Exploring the Impact of Family History, Demographics and Ecological Factors on Urolithiasis Prevalence: Insights from a Nationwide Study.

OBJECTIVE:  This study aimed to evaluate the potential risk factors of lifetime urolithiasis occurrence on a nationwide scale in Iran. METHODS:  All data regarding urinary stone events were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of urolithiasis incidence were evaluated. RESULTS:  Our multivariable logistic regression suggested that while older age at presentation, male sex, and a positive family history of urolithiasis in either of the patient's parents or siblings were all significantly associated with an increased odds of lifetime urolithiasis occurrence (all P < .001), a positive family history in one's sister (odds ratio; OR=5.56) or brother (OR=4.70) were the most significant predictors. Moreover, belonging to Baluch ethnicity (i.e., an ethnical group indigenous to the south eastern regions of Iran) and residing in regions with higher water hardness (i.e., total concentration of dissolved minerals) were also associated with an increased odds of urolithiasis occurrence (P < .001 and P=.023, respectively). Conversely, living in regions with higher mean humidity decreased the chances of developing a urinary stone event during one's lifetime (OR=0.62, P <.001). CONCLUSION:  Our results indicated that a constellation of demographic, ecological, and familial risk factors are associated with an elevated risk of developing urinary stones during one's lifetime. These findings can assist in implementing novel regional healthcare policies, considering the specific demographic and ecological characteristics. They also support tailoring personalized preventive strategies, particularly for individuals with multiple nonmodifiable risk factors.

Prevalence of Urogenital Injury following Road Accident: A Systematic Review.

INTRODUCTION AND HYPOTHESIS: Trauma complications have been one of the most serious public health concerns worldwide. In most reports, urogenital injuries (UGIs) are seen in approximately 10% of adult traumatic patients and less than 3% of children with multiple/severe trauma to the abdomen or pelvis. Traffic accidents are the most common cause of UGIs. The purpose of this study is to systematically determine the prevalence and types of UGIs after car accidents. METHODS: The search strategy was aimed at finding relevant studies in October 2023. No restrictions on language or date were applied. The following criteria were considered eligibility criteria: reporting at least one epidemiological aspect of UGIs in people with road traffic injury (RTI) and a separate epidemiological analysis of RTIs in UGI (we also included those articles that pointed out all RTIs but separately mentioned UGIs). Two experts assessed the reporting quality of articles using standardized critical appraisal instruments from the Joanna Briggs Institute. Statistical analysis for this study was conducted using the CMA statistical software version 3.2.0. RESULTS: A total of 1,466,024 cases following RTIs through 107 studies were included in our review. Of these, 29 studies were related to children (20,036), and the others reported RTIs in adults (1,445,988). The total prevalence was 4.7%, and car accidents were responsible in 36 studies, followed by motorcycle accidents in 25, bicycles in 17 studies, and automobile-pedestrian collisions in 23 related studies. In subgroup analysis based on the damaged organ, the rate of bladder injury was 3.5%. This rate was 5.3% for kidneys. CONCLUSION: This systematic review and meta-analysis found that the prevalence of UGI following RTIs was 4.7%, with car accidents being the most common cause. UGIs were more prevalent in adults than in children, and bladder and kidney injuries were the most commonly reported types. The prevalence of UGI varied by country and study design.

Update on APPEAL, an International Randomized Controlled Trial Evaluating Ciprofloxacin Versus Placebo in Patients Undergoing Shockwave Lithotripsy for Urolithiasis.

The blinded APPEAL trial is assessing the effectiveness of antimicrobial prophylaxis in preventing infections after shockwave lithotripsy for urinary stones. This large, pragmatic, international trial will provide trustworthy evidence to inform guidelines and influence global practices.

A systematic and comprehensive review of the role of microbiota in urinary chronic pelvic pain syndrome.

BACKGROUND: Many genitourinary tract disorders could be attributed partly to the microbiota. This study sought to conduct a systematic review of the role of the microbiota in urinary chronic pelvic pain syndrome (UCPPS). METHODS: We searched Embase, Scopus, Web of Science, and PubMed with no time, language, or study type restrictions until December 1, 2023. The JBI Appraisal Tool was used to assess the quality of the studies. Study selection followed the PRISMA statement. Studies addressing microbiome variations among patients suffering from interstitial cystitis/bladder pain syndrome (IC/BPS) or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and a control group were considered eligible. RESULTS: A total of 21 studies (1 UCPPS, 12 IC/BPS, and 8 CP/CPPS) comprising 1125 patients were enrolled in our final data synthesis. It has been shown that the reduced diversity and discrepant composition of the gut microbiota may partly be attributed to the UCPPS pathogenesis. In terms of urine microbiota, some operational taxonomic units were shown to be elevated, while others became less abundant. Furthermore, various bacteria and fungi are linked to specific clinical features. Few investigations denied UCPPS as a dysbiotic condition. CONCLUSIONS: Urinary and intestinal microbiota appear to be linked with UCPPS, comprising IC/BPS and CP/CPPS. However, given the substantial disparity of published studies, a battery of prospective trials is required to corroborate these findings.

Basic life support training for intensive care unit nurses at a general hospital in Tabriz, Iran: a best practice implementation project.

INTRODUCTION AND OBJECTIVES: Basic life support (BLS) is foundational to the care delivered to cardiac arrest victims. This study evaluated current practices and implemented best practices related to BLS training for intensive care unit (ICU) nurses in a general hospital in Tabriz, Iran. METHODS: This interventional before-after study was informed by the JBI Evidence Implementation Framework. An audit, feedback, and re-audit strategy was used to measure baseline compliance with best practices, develop an implementation strategy to address gaps in compliance, and undertake a final evaluation to measure changes in compliance. The JBI Practical Application of Clinical Evidence System (JBI PACES) and situational analysis Getting Research into Practice (GRiP) tool were used to support data collection and implementation planning. There were 13 evidence-based criteria and a sample of 9 ICU nurses. RESULTS: The baseline audit revealed gaps between current practice and best practice in 9 of the 13 criteria. Barriers included insufficient education tools and programs, insufficient supervision, lack of skills laboratories, and a lack of continuous BLS education. Improvement strategies included providing a human stimulator manikin, developing an education program for nurses, as well as establishing a cardiopulmonary-cerebral resuscitation department, a skills laboratory, and continuous BLS education based on the American Heart Association guidelines. The follow-up audit revealed improvement of 100% across all criteria. CONCLUSIONS: This project indicates that a clinical audit is effective for assessing evidence-based BLS education for ICU nurses, thereby improving resuscitation performance and patient outcomes. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A213.

The MicroRNAs (miRNAs) Expression in Benign Urological Diseases: A Systematic Review.

PURPOSE: The exact molecular and cellular processes that cause benign urological diseases in the stromal and epithelial components of the urinary tract are yet unknown. Reviewing and analyzing the data linking microRNAs (miRNAs) expression in the pathophysiology of benign urological conditions, including overactive bladder (OAB), bladder outlet obstruction (BOO), bladder pain syndrome/interstitial cystitis (BPS/IC), and Lower urinary tract dysfunction (LUTD) is the objective of the current systematic review. MATERIALS AND METHODS: Evidence including all case-control, cohort, and cross-sectional studies that measure participants' MicroRNA as a biomarker for benign urological diseases has been gathered On January 2024, through searching MEDLINE via PubMed, Scopus, Web of Science, Embase, and ProQuest databases. Studies considered eligible that present information on the reference Gene, profile type, and serum levels of microRNA from patients diagnosed with benign urological disease including benign prostate hyperplasia (BPH) or benign prostate enlargement (BPE), overactive bladder (OAB), and bladder outlet obstruction (BOO). These studies appraised by the quality assessment checklist of Joanna Briggs Institute (JBI). RESULTS: A total of 4,587 records related to miRNAs in urological diseases were retrieved. Of these, we identified 28 records for our systematic study. The most frequently associated miRNA was 92a-3p identified which was found upregulated in OAB diagnosis. In BOO, miR-146a-5p was identified to be upregulated. miR-146a-5p was upregulated in BO, and for other benign conditions, different miRNAs were reported. 491-5p miRNAs were found deregulated in OAB-related studies. We expected other miRNAs to have the same trend in the OAB studies. InSUI miR-93 was the most frequent downregulated miRNA. The other reported miRNAs had similar frequencies. CONCLUSION: When it comes to the early detection and treatment of benign urological conditions, 92a-3p, miR-21, miR-199a-5p, and miR-146a-5p, and 491-5p have the potential to be employed as both a biomarker and a therapeutic target. The creation of pre-RNA or anti-RNA molecules within carrier vehicles that may be safely administered to patients should be made possible by technological advancements.

The Potential Role of Urinary Microbiota in Bladder Carcinogenesis: A Systematic Review.

PURPOSE: The quantitative objective of the current systematic review was to identify the potential role of urinary microbiota in bladder cancer (BC) carcinogenesis, invasiveness, progression, and metastasis. MATERIALS AND METHODS: The proposed systematic review was conducted in accordance with critical review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, and the Joanna Briggs Institute (JBI) methodology for systematic reviews. The search strategy aimed to find both published and unpublished studies up to the January 2024. A JBI appraisal checklist was used to assess possible biases. RESULTS: This systematic review was centered on 27 studies comprising 926 BC patients. Overall, 412 control individuals were compared with BC patients. The most common sampling method was midstream urine collection. Regarding microbial alpha diversity, there was no statistically significant difference between cancerous and healthy samples (n = 8), recurrent and not recurrent (n = 1), responders versus non-responders(n = 1), tumor grades (n = 1), and collection methods (n = 1). However, five studies reported higher diversity in controls, and five other studies reported, conversely, high levels of alpha diversity in BC patients or recurrent cases. Furthermore, a responder (RE) to treatment and a non-muscle invasive bladder cancer (NMIBC) groups demonstrated significant difference with non-responder (NR) and muscle invasive bladder cancer (MIBC), respectively. In terms of beta-diversity, nine studies reported significant diversity between BC patients and controls, one article demonstrated difference between recurrent and not recurrent patients, a study reported significant difference in RE and NR groups whereas another showed opposite, and others (n = 4) did not find any difference between BC, controls, MIBC and NMIBC patients, or between tumor grades. One study reported a difference between the collection method and beta-diversity in males and another reported the difference in females. CONCLUSION: The included studies demonstrate that the composition of urinary microbiota is altered in patients with BC. However, the differentially enriched genera in the urine of these patients vary between studies, and there is too much heterogeneity across studies to make any reliable and valid conclusions. Furthermore, well-designed research is necessary to assess the role of microbiota in the carcinogenesis and progression of BC.

The International Female Coital Incontinence Questionnaire: Translation, Validation, and Reliability Study of the Persian Version.

INTRODUCTION AND HYPOTHESIS: This study was aimed at validating the Persian version of the International Female Coital Incontinence Questionnaire (IFCI-Q). METHODS: In the current study, 150 sexually active women with complaints of any kind of sexual dysfunction from January 2022 to July 2023, who were referred to urogynecology outpatient clinics, completed the IFCI-Q. Age ≥ 18 years and sexually active women were the inclusion criteria for the study. Quantitative calculations were made to determine the content validity ratio and content validity index. A test-retest procedure was utilized to determine the scale reliability. RESULTS: The mean (SD) age of participants was 35.66 (7.03) years. Among a total of 150 women, 21 (14.0%) had coital incontinence (CI), and this disorder happened during penetration in 11 cases (7.3%), orgasm in 9 (6.1%), or both conditions in one woman (0.7%). The intraclass correlation coefficient (95% confidence interval) was 0.79 (0.74, 0.84), and the Cronbach's α coefficient was 0.89. A positive association between the Female Sexual Function Index and the IFCI-Q was also demonstrated by the criteria validity (r = 0. 87 and p = 0.001). CONCLUSION: Regarding validity and reliability, the Persian version of the IFCI-Q can properly evaluate CI in women with sexual dysfunction or complaining of CI.

Health care providers' communication with pediatric patients and carers: a best practice implementation project.

INTRODUCTION AND OBJECTIVES: Health care providers need a high level of communication skills in dealing with pediatric patients and their carers. The objective of this project was to evaluate current practice and implement best practices promoting health care provider communication with pediatric patients and carers in a children's hospital in Tabriz, Iran. METHODS: This project used the JBI Model of Evidence-Based Healthcare, which guided the conceptualization of evidence implementation, context analysis, project implementation, and evaluation of outcomes using evidence-based quality indicators. An audit and feedback strategy was adopted to measure baseline compliance with best practices, develop strategies to address areas of non-compliance, and conduct a final audit to measure any changes in compliance. Four criteria were developed for the baseline and follow-up audits. Criteria 1 and 2 were evaluated using a sample of 30 health care providers, while Criteria 3 and 4 were evaluated using a sample of 80 pediatric patients and carers. RESULTS: All four criteria improved at the end of the project. Criterion 1 (health care staff receive communication skills training) had the highest mean score at baseline and follow-up (63% and 83%, respectively). Criterion 2 (implementation of local strategies by health care organizations) increased from 45% to 55%. However, this rate of improvement was the lowest of all the criteria. Criterion 3 (pediatric patients receive relevant education) improved from low to moderate, rising from 18% to 49%. A more significant improvement was noted for Criterion 4 (parents receive relevant education), which rose from 19% to 56%. CONCLUSIONS: The strategies implemented in this project successfully improved health care provider communication with pediatric patients and their carers. To ensure project sustainability, repeat audits will be conducted after 3, 6, and 12 months. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A199.

Peritoneal dialysis vs. hemodialysis among patients with end-stage renal disease in Iran: which is more cost-effective?

BACKGROUND: There is little economic evidence on different modalities among patients with end-stage renal disease (ESRD) in Iran. This study aimed to assess the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) among ESRD patients in Iran. METHODS: From the health system perspective and with a 10-year time horizon, we conducted a cost-utility analysis based on a Markov model to compare three strategies of PD and HD [the second scenario (30% PD, 70% HD), the third scenario (50% PD, 50% HD) and the fourth scenario (70% PD, 30% HD)] among ESRD patients with the current situation (PD, 3% vs. HD, 97%) as the basic scenario (the first scenario) in Iran. Cost data for PD, HD and kidney transplantation were extracted from the medical records of 720 patients in the Health Insurance Organization (HIO) database. The Iranian version of the EQ-5D-5 L questionnaire was filled out through direct interview with 518 patients with ESRD to obtain health utility values. Other variables such as transition probabilities and survival rates were extracted from the literature. To examine the uncertainty in all variables included in the study, a probabilistic sensitivity analysis (PSA) was performed. TreeAge Pro 2020 software was used for data analysis. FINDINGS: Our analysis indicated that the average 10-year costs associated with the first scenario (S1), the second scenario (S2), the third scenario (S3) and the fourth scenario (S4) were 4750.5, 4846.8, 4918.2, and 4989.6 million Iranian Rial (IRR), respectively. The corresponding average quality-adjusted life years (QALYs) per patient were 2.68, 2.72, 2.75 and 2.78, respectively. The ICER for S2, S3 and S4 scenarios was estimated at 2268.2, 2266.7 and 2266.7 per a QALY gained, respectively. The analysis showed that at a willingness-to-pay (WTP) threshold of 3,000,000,000 IRR (2.5 times the GDP per capita), the fourth scenario had a 63% probability of being cost-effective compared to the other scenarios. CONCLUSION: Our study demonstrated that the fourth scenario (70% PD vs. 30% HD) compared to the current situation (3% PD vs. 97% HD) among patients with ESKD is cost-effective at a threshold of 2.5 times the GDP per capita (US$4100 in 2022). Despite the high cost of PD, due to its greater effectiveness, it is recommended that policymakers pursue a strategy to increase the use of PD among ESRD patients.

Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran.

INTRODUCTION AND HYPOTHESIS: Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. METHODS: Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. RESULTS: The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5 cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. CONCLUSIONS: Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.

Long-term follow-up of intravesical abobotulinumtoxinA (Dysport®) injections in women with idiopathic detrusor overactivity.

Objective: Only a few numbers of studies have been published on the use of abobotulinumtoxinA (Dysport®) in idiopathic detrusor overactivity (IDO). This study reported the long-term follow-up of women with IDO who were treated with intravesical Dysport® injections. Methods: Two hundred and thirty-six patients with IDO who had failed first-line conservative and antimuscarinic therapy received 500-900 units of Dysport® between April 2014 and July 2015. All patients were followed up for 5 years after their initial injection and interviewed on the phone. Results: A total of 236 women with IDO aged from 18 years to 84 years (mean±standard deviation: 49.6±15.9 years) were included in our study. The median follow-up time for patients was 36.5 (range: 10-70) months, and the median recovery time after injection was 18.5 (range: 0-70) months. A total of 83 (35.2%) patients stated that they had subjective improvement of their symptoms whereas 84 (35.6%) patients did not report any improvement in symptoms. The initial International Consultation on Incontinence Questionnaire Overactive Bladder mean score was 6.9 (standard deviation 3.4). There was a positive association between the median recovery time and the components of the International Consultation on Incontinence Questionnaire Overactive Bladder questionnaire. Conclusion: In a sub-population of overactive bladder patients with IDO who have failed first-line therapy, a single intravesical Dysport® injection can resolve patient symptoms completely or reduce the symptoms to an acceptable level that can be controlled with antimuscarinics or re-injection on demands.

The Impact of The COVID-19 Pandemic on Hospital Admissions Due to Road Traffic Crashes; a Systematic Review and Meta-Analysis.

Introduction: During the unprecedented COVID-19 lockdowns, road traffic was limited, and a change in the traumatic emergency admission pattern was anticipated. We conducted the current systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on hospital admissions due to road traffic crashes. Methods: This systematic review and meta-analysis was conducted based on the Joanna Briggs Institute (JBI) instructions. The following databases were searched: PubMed, ISI Web of Knowledge, Scopus, ProQuest, and the Cochrane Library. Two independent reviewers screened articles based on the inclusion criteria for the review and assessed the methodological quality of the included studies using an appropriate appraisal checklist, introduced by the JBI, based on the study type. The meta-analysis was performed using Comprehensive meta-analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% confidence interval (CI) for binary outcomes. Results: A total of 13 studies were included in this systematic review, and all of them were considered for meta-analysis. According to the meta-analysis, differences in hospital admission rates during the COVID-19 pandemic and one year before this pandemic were statistically significant [RR: 0.685 CI 95% (0.578 -0.813) p<0.00001]. The heterogeneity assessment of the included studies in the meta-analysis showed high heterogeneity (I2=78%, p<0.00001). Conclusion: The results of this systematic review showed that the COVID-19 pandemic dramatically reduced the number of hospital admissions related to road traffic crashes because of both quarantines and lifestyle changes. Health policymakers and top health managers might use the results of this systematic review in similar contexts in the future.

Efficacy and safety of desmopressin in nocturia and nocturnal polyuria control of neurological patients: A systematic review and meta-analysis.

PURPOSE: Evidence on the efficacy of desmopressin in nocturia in patients with neurological diseases is still very limited except for multiple sclerosis (MS). Our aim was to evaluate the efficacy and safety of desmopressin treatment on nocturia in patients with underlying neurological diseases. METHODS: Studies were identified by electronic search of PubMed, Embase, Cochrane, CINAHL, and Google Scholar databases. Studies were considered if they provided information on the effectiveness and safety of desmopressin (1-desamino-8-d-arginine vasopressin, or DDAVP) in the treatment of nocturia and their participants had acquired neurological pathology. Two researchers independently extracted the articles using specified datasets, such as quality-of-study indicators. Statistical meta-analysis was carried out using Review Manager (RevMan) 5.4 statistical software (Cochrane Collaboration). RESULTS: Of a total of 1042 articles in the initial search, 14 studies were included. Most of the published papers were related to MS (n = 7), two were on spinal cord injury, and other conditions were neural tube defect, myelodysplasia, Parkinson's disease, stroke, and multiple system atrophy. Overall, a total of 200 patients (mostly females) were enrolled. Thirteen studies evaluated the intranasal formulation of desmopressin and one study evaluated oral desmopressin. A significant decrease in nocturia episodes was reported in seven studies evaluating this topic. An increase in the maximum hours of uninterrupted sleep was reported in the three studies in which this outcome was assessed. A significant reduction in the volume of nocturnal incontinence was found in one study. Three studies were eligible to include in the meta-analysis. The results showed that desmopressin compared to placebo, significantly reduced nighttime urination (mean difference: -0.75, 95% CI: -1.10 to -0.41; p < 0.00001). The rate of adverse events ranged from 0% to 68.42%. The critical appraisal results for all trials showed that most of the studies had low or moderate quality. CONCLUSIONS: Our results emphasized desmopressin's safety and efficacy in reducing nocturia episodes, with transient adverse effects on neurological patients. However, the data were achieved from low or medium-quality trials, and further well-designed randomized controlled trials are needed.

Effects of Posterior Tibial Nerve Stimulation on Fecal Incontinence: An Umbrella Review.

PURPOSE: This study aimed to summarize relevant data from previous systematic reviews (SRs) and conduct comprehensive research on the clinical effects of posterior tibial nerve stimulation (PTNS), via the transcutaneous posterior tibial nerve stimulation (TPTNS) or percutaneous posterior tibial nerve stimulation (PPTNS) method on fecal incontinence (FI). MATERIALS AND METHODS: In adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search was conducted on PubMed, Embase, Scopus, and Web of Science databases. We included English-language, full-text SRs reporting outcomes for FI following either PPTNS or TPTNS. The quality of included studies was assessed using the Joanna Briggs Institute checklist. In addition, reanalyzing the meta-analyses was conducted using Comprehensive Meta-Analysis (CMA) software version 3.0 to achieve effect sizes and the level of statistical significance was set at p ≤ 0.05. RESULTS: From a total of 835 citations, 14 SRs met our inclusion criteria. Four of these also conducted a meta-analysis. Most SRs reported an overall improvement in different study parameters, including bowel habits and quality of life. However, there were major inconsistencies across the results. The most studied outcome was FI episodes, followed by incontinence score. The summary outcomes showed no statistically significant changes in comparing PTNS with sham or sacral nerve stimulation (SNS) for FI (p > 0.05). However, the results of subgroup analysis based on the type of intervention in the control group revealed that FI episodes were significantly fewer than in the PTNS arm, whereas PTNS led to fewer episodes of FI than did the sham. In terms of incontinence score, the results showed that PTNS compared with sham did not change the incontinence score; however, SNS improved the score significantly in one eligible study for reanalysis when compared with PTNS (p < 0.001). CONCLUSIONS: The findings of the current umbrella review suggest that PTNS can potentially benefit patients with FI. However, this is concluded from studies with a limited population, disregarding the etiology of FI and with limited follow-up duration. Therefore, caution must be taken in contemplating the results.

Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review.

BACKGROUND: Lower urinary tract dysfunction (LUTD) is a common, troublesome condition that often negatively affects patients' quality of life. Current literature has long been interested in how posterior tibial nerve stimulation (PTNS) can affect this condition. AIM: To extensively and systematically explore how PTNS affects LUTD based on the most recent systematic reviews. METHODS: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the systematic reviews, with or without meta-analysis that assessed the effects of PTNS on LUTD were retrieved. The quality of the included studies was assessed using the Joanna Briggs Institute tool, and analysis was conducted using the Comprehensive Meta-Analysis version 3 tool. RESULTS: From a total of 3077 citations, 20 systematic reviews entered this study, and 13 of them included meta-analysis. The population of studies varied vastly, for instance, some studies included only children or women while other focused on a specific pathology like multiple sclerosis-induced neurogenic LUTD. The majority of included studies reported an overall improvement in LUTD following percutaneous PTNS, although admitting that these results were derived from moderate to low-quality evidence. CONCLUSION: The findings of this thorough umbrella review showed that the positive benefits of PTNS in treating LUTD are currently supported by low-quality evidence, and it is crucial to interpret them with great care.

Compensation based on work relative value unit for cardiovascular surgeons in Iran: A mixed method study.

BACKGROUND: Work relative value unit (wRVU) is a tool for assessing surgeons' performance, compensation, and productivity. It appears that wRVU for cardiovascular procedures does not consider complexity and its value for lengthy operations is low. The aim of the study is to determine wRVU for cardiovascular procedures in Iran according to the proposed approach. MATTERIALS AND METHODS: This study was conducted as a mixed method in teaching hospitals in Tabriz in the period of September 2020 to December 2021. According to Hospital Information System and expert opinions, six procedures in cardiovascular surgery were included in the study. They were compared with 18 procedures in neurosurgery, orthopedics, and otorhinolaryngology in terms of the operation time and wRVU/min. Then, we calculated new wRVUs for the selected procedures based on surgeons' opinions, time measurements, and anesthetists' points of view by content analysis in qualitative and statistical analysis in quantitative parts. RESULTS: Among the six cardiac procedures, the wRVU for five was under-estimated. The wRVU/min value ranged from 0/28 to 1/15 in the studied procedures. Findings demonstrate no significant relationship between the length of operations and the wRVU announced by the Ministry of Health and Medical Education (P value >0/05). Compared to studied procedures in four specialties, thoracoabdominal aortic aneurysm repair has the longest surgery time at 417 minutes. According to anesthesiologists, cardiovascular; orthopedics; ear, nose, and tongue; and neurosurgery specialties obtained 4/2, 2/9, 2/8, and 4, respectively, in terms of surgery duration, complexity, risk, and physical effort. CONCLUSION: Despite policymakers' attempts to bring justice to payments, it seems that there has been little progress in paying cardiovascular surgeons. Improper payment to cardiovascular surgeons will affect the future of the workforce in this specialty. Today, the need to reconsider the wRVUs in heart specialty is felt more than before.

Scientometric Analysis and Mapping of Scientific Articles on Multiple Sclerosis-Related Neurogenic Lower Urinary Tract Dysfunction.

OBJECTIVE: Patients suffering from multiple sclerosis (MS) frequently experience lower urinary tract (LUT) dysfunction, which significantly impacts their quality of life. This study's objective was to conduct a scientometric analysis of the literature on MS-induced neurogenic LUT dysfunction. METHODS: Using bibliometric methods, we examined the literature on neurogenic lower urinary tract dysfunction (NLUTD) in MS patients without restricting it to prevalence studies or specific management methods. We considered contributions from authors, organizations, nations/regions, as well as the evolution of theoretical frameworks, research subtopics, and influential papers. In January 2023, we searched the complete Scopus database, without imposing any language or date constraints, identifying relevant documents related to urology clinical investigations of MS-induced NLUTD. The original articles were categorized into 4 groups: narrative reviews, systematic reviews and meta-analyses, research of levels 1-4, and case reports/series. RESULTS: On January 1, 2023, our search yielded 72 sources published between 1977 and 2022, including journals and books. The average time before publication was 11.2 years. Each document received an average of 18.1 citations, totaling 1.299 citations per year. The author's analysis explored relationships, productivity, and coauthorship networks among authors and institutions based on bibliographic records. Chartier-Kastler E, Karmonik C, and Khavari R ranked highest with 8 publications each. The University of Catania claimed the top position, followed by Houston Methodist Hospital and Paris University, recognized as the leading institutions in this field. CONCLUSION: An analysis of diagnosis, therapy, and rehabilitation of MS-related NLUTD may be helpful for future bibliometric research in the field to better direct output.

The association between oral inflammatory load and semen and sperm functional analysis: A cross-sectional study.

Background: Studies have suggested a correlation between periodontitis and reduced male fertility. Inflammation has been described as the link between these ailments. Oral inflammatory load (OIL) can be measured through oral polymorphonuclear neutrophil (oPMN) count, which is associated with periodontal diseases. This cross-sectional study assessed the possible correlation between OIL and the functional parameters of sperm cells. Methods: In 229 volunteers, oral rinse and semen samples were assessed for oPMN, semen polymorphonuclears (sPMNs), sperm concentration, total sperm count, motility, morphology, and sperm DNA fragmentation index (SDFi). A multiple linear regression model was conducted to evaluate the relationships between oPMN and semen parameters. Results: The effect of elevated oPMN counts on total motility rate, progressive rate, and percentage of sperm cells with normal morphology was significant (P<0.001), with an inverse relationship, i.e., with every unit increase in oPMN count, the mentioned parameters would decline by 0.573, 0.367, and 0.407 units, respectively. oPMN counts also correlated positively with sPMN counts and SDFi (P<0.001), i.e., with every unit increase in the oPMN measures, sPMN counts would increase by 0.126 million/mL, with an 0.733% increase in SDFi. However, there was no significant association between oPMN counts and sperm concentration. Conclusion: OIL, as represented by oPMN counts, might affect male fertility as there is a positive correlation between the levels of these inflammatory cells and decreased sperm motility, abnormal morphological changes, increased sPMN counts, and increased SDFi.

Fixed-effect Versus Random-effects Models for Meta-analyses: Fixed-effect Models.

A fixed-effect model considers a common underlying effect size for all the studies included in a meta-analysis. In the face of appreciable between-study heterogeneity, a fixed-effect model is a valuable tool when precision is the priority.