Patient Perceptions of Telephonic Visits during the COVID-19 Pandemic-Is Video Connectivity Imperative?

INTRODUCTION: We characterize patient perceptions of telemedicine (video-enabled) and telephonic (audio-only) visits conducted during the COVID-19 pandemic. METHODS: A single-center cohort of 76 patients who underwent remote ambulatory visits from March 2020 to July 2020 was evaluated. Patients responded to a questionnaire assessing perception of timeliness, efficiency, overall satisfaction and willingness to have a remote appointment after the pandemic. Responses were compared for telephonic (audio-only) vs telemedicine (video) visits. RESULTS: High satisfaction scores were reported for both telephonic and telemedicine appointments, with a mean score of 6.61 out of 7 (SD 1.0) for overall satisfaction. Telephonic visits demonstrated higher scores regarding timeliness and efficiency of the visit (6.58 vs 5.92, p=0.017) and willingness to have a remote encounter with a urology resident (6.58 vs 5.61, p=0.001) or advanced practice provider (6.21 vs 5.51, p=0.015). No difference in perception of confidentiality or overall satisfaction was observed between both groups. In all, 91% of participants desired the option of a virtual visit with their provider after the pandemic. CONCLUSIONS: Patients undergoing remote urology appointments during the COVID-19 pandemic report high satisfaction rates, though telephonic encounters were more favorable for patients in regard to timeliness and efficiency. Importantly, most patients desired the option of telephonic and telemedicine calls after the pandemic. Further analysis on safety, efficacy, provider perceptions, outcomes and economic impact is needed to assess the feasibility of continuing regular telephonic and telemedicine visits after the COVID-19 pandemic is over.

Ureteroenteric anastomosis in orthotopic neobladder creation: do urinary tract infections impact stricture rate?

PURPOSE: Radical cystectomy (RC) and urinary diversion in the treatment of muscle-invasive bladder cancer is associated with peri-operative complication rates as high as 60%. Ureteroenteric anastomotic stricture (UEAS) is a potential source significant morbidity often requiring secondary interventions. We sought to evaluate our experience with benign UEAS in our open ileal orthotopic neobladder (ON) population. METHODS: After Internal Review Board (IRB) approval, we performed a retrospective review of patients who had RC and ON between 2000 and 2015 at MD Anderson Cancer Center and had at least 6 months of follow-up. Baseline demographics and treatment characteristics, peri-operative and post-operative outcomes, as well as information regarding anastomosis technique and suture types were evaluated. Patients with malignant ureteral obstruction were excluded from the analysis. RESULTS: 418 patients had ON creation and the mean age was 59 years (SD 9.4 years) and 90% were males. The mean follow-up was 57 months (6-183 months). 37 patients (8.9%) developed UEAS in 42 renal units and the mean time to diagnosis was 15.8 months (0.85-90 months). Anastomosis and suture type were not predictive of UEAS (p = 0.594, p = 0.586). Perioperative UTI within 30 days of surgery, and recurrent UTI were predictive of UEAS, HR 2.4 p = 0.03, HR 5.1 p < 0.001, respectively. CONCLUSIONS: UEAS are associated with potentially significant morbidity following ON creation. UEAS may occur early following ON, but may occur as late as 7 years following surgery. Indeed, technical factors and surgeon experience contribute to the rates of UEAS, but perioperative UTI appears to herald future stricture development.

Malignant Infantile Osteopetrosis: A Case Report.

Osteopetrosis is a rare genetic disease of bone resorption. It includes a variety of hereditary skeletal disorders that have the main radiographic feature of increased bone density and thickness due to differentiation or functional defects in osteoclast. The clinical presentation varies widely based on the type of osteopetrosis and ranges in severity from asymptomatic to a fatal course. Our case is of the infantile malignant osteopetrosis (IMOP) form. It is inherited as an autosomal recessive pattern that generally starts in intrauterine life and manifests at birth or early childhood. It is the most severe form and has an incidence of 1 in 250,000 births. The patient presented at the age of two months with a history of recurrent fever, recurrent pneumonia, developmental delay, and infantile spasms. Upon examination, she was found to have hepatosplenomegaly, axial hypotonia, limb spasticity, and visual impairment. Genetic testing revealed a homozygous variant of OSTM1 gene, which is a known Saudi mutation of autosomal recessive osteopetrosis (ARO). IMOP should be considered as a rare differential of hepatosplenomegaly. Early diagnosis by clinical picture, imaging, and genetic testing is important to direct the appropriate management in order to prevent disease progression before the irreversible neurological sequelae occur. Patients should be managed by a comprehensive approach, and currently, hematopoietic stem cell transplantation (HSCT) provides a better outcome for IMOP patients.

Prevalence of Internet addiction and its associated factors among female students at Jouf University, Saudi Arabia.

BACKGROUND AND OBJECTIVES: Internet addiction is an increasing problem among university students worldwide. The Internet provides numerous educational advantages, but too much Internet use can lead to unfavorable outcomes such as social isolation and poor academic achievement. The objectives of the present study were to assess the prevalence of Internet addiction and its associated factors among female students at Jouf University, Saudi Arabia. METHODS: A cross-sectional study using a multistage proportionate sampling technique was done. A self-administered questionnaire was distributed to the female students of Jouf University during face-to-face interviews with them. This questionnaire consisted of two parts; the first is a structured one for identifying sociodemographic features, and the second is Young's Internet Addiction Test (YIAT) to assess Internet use among the students. RESULTS: According to the YIAT scale of Internet addiction, 48.6% of the students were scored to be average Internet users. However, 49.5% and 1.9% of the students had moderate and severe addictions, respectively. The vast majority of students (94.6%) preferred home to access the Internet. Communication was the main purpose of using the Internet as it was reported by 47.3% of the students. The majority of the students (79.5%) utilized mobile phones for Internet access while other devices such as a laptop, tablets and desktop were used by 15.4%, 4.3%, and 3.2% of the students, respectively. More than half of the students (54.6%) used the Internet for an average of more than 4 h every day. Also, more than half (51.4%) used it in the evening being the dominant time of using the Internet. Internet addiction was significantly higher among students with high father education, students who sleep 6 h or less, students who utilize the Internet for entertainment purposes, and students who utilize the Internet mainly in the midnight. CONCLUSION: Nearly half of female students at Jouf University have moderate or severe Internet addiction. The significant predictors of Internet addiction were sleeping hours ≤ 6, midnight as the dominant time for utilizing the Internet and using the Internet for entertainment purposes.

Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement

ABSTRACT Purpose We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. Materials and Methods We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. Results The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. Conclusions We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement.

PURPOSE: We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. MATERIALS AND METHODS: We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. RESULTS: The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. CONCLUSIONS: We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Enhanced cardiac function in transgenic mice expressing a Ca(2+)-stimulated adenylyl cyclase.

The predominant functional adenylyl cyclases normally expressed in cardiac tissue and coupled to beta-adrenergic receptors are inhibited by micromolar Ca(2+) concentration. To modify the overall balance of activities, we have generated transgenic mice expressing the Ca(2+)-stimulatable adenylyl cyclase type 8 (AC8) specifically in the heart. AC activity is increased by at least 7-fold in heart membranes from transgenic animals and is stimulated by Ca(2+) in the same range of concentration that inhibits the endogenous activity. Moreover, the in vivo basal protein kinase A activity was augmented 4-fold. Overexpression of AC8 in the heart has no detrimental consequences on global cardiac function. Basal heart rate and contractile function, measured by noninvasive echocardiography, were unchanged. In contrast, on release of parasympathetic tone, the intrinsic contractility is heightened and unresponsive to further beta-adrenergic receptor stimulation. AC8 transgenic mice thus represent an original model to investigate the relative influence of Ca(2+) and cAMP on cardiac function within a phenotype of enhanced cardiac contractility and relaxation.