Outcomes of symptomatic gallstone disease in pregnant women: A retrospective study

Gallstone disease with advanced symptoms is one of the common abdominal emergencies during pregnancy and it is considered to be one of the most frequently reported non-obstetric surgical conditions in pregnant women. This study aimed to evaluate the outcomes of surgical cholecystectomy in pregnant women with symptoms of advanced gallstones. This is a retrospective analysis of 2814 pregnant women who attended various wards in government and private hospitals in the governorates of Diyala and Kirkuk in Iraq for more than 2 years, between February 2020 and June 2022. The hospital database was used to confirm the diagnosis of advanced gallstone symptoms in these pregnant women. The incidence of symptomatic gallstones in pregnant women, diagnosis and method of therapeutic management, cholecystectomy according to the pregnancy periods, and perinatal complications of patients according to therapeutic methods were determined. The results confirmed that out of 2814 pregnancies, only 126 (4%) had symptoms of gallstones. It was found that the majority of cases 67 (53%) were within the first trimester of pregnancy and the least 29 (23%) was observed in the second trimester. Acute cholecystitis was the generality 84 (67%) diagnosed in pregnant women with symptomatic gallbladder disease and only 9 (7%) of the patients had undergone prenatal cholecystectomy versus 117 (93%) who were managed conservatively. A total of 20 (16%) cases with undesirable complications were recorded, where 12 cases with low birth weight were noted, where 4 of them underwent surgery and 8 were treated conservatively. It was concluded that a large proportion of women suffer from symptoms of gallstones during pregnancy. Most cases can be managed conservatively, and intervention should be performed as often as needed.Copyright © 2023, Codon Publications. All rights reserved.

How has the COVID-19 disease affected patients with kidney stones?

Purpose: To evaluate the relationship between the presence of kidney stones and COVID-19. Materials and methods: Patients, who were treated for COVID-19 as outpatients as well as inpatients in the ward and/or ICU of two different secondary and tertiary care centers between July 15, 2020, and December 31, 2020, and aged ≥18 years were retrospectively evaluated. The patients were divided into two subgroups based on the presence of kidney stones, and then the patients with kidney stone were categorized into three groups: those who were treated in an outpatient setting (Group 1), those who were treated in the ward (Group 2), and those who were treated in the intensive care unit (Group 3). Results: The total of 1,335 COVID-19 patients included in the study. Kidney stone was present in 31 (6.9%) of 450 outpatients, 41 (8.9%) of 460 inpatients treated in the ward, and 60 (14.1%) of 425 inpatients treated in the intensive care unit. In Group 1, the duration of COVID-19 treatment was significantly longer in patients with kidney stone than patients without kidney stone (8.1±1.7 vs. 6.8±2.2 days, p=0.01). In Group 2 and in Group 3, the mean hospitalization duration was significantly longer in patients with kidney stone than in those without kidney stone (9.1±3.7 vs. 6.2±2.1 days, p=0.007;19.1±8.1 vs. 11.3±6.2 days, p=0.001, respectively). Conclusion: The duration of COVID-19 treatment was longer and the COVID-19 infection was more severe in those with kidney stones. © 2022, Pamukkale University. All rights reserved.

An Immunocompetent Adult With Adenovirus Hepatitis

Introduction: In the US there has been a recent outbreak of adenovirus hepatitis in the pediatric population. However, to our knowledge, there has been only one reported case of adenovirus hepatitis in an immunocompetent adult. We have identified another such case. Case Description/Methods: A 25 year old female with no medical history presented with abdominal pain, nausea, vomiting, diarrhea, and subjective fevers for two weeks and was found to have transaminitis 25-30x the upper limit of normal, which were: AST 791, ALT 542, ALP 92, and total bilirubin of 2.9. The patient reported no prior history of liver disease. She denied alcohol, tobacco, illicit drugs, or herbal medications, but did report taking acetaminophen 1500 mg daily for two weeks. Serum acetaminophen levels were normal and serum and urine toxicology were negative. US with doppler was unremarkable, CT showed cholelithiasis, MRCP showed a normal common bile duct without obstructive calculus. Autoimmune causes of hepatitis, ceruloplasmin and alpha-1 antitrypsin were all unremarkable. HAV, HBV, HCV, HDV, HEV, CMV, HSV, VZV, EBV, HIV, and COVID19 were all negative. Ultimately, the serology for adenovirus was positive. After a week of supportive treatment, the patient's labs trended down and symptoms resolved. Discussion(s): Adenovirus is confirmed by a rise in antibody titer or by virus detection. Coagulative necrosis in histopathology is a finding in liver biopsies if they are pursued in unexplained cases of liver injury. Ultimately, adenovirus hepatitis can be diagnosed once all common causes of hepatitis have been excluded. In the current outbreak, only children have been getting adenovirus hepatitis. In adults, a high prevalence of neutralizing antibodies contributes to immunity, and therefore only in immunocompromised states, do adults get such an infection. Supportive care with IV fluids, electrolyte correction, and antiemetics usually is enough with eventual symptomatic and laboratory improvement as it was for our patient. Studies have shown that extensive disease can be treated with antiviral drugs, cidofovir, and ribavirin. Our patient's history of acetaminophen use is a confounder, however, her normal serum level and her symptoms suggestive of an infectious cause made acetaminophen less of a culprit. We hypothesize that our patient's use of acetaminophen when she was initially exposed to the virus is what made her susceptible to developing adenovirus hepatitis and we hope this case adds insight for clinicians dealing with future adult cases.

Cholelithiasis Causing Asymptomatic Cholecystoenteric Fistula

Introduction: Biliary fistulas are a rare complication of gallstones. Fistula formation can occur in a number of adjacent sites;even more rare complication is the formation of a cholecystocolonic fistula. Case Description/Methods: A 74-year-old man who had recently undergone an extensive hospitalization secondary to inflammatory demyelinating polyneuropathy (IDP) and COVID-19 infection. During his hospitalization, he required ICU admission and mechanical ventilation with subsequent PEG tube placement. He was discharged to an inpatient rehabilitation facility when he developed worsening respiratory distress. Laboratory examinations were pertinent for ALT of 252, AST of 140 and ALP of 401 without hyperbilirubinemia. Blood cultures revealed Escherichia coli bacteremia. Given transaminitis and bacteremia, an MRCP was performed which demonstrated evidence absent space between gallbladder and hepatic flexure of the colon suggesting a CCF (Figure A). An ERCP with sphincterotomy was performed which showed extravasation of contrast from the gallbladder into the colon at the hepatic flexure (Figure B). He underwent cholecystectomy and fistula repair without any complications and gradual improvement in liver function test. He was discharged to a rehabilitation facility. Discussion(s): Complications of gallstones are well established, which include the common bile duct obstruction, but also include the rare occurrences of acute cholangitis, malignancy, and fistula formation. CCF is a rare complication of gallstones which can occur in the stomach, duodenum, or colon with a variable clinical presentation. Complications from an undiagnosed fistula can be life threatening including colon perforation and fecal peritonitis. This case highlights the diagnostic challenge and the high degree of clinical suspicion involved in establishing the diagnosis of CCF in patient without abdominal symptoms suggestive of gallbladder disease. We hypothesize that stone formation resulting in the development of the fistula may be secondary to the underlying history of IDP and subsequent immobility. Although rare, CCF should be considered in patients presenting with unexplained pneumobilia and bacteremia. A timely diagnosis should be made to proceed with immediate treatment including cholecystectomy and fistula closure to prevent fatal complications.

Bats, monkeys and plants in the time of Covid-19 pandemic at Angkor monuments.

Knowledge of biodeterioration and protection of cultural heritage depends on the scientific understanding of the substratum materials, the ambient environment, the fauna and flora including the microorganisms so an overall picture can be constructed to serve as a basis for protection and management. Over the past more than 20 years of survey and research, an accumulated dataset is available on the mechanisms on the (bio)deterioration of stone monuments in Cambodia, involving interactions among water cycling and salt dynamics with the presence of a rich surface microbiome, the biofilms. However, during the Covid-19 period (2020-2022), because of a drastic drop on tourist population, the number of bats and monkeys are on the rising, which have an impact on the on-going protection efforts. At the same time, large trees around and on the cultural heritage sites are being managed by trimming and removal to decrease the potential risk and negative impacts from them. The new management scheme needs scientific results for the long-term successful protection of these cultural heritage. A close examination of these issues is also meaningful and important to the research new initiatives and policy to be implemented not only in Cambodia but also elsewhere.

Seasonal and Covid Pandemic-Related Variations in Patients0 Self-Reported Adherence to Nutrition Recommendations for Stone Prevention Suggest Temporal Increases in Stone Recurrence Risk

INTRODUCTION AND OBJECTIVE: Nutrition therapy for stone prevention is indicated if risks are diet-related. Dietary recommendations (DRs) include higher fluid intake, lower salt intake, lower dietary acid load, and normal calcium (neither excessive nor insufficient). Adherence is challenging to assess and optimally includes multiple measures including patient-reported outcomes. We assessed adherence to individualized targeted DRs issued in our multidisciplinary stone prevention clinic. METHOD(S): From 1/2020-1/2021 we invited patients to complete a questionnaire 1 month after their appointment. They were to estimate the number of days within the last week they followed specific DRs prescribed them and number of days they followed all DRs. Questionnaires were sent by mail with postage-paid return envelopes. This was a quality improvement project;patients were offered to respond anonymously. RESULT(S): Respondents (n=132) represented 29% of patients who were sent questionnaires and were 50% female (61+/-13 y). Of those providing clinical details, 77% were recurrent stone formers;46% were on stone medication(s). There were no adherence differences for men vs. women, recurrent vs. one-time stone formers, nor for those on stone-related medications vs. not. Overall, adherence to eating more F/ V was lower (4.7 vs. 5.5 d/week for all other DRs, p<0.004). We separated responses by receipt: summer/fall (April to mid-November) and winter/spring (mid-November to April), and by pre- vs. post- COVID (before/after March 2020). F/V intake was significantly lower during winter/spring than summer/fall (4.4 vs. 5.5 d/week, p=0.009). Related to the COVID pandemic, patients reported lower adherence to all DRs after the pandemic start (5.0 vs. 5.9 d/week, P=0.009 for difference from before). CONCLUSION(S): Overall, adherence to eating more F/V was significantly lower than for other DRs and was lower yet during winter/ spring. The COVID pandemic did not affect F/V intake specifically but did reduce adherence to all DRs. F/V are important in stone prevention because they provide HCO3 precursors that increase urine citrate and pH. F/V also provide other stone inhibitors, including phytate (which in urine inhibits calcium stone formation) and prebiotics, some of which enhance oxalate-degrading gut bacteria. Moreover, F/V intake can account for up to 30% of urine output and thus may help meet fluid recommendations. Barriers to F/V intake, which may include seasonal variations in cost and availability, should be addressed .

New Onset Diabetes and Acute Pancreatitis- A Sequela of Long COVID?

Introduction: The association between worse COVID-19 outcomes and diabetes has been well-established in the literature. However, with more cases of new-onset diabetes and pancreatitis being reported with or after COVID-19 infection, it poses the question if there is a causal relationship between them. Case Description: 31 y/o female with COVID-19 infection 4-6 weeks ago with moderate symptoms (not requiring hospital admission or monoclonal ab), presented to ED with bandlike epigastric pain radiating to back, which is worsened with food, associated with nausea, vomiting, polyuria, and fatigue. Workup showed lipase 232, AST 180, ALT 256. Blood glucose was 281 and HbA1c was 12. CT A/P showed post cholecystectomy status, normal pancreas with mesenteric adenitis. MRCP showed hepatic steatosis with trace fluid around the pancreas s/o inflammation, and no evidence of choledocholithiasis or biliary dilatation. She denied alcohol use and autoimmune workup for pancreatitis was unremarkable. Islet cell antibodies were negative. The patient improved with fluid resuscitation and was discharged home on insulin with plans to transition to oral agents outpatient. Discussion(s): Long COVID is defined as a range of conditions or symptoms in patients recovering from COVID-19, lasting beyond 4 weeks after infection. A retrospective cohort study showed increased new-onset diabetes incidence in patients after COVID-19. This was redemonstrated in a systematic review and meta-analysis that showed a 14.4% increased proportion of new diagnoses of diabetes in patients hospitalized with COVID-19. Possible pathophysiology that have been attributed to this include undiagnosed pre-existing diabetes, hyperglycemia secondary to acute illness and stress from increased inflammatory markers during the cytokine storm, the effect of viral infections on the pancreas, and concurrent steroid use in patients with severe respiratory disease. The binding of SARS-CoV-2 to ACE2 receptors is thought to the other mechanism by which COVID can cause pancreatitis and hyperglycemia. Study showed increased lipase and amylase levels in patients with COVID and the increase in serum levels was proportional to the severity of the disease. Patients who died due to COVID-19 were also found to have degeneration of the islet cells. While, several studies have showed new onset diabetes and pancreatitis during an active COVID infections, we need larger cohort studies to comment on its true association or causation, especially in patients with long COVID symptoms. As more cases of new onset diabetes and pancreatitis with COVID-19 are being reported, there may be a need for more frequent blood sugar monitoring during the recovery phase of COVID-19.Copyright © 2023

Follow-up 24-Urine Studies during and Post-Covid-19 Pandemic

INTRODUCTION AND OBJECTIVE: In New York State, March 16, 2020 marked the end of any in-restaurant dining due to the COVID- 19 pandemic. The general population was forced to do more cooking at home and less dining out. Dietary modifications like this are considered first line therapy for calcium stone formers due to an effort to reduce dietary sodium intake which is known to affect lithogenic risk factors including hypernatriuria and hypercalciuria. This study aims to see if dietary changes made during the pandemic changed the risk of stone disease as evidenced in 24-hour urine studies and if these changes ceased after the end of widespread shutdowns. METHOD(S): All patients with nephrolithiasis seen for an outpatient visit from April 1, 2020-December 31, 2020 were queried and included if they had a 24-hour urine study pre-COVID (before March 16, 2020) and during-COVID (March 16, 2020-December 31, 2020);a post- COVID study was included if available (January 1, 2021- October 31, 2022). Values were compared using paired, 2-tailed t-tests. RESULT(S): 93 patients (54 males, 39 females, mean age 60.1) were studied pre-COVID, during-COVID, and post-COVID time periods with 24-hour urine studies. Stone analysis revealed calcium oxalate (61%), calcium phosphate (15%), uric acid (15%), other (9%). The 24-hour urine revealed a significant reduction in urinary sodium (uNa) and urinary calcium (uCa) in these patients. uNa levels decreased from 166.15+/-7.5 mEq/L pre-COVID to 149.09+/-7.6 mEq/L during- COVID (p=0.015) and maintained improved at 138.55+/-6.83 mEq/L post-COVID era (p=0.0035). uCa levels decreased from 214.18+/-13.05 mEq/L pre-COVID to 191.48+/-13.03 mEq/L during- COVID levels (p=0.010) and remained improved at 185.33+/-12.61 mEq/L post-COVID (p=0.012). There were no significant differences in 24-hour urine total volume, magnesium, or citrate levels. CONCLUSION(S): During the COVID-19 lockdown, dietary choices limited to home cooked meals allowed patients to better identify their food choices. This study demonstrates that known urinary risk factors for lithogenesis, such as urinary sodium and calcium, improved during the lockdown and these improvements were maintained even after restrictions in restaurants were lifted. Moving forward, it will be imperative to monitor patient's 24-hour urine to ensure these dietary modifications are continued in the postpandemic era and to see if these improved urinary parameters will impact stone formation in these patients.

COVID-19 lockdown splits activity peaks of two mesopredators and potentially relaxes interspecific competition in rural habitat

COVID-19 lockdown has provided a unique example of a sudden and significant reduction of human presence in a rural area, especially in villages with high tourist pressure. We used camera-trapping to investigate the effect of reduction of human activity due to COVID-19 lockdown in a rural area on activity patterns of species considered urban exploiters and urban adapters. The activity patterns of both predators changed slightly and activity peaks shifted without significant differences in temporal niche overlap. The stone marten, an urban exploiter, had a bimodal activity pattern and shifted the main peak of its activity earlier during COVID-19 lockdown. It was quick to respond to the decrease in human presence in the first half of the night by increasing activity in that time. Meanwhile, the red fox, an urban adapter, showed larger variation in activity patterns and shifted summer and autumn-winter activity peaks to later at night or even early morning. These changes resulted in slight differences in the overlap of activity rhythms of both species. Stone marten and red fox have adapted their activity to avoid human encounter and are active mainly at night, responding by a small extent to reduction of human presence during COVID-19 lockdown, which occurs mainly during the day. However, COVID-19 lockdown and lower human mobility may partially reduce interspecific competition induced by anthropogenic activities in rural areas.

A Collabortive Model for Lithic Shape Digitization in Museum Settings

The COVID-19 pandemic halted scientific research across the world, revealing the vulnerabilities of field-based disciplines to disruption. To ensure resilience in the face of future emergencies, archaeology needs to be more sustainable with international collaboration at the forefront. This article presents a collaborative data collection model for documenting lithics using digital photography and physical measurements taken in-situ by local collaborators. Data capture protocols to optimise standardisation are outlined, and guidelines are provided for data curation, storage and sharing. Adopting collaborative research strategies can have long-term advantages beyond the COVID-19 pandemic, by encouraging knowledge-sharing between international collaborators, decreasing emissions associated with archaeological research, and improving accessibility for those who are not able to travel for access to international samples. This article proposes that archaeology should use the COVID-19 pandemic as a catalyst for change through encouraging deeper collaborations and the development of remote models of science as a complement to in-person research.

Kidney stone detection using an optimized Deep Believe network by fractional coronavirus herd immunity optimizer

In this study, a computer-assisted kidney stone diagnosis system based on CT images has been proposed. The method is based on a combination of deep training and metaheuristics. The method aims to provide a customized Deep Believe Network (DBN) based on a fractional version of the coronavirus herd immunity enhancer to provide an efficient and reliable kidney stone diagnosis system. The designed method is then authenticated by running a standard benchmark called a "CT kidney dataset". Subsequently, a comparison is made between the results and some other state-of-the-art methods. Simulations show that the recommended DBN/FO-CHIO outperforms the other studied approaches in terms of efficiency with an accuracy of 97.98%. Moreover, the proposed DBN/FO-CHIO recall outperforms others with 92.99%, demonstrating its excellent accuracy compared to other comparison algorithms. Moreover, the higher specificity of the proposed method compared to the other evaluated approaches indicates its advanced event-independent value.Copyright © 2023 Elsevier Ltd

2d Qsar Approach to Develop Newer Generation Small Molecules Active against Sars-Covid

We are in the half past of 2022, but still, we are facing the coronavirus pandemic situation. When a patient is hospitalized, only some FDA-approved drugs were administered to cure the patient. In treating coronavirus infection, nitazoxanide, granulocyte-macrophage colony-stimulating factor inhibitors, and various monoclonal antibodies are present. But all the molecules used in the treatment were not so effective in fully curing the patient. So, to break this jinx to develop of newer generation anti-SARS-CoV-2 drug molecules, computational approaches played an essential role. 2D QSAR studies related to anti-SARS-CoV-2 molecule development, some QSAR models observed with good statistical parameters such as R2: 0.748, cross-validated Q2 (LOO): 0.628, external predicted R2: 0.723 and another model suggested with R2: 0.764, Q2: 0.627 and Rm2: 0.610, Q2 (F1): 0.727, Q2 (F1): 0.652, MAE score: 0.127. We developed a new 2D QSAR model with a higher number of molecules and greater statistical parameters. A dataset of 84 anti-SARS-CoV2 molecules was obtained from literature followed by descriptor calculation PADEL software;the QSAR model was generated using the Modelability index, dataset pretreatment, division, MLR equation, validation, and Y randomization test. The model was pIC50 = -1.79268(+/-0.3652) +0.07995(+/-0.03551) naaaC -0.4051(+/-0.09672) nsssN -0.45945(+/-0.11025) SHsOH +1.23189(+/-0.28144) ETA_BetaP with R2 and Q2 values were 0.87028 and 0.70493 with MAE fitness score value: 0.14298. Atoms E-state and electronic features of the molecules directly related to anti-SARS-CoV-2 drug activity. It can be easily concluded that we want to develop a small molecule effective against SARS-CoV-2 disease in the near future.Copyright All © 2023 are reserved by International Journal of Pharmaceutical Sciences and Research.

A case of pulmonary infection with Prevotella melanogenica having the paving stone symptom.

Prevotella melanogenica is a typical organism present in the human oral cavity and female reproductive tract, which is responsible for causing periodontal disease and the inflammation of the female reproductive tract. The present report discusses the case of a young female patient who presented with cough and fever as the main clinical symptoms. Computed Tomography (CT) revealed multiple clusters of ground glass density shadows in both lungs, with network-like and paving stone-like changes. The alveolar lavage fluid was collected for next-generation sequencing, which revealed the presence of Prevotella melanogenica. The patient received treatments, CT revealed that the density of multiple flakes of ground glass density in both lungs was lower than the previously observed density. Prevotella melanogenica pneumonia is rare, and the paving stone symptom observed in CT is not specific. Therefore, the case reported here provides a novel perspective regarding the diagnosis of pneumonia.

An analysis of stone management over the decade before the COVID-19 pandemic in Germany, France and England.

OBJECTIVES: To understand the implications that the rising upper urinary tract (UUT) stone prevalence in Europe and the increasing burden places on patients and healthcare providers (HCPs), we investigated the evolution of diagnoses and procedures in Germany, France and England over the decade before the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We identified International Classification of Diseases (ICD)-10 codes related to UUT stones diagnosis and extracted procedure volumes for extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy and open surgery using national procedure codes from the German Institute for the Hospital Remuneration System, the French Technical Agency of Hospitalisation Information and NHS England Hospital Episode Statistics. We analysed procedures vs hospital diagnoses from 2010 to 2019 and reported results per 100 000 inhabitants. RESULTS: Between 2010 and 2019, ICD-10 N20 codes for calculus of kidney and ureter increased by 8%, 26% and 15% in Germany, France, and England respectively; whereas procedures increased by 3%, 38% and 18%. Of the patients diagnosed with stones, the percentage that received treatment (of any type) differed between countries. In 2019, in Germany 83% of patients diagnosed with stones received treatment, in France 88%, and in England 56%. These figures were relatively stable over the 10-year study period. Over the past decade, the dominant procedure shifted from ESWL to URS, and the average length of stay for URS decreased. Day case procedures increased in France and England (by 68% and 23%), no data were available in Germany. CONCLUSION: This analysis highlights an increase in stone diagnoses and procedures, and a shift of surgical management. This development may be due to clinical advantages and advanced technology. The continued stone prevalence rise affects patients, hospitals, and HCPs.

Study of Mechanical and Sanitary Properties of Artificial Cast Stone Products.

This paper aimed to analyse the mechanical and sanitary properties of artificial cast stone. To create an artificial stone product of the desired shape and design, a thermoforming process is used, during which heavy presses shape the artificial stone parts at a certain temperature. According to experimental studies, the most suitable temperature for monochromatic and patterned cast stone thermoforming is 160 °C when the material has the least bending resistance and does not react strongly to heat. It is observed that the cast stone bends more easily as the distance increases. The bending test of the glued samples made it possible to find out which of the three gluing methods is the most resistant to the forces acting on the samples during bending. The sanitary properties of the artificial stone were compared with the properties of other commonly used surfaces. In the microbiological study, suspensions of three different bacteria were spread on stainless steel, laminated particleboard and artificial cast stone, and washes were taken from 100 cm2 after 25 min. The results showed that the artificial stone after washing had the lowest number of colonies forming units per cm2, which supports the claim of excellent sanitary properties of the product.

Prospective comparison of extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in patients with non-lower pole kidney stones under the COVID-19 pandemic.

Both shock wave lithotripsy (SWL) and flexible ureterorenoscopy (F-URS) are recommended as the first choice for non-lower pole kidney stones. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of SWL versus F-URS in patients with solitary non-lower pole kidney stones ≤ 20 mm under the COVID-19 pandemic. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or F-URS) for non-lower pole kidney stones were enrolled in this study. The stone-free rate (SFR), retreatment rate, complications, and cost were recorded. Propensity score-matched (PSM) analysis was performed. A total of 699 patients were finally included, of which 81.3% (568) were treated with SWL and 18.7% (131) underwent F-URS. After PSM, SWL showed equivalent SFR (87.9% vs. 91.1%, P = 0.323), retreatment rate (8.6% vs. 4.8%, P = 0.169), and adjunctive procedure (2.6% vs. 4.9%, P = 0.385) compared with F-URS. Complications were scarce and also comparable between SWL and F-URS (6.0% vs 7.7%, P > 0.05), while the incidence of ureteral perforation was higher in the F-URS group compared with the SWL group (1.5% vs 0%, P = 0.008). The hospital stay was significantly shorter (1 day vs 2 days, P < 0.001), and the cost was considerably less (1200 vs 30,083, P < 0.001) in the SWL group compared with the F-URS group. This prospective cohort demonstrated that SWL had equivalent efficacy with more safety and cost benefits than F-URS in treating patients with solitary non-lower pole kidney stones ≤ 20 mm. During the COVID-19 pandemic, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS. These findings may guide clinical practice.

COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis.

PURPOSE: If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment. MATERIALS AND METHODS: Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48). RESULTS: There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05). CONCLUSION: Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

Covid-19—Effects and Mitigation Measures in Stone Industry

In Portugal there are more than 2500 companies and 15,000 people who work directly in the stone industry. In addition to all the known risks in this type of industry, the critical in terms of safety and health that companies and people linked to the stone sector have faced in recent years has been COVID-19, given that, in addition to all the damage that this disease on people's health has (and still does) lead to a reduction in business productivity, an increase in labour costs and a delay in product delivery times. The research in this study intends to investigate safety and health measures to be implemented by the stone industry and their usefulness to mitigate the effects of COVID-19 in the stone industry and analyse how COVID-19 pandemic affected the stone industry. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Impact of COVID-19 on the management and outcomes of ureteric stones in the UK: a multicentre retrospective study.

OBJECTIVES: To determine if management of ureteric stones in the UK changed during the coronavirus disease 2019 (COVID-19) pandemic and whether this affected patient outcomes. PATIENTS AND METHODS: We conducted a multicentre retrospective study of adults with computed tomography-confirmed ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/2019-22/6/2019) and a period during the pandemic (the 3-month period after the first severe acute respiratory syndrome coronavirus-2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection. RESULTS: A total of 3735 patients were included (pre-pandemic 1956 patients; pandemic 1779 patients). Stone size was similar between groups (P > 0.05). During the pandemic, patients had lower hospital admission rates (pre-pandemic 54.0% vs pandemic 46.5%, P < 0.001), shorter mean length of stay (4.1 vs 3.3 days, P = 0.02), and higher rates of use of medical expulsive therapy (17.4% vs 25.4%, P < 0.001). In patients who received interventional management (pre-pandemic 787 vs pandemic 685), rates of extracorporeal shockwave lithotripsy (22.7% vs 34.1%, P < 0.001) and nephrostomy were higher (7.1% vs 10.5%, P = 0.03); and rates of ureteroscopy (57.2% vs 47.5%, P < 0.001), stent insertion (68.4% vs 54.6%, P < 0.001), and general anaesthetic (92.2% vs 76.2%, P < 0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre-pandemic 73.8% vs pandemic 76.1%, P = 0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30-day mortality, and re-admission and renal function at 6 months did not differ between the data collection periods. CONCLUSIONS: During the COVID-19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community.

Did the COVID-19 Pandemic Restrict Access to Emergency Urological Services: Assessment of Reorganisation Effectiveness for Hospital Treatment.

Urolithiasis derived renal colic is a common urological condition. If treated properly, the disease resolves without complications; if not treated, it causes infection and renal failure. The COVID-19 restrictions impacted hospitalised treatment of diseases. We analysed the impact of COVID-19 on renal colic treatment at a hospital in Poland. Clinical and demographic data of patients treated during the COVID-19 era were compared with those treated before this pandemic. During the COVID-19 restrictions, renal colic patient hospital admissions fell significantly. However, more patients presented with chronic renal colic symptoms and urinary tract infections. Nevertheless, the degree of hydronephrosis and the number and location of stones did not differ between the two groups. No marked changes were observed in the chosen treatment options. The observed decrease in emergency admissions of patients with acute renal colic with a simultaneous increase in the rate of infectious stones might indicate that some patients requiring urgent medical help did not report to the emergency department or came later than they would before the pandemic, reporting more serious symptoms. One plausible explanation for this may be that the reorganisation of the healthcare system restricted access to urological care. Moreover, some patients may have delayed their visit to the hospital due to the fear of contracting the SARS-CoV-2 coronavirus.