Urinary Symptoms Are Unrelated to Leukocyte Esterase and Nitrite Among Indwelling Catheter Users.

Objectives: To explore the association between dipstick results and urinary symptoms. Method: This was a prospective 12-month observational study of real-time self-administered urine dipstick results and symptoms in a community setting that included 52 spinal cord injury/disease (SCI/D) participants with neurogenic lower urinary tract dysfunction (NLUTD) who use an indwelling catheter. Symptoms were collected using the Urinary Symptom Questionnaire for Neurogenic Bladder-Indwelling Catheter (USQNB-IDC). The USQNB-IDC includes actionable (A), bladder (B1), urine quality (B2), and other (C) symptoms; analyses focused on A, B1, and B2 symptoms. Dipstick results include nitrite (NIT +/-), and leukocyte esterase (LE; negative, trace, small, moderate, or large). Dipstick outcomes were defined as strong positive (LE = moderate/large and NIT+), inflammation positive (LE = moderate/large and NIT-), negative (LE = negative/trace and NIT-), and indeterminate (all others). Results: Nitrite positive dipsticks and moderate or large LE positive dipsticks were each observed in over 50% of the sample in every week. Strong positive dipstick results were observed in 35% to 60% of participants in every week. A, B1, or B2 symptoms co-occurred less than 50% of the time with strong positive dipsticks, but they also co-occurred with negative dipsticks. Participants were asymptomatic with a strong positive dipstick an average of 30.2% of the weeks. On average, 73% of the time a person had a negative dipstick, they also had no key symptoms (95% CI, .597-.865). Conclusion: No association was observed between A, B1, and B2 symptoms and positive dipstick. A negative dipstick with the absence of key symptoms may better support clinical decision-making.

Outcomes of patients with COVID-19 after inpatient rehabilitation.

BACKGROUND: Rehabilitation outcomes of patients with coronavirus disease 2019 (COVID-19) are unknown. OBJECTIVE: To describe patients with COVID-19 who are undergoing inpatient rehabilitation and their rehabilitation outcomes. DESIGN: Retrospective observational cohort study of all inpatients from a rehabilitation hospital between March 1 and September 30, 2020. SETTING: Inpatient rehabilitation hospital. PATIENTS: Among all inpatients, inclusion criteria are: ≥18 years of age and admission and discharge within the study time frame. The initial search yielded 920 patients; 896 met the inclusion criteria. Subjects were stratified by COVID-19 status and rehabilitation impairment. MAIN OUTCOME MEASURES: Data included age, gender, body mass index (BMI), length of stay (LOS), discharge location, and functional ability in self-care and mobility (FA-SC, FA-Mob). One-sample t-tests were used to assess the difference of age, BMI, LOS, FA-SC, FA-Mob, and FA efficiency between COVID-19+ and COVID-19- patients. RESULTS: COVID-19+ patients were younger (59.4 years vs 62.9 years; t[894] = -2.05, p = .04) with a higher mean BMI (32 vs 28; t[894] = 3.51, p < .01) than COVID-19- patients. COVID-19+ patients had equivalent or superior improvements in FA-SC and FA-Mob, functional change efficiency, and LOS relative to COVID-19- patients. When medically complex patients were compared, those with COVID-19 had greater FA-SC and FA-Mob efficiencies than COVID-19- patients. COVID-19+ patients had similar rates of return to the community. CONCLUSIONS: Patients with COVID-19 who meet the admission criteria for inpatient rehabilitation can benefit from inpatient rehabilitation similarly to their non-COVID-19 counterparts with similar rehabilitation-specific diagnoses.

Topical Sevoflurane: A Novel Treatment for Chronic Pain Caused by Venous Stasis Ulcers.

In the US, an estimated 1 - 2% of chronic venous insufficiency (CVI) patients (of 6 - 7 million nationwide) develop at least one venous stasis ulcer (VSU) during their illness. Of these, approximately 40% develop subsequent ulcers, making VSU prognostically poor. Current management of VSU is costly, with poor prognosis, high recurrence rate, inadequate pain management, and significantly reduced quality of life (QoL). Topical volatile anesthetic agents, such as sevoflurane, offer improved pain relief and symptom control in patients suffering from chronic VSU. The immediate impact of topical sevoflurane in reducing pain associated with ulcer bed debridement has several implications in improving the quality of life in patients with CVI induced ulcers and in the prognosis and healing of the ulcers. This review summarizes a topical formulation of a volatile anesthetic and its implications for the management of VSUs.