European medical Journal. Urology最新文献

{"title":"An Observational Evaluation of Primary Care Online Resources","authors":"P. Millares Martin, Jorge Millares-Bobet","doi":"10.33590/emj/10305829","DOIUrl":"https://doi.org/10.33590/emj/10305829","url":null,"abstract":"Background: General practice websites are getting more relevant as more interaction with patients is occurring digitally; however, there are no regulations governing them, nor much research about their benefit or quality.\u0000\u0000Objectives: To understand the online presence of general practices through time, using a tool developed for this purpose and assessing practices’ websites at two separate times.\u0000\u0000Methods: A form was developed to assess websites on base of their performance against 17 parameters, including information about the practice (logo, interactive address, area covered, telephone, opening times, details about staff, and quality rate), website parameters (number of pages and links on the site, level of link errors, loading speed, and search engine), and online services provided (social media, interactions like messaging, booking appointments, ordering prescriptions, accessing medical records, and allowing video consultations). Possible scores ranged from 17–66 points, with two to four points per factor analysed. A lower score was a mark of quality.\u0000\u0000Results: Practices were scored twice over the last 5 years; however, the sample average, although improving from 36.5 to 31.6, still puts practices websites midway in the quality range of the tool used. Looking at individual parameters, the homepage’s average loading time deteriorated, as well as maps showing the practice location. However, other details improved.\u0000\u0000Conclusions: Websites are taking a more relevant role in healthcare interactions, but their quality has improved little in the last 5 years. There is a need for stricter regulations if the digital presence of primary care is expected to play a safe role in primary care provision.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80344290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthostatic Hypotension and Concomitant Paraneoplastic Syndromes: A Case Report","authors":"Bharati Dev, Ashwin Varkey, Hrede Afsana","doi":"10.33590/emjneurol/10307775","DOIUrl":"https://doi.org/10.33590/emjneurol/10307775","url":null,"abstract":"This case study discusses the incidence of a paraneoplastic autonomic neuropathy in an elderly male who had an otherwise negative work-up for their aetiology of orthostatic hypotension. This case illustrates the importance of trying to correctly identify the aetiology of orthostatic hypotension, which is often overlooked, and frequently diagnosed as idiopathic. Orthostatic hypotension is most prevalent in elderly populations and can be debilitating, leading to a higher incidence of falls and trauma. Thus, it is important to obtain further work-up when traditional treatments are ineffective. In patients with new and insidious onset of orthostatic hypotension, previous history of malignancy, and possible symptoms consistent with ongoing malignancy, it is imperative to consider paraneoplastic autonomic neuropathy as a potential cause of orthostatic hypotension.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86728282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SuPARnostic: An Advanced Predictive Tool for Detecting Recurrence in Renal Cell Carcinoma","authors":"Nessn Azawi, Karina Sif Søndergaard Mosholt, Nathalie Demuth Fryd, Lars Lund, Juan Ignacio Brignone, Nanna Hvid, Helle Wulf Johansson, Ole Birger Vesterager Pedersen, Susanne Gjørup Sækmose, Saeed Dabestani","doi":"10.33590/emjurol/10307275","DOIUrl":"https://doi.org/10.33590/emjurol/10307275","url":null,"abstract":"BACKGROUND AND AIMS Renal cell carcinoma (RCC) is the most common malignant kidney tumour, with clear cell RCC (ccRCC) accounting for 70–80% of all cases.1 Approximately 15–20% of patients have primary metastatic RCC at diagnosis, and 15–20% of those who receive curative treatment for localised tumours will experience recurrence within 5 years of follow-up.2 Despite standard radiological imaging follow-up protocols, 30% of recurrences are found outside these protocols, and only 10% of patients with recurrent disease have curable tumours.3,4 The search for prognostic biomarkers in RCC has led to investigations of the soluble urokinase-type plasminogen activator receptor (suPAR), a non-specific marker of systemic inflammation.5,6 suPAR has been associated with detection and survival in various diseases, including RCC.7-9 In this study, the authors’ aim was to investigate the prognostic accuracy of pre-operative plasma suPAR in predicting recurrence and survival in patients who received curative intent treatment for localised ccRCC. The authors hypothesised that an elevated pre-operative suPAR would be correlated with poorer overall survival and recurrence-free survival. MATERIALS AND METHODS Plasma from 235 patients with pathologically confirmed ccRCC and stored in a Danish National Biobank were identified for this study. Demographic and pathological data were extracted from patients’ electronic medical records. The level of suPAR, along with other factors such as age, gender, method of treatment, T-stage, Fuhrman grade, Charlson Comorbidity Index (CCI) score, presence of hypertension, level of C-reactive protein, level of haemoglobin, and presence of symptoms were analysed. The concentration of suPAR was measured using the commercial suPARnostic® (ViroGates, Birkerød, Denmark) assay kit and analysed through spectrophotometry. Descriptive statistics and the area under the curve operator were used to indicate the overall performance of the diagnostic test of suPAR. Analyses were performed using MedCalc® Statistical Software (MedCalc, Ostend, Belgium). RESULTS This study included 235 patients with ccRCC. The analysis showed that pre-operative plasma suPAR levels of ≥6 ng/mL were significant negative predictors of both overall survival (hazard ratio: 1.69; 95% confidence interval [CI]: 0.99–2.89; p=0.050) and recurrence-free survival (hazard ratio: 1.91; 95% CI: 1.03–3.57; p=0.041) (Figure 1). Furthermore, suPAR levels of ≥6 ng/mL remained a negative predictor of overall survival in multiple regression analyses (odds ratio: 5.18; 95% CI: 1.50–17.93; p=0.009). The prognostic performance of suPAR was 0.576, and adding suPAR measurements did not significantly improve the diagnostic accuracy of the Leibovich scoring system, but the combination of suPAR and T-stage had the same diagnostic performance as the Leibovich scoring system alone (area under the curve: 0.735). These findings suggest that pre-operative plasma suPAR may be a useful prognostic biomark","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135613132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Corticosteroids for Patients with Eosinophilic Diseases: An Expert Panel View on Use, Overuse, and Strategies to Reduce Use","authors":"E. Roberts","doi":"10.33590/emj/10303904","DOIUrl":"https://doi.org/10.33590/emj/10303904","url":null,"abstract":"Severe asthma (SA), chronic rhinosinusitis with nasal polyps (CRSwNP), and eosinophilic granulomatosis with polyangiitis (EGPA) are three conditions driven by IL-5 and eosinophilic inflammation. As these conditions have high use of healthcare services, as well as lifestyle and psychological burdens, safe treatment to achieve optimal control is key. In all three conditions, as for many other eosinophilic diseases (ED), oral corticosteroids (OCS) are often used for both acute and maintenance treatment where disease activity is high. While, in general, OCS are very effective, their use is limited by a well-recognised high potential for adverse effects (AE). Moreover, cumulative exposure to OCS may not be acknowledged in many patients, especially for those predominantly treated in primary care, exposing patients to potentially damaging long-term OCS-related AEs. To discuss the use of OCS for these eosinophilic diseases, as well as to provide guidance on how to help limit their use, a board of European experts within each field was gathered. The experts completed questionnaires regarding treatment and referral pathways for patients with SA, CRSwNP, or EGPA; then, in an online meeting, discussed a number of issues in regard to OCS use. Here, the authors present the key recommendations from the expert advisory panel alongside some background to these conditions regarding treatment with OCS.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73480419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocedurenone: A Novel Therapy for Uncontrolled Hypertension in Advanced Chronic Kidney Disease","authors":"J. George","doi":"10.33590/emj/10301927","DOIUrl":"https://doi.org/10.33590/emj/10301927","url":null,"abstract":"Patients with advanced-stage chronic kidney disease (CKD) have a high burden of disease, which is compounded by serious comorbidities, including diabetes, cardiovascular disease (CVD), and, most commonly, hypertension. Control of hypertension is vital in patients with advanced CKD to reduce the associated risks of morbidity and mortality, but treatment options are limited, largely due to safety concerns for the use of existing antihypertensive agents in patients with poor renal function. During interviews conducted by EMJ in November 2022, two leading specialists in nephrology and cardiology, George Bakris, American Heart Association Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine, Illinois, USA, and Faiez Zannad, Clinical Investigation Centre (CIC 1493 Inserm-CHU), Université de Lorraine, Nancy, France; and Regional and University Hospital Center (CHRU) Nancy, France, discussed the challenges of treating uncontrolled hypertension in advanced CKD. These two experts described the complicated relationship between cardiovascular and renal disease, and identified significant unmet needs for patients with uncontrolled hypertension and advanced CKD. In this context, new agents in the field were viewed with interest, including the emerging class of non-steroidal mineralocorticoid receptor antagonists (MRA). The experts highlighted data from recent studies on the novel non-steroidal MRA, ocedurenone (KBP-5074), and discussed its potential as a treatment for uncontrolled hypertension in patients with advanced CKD.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76397820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Granulocyte-Colony Stimulating Factor Biosimilars for Supportive Cancer Care: A Year in Review","authors":"H. Moir","doi":"10.33590/emjoncol/10305851","DOIUrl":"https://doi.org/10.33590/emjoncol/10305851","url":null,"abstract":"This year-in-review article provides insights into clinical updates relating to granulocyte-colony stimulating factor (G-CSF) biosimilars research presented at five key congresses in 2022. These include the American Society of Clinical Oncology (ASCO) 55th Annual Meeting (3rd–7th June 2022, Chicago, Illinois, USA), European Society for Medical Oncology (ESMO) Congress (9th–13th September 2022, Paris, France), ESMO Asia Congress (2nd–4th December 2022, Singapore), San Antonio Breast Cancer Symposium (SABCS; 6th–10th December 2022, Texas, USA), and American Society of Hematology (ASH) 64th Annual Meeting and Exposition (10th–13th December 2022, New Orleans, Louisiana, USA). Alongside reviewing the current research presented at these key congresses, with a focus on the use of G-CSF agents and biosimilars in patients undergoing treatment for breast, colorectal, and gynaecological cancers, this article provides an overview of current guidelines on the use of G-CSF in supportive cancer care to manage chemotherapy-induced febrile neutropenia and explores trends in G-CSF biosimilars research.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81019369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks and Safety in Paediatric Radiology","authors":"E. Koutsouki","doi":"10.33590/emj/10308469","DOIUrl":"https://doi.org/10.33590/emj/10308469","url":null,"abstract":"In a highly engaging session at the European Congress of Radiology (ECR)in Vienna, Austria, which took place 1st–5th March 2023 and was chaired by Hans-Joachim Mentzel, experts came together to discuss risks and safety measures, including different radiology practices in children.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"302 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74104444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heated Tobacco Products and Chronic Obstructive Pulmonary Disease: A Narrative Review of Peer-Reviewed Publications","authors":"W. Popp, Lindsay Reese, E. Scotti","doi":"10.33590/emj/10309781","DOIUrl":"https://doi.org/10.33590/emj/10309781","url":null,"abstract":"An estimated 65 million people worldwide have moderate or severe chronic obstructive pulmonary disease (COPD), an umbrella term used to describe a group of progressive lung diseases that obstruct airflow such as emphysema and chronic bronchitis. Smoking contributes to an estimated 90% of COPD cases, as the harmful chemicals produced during tobacco combustion damage the lungs and airways. Although smoking cessation is the only intervention shown to improve COPD prognosis in smokers, many patients who try to quit continue to smoke. The continued use of conventional cigarettes exacerbates COPD symptoms, and globally more than 3 million people die from the disease every year. The last two decades have seen the introduction of combustion-free nicotine delivery alternatives that produce significantly lower levels of the harmful components in cigarette smoke, and researchers have begun to assess the impact of switching from cigarettes to these products. Several studies have examined how patients with COPD use e-cigarettes as assistance for quitting, but few have examined how heated tobacco products (HTP) may reduce risk. This narrative review summarises results from pre-clinical, clinical, and real-world evidence studies showing possible harm reduction benefits for patients with COPD who switch to HTPs rather than continuing to smoke cigarettes. Epidemiological studies, real-world data analyses, and randomised clinical trials must be conducted to determine whether switching from cigarettes to HTPs can improve health outcomes in patients with COPD who would otherwise continue to smoke combustible cigarettes.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83242378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Acidosis in Children: A Literature Review","authors":"Syed Ahmed Zaki, P. Shanbag","doi":"10.33590/emj/10302459","DOIUrl":"https://doi.org/10.33590/emj/10302459","url":null,"abstract":"Metabolic acidosis is characterised by a primary decrease in the serum bicarbonate concentration, a secondary decrease in the arterial partial pressure of CO­2, and a reduction in blood pH. Metabolic acidosis, acute or chronic, may have deleterious effects on cellular function and cause increased morbidity and mortality. A systematic review of the available literature was performed to identify data on the prevalence, manifestations, cause, outcomes, and treatment of metabolic acidosis in children. Online databases (Ovid Medline, Embase, and PubMed), commercial search engines (including Google), and chapters on metabolic acidosis in the standard textbooks of paediatrics and medicine were reviewed.\u0000\u0000Systematic approach to acute metabolic acidosis starts with proper history taking and examination. This is followed by assessment of acid-base parameters, including pH, partial pressure of CO2, and bicarbonate concentration in arterial blood. Blood gas is needed to differentiate primary metabolic acidosis from compensated respiratory alkalosis. Once the diagnosis of a metabolic acidosis has been confirmed, serum electrolyte values are used to determine the serum anion gap. The various causes of increased and normal anion gap metabolic acidosis have been discussed in the article. The main aim of treatment in metabolic acidosis is to reverse the primary pathophysiology. In acute metabolic acidosis, sodium bicarbonate therapy is not beneficial due to potential complications and is reserved for specific situations. Base therapy is used in chronic metabolic acidosis where it ameliorates many of its untoward effects. Other modalities of treatment of metabolic acidosis include peritoneal or haemodialysis and tris-hydroxymethyl aminomethane.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75441505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From CoNFLict to Confidence: Solving a Diagnostic Dilemma Using Neurofilament Light – A Case Report","authors":"P. Loveland, D. Eratne, S. Holper, N. Yassi, R. Watson","doi":"10.33590/emj/10300573","DOIUrl":"https://doi.org/10.33590/emj/10300573","url":null,"abstract":"Distinguishing neurodegenerative from primary psychiatric conditions is often challenging for clinicians, particularly when assessing older people presenting with neuropsychiatric symptoms. Measurement of fluid biomarkers of neurodegeneration is an emerging approach offering improved diagnostic accuracy. This report explores the use of emerging fluid biomarkers to address diagnostic challenges, framed around a case where the diagnosis of delirium with dementia was revised based on biomarker analysis, enabling treatment of a primary mood disorder with disabling psychiatric symptoms.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84445313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}