Longitudinal changes in glucose during pregnancy in women with gestational diabetes risk factors.

AIMS/HYPOTHESIS: Despite recommendations to screen women with diabetes risk factors for hyperglycaemia in the first trimester, criteria for normal glucose values in early pregnancy have not been firmly established. We aimed to compare glucose levels in early pregnancy with those later in gestation and outside of pregnancy in women with diabetes risk factors. METHODS: In pregnant women (N = 123) followed longitudinally through the postpartum period, and a separate cohort of non-pregnant women (N = 65), we performed 75 g oral glucose tolerance tests. All participants had one or more risk factors for diabetes. Using linear regression, we tested for differences in glucose levels between non-pregnant and pregnant women at early (7-15 weeks) and mid-late (24-32 weeks) gestation as well as postpartum, with adjustment for maternal age, parity, marital status and BMI. In a longitudinal analysis using mixed-effects models, we tested for differences in glucose levels across early and mid-late pregnancy compared with postpartum. Differences are expressed as ß (95% CI). RESULTS: Fasting glucose was lower in pregnant compared with non-pregnant women by 0.34 (0.18, 0.51) mmol/l (p < 0.0001) in early pregnancy and by 0.45 (0.29, 0.61) mmol/l (p < 0.0001) in mid-late pregnancy. In longitudinal models, fasting glucose was lower by 0.13 (0.04, 0.21) mmol/l (p = 0.003) in early pregnancy and by 0.16 (0.08, 0.25) mmol/l (p = 0.0003) in mid-late pregnancy compared with the same women postpartum. Early pregnancy post-load glucose levels did not differ from those in non-pregnant women or the same women postpartum. In mid-late pregnancy, compared with non-pregnant women, elevations in 1 h post-load glucose level (0.60 [-0.12, 1.33] mmol/l, p = 0.10) and 2 h post-load glucose (0.49 [-0.21, 1.19] mmol/l, p = 0.17) were not statistically significant. However, in longitudinal analyses, 1 h and 2 h post-load glucose levels were higher in mid-late pregnancy (by 0.78 [0.35, 1.21] mmol/l, p = 0.0004, and 0.67 [0.30, 1.04] mmol/l, p = 0.0005, respectively) when compared with postpartum. CONCLUSIONS/INTERPRETATION: In women with diabetes risk factors, fasting glucose declines in the first trimester. Post-load glucose increases later in pregnancy. These findings may inform criteria for diagnosing hyperglycaemia early in pregnancy.

A Systematic Scoping Review of Comparative Effectiveness Studies in Kidney Stone Disease.

OBJECTIVE: To review the status of comparative effectiveness studies for kidney stone disease with focus on study outcome, type, population, time trends, and patient-centered approaches. METHODS: A systematic scoping review was performed for articles published between January 1, 2005, and March 30, 2021, using keywords relevant to kidney stone disease. Studies published in English that compared two or more alternative methods for prevention, diagnosis, treatment, monitoring, or care delivery were included. Two reviewers independently reviewed abstracts and an arbitrator resolved discrepancies. Nine reviewers abstracted information from full-length studies. Descriptive statistics were summarized, and linear regression was performed to evaluate temporal trends of study characteristics. RESULTS: We reviewed 1773 abstracts and 707 full-length manuscripts focused on surgical intervention (440); medical expulsive therapy (MET) (152); analgesic control (80); and homeopathic, diagnostics, and/or prophylaxis (84). Randomized controlled trials were common across all outcome categories, including surgery (41.6%), MET (60.2%), analgesic control (81.3%), homeopathic (41.2%), diagnostic (47.6%), and prophylaxis (49.1%). Patient-reported outcomes were utilized in 71.7% and 95% of MET and analgesic control studies, respectively, but in the minority of all other study themes. Over time, meta-analyses and multicenter studies increased [P < .001]. CONCLUSION: Surgical and MET themes dominate published comparative literature in kidney stone disease. There is substantial variation in use of patient-reported outcomes across surgical themes. Multicentered studies and those generating higher level evidence have increased over time but opportunities exist to improve collaborative, high-quality, and patient-centered research in kidney stone disease.

Participant Perspectives on the Implementation of a School-Linked Text-Message Intervention to Improve Pediatric Asthma Medication Adherence.

Background: Poor adherence to inhaled corticosteroids (ICS) is a significant challenge in pediatric asthma, contributing to health inequities. Text-message reminders for ICS therapy are an evidence-based approach that improves pediatric asthma medication adherence, yet has not been widely adopted into practice, partly due to lack of (1) participant input on design and implementation and (2) use of sustainable community linkages. Remote Asthma Link™ (RAL) seeks to fill this gap as a school-linked text-message intervention wherein parents of children with poorly controlled asthma received daily, 2-way text-message reminders for preventive inhaler use. Responses were shared with school nurses who conducted remote check-ins with families. Enrolled children, largely from underserved backgrounds, experienced improvements in medication adherence and asthma health outcomes. While initial results were promising, we have yet to elicit participant input to refine the protocol for more widespread implementation. Objective: Examine participant perspectives on barriers and facilitators of RAL implementation. Methods: Semistructured interviews were conducted May-June 2022 with intervention participants: 10 parents, 7 school nurses, and 4 pediatric providers (n = 21) until thematic saturation was reached. Interview transcripts were coded using thematic analysis. Results: Several facilitators for RAL implementation were identified, including ease of use and accessibility, personal connection to the school nurse, and receipt of a visual notification for habit formation. Barriers included challenges with school nurses reaching parents, poor understanding of program expectations, and lack of reimbursement structure. Participant-proposed solutions to barriers included utilizing alternate communication methods (eg, social media), educational sessions, and meeting with payors to consider reimbursement models. Conclusion: RAL is a school-linked text-message intervention demonstrating promise in improving outcomes and equity in asthma care. Key implementation facilitators, barriers, and proposed solutions will inform protocol adaptations to promote successful implementation of this and other text-message interventions into clinical practice.

A response to COVID-19 school closures: The feasibility of a school-linked text message intervention as an adaptation to school-supervised asthma therapy.

BACKGROUND: School-supervised asthma therapy improves asthma medication adherence and morbidity, particularly among low-income and underrepresented minority (URM) children. However, COVID-19-related school closures abruptly suspended this therapy. In response, we developed a school-linked text message intervention. OBJECTIVE: The purpose of the study is to investigate the feasibility and acceptability of a school-linked text message intervention. METHODS: In December 2020, children previously enrolled in school-supervised asthma therapy in Central Massachusetts were recruited into this school-linked text message intervention. We sent two-way, automated, daily text reminders in English or Spanish to caregivers of these children, asking if they had given their child their daily preventive asthma medicine. Our study team notified the school nurse if the caregiver did not consistently respond to text messages. School nurses performed weekly remote check-ins with all families. The primary outcome of the study was feasibility: recruitment, retention, and intervention fidelity. Secondarily we examined intervention acceptability and asthma health outcomes. RESULTS: Twenty-six children (54% male, 69% Hispanic, 8% Black, 23% White, 93% Medicaid insured) and their caregivers were enrolled in the intervention with 96% participant retention at 6 months. Caregiver response rate to daily text messages was 81% over the study period. Children experienced significant improvements in asthma health outcomes. The intervention was well accepted by nurses and caregivers. CONCLUSION: A school-linked text messaging intervention for pediatric asthma is feasible and acceptable. This simple, accessible intervention may improve health outcomes for low-income and URM children with asthma. It merits further study as a potential strategy to advance health equity.

Relationship between carbohydrate intake and oral glucose tolerance test results among pregnant women.

AIMS: Evaluate the relationship between self-reported carbohydrate intake and oral glucose tolerance test (OGTT) results in pregnancy. METHODS: We measured carbohydrate intake using 24-hour dietary recall and performed a 2-hour 75-gram OGTT in 95 pregnant women with risk factors for gestational diabetes (GDM) at a median of 26 weeks' gestation. We tested for associations between carbohydrate intake in the 24 hours preceding the OGTT and 60-minute OGTT glucose, glucose at other timepoints, and glucose area under the curve (AUC) using linear regression, with adjustment for potential confounders. RESULTS: We observed an inverse linear relationship between carbohydrate intake (median 237 grams [interquartile range: 196, 303]) and 60-minute OGTT glucose. For every 50 gram reduction in carbohydrate intake, there was an 8.9 mg/dl increase in 60-minute OGTT glucose (P < 0.01) in an adjusted model. Lower carbohydrate intake was also associated with higher 30-minute (adjusted ß = -6.5 mg/dl, P < 0.01) and 120-minute OGTT glucose (adjusted ß = -8.1 mg/dl, P = 0.01) and AUC (adjusted ß = -767, P < 0.01). CONCLUSIONS: Carbohydrate intake in the day preceding an OGTT in pregnancy is associated with post-load glucose values, with lower carbohydrate intake predicting higher glucose levels and higher carbohydrate intake predicting lower glucose levels. Carbohydrate restriction or excess before an OGTT may affect GDM diagnosis.

Do not Forget Burkitt´s Lymphoma! Unusual Case of Primary Malignant Lymphoma of the Prostate in a Young Patient.

Primary Burkitt´s lymphoma (BL) of the prostate is rare in the adolescent population. The etiology remains poorly understood. There has been some proposed associations to Epstein-Barr virus and HIV. Clinical and histopathologic data of a 17-year-old patient who underwent transurethral resection of the prostate was obtained. We report the first case of primary malignant BL of the prostate in a 17-year-old Caucasian male who presented with hematuria, lower urinary tract symptoms. Differential diagnosis of a prostatic mass in adolescent patients must be primary or secondary lymphoma of the prostate, including BL as described for the first time in this article.

Longitudinal Changes in the Relationship Between Hemoglobin A1c and Glucose Tolerance Across Pregnancy and Postpartum.

OBJECTIVE: To characterize the relationship between hemoglobin A1c (HbA1c) levels and glucose tolerance across pregnancy and postpartum. DESIGN AND PARTICIPANTS: In a longitudinal study of pregnant women with gestational diabetes risk factors (N = 102), we performed oral glucose tolerance testing (OGTT) and HbA1c measurements at 10-15 weeks of gestation, 24-30 weeks of gestation (N = 73), and 6-24 weeks postpartum (N = 42). Complete blood counts were obtained from clinical records. We calculated HbA1c-estimated average glucose levels and compared them with mean OGTT glucose levels (average of fasting, 1- and 2-hour glucose levels). Linear mixed effects models were used to test for longitudinal changes in measurements. RESULTS: Mean OGTT glucose increased between 10-15 and 24-30 weeks of gestation (ß = 8.1 mg/dL, P = .001), while HbA1c decreased during the same time period (ß = -0.13%, P < .001). At 10-15 weeks of gestation and postpartum the discrepancy between mean OGTT glucose and HbA1c-estimated average glucose was minimal (mean [standard deviation]: 1.2 [20.5] mg/dL and 0.16 [18.1] mg/dL). At 24-30 weeks of gestation, the discrepancy widened (13.2 [17.9] mg/dL, ß = 12.7 mg/dL, P < .001, compared to 10-15 weeks of gestation, with mean OGTT glucose being higher than HbA1c-estimated average glucose). Lower hemoglobin at 24-30 weeks of gestation was associated with a greater discrepancy (ß = 6.4 mg/dL per 1 g/dL lower hemoglobin, P = .03 in an age- and gestational age-adjusted linear regression model). CONCLUSIONS: HbA1c accurately reflects glycemia in the 1st trimester, but underestimates glucose intolerance in the late 2nd trimester. Lower hemoglobin level is associated with greater underestimation. Accounting for gestational age and maternal hemoglobin may improve the clinical interpretation of HbA1c levels during pregnancy.

Guía de manejo Hiperplasia Prostática Benigna (SCU 2021) / Benign Prostatic Hyperplasia Guideline (SCU 2021)

La Sociedad Colombiana de Urología (SCU) decidió realizar la adaptación de la guía de manejo de HPB.[1] [2] Las recomendaciones finales de esta guía se basan en una revisión sistemática de la literatura hasta 2020. Esta guía ofrece evidencia práctica en la evaluación y el tratamiento de hombres mayores de 40 años que se presentan con síntomas del tracto urinario inferior (SUOB).

The Colombian Society of Urology (SCU) decided to adapt the BPH management guideline.[1] [2] The final recommendations of this guideline are based on a systematic review of the literature until 2020. This guideline provides practical evidence in the evaluation and management of men over 40 years of age presenting with lower urinary tract symptoms (LUTS).

Erratum: Guía de manejo Hiperplasia Prostática Benigna (SCU 2021) / Erratum: Benign Prostatic Hyperplasia Guideline (SCU 2021)

Correction to: Guía de manejo Hiperplasia Prostática Benigna (SCU 2021)

Corrección de: Hiperplasia benigna de próstata (HBP) Guía de manejo 2021

Características clínicas y microbiológicas de pacientes con neutropenia febril en un hospital Universitario / Clinical and microbiological characteristics of patients with febrile neutropenia in one Colombian Universitary Hospital

Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San Ignacio Métodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014 Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos. Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.

Objective: To describe the demographic and clinical characteristics, as well as frequency and type of bacterial isolate and resistance patterns in patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital Methods: This is a retrospective observational study. Data were collected from medical records of adult patients admitted in the Hemato-oncology and Bone Marrow Transplant Unit. Inclusion criteria was presence of febrile neutropenia in the setting of a hematological neoplasm from January 2013 to December 2014. Results: 345 episodes of febrile neutropenia from 193 patients were studied. An infectious focus was identified in 68.1% of episodes, and a bacterial isolate was obtained in 62.9% of episodes. The predominant microorganisms were gram-negative rods, gram-positive cocci, and fungi with a frequency of 63.7%, 27.9%, and 4.9% respectively. In term of resistance patterns, Escherichia coli and Klebsiella peumoniae isolates had a frequency of ESBL susceptibility pattern of 17.5% and 13.8% respectively; and a frequency of KPC susceptibility pattern of 1.25% and 2.8% respectively. The frequency of methicillin resistant Staphylococcus aureus was 6.8%. Death associated to infection ocurred in 16.5% of episodes. Conclusions: In patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital, we found a high rate of documentation of infectious focus, with a predominance of gram-negative rods, specially Enterobacteriacea; with a similar pattern in receptors of hematopoietic stem cell transplantation.

Factores pronósticos médicos y sociales asociados a urolitiasis en pacientes sometidos a nefroureterolitotomía láser / Medical and social prognostic factors associated with urolithiasis in patients undergoing flexible ureteroscopy and laser lithotripsy

Objetivos La fibróptica láser se ha convertido con el paso de los años en el procedimiento de elección en la mayoría de los casos de urolitiasis; sin embargo, se han descrito pocas escalas de predicción de riesgo y las que hay no incluyen el tiempo en el que se hace este procedimiento. Nuestro objetivo es hacer una descripción sobre los factores que influencian los desenlaces relacionados con las complicaciones de esta cirugía. Materiales y métodos Se incluyó a 149 pacientes con patología litiásica a quienes se les realizó nefroureterolitotomía retrógrada con fragmentación láser entre los años 2012 y 2015. Se analizaron variables asociadas a las características del cálculo, la anatomía, el tiempo entre diagnóstico y la intervención y las complicaciones pre, intra y postoperatorias. Se diseñó una herramienta de recolección sobre la base de las historias clínicas y se analizó con medidas de tendencia central y de asociación. Resultados Se encontró una correlación positiva entre las complicaciones preoperatorias, intraoperatorias y especialmente en las postoperatorias con el número de días orden-cirugía, con una pendiente con tendencia positiva a medida que se intervienen los pacientes más tardíamente. En las variables relacionadas con el índice STONE, la única variable que presentó asociación positiva con el tiempo entre la orden y la cirugía fue la presencia de hidronefrosis. Conclusión La realización tardía de la ureterolitotomía láser puede tener un impacto en la morbilidad de los pacientes con patología litiásica, en especial en las complicaciones postoperatorias. Esto plantea una necesidad de priorización de los pacientes según su probabilidad de presentar complicaciones.

Objectives The fibre-optics laser has become the surgical procedure of choice in most cases of urolithiasis over the years. However, there are few risk prediction scales described and in those that are published, they do not include the time delay in carrying out this procedure. The aim of this study is to present a description of the elements that influence the outcomes related to the complications of this surgery. Materials and methods The study included 149 patients between 4 and 74 years who underwent flexible retrograde ureteroscopy with laser fragmentation technology between 2012-2015. The analysis was based on the outcomes related to the calculus features, anatomy, time between diagnosis and intervention, and surgery complications. The statistical analysis was performed using central tendency and measures of association. Results A positive association was identified between preoperative, intraoperative, and in particular, in postoperative complications with the number of days between diagnosis and intervention, and with a positive trend that was related to the delay in the surgical intervention. As regards the STONE score, the only variable that had a positive association with the time between the request and performing the procedure, was the presence of hydronephrosis. Conclusion The delay in the intervention time for this surgery in patients with urolithiasis could have an important impact on morbidity, especially for postoperative complications. These results suggest the need of prioritisation of patients, taking into account the prediction of complications.