Evaluation of Diagnostic Performance of Line Probe Assay on Smear-Negative Samples of Pulmonary Tuberculosis.

BACKGROUND: This study aims to compare the performance of line probe assay (LPA) on smear-negative samples with that of smear-positive samples for diagnosing pulmonary tuberculosis (PTB) and first-line drug sensitivity testing (FL DST). METHODS: A total of 196 sputum samples including both smear-positive (112) and negative (84) samples of patients suspected of PTB were subjected to LPA for TB detection and FL DST. TB culture followed by MPT 64 Ag was done and conventional FL DST was performed on all culture-positive isolates. Results of LPA on smear-negative were compared with smear-positive samples. RESULTS: The LPA confirmed the diagnosis of PTB in 104/112 smear-positive cases but in only 36/84 smear-negative cases. The assay had 47.36%, 72.72%, and 88.88% sensitivity and 86.96%, 95.23%, and 95.65% specificity in smear-negative cases compared to 89.09%, 95.83%, and 98.07% sensitivity and 100%, 98.36%, and 98.24% specificity in smear-positive cases for detecting Mycobacterium tuberculosis (MTB), rifampicin (RMP) resistance, and isoniazid (INH) resistance, respectively. CONCLUSION: LPA performance was better on smear-positive than smear-negative sputum samples. Further larger studies are needed to justify the use of LPA on smear-negative pulmonary samples for diagnosis.

Predictors for multidrug-resistant organisms (MDROs) carriage in haemodialysis patients.

Introduction: Infections in haemodialysis (HD) patients are an important cause of morbidity, hospitalization, and mortality. Patients undergoing HD are more prone to develop bacterial infections by multidrug-resistant organisms (MDROs). Objectives: This study is aimed to detect MDROs colonization in HD patients and its associated risk factors and outcome. Methodology: A total of 62 nasal swabs and 124 rectal swabs were collected from 62 patients coming to the haemodialysis unit from of March to May 2021 and were further screened for MRSA, VRE and CRE. Results: Out of 62 patients, 22.59% showed the presence of methicillin-resistant staphylococcus aureus (MRSA) while VRE was present in four patients (4/62). CRE was found as 24.2% (15/62). Duration of dialysis was found as a significant risk factor-associated MRSA carriage, Whereas Charlson index and drug and medication were found as significant risk factor for VRE carriage. Discussion & Conclusion: HD patients are particularly vulnerable to life threatening infections. Therefore, continuous epidemiological surveillance for these MDROs, including genotypic analysis and implementation of adequate decolonization strategies, is crucial and will reduce the possibility of autoinfection as well as disrupt transmission of multi-resistant isolates to others.

Evaluation of the Current Status of Artificial Intelligence for Endourology Patient Education: A Blind Comparison of ChatGPT and Google Bard Against Traditional Information Resources.

Introduction: Artificial intelligence (AI) platforms such as ChatGPT and Bard are increasingly utilized to answer patient health care questions. We present the first study to blindly evaluate AI-generated responses to common endourology patient questions against official patient education materials. Methods: Thirty-two questions and answers spanning kidney stones, ureteral stents, benign prostatic hyperplasia (BPH), and upper tract urothelial carcinoma were extracted from official Urology Care Foundation (UCF) patient education documents. The same questions were input into ChatGPT 4.0 and Bard, limiting responses to within ±10% of the word count of the corresponding UCF response to ensure fair comparison. Six endourologists blindly evaluated responses from each platform using Likert scales for accuracy, clarity, comprehensiveness, and patient utility. Reviewers identified which response they believed was not AI generated. Finally, Flesch-Kincaid Reading Grade Level formulas assessed the readability of each platform response. Ratings were compared using analysis of variance (ANOVA) and chi-square tests. Results: ChatGPT responses were rated the highest across all categories, including accuracy, comprehensiveness, clarity, and patient utility, while UCF answers were consistently scored the lowest, all p < 0.01. A subanalysis revealed that this trend was consistent across question categories (i.e., kidney stones, BPH, etc.). However, AI-generated responses were more likely to be classified at an advanced reading level, while UCF responses showed improved readability (college or higher reading level: ChatGPT = 100%, Bard = 66%, and UCF = 19%), p < 0.001. When asked to identify which answer was not AI generated, 54.2% of responses indicated ChatGPT, 26.6% indicated Bard, and only 19.3% correctly identified it as the UCF response. Conclusions: In a blind evaluation, AI-generated responses from ChatGPT and Bard surpassed the quality of official patient education materials in endourology, suggesting that current AI platforms are already a reliable resource for basic urologic care information. AI-generated responses do, however, tend to require a higher reading level, which may limit their applicability to a broader audience.

Review of efficacy and safety of same-day discharge after percutaneous nephrolithotomy.

PURPOSE: Prior literature reviews have assessed the efficacy and safety of outpatient percutaneous nephrolithotomy (PCNL) with "outpatient" defined as discharge within twenty-four hours of surgery. To our knowledge, this is the first literature review analyzing ambulatory PCNLs (aPCNL) defined as hospital discharge on the same day as surgery. This review aims to assess the efficacy and safety of same-day discharge after PCNL. METHODS: We conducted a search in the PubMed database for key search terms including "ambulatory PCNL", "ambulatory percutaneous nephrolithotomy", "outpatient PCNL", "outpatient percutaneous nephrolithotomy", and "day surgery percutaneous nephrolithotomy". We reviewed articles defining "ambulatory" as discharge the same day the PCNL was performed. 13 papers were identified in our search. RESULTS: Overall, we found no difference in complication rates, emergency department visits, and postoperative admissions when comparing outpatient PCNL to inpatient PCNL, and to previously published statistics for inpatient PCNL. Some studies even showed lower rates of adverse outcomes in ambulatory cohorts when compared to inpatient cohorts. Additionally, ambulatory PCNL conferred significant healthcare savings over inpatient PCNL. CONCLUSION: This literature review suggests that ambulatory PCNL can be safely performed in both optimal and suboptimal surgical candidates with no significant increase in complications. Additional high-quality studies are warranted to further the evidence surrounding outpatient PCNL and its outcomes.

Comparison of metabolic parameters between pure-uric acid and mixed-uric acid kidney stone formers.

PURPOSE: We seek to compare clinical and 24-h urine parameters between pure-uric acid (UA) and UA-CaOx stone formers in our practice and explore how any differences in metabolic profiles could suggest different prevention strategies between the two groups. METHODS: We retrospectively reviewed patients with either pure- or mixed-UA nephrolithiasis from 2020 to 2023 at a tertiary care center. We included patients with a 24-h urine collection and a stone analysis detecting any amount of UA. Patients were organized into two cohorts: (1) those with 100% UA stones and (2) < 100% UA stones. Differences in demographic characteristics were compared between pure-UA and UA-CaOx stone formers. Twenty-four hour urine metabolic parameters as well as metabolic abnormalities were compared between the pure-uric acid and mixed-uric acid groups. RESULTS: We identified 33 pure-UA patients and 33 mixed-UA patients. Patient demographics were similar between the groups (Table 1). Pure- and mixed-UA patients had a similar incidence of metabolic syndrome, diabetes, history of stones, and stone burden. Table 1 Demographic and baseline characteristics among pure- and mixed-uric acid stone formers Pure-uric acid stones (n = 33) Mixed-uric acid stones (n = 33) p-value Median age [IQR] 63.00 [58.00-72.50] 63.00 [53.50-68.00] 0.339 Median BMI [IQR] 28.79 [25.81-33.07] 27.96 [25.81-29.55] 0.534 Gender, n (%) 1.000  Male 21 (63.6) 21 (63.6)  Female 12 (36.4) 12 (36.4) Metabolic syndrome, n (%) 17 (51.5) 16 (48.5) 0.806 Diabetes, n (%) 13 (39.4) 12 (36.4) 0.800 History of stones, n (%) 23 (69.7) 22 (66.7) 0.792 Median total stone burden, mm [IQR] 12.00 [6.00-26.50] 13.00 [7.05-20.00] 0.995 Median serum uric acid, mg/dL [IQR] 6.20 [4.80-7.15] 5.90 [4.98-6.89] 0.582 IQR Interquartile range BMI Body Mass Index n number We found the pure-UA cohort to have 24-h lower urine volume (1.53 vs. 1.96 L/day, p = 0.045) and citrate levels (286 vs. 457 mg/day, p = 0.036). UA-CaOx stone formers had higher urinary calcium levels (144 vs. 68 mg/day, p = 0.003), higher urinary oxalate levels (38 vs. 30 mg/day, p = 0.017), and higher median urinary calcium oxalate super-saturation (3.97 vs. 3.06, p = 0.047). CONCLUSIONS: Pure-UA kidney stone formers have different urinary metabolic parameters when compared with UA-CaOx stone formers, thus requiring different and tailored medical management.

Are People With Type 1 Diabetes Mellitus Appropriately Following Insulin Injection Technique Practices: A Review of Literature.

People with type 1 diabetes mellitus (T1DM) need to take multiple doses of insulin injections daily throughout their lives. However, a notable portion of people with diabetes mellitus (DM) show suboptimal insulin injection technique practices. They are supposed to follow the recommended insulin injection technique guidelines. Our explorative literature search, including studies from the past 30 years, is expected to identify the deficiencies of self-injection insulin techniques and the associated complications in people with T1DM, where we have summarised the overall incidence of complications that have occurred due to nonadherence of the prescribed guidelines, along with their associated risk factors. We have attempted to include multiple systematic reviews, meta-analyses, literature reviews, case reports, and original articles from the search engines and databases like PubMed, Scopus, ScienceDirect, Cochrane Library, Google Scholar, and BioMed Central, and studies with only human participants were included in this search. The knowledge sharing from this research may be utilised for enhancing the structured education diabetes programme and implementing the population-based corrective measures, including the thrust areas in future multi-centre longitudinal research studies and recommendations, which can prevent unnecessary complications and enhance their quality of life. Correct insulin administration technique, abstaining from administration of injection at the areas with lipohypertrophy, rotation of injection sites, and ultrasound scanning can be used as a complimentary method to detect the lipohypertrophy at an early stage. Liposuction is beneficial in reducing the extensive lipohypertrophic tissues but helps achieve only cosmetically satisfactory outcome; thus, empowering people to follow insulin injection technique guidelines is one of the best strategies to reduce the high prevalence of lipohypertrophy. To conclude, education among the people with DM, especially T1DM who have to take insulin regularly, needs to be carried out consistently in the clinical settings, to prevent the severe complications caused due to inappropriate insulin injection techniques.

Performance of cognitive vs. image-guided fusion biopsy for detection of overall and clinically significant prostate cancer in a multiethnic population.

PURPOSE: Transrectal ultrasound-guided prostate biopsy remains the most used method for the detection of prostate cancer. We recently reported that detection of clinically significant prostate cancer (cs-CaP) using image-guided fusion biopsies (IGFB) varied by race/ethnicity, which calls for further comparison between cognitive fusion biopsy (CFB) and IGFB among non-Hispanic black and Hispanic populations. Therefore, the aim of our study is to compare the rates of detection of cs-CaP and overall CaP by CFB and IGFB in a multiethnic community. MATERIAL AND METHODS: We performed a retrospective, cross-sectional review of men who underwent MRI-transrectal ultrasound-guided prostate biopsy at our diverse, urban academic medical center. Agreement and discordance between fusion biopsies and systematic biopsies for detection of cs-CaP and overall CaP were determined using Kappa statistics. Univariate and multivariate mixed-effects logistic regression models were used to find associations between fusion modalities and prostate cancer detection. RESULTS: In total, 710 men underwent fusion prostate biopsies between December 2015 and June 2021. Upon univariate and multivariate logistic regression analysis, there was no significant association between IGFB vs. CFB and risk of overall CaP (OR = 0.66, 95% CI: 0.36-1.21, P = 0.18) or cs-CaP (OR = 0.57, 95% CI: 0.30-1.08, P = 0.09). We found moderate agreement between fusion and systematic biopsies for both CFB (κ = 0.56) and IGFB (κ = 0.52) in cs-CaP. CONCLUSIONS: CFB and IGFB offer similar detection rates of cs-CaP in a multiethnic population. CFB represents an effective and accessible means of accurately diagnosing prostate cancer.

Comprehensive analysis of factors associated with significant blood loss during percutaneous nephrolithotomy.

INTRODUCTION: The objective of this study is to conduct a thorough investigation of the risk factors associated with blood loss during PCNL, within the setting of a US urban tertiary care center. MATERIALS AND METHODS: We conducted a retrospective analysis of our endourology database to identify adult patients who underwent PCNL for stone extraction at our tertiary stone center between October 2014 and December 2022. Patients were categorized into two groups based on the extent of blood loss: significant blood loss (SBL) and no significant blood loss (NSBL). The cut-off value for SBL was determined as the median change in hematocrit levels from preoperative to postoperative among patients who required postoperative transfusions. Several factors were evaluated, including stone dimensions, operative details, the presence of preoperative drains, patient position, type of access, access site, number of accesses, tract size, tract length, stone location, number of stones, operative time, and the S.T.O.N.E. Nephrolithometry Scoring System. RESULTS: Our analysis included a total of 695 procedures performed on 674 distinct patients who met our inclusion criteria. Of these, 102 patients (14.7%) were included in the SBL group. Patients in the SBL group had a higher mean number of accesses (1.57 vs. 1.29, P<0.001), were positioned prone more often (96.0% vs. 88.6%, P = 0.025), and underwent fluoroscopic-guided access more frequently (89.9% vs. 64.8%, P<0.001). Additionally, significant differences were observed in stone morphology, with the SBL group having higher rates of complete staghorn stones (42.2% vs. 27.0%, P = 0.019) and lower rates of partial staghorn stones (27.7% vs. 36.8%, P = 0.019). A larger proportion of patients in the SBL group required a 16 French nephrostomy tube for postoperative drainage (13.3% vs. 10.4%, P = 0.041). Lastly, the SBL group had a longer mean operative time compared to the NSBL group (P<0.001). Multiple logistic regression analysis identified stone volume (P = 0.039), number of accesses (P = 0.047), and operative time (P = 0.006) as independent risk factors associated with SBL status. CONCLUSION: Surgical complexity factors such as stone volume, number of accesses, and operative time are linked to a higher risk of SBL during PCNL. Stone volume and the requirement for multiple accesses can usually be estimated with reasonable accuracy before surgery.

Human Bocavirus infection in childhood acute respiratory infection: Is it an innocent bystander?

PURPOSE: Acute respiratory infection (ARI) is one of the major attributing factors of under-five mortality and morbidity all over the world. Viruses are the most common cause of ARI. Due to the availability of molecular techniques, new viruses are getting isolated from children with ARI. With the above background, the present study was conducted to enlighten on the pathogenic role of human bocavirus (HBoV) in children with ARI. METHODOLOGY: This retrospective study was conducted over a period of >3 years duration. The clinical and laboratory data of the patients with signs and symptoms of ARI were retrieved and analyzed. Clinical profiles and outcome of the patients detected of having HBoV mono or co-infections were further analyzed in details. RESULTS: A total of 237 respiratory samples were subjected to respiratory panel by fast track diagnosis (FTD) multiplex polymerase chain reaction (multiplex PCR), of which 10 samples (mono-infection â€‹= â€‹4) were detected with the presence of HBoV. The clinical details of 8 cases were studied in details (details of rest 2 cases were missing). All the children were less than 3 years of age, with different co-morbid conditions such as low birth weight (n â€‹= â€‹4), cholestatic jaundice (n â€‹= â€‹1), operated case of congenital diaphragmatic hernia (n â€‹= â€‹1), pancytopenia (n â€‹= â€‹1), and primary immune deficiency (n â€‹= â€‹1). Their clinical course did not improve following antibiotic administration, 2 succumbed to death while the rest 6 cases were discharged. CONCLUSION: The present study highlights the fact that HBoV may not be an innocent bystander in the childhood ARI. Larger studies employing appropriate diagnostic modalities are needed to emboss it as a true pathogen and not merely a bystander.

Diversity of Linum genetic resources in global genebanks: from agro-morphological characterisation to novel genomic technologies - a review.

Linseed or flaxseed is a well-recognized nutritional food with nutraceutical properties owing to high omega-3 fatty acid (α-Linolenic acid), dietary fiber, quality protein, and lignan content. Currently, linseed enjoys the status of a 'superfood' and its integration in the food chain as a functional food is evolving continuously as seed constituents are associated with lowering the risk of chronic ailments, such as heart diseases, cancer, diabetes, and rheumatoid arthritis. This crop also receives much attention in the handloom and textile sectors as the world's coolest fabric linen is made up of its stem fibers which are endowed with unique qualities such as luster, tensile strength, density, bio-degradability, and non-hazardous nature. Worldwide, major linseed growing areas are facing erratic rainfall and temperature patterns affecting flax yield, quality, and response to biotic stresses. Amid such changing climatic regimes and associated future threats, diverse linseed genetic resources would be crucial for developing cultivars with a broad genetic base for sustainable production. Furthermore, linseed is grown across the world in varied agro-climatic conditions; therefore it is vital to develop niche-specific cultivars to cater to diverse needs and keep pace with rising demands globally. Linseed genetic diversity conserved in global genebanks in the form of germplasm collection from natural diversity rich areas is expected to harbor genetic variants and thus form crucial resources for breeding tailored crops to specific culinary and industrial uses. Global genebank collections thus potentially play an important role in supporting sustainable agriculture and food security. Currently, approximately 61,000 germplasm accessions of linseed including 1,127 wild accessions are conserved in genebanks/institutes worldwide. This review analyzes the current status of Linum genetic resources in global genebanks, evaluation for agro-morphological traits, stress tolerance, and nutritional profiling to promote their effective use for sustainable production and nutrition enhancement in our modern diets.

Management of large kidney stones in the geriatric population.

PURPOSE: The aim of this review is to highlight the unique factors that predispose geriatric patients to nephrolithiasis and to compare the utility and efficacy of surgical techniques in this specific patient population. METHODS: PubMed and EMBASE databases were reviewed, and studies were organized according to surgical treatments. RESULTS: Few prospective studies exist comparing kidney stone removal in the elderly to younger cohorts. In addition, various age cut-offs were used to determine who was considered elderly. Most studies which analyzed Percutaneous Nephrolithotomy (PCNL) found a slightly higher rate of minor complications but comparable stone free rate and operative time. For ureteroscopy (URS) and extracorporeal shockwave lithotripsy (ESWL), there were minimal complications observed and no difference in clinical success in the elderly. All surgical techniques were presumed to be safe in the elderly and most found no difference in stone-free rates. CONCLUSIONS: Unique attributes of the geriatric population contribute to stone formation and must be considered when determining appropriate management modalities. This review provides an overview of the utility and efficacy of PCNL, URS and ESWL in the elderly, as well as a porposed algorithm for management in this population.

Evaluating the American Urologic Association (AUA) dietary recommendations for kidney stone management using the National Health And Nutritional Examination Survey (NHANES).

The objective of this study is to evaluate the conventional dietary recommendations for stone prevention among patients in the National Health and Nutritional Examination Survey (NHANES) and compare dietary components and special diets between stone formers and non-stone formers. We analyzed the NHANES 2011-2018 dietary and kidney condition questionnaires, among 16,939 respondents who were included in this analysis. Dietary variables were selected based on the American Urological Association (AUA) guideline for Medical Management of Kidney Stones and from other studies on kidney stone prevention. Weighted multivariate logistic regression models were used to assess the relationship of dietary food components (categorized into quartiles) and dietary recommendations with kidney stone formation (yes vs no), adjusted for total caloric intake, comorbidities, age, race/ethnicity, and sex. The prevalence of kidney stones was 9.9%. Our results showed association of kidney stones with lower levels of potassium (p for trend = 0.047), which was strongest for < 2000 mg (OR = 1.35; 95% CI 1.01-1.79). Higher vitamin C intake was inversely associated with stone formation (p for trend = 0.012), particularly at daily intake levels between 60 and 110 mg (OR = 0.76; 95% CI 0.60-0.95) and above 110mcg (OR = 0.80; 95% CI 0.66-0.97). There were no associations between other dietary components and kidney stone formation. Higher levels of dietary vitamin C and potassium intake may be indicated for stone prevention and warrants further investigation.

Impact of implant metal type and vancomycin prophylaxis on postoperative spine infection: an in-vivo study.

PURPOSE: To evaluate the effectiveness of vancomycin prophylaxis on spinal implant metal types. METHODS: 42 rabbits underwent posterior, single-level instrumentation at L5-L6 with stainless steel (n = 18), cobalt chrome (n = 12), or titanium (n = 12) wire. All implants were inoculated with 1 × 106 colony forming units (CFU) of methicillin-resistant S. Aureus (MRSA). In the intrawound vancomycin subgroup (n = 18, 6 from each metal type), 40 mg of vancomycin powder was placed in the wound. In the IV vancomycin subgroup (n = 6, all stainless steel), 15 mg/kg of IV vancomycin was given preoperatively. Local soft tissue and implants were harvested 1-week postoperatively and separately cultured. RESULTS: Intrawound vancomycin significantly reduced the rate of soft tissue infection (44.4% vs 100%) and implant infection (27.8% vs 100%) (p < 0.001). Within the intrawound vancomycin subgroup, cobalt chrome implants were associated with higher median soft tissue MRSA growth (130 CFU) than stainless steel (0 CFU) or titanium (0 CFU) (p = 0.02). Cobalt chrome implants were also more likely to develop soft tissue MRSA infection (83.3%) as compared to stainless steel (16.7%) or titanium (33.3%) (p = 0.04). Median soft tissue MRSA growth among stainless steel implants without prophylaxis, with IV vancomycin, and with vancomycin powder was 1.18 × 107, 195, and 0 CFU, respectively. The rate of soft tissue MRSA infection without prophylaxis, with IV vancomycin, and with vancomycin powder was 100, 66.7, and 16.7%, respectively (p = 0.015). CONCLUSION: Intrawound vancomycin is more effective than IV vancomycin and effectively reduces the risk of infection, but is less effective in cobalt chrome implants due to residual soft tissue infection.

Implementation and Usability of an Electronic Medical Record-based Ureteral Stent Tracker.

OBJECTIVE: To design and implement a simple electronic medical record-based ureteral stent tracker. To assess its impact on stent dwell time and stent-related complications. METHODS: Patients with stents placed 12 months before and 6 months after stent tracker implementation were identified at 3 urban hospitals. Those with stents-on-strings and intentional chronic indwelling stents (greater than 90 days) were excluded. Patient demographics, stent characteristics (eg, indication, string, dwell time), and clinical outcomes (eg, positive urine cultures, complications) were reviewed and compared between pre- and posttracker cohorts. A 12-question usability survey was administered to surgical nurses to assess usability. RESULTS: A total of 323 stents (173 pre- and 150 posttracker) were placed in 217 patients. The prestent tracker cohort had a longer mean dwell time (pre: 40.9 ± 59.1 days vs post: 28.8 ± 22.0 days, P = .02) and a higher retention rate >90 days (pre: 8.1% [14/173] vs post: 1.3% [2/150], P = .005). The 2 cohorts had no significant differences in positive urine culture rates, patient phone calls to providers, stent-related emergency department visits, or hospitalizations. The usability survey showed that 86.4% of surgical nurses found the tracker to be user-friendly and 95.5% reported that it added less than 1 minute of work per procedure. CONCLUSION: Implementation of an electronic medical record-based ureteral stent tracker decreased average stent dwell time and frequency of retained stents. Surgical nurses reported the tracker to be user-friendly and convenient. Stent trackers can improve the efficiency of postoperative removal of indwelling ureteral stents.

Imaging After Ureteroscopy: Practice Patterns, Patient Adherence and Impact on Subsequent Management in an Urban Academic Hospital System.

OBJECTIVE: To evaluate practice patterns of post-ureteroscopy (URS) imaging, to assess predictors of imaging order, type and completion, and to analyze impact on patient management. METHODS: We conducted a retrospective review of patients who underwent URS for nephrolithiasis at a single institution between May, 2020 to May, 2021. Patient demographic, clinical and operative characteristics were reviewed, and surgeons' years in practice. Post-URS imaging studies less than 6 months post-operative were reviewed. Changes in patient management were defined as additional imaging tests ordered or subsequent unplanned surgery. Patient, provider and surgical variables were compared between those who had imaging ordered and those who did not. RESULTS: A total of 289 patients underwent URS. About 234 (81.0%) had post-operative imaging ordered; 147 (62.8%) completed them. Baseline demographics, stone and surgical variables were similar among those who did and did not have imaging ordered and among patients who completed imaging and did not. Pre-operative hydronephrosis was associated with ordering of post-operative imaging (OR = 4.08, P = .01). Urologists in practice less than 5 years were more likely to order post-operative imaging compared to those in practice for more than 5 years (<5: 90.6%, 15+: 53.7%; P <.001). Management changed for 52 of 147 (35.4%) patients who completed imaging; additional imaging was ordered for 38 patients (25.9%) and a second, unplanned surgery was performed for 14 (9.5%). CONCLUSION: The main predictive factor of ordering post-URS imaging was surgeons' time in practice and pre-operative hydronephrosis. Post-operative imaging changed management in 35.4% of patients. We recommend the development of guidelines encouraging routine imaging for patients following ureteroscopy.

Management of Obese Type 1 Diabetes Mellitus (Double Diabetes) Through Telemedicine During COVID-19 Pandemic Lockdown: A Case Report.

Metabolic syndrome in Type 1 diabetes mellitus (T1DM) has been shown to be an independent risk factor for macro-vascular and micro-vascular complications. Obesity also affects many people with T1DM across their lifetime with an increasing prevalence in recent decades. Individuals with T1DM who are overweight, have a family history of type 2 diabetes, and/or have clinical features of insulin resistance, are known as "double diabetes". It is challenging for a person with double diabetes to achieve reasonable glycemic control, avoid insulin-related weight gain, and prevent hypoglycaemia. This was especially true during the coronavirus disease 2019 (COVID-19) pandemic lockdown. The aim of this report is to show that lifestyle modification through telemedicine can immensely help in managing uncontrolled T1DM with associated morbid obesity in lockdown situations, with the help of the diabetes educator. In this case, the complicated history of double diabetes was taken through telephonic and online consultations with the help of a nutritionist and diabetes educator, and the treating clinician supervised the insulin doses and frequency. Patient Health Questionnaire (PHQ)-9 questionnaire was used to assess depression. Medical nutrition therapy (MNT) was given through online consultations, where the patient was reoriented to carbohydrate counting, insulin dose adjustment, along with modifications in the diet. Regular exercise was advised along with frequent self-monitoring of blood glucose (SMBG). Moreover, the diet order was changed to eat protein and fibre first, followed by carbohydrates, later. The three-tier system of the medical expert, clinical dietitian, and diabetes educator was applied. The subject was trained for carbohydrate counting and insulin dose adjustment by teaching her about the insulin-to-carb ratio and insulin sensitivity factor (ISF). She was asked to examine her insulin injection sites by visual and palpatory methods for lipohypertrophy. Once a week, the diabetes educator and nutritionist did telephonic follow-up and counselling, while online consultation was done by the treating clinician once a month. As a result, her weight, BMI, and waist circumference were reduced drastically, and there was an improvement in haemoglobin A1C (HbA1C), lipid parameters, and blood pressure after the intervention. Thus, implementing diabetes education via telemedicine in circumstances such as the COVID-19 pandemic can help achieve the best possible compliance for strict diet adherence, regular exercise and monitoring, reducing obesity, glycosylated HbA1c, insulin doses, and risk of depression in a person with double diabetes.

Development and optimization of NIRS prediction models for simultaneous multi-trait assessment in diverse cowpea germplasm.

Cowpea (Vigna unguiculata (L.) Walp.) is one such legume that can facilitate achieving sustainable nutrition and climate change goals. Assessing nutritional traits conventionally can be laborious and time-consuming. NIRS is a technique used to rapidly determine biochemical parameters for large germplasm. NIRS prediction models were developed to assess protein, starch, TDF, phenols, and phytic acid based on MPLS regression. Higher RSQexternal values such as 0.903, 0.997, 0.901, 0.706, and 0.955 were obtained for protein, starch, TDF, phenols, and phytic acid respectively. Models for all the traits displayed RPD values of >2.5 except phenols and low SEP indicating the excellent prediction of models. For all the traits worked, p-value ≥ 0.05 implied the accuracy and reliability score >0.8 (except phenol) ensured the applicability of the models. These prediction models will facilitate high throughput screening of large cowpea germplasm in a non-destructive way and the selection of desirable chemotypes in any genetic background with huge application in cowpea crop improvement programs across the world.

Financial Toxicity of Nephrolithiasis: The First Assessment of the Economic Stresses of Kidney Stone Treatment.

OBJECTIVE: To investigate the financial toxicity (FT) related to kidney stone treatment. METHODS: We performed a cross-sectional cohort study with multi-institutional in-person and online cohorts of stone formers.  Participants were surveyed using the validated COST tool (COmprehensive Score for financial Toxicity). The maximum score is 44 and lower scores indicate increased FT. "Moderate FT" was defined by COST scores between 25 and 14 points and "severe FT" for scores <14. Descriptive statistics, X2 tests, T tests, Spearman correlation, and logistic regression were performed using SPSS v28. RESULTS: Two hundred and forty-one participants were surveyed, including 126 in-person participants and 115 online. A total of 60% of participants reported at least moderate FT (COST score <26) and 26% reported severe FT (COST score <14). Patients who reported moderate to severe FT were younger than those with low FT by a median difference of 8 years (95%CI = 4, 12). There was a significant correlation between out-of-pocket expense and COST scores, such that as out-of-pocket expenses increased, COST scores decreased, (Spearman's rho =-0.406, P = <.001). Participants with moderate to severe FT tended to miss more workdays (P = .002), and their caretakers tended to miss more workdays (P = .007) due to their stone disease. CONCLUSION: Most participants reported moderate to severe FT. As prior studies have shown that patients with "moderate FT" employ cost-coping strategies (i.e., medication rationing) and those with "severe FT" have worse health outcomes, urologists need to be sensitive to the financial burdens of treatment experienced by such patients undergoing kidney stone treatment.

Association of the Time to Immune Checkpoint Inhibitor (ICI) Initiation and Outcomes With Second Line ICI in Patients With Advanced Urothelial Carcinoma.

BACKGROUND: Early progression on first-line (1L) platinum-based therapy or between therapy lines may be a surrogate of more aggressive disease and poor outcomes in advanced urothelial carcinoma (aUC), but its prognostic role regarding immune checkpoint inhibitor (ICI) response and survival is unclear. We hypothesized that shorter time until start of second-line (2L) ICI would be associated with worse outcomes in aUC. PATIENTS AND METHODS: We performed a retrospective multi-institution cohort study in patients with aUC treated with 1L platinum-based chemotherapy, who received 2L ICI. Patients receiving switch maintenance ICI were excluded. We defined time to 2L ICI therapy as the time between the start of 1L platinum-based chemotherapy to the start of 2L ICI and categorized patients a priori into 1 of 3 groups: less than 3 months versus 3-6 months versus more than 6 months. We calculated overall response rate (ORR) with 2L ICI, progression-free survival (PFS) and overall survival (OS) from the start of 2L ICI. ORR was compared among the 3 groups using multivariable logistic regression, and PFS, OS using cox regression. Multivariable models were adjusted for known prognostic factors. RESULTS: We included 215, 215, and 219 patients in the ORR, PFS, and OS analyses, respectively, after exclusions. ORR difference did not reach statistical significance between patients with less than 3 months versus 3-6 months versus more than 6 months to 2L ICI. However, PFS (HR 1.64; 95% CI 1.02-2.63) and OS (HR 1.77; 95% CI 1.10-2.84) was shorter among those with time to 2L ICI less than 3 months compared to those who initiated 2L ICI more than 6 months. CONCLUSION: Among patients with aUC treated with 2L ICI, time to 2L ICI less than 3 months was associated with lower, but not significantly different ORR, but shorter PFS and OS compared to 2L ICI more than 6 months. This highlights potential cross resistance mechanisms between ICI and platinum-based chemotherapy.