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 The search strategy aimed to find both published and unpublished studies up to the January 2024.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.

Management of urolithiasis in pregnancy: A systematic review and meta-analysis.

PURPOSE: Management of nephrolithiasis is unique in pregnancy and requires multidisciplinary care. To identify the effectiveness or safety of temporary drainage or definitive treatment methods to manage urolithiasis in pregnancy. METHODS: The search strategy aimed to find both published and unpublished studies was conducted in August 2021. Studies published in any language on any date were considered for inclusion. RESULTS: Of a total of 3349 publications, 36 studies were included in our qualitative evaluation and 32 studies in the quantitative synthesis. The commonly reported method was stent insertion (n = 29 studies), pneumatic (n = 12), laser (n = 9) lithotripsy, and stone removal using any devices (basket, grasper, or forceps) (n = 11). In seven studies, the authors reported the outcomes of conservative management, and the results showed that the stone-free rate is 54%, and symptom relief occurred in 62% of women. Seven eligible studies reported that 79.9% of urolithiasis were expulsed through stent insertion, while this rate was 94.6% among percutaneous nephrostomy use in two included studies, 88.5% for pneumatic lithotripsy (n = 7 studies), and 76.4% for laser lithotripsy (n = 4 studies), or 95.4% for stone removal method. In addition, adverse events were reported in less than 10% of pregnant women. CONCLUSIONS: The results showed that stent, pneumatic or laser lithotripsy, and ureteroscopic stone removal were the commonest used methods in the included studies. They can be effective and safe treatment approaches without major maternal or neonatal complications, and could be introduced as an effective and safe therapeutic method for urolithiasis during pregnancy. However, most of the included studies had moderate quality according to critical appraisal checklists. Further prospective studies are needed to reach a conclusion.

Protecting healthcare workers against coronavirus disease 2019 in emergency departments at a teaching hospital in Tabriz, Iran: a best practice implementation project.

INTRODUCTION: The first case of the novel coronavirus disease (COVID-19) in Iran was officially announced on February 19, 2020, in Qom city. The prevalence of COVID-19 is higher among frontline healthcare workers (HCWs) due to their occupational exposure. OBJECTIVE: The aim of this evidence implementation project was to improve the protection of nurses against COVID-19 in the emergency department of a teaching hospital in Tabriz, Iran. METHODS: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Ten audit criteria, representing the best practice recommendations for the protection of HCWs in the emergency department were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. RESULTS: The baseline audit results showed that the compliances for four (out of ten) audit criteria (criteria 4, 7, 8 and 9), were under 75%, which indicated poor and moderate compliance with the current evidence. After implementing plans such as running educational programs and meetings, major improvement was observed in 3 criteria, criterion 4 was improved from low to excellent (41-81%), criterion 7 was promoted from low to moderate (30-62%), criterion 8 was not promoted considerably (22-27%) and criterion 9 was improved from moderate to excellent (70-84%). CONCLUSION: The results of the audit process increased COVID-19 protection measures for nurses in the emergency department. It can be concluded that educational programs and tools, such as face-to-face training, educational pamphlets, workshops and meetings can facilitate the implementation of evidence into practice.

Potential Impact of 3% Hypertonic Saline Infusion on Tramadol Poisoning-Induced Electrocardiogram Changes; a Randomized Clinical Trial.

Introduction: Tramadol is a synthetic analgesic with weak mu-opioid receptor agonist activity. Tramadol overdose is associated with adverse cardiac effects due to inhibiting cardiac Na+ and K+ channels. This study aimed to investigate the potential ameliorative role of 3% hypertonic saline on the electrocardiogram (ECG) changes in patients presenting with tramadol poisoning. Methods: This was a single-center, controlled, randomized, single-blind clinical trial. Patients were randomized into the case (received hypertonic saline) and control (received placebo) groups. ECG was obtained twice in each group (upon arrival and following the intervention). Response to therapeutic interventions was evaluated using Wilcoxon Signed Ranks Test. Results: A total of 76 patients were included. The mean age of patients was 24.88 ± 4.29 years, and 62 (81.6%) were male. The mean ingested dose of tramadol was 1673.68 ± 608.85 (range: 550-2750) mg. The number needed to treat and the absolute risk reduction of 3% hypertonic saline in the treatment of wide QRS were 1 (95% CI: 1.00 - 1.00) and 100%, respectively. In the treatment of long QTc, these measures were 1.9 (95%CI: 1.2 - 4.5) and 53.85% (95%CI: 22.00 - 85.69), respectively. Conclusion: Given that hypertonic saline infusion can significantly ameliorate tramadol-mediated ECG changes, including QRS prolongation and QT lengthening, it can be regarded as a potential therapeutic strategy to prevent the development of life-threatening ventricular arrhythmias caused by tramadol toxicity.

Outcomes of the anterior approach versus posterior sacrospinous ligament fixation for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: This study aimed to compare anterior sacrospinous ligament fixation (SSLF) with the standard posterior SSLF concerning complications and outcomes in patients with apical compartment pelvic organ prolapse (POP). METHODS: This is an observational descriptive study using prospective data collected from two referral urogynecological centers. The study cohort represents all 135 women in our prospective study who underwent anterior approach bilateral anterior or unilateral posterior meshless SSLF from January 2018 to December 2020 using the PFDI-20 questionnaire and the POP quantification (POP-Q) system pre- and postoperatively. The objective success rate was assessed by the number of POP recurrence cases and total vaginal length (TVL) postoperatively. Patients were followed up for at least 6 months (range, 6 to 18 months). Data were analyzed using SPSS version 21. P < 0.05 was considered statistically significant. RESULTS: Sixty-seven (49.6%) patients underwent posterior SSLF, and 68 (50.4%) underwent anterior SSLF. The mean age of patients was 58.2 ± 9.7 and 64.9 ± 11.6, respectively (P < 0.001). Most patients who underwent the posterior approach had stage III apical prolapse (74.6%), while 65.5% of those who underwent anterior SSLF had stage II apical prolapse (P < 0.001). Following the treatment, no significant difference was detected between these two vaginal approaches in terms of women's satisfaction rate (P > 0.05). One case of postoperative recurrence was found in the posterior group, which ultimately led to surgical retreatment. There were no major intra- or postoperative complications in the groups. Postoperative TVL was higher in the anterior SSLF group (P < 0.001). The postoperative POPDI-6, CRADI-8, UDI-6, and PFDI-20 decreased significantly compared to preoperative status in both groups (P < 0.001). CONCLUSION: It appears that the anterior SSLF approach can be regarded as effective as the posterior approach in the management of apical POP. Therefore, the proper surgical technique can be chosen according to the surgeon's expertise and other compartment's prolapse status.

The ability of Canadian Syncope risk score in differentiating cardiogenic and non-cardiogenic syncope; a cross-sectional study.

INTRODUCTION: Determining the underlying etiology of syncope provides valuable prognostic information and expedites the implementation of a therapeutic strategy. This study aimed to evaluate the ability of Canadian Syncope Risk Score (CSRS) in differentiating cardiogenic and non-cardiac syncope. METHODS: The present diagnostic accuracy study was conducted on adult patients with syncope, who presented to the emergency departments of Shohadaye Tajrish and Imam Hossein Hospitals in Tehran from March 2018 to March 2019. The data required for determining CSRS were collected during the initial assessment and the underlying etiology was confirmed through further diagnostic follow-up under the supervision of a cardiologist or neurologist. Finally, the screening performance characteristics of the score were calculated. RESULTS: 300 patients with the mean age of 56.38 ± 19.10 years were studied. The source of syncope was cardiac in 133 (44.3%) and non-cardiac in 137 (55.7%) patients. The area under the ROC curve of CSRS in differentiating cardiac syncope was 0.77 (95% CI: 0.715-0.824). At a cutoff point of -1.5, the sensitivity and specificity of the score were calculated to be 73.68% (95% CI: 65.21-80.75%) and 73.05% (95%CI: 75.54-79.47%), respectively. CONCLUSION: The present study reveals that CSRS has fair accuracy in differentiating the source of syncope and has no superiority over a clinical examination. Therefore, we do not recommend relying on the CSRS to differentiate between cardiac and non-cardiac syncope alone.

An Umbrella Review of Clinical Efficacy and Adverse Cardiac Events Associated with Hydroxychloroquine or Chloroquine with or Without Azithromycin in Patients with COVID-19.

CONTEXT: The safety and efficacy of several repurposed drugs, including hydroxychloroquine and chloroquine, with or without azithromycin, were presumed to be miraculous in treating patients with COVID-19. However, as it later transpired, these therapeutic agents seem to be associated with critical adverse cardiac events. OBJECTIVES: Given the skepticism around the advantages and disadvantages of the aforementioned treatment strategies, the present study aimed to investigate the clinical efficacy and cardiac toxicity of hydroxychloroquine or chloroquine with or without azithromycin in the setting of COVID-19 infection. METHOD: This was an umbrella review conducted on patients with COVID-19 who received hydroxychloroquine or chloroquine with or without azithromycin from January 2020 to November 2020. We systematically searched PubMed, Scopus, Cochrane, ProQuest, Web of Science, and Embase databases. RESULTS: Three studies (systematic review and meta-analysis) were analyzed to evaluate the arrhythmogenic potential of hydroxychloroquine or chloroquine with or without azithromycin in patients with COVID-19 and identify the clinical efficacy of such a combination. CONCLUSIONS: We found no benefit for patients with COVID-19 who received hydroxychloroquine or chloroquine alone or in combination with azithromycin. Moreover, it is noteworthy that these medications, particularly when considering co-administration, could result in both statistically and clinically elevated risks of notorious arrhythmias, such as TdP.

Philadelphia versus Miami-J cervical collar's impact on pulmonary function.

PURPOSE: The purpose of this study was to compare the effect of two types of cervical collars (Philadelphia and Miami-J) on pulmonary function and ventilation in healthy volunteers through spirometry, peak flow meter, and capnograph. METHOD: Initially, subjects were randomized into two groups in which the sequence of collars' fixation was reversed. Afterward, we assessed the pulmonary parameters without a cervical collar in all participants. Each group underwent two additional test conditions, including measurements after wearing a Philadelphia and Miami-J cervical collar. In any case, we took the measurements half an hour after the collar fixation. RESULTS: The mean age of participants was 48.34 ± 1.35 years. Following either type of collars application, there was a statistically significant decrease in FEV1, FEV1/FVC, FEF25-75%, and PEF (p < .001). However, FVC was not significantly changed (p = .157). CONCLUSION: In summary, we noted a statistically significant expiratory flow obstruction after both the Philadelphia and Miami-J cervical collar. These changes were not clinically significant in healthy volunteers, albeit may have ramifications in patients with pre-existing respiratory compromise.