuous care after returning home to prevent complications. Patients' need assessment is essential to develop effective discharge planning to meet the patient's needs. Materials and methods: This mixed-method study aimed to determine the patient's needs to develop a discharge planning for total knee replacement surgery. The needs for 96 total knee replacement patients were assessed using the Needs Evaluation Questionnaire (NEQ). The in-depth interview primary focus was to explore the lived experience of the post-total knee replacement patients receiving care in the hospital. Results: A total of 96 participants (100%) completed the NEQ questionnaire. Most of the needs concerned by the participants were expressed by at least 70% of them except the financial need (59.4%). The semi-structured interview found two elements which were a support group and patients' needs in terms of emotional, physical and spiritual preparation in developing effective discharge planning. Conclusion: This study clarified that the patient needs assessment in the patient care plan.

Vesicourachal Diverticulum: A Rare Cause of Recurrent Urinary Tract Infections.

Urinary tract infection is a common medical condition encountered in outpatient clinics and emergency departments. Recurrence of urinary tract infections is common. The recurrence can arise from behavioral, mechanical, and physiological factors. Urachal anomalies are very rare congenital clinical entities. We present the case of a 41-year-old woman who presented to the emergency department with dysuria, frequency, urgency, and incontinence. There was no history of fever or flank pain. Physical examination revealed no abnormalities. Initial laboratory markers were within the normal range. However, urinalysis findings showed numerous white blood cells and positive leukocyte esterase and nitrite. While these findings are suggestive of acute simple cystitis, the patient had a concerning history of recurrent urinary tract infections. The urology team advised performing an abdominal computed tomography scan to rule out any structural abnormalities. The patient underwent a computed tomography scan, which demonstrated the presence of a fluid-filled structure arising from the dome of the bladder and extending superiorly toward the umbilicus, representing a vesicourachal diverticulum. The patient underwent surgical resection after antibiotic therapy. The vesicourachal diverticulum is a very rare type of urinary tract anomalies. The case highlights the importance of considering congenital urachal anomalies in patients with recurrent urinary tract infections. A computed tomography scan can make the diagnosis of such anomalies with high accuracy.

Habitat segregation and cryptic adaptation of species of Periophthalmus (Gobioidei: Gobiidae).

A study was conducted on the habitat distribution of four sympatric species of Periophthalmus (the silver-lined mudskipper Periophthalmus argentilineatus, the slender mudskipper Periophthalmus gracilis, the kalolo mudskipper Periophthalmus kalolo and the Malacca mudskipper Periophthalmus malaccensis) from northern Sulawesi. Molecular phylogenetic reconstructions based on one mtDNA marker (16S) were used to validate the morphological taxa, identifying five molecular clades. Periophthalmus argentilineatus includes two molecular species, which are named Periophthalmus argentilineatus clades F and K. Multivariate direct gradient analysis show that these species form three distinct ecological guilds, with the two molecular species occurring in different guilds. Periophthalmus clade F is ecologically eurytypic; Periophthalmus clade K and P. kalolo are prevalent in ecosystems isolated by strong oceanic currents and at shorter distances from the sea; P. gracilis plus P. malaccensis are prevalent in ecosystems connected by shallow coastal waters, in vegetated habitats at larger distances from the sea. This indicates for the first time that mudskipper species exhibit a range of adaptations to semiterrestrialism not only within genera, but even within morphospecies, delineating a much more complex adaptive scenario than previously assumed.

The prevalence of thyroid cancer in patients with hyperthyroidism.

OBJECTIVES: To determine the prevalence of thyroid cancer in patients with hyperthyroidism. METHODS: This is a retrospective observational study using the data of 71 Omani patients with a diagnosis of hyperthyroidism due to Grave's disease, toxic multinodular goiter, and solitary toxic adenoma. These patients underwent thyroidectomy at the Royal Hospital (RH), Muscat, Oman, and were followed up at the National Diabetes and Endocrine Center (NDEC) between 2007 and 2013. The details were collected from the medical records of both the RH and the NDEC. Patients who underwent thyroidectomy for other reasons like non-toxic goiter and hypothyroidism with cancer were excluded from the study. RESULTS: Thyroid cancer was identified in 32.8% (n=23) of patients with hyperthyroidism. Half of these patients 52.1% (n=12) had papillary micro-cancer (intra-thyroidal), and 3 patients with Grave's disease (13%) had lymph nodes metastasis (loco-regional infiltration. The cancer preponderance was higher in young (n=21, 91.3%) and female patients (n=18, 73.9%). Most patients with thyroid cancer had abnormal ultrasound neck findings and thyroid scintigraphy (99 mTc uptake). CONCLUSION: Many patients with hyperthyroidism in Muscat, Oman, especially those with Grave's disease, show malignancy, and hence a proper initial evaluation of these patients is required as part of long-term management.

Early stroke following acute myocardial infarction: incidence, predictors and outcome in six Middle-Eastern countries.

BACKGROUND AND OBJECTIVES: Stroke is a potential complication of acute myocardial infarction (AMI). The aim of this study was to identify the incidence, risk factors predisposing to stroke and in-hospital outcome during the index admission with AMI among patients in the Middle East. METHODS: For a period of 6 months in 2006 and 2007, 5,833 consecutive AMI patients were enrolled from 64 hospitals in 6 Middle East countries. RESULTS: The incidence of in-hospital stroke following AMI was 0.85%. Most cases were ST segment elevation AMI-related and ischemic in nature. Patients with in-hospital stroke were older than patients without stroke and were more likely to be female (36 vs. 18.6%, p = 0.0033). They were also more likely to have diabetes mellitus, dyslipidemia, prior AMI, or percutaneous/surgical coronary revascularization. Patients with stroke were more likely to present with advanced Killip class II-IV, higher mean heart rate and higher serum creatinine. Independent predictors of stroke were age, prior stroke, prior coronary artery bypass surgery, anterior AMI and systolic blood pressure >190 mm Hg on presentation. Early administration of statins was independently associated with reduced stroke risk (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19-0.90, p = 0.025). Stroke was fatal in 44% of the cases and was independently associated with in-hospital mortality (adjusted OR 12.5, 95% CI 5.7-27.4, p < 0.01). CONCLUSION: There is a low incidence of in-hospital stroke in Middle-Eastern patients presenting with AMI but with very high fatality rates. Early statin therapy was associated with a significant reduction in stroke risk. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.

Association of khat chewing with increased risk of stroke and death in patients presenting with acute coronary syndrome.

OBJECTIVE: To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS). PATIENTS AND METHODS: From January 29, 2007, through July 29, 2007, 8176 consecutive patients presenting with ACS were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. RESULTS: Of the 8176 study patients, 7242 (88.6%) were non-khat chewers, and 934 (11.4%) were khat chewers, mainly of Yemeni origin. Khat chewers were older (57 vs 56 years; P=.01) and more likely to be men (85.7% vs 74.5%) compared with non-khat chewers. Non-khat chewers were more likely to have diabetes mellitus, hypertension, dyslipidemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killip class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality. After adjustment of baseline variables, khat chewing was an independent risk factor for in-hospital mortality (odds ratio, 1.9; 95% confidence interval, 1.3-2.7; P<.001) and stroke (odds ratio, 2.7; 95% confidence interval, 1.3-5.9; P=.01). CONCLUSION: In this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death. In the context of increasing global migration, a greater awareness of potential widespread practices is essential.

Outpatient parenteral antibiotic therapy in Singapore.

Outpatient parenteral antibiotic therapy (OPAT) remains in its infancy in Singapore, with the first patients enrolled 4 years ago. Singapore's three largest hospitals, with over 3000 inpatient beds, now have designated and approved OPAT services. This study reviews the demographic, clinical and cost data of all patients enrolled in 2005 to facilitate benchmarking between services in Singapore and abroad and also to identify common needs for further development. In 2005, 225 OPAT enrollments in 208 different patients resulted in 4050 days of OPAT care. Orthopaedic diagnoses constituted 40% of admissions. Vancomycin was the most frequently used antibiotic (34%). The re-admission rate was 8.9%, but complications of OPAT care were only occasionally implicated. An estimated $207,200 was saved by patients despite there being significant financial disincentives to subsidised patients. OPAT is a safe, cost-efficient system that is becoming increasingly accepted in Singapore by patients, clinicians and management. Our three services have evolved independently into very similar practices. There is potential for further innovation, including outreach and carer-delivered dosing. However, major financial disincentives require review.

Relationship between age and susceptibility to altitude decompression sickness.

BACKGROUND: Susceptibility to altitude decompression sickness (DCS) is influenced by a multitude of factors including, potentially, an individual's age. Previous attempts by authors to determine the effect of age on DCS susceptibility have produced conflicting results. The purpose of this study was to try to clarify that conflict and to quantify the impact of age on DCS risk. METHODS: We examined the Armstrong Laboratory DCS Hypobaric Research Database containing data on 1299 subject flight exposures conducted from 1983-94. Subjects were from 18-45 yr of age. Exposure altitudes ranged from 11,500 ft (3505 m) to 30,000 ft (9144 m). The duration of exposure varied from 3-8 h and preoxygenation time ranged from 0-2 h and 15 min. Data were compiled according to seven age groups. RESULTS: The results show a significant three-fold increase in susceptibility between the age group 18-21 and the group > 42 yr of age. The results also show a trend toward increased susceptibility between the 18-21 group and the groups between 26 and 41 yr of age. However, there was no significant change within the range of 26-41 yr. CONCLUSION: There is a trend toward increased DCS susceptibility with increasing age, with a particularly strong trend for individuals over 42 yr of age.

Transgene transmission and expression in rainbow trout and tilapia.

We describe the production of transgenic rainbow trout (Oncorhynchus mykiss) and tilapia (Oreochromis niloticus) by microneedle injection of fertilized eggs with cloned copies of novel gene constructs. Two aspects of the work with transgenic trout are presented; namely, patterns of inheritance of transgenes by the F1 generation following in vitro fertilization of gametes from transgenic and nontransgenic fish, and the degree of DNA methylation of transgenes in different fish and in different tissues of the same fish. Work with transgenic tilapia has been only of short duration, and evidence is presented simply to indicate their transgenic status. Transient expression studies using the bacterial gene chloramphenicol acetyltransferase when driven by fish-derived promoters are also discussed.

Patterns of transgene inheritance in rainbow trout (Oncorhynchus mykiss).

There have been very few studies of the inheritance of introduced genes (transgenes) in fish. We have followed the inheritance of the mammalian fusion gene MTrGH from founder generation transgenics (originating from eggs microinjected with the MTrGH DNA) to offspring in crosses with control fish. Initial screening of the founder generation transgenics was by analysing DNA from blood samples. Only three out of six fish which carried the novel gene in blood DNA transmitted it to their offspring, despite the presence of the gene in DNA extracted from the sperm of all four male fish in this group. The frequency of transgenics in the progeny groups from the three fish which transmitted the gene varied widely: in one of these groups more than one type of MTrGH restriction pattern was found. These results suggest widespread mosaicism in founder generation transgenics.

Vitamin A status in preschool-age Indonesian children as assessed by the modified relative-dose-response assay.

The modified relative-dose-response (MRDR) assay has been validated in rats as a function of vitamin A status and tested in a group of American children. In this study the MRDR assay was applied to West Javan children who are at risk of being vitamin A deficient. Of 86 children enrolled, 75 were tested. In a time-course study involving 22 children aged 3.7-5.3 y, blood samples were taken at different times after doses of 0.35 mumol 3,4-didehydroretinyl acetate/kg body wt. Generally, the ratio of dehydroretinol to retinol (DR-R ratio) peaked between 4 and 8 h. Thereafter, in a survey of 53 children aged 0.6-4.8 y, single blood samples were drawn 5 h after the dehydroretinyl acetate dose. The DR-R ratio ranged from 0.0028 to 0.169. With a DR-R ratio of 0.03 as the cutoff value, 62% of the children were judged to be of marginal vitamin A status.