Tag: nevin manimala

Investig Clin Urol. 2025 Jul;66(4):344-351. doi: 10.4111/icu.20250060.

ABSTRACT

PURPOSE: Intravesical bacillus Calmette-Guerin (BCG) instillation is a cornerstone treatment for non-muscle-invasive bladder cancer (NMIBC) but is frequently associated with significant local and systemic adverse effects. This study aimed to investigate the effects of Uro-Vaxom (UVX) on BCG-related infectious adverse events and oncologic outcomes in patients with NMIBC.

MATERIALS AND METHODS: This retrospective cohort study included 251 NMIBC patients who underwent BCG induction therapy following transurethral resection of bladder tumors at a single institution. Patients were stratified into two groups: those not receiving UVX (non-UVX group, n=142) and those receiving UVX (UVX group, n=109). Clinical and oncologic parameters, including the frequency of antibiotic use, treatment discontinuation rates, and early recurrence rates following BCG therapy, were compared between the groups.

RESULTS: Antibiotic use during BCG treatment was significantly lower in the UVX group compared to the non-UVX group (p<0.001). Furthermore, BCG discontinuation due to urinary tract infection (UTI) was observed exclusively in the non-UVX group (p=0.003). Although tumor recurrence rates within one year were lower in the UVX group, this difference did not reach statistical significance (p=0.212). Multivariate analysis did not identify UVX use as a significant predictor of early recurrence or bacteriuria.

CONCLUSIONS: The administration of UVX during BCG therapy in NMIBC patients was associated with reduced antibiotic use and a lower BCG discontinuation rate due to UTI, thereby improving treatment adherence. These findings highlight the potential role of UVX as a valuable adjunct to BCG therapy to optimize patient outcomes.

PMID:40618210 | DOI:10.4111/icu.20250060

Investig Clin Urol. 2025 Jul;66(4):336-343. doi: 10.4111/icu.20250067.

ABSTRACT

PURPOSE: With the introduction of the AUA Quality Registry (AQUA), physician practice styles and adherence to clinical guidelines are under closer scrutiny. While adherence is critical for optimal healthcare, it has not been studied in men’s health. This survey-based study assessed adherence to American Urological Association (AUA) clinical guidelines on erectile dysfunction (ED), Peyronie’s disease, priapism, infertility, and ejaculatory disorders among members of the New York section of the AUA.

MATERIALS AND METHODS: An anonymous questionnaire was emailed to members, covering five non-oncologic men’s health guideline categories. Each category included two to four specific guidelines, with responses recorded on a Likert scale. Respondents could provide rationale for their answers or omit questions if they did not treat a specific condition.

RESULTS: Among 82 urologists, most treated ED and ejaculatory dysfunction but less commonly treated Peyronie’s, priapism, and infertility. Some guidelines were frequently not followed. For instance, 57% never prescribed tramadol or α1-adrenoreceptor antagonists for premature ejaculation after first-line therapy failure. Half never performed in-office intracavernosal injection tests for Peyronie’s. For priapism, 52% never used ultrasound in initial evaluations, and 45% rarely referred men with ED to mental health professionals.

CONCLUSIONS: This pilot study highlights generally high adherence to AUA guidelines but identifies gaps in areas driven by expert opinion. Findings suggest a need for targeted educational initiatives, particularly in Peyronie’s diagnosis and mental health integration for ED, to enhance patient care and outcomes. Such initiatives are crucial in refining the approach to men’s health, ultimately enhancing patient care and outcomes.

PMID:40618209 | DOI:10.4111/icu.20250067

Investig Clin Urol. 2025 Jul;66(4):329-335. doi: 10.4111/icu.20250011.

ABSTRACT

PURPOSE: To propose a novel surgical approach for managing inflammatory adhesions of the tunica vaginalis (TV) during vasoepididymostomy (VE), and to report surgical outcomes.

MATERIALS AND METHODS: A T-shaped incision of the TV was used to expose the epididymis and vas deferens in cases with adhesions between the TV and the testis. We retrospectively analyzed data from five patients who underwent microsurgical VE for obstructive azoospermia (OA) secondary to epididymal obstruction. Operative time, postoperative patency rate and semen analysis, and natural pregnancy rates were recorded. For comparison, 50 patients who underwent conventional longitudinal TV incision were included to assess operative time, while 46 and 36 of these patients were used to compare patency and pregnancy rates, respectively, with the T-shaped incision group.

RESULTS: The T-shaped incision involves a longitudinal incision of the TV at the epididymal-testicular junction followed by an incision (T) in the direction towards the epididymis and vas deferens area. Among the five patients who underwent this approach, four (80.0%) had sperm detected in semen two months postoperatively, and their partners achieved natural pregnancy (4/5, 80.0%) within one year after VE. No postoperative wound infections occurred. No statistically significant differences were observed in mean operative time, patency rates, or pregnancy rates between the T-shaped and longitudinal incision groups.

CONCLUSIONS: The T-shaped TV incision is a feasible approach for VE in OA patients with inflammatory TV-testis adhesions, providing adequate epididymal access without compromising operative time or surgical outcomes.

PMID:40618208 | DOI:10.4111/icu.20250011

Investig Clin Urol. 2025 Jul;66(4):302-310. doi: 10.4111/icu.20240362.

ABSTRACT

PURPOSE: Transurethral resection of bladder tumors (TUR-BT) requires follow-up evaluation by cystoscopy. We sought to evaluate the prognosis of non-muscle-invasive bladder cancer (NMIBC) patients within 6 months of surgery to identify the optimal timing for the first cystoscopy after TUR-BT.

MATERIALS AND METHODS: In this retrospective analysis, patients newly diagnosed with NMIBC were divided into two groups according to whether they underwent cystoscopy within 6 months after TUR-BT. We considered four outcomes: recurrence, progression, cancer-specific mortality, and all-cause mortality. Inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier analysis was performed to identify the difference in survival for each outcome stratified by cystoscopy status within 6 months after the first TUR-BT. We employed Cox regression models with IPTW to estimate the hazard ratios (HRs) of each outcome according to cystoscopy status.

RESULTS: Among 40,678 patients, 11,940 (29.4%) did not undergo cystoscopy within 6 months. The risk of recurrence was higher for patients who underwent cystoscopy than those who did not (HR 1.32, 95% confidence interval [CI] 1.26-1.38, p<0.001). By contrast, the cystoscopy group had a lower risk of progression compared to the non-cystoscopy group (HR 0.70, 95% CI 0.65-0.76, p<0.001), with lower cancer-specific mortality (HR 0.62, 95% CI 0.56-0.68, p<0.001) and all-cause mortality (HR 0.58, 95% CI 0.56-0.60, p<0.001).

CONCLUSIONS: Cystoscopy within 6 months was associated with a higher risk of recurrence but a lower risk of progression and death. Therefore, regular cystoscopy after the first TUR-BT for NMIBC is essential to ensure favorable survival outcomes.

PMID:40618205 | DOI:10.4111/icu.20240362

J Periodontal Implant Sci. 2025 Jun;55(3):180-190. doi: 10.5051/jpis.2400820041.

ABSTRACT

PURPOSE: Hormonal fluctuations, primarily in progesterone and estrogen during the menstrual cycle, may influence periodontal tissues, with inflammatory cytokines playing a crucial role. Therefore, our primary objective was to assess clinical periodontal parameters and measure levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α in gingival crevicular fluid (GCF) throughout the menstrual cycle.

METHODS: This longitudinal prospective study was conducted from February to April 2022 and included 50 participants. We assessed clinical periodontal parameters-plaque index (PI), gingival index (GI), pocket depth (PD), clinical attachment loss (CAL), and tooth mobility-at three stages of the menstrual cycle: menstruation day, ovulation day, and premenstrual day. Additionally, GCF samples were collected using paper points. These samples were then stored and analyzed for levels of IL-1β, IL-6, and TNF-α using enzyme-linked immunosorbent assays.

RESULTS: There were 25 participants in our study. The GI, PD, and CAL increased significantly during the menstrual cycle and were significantly higher during the premenstrual phase than in the ovulation phase (P<0.05). The levels of GCF IL-1β (P=0.012), IL-6 (P=0.002), and TNF-α (P=0.015) showed statistically significant throughout the menstrual cycle compared to baseline which was the menstrual (follicular) phase. Furthermore, the GCF levels of IL-1β and IL-6 reached their peak during the luteal or premenstrual phase, whereas TNF-α peaked during the ovulation phase. The increase in biological markers was more pronounced between the menstruation phases than the clinical periodontal markers.

CONCLUSIONS: All clinical periodontal parameters, except for the PI, showed a slight increase from the follicular phase to the luteal phase, with significant differences observed between each phase. The levels of GCF IL-1β (P=0.012), IL-6 (P=0.002), and TNF-α (P=0.015) were statistically significant, with increases in IL-1β and IL-6 throughout the menstrual cycle, peaking in the luteal phase. This demonstrates the influence of the menstrual cycle on clinical periodontal and GCF inflammatory markers.

PMID:40618197 | DOI:10.5051/jpis.2400820041

Biophys J. 2025 Jul 4:S0006-3495(25)00417-5. doi: 10.1016/j.bpj.2025.06.040. Online ahead of print.

ABSTRACT

The coronavirus main protease (MPro) plays a pivotal role in viral replication and is the target of several antivirals against SARS-CoV-2. In some species, CRCs of MPro enzymatic activity can exhibit biphasic behavior in which low ligand concentrations activate the enzyme whereas higher ones inhibit it. While this behavior has been attributed to ligand-induced dimerization, quantitative enzyme kinetics models have not been fit to it. Here, we develop a kinetic model integrating dimerization and ligand binding. We perform a Bayesian regression to globally fit the model to multiple types of biochemical and biophysical data. The reversible covalent inhibitor GC376 strongly induces dimerization and binds to the dimer with no cooperativity. In contrast, the fluorescent peptide substrate has a minor effect on dimerization but binds to the dimer with positive cooperativity. The biphasic concentration response curve occurs because compared to substrate, the inhibitor accelerates turnover in the opposite catalytic site.

PMID:40618193 | DOI:10.1016/j.bpj.2025.06.040

BMC Womens Health. 2025 Jul 5;25(1):333. doi: 10.1186/s12905-025-03890-1.

ABSTRACT

BACKGROUND: Our aim was to compare preoperative and postoperative hematological inflammatory parameters in women with endometriosis.

METHODS: Data were collected from 411 patients who underwent laparoscopy surgery between January 2018 and December 2023. Postoperatively, the pathology reports indicated ovarian endometrioma in 201 patients (48.9%) and other benign ovarian cysts in 210 patients (51.1%). Subgroups were categorized as stage 1-2 endometriosis (n = 26, 6.3%), stage 3-4 endometriosis (n = 175, 42.6%) and benign ovarian cysts (n = 210, 51.1%). Hematological inflammatory markers and ultrasound findings were evaluated one week before the operation and six weeks after the operation and compared between groups. Statistical analysis was performed by SPSS version 26.0 Not normally distributed parameters were analyzed with the Kruskal Wallis, post hoc and Mann-Whitney U tests. Wilcoxon signed-rank test was used to determine changes before and after treatment. Chi-square test and Fisher precision test were used in the analysis of categorical data. Receiver operating characteristic analysis was performed to calculate the area under the curve, which indicates the average sensitivity of variables and its 95% confidence interval are reported for each assessed parameter. The appropriate cut-off value indicating the sum of the highest sensitivity and specificity was calculated for the most predictive variable. The p value considered statistically significant was < 0.05.

RESULTS: When comparing the postoperative and preoperative parameters of the main groups, it was determined that the NLR, MLR, and PLR values of both groups increased in the postoperative period, whereas the CA-125 value decreased. In a similar comparison within the subgroups, it was determined that NLR and PLR increased in all three groups in the postoperative period. MLR was found to increase in the stage 3-4 endometriosis and benign ovarian cyst groups. CA-125 decreased in the stage 3-4 endometriosis and benign ovarian cyst groups. RDW > 13.5, PLR > 123.4 and CA-125 > 35 were determined as the cut-off value to predict endometriosis.

CONCLUSION: During the follow-ups, we revealed that CA-125 still maintains its effectiveness. There is a lack of existing literature that directly compares hematological inflammatory parameters before and after treatment for endometriosis.

PMID:40618158 | DOI:10.1186/s12905-025-03890-1

Parasit Vectors. 2025 Jul 5;18(1):261. doi: 10.1186/s13071-025-06885-x.

ABSTRACT

BACKGROUND: Sicilian virus (SFSV), a phlebovirus transmitted by sand flies, is an understudied arbovirus in the Mediterranean region, with limited data on its epidemiology and human health impact. This study aimed to estimate the seroprevalence of SFSV among blood donors in mainland Portugal and explore associations with sociodemographic factors and exposure to other sand-fly-borne pathogens.

METHODS: A cross-sectional study was conducted using serum samples from 800 blood donors collected between February and June 2022. The study sample was selected from a previously established cohort designed for Leishmania seroprevalence assessment. The microneutralization technique was employed to detect anti-SFSV antibodies. Sociodemographic data were obtained from self-administered questionnaires. Associations between SFSV seropositivity and Toscana virus (TOSV)/Leishmania seropositivity or sociodemographic variables were explored using univariate analysis and multivariate logistic regression.

RESULTS: Overall, the estimated national true seroprevalence of SFSV was 4.7% (95% CI 3.4-6.3%). Regional seroprevalence varied significantly, with the highest rates (up to 11.9%) observed in the Algarve, Alentejo, and Grande Lisboa regions, respectively. In univariate analysis, SFSV seropositivity was not significantly associated with sex, age, dog ownership, or positive serology for TOSV or Leishmania. In multivariate analysis, geographic area of residence was the only independent factor associated with seropositivity (adjusted odds ratio 3.05; 95% CI 1.85-5.02; p < 0.001).

DISCUSSION: TThis study represents the first nationwide SFSV seroprevalence estimate in Portugal, revealing wider circulation than previously recognized. The lack of association with TOSV or Leishmania seropositivity could suggest the involvement of distinct vector species.

CONCLUSIONS: Given the observed geographic clustering, SFSV should be considered in the differential diagnosis of undifferentiated febrile syndromes, particularly in endemic regions during peak sand fly activity. Further research is needed to identify specific vectors, improve diagnostic capabilities, and assess the clinical impact of SFSV infections in Portugal.

PMID:40618143 | DOI:10.1186/s13071-025-06885-x

Crit Care. 2025 Jul 5;29(1):281. doi: 10.1186/s13054-025-05527-z.

ABSTRACT

BACKGROUND: Candidemia is a life-threatening fungal infection in intensive care unit (ICU) patients that can be complicated by secondary localization (SL). However, the prevalence, risk-factors, and outcomes of patients with secondary localization during candidemia remain poorly explored.

METHODS: The CandidICU study was a retrospective multicenter cohort study conducted in 16 French ICUs. All adult patients hospitalized from 01-2015 to 01-2023 for candidemia were enrolled. We assessed the prevalence and risk-factors for SL. In addition, we explored the clinical course according to the screening and occurrence of SL.

RESULTS: Among 492 patients hospitalized in ICU with at least one positive blood culture for Candida sp., 376 were screened for SL (76.4%). At least one SL was diagnosed in 82 patients (21.8%). Competing risk analysis identified the SAPSII score and the duration of positive blood cultures as independent risk factors for SL (sdHR 1.01 [95%CI 1.00-1.02]; p = 0.031 and sdHR 1.05 [95%CI 1.02-1.08]; p = 0.003, respectively). Age and Candida glabrata infection were protective factors against SL (sdHR 0.98 [95%CI 0.97-1.00]; p = 0.016 and sdHR 0.38 [95%CI 0.15-0.99]; p = 0.048, respectively). Finally, patients with SL received longer antifungal treatment (18 [11-30] versus 14 [6-18] days; p < 0.001) and had a higher rate of antifungal escalation (27.8% versus 12.3%; p = 0.002).

CONCLUSIONS: In this cohort, 76·4% of ICU patients with candidemia were screened for SL and at least one SL was diagnosed in 21·8%. The severity at ICU admission and duration of positive blood cultures were identified as independent risk factors for SL, whereas age and Candida glabrata infection were protective. Finally, the screening and occurrence of SL were associated with significant changes in the management of patients.

PMID:40618139 | DOI:10.1186/s13054-025-05527-z

BMC Musculoskelet Disord. 2025 Jul 5;26(1):658. doi: 10.1186/s12891-025-08909-0.

ABSTRACT

BACKGROUND: To evaluate the clinical outcomes of the proximal lateral-entry pinning technique in the treatment of supracondylar humeral fractures and to explore its performance in terms of intraoperative nerve protection.

METHODS: This retrospective analysis involved data from pediatric patients with supracondylar humeral fractures who were admitted to the Department of Pediatric Surgery at Binzhou Medical University Hospital between September 2017 and November 2023. A total of 342 patients were included and divided into two groups: Group P (proximal lateral-entry pinning) and Group C (conventional lateral condyle pinning). All patients were followed up for at least 6 months postoperatively. Baseline characteristics, the interval from injury to surgery, the operative time, the fracture healing status, and the timing of Kirschner wire removal were recorded. Elbow function was assessed using Flynn’s functional and cosmetic criteria. Statistical comparisons were conducted using the Mann-Whitney U test, independent samples t-test, chi-square test, or Fisher’s exact test, as appropriate. Complications such as loss of reduction, elbow deformity, vascular injury, iatrogenic nerve injury, and pin-tract infection were also documented.

RESULTS: There were no statistically significant differences in sex, body weight, age at injury, fracture laterality, anesthesia type, or waiting time from injury to surgery between the two groups (P > 0.05). Additionally, the operative time and timing of Kirschner wire removal did not differ significantly between the groups (P > 0.05). At the final follow-up, the proportion of patients with excellent/good elbow function in Group P was 99.42%, which was significantly greater than the proportion of 94.64% observed in Group C (P < 0.05). No radial or ulnar nerve injuries were reported in either group. Three cases of pin-tract infection occurred in Group P, and seven cases occurred in Group C (P > 0.05). Loss of reduction occurred in three cases in Group P and11 in Group C (P > 0.05). No incidences of elbow deformity or iatrogenic vascular injury were noted.

CONCLUSION: The proximal lateral-entry pinning technique yields favorable fracture outcomes and does not increase the risk of radial or ulnar nerve injury when it is performed meticulously. This approach is therefore recommended as a viable surgical technique for treating supracondylar humeral fractures in children.

PMID:40618131 | DOI:10.1186/s12891-025-08909-0