Oral fenofibrate for hyperbilirubinemia in term neonates: A single-blind randomized controlled trial.

Background: Hyperbilirubinemia is common in the neonatal period; however, delayed diagnosis or inadequate treatment can cause irreparable damage to the neonates. We aimed to evaluate the efficacy of oral fenofibrate for hyperbilirubinemia in term neonates. Methods: This single-blind randomized controlled trial included 86 term neonates aged 3-7 days, with birth weight ≥2500 g, admitted to Bandar Abbas Children's Hospital, Bandar Abbas Iran, from July 23, 2019, to July 22, 2020. The fenofibrate group received 10 mg/kg oral fenofibrate and phototherapy, while controls only received phototherapy. Serum total bilirubin was measured at 24 and 48 h and at the time of discharge. Hospital length of stay was also noted. Results: The two study groups were comparable regarding age, gender, gestational age, birth weight, and baseline total serum bilirubin levels. Serum total bilirubin levels at 48 h (P < 0.001) and at discharge (P < 0.001) were significantly lower in the fenofibrate group compared to controls. Although hospital length of stay was lower in the fenofibrate group compared to controls, the difference was not statistically significant (P = 0.612). Fenofibrate was more effective on the reduction of serum bilirubin in neonates aged 3-4.5 days starting at the 24th hour. Moreover, it was more effective in female neonates compared to males starting at the 48th hour. Conclusions: A single dose of oral fenofibrate reduced total serum bilirubin in term neonates with hyperbilirubinemia without any side effects; however, this effect was more prominent after 48 h.

Refractory Atrial Flutter, the Unusual Presentation of Covid-19 Infection in a Neonate: A Case Report and Review of Literature.

INTRODUCTION: The accurate incidence of different cardiovascular consequences of COVID-19 in the pediatric population has been inadequately defined due to ongoing genotype changes in the virus. Although COVID-19 is known to increase inflammatory markers associated with atrial arrhythmias, the contemporary literature has poorly described new onset arrhythmias as a complication in previously healthy neonates with COVID-19. CASE PRESENTATION: A twenty-day-old female term neonate, born by caesarean section with immediate cry, developed labored breathing, cyanosis, and tachycardia after having close contact with a confirmed case of COVID-19. The neonate developed atrial flutter, which was refractory to cardioversion and drugs, namely Amiodarone, Flecainide, and Propranolol. The authors treated the neonate with IVIG. This is the first reported case of atrial flutter in the neonatal period secondary to COVID-19. CONCLUSION: Since the start of the SARS-CoV-2 pandemic, all attention and concerns have been mainly on respiratory manifestations and complications. The cardiovascular complications and treatment have been neglected. This case reports tachyarrhythmia (Atrial Flutter) as an unusual presentation of acute COVID-19 in the neonatal population and shows the role of IVIG in the treatment of refractory arrhythmias.

Prostatic urethral lift (UroLift) versus convective water vapor ablation (Rezum) for minimally invasive treatment of BPH: a comparison of improvements and durability in 3-year clinical outcomes.

INTRODUCTION: Half of men aged > 60 years will develop benign prostatic hyperplasia (BPH) with 40% of these men having moderate-to-severe lower urinary tract symptoms (LUTS). There is limited knowledge on a head-to-head comparison of prostatic urethral lift (UroLift) and convective water vapor ablation (Rezum) for the treatment of LUTS secondary to BPH. We sought to compare randomized controlled trials with 3-year clinical outcome data. MATERIALS AND METHODS: After a thorough literature search, two multicenter sham-controlled double-blind randomized trials for UroLift and Rezum were identified and compared. Both studies had similar designs, baseline characteristics, reported outcomes, and low risks of bias. RESULTS: Rezum and UroLift resulted in significant improvement of International Prostate Symptom Score (IPSS) at 3 months (51.4% and 49.9%, respectively) and 50% reduction of IPSS Quality of Life that was durable across all time points. At 24 and 36 months, there was a statistically significant difference in IPSS between groups, favoring Rezum (-11.2 ± 7.3 versus -9.13 ± 7.62, p = 0.04, and -11.0 ± 7.1 versus -8.83 ± 7.41, p = 0.04, respectively). While Rezum had greater improvement in Qmax at 3 months (6.4 ± 7.2 versus 4.29 ± 5.16, p < 0.01), there was no difference in improvement from 12-36 months between treatments. Only UroLift experienced improvements of Men's Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EjD) function from baseline and was better than Rezum at all time points (p < 0.01). Rezum failed to significantly reduce the MSHQ-EjD bother at 3 months, while UroLift demonstrated a significant reduction of 27.56% (p < 0.01). Both systems offered equal improvements in the bother score by 12-36 months. Surgical re-treatment rates favored Rezum over Urolift (4.4% vs. 10.7%, respectively). CONCLUSIONS: Rezum achieved a greater improvement in symptom relief compared to UroLift. Improvement in ejaculatory dysfunction in patients treated with UroLift was greater than Rezum.

Evaluation of goodness of fit of semiparametric and parametric models in analysis of factors associated with length of stay in neonatal intensive care unit.

BACKGROUND: Length of stay is a significant indicator of care effectiveness and hospital performance. Owing to the limited number of healthcare centers and facilities, it is important to optimize length of stay and associated factors. PURPOSE: The present study aimed to investigate factors associated with neonatal length of stay in the neonatal intensive care unit (NICU) using parametric and semiparametric models and compare model fitness according to Akaike information criterion (AIC) between 2016 and 2018. METHODS: This retrospective cohort study reviewed 600 medical records of infants admitted to the NICU of Bandar Abbas Hospital. Samples were identified using census sampling. Factors associated with NICU length of stay were investigated based on semiparametric Cox model and 4 parametric models including Weibull, exponential, log-logistic, and log-normal to determine the best fitted model. The data analysis was conducted using R software. The significance level was set at 0.05. RESULTS: The study findings suggest that breastfeeding, phototherapy, acute renal failure, presence of mechanical ventilation, and availability of central venous catheter were commonly identified as factors associated with NICU length of stay in all 5 models (P<0.05). Parametric models showed better fitness than the Cox model in this study. CONCLUSION: Breastfeeding and availability of central venous catheter had protective effects against length of stay, whereas phototherapy, acute renal failure, and mechanical ventilation increased length of stay in NICU. Therefore, the identification of factors associated with NICU length of stay can help establish effective interventions aimed at decreasing the length of stay among infants.

Management of erectile dysfunction and LUTS/incontinence: the two most common, long-term side effects of prostate cancer treatment.

The two major long-term concerns associated with different options for the management of prostate cancer, (including surgery, radiotherapy, brachytherapy, cryotherapy, HIFU, etc.) include difficulties with lower urinary tract symptoms (LUTS) and/or erectile dysfunction. LUTS can be in the form of stress urinary incontinence (SUI), urge urinary incontinence (UUI), frequency/urgency, and/or voiding difficulties. While surgery is mostly associated with SUI and radiation mostly results in UUI, there can be an overlap. Incontinence rates after cryotherapy and high intensity focused ultrasound (HIFU) are generally very low. Voiding difficulties can also happen after the above-mentioned options. Treatment of SUI can start with pelvic floor muscle exercises (PFME), penile clamps or urethral plugs. If these fail to provide satisfactory results the surgical options could include: urethral bulking agents, male slings, and artificial urinary sphincter (AUS). Surgical options are usually not recommended during the first 6-12 months after radical prostatectomy. Management of frequency, urgency and/or UUI can also be started with lifestyle modifications and PFME. Oral agents (anticholinergics and ß3-agonists) are also considered before proceeding to third line options, such as Botox injection or sacral neuromodulation. The treatment options for ED resulting from the treatment of prostate cancer can include oral PDE5-I as the first line, local therapy as the second (such as MUSE, intracavernosal injections, and perhaps low intensity shock wave therapy) and finally surgery as the third line. Standard questionnaires and patient reported outcome measurement tools should be used for the assessment of LUTS and erectile dysfunction prior and after initiation of treatment to guide the management.

Clean intermittent catheterization: Single use vs. reuse.

INTRODUCTION: Intermittent catheterization (IC) is one of the fundamental aspects of managing patients with chronic urinary retention. Although reuse of catheters has been allowed to be chosen as the first option for IC, the optimal method of IC and the type of catheter has been a long-standing debate. We conducted a literature review regarding risk of urinary tract infection (UTI) and the costs associated with different methods and catheters. METHODS: A MEDLINE search via PubMed, EMBASE, and EBSCO host was conducted in March 2018. The date of publication was limited to 2014 to present/current. RESULTS: Single use of catheters (hydrophilic-coated [HC] or uncoated [UC]) was considered to impose a lower risk of UTI in all studies, except in one study that included children, but did not test their dexterity to handle HC catheters. Cost-effectiveness of single-use catheters was confirmed by all studies during this period. CONCLUSIONS: Reuse of catheters exposes the patient to a plethora of possible cleaning techniques and duration of catheter use. Patient adherence to cleaning method cannot be predicted and this further amplifies the risk of complications and their burden on the healthcare system. We recommend a patient-centred approach to consider HC catheters as the first option, while considering the patient's/caregiver's ability to accommodate the usage technique. Single-use UC catheters, and finally reuse of catheters are considered as next options if HC catheters are found difficult to handle (especially in children doing self-catheterization). Larger trials investigating this matter are required.

Risk factors for disconcordance between pre and post radical cystectomy stages.

PURPOSE: To investigate the correlation between pre and post surgical staging in patients undergoing radical cystectomy (RC), and study the possibility of predicting their disconcordance. MATERIALS AND METHODS: We reviewed medical records of 186 patients diagnosed with transitional cell carcinoma of the bladder, who had undergone RC between the years 2007 and 2010. We determined the correlation between pre and post surgical stages and then studied the association between stage disconcordance and age, gender, smoking, history of previous transurethral resection of bladder tumor (TURBT) and intravesical treatments, re-TURBT in high-risk superficial bladder tumors, and the treatment delay between diagnosis and RC. Analysis was performed using Chi-Square and Fisher's Exact tests. RESULTS: Post surgical up-staging occurred in 86 (46.24%) patients and even more (69.35%) if lymph node involvement was also considered as up-staging. Smokers and those with pre surgical stages of ≤ T1 and T2 with no history of re-TURBT had a significantly increased risk of disconcordance. The risk of up-staging was almost halved by an early re-TURBT in high-risk patients. CONCLUSION: Disconcordance between pre and post surgical stages in patients undergoing RC is common. Until better ways of staging are developed, decision making in patients with bladder tumor should be done by extra attention to patients who have risk factors associated with increased risk of up-staging, including smokers and those with nonmuscle-invasive bladder tumors or T2 tumors. An early re-TURBT will decrease the up-staging rate.