Characterization of fecal microbiome in biopsy positive prostate cancer patients.

Objectives: To characterize the fecal microbiome in newly diagnosed prostate cancer patients. Patients and methods: Forty-nine consecutive patients who were referred for trans rectal prostate biopsy were tested. Patients who received antibiotics 3 months prior to the biopsy, patients with history of pelvic irradiation, prostate or colon cancer, inflammatory bowel disease and urinary tract infection were excluded. A rectal swab was obtained just prior to the biopsy, immediately placed in a sterile tube and kept in -80°C. Sequencing was performed for the 16S rRNA 515F + 806R gene fragment using the QIIME2 software. Analytic tests included Beta diversity (Weighted Unifrac, Unweighted Unifrac, Bray-Curtis), Alpha diversity (Faith, Evenness), Taxa bar plots and PCoA plots. Results: Forty-five samples were suitable for analysis with at least 8000 readings per sample. All patients were Caucasian. Twenty patients had prostate cancer and 25 had benign prostates (BPH). Among prostate cancer patients, Gleason Score was 3 + 3 in 11 patients, 3 + 4 in 5, 4 + 3 in 3, and 4 + 4 in 2. There was no statistical difference in demographic parameters between the groups. We identified over 1000 bacterial species, typical for the colonic microbiome. No significant differences in bacterial populations were found between prostate cancer versus benign prostate patients nor between age groups or between subgroups of Gleason or International Society of Uro-pathology (ISUP) scores. Conclusions: Although the microbiome has previously been shown to have an impact on the human microenvironment and cancer risk, we could not demonstrate a significant difference between the flora diversity of newly diagnosed prostate cancer patients and BPH patients. Further research into distinct bacterial metabolic pathways may reveal unique risk factors for prostate cancer.

Fluoroless Ureteroscopy: Experience in More Than 100 Patients.

BACKGROUND: Ureteroscopy is becoming the primary treatment for ureteral stones. As a standard of care, ureteroscopy is performed under the supervision of fluoroscopy. Recent advances in endourological technology make the need for fluoroscopy questionable. OBJECTIVES: To summarize our experience with a no-fluoroscopy technique for selected cases of ureteral stones. METHODS: Patients were considered suitable for fluoroless ureteroscopy if they had one or two non-impacted stones, in any location in the ureter, 5-10 mm size, with a normal contralateral renal unit and no urinary tract infection. Procedures were performed using rigid scopes, nitinol baskets/forceps for stone retrieval, and Holmium:YAG laser for lithotripsy. Stents were placed per surgeon's decision. RESULTS: During an 18-month period, 103 patients underwent fluoroless ureteroscopy. In 94 patients stones were removed successfully. In six, the stones were pushed to the kidney and treated successfully on a separate session by shock wave lithotripsy. In three patients no stone was found in the ureter. In five patients, miniature perforations in the ureter were noted and an indwelling double J stent was placed. CONCLUSIONS: Fluoroless ureteroscopy resulted in a high rate of success. We believe that in selected cases it can be used with minimal adverse events.

The Importance of Cystoscopy in Diagnosis and Treatment of Urethral Stricture Following Transurethral Prostatectomy.

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.

The detrimental danger of Water-Pipe (Hookah) transcends the hazardous consequences of general health to the driving behavior.

OBJECTIVE: To determine whether the consumption of tobacco used in Water-Pipe by drivers increases the risk of a motor vehicle collision as a consequence of hypoxia. DESIGN: Analytical case-control study. DATA SOURCES: Seventy exclusive Water-Pipe smokers (Experimental Group--EG)--mean age ± SD: 29.47 ± 10.45 years; mean number of weekly WPS, (6.9 ± 3.7); mean duration of WPS (WPS) is (7.5 ± 2.1 years)--and thirty non-smoker (Control Group--CG; mean age ± SD: 36.33 ± 13.92 years) were recruited during 2011 from two Arab villages located in the Galilee, northern Israel. METHODS: We performed a case-control study exclusively among Water-Pipe smokers with an appropriate non smokers control group. Demographic questionnaire, Pulse Oxymeter for blood oxygenation measure and a driver simulator for measuring various participants driving behaviors were utilized. Statistical analysis for analyzing the different variables, Pearson's x2 analysis for the comparison of categorical variables, continuous variable is compared using Student's t-test and for testing the correlation between the different variables and bivariate correlation analysis were applied. RESULTS: In the (EG) following WPS, we observed increase in the pulse rate--from 80 to 95 (t = 11.84, p < 0.05) and decrease in saturation level from 97.9 to 97.32, the decrease is statistically significant (t = 3.01, p < 0.05) versus no change in (CG). An increased number of accidents among EG (OR is 1.333 with CI of 1.008-1.776), while in CG, an insignificantly decrease (t = 3.08, p < 0.05). In EG an increase in centerline crossings (OR is 1.306 with CI of 1.016-1.679), also the total time not being within the lane was increased and the estimated (OR: 1.329; CI: 1.025-1.722). WPS increases the number of accidents by 33% and Hypoxia can cause driving behavioral turbulences. CONCLUSION: The results show that WPS has a significant impact on driving behavior and on the risk of being involved in road accidents and causing driving to become riskier and less careful and stable. To the best of our knowledge, this is the first time such relationships have been tested. After WPS the total number of traffic accidents and driving violations increase. The results show a significant increase in the pulse rate immediately after WPS with a decrease in the saturation rate (the level of blood oxygenation); these changes continue half an hour after WPS.

Heavy vehicle driver fatalities: learning's from fatal road crash investigations in Victoria.

This study describes the nature and extent of fatal heavy vehicle driver crashes in Victoria between 1999 and 2007 and the factors associated with the crash. A descriptive study was conducted comprising the population of heavy vehicle drivers killed in a road transport crash while operating a vehicle of > or =4.5 tonne Gross Vehicle Mass (GVM) for the purposes of work. Information about the nature of crash, environmental, driver, vehicle and occupational factors were collected from the coroner's death investigation file. Of the 91 deaths identified 61 were eligible for review. All 61 cases were male, solo drivers with a mean age of 44.7 years. Most vehicles were articulated in configuration. One-third of crash scenarios involved a single vehicle leaving the roadway on a straight road. One in every six fatally injured drivers was detected with the presence of stimulants or cannabis. Twenty-two drivers were travelling at excessive or inappropriate speeds for the circumstances. Seatbelt wearing status was documented for only 25 of 61 drivers. This study is the first to comprehensively examine a population of fatally injured heavy vehicle drivers using coroner's investigation files and these findings are consistent with previous, less detailed, Australian research. Information about potential associations between occupational factors and crash risk was limited. Improving driver safety requires incorporation of occupational factors into a standardised approach to heavy vehicle crash investigations.

Síndrome das pernas inquietas na gestação / Restless legs syndrome in pregnancy

O Objetivo do presente estudo é determinar freqüência e características da síndrome das pernas inquietas em grávidas, e detectar possíveis fatores associados à sua ocorrência. Desenvolvemos estudo observacional em gestantes consecutivamente internadas em trabalho de parto durante 60 dias em maternidade conveniada com o SUS. Foi realizada no puerpério imediato entrevista utilizando questionário padronizado para diagnóstico da síndrome, e coletadas informações quanto às características dos sistemas e quanto a história obstétrica e patológica. Os dados foram tabulados e analisados com a utilização do programa Epi-Info 6.04b. Realizadas 262 entrevistas, 9,5 porcento (n=25) das entrevistadas haviam apresentado a síndrome durante a gestação; destas, 60 porcento queixaram-se de insônia. A síndrome foi mais comum no terceiro trimestre, e não houve relação entre a sua presença e qualquer variável obstétrica ou demográfica. Trata-se de síndrome relativamente comum na gestação, que pode levar a insônia e conseqüente diminuição na qualidade de vida. Possivelmente fatores genéticos e outros ligados a alterações do organismo materno, como por exemplo altos níveis séricos de estrogênio, participam da sua gênese neste contexto

Restless legs syndrome in patients on chronic hemodialysis in a Brazilian city: frequency, biochemical findings and comorbidities.

OBJECTIVE: To evaluate the frequency of restless legs syndrome (RLS) in patients with chronic renal failure (CRF) in Petr polis, Brazil, and investigate associations between the syndrome and: demographic characteristics, biochemical variables and comorbidities. METHOD: A cross-sectional study in which we interviewed 176 patients on dialytic therapy based on criteria elaborated by the International Restless Legs Syndrome Study Group, and compared data of patients with and without RLS. RESULTS: The frequency was 14.8 %. There were no significant differences between the two groups in demographic and biochemical variables investigated (iron, creatinine, intact parathyroid hormone, hemoglobin, calcium, phosphate). We found no association between RLS and the most common comorbidities, except for chronic glomerulonephritis (CGN) (OR = 3.84, p < 0.01). CONCLUSION: In the studied population RLS is a common disorder, and is not associated with the investigated biochemical abnormalities. A higher frequency of RLS in subjects with CGN is a finding that needs further investigation.

Restless legs syndrome in patients on chronic hemodialysis in a Brazilian city: frequency, biochemical findings and comorbidities

OBJECTIVE: To evaluate the frequency of restless legs syndrome (RLS) in patients with chronic renal failure (CRF) in Petrópolis, Brazil, and investigate associations between the syndrome and: demographic characteristics, biochemical variables and comorbidities. METHOD: A cross-sectional study in which we interviewed 176 patients on dialytic therapy based on criteria elaborated by the International Restless Legs Syndrome Study Group, and compared data of patients with and without RLS. RESULTS: The frequency was 14.8 percent. There were no significant differences between the two groups in demographic and biochemical variables investigated (iron, creatinine, intact parathyroid hormone, hemoglobin, calcium, phosphate). We found no association between RLS and the most common comorbidities, except for chronic glomerulonephritis (CGN) (OR = 3.84, p < 0.01). CONCLUSION: In the studied population RLS is a common disorder, and is not associated with the investigated biochemical abnormalities. A higher frequency of RLS in subjects with CGN is a finding that needs further investigation

Modelo de planejamento utilizado na caracterizaçäo sócio-econômico-cultural das gestantes pré-natal da Escola Paulista de Medicina / A model for planning used to characterize social, economic and culturally the pregnant women of the prenatal service of the Escola Paulista de Medicina

O trabalho versa sobre o levantamento sócio-econômico-cultural realizado em 273 gestantes normais do pré-natal da Disciplina de Obstetrícia da Escola Paulista de Medicina. Compara, também, características de homogeneidade da amostra estudada com as da populaçäo geral do mesmo serviço, que se fizeram representar por 636 grávidas normais. Os dados obtidos quanto à etnia, faixa etária, renda, escolaridade, profissäo, dieta e composiçäo familiar säo apresentados com a respectiva estatística. Os autores discutem a validade de se inferir que a populaçäo do pré-natal da Escola Paulista de Medicina exibe características que permitem comparaçöes com as encontradas nas cidades industrializadas do mundo ocidental, de onde se tem o maior número disponível de levantamentos epidemiológicos