Botulinum Toxin Type A Injections for Refractory Abdominal Dystonia: A Case Report

Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed in a handpocket direction to the inferomedial abdomen just below the umbilicus. Subsequent dose titration followed the same injection protocol. Methods: Per Bon Secours Mercy Health IRB policy, this case report does not qualify for Mercy Health North IRB, and a formal statement from them has been obtained. Results: When compared to baseline, the patient’s abdominal pain and spasms reduced 33%, with a simultaneous 50% reduction total daily duration by week 1. On week 12, the patient reported exceptional functionality, sleep improvement, and no reduction of postural stability. With symptoms worsening days prior to week 12 follow up, BTX-A dosage was increased to 240U (120U each side). By week 24 follow-up, the patient has an 88% pain reduction from baseline, and eradication of spasms. During this visit, 360U (180U each side) was injected for longer therapeutic relief. The patient will now only return as needed for subsequent injections. Conclusion: To our knowledge, this is the first case reporting the use of BTX-A injection therapy for cirrhosis induced abdominal spasms refractory to traditional interventions. BTX-A injection under electromyography and ultrasound guidance appears to be a safe and effective treatment for refractory chronic abdominal spasms

Metagenomics in diagnosis and improved targeted treatment of UTI

INTRODUCTION: The genomic revolution has transformed our understanding of urinary tract infection. There has been a paradigm shift from the dogmatic statement that urine is sterile in healthy people, as we are becoming forever more familiar with the knowledge that bacterial communities exist within the urinary tracts of healthy people. Metagenomics can investigate the broad populations of microbial communities, analysing all the DNA present within a sample, providing comprehensive data regarding the state of the microenvironment of a patient's urinary tract. This permits medical practitioners to more accurately target organisms that may be responsible for disease-a form of 'precision medicine'. METHODS AND RESULTS: This paper is derived from an extensive review and analysis of the available literature on the topic of metagenomic sequencing in urological science, using the PubMed search engine. The search yielded a total of 406 results, and manual selection of appropriate papers was subsequently performed. Only one randomised clinical trial comparing metagenomic sequencing to standard culture and sensitivity in the arena of urinary tract infection was found. CONCLUSION: Out of this process, this paper explores the limitations of traditional methods of culture and sensitivity and delves into the recent studies involving new high-throughput genomic technologies in urological basic and clinical research, demonstrating the advances made in the urinary microbiome in its entire spectrum of pathogens and the first attempts of clinical implementation in several areas of urology. Finally, this paper discusses the challenges that must be overcome for such technology to become widely used in clinical practice

Pulmonary and intranasal delivery of thymoquinone-loaded nanoparticles for Mucormycosis & Covid-19

India is currently reporting a massive increase of mucormycosis infection among Covid-19 patients. The opportunistic black fungus infection affects the lungs and the brain. Depending on the infected organs, morbidity and mortality rates are between 50% and 100%. To save patients’ life, it is frequently necessary to remove jaws and eyes. The drug of first of choice for the treatment of mucormycosis in the subcontinent is Amphotericin B. There are two problems with Amphotericin B: First, it is currently not available in many pharmacies in India, and second, its effect is restricted by its limited passage across the blood-brain-barrier. Recently, it was shown that thymol is highly effective against Rhizopus oryzea, the fungus causing 70% of mucormycosis. In contrast to Amphotericin B, which in the case of mucormycosis is administered intravenously, thymol can reach the lungs via inhalation and the brain via the nose-to-brain route. Importantly, thymoquinone (TQ) has all the relevant biological properties of thymol and has been already successfully used to treat Covid-19, as demonstrated in clinical studies. Additionally to the action spectrum of thymol, TQ has the capacity to act as a reactive oxygen species and oxidize pathogens upon contact, thereby recommending itself for both treatment of Covid-19 and infections with the black fungus. For maximum efficacy, comprising biodistribution and bioavailability and drug, functionality we describe innovative strategies based on nanomedicines for targeted delivery of TQ to the lungs as well as for intranasal delivery to the brain, bypassing the blood-brain-barrier

Fosfomycin Trometamol in Patients with Renal Insufficiency and in the Elderly

Single oral dose therapy with fosfomycin trometamol (FT) 3 g is recommended inthe treatment of uncomplicated urinary tract infection (UTI) not only in premenopausal,but also in postmenopausal elderly, otherwise healthy women. It can alsobe used as reapplication every 10 days for prophylaxis of recurrent uncomplicatedcystitis. FT 3 g has also been used with two oral doses of 3 g (on two consecutivedays) for perioperative prophylaxis in transurethral interventions or with three doses(every other day, three times) for treatment of complicated lower UTI includingmany elderly patients. The tolerance and safety in the patients above 65 yearsof age did not differ from younger ones. Therefore, there is also an indication toadminister oral FT 3g in adults above 65 years of age for treatment or prophylaxisof uncomplicated UTI.Patients with renal insufficiency up to a creatinine clearance of 20 ml/min can beexpected to have still sufficiently high urinary concentrations of fosfomycin, thattreatment of cystitis should be justified from pharmacokinetic/pharmacodynamicpoint of view. From preliminary clinical results there is also an indication to useoral FT 3 g in adults with renal insufficiency up to a creatinine clearance of 20 ml/min, with single dose for treatment of lower uncomplicated UTI with otherwisenormal urinary tract or with repeated doses (every second or third day accordingto the degree of renal insufficiency) for treatment of lower complicated UTI causedby fosfomycin susceptible pathogens resistant to other oral antimicrobial drugs

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1

Objectives: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Materials and Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, ­EMBASE, and the Cochrane Library to identify literature published in 2010–2015. Results: We provide 75 recommendations and 68 statements in the updated evidence- and consensus-based national clinical guideline. The diagnostics part covers practical recommendations on cystitis and pyelonephritis for each defined patient group. Clinical examinations, as well as laboratory testing and microbiological pathogen assessment, are addressed. Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients. Part II: Therapy and Prevention

Background: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs. Materials and Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010–2015. Results: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection. Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients

Bearberry in the treatment of acute uncomplicated cystitis (BRUMI) : protocol of a multicentre, randomised double-blind clinical trial

Bearberry (Arctostaphylos uva-ursi) leaf is available as a treatment of uncomplicated cystitis in several European countries. The antimicrobial activity of its extracts and some of its individual constituents has been observed in vitro; however, the efficacy of bearberry compared with standard antimicrobial therapy has not been assessed yet.The objective of the study is to assess the safety and non-inferiority of bearberry as an alternative therapy in the treatment of acute uncomplicated cystitis in comparison with standard antibiotic therapy (fosfomycin).This is a randomised controlled double-blinded multicentre trial. Eligible patients will be premenopausal women with a sum score of ≥6 for the typical acute uncomplicated cystitis symptoms (frequency, urgency, painful urination, incomplete emptying, suprapubic pain and visible haematuria) reported on the Acute Cystitis Symptom Score (ACSS) typical domain and pyuria. Patients will be randomly assigned to receive 3 g single dose of fosfomycin powder and two placebo tablets three times a day for 7 days or B a single dose of placebo powder and two tablets containing a dry extract of Uvae ursi folium. At least 504 patients (allocated as 1:1) will need to be enrolled to access non-inferiority with a non-inferiority limit of 14% for the primary endpoint.Improvement of symptoms of uncomplicated cystitis (based on the ACSS score) at day 7 is defined as the primary endpoint, whereas several secondary endpoints such as the number and ratio of patients with bacteriuria at day 7, frequency and severity of side effects; recurrence of urinary tract infection, concurrent use of other over the counter (OTC) medications and food supplements will be determined to elucidate more detailed differences between the groups. The number of recurrences and medications taken for treatment will be monitored for a follow-up period of 90 days (80-100 days).This study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/4225-1/2021/EKU). The results will be disseminated by publication of peer-reviewed manuscripts.NCT05055544

Prostate biopsy-related infection: a systematic review of risk factors, prevention strategies, and management approaches

A systematic review to identify risk factors for prostate biopsy-related infection, preventative strategies, and optimal management of infectious complications was conducted. Significant risk factors for postbiopsy infection include urogenital infection, antibiotic use, international travel, hospital exposure, bacteriuria, previous transrectal biopsy, and resistance of fecal flora to antibiotic prophylaxis (especially fluoroquinolones). Patients at risk may benefit from an adjusted biopsy protocol comprising transrectal biopsy under targeted prophylaxis, and/or the use of rectal disinfection techniques or using a transperineal approach. Management of biopsy-related infection should be based on individual risk and local resistance profiles with input from multiple specialties