Long-term developmental outcomes of children with congenital Zika syndrome.

BACKGROUND: Eight years after the epidemics in Brazil, children with congenital Zika syndrome (CZS) and their families confront ongoing health challenges. OBJECTIVE: This study aims to characterize how virally induced prenatal brain injury impacts development and functional outcomes among children diagnosed with CZS. METHODS: We performed a cross-sectional study of a consecutive series of children diagnosed with CZS. Using validated neurodevelopmental assessments, we evaluated gross motor function, manual ability, communication, eating and drinking, and visual function. RESULTS: Sixty children (29 males, and 31 females) met the inclusion criteria for the study. Comorbidities such as epilepsy (90.0%) and undernutrition (38.3%), along with clinical conditions including dysphagia (68.3%) and dependence on tube feeding (31.7%), were observed. Our results demonstrate a majority of children at level V - the most severe level within a five-tier system - in the Gross Motor Function (86.7%), Manual Ability (85.0%), Communication Function (68.3%), Eating and Drinking Ability (40.0%) Classification Systems, and level IV in the Visual Function Classification System (38.3%). CONCLUSION: CZS is associated with severe functional impairments and comorbidities, adversely impacting child development and quality of life. These findings reveal persistent challenges affecting the functioning of children with CZS, underscoring the need for continued support and specialized care. IMPACT: This study aimed to characterize the long-term clinical and functional characteristics of a subset of children with Congenital Zika Syndrome (CZS). We found that eight years after the Brazilian Zika epidemic, this subset of children with CZS continues to demonstrate major functional limitations impacting mobility, vision, and the ability to eat and drink. Our analysis documented a very high level of disability in several key functional classification systems. Notably, applying a new instrument for visual ability among children diagnosed with cerebral palsy, we found that more than 60% of the study group have poor or very poor visual function.

Does Caffeine Intake Increase the Incidence of Tinnitus? A Systematic Review.

Introduction Excessive caffeine intake has been thought to be a contributory factor for tinnitus. However, there has been no systematic review to elucidate the causal relationship between caffeine intake and the incidence of tinnitus. Objectives We performed the current review aiming at evaluating the evidence from the current literature for the relationship between caffeine intake and the incidence of tinnitus. Data Synthesis Databases including PubMed, Scopus, and Google scholar were searched for relevant articles. A total of 142 studies were screened for eligibility, of which four articles met our inclusion criteria: two were prospective cohorts and two were cross-sectional studies. Although one study found no association between caffeine consumption and the incidence of tinnitus, an inverse relationship was reported by two population-based studies. Concerning patients with preexisting tinnitus, reduction of caffeine intake in a subset who consumed 150 ml to 300 ml/day of coffee yielded a favorable outcome in tinnitus severity. However, those with higher dose intake were less prone to have improvement in the severity of tinnitus. Conclusion Although the current review was inconclusive, it appears that the incidence of tinnitus in previously unaffected individuals might be prevented by a high dose of caffeine intake. However, in preexisting tinnitus, a high dose of caffeine may adversely interfere with the efficacy of caffeine reduction.

Chemosensitizing Effect of Cernumidine Extracted from Solanum cernuum on Bladder Cancer Cells in Vitro.

Cernumidine (CER) is a guanidinic alkaloid isolated from Solanum cernuum leaves. In this work, we investigated the cytotoxicity, chemosensitizing effect of cernumidine to cisplatin (cDDP) and the possible mechanism of action of the combination on bladder cancer cells. Cernumidine showed cytotoxicity and could sensitize bladder cancer cells to cisplatin. The combination of CER+cDDP inhibited cell migration on T24 cells. CER+cDDP down-regulated MMP-2/9 and p-ERK1/2, while it increased EGFR activity corroborating the observed cell migration inhibition. Down-regulation of Bcl-2 and up-regulation pro-apoptotic Bax and further depletion of the mitochondrial membrane potential (ΔΨm) indicates that mitochondria play a central role in the combination treatment inducing the mitochondrial signaling pathway of apoptosis in T24 cells. Our data showed that the alkaloid cernumidine is worthy of further studies as a chemosensitizing agent to be used in complementary chemotherapy.

Peptides with antioxidant properties identified from casein, whey, and egg albumin hydrolysates generated by two novel fungal proteases.

There are many diseases linked to oxidative stress, including cancer. Importantly, endogenous antioxidants are insufficient to protect against this process. Peptides derived from food proteins produced by hydrolysis have been investigated as exogenous antioxidants. The present study aimed to identify novel peptides with antioxidant potential produced from egg and milk proteins hydrolysis with two new fungal proteases isolated from Eupenicillium javanicum and Myceliophthora thermophila. The degree of hydrolysis at several time points was calculated and correlated to DPPH scavenging and metal chelating assays, all hydrolysates presented antioxidant activity. Casein hydrolyzed by the M. thermophila protease showed the best antioxidant activity. The identified sequences showed that the proportions of amino acids that influence antioxidant activity support the antioxidant assay. Our data reveal the conditions necessary for the successful generation of antioxidant peptides using two novel fungal proteases. This opens a potential new avenue for the design and manufacture of antioxidant molecules.

Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure.

Importance: The evolution of fetal brain injury by Zika virus (ZIKV) infection is not well described. Objectives: To perform longitudinal neuroimaging of fetuses and infants exposed to in utero maternal ZIKV infection using concomitant magnetic resonance imaging (MRI) and ultrasonography (US), as well as to determine the duration of viremia in pregnant women with ZIKV infection and whether the duration of viremia correlated with fetal and/or infant brain abnormalities. Design, Setting, and Participants: A cohort of 82 pregnant women with clinical criteria for probable ZIKV infection in Barranquilla, Colombia, and Washington, DC, were enrolled from June 15, 2016, through June 27, 2017, with Colombian women identified by community recruitment and physician referral and travel-related cases of American women recruited from a Congenital Zika Program. Interventions and Exposures: Women received 1 or more MRI and US examinations during the second and/or third trimesters. Postnatally, infants underwent brain MRI and cranial US. Blood samples were tested for ZIKV. Main Outcomes and Measures: The neuroimaging studies were evaluated for brain injury and cerebral biometry. Results: Of the 82 women, 80 were from Colombia and 2 were from the United States. In 3 of 82 cases (4%), fetal MRI demonstrated abnormalities consistent with congenital ZIKV infection. Two cases had heterotopias and malformations in cortical development and 1 case had a parietal encephalocele, Chiari II malformation, and microcephaly. In 1 case, US results remained normal despite fetal abnormalities detected on MRI. Prolonged maternal polymerase chain reaction positivity was present in 1 case. Of the remaining 79 cases with normal results of prenatal imaging, postnatal brain MRI was acquired in 53 infants and demonstrated mild abnormalities in 7 (13%). Fifty-seven infants underwent postnatal cranial US, which detected changes of lenticulostriate vasculopathy, choroid plexus cysts, germinolytic/subependymal cysts, and/or calcification in 21 infants (37%). Conclusions and Relevance: In a cohort of pregnant women with ZIKV infection, prenatal US examination appeared to detect all but 1 abnormal fetal case. Postnatal neuroimaging in infants who had normal prenatal imaging revealed new mild abnormalities. For most patients, prenatal and postnatal US may identify ZIKV-related brain injury.

Nitrate detoxification using antioxidants and probiotics in the water for rabbits / Detoxificación de nitrato usando antioxidantes y probióticos en el agua para conejos / Detoxificação de nitrato usando antioxidantes e probióticos na água para coelhos

Abstract Background: Agricultural practices increase groundwater pollution from nitrate. High nitrate intake could negatively affect animal growth. Objective: To determine the effects of different levels of nitrate in drinking water on digestive, liver, and kidney functions, and on water and feed intake, and to determine the ability of vitamin C, vitamin E + selenium (Se) or probiotics to overcome the effects of nitrate in New Zealand White rabbit bucks. Methods: Forty-two male rabbits were randomly distributed into six treatment groups: 1) control group (with no nitrate); 2) 350 ppm nitrate; 3) 700 ppm nitrate; 4) 700 ppm + 200 ppm vitamin C; 5) 700 ppm + 200 ppm vitamin E + Se; and 6) 700 ppm + 1000 ppm probiotic. Productive performance, digestive, liver, and kidney functions, and hepatic and renal histology were evaluated. Results: Water intake was reduced (p<0.05) by the 350 ppm nitrate treatment. Rabbits given 700 ppm nitrate showed lower (p<0.05) dry matter intake, nutrient digestibility, and increased (p<0.05) water and nitrate intake, as well as urea concentration, and aspartate aminotransaminase (AST) and alanine aminotransferase (ALT) activity. Vitamin C, vitamin E + Se and probiotics improved (p<0.05) feed intake and nutrient digestibility, and reduced (p<0.05) water and nitrate intake, urea concentration, and AST and ALT activities. Conclusion: Rabbits may tolerate up to 350 ppm of nitrate, but 700 ppm of nitrate negatively affect digestive, liver, and kidney functions, which are improved by vitamin C, vitamin E + Se and probiotic supplementation.

Resumen Antecedentes: Las prácticas agrícolas aumentan la polución de aguas subterráneas con nitratos. Una alta ingestión de nitratos posiblemente afecta negativamente el crecimiento animal. Objetivo: Determinar los efectos de diferentes niveles de nitrato en el agua de bebida sobre las funciones digestivas, hepáticas y renales, ingestión de agua y alimento, y determinar la habilidad de la vitamina C, vitamina E + Selenio (Se) o probióticos en superar los efectos del nitrato en conejos Nueva Zelanda Blanco. Métodos: Cuarenta y dos conejos machos se distribuyeron al azar entre seis tratamientos: 1) grupo control (sin nitrato), 2) 350 ppm nitrato, 3) 700 ppm nitrato, 4) 700 ppm + 200 ppm vitamina C, 5) 700 ppm + 200 ppm vitamina E + Se, y 6) 700 ppm + 1000 ppm probiótico. Se evaluó el desempeño productivo, las funciones digestivas, hepáticas y renales, y la histología renal y hepática. Resultados: La ingestión de 350 ppm de nitrato disminuyó (p<0,05) la ingestión de agua. Los conejos que consumieron 700 ppm de nitrato presentaron menor (p<0,05) ingestión de materia seca y digestibilidad de nutrientes, y mayor (p<0,05) ingestión de agua y nitrato, concentración de urea, y mayores actividades de aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT). Las vitaminas C, E + Se y el probiótico mejoraron (p<0,05) el consumo de alimento y la digestibilidad de nutrientes, y redujeron (p<0,05) la ingestión de agua y nitrato, la concentración de urea, y las actividades de AST y ALT. Conclusión: Los conejos pueden tolerar hasta 350 ppm de nitrato, pero 700 ppm de nitrato afectan negativamente las funciones digestivas, hepáticas y renales, las cuales mejoran con la suplementación de vitamina C, vitamina E + Se y del probiótico.

Resumo Antecedentes: As práticas agrícolas aumentam a contaminação de águas subterrâneas a partir de nitrato e a alta ingestão desta substância pode afetar negativamente o crescimento animal. Objetivo: Determinar os efeitos de diferentes níveis de nitrato na água de bebida sobre as funções digestivas, hepáticas e renais, ingestão de água e ração e determinar a habilidade da vitamina C, vitamina E + Selênio (Se) ou probiótico em sobrepor os efeitos do nitrato em coelhos Nova Zelândia Branco. Métodos: Quarenta e dois coelhos machos foram distribuídos ao acaso em seis tratamentos: 1) grupo controle (sem nitrato), 2) 350 ppm de nitrato, 3) 700 ppm de nitrato, 4) 700 ppm + 200 ppm de vitamina C, 5) 700 ppm + 200 ppm vitamina E + Se e 6) 700 ppm + 1000 ppm de probiótico. Foram avaliados o desempenho produtivo, as funções digestivas, hepáticas e renais além da histologia hepática e renal. Resultados: A ingestão de 350 ppm de nitrato diminuiu (p<0,05) a ingestão de água. Coelhos que receberam 700 ppm de nitrato apresentaram menor (p<0,05) ingestão de matéria seca, menor digestibilidade de nutrientes, e maior (p<0,05) ingestão de água e de nitrato, maior concentração plasmática de ureia e maiores atividades de aspartato aminotransferase (AST) e alanina aminotransferase (ALT). A adição de vitaminas C ou vitamina E + Se e probiótico melhorou (p<0,05) o consumo de ração, a digestibilidade de nutrientes e reduziram (p<0,05) a ingestão de água e de nitrato, a concentração de ureia e as atividades de AST e ALT. Conclusão: Coelhos podem tolerar até 350 ppm de nitrato, mas 700 ppm de nitrato afeta negativamente as funções digestivas, hepáticas e renais, as quais são melhoradas a partir da suplementação de vitamina C, vitamina E + Se ou ainda probiótico.

Nesting materials for does: Effect on nest building and performance at first parturition / Materiales de nido para conejas: Efecto sobre la construcción del nido y desempeño al primer parto / Materiais de ninho para coelhas: Efeito sobre a construção do ninho e desempenho na primeira parição

Abstract Background: The material placed into the nest should provide comfort to both does and their kits. Objective: To evaluate the effect of different nesting materials on rabbit doe performance and nest building. Methods: Thirty primiparous rabbit does were randomized allotted in a block design with three treatments and ten replicates each. The treatments consisted of nest bedding with wood shavings (280 g, control), Tifton hay (220 g), and thin strips of newspaper (200 g). The state of the nest was assessed to evaluate mixing of the material with doe's hair and preservation of the original material. Kit body weight, daily weight gain, and survival rate were evaluated from birth to weaning. Results: The nesting material did not affect the mixing level of material and hair, amount of hair in the nest, body weight, daily weight gain, or survival rate of rabbits from birth to 35 d of age (p>0.05). However, preservation of original material in the nest was lower when Tifton hay was used (p<0.05). Correlations between material type and total number of born alive and the amount of hair, mixture level between hair and material, and material preservation in the nest were not significant (p>0.05). No correlation (p>0.05) was observed between material preservation and hair presence or mixture level between both. Positive correlation between hair presence and mixture level (p<0.001) was observed. Conclusion: Tifton hay and cut newspaper can be used as nest bedding for pregnant does in replacement of wood shavings, with no negative effects on nest building behavior or kit performance.

Resumen Antecedentes: El material ubicado en el nido debe proporcionar confort a la coneja y a su camada. Objetivo: Evaluar el efecto de nidos forrados con diferentes materiales sobre el desempeño de la coneja y sobre la construcción del nido. Métodos: Treinta conejas primíparas fueron usadas en un diseño en bloques al azar con tres tratamientos y 10 repeticiones cada uno. Los tratamientos consistieron en forrar el nido con viruta (280 g), heno de Tifton (220 g) y periódico cortado en tiras (200 g). El estado del nido fue determinado para evaluar la mezcla del material y los vellos de la coneja, la preservación del material original, y el peso corporal, la ganancia de peso diaria y la tasa de supervivencia fueron evaluados desde el nacimiento hasta el destete. Resultados: El tipo de material no afectó el nivel de mezcla entre el material y los vellos, cantidad de vello en el nido, peso corporal, ganancia de peso diaria, o tasa de supervivencia de las crías desde el nacimiento hasta el d 35 de edad (p>0,05); sin embargo, la preservación del material original en el nido fue menor cuando el heno de Tifton fue usado (p<0,05). Las correlaciones del tipo de material y número total de nacidos vivos, y la cantidad de vello, nivel de mezcla entre vello y material, y preservación de material en el nido no fueron significativas (p>0,05). No hubo correlación (p>0,05) entre preservación del material en el nido con presencia de vello o nivel de mezcla en los nidos. Hubo una correlación positive entre la presencia de vello en el nido y el nivel de mezcla (p<0,001). Conclusión: El heno de Tifton y el periódico cortado en tiras puede ser usado como revestimiento de nidos para conejas gestantes, sustituyendo la viruta de madera sin efectos negativos sobre el comportamiento de construcción del nido de la coneja ni sobre el desempeño de las crías desde el nacimiento hasta el destete, considerando el primer parto.

Resumo Antecedentes: O material colocado no ninho deve proporcionar conforto à coelha e sua ninhada. Objetivo: Avaliar o efeito de ninhos forrados com diferentes materiais sobre o desempenho da coelha e sobre a construção do ninho. Métodos: Trinta coelhas primíparas foram usadas em delineamento em blocos ao acaso com três tratamentos e dez repetições cada. Foram avaliados três tipos de material para forrar o piso do ninho com maravalha (280 g), feno de Tifton (220 g) e jornal cortado em tiras (200 g). O estado do ninho foi determinado para avaliar a mistura do material com os pelos da coelha, a preservação do material original. Peso corporal, ganho de peso diário e a taxa de sobrevivência foram avaliados desde o nascimento até o desmame. Resultados: Nenhum efeito foi observado do tipo de material sobre o nível de mistura do material e pelos, quantidade de pelos no ninho, peso corporal, ganho de peso diário ou taxa de sobrevivência dos láparos do nascimento até 35 d de idade (p>0,05), entretanto, a preservação do material original no ninho foi menor quando o feno de Tifton foi usado (p<0,05). As correlacões de tipo de material e número total de nascidos vivos com a presença de pelo, nível de mistura entre pelo e material, e preservação de material no ninho não foram significativas (p>0,05). Não houve correlação (p>0,05) entre preservação do material no ninho com presença de pelo ou nível de mistura nos ninhos. Houve correlação positiva entre a presença de pelo no ninho com nível de mistura (p<0,001). Conclusão: Feno de Tifton e jornal cortado em tiras podem ser usados como revestimento de ninhos para coelhas gestantes, substituindo a maravalha sem efeitos negativos sobre o comportamento de construção do ninho da coelha nem sobre o desempenho dos láparos do nascimento até o desmame, considerando-se o primeiro parto.

Magnetized drinking water improves productivity and blood parameters in geese / El agua de bebida magnetizada mejora la productividad y los parámetros sanguíneos en gansos / A água magnetizada melhora a produtividade e os parâmetros sanguíneos em gansos

Abstract Background: Quality of drinking water is an issue that imposes limits on animal farming. Improving water quality can be a solution to animal farming and to the enhancement of animal production in areas with limited water supplies. Objective: To evaluate the effect of water quality and magnetized water on productivity and blood parameters of Egyptian geese. Methods: One hundred and eight (108) Egyptian geese were randomly distributed among four water treatments in a 2×2 factorial design that included two types of water (tap water and well water) and exposure or non-exposure to magnetized tap water and magnetized well water. Results: Well water was of poor quality. Geese consuming this water exhibited lower productive and reproductive performance, lower progesterone and estrogen levels, impaired renal and liver functions and lower total antioxidant capacity. Their eggs had lower weight, lower yolk percentage and reduced shell thicknesses. The magnetic treatment improved the quality of both types of water, with a greater effect on well water. Magnetized water increased water consumption and performance of geese, along with improved renal and liver functions, reproductive hormones, and antioxidant status. Magnetized water improved growth performance, dressing percentage of goslings, and the amount of meat produced. Conclusion: Magnetized tap water improved body weight and feed conversion rate, besides renal and hepatic functions. It also increased production, quality and hatchability of eggs, and levels of reproductive hormones (i.e. progesterone and estrogen), and the antioxidant status in blood.

Resumen Antecedentes: La calidad del agua de bebida es un problema que limita la cría de animales. Mejorar la calidad del agua puede ser una solución para la cría de animales y para aumentar su producción en áreas con limitado suministro de agua Objetivo: Evaluar el efecto de la calidad del agua y del agua magnetizada sobre la productividad y los parámetros sanguíneos de gansos egipcios. Métodos: Ciento ocho gansos se distribuyeron al azar en cuatro tratamientos con un diseño factorial 2×2, que incluyó el efecto de dos tipos de agua (agua de grifo o agua de pozo) y el efecto de la magnetización de ambos tipos. Resultados: El agua de pozo presentó baja calidad. Los gansos que consumieron dicha agua exhibieron peor desempeño productivo y reproductivo, menor nivel de progesterona y estrógeno, deficiencia en las funciones renal y hepática y menor capacidad antioxidante total. Sus huevos mostraron menor peso, bajo porcentaje de yema y reducido espesor de cáscara. El tratamiento magnético mejoró la calidad de ambos tipos de agua, con mayor efecto sobre el agua de pozo. El agua magnetizada mejoró el consumo de agua y el desempeño de los gansos, lo cual contribuyó a una mejoría en las funciones renal y hepática, en las hormonas de la reproducción y en los índices antioxidantes. El agua magnetizada indujo una mejora en el crecimiento, rendimiento en canal y cantidad de carne producida. Conclusión: El agua de pozo magnetizada mejoró el peso corporal y la conversión alimenticia de las aves, además de las funciones renal y hepática; aumentó la producción, calidad y eclosión de los huevos, así como los niveles de hormonas reproductivas (i.e. progesterona y estrógeno) y el estatus antioxidante en sangre.

Resumo Antecedentes: A qualidade da agua é um problema que limita a criação de animais. Melhorar a qualidade da água pode ser uma solução para a criação extensiva de animais e para ampliar a produção animal em áreas com limitado fornecimento de água. Objetivo: Avaliar o efeito da qualidade da água e da água magnetizada sobre a produtividade e os parâmetros sanguíneos de gansos Egípcios. Métodos: Cento e oito gansos Egípcios foram distribuídos ao acaso entre quatro tratamentos de água em arranjo fatorial 2×2 incluindo dois tipos de água - água da torneira × água de poço e a exposição ou não à água de torneira magnetizada × água de poço magnetizada. Resultados: A água de poço apresentou baixa qualidade. Os gansos que receberam esta água exibiram piores desempenhos produtivo e reprodutivo, menores níveis de progesterona e estrógeno, deficiências nas funções renal e hepática, e menor capacidade antioxidante total. Seus ovos mostraram baixo peso, porcentagens menores de gema e espessura de casca reduzida. O tratamento magnético melhorou a qualidade de ambos os tipos de água, com maior efeito na água de poço. A água magnetizada melhorou o consumo de água e o desempenho dos gansos, o qual contribuiu para a melhora nas funções renal e hepática, nos hormônios da reprodução e nos índices antioxidantes. A água magnetizada induziu uma melhora no crescimento, no rendimento de carcaça e na quantidade de carne produzida. Conclusaõ: A água de poço magnetizada melhorou o peso corporal e a conversão alimentar das aves, além das funções renal e hepática, aumentou a produção, qualidade e eclodibilidade dos ovos, também os níveis de hormônios reprodutores (i.e. progesterona e estrógeno) e o status antioxidante no sangue.

Analysis of the Specificity and Biochemical Characterization of Metalloproteases Isolated from Eupenicillium javanicum Using Fluorescence Resonance Energy Transfer Peptides.

Enzymes have important features that may facilitate their application in industrial processes and have been used as alternatives to chemical catalysts. In particular, proteases can be isolated from microorganisms, which provide important sources of advantageous enzymes for industrial processes. For example, Eupenicillium javanicum is a filamentous fungus that has been shown to express industrially applicable enzymes and chemical components, such as antifungal compounds. The biotechnological potential of E. javanicum and proteases made us search a novel protease from this microorganism. The macromolecule was isolated, the main biochemical properties was evaluated, and the specificity of the protease subsites was determined. The protease was produced under solid-state bioprocess with wheat bran and isolated by two chromatography steps with yield of 27.5% and 12.4-fold purification. The molecular mass was estimated at 30 kDa. The N-terminal sequence of the first 20 amino acid residues was AVGAGYNASVALALEKALNN. The enzyme presented higher proteolytic activity at pH 6.0 and 60°C. The protease is stable at wide range of pH values and temperatures and in the presence of surfactants. The "primed" side of the catalytic site showed the highest catalytic efficiency of the enzyme isolated from E. javanicum. The S'1 subsite is responsible for catalyzing the protease reaction with substrates with tyrosine in P'1. These findings provide important insights into the biochemical characterization of a highly active protease from E. javanicum and may facilitate the development of industrial processes involving this protease.

When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

PURPOSE: To assess safety and efficacy of supine percutaneous nephrolithotomy in patients for whom prone position or general anesthesia is contraindicated or not preferable due to associated comorbidities, overweight or ipsilateral upper ureteric calculi. MATERIALS AND METHODS: Fifty two patients (37 males and 15 females, mean age 33 ± 10.2 years) were included in this study. Supine position was selected due to anesthetic considerations (preexisting compromised cardiopulmonary status, morbid obesity (body mass index > 40 kg/m²) and/or other associated medical comorbidities), impossible prone position due to bone deformities or associated ipsilateral upper ureteric stone. Regional anesthesia was used in 24 patients while 28 patients underwent general anesthesia. After standard cystoscopy and retrograde ureteropyelography in the dorsal lithotomy position, the position was modified using 3 liters of saline bag below the ipsilateral upper flank. Percutaneous access to the pelvicalyceal system was performed through the posterior axillary line under fluoroscopic guidance. RESULTS: Successful renal puncture was achieved in all cases. Single access via the lower calyx was the most commonly used access (36 cases). Stone-free rate was 92.3%. Postoperative complications classified according to Clavien Dindo classification included bleeding requiring transfusion (3.8%), prolonged fever (7.7%), deep venous thrombosis (1.9%) [grade II in all] and urinary leakage requiring ureteric stenting (5.8%) [grade IIIa]. CONCLUSIONS: The modified supine position for percutaneous nephrolithotomy is a safe and effective option that offers several advantages with an excellent outcome. It can be performed safely for morbidly obese patients and those with cardiopulmonary compromise.

When prone position is contraindicated or not preferable, can supine percutaneous nephrolithotomy solve the problem?

PURPOSE: To assess safety and efficacy of supine percutaneous nephrolithotomy in patients for whom prone position or general anesthesia is contraindicated or not preferable due to associated comorbidities, overweight or ipsilateral upper ureteric calculi. MATERIALS AND METHODS: Fifty two patients (37 males and 15 females, mean age 33 ± 10.2 years) were included in this study. Supine position was selected due to anesthetic considerations (preexisting compromised cardiopulmonary status, morbid obesity (body mass index > 40 kg/m²) and/or other associated medical comorbidities), impossible prone position due to bone deformities or associated ipsilateral upper ureteric stone. Regional anesthesia was used in 24 patients while 28 patients underwent general anesthesia. After standard cystoscopy and retrograde ureteropyelography in the dorsal lithotomy position, the position was modified using 3 liters of saline bag below the ipsilateral upper flank. Percutaneous access to the pelvicalyceal system was performed through the posterior axillary line under fluoroscopic guidance. RESULTS: Successful renal puncture was achieved in all cases. Single access via the lower calyx was the most commonly used access (36 cases). Stone-free rate was 92.3%. Postoperative complications classified according to Clavien Dindo classification included bleeding requiring transfusion (3.8%), urinary leakage requiring ureteric stenting (5.8%), prolonged fever (7.7%), deep venous thrombosis (1.9%) [grade III in all] and urinary leakage requiring ureteric stenting (5.8%) [grade IIIa]. CONCLUSIONS: The modified supine position for percutaneous nephrolithotomy is a safe and effective option that offers several advantages with an excellent outcome. It can be performed safely for morbidly obese patients and those with cardiopulmonary compromise.