Retrospective Analysis of the Impact of Prophylactic Interventions, in Reducing the Rate of Pd Peritonitis Pre and Post Covid Pandemic

Introduction: - Recurrent exit site infection and peritonitis are major causes of PD catheter removal and PD failure - 1/3 lead to hospitalizations - 5-10% lead to mortality - Reported rate in Australia is 0.6 episode/patient-year - Our first hypothesis is that implementing these prophylactic measures should lead to lower rates of PD peritonitis, PD catheter failure and mortality from 2017 onwards - Our second hypothesis is reduction in the impact of these prophylactic interventions during the covid pandemic Methods: - The aim of this study is to assess the impact of prophylactic interventions that were implemented in 2017 at Gosford hospital, particularly looking at the rates of PD peritonitis, PD catheter failure, transition to HD and mortality - The second aim of this project is to assess the effect of covid pandemic on these interventions Inclusion criteria - Adult (ages 18+) - Patients on peritoneal dialysis in the central coast renal unit - Duration from 2013-2022 - Intervention: Prophylactic antibiotic therapy during PD catheter insertion, prophylactic anti-fungal therapy while on antibiotic therapy, nursing, and patient education - Exposure(s) - Prophylactic antibiotic and antifungal therapies, nursing, and patient education - Confounders - Covid pandemic - Primary outcome - Reduction in PD peritonitis - Secondary outcome(s) - PD catheter failure, transition to haemodialysis, mortality Results: - Our data demonstrates reduction in the rate of PD peritonitis and PD catheter failure following the implementation of prophylactic interventions. - There is no significant difference in the rate of PD peritonitis between the pre and post covid pandemic periods, as the prophylactic measures were still being implemented adequately as per hospital policy. Conclusion(s): - Administration of prophylactic antibiotic and antifungal therapies in PD patients is thought to reduce the rate of PD peritonitis, PD catheter failure and mortality based on our current guidelines. - Our research project has been designed to assess the clinical effectiveness of these prophylactic interventions, in addition to the impact of covid pandemic on these outcomes. No conflict of interestCopyright © 2023

Comparison of High-Risk Pulmonary Embolism Patients with and without COVID-19

Objectives: There has been a significant increase in pulmonary embolism (PE) cases during the coronavirus disease of 2019 (COVID-19) pandemic. In this study, we aimed to compare the effects of COVID-19 positivity on morbidity and mortality in patients treated with a diagnosis of high-risk PE. Method(s): In this single-center and observational study, patients who were referred to our center with the diagnosis of PE between January 1, 2019 and 2021 were retrospectively evaluated. Patients with moderate- and low-risk PE according to the European Society of Cardiology PE guidelines, those who did not undergo computed tomography pulmonary angiography (CTPA) or the ones who did not accept treatment were excluded from the study. The patients included in the study were divided into two groups, as those with and without COVID-19, and compared in terms of demographic data, comorbidities, symptoms, thromboembolism in vessels other than the pulmonary artery, laboratory parameters, treatments, and prognosis. Result(s): A total of 384 PE cases were identified during the study period. Among them, 322 cases that were in the intermediate or low-risk category, 21 cases who did not undergo CTPA, and one case who did not accept thrombolytic therapy were excluded from the study. A total of 40 cases were included in the study. The groups with and without COVID-19 consisted of 23 and 17 patients, respectively. In the group of patients with COVID-19, inflammatory markers were higher, Wells score was lower, and thromboembolism was seen in vessels other than the pulmonary artery. The two groups were similar in terms of other laboratory parameters, demographic data, comorbidities, symptoms, treatment, and prognosis. Conclusion(s): While the involvement of COVID-19 in PE etiology does not change mortality, it may cause more thrombosis development in both venous and arterial systems outside the pulmonary area by significantly increasing inflammation. However, the lower Wells scores in COVID-19 PE cases in our study indicate that new clinical assessment tools are needed to detect PE risk in COVID-19 patients.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

Analysis of Survival in Patients with End-End Chronic Kidney Disease Switching from Peritoneal Dialysis to Hemodialysis Due to Refractory Peritonitis

Introduction: Peritonitis associated with peritoneal dialysis (PD) has complications such as transfer from PD to HD and increased morbidity and mortality. In our environment, there is little information regarding survival in this population. Method(s): Retrospective cohort, 147 PD patients, 18 years, with PD catheter removal between 2018-2021. Clinical, biochemical and technique-related variables were measured. Patients who died of cancer and other unrelated causes were excluded. Descriptive statistics, Kaplan-Mayer analysis and Cox regression analysis were used Results: Age 42 +- 17 years, 65% men, 65% unknown cause of CKD. The time between peritonitis diagnosis and catheter removal was 37 (25-61) days. Nine patients (6%) returned to PD, the rest (94%) remained on HD due to unfit abdomen (55%), patient decision (9%), unknown (17%), others (19%). Mortality was 31% and the causes of death were: sepsis (33%), COVID-19 (29%), pneumonia (19%), pulmonary edema (5%), hyperkalemia (5%), CVD (5%), others (4%). Survival after the refractory peritonitis event was 25 (95% CI 22-28) months. Survival at 3, 12, 24, and 36 months was 87%, 71%, 61%, and 35%. In the bivariate analysis, age, DM, time on dialysis, and serum albumin were associated with a higher risk of death. However, in the multivariate analysis, only time on dialysis was significant (OR 1.014, 95% CI 1.002-1.027). [Formula presented] Conclusion(s): Mortality was 31% and the most frequent cause of death was sepsis. Patient survival was 25 (95% CI 22-28) months. Time on dialysis was associated with a higher probability of death. It is necessary to compare these results with a group of patients who do not present failure of the technique. No conflict of interestCopyright © 2023

Is the rezum treatment effective in patients with BPH complicated by urinary chronic retention? Our preliminary experience

Author of the study: Rezum is one of the most promising minimally invasive technologies for the treatment of BPH. During Covid pandemic era we used this technique extending the indication even in patients carryng urinary catheter or in patients with prostatic adenoma volume higher than 80 ml. In this short communication we report the preliminary results of our experience. Material(s) and Method(s): From January 2019 to September 2021 92 patients underwent a Rezum treatment. Of these patients 51 (55%) carrying catheter for urinary retention secondary to BPH. Inclusion criteria was: age >18 yo, catheterization time >3 months, prostate adenoma volume >30 cc. A 6 months follow up was offered to each patient including uroflometry and PSA. Result(s): Mean age was 75 yo (62-84), mean iPSA 3,7 ng/ml (1,9-5,8), mean adenoma volume 92 cc(65-270). Mean catheterization time before treatment 7,8 months (3-14). Mean operative time (12,5 min (11-14). All patients were discharged 4 hours after the treatment. Catheter removal was performed after 4/6 weeks. 48 (94%) patients obtained a spontaneous micturition. Mean Qmax at 6 months 12,5 cc/ sec, mean Post-void residual 120 cc. In 3 patients we observed post operative IVU treated with antibiotics. 21 (44%) patients continue alpha-litic therapy after Rezum treatment. In 2 patients it was necessary performing a disobstructive surgery. Conclusion(s): Rezum may represent a possible minimally invasive therapeutic strategy for BPH complicated by urinary chronic retention whenever other procedures aren't feasible. Despite the technical card indications, we successfully treated even prostate adenoma volumes higher than 80 ml. In some cases oral therapy was still necessary after the procedure. Our preliminary results are encouraging to continue to performing this procedure in these patients but further studies with longer follow up are needed Copyright © 2022 European Association of Urology. Published by Elsevier B.V.

Catheter-related venous thrombosis: Experience with blue advance peripherally inserted central catheter (PICC) in a day hospital during the pandemic

Background: The PICC in our Day Hospital (DH) has become the central line of choice for the therapeutic management of oncological and hematological patients when the duration does not exceed 6 months. The impact of COVID-19 in these patients led to an increase in risk factors for the occurrence of venous thrombosis (VT) and catheter-related venous thrombosis (CRVT), forcing admission-like immobility, intensification of supportive treatment with granulocyte colony growth factors (G-CSF) and a higher number of PICC insertions in metastatic patients. Given these circumstances, it was decided to use the Blue Advance PICC with antithrombogenic coverage. The objective was record the incidence of symptomatic CRVT related to Blue Advance PICC in oncological and hematological patients in active treatment, as well as the incidence of other complications and causes of withdrawal. Methods: A retrospective observational study was performed, in a consecutive series of patients from November 2019 to June 2021. All catheters were inserted in DH for oncospecific treatment, using PICC Blue Advance Teleflex Medical®, 4'5Fr, 1 lumen, by ultrasound-guided puncture and tip confirmation by fluoroscopy. Variables recorded: demographic data, diagnosis and stage, treatment administered, date of insertion and removal, vein diameter, cause of removal and complications. Results: A total of 295 blue PICC were analyzed, with a total length of stay of 46,150 days and a mean of 156 days per catheter. Ninety-eight percent of the PICCs were placed at the first attempt, and the predominant access was the basilic and brachial veins, with diameter between 2.9-5.6mm. There were 9 cases of symptomatic CRVT (3%, 0.19/1000 catheter days), confirmed by Echo-Doppler, which did not require catheter removal and treatment was completed. Six CRVT were diagnosed between the first and third week of insertion in female patients, with cytostatic Adriamycin and G-CSF. The main cause of withdrawal was end of treatment in 94.9%. Conclusions: The use of the antithrombogenic Blue Advance PICC during the pandemic period, despite the increase in risk factors, kept the incidence rate of symptomatic CRVT unchanged in our historical pre-COVID cohort. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Trend on erectile rehabilitation after radical prostatectomy: Results of an international survey among urologists

Introduction & Objectives: In the last two decades, several therapeutic schemes have been proposed for erectile rehabilitation (ER) after radical prostatectomy (RP), but none has been standardized or validated due to the lack of high-level evidence in the Literature. We performed an international Survey focused on the current worldwide approach to ER, highlighting the contact and divergent aspects. Materials & Methods: We purposed an online Survey between July and December 2020 using email lists and Twitter, aiming to evaluate the ER protocols after RP performed by urologists and andrologists in daily practice. The following sections were investigated: 1) Demographics;2) Number and type of RP performed;3) Type and schedule, timing and duration of ER erectile programs;4) Standard treatment protocol. The specialists were contacted with the support of Confederación Americana de Urología (CAU), Urological SOcial MEdia (UroSoMe) Working Group, Functional Urology- Techno Urology- Research (FUTURe) Group and by a dedicated uro-andrologists spaces on Twitter platform of iTRUE Group. Results: The Survey was completed by 518 responders from 52 worldwide countries. The main criteria to candidate patients for ER were nerve sparing surgery (72.8%), lack of significant comorbidities (66.4%), patient’s request (55.4%), valid pre-operative EF (55%), age (48.1%), and partner’s willing (19.1%). Surgical techniques reported were: 38.9% open RP, 22.9% video laparoscopic RP, 38.2% robot- assisted RP. There were no significant differences (p>0.05) among the main surgical techniques and the time of EF recovery beginning, protocol and duration. The use of specific ER protocols was reported by 61.4%. The beginning of ER was reported by 33% of responders at catheter removal, after one month from surgery by 22%, and before RP by 15%. PDE5i were more frequently used as first line treatment (99.4%). Tadalafil 20 mg was the most prescribed in monotherapy, prescribed daily (48.2%) or 2-3 times/week (46%). PGE1 intra-cavernosal injection (67.9%) was the second more common prescription in monotherapy, followed by the association of PDE5i and vacuum device (29.6%). A minority of specialists 44/518 (8.5%) recommended low intensity shock wave therapy, while 63/518 (12.2%) proposed this in association to other therapies. The duration of ER was: in 16.2% <6 months, in 39% between 6 and 11 months;in 31.9% between 12 and 18 months;in 9.2% between 19-24 months, and in 3.7% >24 months. In case of first-line failure, the majority of the responders shifted to another treatment after at least 3 months (71%). During COVID-19 outbreak, the 37.4% of responders did not perform EF recovery consultations, while 26.8% had normal consultations, and 35.7% used telemedicine. Conclusions: This Survey showed an inhomogeneous approach to ER, reflecting the lack of high-level evidence on this topic. A worldwide accepted guideline on ER is therefore needed.