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PURPOSE: To assess the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier's gangrene (FG) in a referral center in order to reduce the mortality of FG patients. MATERIALS AND METHODS: Patients with FG were admitted and enrolled consecutively in this study from March 2008 to April 2020. Statistical analysis was done to evaluate the differences between the two groups and to identify the best cutoff value to predict mortality and the need for intensive care. RESULTS: Of all 114 patients, 46 patients (40.35%) died in the course of hospitalization and 40 entered the study. No variable manifested a notable difference except for the BUN to albumin ratio, which was significantly different (P-value = 0.045). The ratio of BUN to albumin was not associated with any other variables and was independently a predictor of death in FG patients. CONCLUSION: The ratio of BUN to albumin was significantly different among deceased and survived patients with FG. Therefore, more studies with a larger sample size are still needed to access this parameter properly.
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Fournier Gangrene , Blood Urea Nitrogen , Fournier Gangrene/diagnosis , Humans , Male , Prognosis , Referral and Consultation , Retrospective Studies , Serum Albumin , Severity of Illness IndexABSTRACT
INTRODUCTION: Fournier's gangrene (FG) is a life-threatening disease, even with early diagnosis and administration of vigorous treatment, its mortality rate is high. This study aimed to evaluate the factors relate to mortality in patients with FG or necrotising fasciitis managed in a referral center. METHODS: This retrospective cross-sectional study was conducted on patients managed in a tertiary referral center, Tehran, Iran, from March 2009 to March 2019, with diagnosis of FG or necrotising fasciitis. The correlation between different demographic and clinical parameters with mortality was analysed and reported. RESULTS: 73 cases with the mean age of 59.1 ± 15.8 (range: 25 - 88) years were studied (87.7% male). 21 (28.8%) patients died. Escherichia coli (26 cases, 35.6%) was the most frequent microorganism in cultures. Non-survived cases had higher mean age (p = 0.01), higher frequency of hyperlipidaemia (p = 0.02), immunosuppression (p < 0.001), longer hospital stay (p=0.02), lower blood pressure (p=0.01), and lower platelet count (p=<0.001). Based on multivariate analysis, age (p = 0.015; Odds: 0.88 (0.79-0.97)), haematocrit level (p = 0.01; Odds: 1.27 (1.04-1.55)), platelet count (p = 0.03; Odds: 10.11 (1.14-89.35)), and immunosuppression (p = 0.01; Odds: 0.01 (0.0-0.54)) were independent related factors of mortality. CONCLUSIONS: The rate of mortality due to FG and necrotizing fasciitis was 28.8%. Based on multivariate analysis, the independent related factors of mortality were older age, lower haematocrit level and platelet count, and presence of immunosuppression.
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Introduction: Currently, infertility is a main concern, and it is estimated that 15% of couples are considered infertile. Conventional therapies such as vitamins, antioxidants and supplements have been used widely, but they may not be sufficiently effective. This study evaluated the effect of laser acupuncture on semen parameters in infertile patients with oligospermia. Methods: This study is a clinical trial with a double-blind control group. 35 patients in the intervention group underwent laser acupuncture twice a week for consecutive 5-weeks. In the control group, sham laser acupuncture was performed. The two groups were compared in terms of semen parameters including semen volume, sperm concentration, sperm motility and sperm morphology as the primary outcome. The secondary outcome was a successful pregnancy rate. After data collection, statistical analysis was performed with SPSS version 20. Results: The mean age of all patients was 27.46±2.88 years; in the intervention group, their age was 27.82±2.6 years, and in the control group, it was 27.11±2.96 years, and there was no significant difference (P=0.396). During the study, 4 patients (5.4%) reported adverse effects; three patients in the control group complained of mild weakness and itching, and one patient in the intervention group reported dizziness. The volume of semen and sperm morphology did not differ significantly in both control and intervention groups (P Ë 0.05), while sperm motility and sperm concentration had a significant difference (P=0.0001). Conclusion: Laser acupuncture as a non-invasive procedure is effective in improving sperm mobility and concentration in infertile patients with oligospermia. Due to the surface contact of the laser probe with the skin and the lack of need to insert needles in the skin, laser acupuncture is more convenient and better tolerated by patients.
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Introduction: Urinary stone disease is the third most common affliction of the urinary tract that has been associated with an increasing incidence. Over decades, great advances have been made in the minimally invasive treatment of urinary stones. Recently, transurethral lithotripsy (TUL) by holmium laser was introduced as a possible therapeutic option. This study evaluated the effect of propofol on the success rate of TUL by holmium laser. Methods: A double-blind randomized controlled trial was conducted on 180 patients to investigate the effect of propofol on the success and complication rate of TUL by holmium laser. The enrolled patients were divided into two groups: the first group received sodium thiopental (n=89) while the second group received propofol (n=91). The two groups were compared in terms of the fluctuations of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), operation time, future stone-free rate (SFR), stone migration, post-operative fever, and ureteral complications such as perforation and mucosal damage. Other developed complications were also recorded. After data gathering, statistical analysis was performed with SPSS version 21. Results: the patients' data such as age, sex, stone diameter, stone laterality, duration of stone impaction, primary SBP, DBP and HR were not significantly different between the two groups (P>0.05). TUL and anesthesia duration, first-minute and fifth-minute SBP and DBP, and also changes of HR were significantly lower in the propofol group compared with the sodium thiopental group (P <0.001). Moreover, SFR of TUL was more evident in the propofol group. Ureteral mucosal damage was significantly less in the propofol group. Conclusion: Propofol was associated with a higher reduction in SBP and DBP, decreased duration of TUL, fewer fluctuations in HR, and an increased success rate of stone removal by TUL with holmium laser.
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A net gas flow can be induced in the gap between periodically structured surfaces held at fixed but different temperatures when the reflection symmetry along the channel axis is broken. Such a situation arises when one surface features a ratchet structure and can be augmented by altering the boundary conditions on different parts of this surface, with some regions reflecting specularly and others diffusely. In order to investigate the physical mechanisms inducing the flow in this configuration at various Knudsen numbers and geometric configurations, direct simulation Monte Carlo (DSMC) simulations are employed using transient adaptive subcells for collision partner selection. At large Knudsen numbers the results compare favorably with analytical expressions, while for small Knudsen numbers a qualitative explanation for the flow in the strong temperature inhomogeneity at the tips of the ratchet is provided. A detailed investigation of the performance for various ratchet geometries suggests optimum working conditions for a Knudsen pump based on this mechanism.
