Serum uric acid is associated with chronic kidney disease (CKD) progression; however, causality remains uncertain. Although renal urate handling, rather than merely hyperuricemia, may dominate kidney outcomes, the prognostic value of urinary urate indices and the potential modifying effect of urate-lowering therapy (ULT) remain unclear.

High temperature is a major risk factor for kidney injury, and population exposure to nighttime heat is increasing as the climate warms. However, whether renal responses to heat exposure differ between daytime and nighttime remains unclear. Forty-one healthy adults participated in a randomized crossover experiment conducted in a controlled laboratory setting. Participants were exposed to heat (32°C during daytime; 30°C during nighttime) and thermoneutral conditions (26°C) for 8 hours. Blood and urine samples were collected before and after each exposure to examine various renal biomarkers reflecting glomerular filtration function, tubular injury, and early kidney stress. Heat exposure affected both blood and urinary biomarkers of kidney function, with notable diurnal differences in renal responses. Daytime heat exposure primarily affected blood markers of glomerular filtration, increasing creatinine by 7.67% (95% CI: 4.73%-10.61%) and cystatin C by 3.05% (95% CI: 0.17%-5.93%), while reducing estimated glomerular filtration rate by 0.05% (95% CI: 0.02%-0.08%). In contrast, nighttime heat exposure predominantly elevated urinary biomarkers of early kidney stress, including insulin-like growth factor-binding protein 7 (58.40%, 95% CI: 27.66%-89.14%), kidney injury molecule-1 (47.25%, 95% CI: 18.91%-75.59%), and tissue inhibitor of metalloproteinases-2 (51.88%, 95% CI: 22.26%-81.51%). Moreover, increases in insulin-like growth factor-binding protein 7 were significantly greater at night than during the day. Sleep-related parameters, including sleep quality, duration, and heart rate variability, partially mediated nighttime heat effects on renal responses. These results indicated that heat exposure induced different diurnal patterns in renal responses.

Carbapenem resistance in Pseudomonas aeruginosa and Enterobacterales is a growing threat, with intrinsic and acquired resistance mechanisms resulting in the need for new therapeutic options. In Peru, data on resistance patterns and the effectiveness of new antibiotic combinations are limited A descriptive, cross-sectional, retrospective study was conducted on P. aeruginosa and Enterobacterales clinical isolates collected from 2019 to 2024 at a reference laboratory in Lima, Peru, originating from various public and private healthcare centers. Bacterial identification was performed using VITEK MS MALDI-TOF, and antimicrobial susceptibility testing via VITEK 2 and/or Kirby-Bauer disk diffusion. Carbapenemase production was detected using colorimetric, immunochromatographic, and molecular methods, including the FilmArray® BCID panel for bloodstream infections. Microbiological and epidemiological variables were analyzed with Poisson regression models. A total of 173,308 isolates were analyzed, with E. coli (74%) and K. pneumoniae (10.6%) being most prevalent. Most samples (92%) were urinary. Meropenem resistance in P. aeruginosa reached 33% overall and 60% in respiratory specimens. K. pneumoniae showed 3.4% carbapenem resistance. Among carbapenem-resistant isolates, 43.7% were carbapenemase producers. Carbapenemase production was highest in carbapenem-resistant K. pneumoniae (93.1%), E. coli (87.3%), and P. mirabilis (77.3%), but only 32.7% in P. aeruginosa. Among carbapenemase-producing Enterobacterales, metallo-β-lactamases predominated, with bla-NDM detected in 69.6% of K. pneumoniae and bla-OXA-48-like in 100% of E. coli. Ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T) were highly active (>89%) against non-carbapenemase-producing P. aeruginosa, but <1% effective against producers. Resistance was more common in northern, eastern, and southern Lima. P. aeruginosa exhibited high carbapenem resistance, largely driven by non-carbapenemase mechanisms, supporting the role of C/T for treatment of non-carbapenemase-producing carbapenem-resistant P. aeruginosa. Among Enterobacterales, carbapenemase production was frequent in carbapenem-resistant isolates, with metallo-β-lactamases predominating. The limited activity of CZA against MBL producers underscores the urgent need for novel β-lactam/β-lactamase inhibitor combinations to address MBL-producing Enterobacterales.

ObjectiveThis retrospective observational cohort study aimed to evaluate the mid-term results of anterior vaginal mesh combined with bilateral vaginal extraperitoneal high uterosacral ligament suspension (EHUS) versus sacrospinous ligament fixation (SSLF) for advanced anterior and apical pelvic organ prolapse without hysterectomy.MethodsIn total, 143 patients (age ≥60 years) with apical and anterior prolapse stage ≥2 who underwent surgery for pelvic organ prolapse were retrospectively reviewed. The primary outcome was the effect of the procedures on anatomical reduction (pelvic organ prolapse, stage ≤1) and subjective cure defined as negative response to questions 2 and 3 on the Pelvic Organ Prolapse Distress Inventory-6. The main secondary outcomes included complication and improvement of questionnaire scores based on Pelvic Organ Prolapse Distress Inventory-6, Urogenital Distress Inventory-6, and Patient Global Impression of Improvement.ResultsBetween 2016 and 2023, 80 eligible women underwent EHUS and 63 underwent SSLF. There was significant improvement in the postoperative Pelvic Organ Prolapse Quantification System scores of all patients in both groups. The objective success rate at the 3-year follow-up was 94.7% for EHUS and 96.7% for SSLF (p = 0.999). The procedure duration for the SSLF group was longer than that for the EHUS group (p < 0.001). No bladder or ureteric injury and mesh exposure occurred in either group. The proportion of patients who experienced postoperative pain in the SSLF group was higher than that in the EHUS group (8 vs. 2, p = 0.041). There were significant improvements in the quality of life scores postoperatively. Persistent complaints were primarily related to incomplete resolution of lower urinary tract symptoms.ConclusionThe efficacy of transobturator synthetic nonabsorbable anterior vaginal mesh combined with EHUS was comparable with that of SSLF, even at the 3-year follow-up. However, EHUS was associated with a shorter procedure time and a reduced incidence of perioperative and postoperative complications.

Delafloxacin (DLX) is a novel fluoroquinolone (FQ) with enhanced activity against gram-positive bacteria and under acidic conditions. Since the pH of urine is usually acidic, DLX could be an alternative to current drugs for urinary tract infections (UTIs), especially in male patients, for whom good prostatic tissue penetration is required. The aim of this study was to evaluate in vitro the activity of DLX and FQ comparators against Enterococcus faecalis and Enterococcus faecium, to characterize the resistance pattern of E. faecalis against FQs, and to decipher the genetic basis of resistance among in vitro-selected mutants. DLX showed higher in vitro activity than both levofloxacin and moxifloxacin against E. faecalis, with an MIC50 of 0.06 mg/L, which was 16- and 4-fold lower than those of these two FQs, respectively. None of the three antibiotics was effective against E. faecium (MICs mostly >8 mg/L). DLX exhibited increased activity under acidic conditions, as the MIC50 for 12 E. faecalis isolates decreased by a 3-log2 dilution between pH 7.2 and pH 5, whereas comparator activities were impaired. A total of 19 mutants with significant increases in DLX MICs were selected in vitro, including 12/19 (63%) with at least one mutation in the quinolone resistance-determining region (QRDR) of GyrA (mainly at the position S84). Interestingly, four mutants lacked QRDR mutations but carried mutations in eno or infB genes, which have not previously been reported in FQ resistance. In conclusion, DLX showed greater in vitro activity than levofloxacin and moxifloxacin against E. faecalis isolates, especially under acidic conditions, suggesting its potential use for treating male UTIs.

Population-based data on Serratia bacteraemia are limited. We conducted a population-based cohort study of patients with a first-time episode of Serratia bacteraemia in the North Denmark Region between 1 January 2010 and 30 June 2024 (catchment population ~590,000). Clinical and microbiological data were obtained from medical records and the regional microbiological database. A total of 188 patients were identified. The median age was 70 years (IQR 60-78), 66% were male and 48% had a high Charlson Comorbidity Index score (≥ 3). The annual incidence remained stable at 2.1 per 100,000 person-years (95% CI 1.8-2.5). Bacteraemia was community-acquired in 38% of patients, healthcare-associated in 2% and hospital-acquired in 37%. The most common foci of infection were the urinary tract (25%), hepatobiliary tract (20%) and respiratory tract (14%), while a focus was not identified in 28% of patients. Thirty-day all-cause mortality was 24%. In an exploratory adjusted Poisson regression analysis, increasing age (RR 1.02, 95% CI 1.00-1.05) and high comorbidity (RR 2.58, 95% CI 1.01-6.63) were associated with increased mortality, whereas acquisition was not. Serratia bacteraemia predominantly affected older patients with substantial comorbidity and was associated with considerable mortality. Host-related factors appeared to be important determinants of outcome.

Pancreatic calcification is a hallmark structural change of chronic pancreatitis. However, few reports have described extensive diffuse pancreatic calcification that develops within a relatively short period after acute pancreatitis and is incidentally detected during urological evaluations. We report the case of a 34-year-old man who presented with urinary frequency, gross hematuria, and the passage of sand-like material in his urine. He had smoked five cigarettes per day and consumed alcohol on approximately 10 occasions per month since the age of 29 years, when abnormal liver function was noted on routine tests, and he developed acute pancreatitis at the age of 31 years. Computed tomography (CT) and magnetic resonance cholangiopancreatography performed at that time revealed no pancreatic calcifications. At the current presentation, he was diagnosed with acute bacterial prostatitis, and a urine culture yielded Escherichia coli. A kidneys, ureters, and bladder (KUB) radiograph performed to evaluate suspected urolithiasis incidentally revealed multiple calcified densities in the pancreatic region. Moreover, noncontrast CT demonstrated extensive diffuse calcifications involving the entire pancreas, with mild pancreatic enlargement. Serum calcium, IgG4, intact parathyroid hormone, and HbA1c levels were within the normal ranges, suggesting that alcohol consumption and smoking were the most likely etiological factors. This case suggests that extensive calcific chronic pancreatitis can develop within a relatively short period following acute pancreatitis. Clinicians evaluating KUB radiographs and CTs performed for urological indications should systematically check for clinically significant incidental findings outside the urinary tract.

Urinary retention is a known adverse effect of opioids, but limited information is available on how this adverse event varies among individual opioids. This study evaluated disproportionality signals between major opioids and urinary retention using the Japanese Adverse Drug Event Report database (JADER). We performed a disproportionality analysis of reports submitted between April 2004 and October 2025. Signals were assessed using reporting odds ratios (RORs), 95% confidence intervals (CIs), and the Information Component (IC). Adverse events were identified using the Medical Dictionary for Regulatory Activities/Japanese version (MedDRA/J) term "urinary retention." A sensitivity analysis was conducted using a broader definition of urinary dysfunction that also included "Dysuria." Time to onset was calculated from the start of opioid administration to event onset, and daily doses were converted to oral morphine equivalents. Significant signals were detected for morphine, oxycodone, tramadol, and codeine. Transdermal fentanyl was the only opioid without a detectable signal, even under the broader definition of urinary dysfunction. Among opioids with detected signals and available dose information, urinary retention was reported even at relatively low morphine-equivalent doses, suggesting the need for careful monitoring at the start of opioid therapy. The absence of a signal for transdermal fentanyl may reflect a lower reporting frequency in JADER, but not a lower clinical risk, of urinary retention. Given the limitations of spontaneous reporting systems, these findings are hypothesis-generating and are insufficient to guide opioid selection or switching.