Urinary frequency [keywords]
- Severe congenital anomalies of the kidney and urinary tract: epidemiology can inform ethical decision-making. [JOURNAL ARTICLE]
- J Perinatol 2016 Jul 28.
Decision-making for pregnancies complicated by severe congenital anomalies of the kidneys and urinary tract (CAKUT) are ethically challenging, partly because the outcomes are not well studied.Retrospective cohort study of severe cases of CAKUT over 14 years.Seventy-one of the 108 cases could be completely analyzed. Forty-six percent (n=33) infants were live-born; one-third (n=11) survived to 12 months. Twice as many non-surviving infants received a trial of therapy vs comfort care only. Two-thirds of non-survivors who received a trial of therapy died within the first 9 h of life. Live-born infants faced morbidities such as pneumothorax and neonatal dialysis.Over half of pregnancies complicated by severe CAKUT ended in termination or stillbirth, but one-third of live-born infants survived to 12 months and the majority of non-survivors died within hours. This may allay concerns about prolonged and futile intensive care for parents considering a trial of therapy.Journal of Perinatology advance online publication, 28 July 2016; doi:10.1038/jp.2016.107.
- Evaluation of exposure to phthalate esters and DINCH in urine and nails from a Norwegian study population. [JOURNAL ARTICLE]
- Environ Res 2016 Jul 25.:80-90.
Phthalate esters (PEs) and 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) used as additives in numerous consumer products are continuously released into the environment, leading to subsequent human exposure which might cause adverse health effects. The human biomonitoring approach allows the detection of PEs and DINCH in specific populations, by taking into account all possible routes of exposure (e.g. inhalation, transdermal and oral) and all relevant sources (e.g. air, dust, personal care products, diet). We have investigated the presence of nine PE and two DINCH metabolites and their exposure determinants in 61 adult residents of the Oslo area (Norway). Three urine spots and fingernails were collected from each participant according to established sampling protocols. Metabolite analysis was performed by LC-MS/MS. Metabolite levels in urine were used to back-calculate the total exposure to their corresponding parent compound. The primary monoesters, such as monomethyl phthalate (MMP, geometric mean 89.7ng/g), monoethyl phthalate (MEP, 104.8ng/g) and mono-n-butyl phthalate (MnBP, 89.3ng/g) were observed in higher levels in nails, whereas the secondary bis(2-ethylhexyl) phthalate (DEHP) and DINCH oxidative metabolites were more abundant in urine (detection frequency 84-100%). The estimated daily intakes of PEs and DINCH for this Norwegian population did not exceed the established tolerable daily intake and reference doses, and the cumulative risk assessment for combined exposure to plasticizers with similar toxic endpoints indicated no health concerns for the selected population. We found a moderate positive correlation between MEP levels in 3 urine spots and nails (range: 0.56-0.68). Higher frequency of personal care products use was associated with greater MEP concentrations in both urine and nail samples. Increased age, smoking, wearing plastic gloves during house cleaning, consuming food with plastic packaging and eating with hands were associated with higher levels in urine and nails for some of the metabolites. In contrast, frequent hair and hand washing was associated with lower urinary levels of monoisobutyl phthalate (MiBP) and mono(2-ethyl-5-hydroxyhexyl) phthalate (5-OH-MEHP), respectively.
- High-resolution Melting PCR Analysis for Genotyping Lys109Arg and Gln223Arg in Patients with Renal Cell Carcinoma. [Journal Article]
- Ann Clin Lab Sci 2016 Jul; 46(4):367-73.
Although several studies have documented the role of leptin receptor gene polymorphisms in cancers, the association between leptin receptor gene polymorphisms and renal cell carcinoma (RCC) remains unknown. The aim of this study was to develop a high-resolution melting (HRM) approach for genotyping single nucleotide polymorphisms of leptin receptor gene on the LightCycler 480, and to explore the relation between polymorphisms of the leptin receptor gene and RCC. The study population consisted of 83 patients with renal cell carcinoma and 161 healthy control subjects. The Lys109Arg (A/G) and Gln223Arg (A/G) polymorphisms of leptin receptor gene were examined with HRM assay. Direct DNA sequencing and PCR-restriction fragment length polymorphisms were used as a reference method for genotyping Lys109Arg and Gln223Arg, respectively. Three genotypes of Lys109Arg or Gln223Arg were clearly distinguishable from the melting curve shapes with HRM assay. The data also showed the results of the direct DNA sequencing or PCR-restriction fragment length polymorphisms analysis were in complete concordance to genotyping results obtained by HRM (kappa=1.0). In addition, the data showed the G-G haplotype frequency was higher (p<0.05), and that the A-G (p<0.001) and G-A (p<0.01) haplotypes frequencies were lower in the RCC than controls. We developed a rapid, low cost, high-throughput and reliable single-tube technology for genotyping Lys109Arg and Gln223Arg polymorphisms. In addition, our data suggest that Lys109Arg and Gln223Arg gene polymorphisms are associated with RCC in Chinese Han studied population.
- Polyomavirus detection in Multiple Sclerosis patients under Natalizumab therapy: Profile and frequency of urinary shedding. [JOURNAL ARTICLE]
- J Med Virol 2016 Jul 28.
Patients undergoing Natalizumab therapy are at risk of Progressive Multifocal Leukoencephalopathy. Besides JCV, BK polyomavirus might represent an additional concern for such patients since it can also infect CNS cells. Currently, data regarding the presence of anti-JCV antibodies added to previous immunosuppressive therapy and prolonged NTZ therapy has been used to classify patients at risk of developing PML. Here we investigated the profile shedding of JCV and BKV in MS patients during treatment with Natalizumab. Serial blood and urine samples from 97 MS patients receiving either Natalizumab or β-interferon were investigated for Polyomavirus shedding. While all blood samples tested negative, 36% of the patients shed Polyomavirus in the urine in at least one time point. From these, 21.7%, 9.3% and 5.1% shed JCV, BKV and both Polyomavirus, respectively. No difference was observed between the rates of urinary shedding of patients treated with Natalizumab (38.9%) and patients treated with other drugs (34.5%), also no PML event was diagnosed during the follow up. Therefore, urinary shedding might not be interfered by therapy condition. In our study we also observed 14/27 (52%) of anti-JCV antibodies prevalence, and nearly half of them (42%) did not present any event of urinary shedding during the follow-up. This article is protected by copyright. All rights reserved.
- Effect of environmental phthalate exposure on pregnancy duration and birth outcomes. [Journal Article]
- Int J Occup Med Environ Health 2016; 29(4):683-97.
The objective of this study was to evaluate the impact of phthalate exposure on pregnancy duration and birth outcomes based on the Polish Mother and Child Cohort (REPRO_PL).Phthalate exposure was determined by measuring 11 phthalate metabolites (mono-ethyl phthalate (MEP), mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), 3OH-mono-n-butyl phthalate (OH-MnBP), mono-benzyl phthalate (MBzP), mono‑ (2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-hydroxy-iso-nonyl phthalate (MHiNP), mono-oxo-iso-nonyl phthalate (MOiNP), and mono-n-octyl phthalate (MOP)) in the urine collected from 165 mothers during the third trimester of pregnancy by high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). The following measures at birth were considered: gestational age, birth weight, length as well as head and chest circumference.Pregnancy duration was inversely associated with natural log concentrations (μg/g creatinine) of MEP (standardized regression coefficient (β) = -0.2, p = 0.04) after adjustment for a variety of confounders. Significant impact of MOiNP on head circumference (β = -0.1, p = 0.05) was also observed.The study findings add further support to the hypothesis that phthalate exposure may be associated with shorter pregnancy duration and a decreased head circumference, and underscore importance of public health interventions to reduce that exposure.
- Efficacy and Safety of OnabotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. [Journal Article]
- PLoS One 2016; 11(7):e0159307.
Neurogenic detrusor overactivity (NDO) affects the quality of life (QoL) of millions of individuals worldwide. The purpose of this study was to assess the efficacy and safety of onabotulinumtoxinA in patients with NDO using a network meta-analytic approach, which can also quantify and compare the efficacy of onabotulinumtoxinA across different dosages.PubMed, EMBASE, and the Controlled Trials Register were searched to identify randomized controlled trials comparing onabotulinumtoxinA to a control for NDO in adult patients. The primary outcome was the mean number of urinary incontinence (UI) episodes per week. Urodynamic parameters included the maximum cystometric capacity (MCC) and the maximum detrusor pressure (MDP). The safety of onabotulinumtoxinA was determined by the incidence of various frequent adverse events (AEs). Two authors extracted data independently, and the statistical analyses were performed using RevMan 5.1.0 software.A total of 1,915 patients from six randomized controlled trials were included in this meta-analysis. The onabotulinumtoxinA-treated groups had a significantly decreased mean number of urinary incontinence episodes per week (at week 6) (onabotulinumtoxinA200U: MD: -10.72, 95% CI: -13.4 to -8.04, P<0.00001; 300 U: MD: -11.42, 95% CI: -13.91 to -8.93, P<0.00001), MDP (200 U: MD: -33.46, 95% CI: -39.74 to -27.18, P<0.00001; 300 U: MD: -31.72, 95% CI: -37.69 to -25.75, P<0.00001), and greater increased MCC (200 U: MD: 141.30, 95% CI: 121.28 to 161.32, P<0.00001; 300 U: MD: 151.39, 95% CI: 130.43 to 172.34, P<0.00001) compared to the placebo-treated groups. However, there were no significant differences between the onabotulinumtoxinA-treated groups for the number of weekly UI episodes at 6 weeks (MD: 0.08, 95% CI: -2.57 to 2.73, P = 0.95). Similarly, we also observed that there were no significant differences in MCC (MD: -9.97, 95% CI: -33.15 to 13.20, P = 0.40) and MDP (MD: -1.86, 95% CI: -8.09 to 4.37, P = 0.56). Considering the AEs, the onabotulinumtoxinA-treated groups were often associated with more complications, including urinary tract infections (UTIs) (RR: 1.47, 95% CI: 1.29 to 1.67, P<0.00001), urinary retention (RR: 5.58, 95% CI: 3.53 to 8.83, P<0.00001), hematuria (RR: 1.70, 95% CI: 1.01 to 2.85, P = 0.05), and muscle weakness (RR: 2.59, 95% CI: 1.36 to 4.91, P = 0.004).OnabotulinumtoxinA can significantly reduce the frequency of urge urinary incontinence and improve urodynamic parameters (MCC and MDP) in patients with NDO at 6 weeks after treatment. This meta-analysis indicates that onabotulinumtoxinA is effective and safe for treating patients with NDO compared to placebo. Additionally, we did not observe any statistical or clinical differences in efficacy between 300 and 200 U dosages.
- Cadmium and lead exposure and risk of cataract surgery in U.S. adults. [JOURNAL ARTICLE]
- Int J Hyg Environ Health 2016 Jul 19.
Cataract is a major cause of visual dysfunction and the leading cause of blindness. Elevated levels of cadmium and lead have been found in the lenses of cataract patients, suggesting these metals may play a role in cataract risk. This study aimed to examine the associations of blood lead, blood cadmium and urinary cadmium with cataract risk. We identified 9763 individuals aged 50 years and older with blood lead and cadmium levels, and a randomly selected subgroup of 3175 individuals with available urinary cadmium levels, from the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2008 (mean age=63years). Participants were considered to have cataract if they self-reported prior cataract surgery in NHANES's vision examination. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using survey logistic regression models. We identified 1737 cataract surgery cases (the weighted prevalence=14.1%). With adjustment for age, race/ethnicity, gender, education, diabetes mellitus, body mass index, cigarette smoking (serum cotinine and pack-years) and urine hydration, every 2-fold increase in urinary cadmium was associated with a 23% higher risk of cataract surgery (OR=1.23, 95% CI: 1.04, 1.46, p=0.021). We found no associations of cataract surgery with blood cadmium (OR=0.97, 95% CI: 0.89, 1.07) and blood lead (OR=0.97, 95% CI: 0.88, 1.06). Mediation analysis showed that for the smoking-cadmium-cataract pathway, the ratio of smoking's indirect effect to the total effect through cadmium was more than 50%. These results suggest that cumulative cadmium exposure may be an important under-recognized risk factor for cataract. However, these findings should be interpreted with a caution because of inconsistent results between urinary cadmium and blood cadmium.
- Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible? [JOURNAL ARTICLE]
- Neurourol Urodyn 2016 Jul 26.
Underactive bladder (UAB) is a symptom complex with poorly characterized causation. The aim of this study was to determine if clinical and UDS parameters differed between categories of presumed detrusor underactivity (DU) etiologies.A retrospective review was performed at a single institution from 2011 to 2015 to identify patients with symptoms of UAB. Patients were excluded if they were male, had anti-incontinence, or pelvic organ prolapse (POP) surgery within 1 year, or the UDS did not demonstrate DU as defined within. Subjects were stratified by etiology into four cohorts: cardiovascular disease manifestations (CV), cardiac risk factors (CVR), neurologic (N), or idiopathic (I). Patient demographics, comorbidities, symptomatology, physical exam, and UDS parameters were compared.A total of 200 patients met inclusion criteria (CV: n = 53 [26.5%], CVR: n = 44 [22%] N: n = 81 [40.5%], I: n = 22 [11%]). Women in the CV cohort were significantly older and more likely to be post-menopausal (P < 0.001). There were no differences between cohorts for BMI (P = 0.48), recurrent UTI (P = 0.63), history of urinary retention (AUR) (P = 0.65), POP (0.49), American Urological Association Symptom Score (AUA-SS) (P = 0.06), presenting symptomatology [urgency, frequency, urgency urinary incontinence, AUR, incomplete emptying, hesitancy, UTI (P = 0.97)], or UDS parameters (first sensation [P = 0.25], normal desire [P = 0.80], strong desire [P = 0.58], capacity [P = 0.11], Qmax [P = 0.50], Pdet at Qmax [P = 0.22], post-void residual [P = 0.82]).Though differences were observed between cohorts for age and menopausal status, clinical or urodynamic parameters did not demonstrate distinct differences across presumed categories of etiology, suggesting that the etiology of DU may be multifactorial. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.
- Successful use of cyclosporine as treatment for eosinophilic cystitis: a case report. [Journal Article]
- World Allergy Organ J 2016.:22.
Eosinophilic cystitis is a rare inflammatory disorder characterized by eosinophilic infiltration of all layers of the urinary bladder wall. Due to lack of consensus and potential for side effect from various therapeutic options, treatment of the disease is often challenging.A 64-year old woman with hypertensive nephropathy resulting in stage III chronic kidney disease, obstructive sleep apnea, and obstructive lung disease presented with a 4 month history of dysuria, urgency, frequency, and persistent hematuria. Based on eosinophilic infiltration on bladder wall biopsy in the absence of any evidence of infection, malignancy, or immune disorder, she was diagnosed with eosinophilic cystitis. Despite multiple medication regimens, her symptoms persisted, requiring high-dose prednisone with steroid-related side effects. After four months, she was started on cyclosporine, which led to symptomatic improvement and reduction in prednisone dosage. At that time, repeat urine cytology and cystoscopy did not reveal friable tissues or eosinophiluria.This case illustrates the utility of using cyclosporine to treat eosinophilic cystitis in adult patient with multiple comorbid conditions.
- Prevalence of overlap syndromes and symptoms in pediatric functional dyspepsia. [Journal Article]
- BMC Gastroenterol 2016; 16(1):75.
The purpose was to evaluate the overlap frequency of irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and overactive bladder syndrome (OBS), as well as other gastrointestinal and systemic symptoms, in functional dyspepsia (FD). Additionally, we sought to determine whether adult Rome III FD subtypes were uniquely related to overlap syndromes or symptoms.The study was a retrospective review of 100 consecutive pediatric patients, age 8-17 years, diagnosed with FD. All had completed a standardized medical history including gastrointestinal and systemic symptoms as well as specific symptoms related to GERD and OBS. The frequency of overlap with IBS, GERD, and OBS were determined for the whole group and for those fulfilling adult FD subtype criteria. Individual symptoms were also compared by FD subtype.Overlap IBS was present in 33 % of the FD patients. At least one GERD symptom was present in 74 % of patients with 41 % reporting heartburn. At least one OBS symptom was present in 44 % of patients with 29 % reporting urinary urgency. Other than pain, the most common reported gastrointestinal symptom was nausea (86 %). Systemic symptoms were common. Overlap syndromes/symptoms did not vary by FD subtype. Postprandial distress syndrome was associated with pain with eating, weight loss, and waking at night to have a stool.FD is a heterogeneous condition in children and adolescents with significant variability in the presence of gastrointestinal and non-gastrointestinal symptoms and overlap syndromes. Varying symptom profiles need to be accounted for and analyzed in studies involving subjects with FD.