PURPOSE: To compare the stone clearance rate, efficiency quotient (EQ), and early complications of shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for solitary lower-pole renal stones measuring 15 to 20 mm. MATERIALS AND METHODS: This was a retrospective matched-pair analysis of 142 patients (78 in the SWL and 64 in the PCNL group). Preoperative imaging was done by use of noncontrast computed tomography (CT kidney, ureter, and bladder [KUB]), intravenous urogram, or plain X-ray and ultrasound KUB to assess the largest dimension of the stones. Only patients with radiopaque stones were included. The stone-free rates were assessed with plain X-ray and ultrasound at 4 weeks. Data were analyzed by use of SPSS ver. 19. RESULTS: The patients' demographic profiles (age, body mass index) and the stone sizes were comparable in the two groups. The mean stone size was 17.4+/-2.12 in the PCNL group compared with 17.67+/-2.04 in the SWL group (p=0.45). At 4 weeks, 83% of patients undergoing PCNL were stone-free compared with 51% in the SWL group (p<0.001). The EQ for the PCNL group was 76% compared with 44% for the SWL group (p<0.001). Ancillary procedures were required by 9% of patients in the PCNL group compared with 15% in the SWL group. The complication rate was 19% in both groups. The SWL complications were minor. CONCLUSIONS: Stone clearance from the lower pole of solitary stones sized 15 to 20 mm at the greatest diameter following SWL is poorer. These calculi can be better managed with percutaneous surgery owing to its higher efficacy and acceptably low morbidity.
Calculi ; Humans ; Kidney ; Kidney Calculi ; Lithotripsy ; Matched-Pair Analysis ; Nephrostomy, Percutaneous ; Retrospective Studies ; Shock ; Ureter ; Urinary Bladder

Uropathogenic E. coli (UPEC) is the major etiological agent of urinary tract infections. The objectives of this study were to evaluate E. coli isolates from these patients for the phenotypic pattern of antibiotic resistance and to detect the genes responsible for virulence namely fimH, hlyA and usp. A total of 110 E. coli isolates were studied and 30 antibiotics were applied for susceptibility testing. PCR detection of the genes fimH, hlyA and usp was done followed by sequencing and phylogenetic analysis. The results showed that the isolates were highly resistant to cephalaxin (100%) and cephradine (100%) but displayed high sensitivity to amikacin (96.27%), Imipenem (92.63%) and Meropenem (92.63%). The prevalence of fimH, hlyA and usp was 86%, 83% and 16%, respectively. The sequencing showed 99% similarity with previously reported sequences in NCBI GenBank database. The co-existence of multiple drug-resistant bodies and virulent genes has important implications for the treatment of patients with urinary tract infection. This study provides information about treating drug-resistant E. coli and the relationship of virulent genes with phenotypic resistance patterns.

A panel of stroke experts from the Gulf and Iran region convened a consensus meeting to discuss how the Covid-19 pandemic has affected stroke care in the region. Lower stroke admissions were observed locally, but acute stroke care has largely been maintained in their centres despite the challenges of staff and resource shortages, and public fear of the virus. This article provides a snapshot of the pandemic in the region, its impact on local stroke care, highlights the approaches and practices shared between panellists in order to protect stroke care pathways during this uncertain period, and provides a guideline that is simple and easily adaptable to different locations. The intent is to protect stroke care pathways through Covid-19 risk stratification, infection control measures, and ensuring that all stroke patients have a full Covid-19 diagnostic assessment. Opportunities for increasing the use of telemedicine to reduce physical contact between patients and healthcare workers is also discussed.