ABSTRACT
Introduction & Objectives: Acute renal colic due to ureteral stones is a common emergency, which can be treated with conservative management, drainage of the kidney and delayed treatment, or emergency intervention. With the outbreak of COVID-19 infection and postponement of elective surgeries, emergency ureteroscopy became a valuable treatment option for acute renal colic in a single-stage setting. The objective of this study is to evaluate the efficacy and safety of emergency ureteroscopy as first-line treatment for patients with acute renal colic due to ureteral stones during the COVID-19 pandemic. Materials & Methods: A prospectively collected database of 120 patients with acute renal colic due to ureteral stone who underwent emergency ureteroscopy within 24 hours from hospitalization between March 2020 and December 2021, was reviewed. Data on patients’ preoperative characteristics, stone-free rates and complication rates was analyzed. Results: Patients’ mean age was 51.4±15.2 years. Male-to-female ratio was 73.3%/26.7%. Mean preoperative serum creatinine values were 120.1±64.1 umol/l. 33 patients (2.5%) had a solitary functioning kidney. Stone location was proximal ureter in 3 patients (27.5%), mid-ureter – in 12 (10%), distal ureter – in 73 (60.8%), distal and proximal ureter – in 2 cases (1.6%). Mean stone size was 8.1±3.3 mm. Stone-free rate after a single procedure was 95% and mean operative time – 25.1±11.5 min. Postoperative drainage was stent JJ in 34 (28.3%) and ureteral catheter for 12h – in 22 (18.3%) patients. 21 patients (17.5%) had a narrow ureter, necessitating the use of smaller caliber ureteroscope (6 Fr). In 2 patients (1.7%) the ureter could not be accessed and a stent JJ was inserted. Intraoperative complications were present in 5 cases – 1 ureteral perforation (0.8%) and 4 cases of upward stone migration (3.3%). Postoperative complications were fever in 2 patients (1.7%) and postoperative renal colic pain - in 7 (5.8%). Conclusions: The results of this prospective study suggest that emergency ureteroscopy is a safe and effective first-line treatment for acute renal colic due to ureteral stones. It offers a one-stage management, without the potential complications of obstruction and loss of renal function due to delayed treatment during the COVID-19 pandemic.
ABSTRACT
Type 2 diabetes (T2DM) is a common comorbidity in COVID-19 patients, which could favor disease progression. Our study aimed to evaluate the impact of some glycemic biomarkers on characteristic features of COVID-19. Electronic medical records of patients consecutively admitted to a COVID-19 ward were analyzed. Demographic and anthropometric as well as clinical and laboratory parameters were obtained. T2DM was present in 47% of the patients, with 22.58% of diabetic patients being newly diagnosed at admission. The most important predictors of severe COVID-19 were age (OR 1.214 [1.078-1.366], p = 0.001), creatinine levels (OR 1.018 [1.003-1.034], p = 0.017), glucose above 7.0 mmol/L at admission (OR 7.800 [2.232-27.255], p = 0.001) and HbA1c ≥ 6.5% (OR 4.840 [1.428-16.405], p = 0.011) irrespective of the presence of DM. C-peptide levels correlated positively with age, creatinine level, the severity of hypoxia and ferritin levels of patients (p < 0.05 for all) and appeared to be a significant predictor of leukocytosis. Suboptimal glycemic indices and impaired kidney function might predict COVID-19 disease worsening. Early detection of DM and optimization of glycemic control in diabetic patients should be among the priorities of the public health systems during COVID-19 pandemics. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
In spring 2020 the whole world went through the "black swan"-COVID-19 pandemic. The healthcare systems of all countries and the world economy, in general, became very stressed. The extraordinary decline of activity in all spheres, except healthcare, led to a drop in the demand for transport services, including city public transport. It was important for city management to support the sustainability of the local transport system. The article presents fundamental approaches to assessing the sustainability of a transport service, particularly city passenger public transport (CPPT), for the example of the large Russian city Tyumen (size of population-nearly 807 thousand people). Methods of analysis of the sustainability of the transport process in conditions of negative environmental impact (COVID-19 pandemic) are considered. During the period from 30.03.2020 to 31.05.2020 (nine weeks-the acute phase of COVID-19 pandemic) structural sustainability of the CPPT system in Tyumen kept a high level. By changing the parameters of the planned characteristics of the CPPT system state, an attempt to adapt the transport service supply to a sharp decrease in transport demand was made. In the period of "self-isolation", the demand for the CPPT transport service reduced more than the transport service supply. Sustainability of CPPT functioning was evaluated by calculating the elasticity of the transport supply (number of trips) in relation to the actual demand (actual volume of transportations). Calculation of the elasticity index of the CPPT system of Tyumen during nine weeks of April-May 2020 (duration of "self-isolation") is provided. A conclusion was made from the results of the research. In particular, it was found that the foreground target function of city management was the maintenance of a high level of transportation processes to the detriment of the transportations' effectiveness. Such a policy led to contradictory results-the additional financial expenses at the rate of 135-150 million rubles and quite a high level of contentment of the Tyumen population with the quality of the CPPT work (sociological research established that 80-85% of respondents were satisfied with the quality of the transport service in April-May 2020).