RESUMEN
PURPOSE: To evaluate the impact of COVID-19 pandemic on functional urology procedures in France. METHODS: A prospective study was conducted within 11 secondary and tertiary referral centers in France. Patients aged > 18 years who were diagnosed with a functional urology disease before the national lockdown (March 17th, 2020) and who required a surgery were included. Study period went from March 17th to September 30th 2020. The included interventions were listed according to the guidelines for functional urology enacted by the French Association of Urology and delay of reoperation was compared to the guidelines' delay. The primary outcome was the number of procedures left unscheduled at the end of the study period. Descriptive statistics were performed. RESULTS: From March 17th 2020 to September 3 rd 2020, 1246 patients with a previous diagnosis of a functional urological disease requiring a surgery were included. The mean follow-up was 140.4 days (± 53.4). Overall, 316 interventions (25.4%) were maintained whereas 74 (5.9%) were canceled, 848 (68.1%) postponed and 8 patients (0.6%) died. At the end of the follow-up, 184 patients (21.7%) were still not rescheduled. If the intervention was postponed, the mean delay between the initial and final date was 85.7 days (± 64.4). CONCLUSION: Overall, more than two thirds of interventions had to be postponed and the mean delay between the initial and final date was about three months.
Asunto(s)
COVID-19/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos , Enfermedades Urológicas/cirugía , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos , Adulto , Anciano , COVID-19/prevención & control , COVID-19/transmisión , Control de Enfermedades Transmisibles , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Prospectivos , Factores de Tiempo , Triaje , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/mortalidadRESUMEN
There are insufficient data in managing patients at high risk of deterioration. We aimed to investigate that national early warning score (NEWS) could predict severe outcomes in patients identified by a rapid response system (RRS), focusing on the patient's age. We conducted a retrospective cohort study from June 2019 to December 2020. Outcomes were unplanned intensive care unit (ICU) admission, ICU mortality, and in-hospital mortality. We analyzed the predictive ability of NEWS using receiver operating characteristics (ROC) curve and the effect of NEWS parameters using multivariable logistic regression. A total of 2,814 RRS activations were obtained. The predictive ability of NEWS for unplanned ICU admission and in-hospital mortality was fair but was poor for ICU mortality. The predictive ability of NEWS showed no differences between patients aged 80 years or older and under 80 years. However, body temperature affected in-hospital mortality for patients aged 80 years or older, and the inverse effect on unplanned ICU admission was observed. The NEWS showed fair predictive ability for unplanned ICU admission and in-hospital mortality among patients identified by the RRS. The different presentations of patients 80 years or older should be considered in implementing the RRS.
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Puntuación de Alerta Temprana , Enfermedades Gastrointestinales/mortalidad , Enfermedades Pulmonares/mortalidad , Neoplasias/mortalidad , Enfermedades Urológicas/mortalidad , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Temperatura Corporal , Enfermedad Crítica , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/patología , Mortalidad Hospitalaria , Equipo Hospitalario de Respuesta Rápida/organización & administración , Humanos , Unidades de Cuidados Intensivos , Modelos Logísticos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/patología , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/patología , Curva ROC , República de Corea , Estudios Retrospectivos , Análisis de Supervivencia , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/patologíaRESUMEN
Mink urinary tract disease (MUTD) often presents as urolithiasis and/or cystitis and is known as an important cause of mortality in mink kits during the early growth season. Antimicrobial flock treatment has been routinely applied as preventive/therapeutic protocol on Danish mink farms with increased mortality associated with MUTD. The therapeutic effect of this treatment strategy has not previously been investigated. In this study, we applied controlled parallel group treatment trials to assess the effect of sulfadiazine/trimethoprim and amoxicillin treatment on mortality associated with MUTD in mink kits. On farm A, eight mink kits were diagnosed with MUTD post mortem in the treatment group (n = 1920, sulfadiazine/trimethoprim treatment: 30 mg/kg, q 24 h, P.O for 5 days) compared to 16 in the untreated control group (n = 1920). No significant difference in mortality associated with MUTD were found between the treatment and the control group using the Fisher's exact test (P = 0.15). Treatment group 2 (n = 1920, amoxicillin treatment: 14 mg/kg q 24 h, P.O for 5 days) and treatment group 3 (n = 2088, amoxicillin treatment: 7.5 mg/kg q 24 h, P.O for 5 days) were investigated on farm B. Eight and four mink kits were diagnosed with MUTD post mortem in group 2 and 3, respectively. No difference between occurrence of MUTD were found between the control group and treatment group 2 (P = 0.42) or treatment group 3 (P = 0.75). No significant difference between final body weights or weight gain were found between treatment and control weighing groups on farm A or B. In conclusion, antimicrobial treatment administered in the feed showed no significant effect on weight gain or mortality associated with MUTD on the farms included in this study.
Asunto(s)
Antibacterianos/uso terapéutico , Visón , Enfermedades Urológicas/veterinaria , Animales , Animales Recién Nacidos , Dinamarca/epidemiología , Granjas , Enfermedades Urológicas/tratamiento farmacológico , Enfermedades Urológicas/mortalidadRESUMEN
BACKGROUND: As Enhanced Recovery After Surgery (ERAS®) programs expand across numerous subspecialties, growth and sustainability on a system level becomes increasingly important and may benefit from reporting multidisciplinary and financial data. However, the literature on multidisciplinary outcome analysis in ERAS is sparse. This study aims to demonstrate the impact of multidisciplinary ERAS auditing in a hospital system. Additionally, we describe developing a financial metric for use in gaining support for system-wide ERAS adoption and sustainability. METHODS: Data from HPB, colorectal and urology ERAS programs at a single institution were analyzed from a prospective ERAS Interactive Audit System (EIAS) database from September 2015 to June 2019. Clinical 30-day outcomes for the ERAS cohort (n = 1374) were compared to the EIAS pre-ERAS control (n = 311). Association between improved ERAS compliance and improved outcomes were also assessed for the ERAS cohort. The potential multidisciplinary financial impact was estimated from hospital bed charges. RESULTS: Multidisciplinary auditing demonstrated a significant reduction in postoperative length of stay (LOS) (1.5 days, p < 0.001) for ERAS patients in aggregate and improved ERAS compliance was associated with reduced LOS (coefficient - 0.04, p = 0.004). Improved ERAS compliance in aggregate also significantly associated with improved 30-day survival (odds ratio 1.04, p = 0.001). Multidisciplinary analysis also demonstrated a potential financial impact of 44% savings (p < 0.001) by reducing hospital bed charges across all specialties. CONCLUSIONS: Multidisciplinary auditing of ERAS programs may improve ERAS program support and expansion. Analysis across subspecialties demonstrated associations between improved ERAS compliance and postoperative LOS as well as 30-day survival, and further suggested a substantial combined financial impact.
Asunto(s)
Enfermedades del Sistema Digestivo/cirugía , Recuperación Mejorada Después de la Cirugía , Procedimientos Quirúrgicos Operativos , Enfermedades Urológicas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Sistema Digestivo/mortalidad , Femenino , Adhesión a Directriz , Precios de Hospital , Humanos , Tiempo de Internación/economía , Masculino , Auditoría Médica , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/mortalidad , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Enfermedades Urológicas/mortalidad , Adulto JovenRESUMEN
BACKGROUND AND AIMS: The choice of anesthesia method may influence mortality and postoperative urological complications after open groin hernia repair. We aimed to investigate the association between type of anesthesia and incidence of urinary retention, urethral stricture, prostate surgery, and 1-year mortality after open groin hernia repair. MATERIALS AND METHODS: Data were linked from the Danish Hernia Database, the national patient register, and the register of causes of death. We investigated data on male adult patients receiving open groin hernia repair from 1999 to 2013 with either local anesthesia, regional anesthesia, or general anesthesia. In relation to the type of anesthesia, we compared mortality and urological complications up to 1 year postoperatively. We adjusted for covariates in a logistic regression assessing urological complications and with the Cox regression assessing mortality. RESULTS: We included 113,069 open groin hernia repairs in local anesthesia, regional anesthesia, or general anesthesia. The risk of urinary retention adjusted for covariates was higher after both general anesthesia (adjusted odds ratio = 1.64, 95% confidence interval = 1.05-2.57, p = 0.031) and regional anesthesia (odds ratio = 2.99, 95% confidence interval = 1.67-5.34, p < 0.0005) compared with local anesthesia. The adjusted risk of prostate surgery was also higher for both general anesthesia (odds ratio = 1.58, 95% confidence interval = 1.23-2.03, p < 0.0005) and regional anesthesia (odds ratio = 1.90, 95% confidence interval = 1.40-2.58, p < 0.0005) compared with local anesthesia. Type of anesthesia did not influence 1-year mortality or the risk for urethral stricture. CONCLUSION: Patients undergoing open groin hernia repair in local anesthesia experience the lowest rate of urological complications and have equally low mortality compared with patients undergoing repair in general anesthesia or regional anesthesia.
Asunto(s)
Anestesia/métodos , Hernia Inguinal/cirugía , Herniorrafia/métodos , Complicaciones Posoperatorias/epidemiología , Enfermedades Urológicas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestesia/mortalidad , Anestesia de Conducción , Anestesia General , Anestesia Local , Dinamarca/epidemiología , Ingle/cirugía , Hernia Inguinal/mortalidad , Herniorrafia/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Sistema de Registros , Enfermedades Urológicas/mortalidadRESUMEN
OBJECTIVE: The primary objective was to describe the incidence and risk factors of urologic complications during radical hysterectomy for cervical cancer. The secondary objective was to investigate the impact of urologic complications on long-term survival. METHODS: Patients who underwent radical hysterectomy for cervical cancer from 2004 to 2016 were identified in the MSCCCC (Major Surgical Complications of Cervical Cancer in China) database. Data on demographic characteristics, clinical characteristics, hospital characteristics and urologic complications were collected. Multivariable logistic regression was used to assess the risk factors of urologic complications and Cox proportional hazards models were performed to identify prognostic factors. RESULTS: A total of 21,026 patients undergoing radical hysterectomy for cervical cancer were identified. The incidence of any urologic complications was 1.54%: 83 (0.39%) ureteral injuries, 17 (0.08%) bladder injuries, 1 (0.005%) ureteral injury combined with bladder injury, and 223 (1.05%) genitourinary fistulas. In a multivariable analysis, surgery at a women and children's hospital (OR = 2.26, 95% CI 1.47-3.48), surgery at a facility in a first-tier city (OR = 2.08, 95% CI 1.24-3.48), and laparoscopic surgery (OR = 4.68, 95% CI 3.44-6.36) were associated with a higher risk of urologic complications. Cox proportional hazards models revealed that the occurrence of urologic complications was a significant predictor of 2-year overall survival (OR = 1.78, 95% CI = 1.09-2.92), but was not a predictor of 5-year overall survival (OR = 1.27, 95% CI = 0.83-1.94). CONCLUSION: The incidence of urologic complications during radical hysterectomy is low. The risk of urologic complications may be higher for patients who are treated at a women and children's hospital, are treated in first-tier city hospitals, and receive laparoscopic surgery. Urologic complications have an impact on short-term survival, but not on long-term survival.
Asunto(s)
Complicaciones Posoperatorias/mortalidad , Enfermedades Urológicas/epidemiología , Enfermedades Urológicas/mortalidad , Neoplasias del Cuello Uterino/cirugía , China/epidemiología , Bases de Datos Factuales , Femenino , Humanos , Histerectomía/efectos adversos , Histerectomía/estadística & datos numéricos , Incidencia , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Urológicas/etiología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/mortalidadRESUMEN
Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, pâ¯=â¯0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.
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Síndrome Coronario Agudo/cirugía , Anemia/epidemiología , Enfermedad de la Arteria Coronaria/cirugía , Intervención Coronaria Percutánea/métodos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Hemorragia Posoperatoria/epidemiología , Síndrome Coronario Agudo/epidemiología , Anciano , Anciano de 80 o más Años , Angina Inestable/epidemiología , Angina Inestable/cirugía , Anticoagulantes/uso terapéutico , Antitrombinas/uso terapéutico , Aspirina/uso terapéutico , Causas de Muerte , Clopidogrel/uso terapéutico , Comorbilidad , Enfermedad de la Arteria Coronaria/epidemiología , Stents Liberadores de Fármacos , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/mortalidad , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Hemorragia/mortalidad , Heparina/uso terapéutico , Hirudinas , Humanos , Hemorragias Intracraneales/inducido químicamente , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/mortalidad , Estimación de Kaplan-Meier , Masculino , Infarto del Miocardio/epidemiología , Infarto del Miocardio/cirugía , Fragmentos de Péptidos/uso terapéutico , Cuidados Posoperatorios , Hemorragia Posoperatoria/inducido químicamente , Hemorragia Posoperatoria/mortalidad , Clorhidrato de Prasugrel/uso terapéutico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Proteínas Recombinantes/uso terapéutico , Medición de Riesgo , Stents , Ticagrelor/uso terapéutico , Enfermedades Urológicas/inducido químicamente , Enfermedades Urológicas/epidemiología , Enfermedades Urológicas/mortalidadRESUMEN
Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department.Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality.Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans (Pâ=â.001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels (Pâ=â.01 and Pâ<â.001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; Pâ=â.06 and estimate -3.0; Pâ=â.04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate -2.3; Pâ=â.15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72âhours lengthened the duration of RRT-free days compared with that after 72âhours (estimate -6.0 days; Pâ=â.03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage.Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.
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Enfermedad Crítica/mortalidad , Terapia de Reemplazo Renal/mortalidad , Infecciones Urinarias/mortalidad , Enfermedades Urológicas/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Oportunidad Relativa , Puntuaciones en la Disfunción de Órganos , Estudios Retrospectivos , Factores de Tiempo , Infecciones Urinarias/etiología , Infecciones Urinarias/terapia , Enfermedades Urológicas/complicaciones , Enfermedades Urológicas/terapiaRESUMEN
OBJECTIVE: To assess and analyze the contemporary causes of in-hospital deaths of spina bifida patients. METHODS: It was a cross-sectional observational study of the longitudinal national cohort of all patients hospitalized in French public and private hospitals. We analyzed the data from the French hospital discharge database (Programme de Médicalisation des Systemes d'Information, PMSI) from 2009 to 2014. The number of in-hospital deaths was extracted using the combination of the ICD-10 codes "Q05" or "Q760" and a discharge code = 9. RESULTS: There were 138 in-hospital deaths of spina bifida patients over the 6-year study period. The median age at death was 41 years (IQR: 25-52). The median age at death was significantly lower in patients with vs without hydrocephalus (26.6 vs 45.5 years; P <.0001). The leading cause of in-hospital death was urologic disorders (n = 24; 17.3%). Other main causes of death were pulmonary disorders (n = 23; 16.7%), neurologic disorders (n = 19; 13.8%), and bowel disorders (n = 15; 10.9%). Upper urinary tract damage accounted for most of the urologic causes of death: 8 patients died from urinary tract infections (33.3%), 7 patients died from renal failure (29.2%), 4 died from bladder cancer (16.7%), and 5 from other urologic causes. The only variable significantly associated with a death from urologic causes was the absence of hydrocephalus (OR = 0.26; P = .009). CONCLUSION: Urologic disorders remain the leading cause of in-hospital death in spina bifida patients in France. The present study highlights that efforts to improve the urologic management of the spina bifida population are still greatly needed.
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Causas de Muerte , Hidrocefalia , Disrafia Espinal , Enfermedades Urológicas , Adulto , Estudios Transversales , Femenino , Francia/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Hidrocefalia/complicaciones , Hidrocefalia/mortalidad , Estudios Longitudinales , Masculino , Mortalidad , Evaluación de Necesidades , Disrafia Espinal/complicaciones , Disrafia Espinal/terapia , Enfermedades Urológicas/clasificación , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/etiología , Enfermedades Urológicas/mortalidadRESUMEN
BACKGROUND: Increased postoperative cardiac troponin (cTn) independently predicts short-term mortality. Previous studies suggest that preoperative cTn also predicts major adverse cardiovascular events (MACE) and mortality after noncardiac surgery. The value of preoperative and perioperative changes in cTn as a prognostic tool for adverse outcomes has been sparsely investigated. METHODS AND FINDINGS: A systematic review and meta-analysis of the prognostic value of cTns for adverse outcome was conducted. Adverse outcome was defined as short-term (in-hospital or <30 days) and long-term (>30 days) MACE and/or all-cause mortality, in adult patients undergoing noncardiac surgery. The study protocol (CRD42018094773) was registered with an international prospective register of systematic reviews (PROSPERO). Preoperative cTn was a predictor of short- (OR 4.3, 95% CI 2.9-6.5, p<0.001, adjusted OR 5.87, 95% CI 3.24-10.65, p<0.001) and long-term adverse outcome (OR 4.2, 95% CI 1.0-17.3, p = 0.05, adjusted HR 2.0, 95% CI 1.4-3.0, p<0.001). Perioperative change in cTn was a predictor of short-term adverse outcome (OR 10.1, 95% CI 3.2-32.3, p<0.001). It was not possible to conduct pooled analyses for adjusted estimates of perioperative change in cTn as predictor of short- (a single study identified) and long-term (no studies identified) adverse outcome. Further, it was not possible to conduct pooled analyses for unadjusted estimates of perioperative change in cTn as predictor of long-term adverse outcome, since only one study was identified. Bivariate analysis of sensitivities and specificities were performed, and overall prognostic performance was summarized using summary receiver operating characteristic (SROC) curves. The pooled sensitivity and specificity for preoperative cTn and short-term adverse outcome was 0.43 and 0.86 respectively (area under the SROC curve of 0.68). There were insufficient studies to construct SROCs for perioperative changes in cTn and for long-term adverse outcome. CONCLUSION: Our study indicates that although preoperative cTn and perioperative change in cTn might be valuable predictors of MACE and/or all-cause mortality in adult noncardiac surgical patients, its overall prognostic performance remains uncertain. Future large, representative, high-quality studies are needed to establish the potential role of cTns in perioperative cardiac risk stratification.
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Biomarcadores/metabolismo , Enfermedades Musculoesqueléticas/mortalidad , Enfermedades del Sistema Nervioso/mortalidad , Atención Perioperativa/mortalidad , Cuidados Preoperatorios/mortalidad , Troponina I/metabolismo , Enfermedades Urológicas/mortalidad , Humanos , Enfermedades Musculoesqueléticas/metabolismo , Enfermedades Musculoesqueléticas/patología , Enfermedades Musculoesqueléticas/cirugía , Enfermedades del Sistema Nervioso/metabolismo , Enfermedades del Sistema Nervioso/patología , Enfermedades del Sistema Nervioso/cirugía , Pronóstico , Medición de Riesgo , Tasa de Supervivencia , Enfermedades Urológicas/metabolismo , Enfermedades Urológicas/patología , Enfermedades Urológicas/cirugíaRESUMEN
OBJECTIVES: Normal urinary bladder stores urine at low pressure, does not leak, and completely empties by natural voiding. An abnormal bladder may be due to neurologic or urologic disorders that render the bladder of small capacity, of high storage pressure, or of poor compliance. The aim of this study was to determine the long-term outcomes of renal transplant in patients with abnormal bladders. MATERIALS AND METHODS: We retrospectively compared 30 transplanted kidneys in 25 patients with abnormal bladders with a control group comprising 30 grafts transplanted simultaneously during the same period of time (1990-2014) in 30 patients without bladder abnormality. Patient demographics, graft function, survival, and postoperative complications were compared. RESULTS: Patients with abnormal bladders received transplants at a younger age than the control group (32 ± 17 vs 47 ± 12 y; P <. 001). Graft survival was not significantly different between the study and the control groups at 1 (90% vs 97%; P = .30), 3 (88% vs 91%; P = .67), and 5 years (82% vs 87%; P = .68). On long-term follow-up (20 years), 19 grafts (63%) were functioning in the study group compared with 25 grafts (83%) in the control group, suggesting inferior survival in those with an abnormal bladder after the first 10 years of transplant. In the abnormal bladder group, there was higher incidence of urologic complications (93% vs 50%; P<.001). CONCLUSIONS: Despite the earlier age at transplant, the previous urologic operations, and the high incidence of urinary tract infection after renal transplant, graft survival and functions after renal transplant were not significantly different between patients with abnormal and normal bladders over at least the first 10 years. Therefore, it is safe to transplant into abnormal bladders once they have been assessed, reconstructed if necessary, and managed appropriately.
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Fallo Renal Crónico/cirugía , Trasplante de Riñón , Vejiga Urinaria/cirugía , Enfermedades Urológicas/cirugía , Adolescente , Adulto , Femenino , Supervivencia de Injerto , Humanos , Estimación de Kaplan-Meier , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/fisiopatología , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Vejiga Urinaria/fisiopatología , Infecciones Urinarias/etiología , Micción , Urodinámica , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/mortalidad , Enfermedades Urológicas/fisiopatología , Adulto JovenRESUMEN
BACKGROUND/PURPOSE: The purpose of this study was to explore clinical characteristics and primary surgical diagnoses associated with in-hospital death in pediatric surgical patients admitted to the neonatal intensive care unit (NICU) of a tertiary hospital. METHODS: This retrospective study includes all patients admitted to our NICU for pediatric surgical diseases between January 2001 and December 2015. Univariate and multivariate binary logistic regression were performed to assess independent factors associated with in-hospital death. RESULTS: A total of 440 cases were included and 334 (83.5%) patients underwent one or more surgeries. Thirty six patients (8.2%) died while hospitalized in the NICU. The 5 most common surgical diagnoses were intestinal atresia/stenosis, anorectal malformation, congenital diaphragmatic hernia (CDH), esophageal atresia, and urinary system disorder. Necrotizing enterocolitis (NEC) had the highest mortality rate. Using logistic regression, in-hospital death was predicted by extremely low birth weight (ELBW) (odds ratio (OR)=6.594; P=0.006), CDH (OR=13.954; P<0.001), and NEC (OR=8.991; P=0.049). CONCLUSIONS: This study describes CDH, NEC, and ELBW are independent predictive factors associated with in-hospital death of pediatric surgical patients in our NICU. Novel approaches for those conditions are required to improve the survival. TYPE OF STUDY: Prognostic LEVELS OF EVIDENCE: II.
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Mortalidad Hospitalaria , Unidades de Cuidado Intensivo Neonatal , Malformaciones Anorrectales/mortalidad , Malformaciones Anorrectales/cirugía , Niño , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/cirugía , Atresia Esofágica/mortalidad , Atresia Esofágica/cirugía , Femenino , Hernias Diafragmáticas Congénitas/mortalidad , Hernias Diafragmáticas Congénitas/cirugía , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Atresia Intestinal/mortalidad , Atresia Intestinal/cirugía , Modelos Logísticos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Urológicas/mortalidad , Enfermedades Urológicas/cirugíaAsunto(s)
Envejecimiento/fisiología , Esperanza de Vida/tendencias , Enfermedades Urológicas/patología , Envejecimiento/psicología , Metilación de ADN/fisiología , Atención a la Salud/normas , Disfunción Eréctil/etiología , Humanos , Síntomas del Sistema Urinario Inferior/fisiopatología , Síntomas del Sistema Urinario Inferior/cirugía , Masculino , Calidad de Vida , Caracteres Sexuales , Testosterona/fisiología , Enfermedades Urológicas/mortalidad , Enfermedades Urológicas/prevención & control , Enfermedades Urológicas/psicologíaRESUMEN
BACKGROUND: Some fetuses with congenital abnormalities of the kidney and urinary tract (CAKUT) have severe renal dysfunction during the prenatal period that can result in oligohydramnios, pulmonary hypoplasia, and death following birth. We hypothesized that cord blood cystatin C (CysC) levels are elevated in neonates who have life-threatening pulmonary hypoplasia and oligohydramnios due to severe renal dysfunction. In this study we compared cord blood CysC levels between a non-survivor group with CAKUT and a survivor group. METHODS: This was a single-center, retrospective cohort study conducted between January 2007 and December 2015. Eighty-seven neonates who were prenatally diagnosed with CAKUT were included in the study. Cord blood CysC and creatinine levels were compared between the survivor and non-survivor groups at discharge from hospital. RESULTS: Of the 87 neonates enrolled in the study, 67 survived and 21 died before discharge. Median cord blood CysC levels were higher in the non-survivor group than in the survivor group (4.28 vs. 1.96 mg/L, respectively; p < 0.001). Cord blood creatinine levels were not significantly different between the two groups. In patients with oligohydramnios (n = 28), cord blood CysC levels were significantly higher in the non-survivor group than in the survivor group (4.28 vs. 2.23 mg/L, respectively; p = 0.002). CONCLUSIONS: In this study population, cord blood CysC levels were significantly higher in the non-survivor group with CAKUT than in the survivor group. These results suggest that cord blood CysC levels may be a good marker of the severity of renal dysfunction at birth.
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Biomarcadores/sangre , Cistatina C/sangre , Sangre Fetal/metabolismo , Sistema Urinario/anomalías , Enfermedades Urológicas/sangre , Estudios de Cohortes , Creatinina/sangre , Femenino , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Modelos Logísticos , Masculino , Estudios Retrospectivos , Enfermedades Urológicas/congénito , Enfermedades Urológicas/mortalidadRESUMEN
Between 2007 and 2014, 83 cetaceans were found stranded along the Ligurian coast of Italy, in the Pelagos Sanctuary, the largest marine protected area in the Mediterranean basin. Forty-nine (59%) were submitted to complete or partial necropsy, depending on the conservation status of the carcass. Based on gross and histological pathology and ancillary testing, the cause of death was determined and categorized as anthropogenic or natural (i.e., nonanthropogenic) in origin for 33 animals (67%) and of undetermined origin in the remaining 16 (33%). Natural causes of death, accompanied by either poor or good nutritional status, were attributed to 29 animals (59%), whereas four (8%) were diagnosed with an anthropogenic cause of death, consisting of interaction with fishing activities. Infectious and noninfectious disease was the most common cause of death, involving 29 cetaceans (59%). These data are valuable for understanding health and mortality trends in cetacean populations and can provide information for establishing policies for cetacean conservation and management in such an important protected area of the Mediterranean basin.
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Autopsia/veterinaria , Causas de Muerte , Cetáceos , Neoplasias de la Corteza Suprarrenal/mortalidad , Neoplasias de la Corteza Suprarrenal/veterinaria , Adenoma Corticosuprarrenal/mortalidad , Adenoma Corticosuprarrenal/veterinaria , Distribución por Edad , Animales , Animales Recién Nacidos , Enfermedades Transmisibles/mortalidad , Enfermedades Transmisibles/veterinaria , Femenino , Cardiopatías/mortalidad , Cardiopatías/veterinaria , Hemorragia/mortalidad , Hemorragia/veterinaria , Actividades Humanas , Italia , Masculino , Estado Nutricional , Enfermedades Urológicas/mortalidad , Enfermedades Urológicas/veterinaria , Heridas y Lesiones/mortalidad , Heridas y Lesiones/veterinariaRESUMEN
OBJECTIVES: to evaluate whether exposure to an urban waste incinerator plant operating in Arezzo (Tuscany Region, Central Italy) since the 2000 is associated with mortality and morbidity. DESIGN: a population-based cohort study of inhabitants living close to the incinerator in the period 2001-2010 was conducted. The individual exposure histories to the incinerator and other sources in the area were estimated using a dispersion model producing PM10 concentration maps for each source (ADMS-URBAN model). Hazard Ratios (HR) with 95% Confidence Interval (95%CI) adjusted for the other environmental exposures, age and socioeconomic status were estimated for the highest class of exposure using the lowest one as reference. Trends of HR were evaluated too. MAIN OUTCOME MEASURES: mortality and hospitalization causes with induction-latent period overlapping the incinerator activity period were analysed. RESULTS: morbidity analysis showed an increased risk for cardiovascular diseases (No. 732; HR: 1.18; 95%CI 1.06-1.32; trend of HR: 1.08, p=0.006) and a trend of HRs for urinary diseases (trend: 1.13; p=0.063). Mortality analysis showed a trend of HRs for general mortality in males (trend: 1.10; p=0.014), for cardiovascular diseases in males (trend: 1.15; p=0.036), for respiratory diseases in females (trend: 1.30; p=0.098), and an excess of acute respiratory diseases in females with the highest exposure (No. 11; HR=2.54; 95%CI 0.84-7.68). CONCLUSIONS: the cohort study allowed to characterise the environmental exposures considering the most relevant pollution sources and providing estimation of individual environmental exposures. Residual confounding due to the overlapping of concentration maps cannot be excluded and further investigations are needed. However, the increased risks for cardiovascular and respiratory diseases reinforce the limited epidemiological evidence on health effects of incinerators.
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Contaminación del Aire/efectos adversos , Enfermedades Cardiovasculares/mortalidad , Exposición a Riesgos Ambientales/efectos adversos , Hospitalización/estadística & datos numéricos , Incineración , Insuficiencia Renal Crónica/mortalidad , Trastornos Respiratorios/mortalidad , Adulto , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Femenino , Evaluación del Impacto en la Salud , Humanos , Italia/epidemiología , Masculino , Insuficiencia Renal Crónica/etiología , Trastornos Respiratorios/etiología , Factores de Riesgo , Distribución por Sexo , Factores de Tiempo , Enfermedades Urológicas/etiología , Enfermedades Urológicas/mortalidadAsunto(s)
Síndrome Coronario Agudo/epidemiología , Hemorragia Gastrointestinal/epidemiología , Hemorragias Intracraneales/epidemiología , Enfermedades Urológicas/epidemiología , Área Bajo la Curva , Transfusión Sanguínea , Femenino , Estudios de Seguimiento , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/terapia , Hemorragia/epidemiología , Hemorragia/mortalidad , Hemorragia/terapia , Mortalidad Hospitalaria , Hospitalización , Humanos , Hemorragias Intracraneales/mortalidad , Hemorragias Intracraneales/terapia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Enfermedades Urológicas/mortalidad , Enfermedades Urológicas/terapiaRESUMEN
The aim of this study is to identify and subclassify sudden natural death (sudden death from natural diseases) cases in Seychelles. A total of 484 sudden natural death cases with autopsy at the Clinical Pathology Laboratory, Victoria Hospital, Seychelles between 1997 through 2012 were retrospectively reviewed. Among them, 363 cases (75%) were male and 121 (25%) were female. The most frequent sudden deaths were attributed to cardiovascular diseases (78.5%), and then followed by infectious diseases (9.9%), and gastrointestinal diseases (9.1%). This is the largest population-based study on sudden natural deaths in Seychelles.
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Muerte Súbita/epidemiología , Muerte Súbita/etiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Niño , Preescolar , Enfermedades Transmisibles/mortalidad , Femenino , Enfermedades Gastrointestinales/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Enfermedades del Sistema Nervioso/mortalidad , Estudios Retrospectivos , Distribución por Sexo , Seychelles/epidemiología , Enfermedades Urológicas/mortalidad , Adulto JovenRESUMEN
This article focuses on the issues facing patients with advanced and terminal urologic illness, from the framework of care planning based on defining patient-specific and family-specific goals of care, to palliative management strategies for common symptoms and syndromes that these patients and their families experience. This article also focuses on the management of common urologic issues that may arise in the course of care for all patients at the end of life, as well as the impact of these conditions on caregivers.