Nephrogenic diabetes insipidus in a geriatric patient affected by SARS-CoV-2: complexity of a diagnosis, complexity of a virus

BACKGROUND: Coronavirus disease 2019 (COVID-19) has an important impact on the kidney through direct and indirect damage mechanisms. Most previous studies have highlighted lesions caused by this virus in the early segments of the nephron. However, due to the antigenic characteristics of the virus, with almost ubiquitous receptors, and the molecular release it triggers, the distal segments of the nephron could also be affected. METHODS: A 71 year-old-man with respiratory failure while suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia presented with typical symptoms of diabetes insipidus after ~20 days of hospitalization. The water deprivation test led to the diagnosis of nephrogenic diabetes insipidus. The aetiological study was complex, in particular because of the patient’s previous lithium therapy. RESULTS: The sequence of pathognomonic events typical of diabetes insipidus associated with anamnestic, clinical and laboratory evidence strongly supported the diagnosis of nephrogenic diabetes insipidus due to SARS-CoV-2 rather than other aetiologies. CONCLUSIONS: The collecting duct could represent a target for SARS-CoV-2 infection, directly or indirectly, as a result of lesions of upstream portions of the nephron, which would cascade into the distal segment. Other molecules, besides angiotensin 2 converting enzyme, might be involved in facilitating the viral aggression. The complexity of the geriatric patient shows the importance of a comprehensive approach that integrates careful monitoring of clinical signs and symptoms and laboratory and instrumental tests. This is especially important in the context of SARS-CoV-2 infection and in the management of its unexpected complications

High diversity of genes and plasmids encoding resistance to third-generation cephalosporins and quinolones in clinical Escherichia coli from commercial poultry flocks in Italy

The aim was to investigate occurrence and diversity of plasmid-mediated resistance to third-generation cephalosporins (3GC) and quinolones in clinical Escherichia coli from 200 industrial poultry farms across Italy. E. coli was isolated from colibacillosis lesions in turkeys (n = 109), broilers (n = 98) and layers (n = 22) between 2008 and 2012. 3GC-resistant isolates were screened for extended-spectrum and AmpC \u3b2-lactamase (ESBL/AmpC), while all isolates were tested for plasmid-mediated quinolone resistance (PMQR) genes. ESBL/AmpC - and PMQR-positive isolates were typed by pulsed-field gel electrophoresis and antimicrobial susceptibility testing, and their plasmids were characterised by replicon typing, multilocus sequence typing, restriction fragment length polymorphism and conjugation. EBSL/AmpC genes (blaCTX-M-1, blaCTX-M-14, blaCTX-M-2, blaSHV-12 and blaCMY-2) were detected in 7%, 9% and 4% of isolates from turkeys, broilers and layers, respectively. We identified seven ESBL/AmpC-encoding plasmid types, usually conjugative (78%), with a marked prevalence of IncI1/pST3 plasmids carrying blaCTX-M-1. PMQR occurred less frequently among isolates from turkeys (0.9%) compared to those from broilers (5%) and layers (4%). The PMQR genes qnrS, qnrB19 and oqxA/B were located on three plasmid types and two non-typeable plasmids, mostly (85%) conjugative. ESBL/AmpC- and PMQR-positive isolates were genetically unrelated and 64% of them were additionally resistant to aminoglycosides, sulfonamides and tetracyclines. Our data show that 3GC- and quinolone-resistant clinical E. coli in Italian poultry production represent a highly diverse population often resistant to most antimicrobials available for poultry. These findings underline the crucial need to develop new strategies for prevention and control of colibacillosis

Outbreak of Saprochaete clavata Sepsis in Hematology Patients: Combined Use of MALDI-TOF and Sequencing Strategy to Identify and Correlate the Episodes

New fungal species are increasingly reported in immunocompromised patients. Saprochaete clavata (S. clavata), an ascomycetous fungus formerly called Geotrichum clavatum, is intrinsically resistant to echinocandins and is often misidentified

QUALITY OF LIFE IN 171 PATIENTS WITH BLADDER CANCER UNDERGOING ILEAL ORTHOTOPIC NEOBLADDER: LONG-TERM RESULTS

Introduction: Patients undergoing urinary radical cystectomy (RC) and urinary diversion for bladder cancer had some limitations in health-related quality of life (HRQOL). At present there are no sufficient studies to evaluate the levels of discomfort caused by different urinary diversion in survivors. In the present study we used the validated Italian version of QLQ-BLM30 to assess bladder cancer-specific HRQOL in patients with ileal orthotopic neobladder (IONB) after RC. Patients and Methods: From June 2007 to September 2012, a total of 171 consecutive patients with bladder cancer (156 males and 15 females), who underwent RC with IONB in five urological academic centres, were included in this study. All patients had no evidence of tumor recurrence and were actively followed-up. Clinical and pathological data as well as clinical outcomes were retrospectively analyzed. HRQOL was analyzed using Italian versions of the EORTC BLM30 questionnaires. Questionnaire results were analyzed in order to evaluate the HRQOL in patients with IONB at different times of follow-up (1-18, 19-36, 37-72 and 6573 months). Mean values with standard deviations (\ub1SD) were computed for all items. Wilcoxon rank test was used to verify differences by comparing the short follow-up (1-18 months, first quartile) with subsequent quartiles of follow-up. Statistical significance was achieved if p -value was 640.05. Results: The median age of the patients was 66 years. The pTNM\u2013UICC stages were 36.8% (0-I), 46.2% (II), and 17.0% (III-IV stage). 17 (9.9%) patients underwent adjuvant chemotherapy. The median of follow-up was 38 months. The number of patients for each quartile of follow-up were: 43, 42, 35, and 51, respectively for 1-18, 19- 36, 37-72, and 6573 months. Our data showed that patients with a long-term follow-up ( 6573 months) had an improvement in HRQOL in urinary symptoms in comparison with patients with short-term follow-up (1-18 months) (34.1\ub123.6 vs . 18.9\ub121.1 - p= 0.0004) as well as in sexual life (96.9\ub18.5 vs. 83.7\ub125.2 - p= 0.005). Conversely we found a worse HRQOL in patients with long-term follow-up regarding the abdominal bloating and flatulence (8.9\ub122.2 vs . 17.6\ub120.9 - p= 0.003). In addition in patients with an intermediate follow-up (37-72 months) we found a poor HRQOL in body image (23.8\ub127.6 vs. 35.6\ub127.5 - p= 0.02), and sexual functioning (13.8\ub123.8 vs. 21.9\ub124.5 - p= 0.04). Discussion and Conclusion: The patients with IONB show a progressive decrease of limitations of HRQOL during the years demonstrating a high adaptability to the new body image. Our study based on long-term follow-up in patients undergoing RC with IONB showed improvement in HRQOL with regards to the role of urinary symptoms and sexual life

A COMPARATIVE MULTICENTER QUESTIONNAIRE SURVEY ON QUALITY OF LIFE IN ELDERLY PATIENTS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: A COMPARISON BETWEEN ORTHOTOPIC NEOBLADDER AND ILEAL CONDUIT

INTRODUCTION AND AIM OF THE STUDY Bladder Cancer (BC) is the most common malignancy of the urinary tract and the seventh most common cancer in men and the 17th in women [1]. In the literature, several surgical options of urinary diversion after RC have been described, from simply diverting the urine through a conduit to orthotopic reconstruction The number of elderly patients candidates for radical cystec- tomy (RC) as treatment for bladder cancer is now increasing. Although for younger patients orthotopic neobladder after RC has gained popularity, this type of diversion can be suitable for elderly adults with no additional morbidity compared with an ileal conduit. Sparse data have been published on the comparison of these two types of diversion in elderly patients focusing the attention on QoL. The aim of the study was to evaluate QoL in elderly patients with bladder cancer who received an orthotopic neobladder of an ileal conduit after radical cystectomy (RC). MATERIALS AND METHODS A cross-sectional study analyzing files from 77 patients aged 75 or older (median age 77), who had received an orthotopic neobladder (n. 26, group 1) or an ileal conduit (n. 51, group 2) after RC at 5 Italian institutions was performed. QoL was evaluated by using the Italian version of the European Organisation for Research and Treatment of Cancer (EORTC) instruments quality of life questionnaire C30 (QLQ-C30), a 30- item questionnaire that incorporates five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea/vomiting), and a global health and quality-of-life scale [2] and QLQ muscle invasive bladder cancer module (QLQ-BLM). RESULTS Patient s’ group s were comparable except for gender (0.029), pT stage (0.022), and long term complications (0.005). The scores of all th e QLQ multi-item scales and single-item measures were comparable in the two groups except for the following domains in favor of group 1 pati ents: cognitive functioning (0.008), sleep (0.048), appetite loss (0.033), constipation (0.001), financial difficulties (0.043). Using the propensity score matching, pati ents with orthotopic neo- bladder showed better but not significant QOL scores for the domains of cognitive functioning (0.069) and financial difficult ies (0.065). INTERPRETATION OF RESULTS The results of our study suggest that an orthotopic neobladder in elderly male patients with a low pT stage without long-term complication rate can offer better scores for some aspects of QoL when comparing to ileal conduit CONCLUSIONS Orthotopic neobladder in elderly patients may offer a better quality of life aspects, when compared to ileal condui

QUALITY OF LIFE IN SURVIVORS FROM RADICAL CYSTECTOMY. THE USE OF QUALITATIVE ANALYSIS

INTRODUCTION AND OBJECTIVES Not so many studies have been dedicated to the trajectory of QoL along time in patients with ileal conduit urinary diversion after radical cystectomy. The present study aims at evaluating QoL of patients at 1, 3, 5, 7 years follow-up (FU) and its interaction with clinical variables. METHODS Two health sociologists administered 30 qualitative and narrative-based interviews to patients with radical cystectomy at 1, 3, 5, 7 years FU from three urology units. Patients were asked to compare the steps of their experience with stoma as far as QoL was concerned. 17 male and 13 female patients were interviewed, minimum age being 65 and maximum age 94. The interview guide was constructed evoking the illness and disease trajectory as follows: diagnosis, treatment, surgery; rehabilitation (physical, mental, social); changes of major impact; feelings of shame, embarrassment and rejection; organization of daily routines and time, self-image and self-esteem; family relationships, emotional and sexual relationship, work, friendship relationship and behaviour in public. Interviews were analysed with Atlas.ti software. RESULTS Participants underlined 4 factors as crucial for QoL increase/decrease: 1. concern about urinary leakage and detachment of the bag; 2. (frequent) episodes of detachment of the bag resulting in reluctance to go outside; 3. fear of losing partner (wife or husband) who usually provide assistance in everyday dealing with stoma; 4. QoL complications worsening with age related to stoma management: hernias, infections, gaining weight, etc.. Additional concerns for a bad QoL were: reliance on partner for stoma management, fear of emanating odour of urine, giving-up with friendship and social relations. Surprisingly enough no patients referred to body image problems related to the bag. Because of such crucial factors scholars designed 5 profiles of illness following patients illness narrative: respondents at 1-3 years FU said their previous life times were completely lost, instead QoL was much better in patients at 5 years FU (than in the post-surgery period); Qol as to stoma is still good at 7 years FU though other problems took-over in patients concerns (hernias, kidney infections, obstructions to the stoma); same was for patients beyond 7 years FU where awareness of general deterioration due to age increases. CONCLUSIONS Qol improves along with the timeline of the disease trajectory. After 5 years Qol stabilizes at acceptable levels as far as bearing a stoma tends to become a real routine

Behavioural profile and human adaptation of survivors after radical cystectomy and ileal conduit

BACKGROUND: There is a lack of good data in the literature evaluating the Health-Related Quality of Life (HR- QoL) in patients with urinary diversions. The aim of this study was to examine the changes in expectation and needs in terms of human adaptation and behavioural profiles in patients with ileal conduit (IC) after radical cystectomy (RC) for bladder cancer (BC). MATERIALS AND METHODS: A qualitative, multicenter cross-sectional study using a "narrative based" approach was planned. We proceed with a sampling reasoned choice (purposive), selecting groups of patients with follow-up from one up to more than 7 years after surgery. Data were collected through individual interviews. RESULTS: Thirty patients participated in the study. The processing of the interviews allowed us to identify 2 major profiles: positive and negative. Patients with a positive profile resumed normal daily activities with no or limited restrictions both on the personal and the social level. This profile reflects a good HR-QoL. The negative profile reflects the patients for whom the ostomy has meant a worsening of HR-QoL. A positive profile was statistically more frequent in older patients (p = 0.023), with a longer follow-up (p = 0.042) and less complications rates (p = 0.0002). According to the length of follow-up and the occurrence of complitations, we identified further 5 intermediate profiles. CONCLUSIONS: Patients' satisfaction is related to the degree of adaptation to their new life with an urinary stoma and its correct management. Live "with urinary diversion" represents a new phase of life and not a deterioration

LONG-TERM FOLLOW-UP AND HRQOL IN PATIENTS UNDERGOING RADICAL CYSTECTOMY: STATISTICAL AND CLINICAL ISSUES

Introduction: Patients undergoing urinary radical cystectomy (RC) and urinary diversion for bladder cancer had some limitations in health-related quality of life (HRQOL). At present there are not sufficient studies to evaluate the levels of discomfort caused by different urinary diversion in survivors The aim of this study was to evaluate differences in HRQOL between patients with bladder cancer undergoing orthotopic ileal neobladder (IONB) and ileal conduit (IC) after RC (1). Patients and Methods: A total of 319 consecutive patients with bladder cancer (271 males and 48 females) underwent RC from five urological academic centres with subsequent urinary diversion (171 with IONB and 148 with IC) from June 2007 to September 2012 with no evidence of tumor recurrences and with active follow-up were enrolled in this study. Clinical and pathological data as well as oncological outcome were retrospectively analyzed and compared. HRQOL was analyzed using Italian version of EORTC QLQ- 30 and EORTC QLQ BLM30 questionnaires. Clinical data were analyzed in order to evaluate the HRQOL differences between the two groups of patients. As null hypothesis was assumed that there was no differences between two of the urinary diversion groups in terms of HRQOL. Means values with standard deviations (\ub1SD) were assessed for all items. Wilcoxon rank test was used to verify differences between two diversion groups. Statistical significance was achieved if p -value was 640.05 (two-sides). Results: Patients who underwent IONB was youngest than IC patients: median age were 66 years (range: 31-83) and 71 (range: 49-95) respectively. No significant differences were found in the pTNM \u2013 UICC stage (stage 0-I were 36.8% for IONB and 33.8% for IC) and in the follow-up (38 months and 35 months for IONB and IC respectively). Patients with IC showed a significant worsening in physical functioning (80.8\ub122.2 vs . 74.7\ub124.8 - p= 0.006), in emotional functioning (84.9\ub120.9 vs . 78.7\ub124.7 - p= 0.02), in cognitive functioning (93.1\ub112.6 vs . 85.4\ub121.2 - p= 0.0002) in comparison with IONB. Patients with IC had high level of troubles in fatigue (19.5\ub121.4 vs . 29.6\ub127.0 - p= 0.0006), in dyspnea (12.9\ub122.1 vs . 20.5\ub127.1 - p= 0.007), in appetite loss (6.7\ub117.2 vs . 14.2\ub127.5 - p= 0.01), in constipation (16.0\ub121.4 vs . 31.5\ub134.7 - p< 0.0001), and in abdominal bloating flatulence (11.8\ub119.9 vs . 25.5\ub126.5 - p< 0.0001) in comparison with IONB. Discussion and Conclusion: The patients with IC showed a higher number of troubles in comparison with the IONB group. In particular the patients with IONB seem to be able to improve their activity during the life contrary to the IC group. Cystectomy with any type of diversion remains a complication-prone surgery, nevertheless our results showed that IC showed higher troubles than IONB

HRQOL IN ELDERLY PATIENTS RECEIVING ILEAL CONDUIT OR ORTHOTOPIC NEOBLADDER

Aim: The aim of this study was to evaluate the health-related quality of life (HR-QoL) in elderly patients with invasive bladder cancer who received an ileal orthotopic neobladder (IONB) or an ileal conduit (IC) diversion. Patients and Methods: Files from 77 patients, aged 75 or older (median age=77), who received an IC (n=51) or an IONB (n=26) after radical cystectomy at 5 Italian institutions, were retrospectively reviewed. HR-QoL was evaluated by using the European Organisation for Research and Treatment of Cancer (EORTC) instruments quality of life questionnaire C30 (QLQ-C30) and QLQ muscle-invasive bladder cancer module (QLQ-BLM). Results: IC and IONB groups were comparable for all but one (gender) demographic and clinical variables. Actually, in the IC group, the number of females was significantly higher (12 versus 1, p= 0.029). At a mean follow- up of 60.91\ub142.19 months, mean scores in the IONB group were significantly better (higher in functional items and lower in symptoms items) in the following domains: cognitive functioning (95.87 vs. 81.05, p= 0.008), sleep disturbances (22.54 vs. 23.53, p= 0.048), appetite loss (5.13 vs. 18.95, p= 0.033), constipation (14 vs. 42.48, p= 0.001) and financial difficulties (1.28 vs. 7.84, p= 0.043). Considering only male patients, HR-QoL showed significant more favourable outcomes only in two symptoms items (constipation and appetite loss, p= 0.001 and p= 0.021, respectively). Conclusion: The results of our retrospective analysis suggest that, in terms of HR-QoL, IONB, when compared to IC, can be a suitable diversion for elderly patients with better favourable score for some functional and symptoms' aspects. These results may be affected by gender

MP5-17 QUALITY OF LIFE IN SURVIVORS FROM RADICAL CYSTECTOMY. THE USE OF QUALITATIVE ANALYSIS

Contributo sulla qualit\ue0 di vita di pazienti sopravvisuti a cistectomia radicale